2022-02-28
While our response to Covid must be based on the best evidence-based health knowledge, compassion and care for each other are equally important in getting us through these difficult times
By Dr Jane Ralls, GP and member of Perth Greens and previous Co-convenor of Curtin Greens
I would like to share two things – a letter I wrote early this year and some thoughts a few weeks later on what I believe are some important things to tell people about Covid. I hope that these contributions will be useful to readers in their thinking about Covid-related issues.
FIRSTLY, here is the letter I wrote to the Premier and the Health Minister at the time the decision was made to postpone the planned February 5th border opening (obviously much has changed since then, but I stand by the values and ideas expressed at that time):
Dear Premier McGowan and Health Minister Sanderson
Firstly, I want to acknowledge the fantastic work the WA State Government has done over the last two years in keeping WA safe from Covid-19.
I am a triple vaccinated metropolitan General Practitioner of 30 years’ experience. I have done vaccine clinics from the start, and have inched many “vaccine hesitant” people gently over the line. I have seen patients face to face throughout the pandemic so far, which is my strong preference going forward, while I continue to work hard to keep myself, our staff, and my vulnerable patients safe. My closest “loved ones” are luckily in Perth, and I have no need nor desire currently to travel either elsewhere in Australia nor internationally, nor receive visitors. That is due to pure luck, and means I have as little conflict of interest expressing an opinion re border closures as anyone can have right now.
While I see people for all their medical needs, at all ages and stages in their lives, and have many immunocompromised patients, I specialise in Mental Health and do a lot of Peri-Natal work. This colours my perspective.
Compassion – a victim of the pandemic
While it is really good to hear plans to increase compassion from February 5th in the G2G pass system, I strongly believe the situations mentioned in the press conference should have, and could have, been safely accommodated from the start. I have been very disturbed by the stories I have heard from patients and friends regarding the system, and the families kept apart by it. I have very recently witnessed patients extremely unwell with Post Natal Depression having to choose between returning to their extended families abroad for much needed support, or staying isolated in Perth with their partner who has to stay for work. It really does take a village to raise a healthy child and forcing such a choice is inhumane. That is only one example of the lack of compassion in the current system – I could give you many more, but I chose that one as it will impact the health of future generations.
Re the Delay in Border opening
I can understand the decision to continue the “hard border” beyond 5th February given the apparent lack of serious health planning leading us up to this point. We should not be in the situation we are in, particularly given the surplus in the State budget. If a lot more financial resources had been provided to our hospital sector over the last 6 months it would have been possible to improve morale, keep health care staff in the sector, and importantly clear a substantial number of elective surgeries currently waiting. Then we would be as ready as we can be. Human resources are what matter, but they need financial support. This is why we pay taxes, not to have it kept as a surplus.
I understand that the WA Primary Health Alliance (WAPHA) and the Royal Australian College of General Practitioners (RACGP) are still awaiting advice from WA Health regarding the WA model of care for managing COVID positive patients in the community. This backs up what I mean when I say there is a lack of serious health planning.
I have a very personal story to share here as I have just had “elective” surgery myself, being lucky enough to afford private health insurance and the gaps that go with it, and have it done relatively quickly in the Private Sector. My hip became extraordinarily painful over the last 2 months, and, while I continued to work and provide vaccine clinics, I became only able to walk at all with a crutch, despite being normally very fit and active. It has been an exhausting and humbling experience, and I was only able to continue working by reducing available appointments significantly and because of all the public holidays over the Xmas period. (Most GPs in our practice take holiday over that time, and I cover them).
I share this story because I am horrified at the idea that people who cannot afford private health insurance (this includes many health care workers) would normally have to wait for many months for their surgery (for example hip replacement), even with the level of pain I was experiencing. There are many other situations where surgery is deemed “elective” but is actually quite urgent. To glibly state that “elective” surgery can and will be postponed, before we even have significant Covid-19 here, is to invalidate the suffering of thousands of Western Australians. That is not a “plan” ‒ it is an extreme measure to be considered in the future only if absolutely necessary.
