Introduction by Croakey: Many of Australia’s health leaders are concerned that the nation’s health systems are close to reaching their limits and will struggle to cope with a surge in COVID-19 cases.
With 919 locally acquired COVID cases reported in NSW yesterday, the state has broken another grim national record.
Speaking at the daily 11am press conference, NSW Chief Health Officer Kerry Chant was blunt. “I think we have to be very honest that the surge in cases has put stress on both the health system and the public health [response],” she said.
Two major hospitals in Sydney’s western suburbs – the epicentre of the outbreak – will soon begin triaging COVID patients in makeshift units to help manage the surge in cases.
“Both Westmead and Blacktown hospital emergency departments are continuing to receive ambulances and emergency care continues to be available to everyone from western Sydney who needs it,” a Western Sydney Local Health District spokesperson told the Sydney Morning Herald.
And in Victoria, where 45 locally acquired cases were recorded, plans were announced today to fly in 350 medical staff to ease pressures on the state’s health care workers.
While vaccination rates are picking up pace across the country, with more than 300,000 vaccine doses reported today, concerns remain about Australia’s current plans to begin easing restrictions once 70 percent of the eligible population is vaccinated.
Community leaders have warned that a flat national target will leave many high risk groups, who may have lower vaccination rates, “dangerously exposed” to COVID infection.
The Australian Council of Social Service (ACOSS) has written an open letter to National Cabinet calling for vaccination targets that are specific to population groups and locations, citing its Community Sector Vaccination Principles.
It says priority groups may include people in regional and remote communities, from lower socio-economic groups, those experiencing homelessness or insecure housing, people with disability, people with chronic illness, those who are socially isolated, Aboriginal and Torres Strait Islander communities, people from culturally and linguistically diverse backgrounds, people with low literacy levels, children and younger people or different age groups, or people with mental health issues.
The ACOSS document also says that people in a range of detention settings and prisons should be given priority.
International experience has also shed light on the challenges of easing restrictions, even with high vaccination rates. Israel has seen a resurgence of cases since relaxing its restrictions in June, despite 78 percent of the those aged 12 and over being vaccinated.
“It provides a glimpse of what Sydney faces if we lift restrictions without the population being adequately vaccinated,” wrote Professor Raina MacIntyre, head of the biosecurity program at the Kirby Institute at UNSW, in The Conversation.
With COVID pressures growing across the health care system, Croakey canvassed the views of health and medical leaders on how the health system is placed to cope with escalating COVID cases and the actions required to bolster the system.
Question 1
How well is the health system equipped to cope with the likely escalation in COVID-related demand and care for patients displaced by COVID?
Prudence before politics
Professor Jeffrey Braithwaite, Professor of Health Systems Research, Macquarie University
The Australian health system has proven to be remarkably resilient in the face of the changing dynamics and pressures of the pandemic.
If things get away from us with the Delta or other new variants, depending how dire that becomes, that will not be the case. The health system will be swamped.
So, executing timely lockdowns and continuing other sensible public health measures across society will be the main determinants of whether the health system will cope.
Now, whenever I hear politicians make pronouncements to the effect that they are “following the science” or “listening to the medical experts”, I ask myself “how close is this politician to his or her next election?”
Federally, the election must be held on or before May, 2022: in nine months or less. The Prime Minister is pressing the states and territories to be open if vaccination rates reach 70%. Is that for scientific or electoral reasons? The cynic will say it’s all about the next election. But, if the wrong decision is made, it could be a terrible decision for healthcare, vulnerable groups, and the whole of society.
I would argue for prudence and holding the course. We risk unprecedented cases, deaths, and economic mayhem otherwise. I’d go for 90 percent, not 70 percent, vaccination rates, and counsel continuing public health measures, as stringently as possible.
