Introduction by Croakey: With Victoria’s 14-day COVID-19 rolling case number average dropping to below 30 this week, Premier Daniel Andrews declared the state was on track to “winning the battle” with COVID-19.
The state’s road map to reopening had set a target of a 14-day average of between 30 and 50 on September 28 for a further relaxation of restrictions.
In the latest data (reported on 23 September), 15 cases and five deaths had been recorded in the previous 24 hours, and the 14-day rolling average was 29.4 in metropolitan Melbourne and 1.1 in regional Victoria.
“We are very pleased with these numbers and very grateful for all the hard work and sacrifice and the commitment that every single Victoria is showing,” Andrews said in his daily press conference.
“You can’t achieve these outcomes, you can’t get to that COVID-19-normal without an amazing effort by the vast, vast majority of Victorians and to each of them, I say thank you. And that we are very proud of the work that you are doing.”
Andrews signaled that the state’s success in driving down case numbers would lead to an earlier than forecast relaxation of some restrictions, with an announcement of changes to be made on Sunday 27 September.
Research reported recently in the Medical Journal of Australia estimated that Victoria’s swift public health measures had averted between 9,000 and 37,000 COVID-19 cases in July alone. The researchers wrote that the response had reduced the reproduction ratio from 1.75 to 1.16.
This hard-fought result has brought a widespread sense of relief to a state that has endured Australia’s most severe stage four lockdown, including an 8pm curfew. The stage four restrictions were introduced on 2 August.
Victoria’s success in driving down COVID-19 case numbers stands in stark contrast to the experiences in the US, where more than 200,000 deaths have now been recorded. US President Donald Trump described this milestone as “a shame”, according to a report in The Guardian.
A similarly troubling story is emerging from the UK, where experts this week warned that case numbers may rise to 50,000 per day by mid-October. A second national lockdown was being considered by the UK Government.
But even as Victoria is beginning to emerge from its strict lockdown, politicisation of the state’s COVID response has shown no sign of abating. ABC’s Media Watch this week reported that The Age and Nine News had removed online polls condemning Andrews after it had become clear that the polling had been “hijacked by bots, delivering huge spikes of votes against the lockdown”.
Two hashtags – #DanLiedPeopleDied and #DictatorDan – had been linked to “inauthentic” Twitter accounts, according to Timothy Graham of the Queensland University of Technology.
The state’s response has also attracted considered criticism, with Professor Lindsay Grayson, Professor of Infectious Diseases at the University of Melbourne, calling for the restructuring of the state’s health department in The Age.
In the opinion piece below, Victorian GP Dr Catherine Orr is calling for GPs to be included in the community response to COVID-19 cases, particularly long-COVID-19 cases. Orr tells the story of an international student who was held in prolonged quarantine for four days longer than required due to an administrative error.
“While most of us understand the need for extraordinary measures in a pandemic we cannot take our eyes off the human rights issues that are being generated,” she says.
Catherine Orr writes:
I am a GP working in Victoria’s COVID-19 response in Melbourne. In April, someone told me to keep a diary as it would be fascinating to look back on. Now in September, having ridden the waves of COVID in Melbourne for six months, I regret not taking that advice.
My career has always focused on the health needs of the vulnerable, and COVID has been a great exposer of the vulnerable in our society. While most of us understand the need for extraordinary measures in a pandemic, we cannot take our eyes off the human rights issues that are being generated.
International student burden
I am currently looking after COVID-positive patients in the community, and have seen almost 100 patients over the past few months.
Most of these patients are international students with no GP. They also have no Medicare, no Centrelink benefits, and no income. They have usually been working in insecure work, such as retail or hospitality, and are not eligible for JobKeeper.
Although having health insurance is a requirement of their visa, they often cannot afford to pay upfront for medical/ambulance bills because they don’t have any money coming in.
International students, the cash cow of our under-funded universities, who test positive for COVID-19 have been largely abandoned by our health department and government.
Human rights breach?
I believe the failure of Victoria’s Department of Health and Human Services (DHHS) to clear patients in a timely and transparent fashion is a breach of their human rights.
There is a large number of young people who test positive for COVID-19 and have persistent mild symptoms. Unfortunately, finding a pathway to clear them from active COVID-19 requirements is a nightmare.
One of my patients was a female international student in her mid-20s who was diagnosed with COVID-19 on 30 August. She developed symptoms at the same time and had persistent mild runny nose. Her runny nose resolved eventually, but by this stage had become a “complex case”, meaning she required further testing.
She waited more than four days for the results of her repeat COVID-19 swabs and finally met criteria for clearance on Friday 18 September. She was phoned by DHHS and was told that she would receive her clearance certificate by email that day. It didn’t arrive.
She rang DHHS on Friday afternoon, Saturday, Sunday, Monday and Tuesday asking why the email had not arrived. On each occasion she was told it would be taken up with the team, and they would get back to her.
I eventually sent an email, on my patient’s behalf, to Victoria’s Chief Medical Officer and Deputy Chief Medical Officer, who forwarded my concerns to DHHS. I was told that my patient had received her clearance email just then. But the email still hadn’t arrived.
DHHS had incorrectly recorded my patient’s email address. Once DHHS had the correct email address, my patient finally received her clearance. But she had spent four days longer in isolation than was required and, as a result of her prolonged isolation, had lost her job.
Out of the loop
At no point was I, her treating GP, included in this whole process. I was the doctor managing her COVID-19 in the community and yet I was not involved in the DHHS process of her becoming a complex case and being re-tested. I was not notified of her repeat test results nor of the fact that she had been cleared.
As one of Victoria’s most experienced GPs in managing COVID-19 in the community, I was completely left out of her management by the DHHS. And yet, without my intervention, she may still be waiting on confirmation that her case had been cleared.
This case is far from unique. It is a situation repeated over and over, especially for people who have mild, persistent symptoms.
There does not seem to be an appreciation at DHHS that keeping people in prolonged isolation due to failures on their behalf is a breach of human rights. This patient did not do anything wrong and had obeyed all directives by our government. And yet she was kept in her bedroom for 24 days; four days longer than was required and she lost her job.
GP inclusion
At what point does the failure to manage mild long-COVID-19 in a timely and transparent fashion become a human rights issue? I would argue now.
When are GPs going to be included in Victoria’s COVID-19 response in a meaningful way? Our skills and relationships with our patients are valuable and we can move faster and more efficiently than DHHS can in both contact tracing at one end of the journey and clearance from isolation at the other end of the journey.
Give us permission to manage COVID-19 in our patients. Give us permission to contact trace. Give us permission to clear people from straightforward COVID-19. Include us in managing long-COVID-19.
Of all the medical professionals, GPs are the most experienced co-ordinators of our patients’ care. Without us, you are abusing people’s human rights due to systemic failures, and it is just not fair.
Dr Catherine Orr is a Melbourne GP.
