What COVID forgot

FENELLA KERNEBONE

Welcome. This is the Sydney Ideas podcast, bringing you talks and conversations featuring the best and brightest minds at the University of Sydney and beyond.

ROBYN WARD [GRAB]

What we're going to talk about today is, 'What COVID forgot: the orphans of the pandemic response.'

FENELLA KERNEBONE

Here's the podcast.

ROBYN WARD

I think as we reflect on what's happened over the last year, and this year, most people within Australia would be pretty comfortable with the way our governments and our community has handled the pandemic response. It's extraordinary, the few number of cases we've actually had and deaths compared with comparable countries internationally.

But all the while we've been focusing on COVID, I think many of us are also conscious of the fact that there are other parts of the Australian healthcare system, and other patient groups in the communities that may have been forgotten, while our attention was quite rightly, on COVID.

So today, I'm joined by some very eminent people who are going to talk a little bit about their views around the pandemic response, and particularly about the things that may have been forgotten – particularly the things that they're experts in.

Dr Kathryn MacKay is from Sydney Health Ethics in the School of Public Health at the University of Sydney.

Our next guest is Professor Heiko Spallek, who is the Dean of Dentistry here in the Faculty of Medicine and Health at the University of Sydney.

We have also joining us Associate Professor Melody Ding, who is also from the School of Public Health here in the Faculty of Medicine and Health.

And finally, Dr Brendan Murphy, who you will know as the former Chief Medical Officer, and more recently as the Secretary of the Department of Health in the Commonwealth of Australia.

Welcome to all four guests.

So I think the first thing I'd like to ask all of you to reflect on is a little bit about your views of the context, in particular about what you think have been the orphans of this pandemic response from a health point of view. Maybe if I start with you, Heiko.

HEIKO SPALLEK

Thank you, Robyn. I mean, the title is today, the orphans of the pandemic, and dental care I think it's not really an orphan of the pandemic but has been an orphan all along. The pandemic just shone a bright light on it. Untreated carriers, severe periodontitis – so that's gum disease – and tooth loss are among the 10 most prevalent conditions globally, affecting more than 3.5 billion people.

So a little bit closer to home in New South Wales, 20% of adults in New South Wales avoid eating certain foods because of problems with their teeth, mouth or dentures. And why is that dental care is not part of Medicare? As we think in Australia, the mouth is not considered part of the human body? And so we have 39% of Australians being eligible for public dental service. But that doesn't mean much because they then end up on multi year long waitlists. And now, with the pandemic and clinic closures during that time, the most disadvantaged people in our society are even pushed further down the waitlist. I just checked this yesterday, and use of it alone we have 92,452 people on a waitlist.

So what does it mean for us at university? We train young people to become dental professionals, dentists or therapists or specialists. And there's a lot of experiential learning as part of this training. So COVID had an impact on our clinical placements; they were reduced. And everybody thinks, in regard to dentistry, about dexterity [that it] is very important – what you do with your hands – but it's also working with patients, communicating with them, caring for them. And that's equally important. And that was really an aspect, which we could not do in what we call the simulation clinics where students work on other heads with plastic teeth. So I think we need to think about finding the right balance between infection control and the risk of infection for a pandemic, and then also the need for training the next generation of health professionals.

ROBYN WARD

Could you just talk a little bit further about what sort of modifications you needed to make in order to train students in dentistry during the course of the pandemic, particularly when the risk of infection at peak periods was very high, or perceived to be very high?

HEIKO SPALLEK

Yeah, so the didactic trainings that we normally do in a lecture hall, putting this online was actually the easy part for us. And the more complex part is what we did in our simulation clinics. Because when the pandemic started, we instituted infection control measures and COVID safety measures to continue running this simulation clinic. And it was initially received for some skepticism, but then we were able – as one of the very few dental schools in the world – to continue our training of our students so that they could graduate on time and join the workforce where they are desperately needed. But clearly, not all treatment and all training, or I should say, all training can be done in simulation clinic. It's really important that these students develop the rapport with the patients, and that's something I believe other jurisdictions and other systems like in Japan, they work mostly on simulation, not much on patients.

But we here in Sydney really think that patient support and communication skills are very, very important. And I'm very proud that we were able to graduate our students are on time. And I think that's our contribution to fighting the pandemic not only, but also the problems we have in over areas and Australia.

ROBYN WARD

Thanks Heiko. We might turn to you, Melody, you're an expert on physical health and wellbeing, and management of chronic diseases. So what do you think this has meant to you in terms of change of context that COVID has introduced to your world and in your perceptions of your own areas of expertise?

