The Royal Children's Hospital Melbourne

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Immigrant Health Service

COVID-19 Immigrant health

Vaccine information - main sources
WHO, Commonwealth Department of Health (DH), and cloud view (includes English translations) Victorian DH, Victorian Covid vaccination guidelines, NCIRS, MVEC, University of Melbourne vaccine updates
As of 1/8/2021
Covid cases - World - 198.0M and Australia - 34,384
Deaths - World - 4.22M and Australia - 924
The overall case fatality rate is ~2%. Deaths increase with age (after 50y and more so older than 70y) pre-existing medical conditions, and are higher in Black, Asian and minority Ethnic (BAME) in US and other data. The risk for for serious outcomes exists across the age spectrum, and outbreaks in other countries have caused thousands of deaths in young adults.
Vaccine safety and development process - Australia is following its normal process for vaccine registration and monitoring through the TGA.
Types of vaccine (WHO and also see UoM updates)
Pfizer - mRNA vaccine - uses RNA to generate a protein that itself safely prompts an immune response - 2 doses 3 weeks apart - patient information (includes translated) - age 16y+
AstraZeneca - viral vector vaccine - uses a safe virus that cannot cause disease, but serves as a platform to produce coronavirus proteins to generate an immune response - 2 doses, 8-12 weeks apart (can be as early as 4 weeks apart if needed) - patient information (includes translated)
Vaccine effectiveness (NCIRS) - information from trials in adults (including older adults), trials are ongoing in children
Comirnaty-Pfizer - 95% effective preventing people getting sick with Covid, 85% effective at preventing hospital admission for Covid
AstraZeneca (AZ) - 62-70% effective preventing people getting sick with Covid, 95% effective at preventing hospital admission for Covid
It is not yet clear whether Covid vaccination can prevent transmission of infection (it is possible someone who is vaccinated could still become infected and pass on the infection to others)
Vaccination numbers - World - 4.11 billion doses (2.21B at least one dose, 1.14B people fully vaccinated) and Australia 12.32M doses
Australian Rollout strategy
1a - border/quarantine workers, frontline healthcare workers (HCW), aged care and disability workers and residents
1b - adults 70y+, other HCW, Aboriginal people 55y+, younger adults with medical conditions/disability, essential workers (EW), carers for elders/people with disability/people with specified medical conditions
2a - adults 50y+, Aboriginal people 18-54y, other high risk EW
2b - all other adults
3 - children (pending trial information and approval processes)
The vaccine is free for everyone in Australia, even if they don't have Medicare
The vaccine is not mandatory, people will not get a choice of vaccine, people who have had covid infection should still get the vaccine.
ATAGI recommendations 8/4/21 - Pfizer preferred over AZ for adults <50y, evaluate individual risk benefit of AZ vaccine for for adults <50y, OK to have second dose of AZ vaccine if no serious adverse effects with 1st dose
New Victorian guidelines 27/5/21 - adults aged 40-49y eligible for Pfizer vaccine
ATAGI recommendations 17/6/21 - Pfizer preferred vaccine for age 16-59y
How do I get vaccinated? - check eligibility (also now has languages), sites include a GP (site finder), respiratory infection clinics, State run clinics, and may include workplaces.
Continue normal medicines, seek medical advice if on immunosuppression, immunotherapy, chemotherapy or anticoagulants (heparin), allow 14 days between covid vaccine and other vaccinations (including flu vaccine)
Not yet routinely recommended in pregnancy, OK if breastfeeding
You will need a second dose of the same vaccine (3-6 weeks later Pfizer, 8-12 weeks later AstraZeneca)
Consent process - ATAGI guideline on consent
Side effects and what to do if you get them
All vaccines can cause side effects, usually these are mild and last 1-2 days. Common side effects include a sore arm, fatigue, headache, fever and muscle aches - take panadol or ibuprofen if needed. Respiratory symptoms (coryza/cough) are not associated.
Serious side effects are rare:
Anaphylaxis - AstraZeneca ~ 1/1,000,000; Pfizer ~ 1/200,000 (ATAGI and ASCIA) - typically within 15 minutes, mostly in people with a past history of drug allergy, and with good recovery with treatment (CDC)
Thrombosis and thrombocytopenia (low platelets) syndrome (TTS) after the 1st dose of AstraZeneca vaccine ~4-6/million, usually within 4-20 days and more common in women and <50y - see ATAGI. There has not been a higher rate of more common blood clots (including DVT/PE) - see DH statement on benefit and risk with AZ vaccine
ATAGI and TGA updates - TTS - 90 cases, now using CDC classification - 35 tier 1, 26 tier 2 (total 6.3M vaccine doses); median 12 days post dose (range 1-54) 27 of these required ICU, 5 deaths (5.5% total cases).
estimated risk TTS per 100,000 AZ doses: 3.1 age < 50y, 2.7 age 50-59y, 1.4 age 60-69y, 1.8 age 70-79y and 1.9 age 80y + - current monitoring suggests earlier detection, good surveillance, and higher survival in Australia compared to other countries.
Covid vaccine side effects are being closely monitored by AusVaxSafety - 1,820,321 people have provided information 3 days after their vaccination - overall 53.9% reported no side effects, 46.1% reported any side effects, and 0.9% needed to visit a doctor or emergency department - separate information for Pfizer and AZ vaccines available
Record keeping - vaccines are recorded on the Australian Immunisation register (AIR) - you do not need Medicare to have an AIR record. People can also apply for an Individual Health Identifier (IHI, with certified proof of identity) - you do not need an IHI for AIR records either. Covid vaccination does not affect Centrelink payments.
Questions on vaccinations - Commonwealth - is it true?, NCIRS, MVEC, inc immunosuppression, allergies, hesitancy, and Victorian DH translated
And still always get tested immediately if you have symptoms and also check in using the Services Victoria app
Key data sources

