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Changing Australia’s approach to managing COVID-19 pandemic may help reduce burden on health system

Introduction by Croakey: A change in Australia’s approach to the COVID-19 pandemic is “desperately” needed, according to Executive Officer of the Victorian Allied Health Professionals Association, Andrew Hewat.

In the first article in a series about the ongoing impacts of the COVID-19 pandemic, Hewat says that “fighting COVID is not an all-or-nothing situation”.

Many layers can be applied to drive down transmission and minimise the impact of the virus, including a comprehensive COVID-19 education campaign, improving data collection and focusing on ventilation and indoor air quality.

Reducing transmission and impact of the virus will reduce the burden on the already overwhelmed healthcare system and enable better protection of priority populations and people at greatest risk from COVID-19, he says.


Andrew Hewat writes:

Despite many people believing COVID is over and wanting to move on with their lives, the harsh reality is that COVID continues to have a toll. In 2023, COVID is continuing to kill around 200 Australians of all ages every week.

It was the third leading cause of death in Australia in 2022. We are just coming out of our eighth wave in three-and-a-half years and the number of COVID hospitalisations has not fallen below the baseline of 1,300 inpatients since Omicron started back in December 2021.

On top of the thousands of deaths and hospitalisations, there are tens of thousands more who are suffering the long-term debilitating effects of long COVID. The Australian Institute of Health and Welfare estimates the prevalence of long COVID in Australia to be about 5-10 percent of COVID-19 cases – there have been 11.5 million reported COVID-19 cases in Australia.

COVID is not over.

While the government and business sector keep pushing for a return to pre-pandemic ‘normal’ to sustain the economy, they seem blind to the fact that you can’t have a healthy economy without a healthy workforce.

Importantly from a public health management perspective, you don’t have a health system without healthy healthcare workers.

Pressure on the health system

While people move around in denial, the growing burden of increasing and cumulative sickness is creating labour shortages and crushing our health system.

Pre-pandemic, Australia’s hospitals were already under-resourced and often running short-staffed and under serious workload pressures.

Ambulance ramping and bed-block are not new phenomena that COVID created.

But COVID has taken regular healthcare workload pressure and put it on steroids.

COVID is the proverbial straw that broke the health system’s back. After three-and-a-half years of operating in a crisis response mode, many of our healthcare workers are burning out, suffering mental health stress or simply have left the workforce.

Traditional recruiting countries like the UK and New Zealand have suffered the same health pressures as Australia and are also desperately short of healthcare workers, so the standard fallback of governments to pillage other countries for their skilled labour is failing.

We are all competing for the same shrinking precious resource – healthy healthcare workers.

Healthcare workers are at high risk of catching COVID at work if appropriate protections are not in place. In 2020 around 3,000 healthcare workers were infected at work in Victoria alone.

On any given day, hundreds or thousands of healthcare workers are being forced to furlough because of COVID infections. Each infection takes them out of the workforce, often for considerable time. Each infection increases their chance of developing long COVID and forcing them out of the workforce for a much longer time.

The growing burden of sickness and disability in the community is leading to increasing demand for healthcare – while we are making our healthcare workers sick and seriously depleting our capacity to care for the community.

We are now reaping the ‘rewards’ of successive governments’ inaction on workforce planning and investment. Despite all of this, health employers continue to attack workers’ rights, penny-pinch entitlements, maximise output and generally disrespect their staff.

Unions are regularly hearing from members seeking help over breaches of basic entitlements, failure of managers to consult and pressure to work unpaid overtime.

Governments that rightly approached the acute early phase of the pandemic with an open cheque book approach are now looking to claw back the inevitable debt their necessary actions created.

Meanwhile, nobody has bothered to tell COVID that people are over it and want to move on – the race to normalisation is simply fuelling the ongoing spread of the virus and pressure on the system.

Governments cannot abandon public health strategies to reduce the spread of COVID and simply expect healthcare workers to continue to pick up the tab and battle on with limited and shrinking resources.

The health system will inevitably fail, and we have already seen signs of this with huge numbers of unfilled job vacancies, high rates of Hospital Acquired Infections (not just from COVID), and in Victoria the frequent call of Code Orange emergency response for Ambulance Services, where for several months in 2022 all hospitals shifted to a Code Brown emergency response.

One regional health service in Victoria recently reported over 600 unfilled vacancies, forcing the rationalising or cutting of some services to the public. Hospitals can’t recruit enough staff and the workforce is leaving or burning out. Emergency departments are being overwhelmed, leading to unprecedented waiting times and bed-block, when there aren’t any ward beds left.

At the same time, record surgery waiting lists are continuing to grow, and diagnostic testing, screening, treatment, therapy and imaging, which once were routine and readily accessible, are now subject to long wait times and/or long travel to available services.

Priority populations at risk

Priority populations including the immunocompromised, elderly, very young, disabled and First Nations people have all been left behind.

Not only are these groups at much greater risk from a COVID infection but they are also being excluded from access to healthcare because of the abandonment of masking and HEPA filters and other measures such as a focus on clean air and the screening of visitors in many healthcare settings.

Hospitals are a prime vector for spreading COVID. Immunocompromised and medically vulnerable people know this and fear that a visit to a health professional could make them sick or even cost them their life.

