Fear and abandonment. Empowering patients to look after themselves

AUSTRALIAN governments at all levels have failed to manage the transition from “COVID-zero” to “living with COVID” in both resourcing and messaging, leaving patients and GPs to their own devices, and creating an atmosphere of fear, abandonment and confusion.

Brisbane GP Dr Wendy Burton told InSight+ that some of the government-provided information resources were “too many clicks” to be helpful to the public.

“People want to be told what they should do [if they test positive],” Dr Burton said. “‘What do I need to do? I’m scared, I have COVID-19. What now?’

“There was this great concept that everyone who was positive was going to get a phone call from the health department, and they would be walked through [the information] and they would get a call every day.

“And then [positive cases] happened at scale, and the whole system has collapsed. It’s taking 6 days to get a result from a [polymerase chain reaction (PCR)] test. What are people supposed to do in the meantime?

“Now at least you can report a positive [rapid antigen test [RAT]) in Victoria, Queensland and New South Wales, but there’s nobody at the other end of that process, as far as I know.

“People are scared, and fear is a dangerous driver.”

In response to her patients’ needs and those of herself and her colleagues, Dr Burton has created two resources that have provoked many positive responses.

The first is about what to do once you receive a positive test result, including who to notify, how to treat yourself, monitoring your symptoms, with links to a symptoms checklist, and the State Government resources.

The second is a step-by-step guide for patients who have tested positive for SARS-CoV-2 and are isolating at home. It includes advice about mask wearing, isolating from other members of your household, symptom diaries, cleaning essentials, activities while isolated, and mental health considerations.

Like many other practices, Dr Burton’s practice has a website page which spells out how the practice is responding to the COVID outbreak, with explanations of how they are managing consultations and setting expectations of appropriate behaviour. It links to the resources for people with positive test results and informs those who have recovered from the infection.

“I’ve tried to keep things simple, with as few clicks as possible, so people can quickly access a step-by-step guide to managing themselves,” said Dr Burton.

“The front desk staff in our practice are overwhelmed because people want information.

“We created the resources because we wanted to provide the simple messaging that we all thought the government would be doing,” she said. “But I feel they’re not quick enough to respond to the rapidly evolving outbreak.

“Yes, it’s good to have shared decision making, but sometimes, when you’re sick and you’re scared, you just need someone to tell you what to do now. People need a calm and directive message – step 1, step 2, step 3 – you will be okay. And if you’re not okay, here’s what you need to look for.”

Dr Burton told InSight+ that government messaging had not made the leap from the early days of the pandemic to today’s situation of managing an expanding outbreak.

“I think back to the early days of the pandemic when we had Brendan Murphy on the television every night, and Scott Morrison would introduce him, then step aside and Dr Murphy would talk,” she said.

“That was very calming – it was one consistent message. Then of course, the daily pressers started with each state’s Premier and Chief Health Officer.

“There was always going to be a time when we opened up and the virus would come, but I don’t think we’ve transitioned the messaging.”

The mainstream and social media have also added to the confusion, Dr Burton said, with different media corporations broadcasting different messages depending on the political leanings of their owners.

The key to managing the current Omicron outbreak was “clear, consistent messaging”, she said.

“Calm messaging that empowers people to look after themselves – that’s what we need now.

“One of my concerns is that long after the physical effects of COVID-19 have gone, the fear factor and the feeling of abandonment remain. ‘I got sick, and nobody helped me’ – this is a primal fear.

“We need to empower people to look after themselves. Just be honest – the number of positive cases is too big – here’s what you can do for yourself, and, if you get to a certain point, you need to escalate your care. At that point, there needs to be a pathway, so that people, including the primary care workforce, don’t feel abandoned.”

Politicians carry a fair amount of the blame for the current situation, Dr Burton said.

“The colleges and the Australian Medical Association have been shouting for months: give us an escalation pathway. Empower us with the right tools and we can be part of your solution. But while [governments] don’t have an endless workforce, no one does, they won’t admit that until the workforce is literally shattered.

“There will be intergenerational health care workforce trauma from, again, the abandonment.

“Don’t stand there and applaud us – resource us. Don’t go and buy another tank, or another submarine. Buy RATs.”