RCH – also PPE, COVID Clinical Practice Guideline and Learning Hero resources (intranet only)
State – DHHS (includes Chief Health Officer update, case definition, resources, stay at home restrictions, and Community services sector plan and roadmaps)
Free testing for migrants and asylum seekers and 'getting tested' advice (including test locations)
Data dashboard and Healthcare worker data
Roadmap to reopening
Schools - modelling report
Victorian government updates (includes links to health, financial supports, schools, public sector)
Federal – Department of Health and Australian live guidelines
Australian government updates - including restrictions in States/Territories and 'restriction checker' by activity for jurisdictions
Covid vaccines - and information in language
DHA - advice in language
Australian numbers
Global numbers and WHO Coronavirus
Covid-19 kids research updates and vaccine updates (University of Melbourne), and Research database
National Refugee-led Advisory and Advocacy group - COVID-19 consultation report
Mobility in the time of Covid-19 - Zolberg Institute on Migration and Mobility - including 14 principles of protection.

Timeline related to migration

31 Dec 2019 – Pneumonia cases in Wuhan, China reported to WHO regional office
25 Jan 2020 – Australian restrictions on travel to and arrivals from China
30 Jan 2020 – WHO declares public health emergency of international concern
01 Mar 2020 – Australian restrictions on travel to and arrivals from Iran
11 Mar 2020 – WHO declares pandemic
13 Mar 2020 – Expanded MBS telehealth item numbers
16 Mar 2020 – Victoria declares State of Emergency
16 Mar 2020 – IOM and UNHCR suspend travel for refugees. People with a 202 visa may still travel to Australia pending flight availability, quarantine applies to international arrivals
18 Mar 2020 – DFAT issues standing advice to not travel overseas, with subsequent closure of many transit hubs
18 Mar 2020 - Guard at Kangaroo Point APOD in Qld tests positive for coronavirus - see media reporting
21 Mar 2020 – Victorian Government announces $1.7B economic survival package, including a $500M Working for Victoria fund
23 Mar 2020 – Stage 1 restrictions Victoria
24 Mar 2020 – Prime Minister announces a ban on all overseas travel (with limited exceptions), and advice to avoid all non-essential domestic travel
24 Mar 2020 – Detention visitor program suspended
25 Mar 2020 – Stage 2 restrictions Victoria – non-essential businesses close
28 Mar 2020 – Enforced 14 day quarantine for all international arrivals in Victoria
29 Mar 2020 – New Coronavirus supplement announced – $550/fortnight in addition to existing payments through JobSeeker, Youth Allowance, Special Benefit, Parenting Allowance and others - see fact sheet
30 Mar 2020 – Stage 3 restrictions Victoria – to apply for 4 weeks, no more than 2 people in a gathering, only 4 reasons to be out (essential supplies, healthcare, exercise, work/study if required), playgrounds closed), restrictions now enforceable
30 Mar 2020 – Federal Government announces $130B JobKeeper payments – providing affected businesses with $1500/fortnight per employee (70% median wage) – for citizens, permanent residents, and special category visa (SCV) holders – see fact sheet
31 Mar 2020 – OHCHR, IOM, UNHCR and WHO joint press release - The rights and health of refugees, migrants and stateless must be protected in COVID-19 response
31 Mar 2020 – CDNA guidelines for COVID in correctional and detention facilities - later revised Jun 2020, and Aug 2020
2 Apr 2020 – Federal government announces free childcare – see Department of Education, Skills and Employment Fact sheet, and media reporting
4 Apr 2020 – National COVID-19 Clinical evidence taskforce announced
7 Apr 2020 – Victorian government announces school students to learn from home in term 2
12 Apr 2020 – Additional Victorian Government funding ($59.4M) for mental health during COVID – see media release
