Jacob Madden:
Hi everyone. Thank you for joining us today for our third webinar in our winter preparedness series at today’s session on outbreak recovery and resilience.
Firstly I’d like to acknowledge the traditional owners and custodians of the lands on which we meet today, pay my respects to Elders past, present and emerging. For me here in Canberra it’s the Ngunnawal people. We’ve got people joining the panel from across the country and of course acknowledge the traditional owners of the lands from which you are dialling in from today as well. Extend that to any Aboriginal and Torres Strait Islander peoples joining us as well.
I’m sure most of you are familiar with me by now but my name is Jacob Madden. I’m the Assistant Secretary of the Emergency Preparedness and Response Branch here at the Department of Health and Aged Care. Today on my panel I was just saying I’ve got some of my favourite people. Dr Melanie Wroth who’s a Chief Clinical Advisor with the Aged Care Quality and Safety Commission, Dr Ruth Vine, Deputy Chief Medical Officer at the Department of Health and Aged Care, Craig Gear who is the Chief Executive Officer of the Older Persons Advocacy Network, and Professor Michael Kidd who is the Deputy Chief Medical Officer here in the Department as well.
As people may recall earlier in the year we had two winter preparedness webinars where we provided some practical advice on actions to help prepare for and respond to outbreaks during the winter period. Now that we’re in spring we wanted to have this webinar today. We also ran a follow up webinar with the Commission on the importance of strong leadership and governance as a key component of your infection prevention and control.
In today’s webinar which is the third and final in our winter series we wanted to focus on recovery following an outbreak. This phase recognises the importance of providing support and services and ensuring the wellbeing of aged care providers and residents in and immediately after an outbreak. This is an important time for you to review and reflect on your service’s readiness and your response planning to provide post-response support to your staff and to your residents and to make sure your processes are continually improving. It’s also time for you to consider how recent outbreaks may have impacted your residents, the level of care given during an outbreak and how you can address residents’ physical and emotional wellbeing and any deterioration. These are all topics we will touch on today with our great panellists.
To help with all of this our aged care winter plan provides checklists. These checklists contain examples of the practical and operational actions you can take with post-response support for staff and residents. While the focus of the winter plan is on residential care it also includes a checklist for home care providers.
Fortunately now we are on the other side of the most recent wave and the number of active outbreaks affecting aged care homes has fallen dramatically. In the most recent wave which commenced in June there was a peak of over 1,100 aged care homes reporting active outbreaks and that affected around 6,300 residents and 3,500 staff cases at that point. That was at the end of July was that peak and since that peak we’ve had a steady decline in the number of outbreaks and cases with most recent numbers being 388 active outbreaks and around 1,800 resident cases and 650 staff cases.
Even with this encouraging decline we still need to be vigilant as COVID will continue to circulate in the community and we’ll continue to see waves of outbreaks in the aged care sector. So your ability to be responsive to an outbreak will ensure older Australians continue to receive the care and we focus on this throughout the next waves of COVID and beyond. We need to take note of those lessons from the rolling waves that we’ve seen to date not just to prepare for future outbreaks but also to reflect on their relevance to other emergency events in terms of best practice, and that’s why we wanted to bring this panel together today.
I’m hoping we’ll have some time for some questions at the end. I invite you to submit your questions through the Q&A function and we will address as many as we can. So to do that in the bottom right hand corner of your screen select ‘Q&A’, type your question in there, hit ‘Enter’ and that will pop up for the panel. We’ll attempt to respond to as many as we can in the time we’ve got and anything left over we will take back, look at and try and address through some of our communications materials.
I would now like to hand over to Dr Melanie Wroth to talk about the mental health impacts from COVID, physical reablement supports and building resilience in the recovery phase. Dr Wroth will also give some advice from the Commission’s perspective. Thanks Melanie.
Dr Melanie Wroth:
Hi. Thanks very much. I don’t know how much I can cover in a short time. But certainly we will continue to see outbreaks. There are already outbreaks still happening even though the numbers have reduced. And also these skills and risk managements are transferable to other outbreaks. So I think that outbreak management in general has improved and we will still see outbreaks of such things as gastroenteritis and influenza and really the principles are the same. So the planning can take into account all outbreaks really.
Fundamentally I like to think of the goals of outbreak management in four parts. The overarching goal is to limit the extent and duration of the outbreak. You want to try to be protecting unaffected residents from exposure. You want to detect and monitor and treat in a timely manner people who are affected or become affected or infected in terms of your residents and of course also your staff. And the fourth goal is really the ability to maintain normal care and as close to normal processes as you can including crucially the ongoing detection of risks. And the risks that have been underprepared for in what I’ve seen personally have been actually the non-COVID risks. So I think everyone’s quite aware now of the COVID risks and how to try to prevent and respond to them but the non-COVID risks are still there as they are when you don’t have COVID but they’re much more difficult to detect and even in people who never get COVID or the infection, the outbreaks relating to will still have increased risks because of the disruption to processes. So planning to continue those things is really important and we’ve certainly seen some really good responses and planning and we’ve seen some devastating outcomes where risks haven’t been foreseen or have not been able to be detected.
