Floods leave a legacy of mental health problems — and disadvantaged people are often hardest hit

Sabrina Pit, Western Sydney UniversityYet again, large swathes of New South Wales are underwater. A week of solid rain has led to floods in the Mid-North Coast, Sydney and the Central Coast, with several areas being evacuated as I write.

As a resident of the NSW Far North Coast, which has had its share of devastating floods, many of the tense scenes on the news are sadly familiar.

Unless you have lived through it, it is hard to understand just how stressful a catastrophic flood can be in the moment of crisis. As research evidence shows, the long term impact on mental health can also be profound. And often it is the most disadvantaged populations that are hardest hit.

Disaster risk and disadvantage

In many places, socio-economic disadvantage and flood risk go hand in hand.

In a study published last year, led by the University Centre for Rural Health in Lismore in close collaboration with the local community, colleagues and I looked at population data following Cyclone Debbie in 2017. We found people living in the Lismore town centre flood footprint experienced significantly higher levels of social vulnerability (when compared to the already highly vulnerable regional population). This study would not have been possible without the support of the Northern Rivers community who responded to the Community Recovery
after Flood survey, nor without the active support, enthusiasm and commitment of the Community Advisory Groups in Lismore and Murwillumbah and community organisations.

Notably, over 80% of people in the 2017 Lismore town centre flood-affected area were living in the lowest socio-economic neighbourhoods. The flood-affected areas of Murwillumbah and Lismore regions included 47% and 60% of residents in the most disadvantaged quintile neighbourhoods.

By examining data from the 45 and Up study, we also showed that participants living in the Lismore town centre flood footprint had significantly higher rates of smoking and alcohol consumption. They were also more likely to have pre-existing mental health conditions such as depression and anxiety, as well as poorer general health.

Research from Germany and the US has shown flood risk is often a significant predictor of lower rental and sale prices.

So even before disaster strikes, residents in flood-prone areas may be more likely to battle with financial and health issues. Our study showed disaster affected people also had the fewest resources to recover effectively. When floods arrive, the impact on mental health, in particular, can be acute.

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Underinsurance is entrenching poverty as the vulnerable are hit hardest by disasters

Floods and mental health

A flood can be extremely stressful in the moment, as one rushes to protect people, property, pets and animals and worries about the damage that may follow. Can you imagine clinging to a rooftop in the rain in the middle of the night and waiting to be rescued?

The damage caused by floods causes enormous financial pain, and can lead to housing vulnerabilities and homelessness, especially for those without insurance — and research reveals a pattern of underinsurance in disadvantaged populations across Australia.

Even if you are lucky enough to have insurance, waiting to have your claim assessed and approved, then dealing with a shortage of tradies can take a real toll on your mental health. The waiting and the uncertainty can be especially hard.

Other flood research by colleagues and I, led by the University Centre for Rural Health, showed business owners whose homes and businesses had flooded were almost 6.5 times more likely to report depressive symptoms. Business owners with insurance disputes were four times more likely to report probable depression.

Flood affected business owners whose income didn’t return to normal within six months were also almost three times more likely to report symptoms of depression.

Lack of income can clearly cause stress for the individual, their family and their larger network. Small businesses play an important role in rural communities and employ a large number of people so the sustainability of local businesses is crucial.

We also found the higher the floodwater was in a person’s business, the more likely the person was to experience depressive symptoms.

People whose business had water above head height in their entire business were four times more likely to report depressive symptoms. Those who had water between knee and head height in their business were almost three times more likely to report probable depression. All this adds up to an increase in mental health issues that often follows a flood.

Six months after the flooding, business owners felt most supported by their local community such as volunteers and neighbours. However, those that felt their needs were not met by the state government and insurance companies were almost three times more likely to report symptoms of depression.

Preparedness and awareness

So, what can be done?

Firstly, we can boost preparedness. Risk and preparedness education may be especially needed for people who have recently moved to flood-prone regions. Many who have moved to regional areas recently may not be aware they live in a flood zone, or understand how fast waters can move and how high they can reach. Education is needed to raise awareness about the dangers. People may need help to prepare a flood plan and know when to leave.

Secondly, supporting people and local businesses after a disaster and assisting the local economy in its recovery could help reduce the mental health burden on people and the business community.

Thirdly, mental health services must be provided. A chaplaincy program was implemented in Lismore by the local government to assist business owners with emotional and psychological support after Cyclone Debbie and ensuing floods. This program was largely well received by business owners for having provided psychological support and raising mental health awareness.

However, the ongoing lack of mental health support remains an issue, especially in rural areas, and is exacerbated by disasters.

Fourthly, insurance disputes and rejection of insurance claims were among the strongest associations with likely depression in our research. We must find ways to improve the insurance process including making it more affordable, improving communication, by making claims easier and faster and boosting people’s understanding of what’s included and excluded from their policy.

No single organisation, government or department can solve these complex problems on their own. Strong partnerships between organisations are crucial and have been shown to work, as is direct and real-time support for flood-affected people.

