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As an experienced respiratory physician at a major western Sydney hospital, I am gravely concerned about the NSW government’s ineffective response to the Delta outbreak. As it has overseas, the pandemic is disproportionately affecting low-income migrant populations with insecure jobs.
NSW is almost certainly on the precipice of a massive deterioration. Contact tracers are overwhelmed, with reporting of infection hot spots lagging by days. The whole strategy of relying on contact tracing for infection control is failing, or indeed has failed.
COVID sufferers in western Sydney are reporting to hospital only when very sick.Credit:SMH
Australia’s Chief Medical Officer, Professor Paul Kelly, emphasises the federal government’s overall aim is to eliminate the virus until adequate vaccination rates are achieved. However, the NSW government appears to have abandoned the first part of this strategy. Worryingly, it is now relying on achieving sufficient vaccination rates to allow society to progressively reopen.
This will take time. As a result, overseas evidence strongly indicates the Delta variant will continue to wreak havoc with untold numbers of infections, hospitalisations, ICU admissions and death. This is already happening now. No responsible individual has ever advocated for COVID elimination to be pursued indefinitely. However, it is critical until herd immunity is achieved.
NSW is suffering from a conspicuous failure of leadership. Are we trying to lock down to eliminate COVID, or are we attempting to vaccinate our way out of this pandemic? People are no longer clear what our COVID strategy is. People are losing faith in the lockdown. There is increasing resentment – going both ways – between south-western Sydney and the rest of the city. Of most concern is the loss of a sense “we are all in this together”. A lockdown that people understand and are motivated to comply with in western and south-western Sydney is essential.
So why is the lockdown of western and south-western Sydney failing?
The reasons are complex, but in my experience, some are evident on a daily basis at any outpatient clinic in our region. Between one-third and half of consultations have to be conducted with an interpreter. This could be in-person, over the telephone, or using a family member. Sometimes, doctors must use a common language such as Arabic, even though the patient may be Assyrian. Other patients, often refugees, are not literate in their first language. Federal and state government public health advertising has arguably not even been communicated well in English. To expect multicultural communities to quickly comprehend ever-changing public health directives is almost impossible.
Second, home isolation in south-western Sydney is particularly challenging in smaller homes with multiple family members living under the one roof. The option for hotel quarantining is restricted by the limited local availability.
Furthermore, some patients attending emergency departments are staunchly refusing to get tested because of the implications for their family. The necessity to quarantine close contacts would prevent hard-up family members from working. Some households are very sick, but their members do not seek help as they are trying to avoid restrictions.
Tragically, in certain western and south-western Sydney hospitals, COVID-infected patients are presenting so late in the course of their infection that it is necessary that emergency teams intubate them immediately upon their arrival. Such late presentations are not being seen at hospitals from the north, centre and east of Sydney.
With no economic safety net, no ability to work from home and distrust of governments, some residents fear the public health interventions being delivered. Many have been traumatised in their native countries, so seeing police on horses and troops patrolling neighbourhoods, may not result in the desired outcomes. This is not to say law enforcement should be abandoned, just that sensitivity is required.
If a greater level of COVID elimination is to be achieved, the failures of the current lockdown must be overcome. The NSW government must urgently re-establish trust through targeted advertising in multiple languages. Use local leaders in the community, social media influencers via residents’ children and grandchildren, and even beloved local sporting personalities.
Above all, affected communities must be supported. A large part of the solution to breaking this cycle is financial. A decent level of financial assistance must be offered in conjunction with a lockdown to allay people’s fears of economic loss from disclosing their infection.
NSW urgently needs strong leadership with clearly stated goals in place of the current void and mixed messaging. A vaccination strategy by itself will not work for months. Case numbers in western and south-western Sydney must be dramatically brought down for it to bear fruit.
The author works in a western Sydney hospital but has asked to remain anonymous due to area health service restrictions on employees providing commentary.
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