Friday, 3 July 2020

Big Ideas Forum - Beyond COVID Northern Beaches Council Webinar

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Last night I attended the online Big Ideas Forum Webinar through the Northern Beaches Council called Beyond COVID. It was initially an interview with Dr Norman Swan, a health journalist and physician, then went on to a panel discussion which included Lucinda Brogden AM, Chair of the National Mental Health Commission, Dr Sean Turnell, Associate Professor of Economics at Macquarie University and Greg Jones, former school principal and executive member of Community Co-op Northern Beaches. It is available to watch here.

Before I delve into it, I just want to comment on the Acknowledgement of Country that takes place at the start of these gatherings and how disappointed I always am at the irreverence and insincerity. I know it's an awkward forced protocol that many simply read off a piece of paper without actually thinking about the meaning of what they're saying, but it has become so tokenistic that it feels like an insult to even bother. I refuse to accept that in the whole of the northern beaches, the council can not find one Traditional Owner or First Nations person or group to do a genuine and heartfelt Welcome to Country - particularly NOW, with everything that is going on around the world. My guess is that there has been absolutely no attempt to connect or collaborate. If indeed there has been no progress, then the Acknowledgement itself needs to be better. It's not just something you rattle off, it's something you feel and make people feel and understand so that we can all start off on the right foot. This needs to change. It's confronting, but it needs to happen. We need to acknowledge that we are on stolen and unceded land, we need to address sovereignty, the lack of treaty and pay our respects genuinely to elders past, present and emerging. This is a significant step forward that requires honesty and truth, many are not yet ready to face.

The interview with Dr Swan, as always was informative and evidence based. If you haven't already, get acquainted with The ABC podcast he does called Coronacast. They are short 10 minute episodes released daily, covering the basic updates of what is happening around the country and around the world. 

Dr Swan explained many aspects of the Australian experience with COVID 19 and commented on why we did so well as a country. The main thing we got right was that we closed borders, particularly to China early, back in February 2020 - the first case being discovered on the 25th January. The pandemic was then managed collaboratively by government, particularly the states, business/workplaces and the community. It became a unified movement, largely communicated through social and digital media which forced people to act and the federal government to respond on an evidence based approach. This was to act strongly and intervene as early as possible. The World Health Organisation (WHO) urged immediate lockdown action, as it is impossible to make these decisions retrospectively and undo harm. Australia's early response and heeding of this advice was able to maintain COVID related deaths to just over 100, which while extremely regrettable and tragic, are comparatively good. Locking down early, closing borders and taking advantage of being islands, insisting on physical distancing and later extensive testing to identify clusters saw Australia and New Zealand become world leaders in flattening the curve and keeping numbers down. It gave us time to prepare health services and hospitals for possible case increase and slowed the spread of the virus. In comparison, the US and UK waited much longer and are bearing the tragic consequences now.

The discussion then turned to the recent increase in numbers in Victoria. Dr Swan stated that referring to COVID cases in terms of 'waves' isn't very accurate and applies more to illnesses like Influenza as there are things in place like vaccinations and herd immunity. With COVID it is more accurate to refer to spikes in cases, whereby transmission rates tend to double daily with no cure, no vaccine and still very little predictability about how the disease will impact people, taking into consideration things like co-morbidities, age, and social/economic factors. While Victoria is experiencing high numbers, Dr Swan mentioned the case in Balmain in Sydney which indicates the disease is still present in NSW and it is not yet time to relax.

He talked at length about the difference between NSW and Victoria in terms of the way health services are structured. In NSW we have Area Health Services which include the local hospitals, but also health service provision on the ground in each geographical location. This structure allows bigger areas to be covered in order for the population of that area to receive health services aside from the local hospitals. This infrastructure is not present in Victoria which seems to only have stand alone hospitals and GP/Specialist services. This impacts testing, treatment and service provision.

Locally, Dr Swan discussed the cases around Manly and Dee Why early on in the pandemic and how immediate lockdown and extensive testing was able to contain the clusters, area health and hospitals were able to oversee treatment, isolation and recovery, and this prevented community transmission. This did not work as well in Bondi where community transmission was allowed to travel a little further out. 

It is evident that social distancing has a huge impact on community transmission. Dr Swan talked about the demographic of people who contract COVID and while globally, for example in places like Italy, there was a lot of publicity around the elderly, it is a much younger demographic that can contract the disease, show few symptoms and then transmit through large gatherings and socialisation. In Italy, for example, there was the tragic circumstances around cut off ages for access to ventilators being around the age of 40 mark, when the hospitals were bombarded with extreme cases. Big social networks, which young people are more likely to have, pose the biggest threat, particularly in gatherings that take place indoors, with lots of people and over an extended period of time.

