“ We definitely didn’t get it right in 2009, and there have been plenty of papers written about that.
But Aboriginal people are much more engaged in this (COVID19 ) planning process, so we’re in a much better position than we were then.”
University of Queensland Indigenous health expert James Ward, a member of the working committee that drafted the new guidelines, released on Wednesday .
Full article Part 2 below and for Indigenous guidelines see Part 3 below or Download HERE.
” Major issues include housing people, and the deployment of additional health workforce capacity.
We would need deployment based on where the need is greatest, and will people want to do it? This will need a dynamic response.
But the commonwealth has a clear sense of the need to provide good structures for the vulnerable in our communities.
“The key thing is getting good information, clear and consistent, to our communities.
And the big message is hand-washing.”
There are major issues to consider, “depending on how serious it gets, and events as they unfold”, according to Olga Havnen, a member of the taskforce and CEO of the Darwin-based Aboriginal health organisation Danila Dilba
AMSANT is engaging with our members, NACCHO and the Northern Territory Government and Commonwealth Governments about supporting our members and Aboriginal communities through a potential COVID 19 outbreak : Download
The federal government has set up a national Indigenous advisory group to fast-track an emergency response plan for Aboriginal communities that are among the most vulnerable to any potential spread of Covid-19.
The taskforce met last Thursday as remote Aboriginal communities in South Australia began to strictly limit visitors for the next three months, worried that if Covid-19 arrives it will be “devastating” for their elders and people with existing health problems.
The Anangu Pitjantjatjara Yankunytjatjara (APY) have introduced strict rules for entry to their lands, which they can to do under the APY Land Rights Act.
“We are protecting our people, especially those who hold our ancient cultural knowledge, and we know they are already vulnerable as they are quite old,” APY general manager Richard King said.
“A lot of our people present with comorbidities like diabetes and renal failure. We have high smoking rates, overcrowding in housing, overall poor hygiene.
“It’s almost a perfect storm to support the transmission of these types of diseases.
“The problem with this one is it has a 3.4% fatality rate, which is high, but with our cohort, if it gets here, it’s going to be devastating.”
The Aboriginal and Torres Strait Islander advisory group on Covid-19 is made up of leaders from the Aboriginal community controlled health sector, state and territory health and medical officials, Aboriginal communicable disease experts, the Australian Indigenous Doctors’ Association and the National Indigenous Australians Agency.
The new taskforce will consider the health, social and cultural needs of Aboriginal and Torres Strait Islander peoples, using principles of shared decision-making and co-design. The management plan will focus on current containment activities as well as preparations for mitigation and treatment phases.
The APY board decided on Thursday to refuse entry for the next three months to anyone who has been in mainland China since early February, or been in contact with someone confirmed to have coronavirus, or who has travelled to Iran, South Korea, Japan, Italy or Mongolia.
Anyone in those categories who wants to visit needs to have tested negative for the virus, and will have to submit a copy of the test results along with a statutory declaration to be considered for entry.
State and federal agencies don’t need to apply for a permit to enter but King said he hoped they would comply with the ban.
Indigenous Australians minister Ken Wyatt has agreed to postpone a scheduled visit next month.
There have been no known Covid-19 cases on APY lands to date, but the prime minister, Scott Morrison, has expressed concern about the vulnerability of those in remote Indigenous communities.
During the 2009 swine flu outbreak, Aboriginal and Torres Strait Islander people made up 11% of all identified cases, 20% of hospitalisations and 13% of deaths.
The Northern Territory is also developing a remote health pandemic plan, due to be released this week .
NT Chief medical officer Dianne Stephens acknowledged the “significant” logistical problems with using self-isolation as a response in remote communities, where overcrowding in housing is a major issue.
“So we are working out ways in every community where we can institute social distancing, where we can have a safe place for people to be quarantined if they’re unwell,” she said.
The NT health minister, Natasha Fyles, announced yesterday that a pandemic clinic had been set up at Royal Darwin hospital
Australian health authorities preparing for the threat of a widening COVID-19 outbreak have taken the unprecedented step of producing specific guidelines to protect highly vulnerable Aboriginal and Torres Strait Islander communities.
The initiative is underwritten by memories of the devastating toll on Indigenous communities from the 2009 swine flu pandemic.
An Aboriginal person from a Central Desert community was the first national casualty of that outbreak, with the Indigenous population ultimately suffering death rates six times higher from that crisis than the general population.
“Aboriginal people are much more engaged in this planning process, so we’re in a much better position than we were then”: University of Queensland Indigenous health expert James Ward.
“We definitely didn’t get it right in 2009, and there have been plenty of papers written about that,” said University of Queensland Indigenous health expert James Ward, a member of the working committee that drafted the new guidelines, released on Wednesday.
“But Aboriginal people are much more engaged in this planning process, so we’re in a much better position than we were then.”
Aboriginal health researcher Kristy Crooks said the exclusion of Indigenous people from decision-making was a crucial failure in the government response to the 2009 pandemic.
“The flu pandemic showed that the one-size-fits-all approach to public health emergencies are unlikely to work for our communities, so tailoring approaches to meet the needs of families is important,” said Crooks, a PhD candidate with the Menzies School of Health Research at Charles Darwin University.
It is the first time federal authorities have tailored an epidemic response plan to a specific community.
So far, there have been no confirmed cases of the coronavirus in any Indigenous communities, however health authorities confirmed the first case of the virus in Darwin on Wednesday, raising the prospect that it may spread to remote communities in the Northern Territory.
Ward said that Indigenous Australians faced a number of risk factors for respiratory illnesses like COVID-19.
