Inequities in pandemic responses and outcomes are highlighted in the latest COVID-19 wrap from public health researcher Alison Barrett.
Amid concerns about gaps in national pandemic communications, her latest column links to a stack of resources for those managing COVID at home.
Fines disproportionately impact priority populations
Western Australia has joined other Australian states, including South Australia and New South Wales, in making it mandatory to report positive self-administered rapid antigen test (RAT) results.
The penalty for failing to report a positive RAT result in WA will be up to 12 months’ imprisonment or a fine of up to $50,000.
“It is vital anyone who does a RAT and receives a positive result registers their test with WA Health. This will ensure the important public health protocols that have kept us safe throughout the pandemic can continue to be followed,” WA Health Minister Amber-Jade Sanderson said.
When the NSW and SA mandatory reporting systems were announced, concerns were raised about threatening to fine people for failing to report test results, especially when at the time they were very difficult to find (see these related tweets).
While NSW Customer Service Minister Victor Dominello admitted it would be challenging to police the fines, they have the potential to deter people from self-testing in the first place and negatively impact people living with greater economic stress.
Rather than threatening people who might struggle with this mandate, such as workers in insecure jobs who cannot self-isolate or take a self-test, the Government could have sought to use a more positive approach.
“Indeed, in the circumstance just illustrated, the legal threat could serve as a disincentive to self-testing in the first place,” Dr Christopher Rudge, lecturer in private law at The University of Sydney, wrote in InSight Plus.
As highlighted in an analysis byThe Guardian, fines to enforce COVID-19 public health measures during the NSW Delta outbreak between July and October 2021 disproportionately impacted low socioeconomic suburbs and towns.
The analysis found that people living in the most disadvantaged postcodes in NSW (based on the Index of Relative Socioeconomic Advantage and Disadvantage) were fined three times more than people living in the most advantaged postcodes.
“The suburbs facing larger amounts of fines are some of the most diverse in the country, with large First Nations communities, and where residents faced tough COVID restrictions including a curfew and limits on travel,” Mostafa Rachwani and Nick Evershed wrote in The Guardian.
Rural towns, Walgett, Brewarrina and Wilcannia, all with high Aboriginal and/or Torres Strait Islander populations, had the most fines per capita during the 2021 outbreak. Nearly 70 percent of Walgett residents were fined for breaching COVID-19 rules.
Samantha Lee, Redfern Legal Centre’s police accountability solicitor, told The Guardian that public health orders changed more than 70 times between July and October, making it challenging for community members and police officers to keep up with current rules.
The findings from The Guardian analysis are consistent with other studies about the level of disproportionate infringement notices in marginalised populations.
A review of police enforcement data in NSW and Victoria between March and June 2020 also found that Aboriginal and Torres Strait Islander people were disproportionately stopped and searched for COVID-19 public health infringements compared to non-Indigenous Australians.
“Considering Aboriginal and Torres Strait Islander peoples comprise around three percent of the population, this data alone evidences the disproportionate use of search and arrest powers, and supports concerns raised [by Change the Record and Victorian Aboriginal Legal Service] that COVID policing has intensified the policing of First Nations peoples,” the authors wrote.
Legislation and fiscal measures are one of many methods of preventing COVID-19 transmission.
However, as I discussed in a previous COVID-19 Wrap, while public health legislation is permissible and important in a state of emergency such as a pandemic, “governments and policymakers need to ensure they are following principles and guidelines to ensure that human rights are not being restricted without legitimacy”.
They should be equitably enforced without further harm to marginalised communities, proportionate and based on evidence.
Emphasising the need for greater support and more appropriate communications for communities at increased risk during the pandemic, recent Australian Bureau of Statistics data showed that Australians born overseas were three times more likely to die due to COVID-19 than people who were born in Australia.
Guidelines for mandating COVID-19 vaccines
Publication: Policy considerations for mandatory COVID-19 vaccination from the Collaboration on Social Science and Immunisation
Leask, J and colleagues, The Medical Journal of Australia, 12 September 2021
In the context of COVID-19 immunisation, “vaccine mandates are legitimised through reducing the risk of one person passing an infection to others”. However, “policy makers should balance rights of individuals and the promotion of public good while carefully considering the epidemiological, programmatic and legal issues,” Professor Julie Leask and colleagues wrote in a recent perspective piece for The MJA.
Leask and colleagues from the Collaboration on Social Science and Immunisation outline policy considerations for making COVID-19 vaccines mandatory.
Prerequisites for mandating COVID-19 vaccinations:
1) The mandate should be legal. The Fair Work Ombudsman provides general guidance on this.
2) The burden of disease should be high enough to justify a mandate. For example, it may be justifiable to impose a mandate in a setting the poses a high risk of transmission.
