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It’s an economic catastrophe and a public health disaster. Time to prioritise health?

Introduction by Croakey: The exponential spread of the Omicron variant is causing “an unprecedented, and preventable, economic catastrophe”, through the impact on supply chains, workforces, and economic activity, according to an economist, Dr Jim Stanford, Director of the Centre for Future Work, at the Australia Institute.

Writing in The Conversation, Stanford says the failure of some political and business leaders to recognise that a healthy economy relies on healthy people has resulted in “one of the worst public policy failures in Australia’s history”.

“This catastrophe was visited upon us by leaders – NSW Premier Dom Perrotet and Prime Minister Scott Morrison in particular – on the grounds they were protecting the economy. Like a Mafia kingpin extorting money, this is the kind of “protection” that can kill you,” he wrote.

Stanford says the first economic priority during a pandemic must be to keep people healthy enough to keep working, producing, delivering and buying.

Meanwhile, public health researcher Alison Barrett reports below on the series of events that have led to a public health disaster; it is timely reading as National Cabinet is expected to consider further weakening public health measures, to allow more close contacts to return to work.


Alison Barrett writes:

As Australia’s COVID-19 case numbers continue to increase, New South Wales and Victoria today both reported 21 deaths from the virus. In NSW, seven of the deaths reported were historical, after waiting for coroner’s reports*.

The reopening of state borders and relaxation of COVID-19 restrictions at the same time as a new variant, Omicron, arrived in Australia has resulted in a public health disaster at levels this country has not yet witnessed during the pandemic.

In the United States, a number of states have recently declared a state of emergency due to the Omicron variant, and on Tuesday, the United States recorded its highest hospitalisation rate since the beginning of the pandemic. In London and Scotland, the military has been called in to support hospitals overwhelmed by cases.

The World Health Organization (WHO) reiterated its cautions about Omicron in a 7 January update, warning that the overall risk related to this variant remains “very high” for a number of reasons.

“The rapid increase in cases will lead to an increase in hospitalisations, may pose overwhelming demands on healthcare systems and lead to significant morbidity, particularly in vulnerable populations,” said the update.

These concerns are playing out in Australia, where hours spent in testing queues, days waiting for results, bare supermarket shelves due to disruptions in supply chains, and sick people not being able to access prompt emergency care are just some of the disruptions people have experienced in recent weeks.

Supermarket, Port Adelaide, 12 January, 2022. Photo by Marie McInerney

Except for Western Australia, every state and territory had opened their borders by 19 December 2021, and subsequently experienced an increase in cases due to the simultaneous relaxation of restrictions and the spread of the more infectious Omicron variant.

Nearly two years after the nation’s first COVID-19 case was recorded, Australia passed one million total confirmed COVID-19 cases on Monday 10 January 2022. More than half of those cases were reported in the last week.

Professor Mary-Louise McLaws is an epidemiologist at UNSW and WHO adviser
Source: ourworldindata.org

In reality, the true case numbers are likely to be well higher than that, as many people have had difficult accessing testing ­– whether by polymerase chain reaction (PCR) and rapid tests.

To reduce the pressure on PCR testing, people have been advised by the Federal Government to source and do their own rapid antigen test (RAT).

Amid high costs and widespread shortages of the tests, many Australians have been unable to access them. If fortunate enough to find a test, until last week their results were not being reported in any jurisdiction.

Although online reporting systems have since been implemented in states and territories, except for ACT, reporting requirements are different in each jurisdiction.

Many positive cases will go uncounted in official figures – with implications for clinical care as well as the development of knowledge about the impact of Omicron, not only upon patients’ acute and long-term symptoms, but also upon healthcare and other systems.

NSW Health Minister Brad Hazzard today announced that it would become mandatory, under a public health order, to report positive RAT results. Many concerns have been raised about threatening to fine people for failing to report results.

South Australia followed suit, with Premier Steven Marshall announcing that as of Thursday, it will be mandatory to report positive RAT results.

In addition to cost and availability issues, it is important systems are suitable for people with different language and health literacy levels.

The president of the Royal Australian College of General Practitioners (RACGP), Dr Karen Price, said last week that “phone conversations and online forms can be challenging for some people, including those from a culturally and linguistically diverse background”.

Equitable access to healthcare and health systems is important, particularly when COVID-19 has exacerbated already existing inequities.