Sadly, no government has presented an exit strategy for COVID or a plan to protect the community, let alone the health sector.

Without healthcare workers, who will look after the sick, injured and dying? And not just COVID patients, but ALL patients. There is no healthcare system without healthcare workers.

Reduce transmission

The most important thing that we need to do is reduce transmission of COVID.

We already have the tools and recipe to do this. And we are not talking about lockdowns, as many COVID-minimisers would lead you to believe.

Fighting COVID is not an all-or-nothing situation. Many layers of mitigation can be applied, many that we have previously used effectively and could reintroduce to drive down transmission, without triggering those fearful of any imposition on their liberties.

Public health education: we need a concerted public health education campaign, as can be seen in New Zealand, highlighting that the pandemic is not over, and there are many things that you can do to reduce your risk and the risks to your family.

People need to know that COVID is airborne, and it travels and hangs in the air like cigarette smoke. Indoor spaces, especially when crowded, present the highest risk of infection. Outdoors is much safer but still not safe if crowded. Ventilation is important – people need to open windows and doors. They need to know that they are infectious before they show symptoms and those around them could be infectious without even knowing it.

They need to know they can spread the virus to their family, friends or co-workers or even a stranger on the bus, infecting others in the community, including those at greater risk from severe COVID.

They need to know that besides the risk of death or serious illness, they are at risk of developing long COVID that could be disabling and stop them from working, playing sport or leading a normal life.

They need to know that COVID is more than just a respiratory infection. There is now an abundance of evidence showing that COVID is a vascular and neurological disease that attacks nearly all major organs and can lead to things like Type 1 diabetes in children, early Alzheimer’s, heart attacks and a multitude of other serious and life changing or limiting illnesses.

They need to know that each COVID infection increases their chances of developing long COVID and also decreases their immunity to fight off other infectious diseases.

Data: we need reporting of the COVID situation so that people can better assess their risk and respond accordingly. This can be short, simple high-level reporting, but it needs to be regular, accessible and accurate.

Introduce ventilation standards that ensure optimal Indoor Air Quality to all public buildings, especially schools.

Enforce Workplace Health and Safety standards throughout all industries, especially health and aged care, disability, education and public transport.

Mask and respirator mandates for public transport and in high-risk settings especially hospitals, health facilities and aged care. People need to know the benefits of a close fitting N95 respirator over a loose surgical mask (and to stop using cloth masks).

Continue equitable access to free PCR testing.

Reinstate reporting and recording of positive RATs in jurisdictions where it is no longer required.

Re-introduce a mandatory isolation period when COVID positive and provide financial support to facilitate this. While expensive, the cost of not doing this is far greater.

Stop relying solely on vaccines (that now have poor uptake) and anti-virals (that have very limited access) and promote non-pharmaceutical interventions such as engineering protections like ventilation and HEPA filters.

Political and economic barriers to mitigation measures

The barriers to implementing such mitigation strategies are generally either based on cost and impact on the economy or the fear of blow-back from libertarians for impinging on their ‘freedoms’. Both these excuses carry little substance.

We saw the pressure on governments from the right-wing media and a vocal minority of protesters lead to the ‘let-it-rip’ policy in December 2021. Australia went from one of the best performing countries for protecting its citizens from COVID, to one of the worst with a progressively staged abandonment of public health mitigations.

Healthcare may be expensive, but hospitals still need adequate funding to function. If we want to attract and retain workers, we need to properly remunerate our highly educated, highly qualified health professionals and their support staff. Instead, we find the different professions competing for the same government dollars – doctors competing with nurses, competing with allied health professionals.

Sadly, allied health professionals are too often the forgotten health workforce, despite being intrinsically woven throughout the healthcare web and critical for so many of the hospital core functions.

On an individual and governmental level, the main barriers to fighting COVID now seem to be a mix of complacency, normalisation of death and disease and a ‘throw-your-arms-up-it’s-all-too-hard’ philosophy.

But COVID is proving to be far more resilient than the decision makers, and it continues to circulate and evolve, creating ongoing surges of mass infection on top of a continuous baseline of sickness, disablement and death.

In April 2020, one infamous world leader optimistically proclaimed the coronavirus pandemic would be gone by Easter that year. Wrong.

In December 2021, the Australian Chief Medical Officer Paul Kelly rejoiced in the coming of Omicron as a Christmas present for all Australians that would lead us out of the pandemic. Wrong, again.

We are now well into our fourth year of the pandemic and there is still no sign of it ending anytime soon. We can hold out hope for a neutralising vaccine, but meanwhile more people are dying and being disabled, and healthcare workers are still being crushed under the pressure.

We desperately need a dramatic change in approach at all levels of society, from political leaders to the person on the street.

Note, the Department of Health and Aged Care has provided a response to some of the concerns raised in this article, which will be published in a future article in the series.

About the author

Andrew Hewat is currently the Executive Officer (former Assistant Secretary) at Victorian Allied Health Professionals Association (VAHPA). He stopped practising ultrasound after 40 years to focus on union work, and is still in daily contact with members across all sectors of allied health: public, private, aged care, disability, community,  many who work in the acute hospital setting with COVID patients daily.

During the pandemic he has been leading VAHPA’s response to COVID. This included being a member of the Victorian state government’s Healthca