MELODY DING

COVID has definitely made the whole world aware of the field of public health that we're doing. Because I often think that we work in public health, we work in prevention, we're a field that, you know, when we're doing well, nobody realises that we're actually doing a lot of work in preventing the diseases. And it's when there's situations like COVID, the disease outbreak happen – and initially, we couldn't get our hands on it – and the whole world realises that the work that we fail to do before getting here. So I think that COVID really highlighted the importance of preventions.

I want to use an analogy here, like, you know, for example, a piece of machinery like a car.

When we own a car, we maintain a car, we take the car to a mechanic for checkup. We drive the car in a fashion that doesn't break down the parts, too quickly. So when we're doing all these things, well, it looks like everything is going swimmingly well, and nothing happens.

And then, when we are really not putting the prevention works in place, when we don't take the cars for checkup, when we don't drive – when we drive recklessly, for example – and then we're more likely to encounter the problem. And then all of a sudden, the attention is all about how we fix the problem when emergency situations happen.

I really hope that COVID allows us to rethink about prevention, rethink about doing the groundwork, the upstream work that we put into our public health forces, and also related areas so that we prevent people from getting sick.

And in the broader scheme of things, non-communicable diseases to me, or people often refer to as chronic disease, is what I see is the orphan of COVID. Because all of our attention is on the urgent matter, and we often forget what's important. So to put things into the context in Australia, about 90% of the deaths are attributable to non-communicable diseases. In worldwide statistics, 70% of the deaths are due to non-communicable disease rather than infectious disease, even in the last year.

So the WHO estimates of death from COVID is more than three millions. But at the same time, ischemic heart disease killed more than 13 million and stroke killed more than 9 million. So this is the context out there. And we must take the same initiative efforts and consolidate consulted efforts to address non-communicable disease continuously beyond COVID-19 pandemic.

ROBYN WARD

I mean, you made some great points Melody and I was just reflecting last week, I heard some statistics that we were now consuming 110% of – more than our normal blood supply, more than what we normally use, and that's largely because patients have delayed and delayed and delayed their routine surgery. And so the surgery becomes more complex, the more longer time in intensive care, the more use of precious resources like blood products, which is interesting and it follows along from what you're saying is, if we don't keep the car tuned up early, then we start to get to crisis point and then we have all these other knock on consequences that we're actually now starting to see here are hospitals on a daily basis to manifest in all sorts of ways. So great points.

Now, Kathryn, can I turn to you? Your expertise is in gender and justice, equity. So I wonder if you could reflect on this question from your own point of view?

KATHRYN MACKAY

Yes, absolutely. Thank you, Robyn. And I think when I was asked to be on the panel, I was thinking instead of what did COVID forget, I thought about who did COVID forget. And the group that really stands out to me, and I think this actually meshes with what Melody was just saying and what Heiko said earlier. For me, it's the working class especially. It's hourly paid workers, especially women, especially if they're members of Aboriginal or Asian background communities, or others that are racialised in white Western society, and especially if they have caring responsibilities, so if they have care for elderly parents, or if they have children. There's been a massive burden of care falling upon this group throughout the pandemic.

Women make up the majority of hourly paid workers in Australia, and women of colour make up the majority within that majority. And though this is true, especially true during lockdowns, the care of elderly parents who are wary of infection and the care of children who need to miss school, because say, they're awaiting a COVID test exam, for example, continues even outside of lockdown.

So I think the unpredictability of the virus has made it very difficult for hourly paid workers with caring responsibilities to be reliable in the way that they want to at work, to maintain the shifts that they need to achieve a stable pay. The heightened unpredictability of care demands is likely to be true, at least until Australia's population is vaccinated. But even perhaps beyond that, depending on how mutations develop and things like that. And in addition to having care responsibilities, these women have faced economic and employment precarity, which I think the government has done little to ease in a persistent way.

So from my point of view, the physical and mental health outcomes of this precarious, exhausting, demanding uncertain and stressful new contexts of life and pandemic won't be fully realized for years. It's kind of that upstream stuff that Melody was just talking about. And you know, for a fact, I know from experience, that when you're in this situation, things like dental care and the optionals go out the window. Now, they kind of have to for economic and time-based reasons. So the effects on people's mental health and their physical wellbeing of these women workers and their families, their children will, I think, reveal themselves and continue to develop beyond the next five years, you know, five to ten, and onward.

ROBYN WARD

I'm going to talk to Brendan next. And he's obviously had his mind firmly on COVID, which is actually terribly important. But I guess in quieter moments, he's probably had an opportunity to reflect on things that are, he feels now are being forgotten because of the heightened attention on COVID. So do you want to share with us your thoughts on this Brendan?