17 Apr 2020 – Additional Victorian Government funding ($40.2M) for crisis accomodation and specialist services for family violence
23 Apr 2020 - Additional Victorian Government funding (S77.5M) for vulnerable children and families - including additional payments for foster carers
May 2020 - Additional Victorian Government funding ($17M) for people with disability
6 May 2020 - NRAAG - COVID-19 consultation report
6 May 2020 - RCOA Summary of April 2020 Working Group on Resettlement Briefing on Covid-19.
3 Jun 2020 - UNHCR Policy Brief - Covid-19 and People on the Move - also see commentary by Gillian Triggs, Assistant High Commissioner for Protection.
18 Jun 2020 - UNHCR and IOM announce resumption of resettlement travel for refugees
20 Jun 2020 - Victorian worker support payment ($1500)
30 Jun 2020 - Victorian government announces further lockdowns by postcode - see Premier's media release.
3 Jul 2020 - Lockdown of public housing high rise towers in Flemington - see DHHS information and media reporting
7 Jul 2020 - Victoria announces return to Stage 3 restrictions from midnight Wed 8 Jul 2020
10 Jul 2020 - Victoria asks all people to wear masks in public where social distancing not possible - see DHHS information and media reporting
12 Jul 2020 - Victoria announces return to remote learning for students in prep-year 10
13 Jul 2020 - Guard at the Mantra Preston APOD tests positive for coronavirus - see media reporting
13 Jul 2020 - Extreme hardship program - for people unable to access other Victorian or Commonwealth support, including temporary and provisional visa holders and undocumented migrants (payment of $400 for a single adult, more for families, with a possible 2nd payment after 2 months) - phone - 1800 855 240 (available to support eligible people submit an application).
19 Jul 2020 - Face masks mandated in Victoria from 22 Jul 2020 - for all people aged 12 years and older
21 Jul 2020 - Job Keeper program extended to 28 Mar 2021, with new changes announced including tiered payments (full time workers $1200/fortnight, part-time workers <20 hours/week $750/fortnight), increased checks of eligibility (business turnover), and new conditions for childcare commencing immediately. Changes to payments commence 28 Sep 2020, with further reductions from 4 Jan 2021.
2 Aug 2020 - State of Disaster and Stage 4 restrictions announced in Victoria (note criteria for onsite supervision in Education section of this document and childcare permits).
Aug 2020 - Victorian coronavirus test isolation payment ($300)
10 Aug 2020 - home based testing for vulnerable communities - 'Call to test' (GP referral required)
13 Aug 2020 - Victorian government announces 'Working together for multicultural communities' - $14.3M additional funding.
14 Sep 2020 - Further 2 weeks of stage 4, although curfew 9 pm, exercise - 2 hours exercise/outdoor time daily - 2 people or a household; visitors - those living alone, or single parent - one nominated visitor; distance - 5 km zone, education: remote learning unless exemption
24 Sep 2020 - Job Seeker/Coronavirus supplement payments reduce to $250/fortnight (until 31 Dec 2020, then to $150/fortnight until 31 Mar 2021), also with mutual obligations reinstated, and increased threshold for additional income prior to reduction of payments (to $300).
28 Sep 2020 - Victoria moves to '2nd step' out of lockdown, face masks, curfew stops, exercise as above; up to 5 people from 2 households outdoors, visitors as above, distance - 5 km zone, education - Childcare restarts
28 Sep 2020 - information on DHA transitioning people in community detention to final departure BVE - initially Qld, NSW, SA, subsequent stay for Victoria
1 Oct 2020 - Announcement Extreme hardship payments doubled - see Premier's media release
Oct 2020 - very small numbers of offshore arrivals recommence
5 Oct 2020 - education - Kinder restarts and year 12 GAT testing the same week
12 Oct 2020 - education - prep-2 and years 11-12, and specialist education restarts, otherwise remote learning unless exemption
