Impact of Lockdowns on Australians’ Mental and Physical Health

The extreme life changes that have been thrust upon the world by the COVID-19 lockdowns have taken a considerable toll on our physical and mental health, without discrimination.

Children, adolescents, adults and the elderly have all been challenged by factors including social isolation, boredom and loneliness, unemployment, financial instability, school and business closures, state and international border closures and extreme and unprecedented social restrictions.

“Common consequences of disease outbreaks include anxiety and panic, depression, anger, confusion, uncertainty and financial stress, with estimates of between 25% to 33% of the community experiencing high levels of worry and anxiety during similar pandemics.” (Black Dog Institute 2020)

As can be expected, the COVID-19 pandemic has led to a significant impact on mental health of the Australian population at large, especially among those who are already vulnerable (Dr. Mandal 2020). Nationally, since 16 March 2020, there has been a 15% increase in the number of Medicare-subsidised mental health services delivered to Australians and 7.4 million services provided (Department of Health 2020).

With around 45% of Australians aged 16-85 said to experience a mental illness in their life (Australian Institute of Health and Welfare 2018), the circumstances of the COVID-19 lockdowns and pandemic have amplified our experience of mental health issues.

It is not surprising that the restrictions imposed on socialising with friends and family, visiting elderly loved ones in care facilities, mourning the death of a loved one at a funeral, celebrating a marriage, attending religious gatherings, working amongst work colleagues, frequenting gyms for exercise or even exercising outdoors (Melbourne, Victoria), have seen the rates of psychological distress, anxiety, and depression symptoms rise among adults in Australia during the peak of the pandemic (Dr Mandal 2020).

Melbourne, Victoria underwent some of the strictest and longest lockdowns in the world (Fernando 2020), triggering an increase in usage of mental health services across the state. The use of Beyond Blue’s Support line was 77% higher in Victoria than in the rest of the country, Victorian use of Lifeline was 16% higher and use of Kids Helpline was 24% higher than in the rest of the country (Department of Health 2020).

Ensuring that essential support was available, the Australian Government prioritised mental health and suicide prevention services with record investment in mental health estimated to be $5.7 billion in 2020–21 including an additional 10 Medicare-subsidised individual psychological therapy sessions available each calendar year, a commitment of $2.4 billion to provide all Australians with access to telehealth, $5 million to fast track electronic prescribing and $25 million to support home delivery of medicines (Department of Health 2020).

This unprecedented investment in mental and physical health funding is assisting Australians to deal with the challenges of lockdowns, isolation, fear for loved ones, and concerns about employment (Aust Government Department of Health 2020). However, despite this, the physical health of many Australians with existing chronic health conditions has been a mounting concern following the sharp fall in healthcare participation as a result of the isolation and social distancing advice, as well as a 40% drop in pathology testing – equivalent to over 60,000 Australians per day not getting tests vital to manage their healthcare (Hepatitis Australia 2020).

This delaying or avoiding necessary routine medical care (despite the availability of telehealth consultations) compounded by the fear of becoming infected with COVID-19 as well as feelings of overburdening the health-care system in a time of crisis could put Australians’ long-term health at risk (Ferguson 2020).

Therefore, while the public health messaging has focused on urging people to stay home as a way of saving lives and preventing the spread of COVID-19, it’s important to highlight that as concern over COVID-19 continues, one of the key exceptions to this is the need to seek medical treatment – even if it is in person.

Anyone worried about their mental health, loneliness, finances, family, or other circumstances should be reassured that help is available and accessible and can contact the Beyond Blue Coronavirus Mental Wellbeing Support Service for free advice and counseling on 1800 512 348 or online. Immediate advice and support is also available through Lifeline (13 11 14) or Kids Helpline (1800 55 1800) (Department of Health 2020).