3) The mandated vaccines should be safe.
4) Vaccines should reduce transmission – “ethically, it is difficult to justify requiring someone to do something for their own good alone. A mandate is, however, more justifiable when vaccinating one person helps protect others around them,” they wrote.
5) Vaccine supply should be sufficient and easily and equitable accessible. Considerations should be made for people living in regional areas, people living with disability, culturally and linguistically diverse communities and Aboriginal and Torres Strait Islander communities.
6) Less restrictive, trust-promoting measures should be introduced before mandates. Known barriers, such as language and availability, should be addressed. Non-coercive incentives such as reminders and on-site vaccinations are some methods to implement. Establishing trust and confidence in the community is essential, and communication should be tailored to answer people’s concerns and questions well in advance.
“Mandates can undermine trust in voluntary vaccination programs,” state these authors.
If a mandate is planned:
1) The type of mandate chosen should not penalise the poor.
2) Those implementing the mandate need to plan, and have appropriate supports and systems in place. Support must be provided to those who implement and enforce requirements.
3) Affected populations should be considered in planning. Is necessary to consult specific target groups, be transparent, and maintain trust.
“Mandatory vaccination requires strong justification. If there are ways of achieving the same outcomes using measures that are less restrictive, they should be attempted. The benefits gained by mandates must be greater than the harms they may cause. These harms and benefits may be difficult to meaningfully compare,” Leask and colleagues wrote.
Authors in a Lancet Commission on Vaccine Refusal, Acceptance and Demand in the USA support many of the guidelines outlined by Leask and colleagues, also emphasising the importance of community engagement when planning public health mandates.
“Public health officials must engage with community leaders and local organisations to support accurate vaccine messaging that is culturally attuned to their respective communities”, wrote Professor Saad Omer and colleagues.
The Siracusa Principles, adopted in 1984 and summarised in this article, state that the restriction of human rights in the context of a crisis, such as the coronavirus pandemic, should only be done when, among other things, the restrictions are:
- responsive to a pressing public need (for example, protecting public health);
- deemed necessary and proportionate to a legitimate aim;
- prescribed by law and not imposed arbitrarily; and
- applied as a last resort using the least restrictive means available.
National public health communications still lacking
As Omicron overwhelmed Australia’s healthcare systems in January, Australians were encouraged to self-manage their COVID-19 symptoms.
The Prime Minister asked COVID-19 patients who do not require hospitalisation to contact their GP for care and Australia’s chief medical officer, Professor Paul Kelly, said to be prepared by “having some paracetamol or some ibuprofen in your cupboard”.
While seemingly sensible advice, the recommendations were made without consultation with GPs, placing additional burden on healthcare clinics and their staff, and without sufficient community preparation in the form of public education.
As previously reported at Croakey Health Media, Dr Chris Moy, Vice-President of the Australian Medical Association, recommended a mass education program advising the public what to do if they had COVID to alleviate some of the pressure on GPs.
Similarly, people on Twitter have called for governments to provide nation-wide messaging and COVID-19 information.
As at 23 February, 209,941 Australians currently have COVID-19, with the majority of them self-managing at home, it is important people have easy access to appropriate information and support and information to help them recover.
It is also important that this information and support is available and accessible to people who speak languages other than English and with different health and digital literacy levels.
Clear, culturally safe communication and support is vital during a pandemic.
Croakey has previously covered challenges with health literacy, pandemic communications and negotiating support systems in the following articles:
COVID-19 wrap: vaccine news, toll on the public health workforce, health literacy matters – and more
Even health sector insiders are struggling to negotiate unsupportive COVID systems
New research shows the need to improve COVID responses for culturally diverse communities.
Upon reviewing state and territory government health information and resources, I found that most of the information on government websites about managing COVID-19 is, not surprisingly, in English.
While contact numbers for translation and interpretation services are provided on most of the state, territory and federal websites reviewed, the contact numbers were not always easy to find.
Some websites include quick read factsheets, such as the ones on SA Health website here. However, most of the information available is very detailed and I wonder how accessible it is for people with lower health literacy.
Some examples are provided in the below (not-exhaustive) compilation of self-management resources.
If Croakey readers come across additional resources, please ping me on Twitter (@alisonsbarrett).
Managing COVID-19 at home: resources
healthdirect.gov.au provides information about what to do if you have COVID-19, how to isolate and monitoring symptoms.
Information in other languages is not available from the home page; but can be found by clicking the ‘read more’ link (as highlighted below) and then the ‘Resources in other languages’ section.
Translated information, including in Auslan, about COVID-19 is found on the Australian Government Department of Health website.
Information in Aboriginal languages can be found on the Northern Territory Government’s COVID-19 website.
