A multi-agency response – the Complex Vulnerable Populations Team (CVPT) – was coordinated by the South Eastern Sydney Local Health District (SESLHD) Public Health Unit (PHU), including the Department of Communities and Justice (DCJ), St Vincent’s Homelessness Health Team, Kirketon Road Centre, the SESLHD Priority Populations Homelessness Health Team, the SESLHD Senior Staff Specialist of Drug & Alcohol, and SESLHD senior environmental health officers.
Following notification of a positive case in a shelter or temporary accommodation hotel, an immediate 'stop and stay' verbal direction was issued by the PHU and an outbreak management team meeting called with representatives of the CVPT. A rapid onsite testing response was implemented to overcome barriers to accessing public testing clinics for this population and to incentivise testing participation through offering food vouchers valued between $10 and $25. The 'stop and stay' remained in place until results were received and a risk assessment was completed, usually 12-24 hours post-notification. It put a hold on anyone leaving or entering and was administered by way of cooperation and communication from DCJ and the accommodation management. The risk assessment included a review of floor plans, CCTV, and case and onsite staff interviews to enable a rapid assessment of the level of exposure.
The outcome for those who tested negative to COVID-19 on their day 1 swab fell into one of three contact categories: Close, Casual or Monitor for Symptoms. This, in turn, informed their risk for contracting COVID-19 and their need to isolate. Most commonly, once a case was removed the 'stop and stay' was lifted and all occupants were issued with a notification that they were casual contacts, with a small proportion (perhaps people known to have shared a lift or been in conversation with a case) classified as close contacts. Due to the collaborative strengths of the CVPT it was rarely deemed necessary for an entire hotel or shelter to have a prolonged lockdown.
The CVPT proved to be a highly valuable collaboration and coordination of agencies to assess population risk by location and to minimise spread, disruption, and the costs and trauma of a building lockdown. Later, the CVPT re-oriented the onsite swab team to also offer onsite vaccination to this vulnerable population.
The project demonstrated that DCJ and NSW Health share common goals and can work well together to benefit the vulnerable in local communities. The project also highlighted that PHU risk assessment needed adaptation to respect the differences and complexities of people experiencing homelessness.
A key recommendation from the project is that greater consideration should be given to complex vulnerable populations in future public health orders and emergency responses, and that standard emergency management training should include consideration of complex vulnerable populations.
Toni Cains1, Jody Houston1
