As the latest Close the Gap report spotlights the “leadership and legacy” of the Aboriginal and Torres Strait Islander health sector in keeping communities safe, this edition of the COVID wrap investigates the pandemic responses of Indigenous communities globally.
Columnist Alison Barrett also reviews the latest worrying evidence on some of the long-term implications of a COVID-19 diagnosis.
(Register here to attend the report’s launch from noon AEDT on 18 March, with presentations by co-Chairs of the Close the Gap Campaign June Oscar and Karl Briscoe, Lowitja Institute CEO Dr Janine Mohamed, Minister for Indigenous Australians Ken Wyatt and Sir Michael Marmot, who chaired the World Health Organization Commission on the Social Determinants of Health.)
Alison Barrett writes:
Due to higher rates of non-communicable diseases, limited access to health services in remote communities and sociocultural factors such as racism and poverty, Indigenous people around the globe are at a greater risk from COVID-19.
While some Indigenous populations, such as Aboriginal and Torres Strait Islander people in Australia and Maori people in Aotearoa/New Zealand, have been successful in preventing widespread infections in their communities due to early community-led responses, the pandemic has emphasised great social and health inequities between Indigenous and non-Indigenous populations worldwide.
The latest epidemiological data in Australia shows that 150 Aboriginal or Torres Strait Islanders have acquired COVID-19 during the pandemic, which is 0.5 percent of all cases in Australia.
In contrast, Indigenous Americans’ infection rate from the virus is three and a half times higher than for white Americans, and their mortality rate is two times higher than for white and Asian Americans. By mid-2020, the Navajo Nation in southwest America, had the highest infection rate of any state in the United States.
It has been reported the increase in cases in January in Canadian First Nations is due to overcrowding and relaxed restrictions. COVID-19 testing is also not readily available, self-isolating is a challenge and many First Nations do not have access to clean water.
“Pre-pandemic, governments were already failing in their efforts to reduce the inequities in social determinants and health outcomes between Indigenous and nonindigenous citizens, and Indigenous Peoples are generally under‐resourced for responding to the current crisis,” Dr Tamara Power, from the University of Sydney, and colleagues wrote in May 2020.
Despite this, motivated by reminders of the devastating impact of past epidemics on their people, many Indigenous communities implemented their own public health measures and did not wait for national government support.
Aboriginal and Torres Strait Islander people were successful in preventing widespread infections in their communities via Aboriginal and Torres Strait Islander-led travel restrictions and culturally appropriate health promotion messaging from February 2020.
Similarly, Maori tribes began distributing hand sanitiser, masks, written advice and food parcels to vulnerable people in their communities from March 2020. They also set up checkpoints to manage movement in and out of their communities.
Canadian First Nations people began making and distributing their own protective facemasks. In the US, the Cherokee Nation in Oklahoma took control of their own response to COVID-19, and followed evidence-based public health messages and mandated masks in May 2020 before many countries did.
The COVID-19 Ongoing Impacts Survey, published in January by SNAICC, the national voice for Aboriginal and Torres Strait Islander children, highlighted that COVID-19 restrictions impacted children’s ability to maintain connection to culture. The restrictions also limited access to the Internet in remote areas, interrupting education.
Three-quarters of respondents reported that COVID-19 has had a high to extreme impact on Aboriginal and Torres Strait Islander people’s health and emotional wellbeing.
Issues with vaccine rollout
Because of the disproportionate impacts of COVID-19 on Indigenous communities, it is imperative that they are prioritised for the COVID-19 vaccines.
Vaccine rollout plans for Australia, Aotearoa/New Zealand, the United States, Canada and Brazil indicate that Indigenous people worldwide will be among the first groups to be vaccinated against COVID-19.
While information and material about the COVID-19 vaccine program has been developed for Aboriginal and Torres Strait Islander people, the vaccine advertising guidelines developed by the Therapeutic Goods Administration (TGA) mean that communities may not be able to tailor information to their own community.
Given the success of the ACCHO communication campaigns throughout the pandemic, this has the potential to be detrimental to the vaccine rollout in Aboriginal and Torres Strait Islander communities.
Many Aboriginal and Torres Strait Islander community organisations and media outlets have relied on Facebook throughout the pandemic to share health promotion messages and important information to communities.
The recent Facebook news ban prevented Aboriginal Community Controlled Health Organisations (ACCHOs) and Indigenous media outlets from posting vital vaccine information, and even though pages have now been restored, the impact of this on the vaccine rollout is unknown.
A recent survey conducted in Aotearoa/New Zealand found that Maori people are more likely to be hesitant about the COVID-19 vaccine than other groups. In Australia, concerns have been raised by some ACCHOs that vaccine hesitancy exists among Aboriginal and Torres Strait Islanders.
As highlighted by Brenda Garstone, CEO of Yura Yungi Medical Service, on ABC’s RN Breakfast program on 11 March, vaccine hesitancy among Aboriginal and Torres Strait Islander people appears to be mostly due to a lack of information. ACCHOS are working to overcome this by preparing local messaging and reducing any fears, but resources are stretched, she said.
Mistrust in the health system, resulting from systemic racism, discrimination and mistreatment of Indigenous people, means it is important the COVID-19 vaccine rollout in Indigenous communities is culturally appropriate and safe.
