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Experts call for a change of course on COVID, with urgent recommendations for care of people with disabilities

On 30 December, a senior psychiatrist tweeted out her frustration at mismanagement of the COVID pandemic in Australia using the “#LetItRip” hashtag.

“Australia is a failing nation state with no leadership, accountability, provision of basic services or public health. Any wonder we are disillusioned,” said Professor Louise Newman, a Professorial Fellow at the University of Melbourne.

Since then, the Federal Government has rejected calls to make rapid antigen tests freely available – going against the advice of the Public Health Association of Australia, the Australian Medical Association, the Royal Australasian College of Physicians, and the Consumers Health Forum of Australia, amongst other groups.

Since then, we’ve learnt more about the wider impacts of the Omicron explosion on health services and other sectors, as well as supply chains affecting food and other essential goods. Today the Australian Health Protection Principal Committee provided interim guidance to allow workers who have been exposed to COVID but are asymptomatic to stay at work in critical food and grocery production, manufacturing, logistics and distribution facilities. It does not apply to retail sites open to the public.

This @CroakeyNews Twitter thread wraps other related developments since the beginning of this year, and raises concern about the failures of governments to keep their populations safe and to ensure access to essential goods and services – including clear communications tailored to the needs of diverse communities.

Priority populations, who should be receiving the most support and care during a public health crisis, will be hit hardest by food shortages and lack of easy access to essential supplies such as rapid COVID tests and effective masks.

Many governments and officials are also failing to be straight with the general public – stressing that COVID is mild (it may be relatively mild for many individuals but as we are seeing around the world, it can be catastrophic for services and systems and priority populations). Although the World Health Organization has explicitly cautioned against such framing, the descriptor “mild” was used repeatedly at today’s Prime Ministerial press conference.

Quite incredibly, our national response has now failed to ensure we have accurate data on caseloads while also suggesting, somewhat conveniently, that this is somehow not necessary.

Dangerous framing

The use of metaphors such as “riding the wave” and “pushing through” completely obliterates and obfuscates concerns about equity; it fails to acknowledge that some people are far less likely to be able to “ride the wave” or “push through” and will instead “go under” or get “left behind”.

Today, Prime Minister Scott Morrison again used these metaphors. He told journalists:

You have two choices here. You can push through or you can lockdown. We’re for pushing through. That’s how you get through this. We get through to the other side. It’s going to be tough. The whole pandemic has been tough and Australians have shown a resilience and a patience and a determination. They’ve dealt with the circumstances as they’re in front of them, not behind them. And the Government is taking the same approach based on the best possible medical advice and the best possible medical advice is to push through.”

Professor Nancy Baxter, Head of the School of Population and Global Health at the University of Melbourne, rejected this unhelpful “either or” framing, tweeting:

Why are the only options “pushing through” or “locking down”?

Why can’t we provide high quality well fitted masks for free? Why can’t we focus on clean safe indoor air? Why can’t we provide free rapid antigen tests? Why can’t use public health measures to reduce spread?”

Senior journalist Michelle Grattan and Professor Brendan Crabb, CEO of the Burnet Institute, are among many calling for accountability, as per their tweets below.

Today the OzSAGE group released the statement below calling on Australian governments to take urgent action and change course.

They also call for the preparation and release of a disaster plan before the further deterioration of conditions, including how disaster resources (such as military support, as seen in the UK) will support logistics, food security, the health system and communities.

“The plan must incorporate vulnerable communities including regional, rural and remote communities, people with disabilities, people at risk from domestic violence, older Australians, economically disadvantaged and First Nations peoples,” says the statement.

Beneath their statement is a new position paper from the Centre of Research Excellence in Disability and Health, which makes a series of urgent recommendations at “the most dangerous time yet for people with disability” during the pandemic.

Change course and prepare for disaster

Statement by OzSAGE

Australian governments must immediately take action to tackle the present COVID crisis by delaying the return to face-to-face schooling, and reinstating necessary infection mitigations and financial supports.

The health system is under immense strain, businesses are shutting due to sick staff. Consumer spending estimates show Australians are in a shadow lockdown already. Mass workplace absence due to COVID-19 is already affecting supply chains, food and diesel availability.

Exponential growth of the epidemic, predicted to peak in late January by NSW modelling, means unprecedented case numbers will threaten every sector, not just the health system. Sending unvaccinated children back to school at the predicted epidemic peak will worsen the situation.