REFERENCES

  1. Australian Government Department of Health. The mental health impact of COVID-19, 2020. https://www.health.gov.au/news/the-mental-health-impact-of-covid-19 (accessed Nov 2020).
  2. Australian Institute of Health and Welfare. Australia’s Health 2018: in brief – how do we compare with similar counties, 2018. https://www.aihw.gov.au/reports/australias-health/australias-health-2018-in-brief/contents/how-do-we-compare-with-similar-countries (accessed Nov 2020).
  3. Black Dog Institute. Mental Health Ramifications of COVID-19: The Australian context, 2020. https://www.blackdoginstitute.org.au/wp-content/uploads/2020/04/20200319_covid19-evidence-and-reccomendations.pdf (accessed Nov 2020).
  4. Department of Health – Ministers. Caring for Mental and Physical Health during the pandemic, 2020. https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/caring-for-mental-and-physical-health-during-the-pandemic (accessed Nov 2020).
  5. Dr Mandal, A. Mental health problems peak alongside COVID-19 in Australia, 2020 https://www.news-medical.net/news/20200729/Mental-health-problems-peak-alongside-COVID-19-in-Australia.aspx (accessed Nov 2020).
  6. Ferguson, C. SBS Insight. Managing chronic conditions in the time of coronavirus, 2020. https://www.sbs.com.au/news/insight/managing-chronic-conditions-in-the-time-of-coronavirus (accessed Nov 2020).
  7. Fernando, G. SBS News. Is Melbourne’s coronavirus lockdown really the longest in the world? Here’s how other countries stack up, 2020. https://www.sbs.com.au/news/is-melbourne-s-coronavirus-lockdown-really-the-longest-in-the-world-here-s-how-other-countries-stack-up (accessed Oct 2020).
  8. Hepatitis Australia. Not seeking help may place your health, or your life, at risk, 2020. https://www.hepatitisaustralia.com/news/not-seeking-help-may-place-your-health-or-your-life-at-risk (accessed Nov 2020).

Australian Timeline on COVID-19

On the 3rd of January 2020, China officially notified the World Health Organisation (WHO) of an outbreak of viral pneumonia of unknown cause (Xinhuanet 2020). Cases and deaths around the world rose astronomically over the coming days and weeks, specifically in China. By January 25, a man from Wuhan, China who had flown to Melbourne on 19 January became Australia’s first confirmed case of coronavirus (Ministers Department of Health 2020).

By the 30th January 2020, the WHO declared the coronavirus outbreak as a Public Health Emergency of International Concern (PHEIC) (Kantis et al 2020). World leaders began to make major and unprecedented decisions to prevent the spread of the virus by closing international borders, enforcing travel bans and mandatory quarantining of travellers.

Since the outbreak of what has become known as the coronavirus COVID-19 global pandemic, the virus has thrown the world into complete upheaval in every sense of the word, flooring healthcare systems, entire countries, industries, economies, families and life as we know it.

As of early October 2020, 214 countries have had COVID-19 cases, over 36.7 million cases have been confirmed globally, and over 1 million deaths have been confirmed worldwide (Kantis et al 2020).

Australia’s COVID-19 battle has included nationwide lockdowns, border closures, major governmental blunders involving cruise ships and hotel quarantining, critical issues regarding a lack of PPE and government direction faced by healthcare workers, mental health and employment crises, and Melbourne undergoing one of the strictest and longest lockdowns in the world (Fernando 2020).

Melbourne has been under social restrictions since 16 March in line with the national restrictions. These were initially extended to 11 May, but on 8 July, Melbourne’s restrictions were reimposed following significantly increasing COVID-19 cases. By 2 August, a state of disaster and an 8pm-5am curfew was ordered (Fernando 2020).

 

To date in Victoria;

817 people have lost their lives to COVID-19

20,320 total number of cases

122 active cases

11 cases in hospital

no cases in intensive care

19,313 people have recovered

(Victoria State Government 2020).

While our state government leaders have been praised for implementing strict restrictions and social distancing laws to reduce the spread of COVID-19, they have also been widely criticised regarding issues faced by healthcare workers including a lack of PPE, support and direction.

Along with the extreme dependence on frontline healthcare workers over the past ten months, inadequate national safety guidance resulted in an inconsistent and non-standardised approach to airborne precaution PPE across health care settings, with some making their own independent safety recommendations to their staff (The Conversation 2020).

lack of available PPE including adequate face masks and shields, hand sanitiser, gowns and gloves put the lives of these healthcare workers at risk and indeed lead to large numbers of cases in the sector (Grenfell 2020). Furthermore, the Royal Australasian College of Physicians (RACP) found that 20% of health workers across the country lacked access to the most basic protective equipment including masks, with some reports of staff being forced to reuse disposable equipment (RACP 2020). This is something that no healthcare worker should be asked to do, ever. Equally as troubling, the survey also found that only 61% of respondents reported having had recent workplace training in the use of PPE which is crucial to the prevention of transmission (RACP 2020).

RACP President and Respiratory Physician Professor John Wilson said,

Our Government must be doing everything they can to provide them with sufficient protective equipment. We must do everything we can to ensure that healthcare workers are protected from infection while at work – and that includes urgent PPE training for all hospitals who have not yet rolled this out .

(RACP 2020)

As our country endeavours to pull itself from the grasp of an economic, employment and mental health crisis, it is imperative that we learn from the mistakes made in order to improve national policies surrounding our response to such a devastating pandemic as that of COVID-19.