Disproportionate impact
Dr Amy Coopes, journalist and Croakey editor, and a junior medical officer with the Victorian Rural Generalist Program, based in the state’s North East
The very real concern, and one that we are already seeing play out in real time in North East Victoria, is how little it will take to overwhelm rural and regional health services.
On a good day, these are already incredibly stretched facilities staffed lean with very little local reserve, who service geographically sizeable areas with complex patients and a fraction of the access to technology, specialists, and treatments. In Shepparton alone, we have seen more than 420 staff and counting furloughed, requiring emergency reinforcements to be sent from Melbourne just to keep the hospital running. Several areas including ED, paediatrics, medical imaging and dental services, have become exposure sites.
Simultaenously, we see Royal Melbourne Hospital on ambulance diversion due to COVID impacting more than 500 staff, and Westmead Hospital in Sydney on a Code Yellow.
This system is already under strain. In a Phase B world, where concurrent localised outbreaks could see this replicated across the country, there is simply no give. There are no locums (the only way many rural services continue running in a best case non-COVID scenario), there is no surge capacity. No one is coming to care for these communities.
Rural, regional and remote Australians already have worse outcomes, and they stand – again – to be disproportionately impacted by plans to open up the country without a detailed blueprint for accommodating hundreds of thousands of extra cases and thousands more deaths.
This must address staffing in a realistic and properly resourced way, appreciating from experience overseas that a whole generation of doctors and nurses are burning out under the burden of immense moral injury primarily due to system failures.
We cannot expect things here to be any different – and to do so would be the height of hubris.
Mental health demand
Professor Ian Hickie, Co-Director, Health and Policy, University of Sydney’s Brain and Mind Centre
Despite 30 years of national reform plans, the mental health system, as recognised by the 2020 Productivity Commission report and the 2021 Victorian Royal Commission, was fundamentally dysfunctional pre-COVID.
It is characterised by a lack of early intervention, disrupted and dislocated islands of public sector and private care and an over-reliance on emergency departments, acute care and involuntary forms of care.
Hence, it is very poorly positioned to respond to the increase demand for care – particularly among young people and those who are disadvantaged economically and geographically.
Transparency lacking
Jennifer Doggett, health policy analyst, and Croakey editor
We don’t know how well the health system is equipped to cope with the likely escalation in COVID-related demand and that is a problem in itself.
The lack of transparency around health system capacity and any planning that is underway to prepare for increased demand will add to the anxiety the community is already experiencing.
What we do know from past experience with COVID and other emergency and disaster situations is that there are some weak points in our system where problems are most likely to occur, specifically:
- Workforce shortages – our health workforce is a fixed resource. We can build more hospitals faster than we can train more doctors and nurses. With borders closed we can’t use health professionals from other countries to meet our domestic shortages. Even transferring health professionals across state borders to meet local needs could be problematic.
- Poor co-ordination – poor co-ordination is endemic in our health system. This includes between sectors (eg, general practice to hospital and vice versa) and also across areas of state and federal responsibility (see the delay in vaccination aged care staff and residents). COVID places additional demands on systems – public health processes like contact tracing and testing need to co-ordinate with health services and other relevant sectors (police, social security, quarantine). We have seen already how damaging breakdowns in communications between these systems can be (eg, the Ruby Princess).
Unfortunately, it is always communities already under-served by health and social care systems that are most vulnerable when systems are under stress.
In the current COVID situation communities that will be particularly affected include those in rural and regional areas (where there is no capacity to absorb significant increase in demand), Aboriginal and Torres Strait Islander communities (already dealing with health disadvantage), and culturally and linguistically diverse communities, which have not been well-served by COVID communications to date.
Capacity boost
Leanne Wells, CEO, Consumers Health Forum of Australia
There are some re-assuring steps being taken by the Commonwealth and the states to boost the system’s capacity (eg, private and public co-operation, with private hospitals making facilities available, etc). Most/all jurisdictions have set up surge centres to treat patients with COVID.
