Mental health issues are a significant unforeseen side effect of this pandemic as well as the increase in non-communicable diseases due to the lack of physical activity. Therefore, as we start off another year, people need to focus on their general health; eat healthily, stay well, exercise, and do relaxations, while continuing with the same health guidelines to protect against Covid-19, said Dr. Thanuja Katugampola, a family physician serving in Victoria, Australia.
She spoke to the Sunday Observer of how people could protect themselves from new strains and strategies to cope with the new normal, while highlighting the best practices from Australia in the control of the virus.
Dr. Katugmpola is a Fellow of the Royal Australian College of General Practitioners since 2006. She has been providing voluntary medical assistance in Sri Lanka, which she commenced after the Tsunami in December 2004.
She was awarded the ‘Australian Humanitarian Overseas Service Medal’ by the Governor-General of Victoria in 2007 and also the ‘Australian Alumni Award for Community Services’ by the Australian High Commission of Sri Lanka in 2014 upon nomination by Flinders University of South Australia.
Following are excerpts of the interview.
Q. What were the strategies adopted in Australia in the vaccine rollout?
A. When we started rolling out the vaccines in Australia, we made it available for vulnerable communities first, such as the frontline health workers, frontline age care workers, aged people (over 60), those with chronic conditions and hotel quarantine staff.
Next, priority was given to other health workers in areas other than Covid. Then the wider population starting with over 60 years, moving on to over 40 years, and 16 years and above. The latter had priority because they had to face a milestone exam. Thereafter, vaccines were given for 12 years and above. Vaccines were given when the country was in lockdown so that people are protected in the best possible way. Younger people were offered Pfizer and Moderna.
Borders were closed in the beginning to allow scientists to study the new strains quicker, so that the pandemic would not go out of hand. Border closure is not just to stop people arriving but also to make scientific studies. But Australia cannot keep the borders closed continuously. Australians are scattered all over the world and Australians need migrants to support their economy.
Another concern is that Australia had a significant number of vulnerable communities, especially the aboriginal community. Australia, like other developed countries, have age care facilities where the elderly are segregated in separate facilities, unlike our country Sri Lanka where the aged population are with their families. When one age care gets affected, it is easily spread. So this is why this group was prioritised.
Q. Why is it important to have a booster dose?
A. The fact that anti-bodies reducing in one’s body and the nature of the virus that evolves to evade immunity, are reasons that led to the concept of having a booster dose. There are concerns in the world that we may have to give the booster dose each year, similar to the flu vaccine. Nothing is confirmed. All these ideas are still at experimental stage. But actually, it is not too unrealistic when we think about it. We had the Alfa, Beta and Gamma strains. Later Delta, which was different to the first three. It was believed that AstraZeneca gave better protection for Delta. Now the latest strain, Omicron is still under study and we still do not know how we are going to face it. No specific guidelines have been published yet on this.
In Australia, the booster vaccine strategy is that no matter what the first two doses were, the third offer in Pfizer. It is due to three reasons. One is that Pfizer has become more available, it has less side effects comparatively and most European research data suggests that if people have a different combination of vaccines with the booster dose, they would have better protection. But there are no head-to-head studies done to compare immune levels of combined vaccine administration with same vaccines as the third boost has just been introduced. With the news of Omicron, we may need another vaccination; but nothing is confirmed yet.
Q. What do we know about the latest Omicron strain?
A. When the vaccines were produced in the world, the dominant countries which could afford it started manufacturing and prioritising it to their populations, even when the World Health Organization (WHO) strictly stated that this was a global pandemic and stressed the need for a global response. Still, most of the poorer countries were deprived of the accessibility to vaccines.
I recently saw an interview with an expert in South Africa, who explained that Omicron is a result of the unequal distribution of vaccines in the world. The virus invades easily in a person with lower immunity; those who had chemotherapy, HIV, organ transplant, and so on have weak immune systems.
The Covid virus, not only replicates in their bodies, but it also replicates with different mutations and changes in structure. This is how we end up getting new and more difficult strains. Assuming that there are more immunocompromised people living in the African countries, new strains emerge making them more resistant to the available treatment. Now bulk vaccinations are being supplied to these countries when the damage is already done. The world should have responded faster before these mutations happened.
Another mistake was that most countries did not close their borders early enough. They watched to see what happened. Obviously, economies suffered due to lockdowns and border closures. But in Australia, when the first wave hit in early 2020, Victoria was the worst affected as it had the borders opened and the virus leaked in. Later, there were stringent measures to stop border crossing within Australia, which helped to stop the virus spread. Countries may need to consider such strategies to face new challenges.
Q. What relief packages does the Australian Government provide its citizens?
A. When the Government announces a lockdown in Australia, it simultaneously announces a survival package. people or businesses had to send proof of their income loss and they could get a living allowance. They also gave employers an allowance to keep paying for their employees. It’s a job keeper allowance.
The vaccination rollout was very efficient. Medical practitioners were given all the guidelines and resources from storing the vaccines, recording them through the Australian immunisation registry and so on. Whichever part of Australia one receives the vaccine, it gets recorded in the central immunisation record system. The Health Ministry-generated Australia-wide certificate is given to citizens.
