Some clear messages for how governments can improve COVID control are put forward below, in the second part of a series investigating current COVID concerns.
Alison Barrett writes:
Health sector leaders are calling for governments to take more action to reduce the ongoing impacts of the COVID-19 pandemic, especially for people who are at greater risk of severe outcomes from the virus.
Many people are still dying and being hospitalised from COVID in Australia, and many more are being impacted by long COVID. Inequities in the burden of COVID are clearly evident, with some groups disproportionately at risk of dying from the illness.
Interviews by Croakey with nine health leaders and organisations identified these additional key concerns:
- the Federal Government’s ongoing failure to provide public leadership on the pandemic – despite longstanding calls for them to step up
- a need for comprehensive public health communication and education campaigns
- an imperative to address longer-term systemic issues in the health sector that are being exacerbated by the pandemic.
Another recurring theme is the disproportionate impact upon at-risk groups, including the aged, people with disabilities and medical vulnerabilities. This applies not only to their increased risks from infection but also to the wider impacts upon their lives.
People with disability or who are immunocompromised “have been left behind and their needs have been rendered fairly invisible in recent times, including their right to access safe spaces where they can be part of society”, Professor Deborah Lupton, from the Centre for Social Research and Health at University of New South Wales and an OzSage member, told a recent webinar.
Similar concerns were also raised by Dr Rebecca Ryan and Dr Louisa Walsh, Research Fellows at the Centre for Health Communication and Participation at La Trobe University, in a recent article in The MJA’s Insight+ publication.
“…one group that has been particularly affected [by COVID-19] but remains largely invisible in public health communications are people who are medically vulnerable (including the chronically ill, immunocompromised and elderly),” they wrote.
Health equity matters
Adjunct Professor Tarun Weeramanthri, President of the Public Health Association of Australia, highlighted the importance of ‘vaccines-plus’ strategies, as he did in January.
“Vaccination remains the most vital defence against COVID-19, both for individuals and at a population level, and all adults can now get a booster six months after their last vaccination or COVID-19 illness,” he told Croakey in a statement.
But, he said, “public health responses to complex challenges almost always require a comprehensive approach and the other elements of ‘vaccines-plus’ (ventilation, testing, masking, antivirals and public awareness) also need emphasis if we are to reduce transmission and (re-) infection rates.”
Weeramanthri said: “In early May 2023, after more than three years, the World Health Organization Director-General [Dr Tedros Adhanom Ghebreyesus] declared an end to the COVID-19 emergency phase. WHO advised that the challenge now is to transition to ‘long term management of the COVID-19 pandemic’.
“In Australia, there are a continuing high number of COVID-19 cases, hospitalisations and deaths. Winter has also seen a surge in respiratory infections of many kinds.
“As we enter the second half of 2023, we need to learn how to manage an ongoing pandemic amongst other major public health priorities, and monitor new viral strains, healthcare stresses, impacts on vulnerable groups, excess deaths, and new treatments (for acute infections and long COVID).”
National Aboriginal Community Controlled Health Organisation Medical Advisor Dr Megan Campbell said that “it’s important people continue to minimise infection transmission, including by staying home when unwell”.
She urged people to keep up-to-date with their COVID-19 boosters, as “key to minimising the impact of COVID-19 in communities”.
A director of the Australian Health Promotion Association, Glen Ramos, told Croakey that the “current ‘do close to nothing’ approach is probably one of the worst strategies to prevent or minimise the impact of COVID”.
“It’s incredibly inequitable, impacting on those most vulnerable in our communities who are least able to take ‘personal responsibility’,” he said.
Ramos suggested a range of measures to minimise the impact of COVID that “would vary to the local context”, including having a greater focus on reducing transmission, facilitating clean air especially indoors, and a “more detailed communication strategy around the real health impacts of repeated COVID infections including long COVID”.
In an article for Croakey last November, he urged those making public health policy “to remember that health equity requires attention to privileging the needs and concerns of those most at risk from current structures and policies”.
Public health failure
Australian-born artist, researcher and evaluator Dr Karen McPhail-Bell told Croakey she noticed a real difference in the way people in South East Queensland respond to COVID compared to the Bay Area, California, where she now lives.
She told Croakey that an elderly family member recently contracted COVID at an event held at a residential retirement village and, a couple of months later, is still suffering associated health problems.
“It’s like people don’t have any memory of COVID [in SE Queensland]. Wherever I go, I’m usually the only one wearing a mask,” she said.