On the vaccination side, jurisdictions in current lockdowns are also calling on emergent and retired workforce to come forward to join the rollout.
In the longer term, pledges in recent days by the Commonwealth to provide more support to states for hospital capacity for when we hit 80 percent vaccination rate but will still have cases requiring hospitalised care.
Any delays to elective survey are concerning. While not emergency care, access to timely elective surgery such as joint replacements can make such a difference to a person’s quality of life and productivity.
The expansion of telehealth services since the onset of the pandemic last year has played an important role in enabling people, otherwise prevented from getting to the doctor and accessing medicines, to get medical advice by phone or online.
In a rapidly evolving management and treatment field, the COVID Living Evidence Taskforce played a significant role in providing the latest available assessments and results of new and emerging therapies. CHF supports a consumer panel advising the Taskforce.
Collaboration key
Dr Clare Skinner, President Elect, Australasian College for Emergency Medicine
Health care workers are amazing people – hard working, competent, flexible and very compassionate. I have no doubt that we will find a way to get the health system and community through this. But – it will be difficult.
Our hospitals have very limited surge capacity at the best of times. We will need to redirect resources to meet the demands of COVID-19 and this will involve making compromises. We will need to use all resources – acute hospital beds, trained staff, equipment, medication and oxygen – as efficiently and effectively as possible.
This will require teamwork, collaboration, and communication across the entire health system. COVID-19 will impact on all corners of health care.
Only a fraction of patients with COVID-19 infection require hospitalisation, and only a small percentage require treatment in ICU. We need to make sure we have an integrated whole-of-system response – including primary and community care. We need to smooth the interfaces, to allow rapid interdisciplinary consultation, effective patient flow, consistent decision-making, and sharing of information and resources.
Actions needed
Associate Professor Lesley Russell
The rising numbers of cases of COVID-19 and the need to isolate hospital workers who have been exposed have brought the NSW and Melbourne hospital systems and their clinical staff under great pressure. In addition, the testing and contact tracing systems in NSW as a whole and regional areas in some other states are currently unable to keep pace with the need.
The proposal to begin opening up the nation with less than full vaccination coverage will aggravate these situations because at least in the short term (and maybe longer) there will be more COVID-19 infections.
This will mean more pressure on GPs, respiratory clinics, ACCHOs and acute care. The system will cope, but this will be at the expense of non-COVID-19 related treatment and care. Already we are hearing stories of cancer treatments delayed and paediatric cardiac patients unable to get needed surgery because specialist doctors are in isolation.
The pressures will be aggravated if the policy of isolating infected healthcare workers continues. It’s hard to see how this would not be the case. In NSW a significant proportion COVID-19 deaths have been in vulnerable and older patients who were infected while in hospital care, and many patients are immune-compromised and thus not fully protected by vaccination.
To date little effort has been made to utilise the resources of the private hospital system. It makes no sense to have these under-used when the public system is straining to meet demands.
Efforts must be made to better integrate the capabilities of private facilities and staff into the national healthcare system in ways that do not discriminate on the basis of patients’ private health insurance status.
Additional resources will also be needed to assist regional and rural hospitals in areas where COVID-19 hospitalisations are high, along with plans to ensure that access to ICU and ventilators and the staff to operate these are available.
The Doherty Institute modelling assumes that current public health measures, including testing and contact tracing, continue; indeed, it shows that these need to be done at optimal levels. This will require significantly more resources. It is also essential to ensure that there are sufficient resources available for the usual public health work such as the tracking of food and water contamination.
There are two caveats to my optimism about the ability of the system to cope with both continued COVID-19 infections and the ongoing need for non-COVID-19 treatment and care.
First, if the current rate of vaccination stalls for any reason (lack of supplies, complacency) or vaccination rates in certain population groups remain low, then healthcare professionals can rightly be expected to protest, perhaps in ways that are disruptive.