In efforts to reduce pressures on PCR testing systems, National Cabinet made changes to the definition of ‘close contact’ and subsequent changes to testing requirements.

‘Close contacts’ are now only required to be tested if they have been in the same room for four hours with someone who is positive. This is problematic as transmission of SARS-CoV-2 can occur in a few minutes or less.

All states and territories except SA have applied the new definition for close contact, meaning that many people are no longer required to test and isolate for COVID-19 and that many people with the virus in the community are likely to go undetected.

While taking pressure off the PCR testing and pathology system, the policies to reduce the amount of testing required make it difficult to monitor the development of the virus and isolate positive cases early.

As Professor Jonathan Karnon and colleagues from Flinders University have written: “One of the benefits of population wide active testing for cases is that it allows countries to rapidly identify new cases, isolate affected individuals and their close contacts and slow further transmission of the disease.”

The reduced surveillance and testing also goes against the WHO’s most recent priority recommendations for managing the spread of the Omicron variant.

Spread of the virus, especially if undetected, could be disastrous for some populations, including those in rural and remote areas where access to health and other services was already limited prior to the pandemic; and in Aboriginal and Torres Strait Islander communities, particularly those with low vaccination rates.

Concerns for Aboriginal and Torres Strait Islander communities

Impacts of COVID-19 in Aboriginal and Torres Strait Islander communities are already being felt. The first cases in the APY Lands in northern SA were reported last week, resulting in inbound closure to everyone except essential workers.

While closing the community was important to protect the health of its people, many Anangu are now stuck in Adelaide. A charter bus scheduled to return them to country yesterday was cancelled due to COVID-19 detected among passengers in pre-departure screening.

Concerns have also been raised about the impact of food insecurity and failing supply chains upon Aboriginal and Torres Strait Islander people and about the lack of accurate data about the spread of COVID-19 among communities.

Dr Jason Agostino, medical adviser with the National Aboriginal Community Controlled Health Organisation (NACCHO), said not all state testing sites and pathology companies included Aboriginal and Torres Strait Islander status in their reporting of PCR results.

“Laboratories shouldn’t be able to be accredited unless they have a way of reporting Indigenous status,” he told Croakey’s Dr Melissa Sweet in an interview.

The move to rapid testing was also contributing to this critical information gap, which had significant implications for patient care.

NSW and Victoria were including Indigenous status within their self-reported system of RAT results, but Queensland and Tasmania were not, he said.

Agostino said he was frustrated and worried that many of the sector’s requests for help from Federal and state governments had not been acted upon.

The sector had long been asking for supplies of RATS for screening of staff, for improved data collection, and for appropriate Personal Protective Equipment (PPE) supplies for staff seeing patients, but these requests had been left hanging by the Government.

The Government’s scale-back of telehealth services, restricting access to services via telephone, was also affecting care for Aboriginal and Torres Strait Islander people, who often did not have access to video links.

“These are all the things we were asking for through Delta; had we been meeting these needs through Delta, we’d be better prepared for Omicron,” said Agostino. “I’m frustrated that the steps we could have taken earlier weren’t taken.”

He said food security was always an issue, and that anything affecting supply chains would hit communities harder, both in terms of cost and access. “It’s a big concern,” he said.

One positive story was that ACCHOs generally had avoided problems with the supply of vaccines for children returning to school. “We have largely avoided the problems around access; our services have a larger amount of supply recognising the priority and that we have more young kids. That is a positive story. That seems to be working out OK,” he said.

Aged care crisis

As COVID-19 outbreaks occur in aged care across the country, the Australian Nursing and Midwifery Federation (ANMF) has expressed “its concern that the Morrison Government has no real plan to protect vulnerable nursing home residents and staff during the pandemic”.

As of 7 January, 3,205 people in aged care, including staff and residents, currently have COVID-19 across 495 facilities.

Staff levels are “dangerously low”, the ANMF said, and many aged care facilities are waiting for RATs and booster vaccinations.

Outbreaks have been reported in prisons across the country, including in SA, Tasmania and Cairns, and also in refugees in the Villawood Detention Centre.

“Government inaction and COVID protocol failures means that all of the 450 Villawood detainees are at high risk of infection. The staff shortages magnify the risk that the Villawood outbreak cannot be safely managed,” a spokesperson for the Refugee Action Coalition, Ian Rintoul, told SBS.

Overwhelmed

The rapid increase in cases over the past three weeks is having a devastating impact on the nation’s health system and already fatigued healthcare workers.