Read more:
You can’t talk about disaster risk reduction without talking about inequality

This story was updated to add more detail about the author’s research funding, collaborative partners and affiliation. It is part of a series The Conversation is running on the nexus between disaster, disadvantage and resilience. You can read the rest of the stories here.The Conversation

Sabrina Pit, Honorary Senior Research Fellow at the University of Sydney, Honorary Adjunct Research Fellow, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How the latest COVID cases slipped through in NSW and Queensland — and what we can do better

Catherine Bennett, Deakin University

Health authorities in Queensland and New South Wales are racing to prevent COVID outbreaks after one community case was recorded in each state over recent days.

Brisbane’s Princess Alexandra Hospital was put into lockdown on Friday night after a doctor who treated a returned traveller with COVID tested positive.

In Sydney, a security guard who worked at two quarantine hotels returned a positive result yesterday.

Neither state has recorded any further community cases so far, although hundreds of close contacts remain in quarantine. Let’s take a closer look at what’s happened.

The vaccine doesn’t work immediately

The Sydney security guard had received a first dose of the Pfizer vaccine. But this isn’t reason to be concerned about the vaccine’s effectiveness.

Reports indicate the man received his first dose on March 2, and health authorities’ working hypothesis is that he caught the virus during an overnight shift at the Sofitel Wentworth from March 6-7.

Data on the Pfizer vaccine show it only starts to protect 12 days after the first dose. Maximum protection, of course, only comes after the second dose.

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So we wouldn’t yet expect this person to be reaping the vaccine’s benefits at the time he was exposed.

It’s possible the first dose may have already conferred some level of protection, and we can hope this person may experience a less severe infection, and be less infectious to other people, than he would have had he not received a single dose days earlier. But we don’t know this will be the case.

We should be more worried about the fact the infected worker was employed at two Sydney quarantine hotels. Reports also indicate he worked a day job in building management.

I’ve previously argued we need to create a model in which hotel quarantine workers only need to work across one site to minimise the risk of transmission.

The Victorian government adopted a recommendation to discourage secondary face-to-face employment for key staff following the hotel quarantine inquiry.

The Queensland case

The doctor who contracted COVID in Queensland, on the other hand, hadn’t received the vaccine. This has raised the question of why a doctor working with COVID-positive patients — irrefutably on the frontline — hadn’t got the jab yet.

The vaccine rollout is still in its early phases, and we can’t expect everyone in the first group (1a) to have already received the vaccine.

However, where a large number of health-care staff have received at least a first dose, it would have been sensible to have a vaccinated doctor treating COVID-positive patients.

Read more:
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Another hotel quarantine outbreak?

Queensland is also now facing a possible outbreak within hotel quarantine, with genomic sequencing linking a second case in the Hotel Grand Chancellor to the returned traveller we understand passed the virus to the doctor. This second guest tested positive on day 12 of their quarantine.

We don’t yet know for sure whether this second guest picked the virus up in quarantine; investigations are continuing. But we’ve seen the virus spread in hotel quarantine before, most recently at the Holiday Inn, which sent Melbourne into a five-day lockdown.

One thing we could be doing better would be to test returned travellers every day, or at least every second day, rather than only at the beginning and towards the end of their 14 days, or if they develop symptoms.

For example, in Victoria, returned travellers are routinely tested on the third and eleventh days, and the policies seem to be similar in other states.

We’re missing a significant window here. Having a more precise idea of when the person became infected would give us a better idea of how they became infected.

For example, if it was closer to the beginning of their stay in hotel quarantine, it may be more likely they contracted the virus overseas or in transit and were still incubating the infection on arrival. Whereas if they did become infected only around day 12, we may be more inclined to explore the possibility they contracted the virus in quarantine.

This would also allow us to manage cases better, because as soon as someone tests positive, they could be moved to a “hot hotel” to minimise transmission risk.

This daily testing could be less invasive than the standard PCR tests, for example saliva testing. Any positive result could be validated with a PCR test.

Hopefully we’ll avoid border closures and hard lockdowns

Other Australian states have instructed people who have been at any of the main exposure sites linked to these cases to get tested and quarantine. Victorian health authorities are actively seeking out people who have passed through Sydney to identify anyone who may be at risk.

Being able to trace, test and isolate, without closing borders, is the way the system should ideally work.

These cases in NSW and Queensland remind us leaks are still possible and we have to be prepared. We can never get the risk down to zero, but everything we can do to reduce the risk is critical.

Along with continued infection control measures, the vaccine plays a big role. It can’t eliminate the risk completely, but as more people are vaccinated, the hope is it will reduce the impact of events like these.

We now wait to see the results from the close contacts’ tests in both states. Hopefully, these situations won’t escalate further and we’ll avoid the need for snap lockdowns and border closures.

But even if we’re able to avoid city-wide lockdowns, these events cause significant disruptions in the community. So it’s critical we investigate them thoroughly, and do everything we can to mitigate the risk they will happen again.

