NACCHO Aboriginal Health and #CoronaVirus News Alert No 18 #KeepOurMobSafe : Contributions from @ScottMorrisonMP , @TheAHCWA Dr Jason Agostino @crikey_news @DonnaAhChee1 @CAACongress Dr @normanswan @WWeno7 @Apunipima

1.PM Press Release : Testing rural and remote Aboriginal and Torres Strait Islander communities.

2.Plea for tents ‘or anything’ to help with self-isolation in overcrowded Indigenous communities.

3.The coronavirus could decimate Australia’s Aboriginal and Torres Strait Islander communities.

4.Donna Ah Chee COVID19 CAAMA Radio.

5.Dr Norman Swan Link to Podcasts.

6.Dr Mark Wenitong Cape York COVID19 update

See NACCHO Corona Virus Home Page

Read all 18 NACCHO Aboriginal Health and Coronas Virus Alerts HERE

Above image thanks to the team at AHCWA

“It seems to have been forgotten or missed that the large majority of cases in China spread within families and within households.

Yarrabah, about 50km from Cairns, has about 3,500 people but only 350 houses. Around 580 people are over the age of 50, and 80% of them have some form of chronic disease. There are 82 people over the ago of 70.

So while we are considered remote, we are only 50km from Cairns, a large population centre with a lot of tourists, as well as local people who’ve traveled overseas and returned.”

There are currently two Covid-19 cases being managed in Cairns.”

Dr Jason Agostino is medical advisor to the National Aboriginal Community Controlled Health Organisation (Naccho), which has been pushing for governments to make isolation space available and pitch in to help build temporary accommodation. See Part 2 Below

Part 1.PM Press Release : Testing rural and remote Aboriginal and Torres Strait Islander communities

The Prime Minister, state and territory Premiers and Chief Ministers continued their meeting on 25 March as the National Cabinet to discuss enhanced health measures to support our efforts to quickly test and contact trace coronavirus in our community.

Expansion of coronavirus testing criteria

Australian has one of the most rigorous coronavirus testing systems in the world. To further protect Australia, National Cabinet agreed to an Australian Health Principal Protection Committee (AHPPC) recommendation to expand the current coronavirus testing criteria to include testing people with fever or acute respiratory infection in:

  • all health workers
  • all aged/residential care workers
  • geographically localised areas where there is elevated risk of community transmission as defined by the local public health unit
  • where no community transmission is occurring, high risk settings where there are two or more plausibly-linked cases, for example:
    • aged and residential care
    • rural and remote Aboriginal and Torres Strait Islander communities
    • detention centres/correctional facilities
    • boarding schools
    • military bases (including Navy ships) that have live-in

National Cabinet also agreed that testing will be expanded to include hospitalised patients with fever and acute respiratory symptoms of unknown cause, at the discretion of the treating clinician.

This is the minimum testing criteria. States and territories have the discretion to expand their own criteria for testing if they have capacity.

Download PM Press Release HERE

Prime Ministers Press Release March 26

2. Plea for tents ‘or anything’ to help with self-isolation in overcrowded Indigenous communities

Aboriginal doctors in regional centres are sounding the alarm about overcrowded housing as a “massive problem” that will make it very hard to stop the rapid spread of Covid-19, and are calling for the urgent provision of “good quality tents” or any safe place where people can isolate.

As territories and states including Queensland close their borders, Aboriginal health services said they must now secure the safety of vulnerable communities in regional areas, who are close to centres of infection.

They are asking the national cabinet to urgently approve plans for safe places where Aboriginal people can self-isolate or quarantine, including repurposing vacant hotels, motels, offices and rental properties.

“People are saying anything would do, even if we got some good quality tents,” Dr Jason Agostino, a GP and epidemiologist who works with the north Queensland community of Yarrabah, said. “It’s coming into dry season, and while that’s definitely not optimal, at the moment communities don’t have funded options.”

Agostino said a tent could be safer than sharing an overcrowded house.

“It seems to have been forgotten or missed that the large majority of cases in China spread within families and within households,” he said.

Yarrabah, about 50km from Cairns, has about 3,500 people but only 350 houses. Around 580 people are over the age of 50, and 80% of them have some form of chronic disease. There are 82 people over the ago of 70.

“So while we are considered remote, we are only 50km from Cairns, a large population centre with a lot of tourists, as well as local people who’ve traveled overseas and returned.”

There are currently two Covid-19 cases being managed in Cairns.

Agostino is medical advisor to the National Aboriginal Community Controlled Health Organisation (Naccho), which has been pushing for governments to make isolation space available and pitch in to help build temporary accommodation.

At Yarrabah, he said, about 70% of the health workforce lives in overcrowded houses, and keeping them healthy in coming months is vital.

Dr Jason King is senior medical officer at the Yarrabah clinic, Gurriny Yealamucka.

In 2018, King said an outbreak of mumps raced through the community and within weeks was estimated to have infected over 150 people. Half of those surveyed afterwards had been sharing a bedroom with two or more people.

“The advice we were giving people then is precisely what we’re giving people now: socially isolate to help prevent the spread,” Dr King said.

“But when you’re talking to someone who lives in a house with ten other people, they’ve got three bedrooms, one bathroom where maybe the plumbing and the tapware is not particularly functioning, their ability to self-isolate is incredibly impacted.

King echoed concerns raised by Northern Territory Aboriginal health groups last week, about long delays in testing for Covid-19.