With more than 4,000 Australians currently in hospital with COVID-19 – including 342 in intensive care and 92 on ventilators – hospitals are overwhelmed caring for them as well as trying to maintain usual care to other patients, with many healthcare workers themselves away from work sick.

Dr Omar Khorshid, president of the Australian Medical Association (AMA), said last week about the situation in NSW:

Look, the reality is our hospitals are under extraordinary pressure, and those long-suffering staff who’ve had a very difficult couple of years, instead of having a break over Christmas, they’ve had their leave cancelled and they’re facing huge demand at the front door of the ED whilst their colleagues, their co-workers, other doctors, other nurses, are falling sick, having to stay at home and look after sick children….

And it’s just not true to say our health system is so resilient it can cope with anything, there are limits, unfortunately.”

Elective surgeries have been cancelled in most states and emergency departments across the country are overwhelmed.

With hospitals under pressure, the Prime Minister asked COVID-19 patients who do not require hospitalisation to contact their GP for care, placing additional burden on them.

Dr Chris Moy, Vice-President of the AMA told the ABC that “it was frustrating that, two years into the pandemic, GPs had been put in this position”.

Moy recommended a mass education program advising the public what to do if they had COVID; this would alleviate some of the pressure on GPs.

Twitter has shared similar calls for governments to provide nation-wide messaging and COVID-19 information.

The WHO advocates for early risk communication and community engagement during the pandemic:

Authorities should regularly communicate evidence-based information on Omicron and other circulating variants and potential implications for the public in a timely and transparent manner, including what is known, what remains unknown and what is being done by responsible authorities.”

Community action

In the absence of sufficient information from governments, community members have volunteered their services – creating social media accounts, such as Facebook groups in Tasmania, Queensland and South Australia, to share exposure sites advised by the people in the community.

The Tasmanian Department of Health website states that “due to the rapid spread of the Omicron variant,” they will no longer publish exposure sites, another indication of how overwhelmed the health system is.

The creator of Twitter account, @COVID-InfoSA, who prefers to remain anonymous, said: “When I saw that people were getting frustrated with the amount of information that SA Health was providing, I wanted to help ease the pressure by posting known exposure locations that the community would either send in or post on other social medias.”

Upon his daily check of NSW Health’s COVID-19 update in early January, futurist Tim Longhurst realised the “official infographic checked by thousands each morning failed to convey the signals that the COVID surge was stretching the health system”.

“Over 5,000 healthcare workers are in isolation; the state’s test positivity rate is above 20 percent; no child under 12 is fully vaccinated and fewer than 15 percent of the state has received their booster shots. These numbers tell a story,” he said.

As someone who thinks it would be better that “the sense of crisis occurs before things really crash”, he believed it was important for the public to see that while the official number of patients in hospital were 2,242, more than 13,000 COVID-19 patients were being cared for in other settings, such as Hospital in the Home, Medi-Hotels and community clinics.

Thus, he created a ‘NSW Citizen COVID Dashboard,’ sourcing publicly available data about vaccination, testing positivity rates, and healthcare data. He publishes every day after the NSW Health data has been made public.

Looking for leadership

Many health leaders, such as Dr Norman Swan, Professor Stephen Duckett and Professor Raina McIntyre, have called for a national strategy and leadership to manage the current and future waves.

Two years into the pandemic, it is staggering that no national or cohesive strategy exists.

This is especially critical as children are due to return to schools at the end of January and Western Australia is set to reopen their borders at the beginning of February.

A change of course is required to mitigate the current situation, relieve pressure on our healthcare system, essential workers and improve the supply of basic and necessary requirements.

In an article describing the impact of the crisis upon family members, the CEO of the Public Health Association of Australia, Adjunct Professor Terry Slevin said:

We were riding the “Open the Economy” train for too long.

Clearly it is too late to stop the virus, but we can slow it down considerably.

Control and contain measures are essential. If we “Let it rip” it will be a disaster from which no one will benefit.”

Note from Croakey: The introduction to this article was amended on 13 January to make it clear that seven of the 21 deaths reported in NSW were historic. Additional tweets were also added below.


More from Twitter




Alison Barrett is a columnist with Croakey. See previous editions of her COVID-19 wrap.

Croakey thanks donors to our public interest journalism fund for supporting this article.

 

 

 

 

 

 

 

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