So the non-infection related risks that I like to think of are, I came to call them, the big three. And they’re interlinked and they impact slightly differently and need a slightly different preparation and response for people who are suffering from dementia or who have other forms of cognitive or behavioural issues. But the risks broadly are nutritional. We see time and time again that as soon as an outbreak is declared and a shutdown occurs that the nutrition of residents starts to decline sometimes dramatically. Sometimes we are seeing large numbers of residents losing in excess of ten kilograms of weight each, not because they’ve got the infection themselves. So there are many reasons for this. Obviously people are having to eat in their rooms. They’re eating alone. They’ve got decreased access to assistance. There’s decreased choice. And all of the normal systems disruption as in not being able to have any social eating, people caring for them who don’t know whether they need or don’t need support, and a failure to detect when people aren’t eating. So obviously if somebody’s not eating, and there are many reasons for that, it’s much better to detect it when they’re not eating than when they’ve lost weight which is weeks later.
There’s also a decreased ability to respond to when this is detected but you can understand also the interaction with psychosocial factors that impact on nutrition and appetite. Those include fear, loneliness, depression, boredom, and all of those will go to make a resident potentially eat less or in some cases eat nothing and drink nothing. So don’t forget hydration with all of that.
The second of the big three is physical. This is probably a bit easier to foresee but the impact can be really, really profound particularly for frail or people with borderline function. So the use it or lose it can happen in literally a day or two, that somebody who stays in bed for two days and normally gets up with assistance and is able to walk around may very well lose the ability to get out of bed independently or to move from sit to stand. So that’s because really of largely the lack of incidental exercise where people might be left in bed, where there’s a sudden cessation of the normal daily activities, where they’re not allowed to walk out of their room or out into the garden where family who might visit them and walk with them don’t come, there’s no outings and often most daily activities and physios stop.
And we see really rapidly – and again I say particularly in people who are frail – significant decrease in strength, in muscle mass, which obviously flows on to balance and falls, to independent walking, to the ability to participate in activities, and all of those things impact a lot on the quality of life of people and it’s very hard to regain. So it’s much more difficult to regain a previous level of function if it was relying on borderline processes or borderline physical processes and so prevention is really, really important. So people who you know are going to decline because they’re not able to self-motivate like you might and get up and do your exercise four times a day, that there is some mechanism to try to address and minimise these things.
The psychosocial impacts is the third of the big three and I think that’s been really under‑recognised. Because there’s less interaction you don’t recognise the impact of that less interaction. So where people have much fewer interactions with staff, where people may come into their room very infrequently or if you’re sitting in a room where lots of people are, that staff would talk to lots of people at the same time or people talk to each other. So residents have great friendships sometimes and were denied access to their friends for understandable reasons but this is what happens. Family obviously, seeing activities around you, being able to watch television or have that put on for you. And I don’t think you can underestimate the loneliness, the fear, the helplessness and the boredom and the feeling of disconnection from community that people living in residential aged care felt. And they’re not very likely always to be articulating that and it really is profound.
And if I just touch briefly on people with dementia where they may have difficulty in understanding that there indeed is a lockdown and certainly the reason for it or if they can understand it they may not remember it, and that they’ve often lost access to the few people that they still recognise and can meaningfully interact with. And they may suffer profoundly from a disruption to all of the normality or the perceived normality around them. They have difficulty engaging with technology. They’re certainly not able to articulate any of their problems or problem solve in some cases. And there’s a risk that those with mild dementia who can interact and can understand these things, there are assumptions that they can’t so they may be left out of things. And it’s well recognised that people in this situation certainly during COVID, but people who don’t have normal levels of stimulation will suffer an irreversible hastening of their cognitive decline.
So all of these things really can be thought about both in retrospect where it’s occurred, how you can best try to solve the problem depending on what the dominant problem is for your service and for your individual residents and what’s available locally. But it can also be thought about in advance, so in a preventive way. We’ve seen many creative ways of trying to prevent these things but you can only prevent them if you know they’re going to happen. So it’s really good to look at such things as partners in care, to look at what available supports there are in your location, volunteers, psychologists. I know that Ruth is going to talk about mental health services in more detail, but lifestyle people, occupational therapists, physios, social workers, spiritual and religious personnel. So all of these people can help address these problems and where they have been locked out in a very hard way that actually may make the risks worse and it’s just important to remember that you’re balancing the risks of infection with all of the associated risks of lockdown and an outbreak. So that’s probably all I wanted to say at this stage.