While the USA has dropped its COVID-19 State of Emergency and most of the associated public health measures, she “still saw people wearing masks” and “COVID-conscious people around” where she lived, although she points out the USA and even California are so diverse, it is hard to make comparisons between jurisdictions.
“People are being let down” in Australia, McPhail-Bell said.
“There’s a complete failure of public health messaging. People often don’t know what the symptoms are and how it’s airborne, and there’s almost no mention of long COVID anywhere. It’s so unfair on everyday people that they don’t understand their own risk and protect to care for each other.”
She wondered if Australia’s response to the pandemic is “an extension of colonial capitalism”, which has a pattern of fuelling misinformation and attacks on science, and promoting medical solutions for public health issues.
McPhail-Bell, who left Australia five-and-a-half years ago, said “the thing that keeps baffling me is, before I left for the US, I feel like there were a lot more public health folks who would have been fighting against the ableism and inequity we see in Australia’s COVID response”.
Australia has no “right to call ourselves one of the best health systems in the world when we’re failing so many people,” she said.
She suggested that with the limited top-down response, more support is required for community-led bottom-up responses.
“It seems so important right now” to have systems for mutual aid and protecting workers, she said, in ways that centre those affected by COVID’s impacts.
Inequitable outcomes
COVID mortality is affecting some groups of people disproportionately.
According to recent ABS data on COVID-19 mortality since the beginning of the pandemic until 31 May 2023, people born overseas have a greater risk of dying from COVID than people born in Australia (16.1 deaths per 100,000 compared to 11.4 deaths).
People living in the most disadvantaged quintiles of Australia, as per the Socio-Economic Indexes for Areas (SEIFA), were nearly three times more likely to die due to COVID than those in the least disadvantaged quintile.
The same report also highlighted that the mortality rate from COVID is 1.6 times greater for Aboriginal and Torres Strait Islander people than non-Indigenous people. The highest age-standardised death rate for Aboriginal and Torres Strait Islander people was among those living in remote and very remote areas.
As at 14 July, Our World in Data reports that the seven-day rolling average of daily new confirmed COVID deaths in Australia is approximately 55 each day, noting that “due to varying protocols and challenges in the attribution of the cause of death, the number of confirmed deaths may not accurately represent the true number of deaths caused by COVID-19”.
In the week leading up to 4 July, the seven-day rolling data on Department of Health and Aged Care website shows that 1,812 Australians were being hospitalised each day.
Also in the same period, 215 active outbreaks were recorded in aged care facilities, with 1,101 residents and 364 staff acquiring a COVID infection.
An Actuaries Institute analysis of the ABS’ provisional mortality data for the first quarter of 2023 found that total excess mortality – the difference between actual deaths and a predicted (baseline) level of deaths – for January-March 2023 is six percent. This is less than the 12 percent excess mortality they calculated for 2022.
Given challenges counting deaths due COVID (variations between jurisdictions, delays, inaccurate records, etc), excess mortality data provides another indication of the impact of the pandemic.
The Actuaries Institute COVID-19 Mortality Working Group base their predicted (baseline) number of deaths on the “current size and age composition of the population and the continuation of pre-pandemic mortality improvement tends” – representing the expected number of deaths “had the pandemic not occurred”.
The COVID-19 Mortality Working Group found that just over half (54%) of the excess deaths were from COVID and estimates that excess mortality will be between seven and ten percent in April-May.
COVID was the third leading cause of death in 2022 and accounted for half of the excess mortality in Australia last year.
Vaccines and antivirals
Vaccines and antivirals remain important to preventing severe COVID – they are one of the main measures that Australian governments remain focused on in responding to the pandemic.
However, while 82.7 percent of the total Australian population received the initial vaccine protocol of two doses, data from COVID live indicates that more than 16 million eligible Australians have not had their recommended booster vaccination within the past six months.
As per the Australian Technical Advisory Group on Immunisation recommendations, people 18 years or older are eligible to have a booster vaccination if it has been six months since their last booster or a confirmed COVID infection.
COVIDLive note there is currently limited available data on vaccination status. The Department of Health and Aged Care website reports that 90,000 boosters have been administered in the seven days prior to 5 July.
Given the importance of vaccines for reducing severe COVID – and the Government’s focus on them – it is surprising the data is not easily accessible. How are we to know how many people are sufficiently immunised?
The eligibility for access to Paxlovid anti-viral treatment was expanded from 1 July 2023 – people aged between 50 and 59 years with one risk factor for severe COVID – instead of two – may be eligible for PBS-subsidised Paxlovid.
