As COVID-19 has been escalating in recent weeks, I’ve been speaking with PHNs, GPs and pandemic specialists across our network in Australia and internationally about the PHN response to COVID-19. Back in 2009, I led the UK Department of Health Olympic & Paralympic Program through the 2009 Swine Flu Pandemic, so I’ve been applying these experiences in thinking through the Australian COVID-19 response. I’ve also benefited from tapping into the insights of seasoned health veteran, Lawrie Donaldson who has supported health systems through several health pandemics and natural disaster responses over his long and varied career.
With the World Health Organisation formally declaring a pandemic yesterday, confirmed cases in Australia doubling in a week, and demand on primary healthcare surging, expectations of PHNs are significantly increasing.
PHN COVID-19 Considerations
We see several key issues for PHNs to consider in their local responses in the coming days and weeks. These are summarised below and explained in more detail underneath:
|Indigenous Communities||COVID-19 is a potential ticking time bomb for Indigenous communities – high levels of health inequities, long-term conditions, remoteness and over-crowding coupled with low health literacy levels and lack of access to critical care mean that the Case Fatality Rates for Indigenous communities will be much higher than for mainstream communities. Targeted prevention, containment and treatment strategies need to be developed.|
|Rural & Remote Communities||Many rural communities across the continent are already experiencing a degradation of their services due to health workforce shortages, drought and bushfire. While the national efforts to date will naturally have focussed on preparing the large populous metropolitan centres, urgent attention is now required to protect those in rural communities.
An understanding of the inherent strengths and weaknesses of rural communities is essential to ensure that planned responses will work. For example, opportunities exist for metro-based healthcare professionals to support rural colleagues through highly coordinated telehealth models.
|Patients of Concern||GPs need to urgently identify their patients of concern and develop strategies for monitoring and caring for these people should they contract COVID-19 (such as telehealth / phone-based support, and effective utilisation of the expanded telehealth MBS items announced this week.)
This includes frail elderly people living in the community (especially Indigenous people), people with disabilities living alone, and people with complex chronic illness, those under cancer treatment with suppressed immune systems etc.
|Aged Care||Whilst significant planning is being undertaken to help prepare Residential Aged Care Facilities, we recognise the risks for older Australians living in the general community in susceptible places like private retirement villages or indeed those living in their own homes. Special consideration also needs to be given to the “Grey Nomads” who are soon to be travelling North with the onset of winter and staying in caravan parks.|
|Fever Clinics||We see 3 broad options for the establishment of Fever Clinics:
Hospital Based Fever Clinics, geographically separated from normal hospital flow especially ED and any co-located After Hours services.
GP Based Fever Clinics that leverage existing infrastructure.
Community Based Fever Clinics in stand-alone facilities (many such empty facilities exist nationwide).
In all three cases, the over-riding considerations need to be:
(a) effective and safe testing, advice, treatment and referral of COVID-19 patients.
(b) reducing the likelihood of transmission of COVID-19 to other patients.
(c) reducing the impact on the normal flow of existing healthcare services.
(d) staffing these new clinics whilst enabling back-fill of staff from their primary services.
|After Hours Phone Support||We understand that COVID-19 has led to HealthDirect receiving an unprecedented volume of calls. One potential option is for the coordinated mobilisation of After Hours Call-Centres to work with HealthDirect to help carry the Covid-19 Hotline load.|
|Optimising Telehealth MBS Item Usage||To ensure primary health professionals are working to the top of their scope of practice, we see a lot of benefit in Nurse Led Telehealth within General Practice. Nurses are well placed to distinguish mild and moderate symptoms, escalating to GPs for more complex decisions.|
|Community Activation||Many people with mild to moderate illness will not require hospitalisation and many with COVID-19 symptoms will be advised to stay at home and self-care. Health promotion for these groups should focus on activating communities and encourage them to support relatives, friends and neighbours. This can be done in very practical but useful ways, such as regular check-in phone calls, grocery shopping, picking up medication, providing meals, emptying bins etc. At times like this communities need to be able to rely on each other.|
|Homeless People||After speaking with colleagues at NSW Specialist Homelessness Services yesterday I also wanted to flag special consideration for how PHNs can work with your government partners to support homeless people in your communities. Homeless people will be affected particularly badly by COVID-19. Targeted outreach and temporary accommodation will save a lot of lives here.
Read more about this here.
Coronavirus COVID-19 Pandemic Approach
This is taken from my blog last week on Preparing for a Pandemic which you can read in full here
Behavioural Insights Into Pandemics
Psychological research shows people fail to grasp the nature of exponential growth. This partly explains why many people have flipped from being relatively relaxed about COVID-19 to very stressed. Read about it here
COVID-19 Graph Of The Week
Here is the most insightful graph I’ve seen this week, reminding us that COVID-19 is between 10x and 20x more deadly than Seasonal Flu. Read more about this here
How case fatality rates from COVID-19 compare to those of the seasonal flu
We recommend the following two podcasts to get a fresh perspective on the progression of the COVID-19 pandemic:
Early Thoughts on a Pandemic – Amesh Adalja, MD – infectious disease specialist (Johns Hopkins University Center for Health Security). Listen here
How Should We Respond to Coronovirus – Nicholas A. Christakis – Co-Director of the Yale Institute for Network Science. Listen here
COVID-19 Data Summary
Here’s the best one-stop shop source I’ve found so far for COVID-19 rolling data (this includes the WHO dashboard, Johns Hopkins dashboard and many more). View it here
Share Your Insights
Get in touch at firstname.lastname@example.org if you have any other PHN COVID-19 insights you would like us to share in future blogs.