dr lucas de toca


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This pandemic is affecting everyone around the world, and it's making fundamental changes to how we operate in our day to day lives.

But we are particularly careful and aware, that some particular groups in society might be at a higher risk of developing severe disease or serious consequences from this condition, and we want to make sure we have everything in place to address those populations.

What are the challenges that you are observing with this particular cohort?

It's important to distinguish what could be issues that might mean that Aboriginal and Torres Strait Islander people, based on what we know, are at higher risk of severe disease. 

Some of the challenges of ensuring that appropriate pandemic response supports and recognises the needs of Aboriginal and Torres Strait Islander people. They're not disconnected but they're different things.

We can talk about some of the indications that we have and the experience from previous outbreaks that give us a concern that Aboriginal and Torres Strait Islander people may be at higher risk.

And then we can talk about some of the elements of the response that need to be particularly shaped so that there's support and enable this to work in Aboriginal and Torres Strait Islander cohorts.

They've given out health warnings to particularly the elderly, for the general public it's the 70 year olds and 60 year olds have to be particularly careful but when it comes to Indigenous communities the age limit starts at a lower age?

On average we know that Aboriginal and Torres Strait Islander people have a high burden of disease. So on average have a higher proportion of chronic conditions than other Australians. 

That's why we need to be really upfront with what the risks are maybe and how the risk may be higher compared to others. And we have seen that with previous outbreaks (2009 H1N1 pandemic) and also during flu season, Aboriginal and Torres Strait Islander people on average are at a higher risk of this. But it's also important to note, and what we want to make sure that we are doing, is that any response that we take and any approach that we do, also draws on the strengths that Aboriginal and Torres Strait Islander communities have in this country and we have seen that leadership, and we have seen that sort of proactive stance to look further into community from Aboriginal and Torres Strait Islander organisations and Aboriginal and Torres Strait Islander people from the beginning.

We need to make sure that strategies are in place to address what can be a higher risk, but we also recognise that there's a lot of strength in Aboriginal and Torres Strait Islander organisations and communities that is actually enabling a very proactive response that wouldn't exist otherwise.

We've seen a lot of communities itself actually locking themselves down and self-isolating and measures are being taken by the National Aboriginal Community Control Health Organisation and so on. On a national level, what else is being done?

It's important to acknowledge that the National Aboriginal Community Control Health Organisation (NACCHO) and other Aboriginal health peak bodies have been absolutely leading on this response. And the government's approach has been to partner from the outset to ensure that every step we take is not in consultation but in actual partnership with community organisations and with the experts which are the Aboriginal Community Control Health services and other Aboriginal health bodies. In many ways what we have been doing has been enabling and supporting activities that were already happening. Many remote communities had already established access restrictions before we had activated the national biosecurity determination to designated remote areas as restricted access zones that we essentially are following up on what communities were already requesting. And one of the first steps that we took was to establish a National Aboriginal and Torres Strait Islander Advisory Group on COVID-19 that reports directly to the Chief Medical Officer and ensures that all that knowledge, all the voices and all the issues can be raised to the highest level to make sure that the response is appropriate. And that group is co-chaired by the Department and by NACCHO.

That sounds like a very, very big initiative?

Yeah and as I said we recognise that there is no way that the response can be put in place without partnership with communities. And the strength that communities can bring to the table is really important. There's a lot of doom and gloom, there's a lot of fear, and it is understandable and it is importnat that we recognise that this is a serious threat. And we need to put in place all the mecanisms that we have to make sure that communities are safe. We need to ensure people understand the risks, we need to ensure people practise good social distancing, people practise good respiratory hygiene (so when they cough and when they sneeze they do it onto their elbow) and that people reduce any non-essential travel outside of the home when possible and definitely travelling in between communities. But we also need to recognise that there is strength in all that response and we have been seing that from the outset. 

Communities have developed their own messaging, communities have deveoped their own campaigns. Organisations have been hammering public health messages from the outset and what we are doing is bringing all of that together and ensuring that we have a mechanism to address any issues that arises.  

One of the things that has come in the news in the last few days in actually the risk to front line personnel doing out of their way and going to support the communities. What measures are being put in place to support the front line personnel?

No health care worker should undertake an activity that is not supported by the appropriate level of protection. We think that the safety of front line workers is absolutely paramount and we have a very strong stance in ensuring that only activities that can be safely conducted happen. The government is providing masks, surgical and P2 and N95 masks from the national medical stockpile to Aboriginal Community Control Health Services, general practices and some community pharmacists, and we are doing that in recognition that Aboriginal Community Control Health Services are often the front line in their fight against this virus and their workers need to be protected appropriately. There have been confirms about the availablility and distribution of PPE and we absolutely recognise that there has been and there is a global shortage of personal protective equipment (what we call PPE). That's the masks, the gowns, the goggles, all countries are bidding for access to these very important materials. Australia has made a very significant investment in ensuring that the stockpile is replenished and we're also working with local manufacturers to ensure that domestic manufacturing is ramped up so that we don't rely on international supply chains. But the reality is that we need to make the most of the precious supply that we have. Aboriginal Community Control Health Services are a priority in the distribution of PPE and we have been responding specifically to concerns that have been raised directly or through representative bodies about access to masks. But we do acknowledge the demand is always higher. It's important that we make sure that access occurs, but also that we are using this precious resource in the most efficient and effective manner.

Because in the world market, countries are out-bidding each other for the same masks and the worst is happening out there. Some countries stealing from others and, it's a very, very strange time to be in.

Well Dr Lucas before you go, anything I haven't covered that you'd like to add to the conversation?

Just to strengthen that we really are in all this together. It sounds like a very common place thing to say, but we can only beat this if everyone does their bit. And from our perspective Aboriginal and Torres Strait Islander communities, their organisations and representative bodies, have more than stepped up to the task to be leading on this response and we just need to ensure that everyone continues to make this incredible effort because this is not a one off thing, this is not something that we need to do for a week, we need to ensure that we practise social distancing, we cancel all non-essential trips out of the home and between communities, and we ensure that we practise safe cough and sneezing and look after each other as much as we can because the only way we can beat this is together.

General public

In collaboration with NITV radio, Dr Lucas de Toca shares his views on the effect of the coronavirus on Aboriginal and Torres Strait Islander communities.