One quarter of the Indigenous population lives in remote areas, which makes access to health services difficult. While many communities had some health services, he said, they are already at capacity and therefore ill-equipped to handle the surge in demand an outbreak of COVID-19 would bring.
The Indigenous population is also highly mobile, with people frequently travelling between communities, often over long distances. Many also live at close quarters in overcrowded housing, meaning disease can spread rapidly and widely.
Then there is the reality, underlined in the latest Closing the Gap Report to Federal Parliament, that Indigenous Australians are already sicker than the rest of the population, and have far more comorbidities, which can make respiratory illnesses much more severe. This was often compounded by a reticence within the Indigenous community to seek medical care, Ward said.
“I think it’s quite clear that Aboriginal people have had very negative experiences with health care services,” he said. “So our population might ignore or not recognise symptoms, or think ‘why would it be coronavirus?’.
“So they might present late to a hospital or clinic, and that may be too late to prevent major outbreaks in communities.”
The newly published guidelines include six “key response strategies” for assisting Aboriginal and Torres Strait Islander communities in the event of an outbreak.
Several focus on appropriate communication and engagement with community leaders, to ensure Indigenous people are at the heart of the decision-making process.
Kristy Crooks said the direction for people to isolate themselves from the rest of their community during the flu pandemic was unrealistic due to cultural and family obligations outweighing national health policies.
“Celebrations are seen as important as sorry business, so people might have still attended large events and gatherings while sick with respiratory problems.”
Crookes will be considering how pandemic planning for COVID-19 can be tailored to communities through First Nations panels.
The research, supported by the Australian Partnership for Preparedness Research on Infectious Disease Emergencies, will empower Indigenous people to determine what the best strategies are to reduce the risk of Covid-19 spreading in their communities, Crooks said.
The working committee responsible for the Indigenous response will remain in constant communication with both the chief medical officer Brendan Murphy, as well as hundreds of health organisations and Indigenous community leaders around the country.
“We will be monitoring very closely to ensure that appropriate messaging and communication goes out to Aboriginal communities,” said Ward. In the Northern Territory, this will include delivering messages to remote communities in the local language.
But Ward said it was equally important to involve non-Indigenous organisations in the preparations.
“We need to make sure there is an adequate response from other organisations too, because this will ensure flexibility in delivering the necessary health care services.”
The new guidelines also include provisions for quarantine and isolation in Indigenous communities, emphasising that families need to be involved in the decision-making around quarantine.
“This can be achieved through exploring with families what quarantine looks like, working through how it might impact on the family and their way of living, and identifying ways around it.”
Ward said at this stage Indigenous health services, including those in remote communities, were not being sent any extra medical supplies or personnel.
“There’s a whole lot of activity going on, obviously, but at the moment there is no coronavirus in a remote community and we don’t expect it’s an immediate threat.”
Part 3 : Aboriginal and Torres Strait Islander communities
Key drivers of increased risk of transmission and severity
- Mobility: Aboriginal and Torres Strait Islander peoples are highly mobile, with frequent travel often linked to family and cultural connections and community events involving long distances between cities, towns, and communities. In addition, remote communities have a high flow of visitors (e.g. tourists, fly-in fly-out clinicians and other workers). This increases the risk of transmission even in generally isolated
- Remoteness: A fifth of the Aboriginal and Torres Strait Islander population lives in remote and very remote areas. There is often reduced access health services, these are usually at capacity in normal circumstances and are often reliant on temporary staff. Limited transport options may further inhibit presentations and delay laboratory
- Barriers to access: Unwell people may present late in disease progression for many reasons including lack of availability of services, institutional racism, and mistrust of mainstream health
- Overcrowding: Many Aboriginal and Torres Strait Islander communities have insufficient housing infrastructure, which results in people living in overcrowded conditions. This facilitates disease transmission and makes it difficult for cases and contacts to maintain social distance measures and self-quarantine.
- Burden of disease: Aboriginal and Torres Strait Islander people experience a burden of disease 2.3 times the rate of other Australians. This may increase the risk of severe disease from SARS-CoV-2.
Key response strategies
- Shared decision-making and governance: Throughout all phases, COVID-19 response work should be collaborative to ensure local community leaders are central to the response. Further risk reduction strategies and public health responses should be co-developed, and co-designed, enabling Aboriginal and Torres Strait Islander people to contribute and fully participate in shared decision-making.
- Social and cultural determinants of health: Public health strategies should be considered within the context of a holistic approach that prioritises the safety and well- being of individuals, families and communities while acknowledging the centrality of culture, and the addressing racism, intergenerational trauma and other social determinants of health.
- Community control: The Aboriginal Community Controlled Health Services (ACCHS) sector provides a comprehensive model of culturally safe care with structured support and governance systems. The network of ACCHS and peak bodies should be included in the response as a fundamental mechanism of engagement and
- Appropriate communication: Messages should be strengths-based and encompass Aboriginal ways of living, including family-centred approaches during both prevention and control phases. They should address factors that may contribute to risk such as social determinants of health, including living arrangements and accessibility to
- Flexible and responsive models of care: Consider flexible health service delivery and healthcare models (e.g. pandemic assessment centres, flexible ACCHSs clinic hours/location with additional staffing, and home visits). Consider employing the use of point of care influenza tests, where available, to help determine whether influenza is implicated in presentations in the
- Isolation and quarantine: Families should feel empowered and be part of decision- making around quarantine. This can be achieved through exploring with families what quarantine looks like, working through how it might impact on the family and their way of living, and identifying ways around it. Family members will want to visit unwell people in hospital. It should be made clear that there are other ways to be with sick family members in hospital, maintain communication with families and communities in lieu of gatherings (e.g. staying socially connected through the internet and video calling).