Helping Rural and Indigenous Australians Stay Safe from COVID-19

3 Questions for Dr. Lucas de Toca

Lucas de Toca wears a blue jacket and white shirt
Dr. Lucas de Toca, MPH ’13

A/g First Assistant Secretary, Australian Department of Health

Dr. Lucas de Toca, MPH ’13, leads the Australian Government’s Primary Care Response task force for COVID-19, reporting to the Chief Medical Officer of Australia. He has direct responsibility for the rollout of 150 primary care-based respiratory clinics nationwide, as well as for the rural, remote, and Indigenous health aspects of the government response.

What is Australia’s approach to limiting the spread of coronavirus to remote and Indigenous communities?

In early March, we established a national task force to bring the Aboriginal-led health services and the government together to mount a response [to COVID-19]. We’ve developed a whole range of policies to ensure that remote communities and Aboriginal communities are protected from introduction of the virus. That included listening to community calls for restrictions on travel. By March 26, we essentially had a quarter of the Australian landmass under [Biosecurity Act] restrictions. As of today there have been only 60 cases of COVID-19 in Aboriginal and Torres Strait Islander people, not a single one of them in a remote community. This is an excellent result compared to how many First Nations communities have been affected by this virus worldwide.

Every decision was made in true partnership with the Aboriginal health sector. If you don’t do that, then there’s a potential of these measures being perceived as reminiscent of the darker times of Australian history where governments were imposing limits on movement for Aboriginal/Torres Islander people. This time, the communities themselves were asking for the federal government to use its powers to limit access, and we responded to that request.

How else is the Australian government protecting people in remote and Indigenous communities?

We’ve worked to strengthen all the other aspects of our health system that relate to COVID-19. We’ve strengthened the capacity for aeromedical retrievals and medical evacuations, so that if there was a case in a community, the system is ready and agile to respond. We’ve also rolled out point-of-care tests across 85 remote communities for diagnosis of COVID-19 in the primary care setting using the same technology that is used in laboratories, but in a more compact desktop platform, which in some cases will cut the time from specimen collection to diagnosis from nearly two weeks in some of the more remote communities to 45 minutes. I’ve also been involved in the broader health approach, including rolling out nearly 150 respiratory clinics to ensure that the health system capacity is preserved while we have a specialized pathway for COVID-19 care.

Tragically, 103 people have lost their lives, but compared to what an uncontrolled outbreak would have been, we think Australia’s response to date has been extremely effective.

What are your next steps (and challenges) in coming months?

In the next few months we maintain the current approach as some of the movement restrictions are relaxed. But we keep ensuring that we have the capacity to rapidly identify, contain, and respond if an outbreak occurs.

It’s always the irony of specialties like public health that when we do our job well, no one notices, or people start to say that we exaggerated and we over-reacted. We are starting to see some public commentary along the lines of: “Well, we clearly went too far. We didn’t need to do this. The virus wasn’t that bad.”

We are on a winning path, but we haven’t won yet. We’re still in the midst of it. This is not going to be a sprint, it’s going to be a marathon. So we’d better stay prepared to keep talking about COVID-19 for quite some time.