Jacob Madden:
Thank you very much Melanie. Some really interesting insights. And I liked how you grouped them together in terms of those three big themes. Some easy take aways for people.
I would now like to hand over to Dr Ruth Vine to provide her insights on mental health impacts of the pandemic. Just before we jump there want to remind people Q&A is in the bottom corner and this session is being recorded. So you can let your colleagues know it will be available upon request later. Thanks Ruth.
Dr Ruth Vine:
Thank you. Thank you very much Jacob, and Melanie thank you for setting the scene so well. I mean I think one of the things to note about mental health and indeed recovery from ill mental health during these strange times in which we live is to consider what was there before and what’s happened during and maybe some of the newer service models. So I do want to start by noting that if we’re thinking about residential aged care facilities and the staff who work in those facilities mental health services before COVID were not that good and indeed there were real problems I think with under-recognition and under-treatment of mental ill health in elderly people. And although there had been some attempts to get increased services into facilities either PHN funded or some of the extensions under Better Access I think it’s fair to say that all was not well before COVID.
And then as Melanie has highlighted really during COVID there were those additional COVID related and non-COVID related pressures and particularly those ones of isolation, social disconnection, all the things that we talk to people about, about how to maintain your mental health, about structuring your day, about things that you enjoy, about maintaining social connection and social connectedness just became that much harder. And I think it’s also very important to realise in terms of the staff the majority of staff were female and often the impacts of COVID on mental health were felt most strongly I think by women, women in employment and women in family situations and also by younger people. And again it’s often the women who are shouldering a lot of the worry about that. So recognising the additional pressures that were on those staff is also important.
Of course what happened during COVID was a number of shifts and some of those shifts have been very good things and some of them not so good. So one of the big shifts was to video health and telehealth. Now that enabled healthcare to continue to be provided and it was very important in terms of continuing to have access but of course again it reduced some of that face to face contact and reduced engagement with people’s usual practitioner to some extent. Overall a good thing. I hope we’re going to learn how to live with that hybrid model now between face to face relationships and the perhaps easier to access means of healthcare.
Some of the other things that happened during COVID of relevance were again an increase in the availability of some of the Better Access services, again a mixed benefit for those in the aged care sector. But there were also some special services put in place. There was the essential network to help healthcare providers. Particularly important I think for nursing staff. And in those places, New South Wales, Victoria, where there were extensive lockdowns there was fairly rapid establishment of the Head to Health clinics and the establishment of an access line, 1800 595 212. But there was also a lot of social media information and communication and indeed webinars like this were one example of that.
So quite a few things happened I think during COVID and I think we continue to benefit from those. But I think COVID also exposed some of those real gaps in service provision and in particular some of the gaps in affordability of the Better Access funded services and availability and accessibility with workforce being maldistributed and often long wait times and limited provision. So I did just want to talk a bit about the now scenarios. And we’re currently actually undertaking an evaluation of Better Access and part of that evaluation has been to discover that Better Access was very poorly taken up by people in residential aged care facilities because of probably a mix of referral pathways and provider availability. So I think one of the outcomes of that evaluation will be a further deep consideration of what are the best ways to get appropriate mental health services to aged care residents and indeed to elderly people in their homes and do we need to think about different models of care, different staffing models of care, including the development of more multidisciplinary teams who could provide in-reach and outreach.
So there’s that. One of the other outcomes I think of reports that came out during COVID was again in recognition of those gaps in the system of care, the development of newer models like the Head to Health one. And I don’t know if everyone’s aware but that 1800 number is now available across Australia. And what happens when you ring it, which I do from time to time just to check in, is that you do speak to a clinician who can take you through an assessment and can help you determine the level of intervention or support you might need and how to access that. And we’re just starting to open new centres across the country where there is a sort of free, rapidly available service that’s staffed usually by a mixture of clinical and non-clinical staff, a mixture of nursing, psychology, very rarely psychiatry but sometimes psychiatry, availability. And so that’s sort of being developed too as a new model of care.
So I look forward to the questions but I do think that it will be really important as we go on to think about how we can get the best access in the most consistent way. And I absolutely reinforce what’s previously been said about that importance of the non-clinical supports to mental health and mental health recovery. And they often are about engagement, about more visits, not fewer visits, and being able to maintain people’s social connections to the best of their ability and for as long as they can.
Jacob I think that will do for me but happy to take questions later. Thank you.
Jacob Madden:
Wonderful. Thank you very much Ruth. There’s a comment in the chat, ‘Well said’, and I echo that comment from Brenda there in the chat. So thank you very much for your insights.