22 Nov 2020 - 'third step' - curfew - stops;  distance - no restrictions; outdoors - up to 50 people, visitors - household visitors - up to 15 visitors, education - staged return to school for years 3-10
24 Nov 2020 - Victorian State Budget - includes $3.9 million for asylum seekers in 2020-21, and free 3-year old kindergarten (15 hrs weekly) for all refugee and asylum seeker children from 2021 across Victoria.
7 Dec 2020 - face masks public transport/taxis and shared vehicles/supermarkets and department stores, outdoors - up to 100 people, visitors - household visitors - up to 30 daily (can be across different visits); international arrivals to Victoria restart
18 Dec 2020 - new cases of Covid in NSW (Northern Beaches) and face masks also applied to airport terminals in Victoria
18 Dec 2020 - Refugee Council of Australia (RCOA) report - Homelessness and hunger among people seeking asylum during Covid-19
21 Dec 2020 - Hotel quarantine inquiry final report.
Jan 2021 - Medevac refugees released from APODs in Victoria - see ASRC summary numbers
12 Feb 2021 - snap 5 day lockdown in Victoria, and tightening of restrictions - 5 km rules, essential reasons to leave home, 2 hours exercise, masks inside and outside
17 Feb 2021 - Victorian restrictions change - masks inside and outside if social distancing not possible, max 5 visitors, max 20 people outside
22 Feb 2021 - Vaccine rollout commences - stage 1a - border/quarantine, frontline health, aged care/disability staff/residents
26 Feb 2021 - Victorian restrictions eased again - masks on public transport, supermarkets, department stores
14 Mar 2021 - Telehealth extended to 30 June 2021 - see PM media release and MBS guidelines (note different for GPs)
17 Mar 2021 - Minister Hunt announces booking system for GPs - concerns then raised by GPs around lack of notice - see media
22 Mar 2021 - Vaccine rollout stage 1b - adults 70y+, other HCW, Aboriginal people 55y+, younger adults with medical conditions/disability, essential workers (EW)
26 Mar 2021 - Victorian restrictions eased - masks on public transport/ride-share, hospitals, airports/flights, symptoms; max 100 visitors, max 200 people outside, workplaces 100%, most venues 75%; 1 person/2m²
28 Mar 2021 - Jobkeeper supplements and tenancy protections end
31 Mar 2021 - Jobseeker coronavirus supplement payments end, and temporary waiver for newly arrived residents waiting period ends
8 Apr 2021 - ATAGI recommends Pfizer preferred vaccine for adults <50y, with PM press conference.
3 May 2021 - Vaccine rollout stage 2a - AZ vaccine for people >50y at Cth and State services, then 17 May 2021 - same in general practice
24 May 2021 - new community acquired cases in Victoria, with a rapidly increasing number of exposure sites
27 May 2021 - Victoria opens vaccination to people aged 40-49y
28 May 2021 - 7 lockdown for Victoria, masks inside and outside, 5 km, 5 reasons to leave home only, schools move to online - see guidelines
2 Jun 2021 - further 7 days lockdown announced for Victoria, 10 km radius
3 Jun 2021 - Federal government announces 'temporary covid disaster payments' for people in greater Melbourne area with <$10,000 in 'liquid assets', $500 if work >20h, and $325 <20h.
10 Jun 2021 - lockdown lifted in Victoria
16 Jun 2021 - first case of delta variant in NSW --> becomes a more widespread outbreak
17 Jun 2021 - ATAGI recommends Pfizer as preferred vaccine for age 16y - 59y
25 Jun 2021 - NSW commences lockdown, followed rapidly by lockdowns in Queensland, NT and WA
28 Jun 2021 - PM announces AZ vaccine available to anyone aged 18y+ by choice, and announces new no-fault indemnity scheme for GPs - it is not clear whether this scheme includes nurses/specialists, and details are currently unclear - see media reporting
15 Jul 2021 - 5 day lockdown commences at midnight after new cases of covid delta variant in Victoria, later extended for a further 2 days, ending 28 July 2021
23 Jul 2021 - TGA approved Pfizer vaccine for 12-15 year olds

