Living through a pandemic as an MJA editor and a general practitioner

The end of 2021 offers many opportunities to look back on the year that was and make predictions about what is to come. At the time of writing, modelling based on vaccination rates and plans for reopening the country are the trends du jour. Yet, in approaching the end of another year in which coronavirus disease 2019 (COVID‐19) has dominated medical, public health and media agendas, it is vital we take an opportunity to reflect on the impacts that the pandemic has had on Australia’s health system, including the way in which the crisis has spurred valuable innovation and reform. For me personally, experiencing this year as an MJA editor and a general practitioner working in Western Sydney, alongside being an expectant mother from a migrant background, has given me intersecting lenses through which to view the impact of the pandemic on medical publishing, clinical practice, and learning to “live with COVID”.

The impressive response of our scientists and clinicians to this global health emergency has led the MJA, like many other medical journals, to experience an exceptionally high number of submissions related to COVID‐19. In response, we have had to adapt our editorial processes within a rapidly changing clinical, political and scientific landscape, to maintain the quality of the research published, while finding new ways to rapidly publish research that could have a significant impact on health policy and clinical practice. As an MJA editor, I have spent many hours evaluating studies on COVID‐19, including modelling that challenges assumptions inherent in government policy, social research on the readability of COVID‐19 vaccine information, and urgent discussions on the evidence of aerosol transmission of SARS‐CoV‐2, with possible implications for the future of quarantine arrangements and ventilation for indoor spaces.1,2,3

While engaging in this research and analysis from Australia’s leading health and clinical experts, I have also been working as a GP in Western Sydney and awaiting the birth of my first child. It has been surreal to watch public health think tanks trying to predict what the next few months of my life as a new parent will look like. Despite the Royal Australian and New Zealand College of Obstetricians and Gynaecologists updating its advice regarding COVID‐19 vaccination in pregnancy, and international data showing that pregnant women experienced high rates of morbidity when infected with the Delta variant, it took several weeks for pregnant women to be officially accepted as a high risk group on the New South Wales vaccine booking website.4,5,6

Once the Delta strain seeded outwards from Sydney’s Eastern Suburbs into the communities of South Western and Western Sydney, it soon became apparent a target of “COVID zero” was no longer realistic. As I continued to work in my Western Sydney clinic, compared with previous lockdowns, many of my patients felt there was an increased police presence and a tendency to blame prohibited gatherings in homes for the worsening outbreak.

Such strategies and rhetoric revealed a lack of understanding among political leaders of how migrant communities lived and worked in their local areas. To many, it felt as though a community that had experienced barriers to accessing COVID‐19 vaccinations, often had multiple generations living in one household, and usually had jobs that required a significant amount of travel were being inappropriately blamed for rising case numbers. The lack of adequate and early messaging to ethnically diverse populations regarding the importance of vaccination and following public health orders highlighted a missed opportunity during the pandemic, despite the publication of relevant information.7

As a GP working in a diverse community, it was frustrating to be managing the mental health impacts of the greater public health restrictions on my patients while noticing a lack of equivalent policing around public health orders in the city’s Eastern Suburbs and Northern Beaches. Melbourne followed a similar trajectory to Sydney regarding its outbreak, and it has been equally frustrating to see similar reports of concern from GPs managing ethnically diverse populations in Melbourne’s northern and western suburbs regarding government messaging and resourcing.8

Nonetheless, one of the biggest good news stories to emerge during 2021 was the high vaccination rate in Western Sydney and beyond, despite significant issues around government vaccine supply and messaging. It was heartening to see health practitioners and GPs advocating in their local community and disseminating evidence‐based information in local languages to reach their broad patient base. GP clinics continue to provide a significant portion of the vaccinations around the country, having converted their practices into safe and secure vaccination hubs for their patients.9 Many GPs have worked tirelessly to achieve this, working out of hours to establish the blueprint for the logistics and do the necessary paperwork, and scaling up nursing capacity without any added government funding to do so.

Although vaccination rates have picked up, gaps unfortunately remain for our Indigenous population.10 COVID‐19 has exposed and exacerbated longstanding health inequities in Australia, laying bare injustices that have persisted for too long. There has been some innovation in terms of mobile outreach units and community engagement for vaccination, but it is it has taken a pandemic and several weeks of restrictive lockdown to get to this point. Despite affected states opening up during Delta outbreaks, rates of vaccination in many remote Indigenous communities remain worryingly low.10

Telehealth is another positive that has emerged out of the pandemic. Initially considered a domain of rural medicine, it has become an integral part of health management during the pandemic. There are concerns about some of its limitations, but several published studies have highlighted its important role in safe health delivery during the pandemic.11,12,13 Unfortunately, funding for telephone consultations in general practice continues to be contentious, and health care providers have expressed their ongoing frustrations at frequent rule changes and the lack of a cohesive plan regarding this from the federal government.14,15 After Sydney’s first round of restriction relaxations in October 2021, item numbers for telephone consultations were only given a last minute one‐week temporary stay. This was despite extensive advocacy for their continuation from the Royal Australian College of General Practitioners and the Australian Medical Association. Negotiations are currently ongoing regarding management of mild COVID in the community by GPs through face‐to‐face consultations.

These were some of the big picture, good and bad stories to emerge from 2021, but the stories that stick with us are often the ones we see unfolding ourselves or within our community. Various religious and non‐profit organisations have been doing important local charitable and advocacy work. Social media has been awash with community acts of kindness, with donations of food, toys and household items commonplace. Small businesses have had to adapt to online selling and delivery in a short amount of time. Suburbs with young families have created various games to encourage children to walk and exercise with their parents. Parks have been filled with boxes of chalk for young people to create artwork.

Our leaders continue to remind us, at federal, state and territory levels, that there is some light at the end of the tunnel, and this is of course true to an extent. Young people aged 12–15 years are now being vaccinated at high rates, and borders are beginning to open, but life in 2022 is likely to still look quite complex. Despite the mental health strain of dealing with an ever changing and unpredictable “COVID‐normal”, community engagement and support continues be one of the strongest tools along with vaccinations in our arsenal against the disease. At the time of publication of this article, I will be 2 months post partum and will be considering what my return‐to‐work plan looks like for another year as an MJA editor and a GP while juggling motherhood. It’s a timely reminder that uncertainty, regardless of a global pandemic, is a fact of life.