Second, with the capacity of health systems stretched to the limit by COVID-19, they could well break if a new coronavirus variant or a virulent flu or another disaster – a terrible bushfire season, an earthquake or a terrorist attack – happens.
Fine line on lockdowns
Dr Simon Judkins, emergency medicine specialist
[The health system’s ability to cope] really relies on whether there is a surge of patients, or whether it’s a constant drip feed.
If the current numbers in NSW remain as is, although very stretched and stressed, as long as there are beds in the system (ICU and COVID ward/isolation beds), the health system will manage as we get through to 80/90 percent vaccination levels. If the lockdown is lifted too early, cases spike, the system gets flooded, and ICU’s fill up … it is a very fine line.
The other significant part of this is where the vaccinations and cases are occuring. The variations across different parts of the country are concerning, particularly if you go regional/ rural, where access to an ICU bed is 500km away.
So, in areas of Australia with an increased fraction of vulnerable patients with low vaccination rates, the issue of “opening up” will potentially have large impacts, as COVID spreads into those areas. If the vaccination rates there are lagging, the COVID will spread, the local hospital won’t manage, and we will need to send teams to retrieve patients on ventilators to bring them into ICU beds.
The other ‘forgotten’ issue is the longer term morbidity and mortality for every other illness that isn’t COVID. So, the clear issues of increased morbidity and mortality associated with system overcrowding will not be apparent until we look back at the data and realise what impact this has had on all parts of the health system. Delays to stroke care, cath lab cases, treatment of sepsis, delays to cancer diagnoses, complex surgeries all of background issues being impacted in ways we don’t appreciate.
The Government talks of having enough ventilators, but we don’t have enough staff to manage them. Many parts of the country don’t have a ventilated bed within 100km of where they live, and we haven’t accounted for the ongoing furloughing of staff, the increases in staff dropping hours, dropping out.
Overall, I think we will ‘cope’, but the cost to all parts of the system, all other diseases and outcomes will not be known for quite some time.
Remote system fragility
Katherine Isbister, CEO, CRANAplus
In remote and isolated Australia, we know that the workforce has been incredibly resilient over the past 18 months and has risen to the challenges that the pandemic has presented.
What we are concerned about is its fragility. In small health services that run on minimal staff, there only needs to be one COVID-19 case that affects staffing and the ability to deliver care to that community is significantly impacted.
We don’t want that to happen and are incredibly concerned about the potential for an outbreak in a small community.
Workforce constraints
Mark Burdack, CEO, Rural and Remote Medical Services (RARMS)
Workforce remains the key capacity constraint in rural and remote areas. Rural and remote GPs have endured years of under-funding and poor support, which has led to many of them closing shop, leaving rural and remote practice or cutting back capacity.
COVID has just made things more difficult:
- To deliver the COVID vaccination program we have had to roster our rural and remote doctors and nurses to deliver vaccines, taking them away from managing patients with chronic diseases.
- In some cases, rural and remote GPs have been unable to get to work due to state border closures or regional lockdowns.
- COVID test results can take days to return impacting availability.
- Our GPs have needed to take on additional work for specialists because patients cannot attend appointments in the cities.
- The lack of effective coordination and communication with the rural and remote primary health care sector has resulted in wasted time and duplication that we can ill-afford.
If hospitalisations continue to grow at the current rate, we expect that demand for medical and nursing workforce will further increase in city and regional hospitals, resulting in fewer doctors available to work as GPs in rural and remote communities further jeopardising capacity.
Continue GP visits
Dr Karen Price, President, RACGP
Australia’s health systems are world class, and well prepared to deal with COVID-19. However, if we start to see very large numbers of cases with severe illness there is a risk health services will start to struggle. The last thing we want to see is health services overburdened, as it may impact access to care for some patients.
The COVID-19 pandemic means some patients are avoiding visiting their usual GP and it is vital that patients continue to talk to their GP about any health concerns they have. GPs are still available to give expert advice on all health matters, safely and easily.