Queensland Government’s ‘I have COVID-19’ information provides step-by-step guides on what to do if you have COVID-19, how and when to isolate, and managing symptoms, but information for people who speak a language other than English is lacking on these pages.
Multicultural support services are listed on a separate ‘Where to get support’ page.
A flyer with information about ‘What to do if you’ve tested positive for COVID-19’ provides a brief summary about managing symptoms, isolation and wellbeing.
The flyer includes details about financial support for eligible Victorian workers and a phone number for an interpreter service.
Additional, more detailed, information can be found on Victorian Government coronavirus website, where all information can be translated into multiple languages.
A detailed guide by SA Health for ‘Managing COVID-19 at home’ includes information about monitoring symptoms and when to call a GP or the COVID Response Care Team.
SA’s COVID Response Care Team oversees and coordinates care and support for people with COVID-19 who require support.
More information, including answers to FAQs, is available on the SA Health website.
Tasmania has a similar program to South Australia’s COVID Response Care Team, COVID@home, that provides access to remote health care 24 hours a day, seven days a week for people who choose to be enrolled in the program.
Tasmanian Government website also includes information for ‘Managing your COVID-19 symptoms at home’.
Translated COVID-19 information, including in Auslan, can be accessed on the coronavirus home page.
New South Wales
Similar to Victoria, NSW Government ‘Managing COVID-19’ webpage has capability to translate their COVID-19 information to multiple languages.
The page includes links to information about self-management at home, how to register a rapid antigen test results and self-isolation rules.
‘How to manage COVID-19 at home’ factsheets are translated into multiple languages and accessible from one of the main webpages.
‘COVID-19 Care at home videos’ are available in ten different languages including Mandarin.
The ‘Managing your COVID-19’ webpage by the Northern Territory Government includes information about managing COVID-19 at home, based on symptoms.
Includes links to information for parents caring for children with COVID-19, and contact details for mental health support.
Western Australia’s Department of Health provides information for Managing COVID-19 at home and in the community including information about monitoring symptoms, testing and accessing support from WA’s COVID Care at Home program.
Contact details for an interpreter service are not included on the main page, but resources in languages other than English can be accessed on the COVID Care at Home page.
The Royal Australian College of General Practitioners has developed several detailed guides for managing COVID-19 at home.
Home-care guidelines for patients with COVID-19: Information for GPs supporting COVID-19 patients at home
Managing COVID-19 at home with assistance from your general practitioner: A detailed guide, action plan and symptom diary for COVID-19 patients that ncludes:
- Contact details for accessing COVID-19 assistance in languages other than English
- Information about how to manage isolation at home, including monitoring symptoms and looking after mental health and wellbeing
- A COVID-19 action plan, with a symptom diary.
So, you’ve got COVID, now what?
Dr Suzi Nou, an anaesthetist seconded to the COVID Community team has created a series of videos, available on YouTube, to help people manage COVID at home.
Dr Magdalena Simonis, a Melbourne GP, provided some practical tips for self-managing COVID-19 in the Sydney Morning Herald.
Resources for Aboriginal and Torres Strait Islander people
NACCHO COVID-19 primary healthcare guidance: A rapid summary of the evidence has been developed by the National Aboriginal Community Controlled Health Organisation to guide primary healthcare workers in supporting COVID-19 patients.
COVID-19 resources for Aboriginal and Torres Strait Islander Health Professionals: A guide for Aboriginal and Torres Strait Islander health professionals, includes information about PPE, wellbeing self-management for staff, and resources for staff to help keep communities safe.
SA Health Aboriginal Communities and COVID-19: Sourced from Twitter, information for South Australia’s Aboriginal communities has been created in English and Pitjantjatjara, including videos and fact sheets.
Queensland Aboriginal and Islander Health Council
A compilation of culturally safe COVID-19 resources, including information about managing symptoms and testing.
How to do a rapid antigen test
Ear, nose and throat specialist, Dr Eric Levi, created some videos with instructions on how to perform a RAT. Three different videos by Levi can be viewed here.
Educator Sue Larkey, who has a Masters of Special Education, has collated some information for doing rapid antigen tests with students and children, which may be particularly helpful for children with autism, sensory issues and/or anxiety.
Top tips for rapid antigen tips – a PDF guide can be downloaded here.
COVID-19 hits the vulnerable in aged care yet again: Professor Kathy Eager and Research Fellow Anita Westera, InSight Plus, 7 February 2022
Australia is failing marginalised people, and it shows in COVID death rates: Professor Gemma Carey and Adjunct Fellow Ben O’Mara, The Conversation, 18 February 2022
Setting it Straight: A weekly column by Nobel Laureate Professor Peter Doherty discussing COVID-19 vaccine and immune response.
Alison Barrett is a research assistant at University of South Australia, with interests in public health, rural health and health inequities; and science and public health communications. 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.