Q. Practising in a country ahead in health technology such as Australia, how do you think 2022 would look like for the world?
A. In 2020, we were much more hopeful about 2021 because of the vaccinations. Now it’s December 2021. Most countries have achieved their vaccination targets but now we get the news of new strains. Realistically, we all have to go into 2022 with a cautious mind. I don’t think we can ever go back to the way we lived in 2019 and need to look at 2022 with a new mindset continuing to live according to health guidelines. I cannot comment on the new challenges the virus would pose, but definitely, the aftermath of the virus will impose more challenges, especially in terms of mental health, apart from other issues.
Mental health is a significant unforeseen side effect of this pandemic. Isolation is not an easy thing for people. In countries like Australia, most people live by themselves and only on weekends do they have time to socialise with families and friends. It is a part of their culture. It is the same here. We in Sri Lanka have various celebrations where people come out to enjoy. Important events are being missed. Especially the elderly population have a hard time with the lockdowns. So there needs to be more advice for people on how to address mental health issues.
Social isolation is impacting negatively on all age groups. The physical activity levels have dropped drastically. We are predicting a cardiovascular health and diabetes pandemic following the Covid pandemic. All the tests I have done in the past few months showed high levels of cholesterol and sugar, liver failures etc. This is due to the lack of physical activity and ignoring healthcare. Some couldn’t do their routine checks and others couldn’t access their medication. In Sri Lanka, people have faced so many issue in not having access to medical services on time.
The children’s mental health could be another pandemic that we may have to focus on next year. Going to school is not only to engage in academic activities but also for social interactions, building teamwork, communication skills, and so on. But this is lost for almost two years for our children. Children have built their own electronic worlds which is not a good trend.
Q. As a medical practitioner, what advice would you give the public in facing these challenges next year?
A. A public awareness and health campaign is crucial, with special emphasis on mental health. We can design special activities for children. Many schools in Australia sent out emails to parents with a list of activities for children during lockdowns. Some activities were just simple things like, counting the clouds, looking at cloud patterns, playing with your dog, reading three books a day and comparing, etc. Each community, region and country must adopt socially and culturally acceptable and appropriate messages for their people in facing challenges.
People need to focus on their general health; eat healthily, stay well, exercise, and do your relaxations. Sri Lanka people can have their religion as the guideline. All religions in Sri Lanka provide a lot of strategies for mindfulness. We have a spiritually aligned culture than most of the other parts of the world. We can use these to address mental health needs effectively.
Q. What lessons can Sri Lanka learn from Australia in the fight against Covid?
A. Sri Lanka has done exceptionally well comparatively with the limited resources. Sri Lanka has achieved the vaccination targets. However, the public could have been more educated on Covid. Sri Lankans are highly literate people. They could be given broachers with more information as extra precaution to avoid complications from the vaccine. Most of the significant and life threatening side effects with both Pfizer and AstraZeneca were reported worldwide later; 4-20 days after the vaccine administration. Therefore, medical attention would be needed if a person identifies complications. This kind of awareness is important as this is a new vaccine and side effects are seen late. The flip side of this awareness may be that there would be unnecessary fears among the public in taking a vaccine.
In Australia, when vaccines were provided, all the medical professionals had to do mandatory training on administering the vaccine because it was a new product and the way it was presented was different to other vaccines we had before, including the storage guidelines and packaging. So, we had a strenuous six module training and some doctors were not keen to do this in the beginning because of the time it takes. But this is to avoid any confusion or miscalculations. Also, the vaccination storage guidelines, temperature recording, monitoring and so on were very strict in Australia. But I’m sure in Sri Lanka too these are followed although the procedures may not have been as sophisticated.
Q. As Director of Australia Gateway migration agency, what can you tell us about travelling to Australia and immigration opportunities?
A. As of November 1, Australia recognises the following vaccines for the purpose of travel to Australia: Coronavac (Sinovac), Covidshield (AstraZeneca - Serum Institute of India), BBIBP-CorV for people under 60 years of age on arrival in Australia (Sinopharm China) and Covaxin (Bharat Biotech).
Victoria, New South Wales and Australian Capital Territory have the highest vaccination rates. Ninety percent of the population who are 12 years and above are double vaccinated. The least vaccinated states are Western Australia and Northern Territory.
Australia was going to open the international borders in a stage by stage approach. From December, Australian borders were to open for Australian citizens, permanent residents and their families so that parents could travel considering the young families. Border opening is already implemented and flights which had severe restrictions on passenger numbers have lifted.
This is good news for Sri Lankan expats in Australia as well as Sri Lankans with direct links. The next plan was for students to come in from the February intake with a PCR negative report and double vaccination. The law changed last week after Omicron news; Australia closed borders for 10 countries in the South Africa region. For other international arrivals, apart from a negative PCR report and double vaccine, they have to self-isolate in the houses for 72 hours. Any family member of Australian citizens and permanent residents are now able to apply. Those who had visa and couldn’t travel can apply for renewed visa. 2022 won’t be as grim as 2021 for international travelling to Australia.