We wanted to also have along today someone from the sector, Craig Gear, the CEO of the Older Persons Advocacy Network who will be able to discuss the support services available for residents, their representatives and families, as well as for older people in the community more broadly. So I will now hand over to you Craig. Thank you.
Craig Gear:
Thanks Jacob. Thanks for having me along today. It’s a really important webinar. Acknowledging today I’m coming to you from the land of the Gadigal people of the Eora nation and I thank their Elders for welcoming me on the land today and allowing us to be on their land today.
It is a webinar focused on recovery but we have to acknowledge that there’s many, many older people who haven’t recovered and have passed during this time. And just want to take a moment to acknowledge that grief and the impact that it had on older people and their friends, partners, families and other representatives as well. And just as Ruth was saying about those services, so important that there’s also the Australian Centre for Grief and Bereavement that are actually providing COVID specific residential aged care services so just reach out and use those services. People that we spoke to during some of the outbreaks and when we were doing family meetings said they found those services really, really useful and it’s in this recovery phase that people really need that support and we shouldn’t ignore that older people are going to feel that grief and bereavement just as much as anyone else and we need to provide supports to them like Ruth has said.
I also want to acknowledge what a huge impact and effort every aged care worker has made right across Australia in residential aged care but also home care as well to keep older people safe, to keep them connected, to keep their activities of daily living up as much as possible. And I think what we are now is needing to wrap around a whole lot of supports for the aged care workforce, for residents and families, but also to make sure those services are coming back in as we try and recover in this recovery phase but being prepared that we may not be out of this as yet as well. So thank you to managers, to staff. We know it’s been really hard and we know you’ve been doing your absolute best to keep people safe.
Five things I wanted to run through of I think supports that are there. Obviously visitors. The industry code still gives some really good guidance about getting people back in but also allowing excursions to happen again. Older people are telling us they’re really looking forward to being able to walk, to go to the shops, to go out on excursions. Thinking about even when there might be still the risk of COVID in the community or recovering from an outbreak, when can you get those services back in, when can the lifestyles work get going again. And that’s really important to communicate with family and friends.
So that’s my number two is really being ready for the communications with families and continue that on. We saw some great communication with nominated representatives and communities more broadly of a residential village or families that are connected to that and we want to see that keep going, and also be prepared for the ongoing communication that may be needed if someone is in need of antivirals, to really make sure that we’ve thought about the right to access the antivirals but also sometimes the right of someone who makes an informed choice with all the information to them to maybe not take those antivirals as well, and how we build in that respect for rights, for the right of the person to have carriage and citizenship and autonomy during this time as well.
My third point is around partners in care. So we did see some really wonderful programs where there was a recognition of the additional support that someone who comes in regularly, who can be trained in infection control, who can be there to help support a person with feeding, connection, communication during that time and connecting out of the facility to families and friends. So the Aged Care Quality and Safety Commission have some great resources on their website. HammondCare have done some work around the model as well. So I suppose ask people to really look at that program and to use this recovery phase to get a program like that in place.
Four is around volunteers. So there’s a couple of great programs. People will know about the community visitors scheme, the boosts that have happened in that. It’s time to make sure those CVS volunteers can come back in and have that personal one on one connection. We knew from comments prior to COVID that sometimes around – I think the figure was estimated – possibly 40% of people not having a visitor each year. CVS really important in getting people back and connected but also your own volunteer programs. Let’s support the volunteers and see how we can get them engaged and get that personal one on one connection. Intergenerational programs. If people saw the wonderful Old People’s Home for Teenagers and Old People’s Home for Four Year Olds that’s been on last night it just shows the remarkable opportunities there is in intergenerational programs and support.
The fifth and final one is around our aged care advocacy services. The National Aged Care Advocacy Program. We’ve got around 200 advocates across the country now who are providing information, education and individual support to older people and their representatives. Engaging an advocate or having an advocate come into your facility is not a scary thing. It actually helps you to know what’s going on. It demonstrates you’re meeting the aged care standards. It also demonstrates that you’re supporting older people to have a voice. And during this time we know so much that older people’s voices were challenged and it was hard to actually have them speak for themselves. And so our aged care advocates are ready and willing to come and support people to talk about their rights, to talk about the charter of aged care rights, but to work in partnership with you as providers and your staff to make sure you’re aware of some of the issues that might be there that we just didn’t know because someone was too worried to speak up. So it’s not about a blame game or anything like that. They’re a great support and to help you deliver just exceptional care.