Read more:
South Australia’s 6-day lockdown shows we need to take hotel quarantine more seriously

The Conversation

Catherine Bennett, Chair in Epidemiology, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Vic, QLD and NSW are managing COVID outbreaks in their own ways. But all are world-standard

Hassan Vally, La Trobe University

It hasn’t been the start to 2021 many of us wanted. In the past three weeks Victoria, Queensland and New South Wales have dealt with fresh COVID outbreaks, but it’s worth remembering each have faced unique challenges, and tackled them in different ways.

Despite their differences, however, all three have been clear about their intention to aggressively suppress transmission, and all have been effective in their responses.

Significant challenges remain, including the vexed issues of how we define hotspots, manage state borders and deal with threats posed by new COVID strains. And of course, how we deliver the vaccine en masse.

But triumphing over the challenges we’ve faced over the past few weeks should give us confidence as we move to the next phase of the pandemic.

Queensland’s precautionary approach

Queensland’s strategy was clear, decisive, and well articulated. As health authorities explained, the Greater Brisbane lockdown was a circuit breaker aimed at limiting interaction and buying time. This allowed contact tracers to do their job and authorities to learn more about the nature of the outbreak.

The fact it involved a new, more transmissible strain posed a significant threat. And it wasn’t clear, at first, how many chains of transmission had been initiated by the hotel quarantine cleaner who tested positive for it.

Read more:
Brisbane’s COVID lockdown has a crucial difference: it aims to squash an outbreak before it even starts

This was no doubt a cautious response informed by the precautionary principle. Given what was at stake, it was justified.

Greater Brisbane’s three-day lockdown ended at 6pm Monday night, and Queensland has recorded just one case of community transmission in the last four days — the partner of the cleaner, who has been in quarantine since January 7 (though could have been infectious in the community for two days prior).

The threat seems to have been averted for now.

We need to wait out the full incubation period for the cleaner’s more than 350 close contacts to see if there are any more cases connected to her, though all of these contacts are in quarantine, and so pose no threat to the broader community.

Victoria showcased its improvement

The Black Rock cluster in Victoria posed a significant risk and required an equally decisive response. It didn’t represent the level of threat Victorians faced at the beginning of its second wave, but given it occurred during Christmas and New Year’s plus the scars Victorians carried from the second wave, the threat couldn’t be underestimated.

Read more:
Dear Australia, your sympathy helps, but you can’t quite understand Melbourne’s lockdown experience

The response to this cluster was rapid and decisive. It allowed the Victorian health department to showcase just how much their response capacities had improved in the previous six months. It was incredibly reassuring to see how quickly the public health team was able to establish links, and how quickly they were able to identify contacts of contacts in order to block chains of transmission.

It was a test they passed, and with six consecutive days of no locally acquired COVID cases, Victorians can breathe a collective sigh of relief — for now at least.

While the rapid closing of the border to NSW was an important element of the response, I remain uncomfortable with the scenes we witnessed at the borders, and the notion of Victorian residents being locked out of their homes. I hope that, as we have seen over the previous 24 hours with the new “traffic light” travel system, the government can continue to refine the way it handles this issue.

New South Wales less risk-averse

New South Wales has always appeared to have a greater tolerance for risk when it comes to COVID than other states. Its response has been characterised by a “test, trace and isolate” approach and a reticence to lock down huge areas of Sydney. Lockdowns have been localised and relatively brief.

Many restrictions, however, are still in place — residents of Greater Sydney, Central Coast and Wollongong, for example, can still only have five visitors to the home, including children, and masks are now compulsory in many places. Hotel quarantine remains a vulnerability and refinements continue to be made, in NSW and elsewhere.

Despite its challenges, time and time again the state has shown it can keep virus transmission under control.

The situation it faced with multiple new clusters over the past three weeks could be considered one of its biggest tests. And for the most part, the state seemed to have a reasonable understanding of chains of transmission.

The way authorities respond to threats must be proportionate, but it’s as much an art as it is a science. Judgement calls must be made, and striking the right balance is not easy when uncertainty is high and luck plays such a huge part.

NSW has seemed to walk this line successfully so far. The latest outbreak did call for more aggressive measures such as a targeted lockdown in the Northern Beaches and the introduction of mandatory mask wearing. Along with testing, tracing and isolating, this has helped bring transmission rates under control.

On the downhill run to the end of this pandemic

There’s still a way to go in the fight against COVID. But unlike other parts of the world, Australia is on the downhill run to the end.

As much as we should be thankful for the good leadership shown by those making decisions, the real thanks is to the community, who have followed the rules and made huge sacrifices to get us where we are now.

Although we will face many challenges over the next year, Australia remains one of the shining lights in the fight against COVID. We are seeing the benefits of our sacrifices now, and will continue to see them for many years to come.The Conversation

Hassan Vally, Associate Professor, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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