Restrictions ease, but ‘main problem’ with Vic contact tracing remains

Matt Woodley

26/10/2020 4:08:40 PM

A lack of communication between health authorities and local doctors is still hampering efforts, GPs say.

Contact-tracer knocking on door
Some patients are still reportedly confused about advice related to testing and isolation. (Image: AAP)

After 111 days, Victorian Premier Daniel Andrews has announced one of the world’s longest coronavirus lockdowns is ending.
While that news is cause for celebration, local GPs have said a recent coronavirus cluster in Melbourne’s northern suburbs has laid bare ongoing and unresolved issues in the state’s pandemic response.
Apparent communication issues between the Department of Health and Human Services (DHHS), coronavirus cases and close contacts, and local healthcare workers have left many at the coalface concerned.
In particular, RACGP Victoria Council member Dr Bernard Shiu told newsGP that some patients are still confused about DHHS advice related to testing and isolation, and health authorities have failed to heed lessons from earlier outbreaks in public housing towers .
‘I worry culturally diverse groups could become the beginning of next outbreak. But the main problem is still the same since the beginning – a lack of communication and lack of engagement,’ he said.
‘We must move away from the centralised control model and empower the local GPs and health service to facilitate the contact tracing and quarantine process.’
The DHHS contact-tracing system has undergone a massive overhaul since problems were identified during Victoria’s second wave, transitioning towards a decentralised system less reliant on pen and paper to one more focused on cloud-based technology and analytics.
The changes helped reduce Victoria’s daily case numbers from a peak of 725 on 4 August to zero on 26 October. But GPs say they failed to address issues related to poor communication with culturally and linguistically diverse (CALD) communities, leaving the state open to further outbreaks.
In response to last week’s emerging cluster – which stemmed from a family not understanding official advice and has put about 800 people into isolation – the DHHS further tweaked its system so households with at least one positive coronavirus case have only a single case manager, rather than of multiple.
But while such an approach may help the DHHS avoid inconsistent messaging to COVID-19 patients, GP Dr Catherine Orr told The New Daily it will not fix all of the issues with the system and that primary care needs to be more involved.
‘In the last few weeks, I’ve had to argue on behalf of families getting incorrect messaging,’ she said.
‘In linking the GP into a COVID-19 patient, it’s been shown over and over in regional and rural areas they can contact-trace faster.
‘They have the trust of their patients and can be an advocate for them when the messaging can go wrong or they need support accessing payments.’
Dr Shiu also believes GPs are well placed to help with contact tracing and communication – especially  in CALD communities – as they are embedded locally in a way public health officers are not.
‘All communication to the patients and families involved must be personalised, culturally appropriate, and coming from one source – the GPs whom they trust,’ he said.
‘GPs should have direct contact with the DHHS, [and] the communication between the DHHS and healthcare professionals must be timely with clear, unified and precise instruction.
‘Someone needs to take the ownership of care for each family, so why not the GPs who know them well and may speak their language?
‘Just imagine one of us is infected – would I prefer to speak to a bunch of strangers in hazmat suits who do not speak my language, or would I want to speak to my own GP who has been there for me and my family since I was born?’
Epidemiology Chair at Deakin University, Professor Catherine Bennett, also supports a community-led approach for contact tracing. She recently highlighted this approach as one of the crucial reasons NSW has had better success controlling outbreaks than Victoria.
‘Fundamentally, NSW’s system of decentralised local area health districts meant when the second wave hit, that state was able to draw on teams embedded in their local communities to manage contact tracing. These teams worked independently but also in concert under the mothership of NSW Health,’ she wrote.
‘What’s crucial is a nuanced understanding of local, social, and cultural factors that may facilitate spread or affect how people understand self-isolation and what’s being asked of them.
‘If you’re doing a contact-tracing interview with someone and they’re talking about a key landmark at a certain time of day, you can [also] visualise it and understand what it means in terms of risk.’
Professor Bennett says this connection can also make a critical difference when encouraging people to come forward for testing.
‘It’s not just about making sure you have materials printed in the right language. It’s about understanding how people view the health system from their context,’ she said.
‘If you have people who come from a part of the world with a health system that operates differently to ours, they will bring that understanding with them.
‘If local health workers and contact tracers are already part of a community, they can bring that expert knowledge into the mix; they can make sure public health messaging is meaningful for local communities.’

Dr Bernard Shiu wants health authorities to ‘stop sidelining GPs’ in their contact-tracing efforts.

Dr Orr, who has treated dozens of coronavirus cases from multicultural communities, uses interpreters for verbal communication when speaking to a patient who has English as an additional language.
But, to her knowledge, the DHHS has never used translation or interpreting services when contacting her patients, either verbally or via written communication.
‘I know DHHS say they use interpreters and have access to interpreters, but not one of those 100 [positive cases] who I’ve treated have had an interpreter,’ Dr Orr told the ABC.
‘They never got an SMS or letter in any other language than English. The [DHHS] certificate to release people from isolation is in English.’
Problems are compounded when there are multiple people living in the one house, with confusion often stemming from the requirements for those having to isolate because they are infected, and others who are quarantining because they are close contacts.
However, Premier Andrews said it is ‘simply wrong’ to say that interpreters have not been offered when needed.
Despite fears of a major outbreak, DHHS testing commander Jeroen Weimar said no new positive cases have so far been linked to the northern Melbourne cluster.
‘My job is to be out there to make sure we give people an effective and a fast testing system so we can control any outbreaks to date all going forward,’ he said.
‘Let me just say, 39 positive cases over 11 households is a big and complex outbreak, the likes of which we don’t see very often in Australia.
‘We now have a battle-tested system, with literally thousands of people working both on the streets to control this, going door to door, testing people in their homes, manning up the testing stations as well as working behind the scenes.
‘We will be ready to do this time and time again as we go forward.’
Even though Victoria appears to have this most recent outbreak under control, Dr Shiu remains unconvinced the system is foolproof.
‘Please listen to us who are doing it day and day out; let’s make the process smooth, effective and air tight,’ he said.
‘All it takes is one case and a whole community, and potentially the whole of Victoria, will be devastatingly affected.
‘Stop sidelining GPs.’
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Dr JElm   27/10/2020 7:45:09 AM

As a female GP who has worked in CALD and comes from a CALD background, my concern with contact tracing and advice about isolation and quarantining, being placed in the hands of GPs is that there is not as much respect for female doctors as there is for male or for government officials. This is not only in CALD communities but across the board.
I wonder how would a solo/ single GP then also organize a ‘wrap around’ service with food, medication etc for individual families in quarantine. I do not have the time at this point to do such a comprehensive job that takes perhaps several people per family.
At the moment I have a post COVID patient, and this is where our work as GPS will come in.
I agree there needs to be collaboration with DHHS, but I do not covet or envy their service at this time.