Telehealth

Like many services, Immigrant health transitioned to telehealth for many consultations in 2020 - a high proportion of our patients rely on public transport, and there are challenges with social distancing in a family based clinic model working with interpreters. In 2020 - direct attendances were limited to targeted visits where examination, tests, or immunisations were essential. In 2021 - we may still complete some visits by telehealth, including 1st visits where families prefer - which will allow us to ascertain transport and technology options.

Quick tips

Data usage: HealthDirect telehealth uses ~230 MB on a mobile device and 450 MB on a PC for a 20 minute call – similar to Skype or FaceTime, and less than half the data of an HD YouTube video. Data use is more on three party consults, and less on lower speed internet connections. There is no data use while waiting for the consult to start.Phone companies
Functions: HealthDirect allows clinicians to open a chat function, share a screen and use a whiteboard function and send messages (in language!) via email or SMS
Three party consultations: work well for interpreting or for JMS supervision, however data use increases which may affect call quality.
Billing:
Consults should record consent for telehealth and bulk-billing – verbal consent is adequate if the consult is not recorded. See ACRRM consent form for an outline of benefits and risks.
Previous telehealth item numbers – Item 112 – attendance by video conference, patient not admitted, and located within a telehealth eligible area and at least 15km away from physician – see health workforce calculator - select ASGS - area RA2 or greater eligible (RA1 = metropolitan). Use together with 110, 116, 132, 133.
New temporary (until 30/9/2020 - extended to 3/2021 & then 6/2021) telehealth item numbers are available – for bulk-billed, non-admitted patients across a range of disciplines. See table of MBS item numbers:
Specialist telehealth – 92422¹³²92423¹³³91824¹¹⁰ 91825¹¹⁶ 91826^{minor attendance}   92140¹³⁵92141¹³⁷
Specialist telephone – 92431¹³² 92432¹³³91834¹¹⁰   91835 ¹¹⁶   91836^{minor attendance} 92143¹³⁵ 92144¹³⁷

Telehealth resources

Health Direct - Guidelines for clinicians and patients, and translated
RCH Telehealth site
RACP telehealth resources
BMJ Editorial – Video consultations for covid-19.

Translated resources

DHHS - Coronavirus translated resources (57 languages – note increasing number of excellent resources, inc picture-based resources and videos)
Face masks - subtitled videos (also how to make a mask)
Department of Home Affairs - 63 languages, wide range of information
SBS audio resources - 65 languages
Health Direct - translated
Health Translations – Coronavirus
Department of Health – Coronavirus translated resources (84 languages) and vaccine information
Job Keeper - translated information
Job Seeker - translated information (drop down box)
NDIS - Translated information on coronavirus and NDIS
RCH - Translated resources for parents
Refugee Council of Australia (RCOA) - COVID resources
Vaccines - Cloud view of translated resources (this view includes English versions) and Victorian DH translated
WHO – WhatsApp Covid-19 Facts - includes Arabic, French, Spanish, English
US Society of Refugee Healthcare Providers resources.
Supports

Emergency relief and food

Summary of Victorian payments - and June 2021 announcements on additional funding
Emergency relief - temporary/provisional/undocumented migrants (Red Cross) - Extreme hardship program - (payment initially $400/single adult, more for families, (increased to 800/single adult as of 1/10/2020) with a possible 2nd payment after 2 months) - phone - 1800 855 240 (available to support eligible people submit an application)
Family recovery program - statewide support program for CALD families who have been impacted by Covid (positive diagnosis, close/secondary contacts, required to self-isolate or quarantine) - to refer email frp@dffh.vic.gov.au, and either ask for a referral form, or include the following details:
Client name, address, contact details
Eligibility - Covid-19 positive, close or secondary contact, public health order to self-isolate or quarantine; and CALD
Interpreter required and language
Type of support required - education, employment/training, mental health)
Referrers name, organisation and contact details
Verbal consent to share details
Foodbank (Statewide service)
RCOA - services - select area, then select 'food' or 'everyday things'
Rental relief payments (Housing Victoria, up to $2000) - criteria - revised rental agreement with reduction/mediation (not deferral), and income/proportion of income spent on rent thresholds (Note - no residency requirements).