Repeated claims from politicians and some health leaders are wrong – that cases ‘do not matter’; that cases had ‘decoupled’ from hospitalisations; and, that the spread of Omicron is a wave that we must ‘ride’.

These statements undermine the gravity of the situation, and erode trust in decision-making and leadership, especially when the community is left without access to testing or support. OzSAGE notes the World Health Organization’s latest briefing which states that Omicron is not mild and should not be described as such.

“A major course correction is required to support our health system, businesses, children and the general health and wellbeing of all Australians,” OzSAGE Member James Bolster said.

“Every Australian needs access to free rapid tests and N95/P2 masks, because public health must be publicly funded. And, additional infection reduction measures must be reinstated, alongside financial supports for individuals and businesses who have already been hit by reduced activity caused by this outbreak,” Mr Bolster said.

In addition to recent recommendations, OzSAGE recommends the following immediate actions:

  • Free rapid tests and N95/P2 masks, readily available to everyone
  • Reinstatement of work from home arrangements, and additional social distancing and venue measures; for the avoidance of doubt, most states and territories must increase their present infection reduction measures further than recent changes
  • Reinstatement of significant financial support packages for both individuals and businesses impacted by COVID
  • The postponement of face-to-face schooling for primary and secondary students to enable double vaccination of children; to avoid the late January peak of the present wave (per NSW modelling), and; to ensure indoor air standards are able to be met at all schools. This action must include hybrid learning or alternative arrangements for vulnerable children requiring supervision and emotional support, as well as appropriate IT provisions and support
  • Review the recent reclassification of ‘close contact’ to align it with evidence and best health practice
  • Preparation and release of a disaster plan before the further deterioration of conditions, including how disaster resources (such as military support, as seen in UK) will operate to support logistics, food security, the health system and communities. The plan must incorporate vulnerable communities including regional, rural and remote communities, people with disabilities, people at risk from domestic violence, older Australians, economically disadvantaged and First Nations peoples.

Urgent recommendations

Statement by the Centre of Research Excellence in Disability and Health

Two years into the COVID-19 pandemic we have reached the most dangerous time yet for people with disability. While Australia fared well for the first two years of the pandemic, we have reached a critical juncture. Without urgent action we will see major adverse impacts for people with disability and their families, including death.

There are now unprecedented levels of infection in Australia because of the high transmissibility of Omicron. This has resulted in major staff shortages in health and disability services.

Right now, people with disability are at high risk of not getting essential supports for ordinary daily activities from eating to assistance with personal hygiene. They are also at very high risk of being infected with COVID-19 from workers and their household members, especially if they and/or their workers and household members are not fully vaccinated or have not received booster doses.

The Centre of Research Excellence in Disability and Health makes urgent recommendations in relation to health care, disability supports, vaccination and monitoring to reduce the risk for people with disability in this current situation.

COVID-19 and COVID-19-related health care and planning

The health system is under significant pressure with furloughing of staff due to COVID-19 infection or as close contacts. More people with disability with COVID-19 will need to be cared for where they live rather than in hospital. This is also critical where hospitals have moved to mixed wards, such as in ACT, where positive and non-positive people are placed together – increasing the risk of exposure and transmission.

Health system pressures are impacting vaccination capacity and COVID-19 PCR testing, with some people with disability experiencing seven day waiting times on results. There is limited supply of Rapid Antigen Tests, which are essential for ‘screening’ workers before they provide support.

We call on governments across Australia to ensure that people with disability receive essential health care and that they are protected from COVID-19 infection.

  1. Clear guidance to people with disability, families, services, and support workers on how to monitor people with COVID-19 at home including accessible information and self-care kits (for example, oximeters, thermometers) potentially extending the Disability Liaison Officer model in Victoria to do this
  2. Continuation of telehealth for primary and specialist care for all health care without restriction to non-bulk billed services or geographic location of provider or patient
  3. Prioritisation when processing PCR tests, ensuring people with disability who are at high risk receive results within an acceptable timeframe
  4. Individualised emergency COVID-19 plans for all people with disability that can be enacted if they are COVID-19 positive
  5. Re-establishment of disability COVID-19 health professional expert panel to provide advice to other health care professionals supporting people with disability who are COVID-19 positive
  6. Ensure all people supporting people with disability – disability support workers, families, and carers – report RAT positive results for individuals with disability to link to monitoring at home and any changes in health condition or health advice.