Sadly, the current situation is showing that it is impossible to keep the Omicron variant of SARS-Cov2 out, and slowing it down in WA will have serious adverse effects. The further we delay, the greater the chance of a peak in cases in the winter, which I, as a GP, call “snotty kid season”, and which is also “ambulance ramping” season. The adverse consequences in Primary Care as well as in the Hospital sector of this timing cannot be understated. While we struggle to triage and work out who to see safely face to face and how, health workers’ immunity from boosters may wane. While I certainly don’t believe we should “let it rip”, there are many other nuanced solutions that could be implemented to try to prevent a peak mid-winter.
Planning ahead
I believe WA needs a very definite date, preferably before March this year, that will be adhered to by the State Government for some sort of border opening. [Subsequently, the WA Government announced that the border opening date would be 3rd March] This date should clarify when people no longer have to justify their reasons to travel in or out of WA. Rules can and should be put in place for travellers, (for example avoiding crowded indoor venues for 7 days after arrival), in addition to testing prior to travel and in WA maybe Days 2 & 6. Going forward, RATs should be available for this. There can and should be different rules for the vaccinated and the non-vaccinated, but the latter should not be excluded.
It is time for Australia to come together more as a nation and for WA to make some compromises in the name of kindness and inclusion. For example, a 14-day isolation period is not necessary for people who have received their second or subsequent vaccine within 4 months, and having different rules across Australia is becoming confusing and inequitable. However, regardless of Federal decisions, within WA RATs should be made available for free with very clear instructions when to use, and what to do given a negative or a positive result. There is plenty of experience in the UK and elsewhere in the world we can draw on, and these will save the WA economy money going forward.
My last point I would like to make is that anti-vaxers are humans too. While I and the science do not agree with them, they do have a right to their opinions, and while it is right to exclude them from situations where the risk of passing SARS-Cov2 to vulnerable people is significant, we must not completely exclude them.
Yours sincerely
Dr Jane Ralls MBBS MRCGP (UK) DCCH
Secondly, I offer these four pieces of advice (all based on The Greens Social Justice pillar) to help us care for each other through these difficult Covid times.
1. RATs must be free, and the RAT reporting system should include reporting all results including negative ones.
2. We need to strengthen primary care and the communication with GPs including devising a method of informing us of all RATs done by our patients (with each patient’s consent). Primary care is Federally funded, yet we work in the state ‒ something innovative needs to happen in this siloed space!! Primary care will inevitably be the cornerstone of management of the pandemic, and is already over East. I’m not sure if it is known that GPs are hardly informed about anything. I run a vaccine clinic, yet I have discovered every change to the roll out over the last nearly a year from the news. None of the changes to eligibility, age and type of vaccine recommended, and more recently booster time schedules, was communicated to us before being public information. When information also tends to add “ask your GP” it puts us in a very difficult position, and forces us to attend to the news cycle 24/7 as well as doing our normal work. GPs are human too and we need some downtime ‒ this is not appropriate.
3. Anti-vaxers. I am increasingly concerned about the risk of alienating even just a small proportion of the population. I stand by my letter and am more concerned now than when I wrote it. There is illogicality to a lot of the state government’s current rules, to which a natural human reaction is to question, even rebel. As an example, I went to the RE store recently and could have bought groceries without question, but had to show my vaccination status for the bottles of wine. Why?? If there is no rationality to such a rule, it will only create disquiet and disunity at a time when unity, compassion and a sense of togetherness are paramount. I couldn’t begin to write a policy here (!!) but think we should all tread very very carefully.
[Update late February – I’m pleased that common sense has prevailed and proof of vaccination is no longer required at bottle shops! The border opening early March is sensible with restrictions in place – I do think things are beginning to move in the right direction, although a lot of people seem strangely unconcerned and don’t seem to realise how serious this is going to get.]
4. Vaccinate the world!!! - let’s try to prevent the next horrible variants developing in the first place.
Header photo: Rockefeller Center Prometheus Statue COVID19 Face Mask New York City. Creative Commons
[Opinions expressed are those of the author and not official policy of Greens WA]