Rural and coastal populations more vulnerable to coronavirus

Matt Woodley

1/04/2020 5:15:48 PM

ANU research suggests areas outside the major cities have a significantly higher concentration of risk factors linked to COVID-19 deaths.

Older couple at the beach
Efforts to protect vulnerable patient populations in rural settings will be complicated by an ageing medical workforce, and reduced access to services and PPE.

With older populations and more people with chronic disease, rural and coastal areas are particularly at risk from deaths from coronavirus, an Australian National University (ANU) study has found.
The research suggests Australia’s rural east coast is particularly at risk, along with Tasmania and the Northern Territory.
The researchers used known coronavirus death risk factors such as age, and underlying health issues including heart problems, diabetes, asthma, obesity and other chronic conditions to form their findings, as well as other factors such as smoking and disability.
The study was originally developed as an electorate-based health index for Catholic Social Services Australia to help it determine the areas where services are most needed.
However, ANU researcher Associate Professor Ben Phillips told the ABC it also contains ‘effectively the same variables’ associated with higher coronavirus death rates.
‘We’re saying nothing about where the infection rates will be greater or smaller,’ he said.
‘But for a given infection rate – let’s say 10% – these are the areas where there may be more call on hospitals, greater levels of sickness and, unfortunately, greater death rates.’
RACGP Rural member Dr John Kramer is based in Woolgoolga in NSW, which sits within one of the electorates predicted to be most vulnerable to coronavirus. He told newsGP he fears the number of cases is about to ‘explode’ in his area.
‘There’s a very, very high retired population around here,’ he said.
‘I heard of two more positive cases in Coffs Harbour yesterday from one general practice alone, so I think it’s just about to explode.’
Dr Kramer said aside from the local population’s higher vulnerability to the disease, access to medical services will be the largest issue affecting the identification and treatment of coronavirus.
‘We’ve got less access due to fewer doctors, fewer hospital beds and fewer community services, against an older population, with some [areas] that have relatively high Indigenous populations as well,’ he said.
‘So we’re going to have to battle with that.’
Repurposing public buildings as make-shift respiratory clinics has been discussed as a potential option, but Dr Kramer believes it is inevitable more pressure will be placed on primary care in the region.
‘The ICUs in all the base hospitals will be full. They also won’t be able to send people off to Sydney or Newcastle because all their ICUs are going to be full. So there’ll be a backwards effect,’ he said.
‘Hospitals won’t be able to take a lot of people, and so those people will have to be cared for somehow in the community.
‘There will be very sick people in the community needing palliative care, basically. I think that’s probably the thing that scares me the most – how can adequate palliative care be delivered in that sort of setting?’
While regional towns are more isolated than major cities, ANU epidemiologist Professor Ross Andrews told the ABC the experience of more affected countries suggests coronavirus will still make its way into these areas.
‘It’ll get there. It’s just a question of how long it will take,’ he said.
‘Once the infection gets there, you’ll see higher death rates and higher rates of complications that need acute intervention.’
Complicating the situation further, Dr Kramer says, is the continued lack of access to personal protective equipment (PPE) currently being experienced all over Australia.
‘I went and looked two days ago and basically we’ve got four or five sets, which we can’t use for this because you have to reserve that for other situations – somebody comes in bleeding and might be hepatitis B-positive,’ he said.
‘[But eventually] the situations that don’t include COVID-19 where you have to have it, we simply [won’t be able to] use it.
‘Our PHN was supposed to provide PPE but it still hasn’t arrived. Whenever you contact them, if you can get them to answer the phone, the answer is “we don’t know”.’
Dedicated respiratory clinics should help, but Dr Kramer said these could also come with their own problems.
‘We’ve got to find somewhere for [coronavirus patients] to be seen other than our practices, because once our practices become contaminated nobody can come there and that means we won’t be able to provide all the other healthcare that still needs to be delivered,’ he said.
‘[A respiratory clinic has] just been set up in Coffs Harbour at the hospital and they’re getting them in various places, but [determining] who’s going to run them is also a challenge.
‘We’ve got an ageing rural workforce who, if they have any sense, will not be working in those clinics because they’ll be the first ones to go down and then they’ll just add to the burden on the system.
‘It will get worse if the doctor numbers drop away, the issue will just be magnified … we’re going to have to basically have two strains of medicine. Anything that is or might be COVID-19, and everything else – and we have to keep them separate.’
The RACGP has more information on coronavirus available on its website.
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