Professor Nick Talley, Editor-in-Chief of the Australian Medical Journal, said the outbreaks in the two states (NSW and VIC) are actually the first wave of the virus in the pandemic.

People talk about the 2nd coronavirus WAVE. It’s NOT the 2nd in Australia.

We essentially never had serious community COVID transmission. Until now.

Please see full article for clarification here – https://7news.com.au/lifestyle/health-wellbeing/coronavirus-outbreak-seen-in-victoria-and-nsw-is-actually-australias-first-covid-19-wave-expert-says-c-1166607

REFERENCES

  1. Fernando, G. SBS News. Is Melbourne’s coronavirus lockdown really the longest in the world? Here’s how other countries stack up, 2020. https://www.sbs.com.au/news/is-melbourne-s-coronavirus-lockdown-really-the-longest-in-the-world-here-s-how-other-countries-stack-up (accessed Oct 2020).
  2. Grenfell O. World Socialist Web Site. Twenty percent of Australian health workers lack PPE as infections in the sector soar, 2020. https://www.wsws.org/en/articles/2020/08/10/vict-a10.html (accessed Oct 2020).
  3. Kantis C, Kiernan, S, Socrates Bardi J. Think Global Health. UPDATED: Timeline of the Coronavirus. A frequently updated tracker of emerging developments from the beginning of the COVID-19 outbreak, 2020. https://www.thinkglobalhealth.org/article/updated-timeline-coronavirus (accessed Oct 2020).
  4. Ministers Department of Health. Media Release: First confirmed case of novel coronavirus in Australia, 2020. https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/first-confirmed-case-of-novel-coronavirus-in-australia (accessed Oct 2020).
  5. Royal Australasian College of Physicians. RACP survey: 20 per cent of physicians in public hospitals sourcing their own PPE – calls for greater transparency on government stockpile, 2020. https://www.racp.edu.au/news-and-events/media-releases/racp-survey-20-per-cent-of-physicians-in-public-hospitals-sourcing-their-own-ppe-calls-for-greater-transparency-on-government (accessed Oct 2020).
  6. The Conversation. PPE Unmasked: Why health-care workers in Australia are inadequately protected against coronavirus, 2020. https://theconversation.com/ppe-unmasked-why-health-care-workers-in-australia-are-inadequately-protected-against-coronavirus-143751 (accessed Oct 2020).
  7. Victoria State Government Health and Human Services. Media Release – Coronavirus Update for Victoria – Tuesday 20 October, 2020. https://www.dhhs.vic.gov.au/coronavirus-update-victoria-20-october-2020 (accessed Oct 2020).
  8. XINHUANET. https://www.linkedin.com/redir/general-malware-page?url=www%2enews%2ecn%2e China publishes timeline on COVID-19 information sharing, int’l cooperation, 2020. http://www.xinhuanet.com/english/2020-04/06/c_138951662.htm (accessed Oct 2020).

COVIDSafe help – Technical support

How will the COVIDSafe app work?

A user voluntarily downloads the app from the app store. The user registers to use the app by entering a name, phone number and postcode, and selecting their age range. They will receive a confirmation SMS text message to complete the installation of the app. On the basis of this information, an encrypted reference code is generated for the app on that phone. That code is changed every 2 hours to make it even more secure.

The app uses Bluetooth to look for other devices that have the app installed. It takes a note when that occurs, securely logging the other users’ encrypted reference code. The date and time, distance and duration of the contact are generated on the user’s phone and also recorded. The location is not recorded.

This information is securely encrypted and stored on the phone.

The app uses a rolling 21 day window to allow for the maximum 14 day incubation period, and the time taken to confirm a positive test result. The rolling 21 day window allows the app to continuously note only those user contacts that occur during the coronavirus incubation window. Contacts that occurred outside of the 21 day window are automatically deleted from the user’s phone.

The contact information on the phone is not accessible by anyone (including the user of the phone), until the user is diagnosed with coronavirus and they upload the contact information to a highly secure information storage system.

The uploaded information enables state or territory health officials to contact the user and close contacts to provide advice on actions they should take to manage their health.

This cycle continues if a user of the app who was a close contact subsequently tests positive.

What will the app do?

The COVIDSafe app will allow state and territory health officials to contact you if you have been in contact with someone with COVID-19 (coronavirus). They tell you:

  • what to look out for
  • whether you need to quarantine
  • how, when and where to get tested, and
  • how you can protect yourself and your family and friends

 

If you become infected with coronavirus, the app will assist state and territory health officials to notify people with whom you have had close contact and advise them about self-quarantine and getting tested.

This will speed up current manual processes and make it quicker to stop the spread of the virus, particularly if restrictions are eased.

