Advice on COVID-19 must be prompt, calm and clear

After millions of words and hours of footage, mixed and inconsistent messaging about the coronavirus across different states has left the public confused and therefore more vulnerable to its effects. While attention has switched to the economic effects of the disease, basic public health issues remain in need of serious, immediate attention. As reported on Tuesday, a special national hotline has been overwhelmed by callers seeking advice, and confusion within the health system has seen patients given conflicting information. People seeking tests have struggled to find out what symptoms justified immediate action.

The closure on Monday morning of two Sydney schools, Willoughby Girls High and St Patrick’s Marist College Dundas, after three students tested positive to the virus, and the diagnosis of fresh cases in Victoria and Western Australia, were a sign of what to expect in coming days and weeks. Melbourne’s Carey Grammar School has shut its doors for 24 hours. School shutdowns, NSW Health Minister Brad Hazzard said, are likely to become “the new normal”. Australia’s first coronavirus case was confirmed on January 25. By Wednesday last week, the total had risen to 46. By Monday, it was 94, out of 110,000 reported cases worldwide. What started as China’s problem, then rapidly spread in South Korea, Iran and Italy, is now Australia’s problem. Experts such as Professor Raina MacIntyre, head of the University of NSW’s school of public health and community medicine, warn that given our relatively older population, the death rate in Australia could be proportionately higher than the 2.3 per cent rate of confirmed cases seen in China. With a vaccine possibly a year away, optimum treatment, especially of those in their 70s and older, will be vital. The aged-care sector, already under pressure, will be tested.

Governments and health authorities have sought to reassure the public that the nation’s health system is among the best-placed in the world to handle an epidemic. Most, but not all, of those who have caught or will catch the virus will experience mild flu-like symptoms. Panic buying and other overreactions, however, are signs of unease in the community. Better information is needed to reassure those who are uncertain about what they are facing and those worried about what they should do — if anything. Is it safe, for example, to leave loved ones in nursing homes or would it be better, where possible, for them to stay with family until the crisis passes? How long might that be? Is it sensible to visit people in nursing homes? And who will step up to cover for staff who refuse to attend work at aged-care facilities where residents are diagnosed with the virus?

The Australian Medical Association advises it is important not to “clog up’’ the system with unnecessary testing. But who should be tested, where and when? As reporter Lachlan Moffet Gray found when he experienced flu-like symptoms in Sydney on Monday, the system is woefully inadequate. Patients face long telephone delays and, despite being potentially contagious, are shunted from one pathology clinic to another, many of which close at 3pm. Moffet Gray spent hours traipsing around the city, from one medical facility to another and finally to hospital, mainly on public transport. Patients may be told they need to wait four days to be tested. Given the spread of the disease internationally, it would make sense for inbound travellers, but that does not appear to be on the radar. The downside of not testing inbound travellers was evident in Western Australia on Sunday when a woman tested positive after attending an orchestral concert on Saturday night. She had recently returned home from Cuba and London. The WA Health Department is now working to track down those who may have sat near her at the concert. As a result of the incident, West Australians who arrive home from overseas showing symptoms will be asked to self-isolate until their test results are known.

In Tasmania, Premier Peter Gutwein is considering imposing fines of up to $8500 for people ignoring directions to self-quarantine. Self-quarantine is also causing confusion, however. Should immediate family members and housemates move out or isolate themselves as well? Should a patient diagnosed with the virus move out and, if so, where? Those practical issues could be influenced, in part, by the Morrison government’s economic stimulus package. The needs of casual workers, for example, who do not have sick leave but are compelled to stay away from work, will be addressed at a meeting on Tuesday between business, unions and government. It is also vital that the public is told, clearly and often, in English and other languages, about how best to prevent contracting the virus and what to do if they show symptoms. People want to know whether it is safe to attend large gatherings or to travel in crowded trains and buses. What are the risks of flying domestically or overseas, even to areas not regarded as hotspots? In addition to widespread advertisements, such information needs to be distributed via schools, hospitals, nursing homes, doctors’ surgeries and indigenous health and community centres. The information provided on various states’ Health Department websites is good. But many nursing home residents, poorer people and those in remote areas do not access the internet. Others are uncertain about where to search and what to believe.

State governments and chief medical officers are holding almost daily press conferences. In the interests of uniformity and consistency, Health Minister Greg Hunt and the federal government’s Chief Medical Officer, Brendan Murphy, need to draw state and territory ministers and chief medical officers together regularly to ensure the messages being relayed are uniform and clear. Far greater information needs to be provided as soon as possible.

On Sunday, AMA president Tony Bartone underlined the need for consistency. The federal government and the states needed to be “singing from the same song sheet’’ by co-ordinating their messages, he said. “Right from the beginning, we have had the states going in different directions … whether it was ­attending schools or the advice on handshakes. People need calm, consistent messaging from governments. Right now, frontline doctors feel utterly exposed.” Many doctors had found it difficult to obtain accurate clinical guidance or access to personal protection equipment, he said. GPs are on the frontlines of fighting the epidemic, as are hospital casualty departments. But confusion is also rife in that sector, unfortunately. On Friday, South Australian AMA branch president Chris Moy told the ABC that initial advice provided in some states had not made it clear that individuals who suspected they had the virus should ring from home before heading to hospital. He said posters in Victorian and South Australian hospitals had originally recommended patients present in person. But he intervened to have that changed in South Australia.

The AMA also complained last week about a shortage of gloves and masks. More are on the way, but the delays are not good enough. The public also has a right to know that health experts and mask makers warn that only a properly used reusable N95 respirator mask, certified by an independent agency, is effective. In advice posted by The Wall Street Journal, and available on our website, experts advise that paper or polyurethane foam masks do not filter out smaller particles responsible for transmitting infectious agents. They may have a role, however, in helping prevent sick people from transmitting the virus to others. Australia’s Deputy Chief Medical Officer, Paul Kelly, advises that it is unnecessary for people in the commun­ity to wear masks.

The Morrison government’s stimulus package will tackle the economic fallout of the emergency. But the government must prioritise the needs of those most at risk of contracting the virus, especially the elderly, and those battling it in the health system. As COVID-19 spreads, ensuring sufficient tests, laboratory facilities and personnel are available will be front and centre. Making good use of private pathology services makes eminent sense. Treating and caring for those who need nursing back to health and home care, including shopping and collecting medicines for those in self-isolation, could also become important. Authorities need to be flexible and practical in supporting and protecting health workers and patients. A nationally co-ordinated information push, to help overcome anxieties and uncertainties, must also be a priority.