BRENDAN MURPHY

Thanks Robyn. I think the first thing I would say is that I don't think these things have ever been other than front of mind, you know, all the way through the early phases of a pandemic, we were very, very aware of the impacts of what we were doing on the general health, mental health, emotional health of the population, and there were a lot of things done to try and mitigate that impact. But it's not possible to mitigate many of those impacts. And you're absolutely right, we are now seeing the likely the end result of, for example, the whole health system. The public hospitals are in a state of significant demand at the moment and I think that is in part due to the fact that people and hospitals delayed care last year, and we have a lot of quite complex people in hospital.

But we are worried right from the beginning about people not having access to non COVID healthcare, which is why we sort of introduced telehealth really early on so that people could get to see their doctors; e-prescriptions, so that you can sort of get a script sent to your phone. Interestingly, some of the impacts were not so much the public health measures but some rather frightened health professionals withdrawing their services.

So I had a big, interesting example where, we had to battle with some of the cancer screening services to keep going when really the outbreak risk was quite low. And yet people were – a lot of health professionals were quite frightened in this pandemic, and actually didn't want to interact with patients, despite the fact that we didn't think the public health risk was very, very high at the time. So that's an interesting reflection.

The other thing that I think troubled me absolutely terribly was when we introduced back in March last year, physical distancing measures and restrictions; the impact of putting millions of people out of work was huge. And fortunately, JobKeeper and everything sort of kept those things, kept people going and kept businesses going. But those long-term effects of people who thought at no stage in their life, if they ever been out of work, suddenly being unemployed.

We were worried about the impact on Indigenous and culturally and linguistically diverse communities. The Indigenous response is done very well. But we were locking down whole remote Indigenous communities and had all those impacts of not having health professionals and others coming in. Elective surgery – huge issue. I mean, initially it was paused because of were concerned about PPE and the availability of that. Once, even when we got that back, actually getting the confidence of a health system to get going again, has been really, really, really interesting. And I think we've got to always remember that. And we are in a very risk averse environment in Australia – now some of our states and territories are terribly risk averse. And we've got to get a proportional balance between the risk of the virus versus the risk of the impacts on the general mental health of the community.

And finally, just for you, we have been very worried about the impact on education. There's a whole generation of health professionals whose practical education has been significantly impaired by lockdowns and remote learning. And ultimately, the other impact we've seen as not having access to the migrant population who provide a very valuable part of our health workforce. So we are seeing that impact in some remote communities. So all of those things have been a topic of discussion the whole way through the pandemic, and we are doing a lot of things to try and continue to invest and resolve them in partnership with the states and territories.

ROBYN WARD

And, Brendan, just another follow up is how successful – how will you measure how successful some of these interventions have been? If you take, for example, telehealth, the idea there was to keep people, you know, staying connected with their healthcare provider, etc. Do you think that that has been successful and how much of that will continue as a mode of delivery?

BRENDAN MURPHY

I think telehealth will continue forever. I think we've got to get the place of it correct. There's a big debate about whether how good a consultation you can have with a doctor over the phone. I think if it was just getting how you're going, have a repeat script – that's fine. I think it’s I'm concerned about people; and most of the GPs doing telehealth, do it by phone. Most of the non-GP specialists do it by video, which I’m much more comfortable with. So we've committed to the medical profession and the community generally that telehealth in some form or another will be here to stay. But I'm still not sure that we've totally landed what its place is. There are risks to doing telehealth, there are risks to people setting up sort of online businesses, and so we have to have a lot of checks and balances in there.

But I think people, you know, in the past, if you wanted to go and get a repeat prescription for your antihypertensive drugs, you might have to take a day off half a day off work to go to your GP, sit there for an hour, have a five to ten minute appointment, get your prescriptions, then go to the chemist. Now you can ring up – you can be in your office working, ring your GP, the prescription's dinged to you on your phone, you'd ding it to the pharmacists and pick up the pills on the way home. So those sorts of things we don't want to lose.

ROBYN WARD

One of the things we wanted to explore a little bit further was, when we start to think of solutions, like we're coming out of this pandemic, or learning to live under a different sort of operating environment, how are we not going to create more orphans? How are we not going to engineer solutions that aren't really solutions, that end up exacerbating our problems all with the best of best of intent? And as you said, you touched on one there, Brendan – might be great idea to introduce telemedicine but we don't want it being used in a way that actually has unintended consequences or unintended costs.

So maybe I'll ask Melody first. What are the big solutions you have or the big learnings and then how do we ensure that that doesn't create further problems now we've had this sort of shock treatment for the last year?