Ramped up response
Dr John Hall, President, Rural Doctors’ Association of Australia
Protocols have been in place in rural hospitals and rural general practices since the start of the pandemic, but the low number of COVID cases in rural Australia during the first wave has naturally led to some complacency in rural communities, and this risks morphing into more COVID cases presenting at rural health services.
The Delta strain is a new beast – so there is an urgent need for rural communities and health services to ramp up their response to it and ensure all COVID-safe measures are being enacted.
The outbreaks in towns like Bourke and Dubbo have been a catalyst for many rural health services to re-activate their infection prevention protocols – this has been great to see.
At this point, in locations where there is known community transmission, we strongly recommend that rural general practices and hospitals assume ALL patients – particularly those presenting to rural emergency departments – are COVID positive.
The last thing we need are rural hospitals having to close for deep cleaning, or hospital and general practice staff having to quarantine. So, assuming now that any patient in these locations is potentially COVID positive is the safest strategy.
Keep in mind too, that while one or two COVID patients from a rural community can be retrieved without too much hassle to a distant base hospital, once you have 30 or 40 COVID patients across multiple rural communities, retrieval services could become overwhelmed. This could lead to lengthy delays in moving patients from rural hospitals.
Breaking point
Annie Butler, Federal Secretary, Australian Nursing and Midwifery Foundation
Public health services across Australia, not just in NSW, are already at breaking point. We have a highly-skilled nursing and midwifery, medical, allied health and paramedic workforce doing the very best they can, but they’re already stretched beyond capacity.
Frontline nurses and others are struggling with the ‘normal’ load let alone with COVID as nurses are constantly pulled from public hospitals to work at COVID testing and vaccination centres, leaving hospitals understaffed and affecting non-COVID health care delivery with some elective surgery now needing to be cancelled or postponed.
This is exacerbating the current backlog across the health system as we struggle to catch up from last year, and now risks compromising the public’s health further, only adding to the system pressures and workforce burden.
We are becoming increasingly concerned that Australia’s public hospitals will not be able to cope with the growing demand if we allow COVID to take hold before we’re truly prepared, which will involve careful planning and consideration, and critically which means that we must not open the country up and ‘learn to live with COVID’ too rapidly.
We saw what happened in the health system during Victoria’s second wave of COVID and now, even with vaccination, we’re seeing the crisis caused by the ongoing rise in COVID cases in NSW. Governments around the country must be able to guarantee sufficient staff and resources to support a public health system in crisis.
Iatrogenic harms risk
Dr Tony Sara, President of Australian Salaried Medical Officers’ Federation (NSW)
With all surgery except category one now cancelled, 645 COVID-19 patients in hospital and 40 on ventilators in NSW, the health system is at its limits.
We were not well equipped to cope, but with staff working beyond their normal duties and good management, we are coping. Across NSW, there has been a call-to-arms, with staff in vaccination centres, nursing homes, and group homes, and we have recruited defence force personnel, private hospital staff, as well as QANTAS staff to act as concierges in the large vaccination hubs.
Could we manage with an explosion of cases? No, we couldn’t. We could end up with similar scenes as Italy, France the UK last year, and we may see iatrogenic harms, with stressed and overworked staff not coping.
Fraudulent targets
John Paterson, CEO, Aboriginal Medical Services Alliance Northern Territory
The lessons of western NSW are stark reminders of the threats facing Aboriginal people across Australia as we face the pandemic.
Our hearts ache for countrymen and women in places like Wilcannia and Dubbo — a number of our staff here in the Territory have relations and close ties with them.
Wilcannia now has around a 10 percent infection rate — the equivalent of 400,000 people in Greater Sydney.
If this were to happen in one of our larger communities, say Wadeye, this would be the equivalent of 300 people. Quite simply, our health system couldn’t cope.
Our expectation is that this would likely increase beyond 10% rapidly, and it would likely spread to other remote communities given high mobility.