Childcare and schools
Department of Education and Training (DET) - General, Learning from home for schools, Learning from home for parents – and translated versions (23 languages)
FUSE (includes grade/level based resources from early childhood onwards, DET)
Khan academy – free multilingual teaching and learning resources.

Employment related and income support

Summary of Victorian payments - includes worker support payment ($1500) coronavirus test isolation payment ($450) and extreme hardship program (= Red Cross Emergency Relief) - phone - 1800 855 240 (available to support eligible people submit an application)
Coronavirus supplement was in place until 24 Sep 2020 – $550/fortnight in addition to existing payments through JobSeeker, Youth Allowance, Special Benefit, Parenting Allowance and others. There are provisions around faster access, and waiving the newly arrived residents waiting period (NARWP). As of 24/9/2020 - payments reduced to $250/fortnight (between 25 Sep 2020 - 31 Dec 2020), also with mutual obligations reinstated, and increased threshold for additional income prior to reduction of payments (to $300).
JobKeeper payments – provided businesses with $1500/fortnight per employee (70% median wage) - for citizens, permanent residents, and special category visa (SCV) holders – see fact sheet. Payments remained in place until 28 Sep 2020, then Job Keeper changes included tiered payments (full time workers $1200/fortnight, part-time workers <20 hours/week $750/fortnight), checks of eligibility (of business turnover), and further reductions from 4 Jan 2021.
Household support payments – 2 separate payments of $750 were available in 2020 for social security and income support recipients and eligible concession card holders (includes carer allowance and carer payment). The first payment was made from 31/3/2020 and the second from 13/7/2020
Foster carers - State government funded supplementary payments of $600 per child (late May 2020)
Other possible payments - Services Australia
RCOA - services - select area, then select 'getting work'
Detailed information - eligibility for payments and Medicare for temporary visa holders (Red Cross)
Stage 4 restrictions and employment rights (Job Watch, Employment Rights Legal Centre).

Mental health

HeadtoHelp - Mental health hubs - 15 locations
Department of Health (Vic) – mental health resources and additional funding announcements June 2021 - notable focus on child mental health
Beyond Blue – Mental health and COVID-19
Paediatrics.online – collated resources.

Other

RCOA - service guide (search by area and then select area of need)
Family violence
Summary of the Australian Government Treasury response
Services Victoria check in app

People seeking asylum

Are not eligible for supports directed to permanent residents/citizens, see Asylum seekers webpage for additional resources.
Refugee Council of Australia - service guide (search by area)
SRSS – evidence for new applications is unchanged, clients should contact their case management agency.
Free childcare – see media release,  DESE Fact sheet and  media reporting - free childcare was not limited by residency status but ended mid-July 2020.
Covid testing and vaccination is free for everyone, regardless of visa or Medicare status
Disability supports, including through HACC.
Housing - July 2021 - $355,000 short term COVID-19 Asylum Seeker emergency rental brokerage fund providing emergency assistance to maintain secure housing and assist with rental arrears. The funding is being administered through the NASAVic HEF mechanism via Launch Housing, and can be accessed via ASRC, Red Cross, Uniting, Baptcare and the Brigidines.
Support for Asylum Seekers initiative – $3.9 million announced in the Victorian State Budget (May 2021), extending case coordination, basic needs, utilities and homelessness assistance; mental health support and primary care support.

Other resources

Australian Government Coronavirus app
NDIS and COVID-19 – Minister's media release, and information and support
Community services providers (DH)
Resources for children – Raising Children Coronavirus, and paediatrics.online – collated resources.

^{Immigrant health clinic resources. Author Georgie Paxton, Sophie Oldfield, Linny Phuong, 2 April 2020, updated 1 August 2021. Contact: georgia.paxton@rch.org.au}