In doing that we’re really looking forward to re-engaging our advocates to come in and provide education. There’s nothing better than being there, sitting around having a cup of tea, talking to people about their rights and their responsibilities and to help facilitate that discussion so people feel confident to be in your service and to raise issues when they need to but in the right way. So 1800 700 600 is there to access our advocacy services or to get someone to come into your facility to provide ongoing education and support.
The other thing we’ve got on our website is our Christmas concert with Damian Leith last year and our concert with Kamahl that we did at Christmas in July because we knew that people couldn’t get out to concerts. So looking at activities like that that keep people engaged and we’ll be doing some future work in that area as well. So playing those, using those. Go to our website. We’ll send them out again as well. So all our resources are available free and online and of course we’re sort of independent of Government and providers to provide that support to older people.
So I’ll pause there and happy to take questions as we go through. Thanks.
Jacob Madden:
Thanks very much Craig. Someone has asked if you could provide the number again and we’ll drop that in the Q&A as well.
Craig Gear:
1800 700 600.
Jacob Madden:
1800 700 600. Thank you very much. We’ll pop that on the slide at the end. Ruth you also referred to the number for Head to Health which is 1800 595 212. We’ll pop that on the slide at the end as well. And someone has asked Ruth while we’re on the phone number question, is there an afterhours or outside hours option on Head to Health?
Dr Ruth Vine:
Look I don’t think so. I think it runs extended hours but it’s not a 24 hour 7 day a week service. The actual centres as they’re being established also run extended hours including some hours on weekends but again not 24 hours a day 7 days a week which means you do fall back on your normal mental health triage lines or of course crisis lines. And of course I should have mentioned during my talk Jacob that again during COVID there was increased availability of a number of those crisis lines including Lifeline and Beyond Blue and Kids Helpline and not only was there increased availability but absolutely increased demand, which has come back down but not returned to pre-COVID normal. So I think people do need to remember there’s those sort of supports out of hours as well as the more sort of assessment and decision making supports in terms of level of service needed in hours.
Jacob Madden:
Thank you very much. Thanks Ruth and thank you again Craig. I think the advocacy services and the other points you raised are really crucial and another piece of this important recovery puzzle.
I would now like to welcome Professor Michael Kidd, Deputy Chief Medical Officer who is on the line to provide some advice on recognising and managing long COVID. So thank you very much Michael. Welcome.
Professor Michael Kidd AM:
Thank you Jacob and hi everybody. Really pleased to be able to join you again for this webinar. So I’ve been asked to talk a little bit about long COVID. And I know that you’ll have probably been reading quite a lot about this in the media over recent weeks. And I particularly want to focus on the implications of long COVID for older people and especially for people who are living in residential aged care facilities. So we’re still learning a lot about long COVID. There’s research happening all around the world including in Australia to try and get a better understanding of this condition. But what we know is that some people who are infected with COVID-19 will have symptoms which can last for weeks and in some cases months after they’ve recovered from the initial viral infection. You may even have experienced this yourself as so many of us have been infected with COVID-19 over recent weeks and months.
The most common symptoms that people develop include tiredness and fatigue, headache, problems with attention or concentration issues, what is referred to in the media as brain fog, shortness of breath, chest pain, muscle aches and pains. And some of these symptoms can just last for a few weeks and then get better. For other people as I say these symptoms can go on for weeks or months. Some other people can develop symptoms which relate to specific organs. So we have seen an increase in cardiovascular difficulties, in respiratory difficulties, in neurological problems including strokes occurring in some people as part of long COVID. And we’ve also seen people who become depressed and anxious. Now again this can often happen after a viral illness but we’re seeing this as quite prolonged in some people with long COVID.
We don’t know how many people are going to be affected by long COVID and we don’t know who is going to be affected by long COVID. The estimates from overseas is anywhere between 10% and 30% of people developing symptoms. Many of those people though the symptoms will last for a month or so. A much smaller percentage they can last for much longer. But what we do know is that older people are at greater risk of developing long COVID. Women tend to have long COVID reported more commonly than men. People who become seriously unwell with COVID-19 are at more risk of developing long COVID than people who have mild symptoms. But we have seen some people with mild or no symptoms who’ve become actually quite unwell with long COVID as well.
What we do know which is good news for Australia is that vaccination helps to protect against long COVID and if someone is vaccinated it may cut their risk of long COVID by at least 50%. What we don’t know is what is the impact of the Omicron variant and its sub-variants on long COVID. We seem to be seeing that it is producing less long COVID than the previous variants, the Alpha and Delta variants which we were dealing with in 2020 and 2021 and that may be good news for Australia where most of our population has been infected so far with the Omicron variants.