MELODY DING

That's a very good question Robyn. So in the context of chronic disease prevention, we often think about it as a complex problem in a complex system. So there's so many players involved, we really have to think through all these players. And in my perspective, we really need to think of health, not as just a health problem, but as a societal problem that engages, transportation, urban planning, and all the other sectors. And for me, I want to from now on take more of an optimistic and lens to look at COVID. Because we often see transformation coming out of disruption, right? Creative ideas happens. And so what COVID has really taught us as populations is the importance of health.

So we're seeing there’s a lot of online interest, for example – I'm speaking about my personal research on physical activity in Australia and around the world – that people are engaging online fitness lessons, for example. And there's a growing number of interesting cycling. And if you guys can think back, about the same time last year, that's probably the time when you couldn't even buy a bicycle or couldn't get your bicycle service, because all of a sudden, everybody's thinking that, “I can't take buses and trains, I want to take the bicycle as an alternative way to travel.” I think all of this is really positive. Now, we're almost out of COVID, hopefully.

Moving forward, I think we need to think about what the post-COVID world looks like, and how we take all these momentums and turn them into transformation. For example, we have, in Sydney, built so many pop-up bike lanes, but can we make them more permanent changes? Can we work with education, transportation, urban planning, all these sectors to make healthy living, active living, a little bit easier? You know, even if not in the context of the pandemic. So I think there's a lot of dialogues that need to happen, there's a lot of collaboration that can happen along the way. And COVID might really be the catalyst for systematic changes.

ROBYN WARD

It's very optimistic view. That's good to hear.

So Kathryn, maybe I can speak to you next about what you see, is the new world that's going to be created post-COVID? And what's that going to look like for you? And how do we make sure we don't generate more orphans in this process?

KATHRYN MACKAY

It's such a difficult question. And I completely – I couldn't agree with Melody more, that we have to be looking at, you know, complex health is a complex state that arises out of a complex system and looking at all of the different parts of it, which include education and housing, and your workplace, the kind of work you do. I think there's been some early collection of evidence that COVID has affected women and women's careers unequally. It's affected women and women's careers to a greater degree than it's affected men and men's careers. And I think one concern that I have – this is something that we'll need to kind of collect data on moving forward, of course, over the next few years – but it's just about how this has set women back. How different workplaces and work styles are going to be changed permanently.

We know that the nature of our work has now shifted massively, even just from inside the university, the way that we work, the way that we deliver, education has shifted. And this is true for a lot of different industries. And unfortunately, it means that a lot of people are even more precarious than they were before. They were already in precarious environments and now even more so.

So the Treasury reported that when JobKeeper ended on the 28th of March, 56,000 jobs were lost in Australia. And we know that this is going to kind of be an ongoing problem, as businesses have to lock down kind of again, and again. We don't know what's going to happen as the virus mutates, as there continue to be small outbreaks. So I think I'm very concerned that women and women of colour in particular who work in precarious hourly paid work, who don't have sick leave, who don't have care leave, are going to be put back a lot by what's already happened and perhaps by what continues to happen as we try to get vaccine rates up and try to get a more kind of permanent handle on the virus so that we can do things like open borders, or have a more free kind of exchange of people. I don't think it'll really ever go back to the way it was. I think that's one takeaway for me.

ROBYN WARD

So Heiko, we've learned that the mouth is part of the human body. That's an important takeaway. So what's your thoughts now on the new world?

HEIKO SPALLEK

I think we've learnt a lot, not just how to use QR codes, but really that delaying and disrupting dental care has really severe consequences. And I think it's very easy always to lower priority of dental care and also research I should say, given the mostly non-fatal nature of the disease, but it has huge social impact. And following on what Kathryn said, I think we are moving towards a paradigm where all the health and dental appearance are really used to denote status and social position. And that really separates the relevance of dentistry to other facets of medicine, and introduces an alternative set of values by which dentistry is measured by society. And so I think it's really important that we use the pandemic as a trigger to think about that all Australians should receive appropriate and timely dental care.

And I think many people think about, you know, teeth is pretty important too, important to chew and swallow your food, but it goes far beyond that. There's a lot of evidence demonstrating that there's a higher risk for cardiovascular disease, diabetes, mental health, and persons with poor oral health. So not funding dental treatment, and dental research and dental education is missing out on how we can improve general health and therefore, lower the cost of the whole healthcare system.

So I think we need to change that dentistry is not a luxury, but a necessity. And that also requires some societal changes.

ROBYN WARD

And one of the things that I've just been reflecting on is how some barriers to previous activities were broken down during COVID. And if I could think of your research as an example of that, where traditional barriers around data sharing, around collaboration internationally that had been in existence forever and impossible to actually pull down, finally became possible. And I know, there was some fantastic work funded on COVID, and genomic identification of variants, and that moves so fast. So are there other examples or anything you want to highlight as really extraordinary positive outcomes, that perhaps we need to make sure we don't lose during this next period?