The app operates on a person’s phone as they go about their day.

It securely logs the encrypted reference codes of devices of other people who are using the app who have been in close proximity to you.

The close contact information can only be accessed by relevant health officials if there has been a positive case to help alert those who may need to be tested.

The app will never track your location.

Is there a risk that people may report false positives?

Information collected by the app that is uploaded to the highly secure information storage system will only be accessed by state and territory health officials once a user has a positive diagnosis. This positive diagnosis must be verified by health officials.

Who is a ‘close contact’ for notification purposes?

State and Territory public health officials will have the contact information for other users who have been within approximately 1.5 metres of the infected user for 15 minutes or more.

How does the app know a ‘close contact’ has occurred?

When 2 (or more) app users come into close proximity their phones exchange Bluetooth signals and make a series of ‘digital handshakes’.

The app records the encrypted reference code, time and proximity of 2 users, through the strength of the Bluetooth signals. This allows the approximate distance between the users and the duration the contact occurred to be determined once the data is uploaded to the highly secure information storage system.

The proximity for a close contact is approximately 1.5 metres, for a period of 15 minutes or more.

To be effective, users should have the app running in the background of their phone whenever they are coming into contact with people. Users of the app will receive daily notifications to ensure the app is running.

Why does the app only notify close contacts in the last 21 days?

The average incubation period for someone who contracts COVID-19 is typically 5 to 6 days, however the World Health Organization currently estimate that the incubation period can be up to 14 days.

The app uses a rolling 21-day window to allow for the maximum 14-day incubation period, and the time taken to confirm a positive test result.

The rolling 21-day window allows the app to continuously monitor only those user contacts that occur during the coronavirus incubation window.

Contacts that occurred outside of the 21-day window are automatically deleted from the user’s phone.

What information is captured by the COVIDSafe app?

The app only uses the information that’s needed to alert close contacts and allow health officials to make contact with them.

This information is only the encrypted reference code, date, time, duration and proximity of contacts.

At registration, the user provides their name, phone number and postcode, and selects their age range, which generates an encrypted code

All further information about contacts collected by the app is encrypted and stored within the app on the phone. Users cannot access contact information stored on their phone.

If the user deletes the app, all contact information is deleted.

The contact information on the phone is not accessible by anyone, unless the user is diagnosed with coronavirus and they upload the contact information to a highly secure information storage system.

Can a user or health official view the information stored on the phone including the contact log?

No. All information that is stored on the phone is digitally encrypted and cannot be accessed or viewed by any users or health officials.

Contact information older than 21 days on your phone is automatically deleted.

Can the app be used to track a user or contact?

No. It does not record an individual’s location or movements. The app only records that a contact occurred to allow health officials to contact those users to enable them to quickly self-quarantine and/or seek medical attention.

The app cannot be used to enforce quarantine or isolation restrictions or any other laws.

Commonwealth and state/territory law enforcement agencies will not be allowed to access any information from the app, unless investigating misuse of that information itself.

Do I have to use the COVIDSafe app?

No. Its use is entirely voluntary but using it will help save lives.

For the app to work, it must be running in the background on your phone. Other apps can be used at the same time.

You can delete the app from your phone at any time. This will delete all the app information from your phone.

At the end of the Australian pandemic, users will be prompted to delete the app from their phone. This will delete all app information on a person’s phone. The information contained on the highly secure information storage system will also be destroyed at the end of the pandemic.

If a user receives a close contact notification, will they be advised who the contact was?

No. This will operate in the same way as existing contact processes run by State and Territory health officials.

A phone call will be made to users who have had close contact with another user once that user is independently confirmed as having COVID-19. This phone call will be made by State or Territory health officials.

Close contact information is only available to State and Territory health officials once a user is confirmed as coronavirus positive, and the user securely uploads the information stored on their phone.

These calls will only be made to close contacts that have occurred in the 21 days before the information has been uploaded. This early notification allows users to quickly self-quarantine and seek medical attention.

Why should I use the COVIDSafe app?

Receiving early notification that you may have been exposed to coronavirus means you can be tested or go into quarantine, so your health and others’ is protected.

Without the assistance of technology, finding people who may have been exposed to the virus relies on people being able to recall who they have been around and knowing the details of every individual they have been in close contact with. In many cases, we don’t know the names and contact details of those we’ve been in close contact with (for example, at the supermarket or on the train).

The COVIDSafe app uses technology to make this process faster and more accurate.

The COVIDSafe app has been developed to ensure your information and privacy is strictly protected.

Telehealth services

Telehealth – Connecting your people to medical specialists – anywhere, anytime.