Disability services and support workers

Just like healthcare, disability services are facing staff shortages which is having an impact of the people’s capacity to access essential supports.

  1. Immediately establish surge workforce capacity for people with disability or their families and carers to access in an emergency by recruiting students in allied health, nursing, and medicine and maintaining and extending temporary visa measures
  2. Where practicable, mandate and fund the use of TGA approved respirator masks (N95/P2) for workers supporting people with disability and organise fit testing of workers and training in their use
  3. Priority and free access to TGA approved Rapid Antigen Tests for workers, and guidelines on frequency of use in various risk settings (for example, residential care, community)
  4. Priority access and processing of PCR tests for disability support workers who are symptomatic or close contacts
  5. Paid pandemic leave for workers who have COVID-19 like symptoms, are COVID-19 positive, or are required to isolate
  6. Restrict worker movement, particularly between homes, to reduce transmission risk and compensate workers and services where appropriate
  7. Provide immediate guidance and funding for services and people with disability to reduce transmission risk through ventilation adopting the recommendations of OzSAGE on Safe Indoor Air
  8. Guidelines for people with disability in accessible formats on what to do if they or someone they are living with are COVID-19 positive
  9. Do not allow or force non-symptomatic COVID-19 positive workers back to work, except for when they are supporting COVID-19 positive people with disability
  10. Do not allow or force workers who are isolating as close contacts back into the workforce.

Vaccination

Vaccination remains central to the prevention and control of COVID-19 pandemic and reducing risk for those most likely to be severely affected. With limited health care capacity nationally to deliver vaccines it is critical people with disability are prioritised. We recommend:

  1. Intensive outreach to people with disability who have not been vaccinated and substitute decision-makers to ensure they are vaccinated, noting that 16 percent of people with disability in residential settings have not had two doses of the vaccine
  2. Contact all people with disability and workers due for booster or third doses and organise appointments immediately where needed
  3. Mandate booster or third doses for disability support workers
  4. Prioritise access to vaccination for clinically vulnerable 5- to 11-year-olds and boosters or third doses for 12- to-17-year-olds with disability.

Monitoring

In this rapidly changing situation, it is critical that we collect data on COVID-19 infections, hospitalisations, and deaths among people with disability.

  1. RATs should be regarded as positive and reportable to the NDIS Quality and Safeguards Commission recognising that these will be an undercount.
  2. Transparent reporting on numbers of positive COVID cases and deaths of people with disability
  3. Link disability data to infection, hospitalisation, and death data to establish a better picture of the true situation.

Implementation of recommendations

Our recommendations for healthcare and disability services and supports require extensive coordination across the State and Territory and Commonwealth government agencies responsible for disability and health. Cooperation and coordination are essential to ensure timely distribution of free RATs and PPE to people with disability and services; outreach to services and people with disability to ensure optimal COVID-19 and non-COVID-19 health care; and the provision of accessible information through multiple channels, especially community and locally based and accessed information points.

We have found throughout the pandemic that responsibility for disability has fallen between government silos (health and disability), and agencies (National Disability Insurance Agency and the NDIS Quality and Safeguards Commission). There is a need for clear decisions regarding who holds responsibility for implementing different actions to ensure the health and safety of people with disability during the pandemic.

Data also needs to be shared across agencies, with the necessary privacy provisions, to enable outreach and coordination of public health responses to COVID-19.

The Disability Gateway should continue to provide a single point of contact for information related to COVID-19.

The statement’s authors are:

  • Professor Anne Kavanagh, Chair in Disability and Health, Melbourne School of Population and Global Health, University of Melbourne; Co-Director CRE-DH
  • Professor Gwynnyth Llewellyn, Centre of Disability Research and Policy, University of Sydney; Co-Director CRE-DH
  • Professor Helen Dickinson, Public Service Research, UNSW; Chief Investigator CRE-DH
  • Professor Gemma Carey, Research Director, Centre for Social Impact, UNSW; Chief Investigator CRE-DH
  • Dr George Taleporos, Disability Rights Advocate; Policy Manager, Summer Foundation.

See Croakey’s archive of articles on public health.

 

 

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