Maybe I'll start with Melody and then ask the rest of the panel. Melody. Is there anything internationally or nationally, you've seen that you think, 'Wow, we don't want to lose that now. Amazing'?

MELODY DING

Yeah, I think I mentioned a few over there. And I actually did an analysis on Google Trends, just looking at people's search behaviour before and after COVID. And what we saw in Australia, is about 20 times higher than ever, people searching for exercise, and that started during the lockdown last year, and that high level actually sustained. I think there's a lot of awareness out there. I think there's a lot of campaigns and public messaging in terms of the importance of preventing chronic disease and staying active during the pandemic, because one thing we know is that a lot of the unfortunate victims of COVID, who had severe symptoms or died from COVID, tend to be the ones who are physically active and have obesity and other chronic conditions. So I think there is definitely, like I mentioned earlier, a higher awareness and then also people are using the online platform so much more than before. So not only using that for physical activity lessons, for example, which breaks down some of the barriers to access that we previously identified, but also using that as a way to connect with people that they cannot see in person and we're seeing you know, e-health literacy and generally speaking, online literacy, improving with you know, grandparents learning to use Zoom to socialise with their grandchildren, for example. I think all of these are positive.

And we're seeing people flying less, because a lot of the work that used to be done by in-person meetings are now you know, proven to be not only possible, but actually going quite well with virtual meeting. So hopefully that reduction in carbon emission as a result of reduced flying, all of these changes will be here to stay.

ROBYN WARD

So that's very optimistic. I'm a bit skeptical sort of person but don't you think that once you know the necessity to exercise because you're locked down sort of passes, that people will revert to their slovenly ways, they'll fill their mouth full of sugar, they won't exercise. How do we make these good habits stick? You have any thought on that?

MELODY DING

Yeah, that's why we need to not only target the individual we need to target our environment, right? That's why I mentioned bike paths and cycling infrastructures. Because if we can sort of lure people into cycling during COVID, out of necessity, but we actually give them a good experience, we give them a protective buffer from the traffic and good cycling infrastructures, and then people actually start to enjoy the process and realise, 'Hey, it took me 20 minutes to cycle to work as compared with you know, 25 minutes driving and parking'. Only when we can really support with policies and environment can these positive changes in behaviours, days. So that's why it's really important that we kind of drive home the message that we need to involve other sectors. As again, transportation's a good example here, to really put this in the forefront, as post COVID recovery and help us build a city forward to facilitate healthy living.

ROBYN WARD

So Brendan, how you going to convince your counterparts in other parts of the Commonwealth to follow Melody's advice about good cities, active environments?

BRENDAN MURPHY

Well that's essentially environmental health. And that whole thing is a really high focus of the health ministers are really interested in this, and we are at the health care level.

But I think just getting back to that point about how things have changed, I think there are some significant enduring changes.

I don't think we'll ever go back to the way we were working in the past. I've got about a quarter of my staff at any one time, working remotely. We used to think that everyone – to be a senior public servant – has to be in Canberra. I don't think we'll go back to [that].

I used to chair a meeting about once a week in a capital city airport and we'd all fly around and sit there with a long agenda, whereas during the pandemic, we would just get the people together at two hours notice and make a decision without all of those briefing processes.

I mean, a good example was February one last year, when I woke up on a Saturday morning and looked at the epidemiology in China, and find the Prime Minister and said, we need to close the borders – and they were closed at nine o'clock that night.Now the concept of the processes of government that you would have to go through to do a decision like that would normally take months. And so I think we have developed the nimbleness now, that will will ensue. And I think we are, I suppose one of – just coming on to the broader health point, we are very focused now on what we can do to strengthen primary care. That's probably the next objective, because that is the sort of thing that leads to all of the things that we've been talking about today, is how we reform and improve our primary care system. So that's been driven very much by some of the experience of a pandemic.

ROBYN WARD

Kathryn, what's your thoughts on on this topic?

KATHRYN MACKAY

I do think that the changes in workplace culture has been really good for certain people, like the workplace changes that people who are in salaried jobs would face I think, have made working from home and therefore being a carer a lot easier. So parents or people who are taking care of elderly relatives or people who are taking care of sick partners, now have much greater flexibility. It no longer is a matter of having a bum in a seat in order to be doing your job and doing it well.

