COVID-19 Q&A Dr San Clarke 2 April 2020

Dr San Clarke BN MBBS FRACGP

Dear Lord Howe Islanders,

There seems to be an elephant in the room, so let’s talk about it.

Last week, a person passed through Lord Howe, stopping in at the airport, and needed to spend 20 minutes or so conducting routine business in the presence of a resident whilst out at the airport.

The person passing through was asked to don a mask to comply with our regulations and they did. The person on the ground followed protocol throughout the interaction. Unfortunately, the person that passed through was infected with COVID-19 when they were here but felt well at the time and hadn’t yet been diagnosed. The passer-through then became unwell and they were diagnosed COVID-19 positive at the start of this week, which triggered contact tracing and the resident from here that spent time with him was notified and subsequently tested in the clinic here first thing Tuesday morning. That meant that a few non-essential medical appointments needed to be delayed until next week. As you know, there was a plan in place to avoid all non-essential medical appointments this week prior to these events unfolding (see my previous letter to the community), but a few appointments had been made despite that. With the clinic being used for COVID testing, we toughened our stance and went with the original plan of cancelling non-essential medical appointments until next week to keep in-line with national recommendations and in recognition that up to Sunday 22nd March, people arriving on Lord Howe (including, but not limited to, myself) were not required to quarantine themselves for 14 days.

I’m writing this to you in the hope that I can pre-empt a few questions people are likely to have. If you have any others, please feel free to phone in for advice, or make an appointment for next week and pop in to see me. A good take-home message is that there is no significant change to our “risk” level from last week – there was a contact made (through no-one’s fault or irresponsibility) and protocols were followed. This is not a cause for alarm but a call to remind us that we need all follow guidelines and stay vigilant – calmly vigilant.

Q. Are we able to find out who was tested?

A. No. All patients here are protected by confidentiality; though no-one is immune from the LHI grapevine, the clinic will not itself hand out any personal demographic information without the expressed permission of the person involved. That extends to all patients and all clinic interactions.

Q. How do we know if we were in contact with that person before they went into isolation?

A. There is no obligation for people being tested to contact trace, and really, no practical need. It should not affect our behavior because we should all be practicing social distancing and staying home when we are able to, as a matter of our new daily normal. Once testing was triggered, the person and their family went into isolation. They most certainly were in the community prior to going into isolation and will have been around some of you for sure. Simply using good hand-washing, basic hygiene, and observing social distancing and all the recommendations associated with that means that your risk of contracting anything unwelcome (including colds, flu, viral gastroenteritis… all the yucky stuff) becomes vanishingly small. The whole point of social distancing is that it is a very good way of preventing contact with a disease that you don’t even know is there – even if it’s a person with COVID-19 passing through the island, or one of their contacts a few days down the track. If the person in this case has a positive test for COVID-19, formal contact tracing will begin for them, and has largely already been done in an informal manner to try to ameliorate some of the natural anxiety associated with the first formal test indicated by on-island contact to-date. This won’t be the last test done here, I’m sure, and it will become less of a big deal as time goes on – it’s all part of the new way we need to conduct business; no cause for alarm, just calm vigilance.

Q. How do I keep my family safe, if I go to work and contact people that may or may not have been in contact with COVID-19?

A. The rules for distancing apply in the workplace as well and, if correctly observed, are very protective against spread of any contact/droplet-borne disease. There are some modifications in the laws to facilitate workplace functioning that are more “accommodating” of contact than general socialisation rules are. Following the guidelines is very likely to keep you safe. You can control how you interact with your environment and can institute things like changing your clothes when you get home, and showering before spending time with your family. When you are at home (and no-one is being quarantined), you should relate to your family normally, and hug and kiss them normally, if you are careful outside of your home. PLEASE hug your children! People are, by nature, physical creatures and our children are used to human contact and thrive on touch, as do most of us. There are no guarantees in very much of life, and our set-up on Lord Howe is no exception. We are all LOW-RISK, not no-risk, so please, observe distancing in the community and hug your loved ones at home. Lots.

Q. Will COVID-19 get to Lord Howe Island?

A. There is a very high probability that it will, at some stage. We still have people coming and going from the mainland and there are still new infections on the mainland every day. Using our current practices means that we may delay getting it here and in doing so buy time so that if it does arrive, it may be after treatments have been developed or better prevention has been detailed. Slowing the rate of spread through social distancing means people can have treatment in a health service that doesn’t have an untreatably high number of new cases each day, but a slow spread. This means in turn that equipment is available as new cases present, staff are free to assess them in a timely manner, medications are available, etc. It may never ever get here, but I think that’s unlikely. We should use this time to stay well and educate ourselves. And not panic – we’re in the very best place.

Q. What’s going to happen now?

A. With regard to our local situation, we will continue to monitor people’s success in observing the recommendations and, so far, so great! We have remained COVID-free in a world where there’s heaps of it. There is no need for any further testing on anybody here at this stage, and if that changes we’ll all talk about it again. I feel strongly that we’re on a good path here, and we are keeping as safe as possible and doing well. Lord Howe Island People are innovative and respond to a challenge with vim and vigor, so we will find ways of keeping safe and making good of the situation. We will find ways without jeopardising our community as a whole.

As a global population, this is going to go on for a long time – many months, maybe a year or two. That’s frightening if you dwell on it, but dwelling is not problem-addressing or solution-creating. What can you do to lighten the load for yourself, your family, your community, your fellow humans? A lot of people will struggle out there and the real heroes of the time will be those that used the challenges around them to build something brilliant, so get into it!

In the meantime, we will establish a new “normal” way of interacting – lots of things will now be conducted online, and it will be less common for us to group together physically. I am hopeful that we will go back to being a species that hugs and touches each other because I think it’s an important part of how we communicate – but – maybe it will be the start of how we eliminate some things from our life that were not very helpful anyway. Can you think of anything we are stopping doing now for COVID, that we probably should have stopped long ago?

I hope that addresses a few of the worries floating around people’s awareness. It’s my intention to provide information and clarity where I can, without compromising that patient confidentiality and care to which you are all entitled. We are, truly, all in this together.

In great news for us as a practice, we have all remained well (as expected), and the clinic quarantine, if you like, ends midnight Saturday night – 14 days after the Lord Howe Island Order came into place. On a family note, Scruffy will complete his mandatory quarantine on Sunday night and we are doubly excited for that – it’s incredibly challenging to quarantine at home, as many of you are finding out, and we are both super-excited about diving into our life here personally and professionally, even in this wacky time.

For information on the clinic as it starts on Monday, please see Lord Howe Island Family Practice Clinic Information or come in and see us.

Much warmth and gratitude for your patience,

San