STEPHEN LEEDER.We’ve flattened the curve, but the nation’s health is still in danger

2020 is not panning out to be the Year of Tranquillity in Australia.

While the coronavirus catastrophe is global – and far worse in Italy, Spain, France and America than in Australia so far – we in this country had already had to contend with prolonged drought, cataclysmic fire and then flood.

Serious stress lines in our economy were already visible early this year. The pandemic has now necessitated massive national expenditure to save our economy at levels we would only normally see if we were at war.

But, despite astonishingly generous national outlays to preserve businesses, individuals both employed and unemployed, and to assist with childcare, financial stress is common.

Unemployment, recession and the impact on society are central worries.

On 6 April 360,000 people had applied to draw down $20,000 from their superannuation. [1] That’s one quarter of all those with superannuation and is an indicator of financial stress and uncertainty.

What happens to people who lose their jobs has been described countless times in the medical research literature. Not only is there loss of income, but also the structure that gives them identity.

The psychological effects of unemployment are many and varied. Research draws attention to the loss of a sense of control among those who lose their jobs, and a fall in their self-esteem, which can be precursors of depression and anxiety.

A study of New Zealanders found a strong association between suicide and unemployment and inactive members of the labour force. The risk of suicide was found to be about 2.5 times higher among 25 to 64-year-olds among the employed compared with those in-work. Existing mental illness accounted for about half the increase.

When it comes to recession, a Monash University survey of 1,000 Australians published this past week found 52% of responders were very worried about this, compared with 38% who were very worried about contracting COVID-19. [2] Interestingly, their biggest fear centred on the health system being overloaded, with 54% citing this as what they worried about.

The stress of isolation is another issue being borne by our community. It is a key element of COVID-19 control. But the absence of enjoyable group interactions and a sense of belonging can be crippling.

Last month a study in the Lancet summarised research into the psychological effects of quarantine and pointed to how cases of PTSD often followed. [3]

The authors looked at more than 3000 papers on the subject and made recommendations on how to avoid a mental health catastrophe which included that the quarantine-period should be short, and the duration only increased in extreme circumstances.

They also advised that most of the adverse effects of quarantine came from the restriction of liberty and that voluntary quarantine was associated with less distress and fewer long-term complications.

GPs are, of course, front-line workers in this war, and have been adapting brilliantly to the new opportunities for telehealth consultations and appropriate testing.

The current problems faced by our patients are part of a complex social web. This is not within the capacity of the medical profession to unravel or solve, but we can offer support which, while it may seem low-key, can make a big difference.

Discussing and acknowledging the problems faced by our patients is critically important. Soon the augmented flu vaccine will be available, which (PPE allowing), will give us the opportunity to interact face-to-face with many patients, especially older ones. This will be important to gauge their mental health.

We must also care as best we can for our fellow health workers. The occasional phone call from a colleague has made a big difference to several of my days – and I am remote from the front line.

Stephen Leeder is Emeritus Professor of Public Health and Community Medicine in the Menzies Centre for Health Policy at the University of Sydney and Editor-in-Chief of the International Journal of Epidemiology.

References

  1. The Australian April 6, 2020
  2. The Conversation on 7 April
  3. Lancet March 14
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Stephen Leeder is an Emeritus Professor of public health and community medicine at the University of Sydney.  Steve has 45 years of experience in epidemiological research, medical education reform and in mentoring young investigators. Most of his research has been collaborative and he has always sought ways of ensuring the career development of members of his teams.

Steve is currently Editor-in-Chief of the International Journal of Epidemiology. He held the position of Chair of the Western Sydney Local Health District Board from 2011 until 2016 and was Editor-in-Chief of the Medical Journal of Australia from January 2013 until April 2015.

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