I think there's much greater recognition that we are effective workers when we're not under the immediate gaze of our boss, perhaps. But that's not under even results, that people who are hourly paid, who don't have paid leave are still facing that problem. I think that's a massive problem for controlling the virus. And I even heard on the radio this morning, that it's a problem for people getting vaccinated that they can't have time off to go get vaccinated. So we we need to solve that, in addition to maintaining the good changes that we've found.

And I think for me, definitely having my older relatives learn how to use Zoom has been a real lifesaver. Because of the pandemic, we've been having meals together that we would never do before, even when I was living overseas before, because it never occurred to us. So that's one of the silver linings that I think we shouldn't take forward. Absolutely.

ROBYN WARD

Absolutely. Now, I think it's about time to turn to some of the questions. So from the audience, so someone's very keen to understand how the Commonwealth state divide and the disjointed health system we have could be better connected. And is there something Brendan that you've learned about how you can overcome this long standing barriers created by working in a federation?

BRENDAN MURPHY

Thanks. So the federation is an interesting beast to deal with. We are a federation, we have to work in that context. I think we learned a lot about how the federation could be improved during COVID.

The national cabinet was particularly early in the pandemic and I was privileged to sit through every meeting of the national cabinet where the the first ministers, the Prime Minister, and the Premiers and Chief Ministers decided that they they had to – to save the nation and the economy, they had to make decisions real time so that. They would meet for two hours and implement, and so that all of those somewhat tedious processes of federation of meetings and coming up various layers were sort of put aside. And in fact, the whole council of Australian government structure has been partially dismantled with a new approach so that if we have a problem in health, and a good example might be mental health, where it's crucial that the states and territories and the Commonwealth programs intersect properly. So the national cabinet has sort of decreed that there should be an early reform process in that space, which doesn't involve years of consultation and planning, but actually getting a set of agreements and working out some joint programs. And so I think it is always going to be problematic.

We've got to connect our primary care system with the local health networks, and that being accelerated through the PHNs [Primary Health Networks]. And as I said earlier, I think the glue that will hold this all together as a strong primary care system.

So, you know, there are issues with working in a federation. But the capacity for joint decision making, rapid decision making and collaboration, has been significantly improved over the last 12 months. You'll sometimes hear a bit of political noise coming out sometimes. But but mostly it's working well.

ROBYN WARD

Thanks, Brendan. Maybe we could go to you Heiko next. And then I'll come back to Brendan, there's a question here about the Royal Commission into aged care quality and safety for oral health.

HEIKO SPALLEK

Thank you. I think recommendation 38 is obviously the one we are most interested in where it essentially says that aged care facilities need to have someone in dental professional helping and supporting the residents of these facilities. And I think it's very important that it talks about dental professionals. So it doesn't have to be a dentist could be an oral therapist who could do a lot of the work and help and cost effectively support the residents. Unfortunately, in the past, all health was always on the back burner when it came to residents in aged care facilities as well as in home care. Because the other things perceived as more important. And I think this obviously, is something where people suffer, many of them cannot express their dental pain and suffer silently. And I think that's something which should not happen to any Australians. And we need to address this. Unfortunately, it doesn't look like there's full funding for these recommendations. And so we will hopefully see some uptake in that space. But as you well know, without proper funding, this will become increasingly complicated.

ROBYN WARD

So let's move on. We've got some other suggestions here about what COVID forgot, and the next one is around the disability sector. People have, or this questioner has asked about, what the speakers think about the disability sector and have they been forgotten through this era of COVID. Kathryn, could I ask you to pick that one up?

KATHRYN MACKAY

Yeah, definitely. I think it's true that people with disabilities have been orphaned or forgotten by responses to the pandemic.

I think it's a difficult group in some ways, because not everyone with disabilities have been affected in the same way, because obviously not every disability is alike. So certain kinds of impairments like a hearing impairment – a person is otherwise just as healthy as I am – so we're not equally; we're similarly vulnerable to the virus, a person with that kind of disability isn't more vulnerable to the virus. There's an assumption that everyone with disability will be more vulnerable to the virus. So there's this kind of unequal and unfair assumption that there's this particular kind of vulnerable group in our society that needs extra protection, when actually they kind of just need what they've always needed, which is accommodation of different kinds by wider society.

Some things have been helpful, like the fact that people are meeting on Zoom, and often that can have closed captioning, [it] has been very beneficial for some people.

Being able to flexibly work from home again, is really helpful for some people who have intermittent effects from their disability.

Other people have been really adversely affected by social exclusion by being made completely isolate isolated from normal community activities that they would have engaged in in their lives.

So it's been a really uneven effect, I think, on people who have disabilities. And I think that's a really big area of work that people who are at University of Sydney in the disability studies centre and also at the disability centre at UNSW have been working on quite a bit to figure out what's happening with this group, and what to do going forward to make it better.

