On 25 March 2020, the Australia Government announced $6.9 million in support through the National Aboriginal Community Controlled Health Organisation: providing 45 grants to help 110 remote communities protect themselves against COVID-19 as part of a $57.8 million Remote Community Preparedness and Retrieval package.
This news is welcomed, because Australia’s Indigenous, regional and remote communities may be particularly vulnerable to COVID-19. Here’s why decentralised testing will be key for these communities.
Considering community spread
Official government communication states that Australia does not have widespread community transmission of COVID-19, although an early shortage of tests meant that tests were initially rationed exclusively for high-risk patients such as those returning from overseas. As such and without thorough testing, it’s difficult to assess the true numbers of community-based transmission. We know that confirmed cases are rising and that the virus can spread through contact with cough or sneeze droplets from an infected person, so it’s safe to assume that community transmission is occurring.
Most Australian states and territories have now closed their borders and some, like Western Australia, are also aiming to limit movements within regions. Non-essential travel restrictions were set in place for several remote Indigenous communities in early March and more have followed suit, recognising the greater risk for these distant populations. As of 27 March we’re pleased to see decentralised testing being set up in regional centres, however testing capabilities will need to be extended to the furthest reaches of Australia’s population.
The vulnerabilities of Indigenous and remote populations
The risk for Indigenous, remote and regional populations is quite clear. Australians living in rural and remote areas record higher levels of disease in general, and poorer access to health services than those living in metropolitan areas. Indigenous Australians are significantly more likely to suffer from long-term respiratory disease than non-Indigenous Australians, and Indigenous Australians living in remote areas are particularly likely to have cardiovascular disease and diabetes. Each of these comorbidities have been reported as risk factors for severe patients in early COVID-19 research.
Healthcare facilities in remote communities can be stretched thin at the best of times, leading to concern that the presence of COVID-19 in these communities could overwhelm medical services. It’s worth mentioning that during the 2009 H1N1 Influenza epidemic, the relative risk of hospital admission for Indigenous people was found to be 7.9 in comparison to non-Indigenous people in one north Queensland community. It would only take one infected person to introduce COVID-19 into a remote community, and left unchecked the virus could spread exponentially. In order to identify, trace and treat infected people in Australia’s most remote areas and protect those who are at higher risk, decentralised testing will be essential.
The case for decentralised testing
Testing for COVID-19 was initially limited to a number of private pathology labs and hospitals in Australia, however centralised testing raises several concerns:
- Firstly, Australia has many regional and remote communities where testing may not be available. Suspected cases that cannot travel to a testing facility will have no way of knowing whether they should be isolated.
- Secondly, there’s the time it takes to transfer samples from more remote areas to central testing facilities. This could have a critical impact both in individual treatment and in community risk management, particularly as spread can occur during the incubation period of 5-14 days without symptoms.
- Thirdly, this can increase the number of people at any one testing facility and therefore increase the risk of exposure to healthcare workers.
We know that mobile diagnostic laboratories are certainly possible. A truck-based mobile biosafety level-3 laboratory was used in the 2018 Ebola outbreak in Sierra Leone, and a generator-powered lab taken overland to a remote northern Australian community during the 2009 influenza epidemic.
In the case of COVID-19, the World Health Organization’s Laboratory Testing Strategy Recommendations suggest that decentralised and mobile testing be utilised where possible:
If testing is available at the national level, plan for surge capacity by establishing decentralized testing capacity in sub-national laboratories under the supervision of the COVID-19 national reference laboratory. Options to engage private laboratory services or the academic sector should be considered. When testing facilities are limited, available facilities tend to be located in or near a capital city, making timely access to testing difficult for people living in other parts of the country. Consider the possibility of mobile laboratories or, if available, automated integrated NAAT systems that can be operated in remote regions and by staff with minimal training.
We’ve already seen South Korea successfully deploy 600 testing centres, including 50 drive-through stations where patients don’t even need to leave their car. Here, we’re seeing more decentralised laboratory facilities being set up across Australia. With a qPCR machine that can be powered by a battery or inverter system, testing facilities can be set up in regional community centres, demountables or caravans. One doctor in Gloucester, NSW has even set up a horse float as a mini consultation room for remote testing.
Extensive and timely testing of a general population can provide insights into where outbreaks are occurring and where attention should be focused. As of 27 March the Australian Government is facilitating new facilities in regional centres, but it’s important that we continue to use localised laboratories, lab automation and mobile testing options to full use so we can minimise the impact on vulnerable communities.
*Mic is Research Use Only.
As COVID-19 has taken hold in Australia and around the world, we’ve had enquiries for our Mic qPCR machine from remote minesites, oil & gas companies, aged care homes and more, reflecting the demand for more localised testing facilities. Bio Molecular Systems’ Mic is the world’s first Magnetic Induction Cycler which provides faster and more accurate results than standard PCR lab equipment. This unique qPCR system can be scaled from a small solution with 35 cycles in 25 minutes, right up to 10 machines with outstanding reproducibility. You can learn more about Mic over on the features and specifications page.