Our remote clinics are already chronically understaffed and tasked with dealing with the day-to-day problems of massive overcrowding and co-morbidities that would make our people particularly susceptible.
Our hospital system could not cope with the numbers that might need to be transferred from the community, let alone the potential need for ICU facilities.
The targets suggested of 70 or 80 percent vaccination are totally fraudulent if applied to remote Australia. They do not take into account already low and uneven vaccination levels; they do not take into account the demographics of a high number of children in our communities.
These targets may or may not work in the northern beaches of Sydney: they would totally fail our people.
Vaccine supply concerns
Associate Professor Megan Williams, Assistant Director and Research Lead, National Centre for Cultural Competence, University of Sydney.
The availability of vaccines could be called poor in inner Sydney. Demand seems to outstrip supply in particular locations, waiting times are frustratingly long.
There is an urgent need to use local community structures to increase access to vaccinations – use the strengths and knowledges of local leaders and local organisations, including to support people who are not able to have other healthcare needs met due to COVID-related demands. People need more support to come to terms with missing out on care.
This could be used as an opportunity for community development, not the divisiveness and fear that comes with the sense of punitivity from bringing outsiders in such as the defence force and police.
Sharing stories of how people are experiencing COVID-19, how they got infected, how they have prevented the spread, could put a personal face to the numbers, explain why things are the way they are right now, and highlight the implications of government decisions on families.
Public health workforce pressure
Terry Slevin, CEO, Public Health Association of Australia
I am concerned about the public health workforce capacity. All of the modelling presumes ongoing capacity to continue with TTIQ (Test/Trace/Insolate/Quarantine). Public health staff across the country have been under enormous pressure for more than 20 months.
They were understaffed from the beginning and various commitments to boost the public health workforce seem to have not been adequately advanced.
Protecting teams
Dr Kim Webber, Executive Lead, Strategy and Partnerships, cohealth
Ensuring the health system can continue to provide care is critical. The pandemic has shown that we need to develop better ways to rapidly expand our overstretched workforce.
We’ve seen devastating consequences when health workers are furloughed in large numbers. We need to protect health service teams from COVID through preventing transmission in health services.
Appropriate PPE and rigorous infection control services are paramount.
We also want to keep people away from hospitals more than ever which means investing in more community-based primary health care that supports people to be able to stay healthy and safe are at home, and early intervention to prevent conditions from deteriorating.
Question 2
What is the single most important action to help ensure the system and health professionals are better placed to cope?
Society settings crucial
Professor Jeffrey Braithwaite
Providing backup, resources, and personal protection equipment (PPE) are the key to supporting health professionals on the front lines.
The best thing to help them, however, is what we do outside the health system – that is, to manage the pandemic well across society.
Vaccinate everyone who is willing, set up immunisation passports for those who have been vaccinated so they enjoy some benefits, and have a proper quarantine system, not one in ill-equipped hotels.
Get those right and the health system will cope well because quite simply it will be dealing with fewer cases, and less severe ones when it does receive COVID-19 affected patients.
Honest reflection
Dr Amy Coopes
The single most important thing we need to do is reckon with this honestly, reflecting on the failures and successes of other countries who have already navigated the path we are about to walk, and to plan for the worst case scenario of simultaneous outbreaks taking out multiple regional health services and constraining tertiary surge capacity.
We need to plan for what happens when a regional hospital’s entire medical ward is full of COVID patients, its limited ventilatory capacity is maxed out, and aeromedical retrieval is pulled in multiple directions. What happens when a regional hospital becomes an outbreak epicentre and has, literally, no staff or beds to care for people in a 500km radius?
We also have to grapple as a community, with the downstream effects that will echo down the years of COVID bottlenecking our health care system. The costs of delayed diagnoses and treatments. Loss of rehab and other essential services because staff have to be diverted.
Our mental health system was already in crisis before this pandemic, and to see the mounting toll – particularly on young people – underscores that this will be a defining challenge in our post-Doherty world.