Now more than ever solutions to connect people to services they need is critical and mlcoa Telehealth aims to do just that.  While our offices are open for in person assessments, our Telehealth service offers you an alternative, allowing a virtual assessment with an independent medical specialist to minimise delays and maintain case progressions in a safe, secure and effective manner.

Learn how Telehealth can assist you, as mlcoa Consultant Occupational Physician Dr Farhan Shahzad takes you through the process in this short video. If you want to know more or access our telehealth toolkit, simply contact mlcoa on 1800 652 621 or email contact@mlcoa.com.au

Occupational Physicians in the Climate of COVID-19

The unprecedented situation that has been brought upon the world by the rampant spread of COVID-19 has forced hundreds of thousands of frontline medical staff to adapt to new and unfamiliar work routines, procedures and expectations surrounding the provision of health care.

While we take off our hats to medical staff working in hospitals, primary care and ICU units while placing their own health in unchartered territory, other medical staff have essentially been removed from normal healthcare settings to instead perform consultations via virtual offices in order to reduce the chance of transmission of this disastrous and debilitating virus.

Never in our lifetimes have we been faced with such a critical situation that has warranted international border closures, office and community lock-downs, business closures and global concern about the long-term social and economic consequences. But these new rules are necessary and compliance is crucial, as social distancing and enhanced hygiene practices are the most significant ways to slow the spread of COVID-19.

Below is a graph outlining the total confirmed COVID-19 cases by sex and age in Australia.

Across the world, there have been more than half a million confirmed cases of COVID-19 in 201 countries, areas or territories (according to the WHO Coronavirus Disease (COVID-19) Situation Dashboard.)

Occupational Health & Safety and COVID-19 – a Duty of Care

In the most recent RACP (Royal Australasian College of Physicians) President’s message, Associate Professor Mark Lane states,

“In these very difficult times, many members of the community are looking to us for advice and for leadership.”

With so much information surrounding COVID-19 now available, access to timely and accurate health advice from credible sources of information is critical for not only the general public, but for health professionals providing health care and advice regarding COVID-19. Accurate information regarding minimising exposure to COVID-19 in the workplace and early intervention for suspected cases will complement public health measures while reducing disruption to businesses.

Businesses and organisations have a duty of care to reduce the rate of transmission of COVID-19 in the workplace and community. To assist with this need, the RACP has outlined a number of recommendations to guide employers in their response to this global health pandemic including;

  1. Prioritising the health and wellbeing of workers and their families
  2. Showing leadership
  3. Effective two-way communication between employers and workers
  4. Showing empathy and compassion
  5. Applying innovative thinking
  6. Being responsive to the changing situation, and
  7. Planning ahead

When it comes to Planning Ahead, the RACP is urging businesses to continue to ensure the health and safety of their workers in this changing environment, as it is anticipated that this disruption will last for a significant period.  As such, employers are beginning to focus on what their future business might look like, and how to ensure that together with their workers and the nation more broadly, they can survive and thrive once the pandemic ends.

Working from home our new norm

The recommendations outlined in the RACP’s Applying Innovative Thinking specifically emphasise adopting new and innovative solutions that comply with the current official advice including social and physical distancing and self-isolation (i.e. staying at home only with people who usually live in the home, not going to public places including work, school, childcare, university or public gatherings and not seeing visitors).

These innovative solutions include adopting flexible working hours, working from home, or creative use of technology, all of which allow workers to continue to undertake their work roles as far as feasibly possible, whilst limiting contact with their colleagues and the general public as much as possible.

However, it is also highlighted that employers will also need to acknowledge that depending on employees’ personal circumstances, working from home may impact on productivity and there may be an increased need for flexibility in working arrangements.

Occupational Physicians in the Climate of COVID-19

As specialist doctors in the health and wellbeing of workers and the working population more broadly, Occupational Physicians are well placed to assist in this situation.

In order to assist employers in creating work environments and conditions that are beneficial to the health and wellbeing of their employees during this challenging time,

Occupational Physicians can incorporate organisational structures and workplace specifics into each your COVID-19 response.

This insight and guidance will be very useful in helping to provide employers with targeted workplace-specific advice and solutions amidst this unprecedented health crisis marked by hundreds of thousands of worldwide fatalities globally.

For further access to timely and accurate COVID-19 Health Information

CLICK HERE for the central resource that informs all official public health advice in Australia.

CLICK HERE to see the Australian Government’s Department of Health Coronavirus (COVID-19) health alert. This page includes information about how the Australian Government is monitoring and responding to the outbreak, how you can help slow the spread of COVID-19 in Australia, and what to do if you have symptoms. It also includes the latest official medical advice and case numbers.

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