In regards to a vaccine, Dr Swan thinks this is a long way away and while there is promising research coming out of Oxford University, there are many barriers to a vaccine for a respiratory illness due to the nature of the membranes and organs involved and how they function. Usually treatment relies on activating an immune system response and then needs to be administered annually. In some cases like with SARS, vaccines were found to create a hyper immune response which can cause autoimmune disease. The good thing is that any vaccine progress coming out of the UK will likely be publicly funded and therefore widely available and shared. The opposite is happening in the US where research and funding will likely be privately conducted and therefore not shared. Finding a vaccine is condensing 10 years of research into 1. It's obviously urgent.

Discussion turned to the effectiveness of wearing masks. Dr Swan is of the opinion that masks are a good idea when there are high rates of community transmission, as is happening in Victoria. Wearing a mask is not about protecting yourself from getting infected, although that's a bonus. It's about preventing transmission of the disease to others if you are carrying it and have no symptoms or if you are indeed ill. Masks are particularly useful indoors, for example whilst shopping and on public transport. The main factors to consider are things like the quality of the mask and availability. Both issues are easily addressed, but the culture of wearing masks is a bit harder to change. 

The health implications during this pandemic are complex, particularly in relation to how each individual is likely to recover from infection and all the factors that contribute to their well-being before and after having COVID. Another matter to consider is how people have responded to healthcare generally during lockdown to minimise risk. Telehealth in Australia has been particularly effective as people have been able to consult with GPs remotely and continue any ongoing or chronic health issue management. An area of concern was the decrease in cancer screening numbers whereby people have avoided going to routine screening while in lockdown. There is some unease around people delaying testing for early detection and risking delayed diagnosis. 

The impact of the pandemic has not only been on public health but also the economy. Dr Swan mentioned that data from the 1918 influenza pandemic demonstrated that places where lockdown happened earlier were able to recover economically much quicker. It focuses on the idea that in the long run prevention is better than cure and the impact on the economy will happen either way but will have more long term consequences and will be harder to recover from if we allow people to get sick, overwhelm our health services and create more trauma.

At this point the panel joined the discussion. I was disappointed but not surprised that it consisted of four white men, including Dr Swan and the facilitator and one white woman. Until we allow diverse voices in these discussions we continue to assume that the majority of people are white and middle class. This is simply not the case and while divergent groups are often referred to as 'minorities', they are not in fact less than in number and importance but instead are marginalised as such. This is prevalent in the local area.

The panel discussion was mainly an exchange of ideas about community support, focusing on mental health and connection. There were some examples of the local community exchanging material necessities like donations of food, volunteering of time and provision of support to those impacted by lockdown. It's nice to live in a community where everyone is doing great and can help those doing a little bit less than great and then taking comfort in the ease with which we got through hardship working together. However there was no mention of people who may fall through the cracks and the reasons why, which can erase the experience of many people. 

At one point there was mention of the suffering experienced by self-funded retirees. How they have paid taxes all their lives and never needed government assistance and now suddenly their investments might be worth less and they may be embarrassed or ashamed to ask for assistance. It is important to express empathy and to consider anyone who may be impacted by this pandemic in a substantial way. We just need to truthfully define what substantial means. Not having enough money to pay rent or feed your children is very different to a decrease in wealth that does not impact your day to day survival.

Mental health was discussed extensively, particularly community connection and loneliness, but the discussion stopped short of addressing issues like individualism, capitalism, cultural diversity and wealth inequality. There is still a long way to go in facing some of these issues in this demographic.

Some talk centered on things like working from home, how this has been a necessity and many have adapted well, but for so many businesses and organisations, there needs to be a face-to-face market place and people are social animals that need human interaction. All this is true, however it shouldn't take a pandemic to provide people with flexibility and work/life balance. There was brief mention of people who benefit from the ability to work from home occasionally, but it wasn't discussed adequately. Parents/guardians of young children for example can benefit greatly from flexibility in the workplace. Current employment structures and culture can increase the exclusion of women from the workforce and public life when they have very young children and this inflexibility can also prevent men from spending quality time with their children. Many people take care of aged parents, family members with disabilities or themselves experience mental health issues that are alleviated with working from home options. It's important to maintain a functioning economy but not at the expense of a healthy and balanced society. There was no acknowledgement of front line workers who never had the option to stay home; doctors, nurses, teachers, community workers, supermarket staff, delivery drivers. Essential workers were not mentioned at all. There was also no recognition that for many, online options are still unavailable and inaccessible due to cost, access to devices and reception issues. Connectivity was a big local issue. Just ask anyone who worked from home or home schooled.

It was a valuable webinar, and I appreciate the limitations of time that don't allow every single aspect to be covered, but the panel discussion fell short. It was out of touch and outdated, particularly in the face of the global sociopolitical movements that have emerged rapidly in response to and simultaneously with the pandemic. The ideas seemed to come from very traditionalist and conservative perspectives that are no longer relevant or are only true for some people. We now have the information and technology to question the systems and structures that are only serving a small number of people and it isn't justified for those people to declare that everything is working, when it clearly isn't for many. It was a missed opportunity to address broader issues and failed to acknowledge that to come out of this pandemic relatively well is to have access to immense privilege.

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