ROBYN WARD

So do you think there's sufficient research going on to sort of map out those impacts? As you say the impact is different on people with different disabilities? Is there studies going on in that area to your knowledge?

KATHRYN MACKAY

I think there are some, but I don't think that it's sufficient. I think that there should be a little bit more support for that kind of research, because disability is something that reaches into everyone's lives, whether it's temporarily or more longer term. A lot of illnesses can disable us for shorter or longer term, or you might be, you know, sort of born with a kind of impairment that is interpreted as a disabling condition. So I definitely think that that area needs a lot more research, especially in light of the pandemic. But it's just it's one of those issues that was always there in the background, like Heiko said about oral care. In fact, it was always there in the background. But this has really brought it to the fore.

ROBYN WARD

Let me just go to one more orphan question, which is around a question I wanted to us to talk a little bit about mental health care, and the funding for the extra sessions were fantastic, but the capability, workforce development, you know, what are our plans on health workforce?

Maybe this is one again, for Brendan. I know you were heavily involved in leading a lot of this work. Has your views on what the workforce needs are changed now?

BRENDAN MURPHY

Thanks, yes, look it's not really changed. I think it's just exacerbated some of the issues that were existing in the past.

Just going back to disability, I actually would say that we didn't forget disability, we had a fantastic outcome with hardly a handful of cases of COVID in the disability community. We were engaging the disability community the whole way through. And the most complex part of the whole vaccine rollout that we're doing now – I've got teams of literally hundreds of people going into disability homes working with NDIA and delivering vaccines into disability care. So I think that disability, aged care, did have some, you know, in the Victorian second wave, pretty tragic outbreaks, but we have protected our disability community incredibly well through COVID. And we're quite proud of that.

But back to workforce, mental health, again, a big mental health reform package in the last budget. And a big part of that was a workforce package. We have to get more mental health professionals, there's no doubt about it, we've got to make [it].

And in our medical workforce strategy, there's a big focus on how we can proactively get people into psychiatry and train particularly Australian doctors in psychiatry and change their training paradigm but it's much more than doctors.

We need a whole lot of mental health nurses and again, a range of strategies to train more people in mental health nursing to get young nurses into that specialty and also allied health. So that was a – there was a lot of myths of mental health workforce in that and absolutely, we found that during the pandemic, we're in Victoria when during the second wave, Commonwealth set up some really innovative new mental health clinics. You know, set them up within about a week, when they normally would have taken two years. And the only barrier to getting them going was actually finding the workforce. But in that environment, people did turn up.

So workforce, the health workforce is a really crucial issue. And we've got to start training the right sort of people for the jobs that we need in the future. And, you know, making sure that we use the levers that we as governments have and universities too, to attract people and get them into the areas where we need them.

ROBYN WARD

And I think one of the other questions that have come up, which was sort of on my mind, as you were talking, is the social isolation and people that's fabulous with Zoom, and it's fabulous they can connect electronically, but is there, you know, on the horizon, an increasing number of people who are going to have issues related to social isolation from, you know, physical isolation from family, friends, contacts, and what does that mean for their mental health and their wellbeing overall? Maybe start with Kathryn, and then we can hear from the rest of the panel on that.

KATHRYN MACKAY

Yeah I mean, I think part of that is for people who have more experience and expertise in mental health and psychology to answer, but I think it does connect to a couple of the things that I was saying, especially about people who have disabilities, who are young, but who are being excluded, or who are at home, out of some sort of view that that's better for them when they're not at any greater risk, in fact, than any of their peers. I think the social isolation is really quite serious. People who were in Melbourne for that long lockdown last year, kind of have some already showing ongoing effects of just having been isolated in their homes for such a long time.

Here in New South Wales, in Sydney, where I am, where we are, we had it much easier. And I know that my friends and family in other countries have had completely different experiences. So my family in Canada has been through multiple lockdowns, my colleagues in Britain have been through multiple long lockdowns. That impact is kind of connected to the mental health effects that I see unrolling over the next few years. It's something that I don't think we can even start to measure just yet. It's something that we'll have to see over the next few years, how people react when they're back in social settings, how it feels to be surrounded by people, again, if we ever do go back to the kind of big crushing settings that we used to have, and how people's cues like one of the questions is kind of about, you know, young workers, if you're picking up on the right kind of cues, when you're on zoom. I think there's some really interesting studies going on about that. That's not really in my wheelhouse. But I don't know, I think there will be some effects.

ROBYN WARD

And I think, Heiko, you've seen that either in the student population, as you spoke about earlier, but particularly so, with zoom calls and zoom training; hybrid learning models.