Working with communities
Jennifer Doggett
Proactive planning is crucial and communicating what is being done to reassure the community that governments and health authorities have thought about how to respond to escalations in demand.
Engaging local communities, particularly those likely to be most affected, is crucial.
As we have seen from Cate’s story [ADD LINK] there are already community leaders out there responding to needs. They need to be closely involved with planning for upcoming surges in demand.
Improving communications is also crucial. The public will quickly lose trust in government and health authorities if communication is not done well. This includes working with communities which have not to date been well served by public health communications to ensure messaging is appropriate and well-targeted.
Public and private
Professor Ian Hickie
Immediate enlistment of the entire national public and private sector workforce and infrastructure capacity. This can be organised regionally (through co-operation of Primary Health Networks and State Public Services) and enhanced by new IT systems that promote much more effective co-ordinated and continuity of care.
Skills focus
Dr Clare Skinner
There is no health care system without skilled health care workers. We need urgent attention to ensuring the health workforce has the right skills in the right places.
Many clinicians trained in critical care are currently working in other roles. We should incentivise them to return to acute practice.
We should also upskill health care workers who are likely to be redeployed to assist with care of COVID patients in hospitals and the community. We should also consider rapid vocational training of technical and personal assistants, who can then perform routine tasks and free up highly skilled clinicians to work at the top of their scope-of-practice.
We need mechanisms to move essential health care workers between regions to meet demand. We need to make sure they are protected at all times, with full airborne, droplet and contact PPE.
Working in a pandemic is exhausting, so we need rosters that allow adequate time and support for debriefing, rest, and recovery.
Above all, health care workers need the community to work with them by flattening the pandemic curve. Follow the spatial distancing rules, wear a mask, and get vaccinated. Minimise your risk of catching or spreading COVID-19 and give the health care system the best possible chance of providing effective care to the entire community.
Flatten the curve
Dr Simon Judkins
It’s largely back to the original messaging from the start of the pandemic – flatten the curve.
NSW is clearly moving into suppression rather than elimination. Ultimately, that will be the world we will all live in; we will suppress COVID through annual vaccination programs to keep COVID at bay.
So, the suppression needs to be in place until vaccination rates are high enough to allow a trickle of COVID, not a surge.
We also need to ensure that all health care workers are vaccinated and systems can run at 80-85 percent capacity, so spikes can be absorbed. Pushing every part of the health system (people and infrastructure) at close to 100 percent all the time will ensure breakdown..
Timing is of the essence. The balance of vaccination numbers, who is vaccinated, where they are in the country, will all need finetuning. If restrictions are eased too early, increased disease will have adverse consequences; if there is delay, people suffer in other ways, including mental health impacts access to other care.
The main thing that will help clinicians cope is seeing the vaccination numbers increasing at a rapid rate and knowing that each day is closer to “the new normal”.
Culturally safe care
Katherine Isbister
We would like to see culturally safe care being delivered, for both COVID-19 testing and the vaccine rollout.
This needs to be tailored and delivered in partnership with each community and known and trusted health care professionals must be a part of this.
Also, as resources are channelled towards testing and vaccinations, we must remember these communities bear some of the greatest burden of chronic disease and poor health outcomes.
We cannot ‘drop the ball’ on the provision of timely primary healthcare at this time. To do so will most certainly result in a terrible pay off into the future. Now is the time for all of us to pull together to ensure that there is equitable access and care in remote and isolated Australia.
Planning paramount
Mark Burdack
Better primary health planning, communication and coordination!
RARMS developed a detailed COVID Management Plan at the beginning of the pandemic. We surveyed rural and remote people to inform our responses. We published a guide for local government to help deal with the crisis. We worked with a small Aboriginal community to help them to develop the first at-risk community plan in western NSW.