Employing Indigenous or familiar healthcare workers, communicating in language and working with community leaders will be vital. Shortages of nursing and administration staff to administer the vaccine rollout in Indigenous communities, as seen in Canadian First Nations, is an issue of concern.
Positive vaccine rollout news in North America
In the US, the vaccine rollout in some Indigenous American nations is reported to be going efficiently and fast, with local healthcare organisations focused on tailored and consistent vaccine messages to encourage uptake of the vaccine.
As of 1 March 2021, the Cherokee Nation has administered 24,000 vaccine doses to its 140,000 reservation residents, prioritising Cherokee-fluent speakers.
In February, Cherokee Principal Chief Chuck Hoskin Jr said, “Our doses have been administered without any lag time. The only question is whether the United States can keep up with the Cherokee Nation.”
They did this by setting up call centres to answer phone inquiries about the vaccine, administered the vaccines from locations where people are used to gathering, and delivered information about the rollout via existing outreach programs and communication channels.
In Navajo Nation, almost half of their reservation residents have received at least one dose of a COVID-19 vaccine, through a coordinated effort by Navajo Nation leaders, the Indian Health Service, and local tribal health organisations.
These examples highlight the importance of community-driven communication and health promotion campaigns in delivering successful vaccine rollouts for Indigenous populations worldwide.
Listen to Dr Jason Agostino, GP and medical advisor at NACCHO, discuss the COVID-19 vaccine rollout in Aboriginal and Torres Strait Islander communities here.
Listen to Queensland Premier Annastasia Palaszczuk, Pat Turner, CEO, National Aboriginal Community Controlled Health Organisations (NACCHO) and other Aboriginal healthcare leaders discuss the COVID-19 vaccine rollout on ABC Radio National here.
Long-term effects of COVID-19
There is a growing body of evidence on this.
Publications: More than 50 long-term effects of COVID-19: a systematic review and meta-analysis by Lopez-Leon, S et al. on 30th January 2021, in medRxiv preprint server
6-month consequences of COVID-19 in patients discharged from hospital: a cohort study by Huang, C et al. on 16th January 2021, in The Lancet
Respiratory and psychophysical sequelae among patients with COVID-19 four months after hospital discharge by Bellan, M et al. on 27th January 2021, in JAMA Network Open
Several studies have been published over the past few months, adding to the growing body of evidence about the long-term effects of COVID-19, highlighting that many patients experience symptoms long after their initial diagnosis.
A systematic review estimated that approximately eighty percent of COVID-19 patients experienced symptoms longer than two weeks after the acute phase of their infection. The review included 15 studies with a total of 47,910 patients, and 55 long-term effects were described.
The most commonly reported symptoms included fatigue, headache, attention disorder, hair loss, and loss of smell and taste. Other symptoms include long-term pulmonary deficits, cardiovascular and neurological issues, highlighting that prompt diagnosis and medical, psychological and potentially social intervention are needed.
The authors wrote: “The recovery from COVID-19 should be more developed than checking for hospital discharge or testing negative for SARS-CoV-2 or positive for antibodies.”
Although it is still to be peer-reviewed, the systematic review provides evidence consistent with other studies about the worrying levels of long-term effects for COVID-19 patients, and of the need for long-term patient management and care.
The authors noted that it is quite difficult to compare studies about the long-term effects of COVID-19 as they include patients from different backgrounds, severity of illness, duration of follow-up and definition used for long-term effects of the coronavirus.
As it is still unclear why some patients experience long-term symptoms, authors recommend that future studies collect and analyse data based on age, sex, pre-existing illnesses, severity and duration of COVID-19.
Three-quarters of patients in the Chinese study reported experiencing at least one symptom six months after their first symptoms. Concerningly, almost one-quarter of patients in this study reported anxiety or depression.
“The persistent follow-up of discharged patients with COVID-19 is necessary and essential, not only to understand the association between extrapulmonary diseases and SARS-CoV-2 infection, but also to find ways to reduce morbidity and mortality by efficient prevention,” Huang and colleagues wrote.
The most common pre-existing medical conditions reported in these patients were hypertension, which was present in 29 percent of patients, and diabetes, which was present in 12 percent.
The study in Northern Italy focused on long-term pulmonary function, physical performance and post-traumatic stress (PTS) in patients who had been discharged four months prior, and found that 53 percent or patients had impaired physical function and 15 percent had severe respiratory impairment.
Six percent showed severe symptoms of PTS and one-quarter showed mild PTS symptoms.
Worryingly, recent data from the UK shows that 13 percent of children aged between two and 11 years, and 15 percent aged between 12 and 16 years, experience at least one symptom from COVID-19, five weeks after infection.
As Bellan and colleagues wrote, these studies “suggest that many patients experience a slow recovery after the acute phase of COVID-19.”
As countries ramp up vaccinations and we move into the next phase of the pandemic, it is important to remember the many people who have not yet fully recovered from COVID-19 – and to ensure research and government funding is directed to supporting them.
Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.
See previous editions of the COVID wrap.
COVID-19 Twitter lists
Follow this Twitter list for informed news sources, global and Australian.
Follow this Twitter list for news from Aboriginal and Torres Strait Islander health organisations and experts.
Follow this Twitter list for news from South Australia on COVID.