So still quite a lot we don’t know but as I say we’re particularly worried about older people because the risk of long COVID seems to be greater. And this is important especially for people in residential aged care facilities. We have of course seen outbreaks in many of your facilities and sometimes multiple outbreaks over this year, over the last nine months in particular, and we’ve seen many people in your facilities who’ve been infected with COVID. I think one of the things is we need to make sure that if someone does have long COVID that we’re actually making that diagnosis and we’re not just putting any symptoms down to being old or being frail. Because there are things that we can do to help people with long COVID and if we can look at improving the quality of life of someone with these symptoms in one of your facilities then obviously that’s what we want to be doing.
Sometimes the other conditions that people have, elderly people have may mask the symptoms of long COVID. So I think what’s really important is just noting how people are compared to how they were before they were infected with COVID-19 and then having a talk with their general practitioner, having a talk with their family members about whether this change could be due to either the acute impact of COVID-19 or could it be long COVID which is causing these symptoms. So for example if you had someone who before they were infected with COVID-19 was happy and outgoing and afterwards they’re depressed and they’re withdrawn and they’re not wanting to engage with other people, this could well be the depression symptoms that can occur with long COVID and that may well improve with treatment or with antidepressants or with therapy, with talking with a psychologist. So we don’t want to mistake long COVID and just say it’s just part of growing old.
I think one of the things we’ve learned about long COVID is that some people really benefit from a multidisciplinary approach, so from having assessment by their regular GP, by having the assessment by the nursing staff who know them and know them well. And then some people will benefit from having a physiotherapist involved helping to get them mobilising, get them walking, get them moving again. Some people will benefit from having a dietician involved, looking at helping to build up their condition after COVID-19 and after the long COVID symptoms have begun. Some people may benefit from counselling as I mentioned or from medication as well. So lots of things to think about with your patients.
One of the areas that we’ve seen is some people may develop diabetes after COVID infection as part of long COVID. So if you have one of your patients and they’re tired, particularly if they have symptoms of diabetes, increased thirst, increased urination, increased other infections, skin infections or other infections, really important to talk to their treating GP about maybe assessing them for diabetes which can come on after COVID as well.
So lots of things to talk about and lots of things to consider. And I think my take home message is be on the lookout for long COVID in your residents and don’t just put new symptoms down as being part of being old and frail. If it’s long COVID there may actually be things that we can do to help improve people’s quality of life and maybe even get them back to where they were before they became infected with COVID-19 in the first place.
We’ve published a webinar with our top three questions on long COVID and that’s available on the Department of Health website. Someone might do me a favour and pop that into the chat so people can find that directly. And as always very happy to respond to any questions. If you do have questions about long COVID we’d really like to hear them because they help to inform the fact sheets which we develop and help us with updating our web pages. If you’ve had experience of long COVID in some of your residents we’d be really interested to know about that as well and what’s actually being done to help those residents to recover from this condition.
So Jacob I might stop there but as always happy to respond to any questions.
Jacob Madden:
Thank you very much. Thanks for joining and for another informative update from you Michael. I think it really kind of completes the picture that we’ve heard from all the panel members today.
There are a few questions in the chat and a few questions that we’ve had pre-submitted. Michael just referred to the top three video. I’ll ask the team to quickly pop that on the slide that we can put up at the end of this session as well. But all of the phone numbers and a link to that will circulate in our next newsletter after this as well.
So just a reminder people can pop questions in. We’ll go through some that are in there now. I know our last webinar we had Helen with her pet lizard behind us. Sadly I don’t have a pet lizard behind me but hopefully Michael’s and Ruth’s artwork is not too distracting either.
Michael a couple of questions for you that we might go to first. A question about whether we know anything about people who’ve received antivirals and the impact on long COVID.
Professor Michael Kidd AM:
Yeah. That’s a really great question Judy. Thank you for that one. We’re still learning what is the impact. What we’re hoping is that people who’ve had the antivirals, because they’re much more likely to have less severe COVID-19 – in fact if we start the antivirals when people turn positive before they develop symptoms they may not develop any symptoms at all. And what we do know about long COVID is the more severe the infection you have the more likely you are to get long COVID. So we’re hoping the antivirals are actually going to have a big impact in either preventing long COVID in older people or reducing the severity and duration of any symptoms of long COVID that people experience.
It’s still very early days with the research into the antivirals. So there is a number of groups both in Australia and around the world who are looking at what’s happened in real life to people who got the antivirals and then seeing how they recovered and how they compared to people who didn’t get them. So I hope that over the next month or so I’ll have more information about that specific issue but it’s a really important question that we’re looking at very closely.
Jacob Madden:
Thanks Michael. And as Michael said earlier these questions are really important. The info we get through the questions that are submitted in these webinars my team certainly looks at and makes sure we’re targeting our communication and engagement activities accordingly. So I encourage anyone to submit additional questions or reflections. As Michael said if you’ve had experiences with residents or with clients in your home care services we also welcome that through our COVID Liaison mailbox.