Paxlovid has been found to be effective in reducing hospitalisation and death from COVID. However, equitable access to the antivirals is a concern.
An analysis of Paxlovid antiviral rollout in Victoria in September 2022 found that people who lived in the most disadvantaged areas (based on the Index of Relative Socio-economic Disadvantage or IRSD quartile) were 15 percent less likely to receive antiviral treatment than those in the least disadvantaged area.
The authors found that 64.4 percent of reported COVID-19 cases in people aged 70 years and older received antiviral treatment.
Most (95%) of the antivirals were supplied within three days of COVID diagnosis, which was consistent across all IRSD quartiles except in the most advantaged, where 95 percent of people received their treatment within two days of diagnosis.
No difference was found in time to treatment when the researchers compared Aboriginal and Torres Strait Islander people with non-Indigenous people, or compared people living in metropolitan and rural areas.
The authors write that as supply and prescribing levels of COVID antivirals has improved since last year, “equity must now be our top priority”.
Echoing Andrew Hewat’s comments in a recent article at Croakey, they write: “If Australia reverts completely to a ‘business as usual model’, relying on stretched primary healthcare services with no additional resourcing (including addressing Medicare indexation as a matter of urgency), we will fail to reach the people likely to benefit from treatment.”
Politics of COVID
In the politics and COVID webinar, Lupton said Australia’s neoliberal focus contributed to the public health response with its privileging of the economy and emphasis on personal responsibility.
Another speaker at the webinar, Dr Patrick Harris from University of New South Wales said that as well as non-pharmaceutical interventions, which remain important, we also need to consider the “socioeconomic and equity dimension to COVID, both in terms of preventing and also the response”.
“Policy measures to support financial wellbeing in the face of something like COVID” is also really important, he said.
Professor Chris Wallace from the School of Politics, Economics and Society at University of Canberra said that “anti-public health lobbying dominates the channel and communications across the board”. She said that politicians tend to “succumb to dominant media narratives”.
“The tendency to conform to the dominant narrative has very much been in evidence since May 2022 when the Albanese Government was elected,” she said.
Wallace said it was important to find the “cabinet champions” in all levels of government “who will not only understand but take the case strongly forward” with more “intelligent public health action on COVID-19”.
Ramos told Croakey that barriers for more action on COVID “appear to be political and economic. Politicians appear to be reticent act in the current context – to the point of not publicly addressing COVID issues or not even using the word itself”.
“Ignoring COVID may provide some brief political expediency but with continued transmission and its effects – reducing workforce capacity, increasing burdens on hospital and healthcare systems, and growing a new pool of people with long COVID disabilities – it will have to be dealt with eventually,” Ramos said.
Ramos called on the public health community to keep COVID visible through research, news articles, social media and advocacy groups. “Public health is inherently political,” he said.
These activities can provide an “antidote to the persistent push to move us into a COVID “normalcy” where we seem to simply accept that a novel communicable airborne disease that has become the third highest cause of death in Australia is ok, he said.
“It’s not ok and we need to keep making that clear.”
Public communications lacking
Professor Stephen Duckett from University of Melbourne, who wrote in mid-2022 of the need to improve public health messaging around COVID, told Croakey that while it was good to see government COVID-19 vaccination campaigns, more could be done to reduce the impact of COVID-19.
This included all governments acknowledging the impact of COVID, and putting increased emphasis on the importance of ensuring clean air in meeting rooms and masks on public transport.
Ryan and Walsh also wrote that “the main public health messaging focuses almost exclusively on vaccination uptake and few preventive measures remain”.
They call for governments of all levels to do more to keep medically vulnerable people safe from COVID-19, including clear, up-to-date and evidence-based communication that is tailored, acceptable and accessible to people with different needs.
“As we work to control the pandemic’s effects in Australia, we cannot say we are successfully ‘living with COVID-19’ while medically vulnerable people remain isolated from many activities of daily life,” Ryan and Walsh wrote.
• Note, the Department of Health and Aged Care has provided a response to some of the concerns raised in the first two articles in this series, which will be published in a future article.
Previously at Croakey
- Changing Australia’s approach to managing COVID-19 pandemic may help reduce burden on health system
- Why more needs to be done to reduce COVID-19 transmission in health and aged care settings
- Calls for a national and consistent approach to clean air in health and aged care
- The Health Wrap: deep dive into COVID matters…
- Health leaders urge governments to step up COVID control
See our archive of articles on prevention