“You have this incredibly fertile breeding ground for the rapid spread of infectious diseases in a community like this. And even when people want to be able to follow the advice to self-isolate, they just don’t physically have the ability to do that.

“It’s heartbreaking because you don’t want to be the one that brings it home to your family, and that’s the thing we’re faced with.”

Crowding in Aboriginal and Torres Strait Islander communities occurs at around three times the rate of the non-Indigenous population, with over 115,000 Aboriginal and Torres Strait Islander households living in overcrowded homes nationwide.

3.The coronavirus could decimate Australia’s Aboriginal and Torres Strait Islander communities

The coronavirus could decimate Australia’s Aboriginal and Torres Strait Islander communities, with public health experts warning there hasn’t been a health risk this severe since the early days of colonisation.

Amber Shultz from Crikey examines why indigenous Australians are especially at risk.

COVID-19 may already be spreading

Until last week, international travellers still wandered across popular tourist spots, with free national park entry advertised in a bid to attract more tourists to the Northern Territory.

Non-essential travel permits for remote communities have been revoked with the NT government announcing its bordered will shut this week, with any arrivals to be quarantined for 14 days.

Slow-moving decisions could have a disastrous effect, Juanita Sherwood, associate dean of Indigenous strategy and services at Sydney University’s faculty of medicine and health, told Crikey.  “The impact of this will be devastating to our community,” she said.

Sherwood pointed to North American reports which liken the effect of smallpox on the native population to what’s expected from coronavirus. “This is going to be the same thing.”

Prime Minister Scott Morrison has already warned Australians about the dangers of travelling to remote areas of the country. Aboriginal health organisations have also called for the federal government to allow police patrols to protect isolation zones.

Peter O’Mara, chair of the Royal Australian College of General Practitioner (RACGP) Aboriginal and Torres Strait Islander Health, said the last time anything had the potential to have such an impact on Indigenous communities was when the British first arrived. “In all my years as a medical professional, I’ve never seen anything with the same broader national significance,” he said.

The potential impact of coronavirus comes down to a system which fails in almost every aspect: limited immunity and access to healthcare, and too many forced into overcrowded housing and prisons.

It’s all about immunity

Indigenous peoples are three times more likely to have type-two diabetes than non-Indigenous Australians. They also have a higher risk of respiratory disease. These health issues make a severe case of coronavirus all the more likely, Sherwood said.

“Our people are basically sicker than most, and chronic disease issues make our people more vulnerable,” she said.

Generational traumas from the impact of colonisation, smoking rates and lack of access to fresh fruit and vegetables in remote communities are to blame, she said.

“Nutrition is key in the ability to fight infection, but when communities are paying $10 for lettuce that’s withered and dead, there’s not a lot of positive health nutrients. People have been neglected.”

Healthcare is inadequate 

Limited access to healthcare in remote communities is an ongoing issue. In 2016, there were 37 areas with no access to Indigenous-specific primary health care services and poor access to general GPs.

COVID-19 tests are limited in remote regions, O’Mara said. Even if test kits make it to these areas, “testing is only available over a prolonged period, it takes a while for test kits to get back to the lab”. Remote communities are currently experiencing delays of a week or more on COVID-19 testing.

Even for those who live in major cities, “accessing appropriate care, care where they feel safe, is always an issue,” O’Mara said.

“Access to health professionals will be an issue now and in the future.”

Houses are packed to the rafters

The homelessness rate of Indigenous Australians is 10 times that of non-Indigenous Australians. One in 28 Indigenous people do not have stable and secure housing, and 70% of those experiencing homelessness live in severely crowded dwellings (which are classified as needing four extra bedrooms).

“Many people live in overcrowded housing. Once it hits saturation in the general community, more people are at risk of catching it, then having serious health complications,” O’Mara said.

Along with increasing the rate of transmission, overcrowding is a risk factor for respiratory infections, which can be caused by coronavirus.

“Outcomes for us are likely to be far different than people in other populations,” he said.

Overrepresented and overcrowded in prisons

Disease rates skyrocket for those in prison too, said Thalia Anthony, a law professor at the University of Technology Sydney.

“Notable diseases in prisons are diabetes and heart-related illnesses, which are especially chronic in the Aboriginal population,” she said.

Aboriginal and Torres Strait Islander people make up just 2% of the Australian adult population, but 27% of the national adult prison population.

Transmission rates are made worse by overcrowding too, Anthony said. “Prisons across Australia are on average over 100% capacity, with some at 130%… There are several people in cells. There are simply not the facilities to make them safe or secure for social distancing.”

Given one-third of those in prison are unsentenced and may be released following the remand period, there are potentially thousands of Indigenous Australians who could return to their communities. Fortunately, Anthony said NT indigenous communities had made the decision to stop remanding people.

Anthony said the government has two choices: follow the lead of Iran and release low-risk offenders, or repeat the mistakes from the leper colonies of the late 1800s.

“All those populations died. There needs to be a strong warning that prisons are the most dangerous place to send people.”

Just like with prison populations, Indigenous Australians are likely to be disproportionately represented in coronavirus fatality statistics. More action is needed to protect vulnerable communities.

4.Donna Ah Chee COVID19 CAAMA Radio

LINK HERE

5.Dr Norman Swan Link to Podcasts

Coronacast is a podcast that helps to answer your questions about coronavirus or COVID19. We break down the latest news and research to help you understand how the world is living through an epidemic.

Listen for free on ABC listen appApple Podcasts or Google Podcasts.

 

6.Dr Mark Wenitong Cape York COVID19 update

 

 

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