Another question for you Michael about vaccination from Mary.
Q: Is there any advice in relation to whether the fourth shot should be a different vaccine from what’s been received earlier? Should you mix?
Professor Michael Kidd AM:
Yeah. Again it’s a really interesting question Mary. The Australian Technical Advisory Group on Immunisation, ATAGI, provides advice on the vaccines. At the moment they’re saying it’s fine to have the same vaccine for all four vaccines but also it’s okay to mix the vaccines as well. A lot of people received the AstraZeneca vaccine for their first two doses and then have had one of the MRNA vaccines, either Pfizer or Moderna or in some cases one of each as their booster vaccines as well. I think the most important thing is if you’ve had significant side effects from one of the vaccines then talk to your doctor or the nurse who’s administering the vaccines as to whether it would be a good idea to have a different vaccine this time around. But there’s no hard and fast rules on what you should be doing with your vaccines and no really clear benefit of either having the same vaccine or of mixing the vaccines.
I’m not sure if Melanie wants to add on this one as well Jacob.
Dr Melanie Wroth:
I don’t really Michael. I would have more or less the same answer. I mean the only other thing to potentially take into account in the discussion would be if you had severe side effects to one vaccine you might want to hope that you might not with another. But I don’t think that that would necessarily be the case anyway. So I can’t really add anything more Michael except it is a great question.
Jacob Madden:
Thanks Melanie, thanks Michael. Melanie while we’ve got you one of the pre-submitted questions which again might be between yourself and Michael to answer, but we’ll start with you, was:
Q: Is there any advice for residents who may experience hypertension either after a COVID infection or after a vaccination?
Dr Melanie Wroth:
Hypertension?
Jacob Madden:
Yes.
Dr Melanie Wroth:
Or Hypotension? Sorry. Hypertension. Nothing specific other than manage it as you would. It depends on the degree and the context and whether it’s just systolic hypertension or whether it’s got a raised mean arterial pressure and whether the person’s normally hypertensive and it’s actually not very different or whether it’s a dramatic increase. And obviously sometimes it’s related to physiological issues and sometimes it’s related to psychological issues. So I think that just has to be individualised. And wherever you have vaccination you would have the sort of expertise that could assist in that situation.
Jacob Madden:
Thanks Melanie. Michael anything to add on that one in terms of cardiovascular symptoms and long COVID?
Professor Michael Kidd AM:
No I don’t think so. I think Melanie and I are playing back and forward. I haven’t got anything to add. Thank you.
Jacob Madden:
US Open tennis.
Great one for – well I’ll throw to Craig and Ruth for the next one. Give you a bit of a breather Michael. A question again from Judy.
Q: How do we encourage aged care homes to take up social and emotional wellbeing programs offered during outbreaks and post?
Dr Ruth Vine:
Sorry were you throwing that one to me?
Jacob Madden:
Yep. We’ll start with you and then we’ll go to Craig.
Dr Ruth Vine:
It may well be one more for Craig. But look I think one of the things to say about this is perhaps one of the positives about COVID is that we’re much more aware I think of levels of psychological distress that are being experienced across the population. And I think we’re also perhaps much more aware of the importance of if you like the psychosocial rather than the clinical. Not to in any way denigrate the clinical but the importance of those issues around as I said earlier sort of our connection with others, our activities that we enjoy, the sort of sense of purpose and hope and structure in our day. So I would hope that there is much greater awareness across residential aged care facilities of those issues as well and as Craig has pointed out perhaps greater availability.
And the other thing I would just touch on is I do think that as we expand programs related to mental health beyond Better Access and do think more of those multidisciplinary approaches – multidisciplinary in this sense usually will include either people experienced in occupational therapy but also often people with carer or consumer experience themselves and who are wanting to sort of help people to make those connections and integrate with services. So I sort of would like to think there’s both awareness and also something to do with that awareness and that COVID in fact has increased that notwithstanding the terrible deficits that occurred in some places during some parts of the COVID time.
Craig Gear:
So taking the uptake by providers of social and emotional wellbeing but also I think as I said partners in care, volunteers, community visitors scheme that I think is just back in, I say to providers probably do a risk-based assessment. We’ll never eliminate risk completely but really it is the benefit of the volunteers and these programs coming back in and engaging people. I suspect in most cases it will be – even if there was risk of COVID at the time or community, the benefit that this would be done and done in a safe way, which it can be facilitated, is going to be overwhelmingly better for older people and the volunteers and people delivering the programs as well, than that risk. So we really need to get to this risk-based assessment.
