Issue: Perceived lack of community preparedness for potential COVID19 outbreak in Aboriginal communities in Western NSW.

Background:  While alarm has recently been sounded about the serious threat a COVID19 outbreak poses to remote Aboriginal communities in Australia the current focus appears to be on Western Australia, the Northern Territory and Far North Queensland, with little consideration of Aboriginal communities in Western NSW.  Given regional Western NSW Aboriginal bodies like Maari Ma Health and the Murdi Paaki Regional Assembly have heard and seen little in terms of proactive Government COVID community preparedness for Aboriginal communities in Western NSW, we suspect not much is happening.  This apparent bureaucratic omission of remote NSW from the calculus of prevention is especially concerning given our assessment is that the Aboriginal communities in far western NSW have the same if not greater risk to the Aboriginal communities in northern Australia. Factors influencing this assessment include: 1. Restricting access to many of our towns (in a similar manner to WA’s and NT’s approach) is near impossible (eg linking SA and NSW runs through the towns of & Wilcannia) 2. Geographically, the Aboriginal communities in far western NSW are much closer to the current epicentres of the outbreak in and to a lesser extent Melbourne, than the communities in northern Australia (eg first case identified in Mildura on 21 March) 3. Aboriginal communities in far western NSW have well recognised high rates of residential mobility (eg up and down the , between Broken Hill and its surrounding communities) which increases the likelihood of spread 4. Isolating COVID19 cases and close contacts in the Aboriginal communities in far western NSW with its overcrowded housing and poor housing conditions is simply unrealistic 5. Current lack of food security and access to essential hygiene products in the remoter townships in far western NSW will hamper preparedness for self-isolation and quarantine 6. Low health literacy levels of some people, coupled with the poverty in the Aboriginal communities in far western NSW, means quickly changing individual behaviours is more challenging 7. It is practically more difficult for many people in the Aboriginal communities in far western NSW to apply health messages (eg social distancing, hand washing, respiratory hygiene) due to overcrowded houses and poor housing conditions and lack of access to basic commodities required for hygiene 8. Aboriginal communities in far western NSW are more at risk of COVID19 and poorer outcomes from the disease, due to higher rates of chronic medical illness and less access to medical services 9. Higher smoking rates in Aboriginal communities in far western NSW means worse outcomes in managing COVID19 related respiratory illness  The following table is based on Census data and Murdi Paaki Regional Housing and Business Consortium household surveys, and overviews the parlous state of Aboriginal housing in the Aboriginal communities in far western NSW. Lowlights include: 1. Both the Census and the surveys demonstrated higher levels of visitor numbers. A lot of Broken Hill households had long-term visitors, and the proportion of

1 households sheltering people who would otherwise have been homeless was almost a third in Wilcannia. 2. Standard occupancy calculations indicate that a substantial proportion of households in most communities, but especially Wilcannia, were overcrowded. Tenant perceptions reinforced that this is a problem. 3. Broken Hill and Wilcannia have a relatively high proportion of households who view their housing as impacting negatively on their health. In communities other than Broken Hill, the leading cause for concern was housing condition. 4. Wilcannia is a hotspot for housing problems which might make it difficult for households to isolate themselves, but a substantial proportion of households in each community is in this situation. Particularly concerning is the number of households which are unable to keep people out because of lack of secure entry doors. 5. Broken Hill is far more reliant on private housing (ie 7.4 Aboriginal households to each Aboriginal social dwelling) compared with other communities in the region. Alarmingly the Broken Hill survey highlighted the poor quality of commercial housing and uncovered instances of slum conditions.

2 Advice:  Given the vulnerability of Aboriginal communities in far western NSW, urgent and drastic action is needed now, especially in setting-up fully functioning isolation/quarantine facilities and organising services to enable people to properly isolate at home. Given the size of the threat this will require blue-sky thinking Options that might be considered could include 1. re-purposing available motels/hotels/caravan parks 2. re-purposing Wilcannia MPS 3. re-purposing Ivanhoe Corrections Centre (due to close mid 2020) 4. use of shearers’ quarters on properties reasonably close to townships 5. commandeering some of the substantial number of unoccupied private dwellings in Broken Hill 6. prohibition of stopping of through traffic in Wilcannia and possibly Broken Hill 7. designation of Emmdale and Little Topar as stop points for through traffic prevented from stopping in Broken Hill and Wilcannia 8. engaging appropriate NGOs like World Central Kitchen to make and deliver meals to those in isolation/quarantine at home or in a dedicated facility. 9. commandeering a commercial kitchen and their workforce in Broken Hill (eg one of the Clubs in town) to provide a meals on wheels style service to all those in isolation/quarantine at home or in a dedicated facility 10. commandeering a warehouse in Broken Hill as a regional centre to stockpile and distribute essential items to people requiring to isolate/quarantine at home or in a dedicated facility  NACCHO has recently advocated that the size of the problem warrants deploying the army. To this end proactive intervention by all levels of Government is required.  Warnings from around the world are clear: the earlier we prepare and act, the better the outcomes will be. We cannot wait until the first case turns up in the community, or worse the first hospital case presents. Based on back of the envelope calculations, if by the time our first hospital patient presents they will have been ill for about 3 weeks, this means there were 6 cases in the community 3 weeks ago (assuming 1 in 6 cases are hospitalised), then a further 12 in week 1 (if we assume the number of new cases doubles per week), 24 in week 2 and 48 in week 3, meaning around 100 cases in the community by the time of the first hospitalisation (nb: this would be best case modelling).

Recommendations:  Key message is that urgent and drastic action is required to prepare the Aboriginal communities in far western NSW for the spread of COVID19  Use formal and informal contacts to determine whether community preparedness of Aboriginal communities in far western NSW is being proactively considered by State and Commonwealth Governments  If planning is happening, find out by whom so Maari Ma Health and the Murdi Paaki Regional Assembly can contact them and support their endeavours  If planning is not happening, or is happening too slowly, advocate the need for a greater focus on and more urgent action in the Aboriginal communities in far western NSW

Dr Hugh Burke Maari Ma Health (Broken Hill, NSW)

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