HEIKO SPALLEK

Yeah, I think it's very important that we have too, social interaction, and Zoom cannot replace healthcare provider/patient interaction in its full capacity. So as I said, we believe that we've learned a lot from COVID. One of them, one of the learnings is that we can actually do quite a few things when it comes to training in simulation, but not everything. And I think that's really, really important that our students are prepared to deal not just with teeth but the patients, and see them as complete human beings with different needs, which really go beyond their teeth.

ROBYN WARD

Well we're drawing close to the top of the hour. So I'm going to ask now each speaker to just give me two or three – if you've got three – take home messages.

Okay, so given that we started and ending with the mouth, Heiko, what are your two or three, take home messages? And what do you want the audience to go out and do as a result of hearing your points?

HEIKO SPALLEK

So as you already said, and I think everybody seems to agree that the mouth is part of the human body, let's all work together on finding solutions so that all Australians can actually speak, smile, smell, taste, touch to swallow and convey a lot of different emotions, with confidence and without pain or discomfort, or disease.

KATHRYN MACKAY

I think that – I mean, what I would really like people to take away from this talk is that health is a really complex and multifaceted state, that it involves all kinds of different sorts of wellbeing so it involves social, economic, oral, mental and physical wellbeing. And I think, for me, the gaps that are appearing between people's wellbeing as a result of COVID-19 is something we're really gonna have to keep our eye on going forward.

So this is less perhaps for just the general audience, but certainly I think we all have a responsibility to send that message to our elected officials to make sure that groups in society who need advocacy aren't left behind by us when we have a platform and a voice to use to help them.

MELODY DING

So first, I think we need more funding for research on chronic disease prevention. COVID-19 has really highlighted the importance of scientific evidence. And I think that has particularly helped Australia in fighting COVID. And the same goes with chronic disease prevention. So this might not be within the control of the audience, but I think we need to invest way more than we currently do in prevention, whether that's prevention of physical diseases, mental health issues, or a health issue, and many others.

And the second, I think, I just want to remind the audience again, health is not just the issue for the health sector. Health is the issue of so many sectors that are involved in building this environment that we're living in. So it's very important that we keep on reminding us that there's so many partners out there that we can work with, to not only prevent people from getting sick, but have having people the opportunity to live well – and physically, mentally, spiritually and many, many ways.

ROBYN WARD

Okay, final words to you, Dr Brendan Murphy.

BRENDAN MURPHY

Thanks, Robyn. I used to be an academic, I used to never pass up an opportunity to seek more money for my area of interest. Good on you. We all do that.

Look, I think the two things that I would say is one: we still don't know what the long term effects of this pandemic will be, and we're certainly not out of it yet. You know, there are countries in the world that are still raging, and countries like Australia that have had no real outbreaks has remained at risk. So there's still a long way to go, and we don't know what the long-term non COVID health effects will be. And all of those things that we talked about before, we do need to keep a very careful eye on those trends.

And the other thing is, I think, going back to a theme from earlier, is let's not fail to benefit from those innovations that we brought about in that time of need and that it really served us well and make sure we build on them and embed them, such as, you know, things like telehealth and the like.

ROBYN WARD

Thank you. Well, that concludes our session. And I'd like to just thank our guests today, Dr Kathryn MacKay, Associate Professor Melody Ding, Professor Heiko Spallek and Dr Brendan Murphy.

FENELLA KERNEBONE

Thanks for listening to the Sydney Ideas podcast. For more links, resources or the transcript for today's podcast, head to sydney.edu.au/sydney-ideas or search for "Sydney Ideas podcast". And if you haven't already, subscribe to the Sydney Ideas podcast on your favourite app.

Podcast transcript

Further reading

Associate Professor Melody Ding, The University of Sydney School of Public Health

Dr Kathryn MacKay, Sydney Health Ethics

Dr Brendan Murphy, Secretary of the Department of Health

Professor Heiko Spallek, Head of School and Dean, The University of Sydney School of Dentistry

Professor Robyn Ward (Moderator), Executive Dean and Pro Vice-Chancellor Medicine and Health, University of Sydney

What COVID forgot

Resources

Podcast transcript

Further reading

The panel

Associate Professor Melody Ding, The University of Sydney School of Public Health

Dr Kathryn MacKay, Sydney Health Ethics

Dr Brendan Murphy, Secretary of the Department of Health

Professor Heiko Spallek, Head of School and Dean, The University of Sydney School of Dentistry

Professor Robyn Ward (Moderator), Executive Dean and Pro Vice-Chancellor Medicine and Health, University of Sydney

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