I think then we might look at getting some messaging out there as well about the real benefits. I’ve had people who’ve been sort of part of a partners in care program or staff that have been involved in the program and it’s not taking over from aged care staff but it’s so supplemental and complements what’s going on that staff just go ‘Oh my goodness. We couldn’t have done without this’. So again benefits outweighing any risks and the investment of time in these programs but getting some information out, some testimonials about that real benefit for the volunteers. We know there were some volunteers that sort of dropped off during this time and we need to sort of target and re-engage with them and make sure that they know that they’ll be supported, they’ll be respected and that they’ll get the supports and training they need to still deliver friendship support in a safe way as well. So I think we need to tackle both the volunteer pool and the friendship pool and for providers to know it’s a bit of a no brainer I think.
Jacob Madden:
Thank you very much Craig and Ruth. A couple of questions that have come in on the public health directions topic. A question about isolation periods from Tahlia.
Q: Now that isolation period is reduced to five days instead of seven days but remains seven days for high risk settings are home care providers subject to seven days or five days?
This one I think is very much subject to the public health orders that the states and territories put in place but the National Cabinet decision did include care provided in the home. Michael was there anything you wanted to add on that one as well?
Professor Michael Kidd AM:
Yes. So obviously the most important thing is that we’re protecting vulnerable people in vulnerable settings and that of course includes vulnerable people living in their own homes as well as those who are living in residential aged care facilities. So again you need to follow the instructions in your state or territory as to what the rules are. But my advice is that people should not be returning to providing home care until at least seven days after the diagnosis of COVID-19 and of course not at all until symptoms have totally cleared up. And for some people it may take ten days to two weeks before symptoms totally clear up and people are less likely to be at risk of infecting people. I think also I’d be wearing a mask if I was going into a setting with someone who is vulnerable in their own home especially in that period afterwards.
I think also it’s important for the wider public. If you come out of isolation at five days stay away from grandma or grandpa for the full week as you normally would have because older people are just more at risk than younger people.
Jacob Madden:
Thanks Michael. We’ve talked a bit about vaccination. It’s come up in a couple of different contexts today. Rafael has asked:
Q: Will COVID be a yearly shot and will that be mandatory like the flu vaccine?
Again I think I’d point to vaccination mandates currently being in state and territory public health directions. So look for that advice in your state. But on the question more broadly about whether we expect to require yearly vaccinations Michael?
Professor Michael Kidd AM:
Yeah. So whether the vaccines will be mandatory or not remains to be seen over months and years ahead. But we will need to follow the advice. And at the moment it’s too early to know whether we’ll end up having a yearly vaccine against new variants which have emerged of COVID-19, whether we’ll end up with a combined vaccine of influenza and COVID-19. Certainly that’s being looked at. It’s under development by some of the manufacturers to try and have a double dose vaccine for the winter.
Also people may have seen we’ve just had approval by the Therapeutic Goods Administration of the first what’s called a bivalent vaccine which includes the original COVID strain but also the Omicron strain. So these vaccines will start being developed and they’ll start coming into Australia as well. They have to be approved by the Australian Technical Advisory Group on Immunisation as well as the Therapeutic Goods Administration. So the Moderna bivalent vaccine which TGA approved last week we’re now waiting for advice from the Australian Technical Advisory Group on Immunisation as to how that particular vaccine might get used. So great questions. A little bit early. We’ve just got to keep following and we’ll keep people updated as we know more and as more recommendations come through.
Jacob Madden:
Thank you very much Michael. Thanks everyone. I think we are just about out of time. Thank you all for your questions today. As I said the team will circulate some of those phone numbers and links to key information we’ve discussed today following this webinar.
It’s also important we keep you up to date with all of those latest changes coming through in COVID management. As a number of the panellists have touched on we’re talking today about recovery post-outbreaks but outbreaks are still occurring. So we are still living in that environment. We’re keen to make sure everyone’s kept up to date. I encourage you all to keep an eye out for future webinars in our notices and subscribe to the newsletter which hopefully you all subscribe to to get today’s invite.
So big thanks to our panellists for giving up your time today. Thank you to everyone who has joined and participated in this session. It was extremely valuable for me. I hope it was for you as well. So thank you very much.
[Closing visual of slide with text saying ‘Thank you for joining us today’, ‘For more information or if you have further questions:’, ‘Email: AgedCareCOVIDLiaison@health.gov.au’, ‘Visit: health.gov.au/covid-advice-aged-care’, ‘Health to Health’, ‘Provides free advice, assessment and referral into local mental health services. Call 1800 595 212 between 8:30am to 5pm on weekdays (public holidays excluded’, ‘Older Persons Advocacy Network (OPAN)’, ‘Provides a free and confidential aged care advocacy support line on 1800 700 600’, ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘www.health.gov.au’]