With a major COVID outbreak in western NSW, we need this sort of strategic leadership at a sectoral level including a plan to:
- Define the scale of the issue we are facing in rural and remote communities;
- Articulate the end-goal;
- Establish deadlines; and
- Clearly state who is responsible for what.
Our residents are older and more likely to have chronic diseases, so planning needs to reflect the greater risks of higher rates of transmission, more severe illness, and deaths.
The plan needs to be developed in collaboration with all primary health providers on-the-ground in rural and remote communities, and not a desktop exercise without any local input or engagement with rural and remote services.
RARMS has decided to jump in and convene our own workshop in the next two weeks to update our COVID plan to help us prepare for the easing of restrictions. We’ll bring in community members, clinical and management staff, as well as senior academics, policy makers and clinicians.
We’re planning for the worst, hoping for the best.
Care for precious resources
Associate Professor Lesley Russell
Lessons from Australia and internationally clearly highlight that the most precious and most vulnerable resource in managing the coronavirus pandemic is healthcare workers – not just ICU doctors and nurses, but those who work in mental health, aged care and disability, primary care and pharmacy and the rehabilitation specialists who work with people with long-COVID.
Everyone is aware of the risks of burnout and mental health issues, but what is being done in a concerted, long-term way to address this?
The resilience of health professionals in the face of extended times of pressure requires effective administration of their working schedules, acknowledgement of personal and family needs, and mental health and wellbeing supports.
Part of the problem would be solved if the workforce was larger and better distributed, employment was more secure with better pay and more benefits and there was less reliance on contractors, and all healthcare professionals were able to work to full scope of practice. If ever there was a time for better workforce planning and a rationale for eliminating professional turf fights, this is it.
None of this will happen without increased workforce funding. Governments and administrators must realise this and come to the table with funding commitments at hand.
Today’s students and trainees in the healthcare professions are learning about their chosen profession in an environment that highlights the value of prevention and affordable access to healthcare services, the inter-relationships between physical and mental health, what investments in technology and research and development can deliver, and the critical role of communication, compassion and care.
Perhaps the single most important action here – one that will return lasting benefits – is to ensure that these emerging health professionals learn those lessons well and carry them through their working lives.
Vaccination key
Dr Karen Price
Vaccination is the key to ensure we are better placed to cope with rising cases. We need to vaccinate as many people as we can, as quickly as possible, as this minimises the risk of severe illness and patients ending up in hospital and needing a ventilator.
We also need people to do the right thing; adhere to local restrictions, and keep up the social distancing and hand hygiene.
Border barriers
Dr John Hall
Many rural hospitals are already having trouble staffing their rosters due to the COVID situation, so we need to see action now around planning for and enabling surge workforce and support.
First and foremost, health professionals must be able to move more freely across state borders without having to quarantine.
The current need for health professionals to quarantine when travelling to and from rural towns across state lines (and outside border bubbles) is making it very difficult for some health services to maintain a full cohort of staff. Should the Delta strain hit more rural communities, we need to ensure we can quickly bring in health professionals from other states to provide a surge workforce.
We have been raising this issue with the Federal Government, and want to see a targeted exemption for rural health professionals who need to move across state borders to provide healthcare services.
It also goes without saying that all those working in the rural healthcare system – particularly in our rural hospitals – need to be fully vaccinated as soon as possible. This doesn’t just include the doctors and nurses, but all other staff working in rural health facilities too.
Prioritising vaccination
Leanne Wells
Widespread vaccination is the first priority, to reduce demand on health services and hospitals. Co-ordination of vaccine supply and vaccinations appear to have improved in recent weeks.
There is however growing concern right now of the strain being placed on nursing and medical staff in the hospitals. The scope of the challenge is indicated by an ABC report today that the Victorian Government is “flying in” 350 medical staff from overseas
UK warning
Dr Tony Sara
Two actions are needed. First, we need to vaccinate, vaccinate, vaccinate; 98 percent of persons in our hospitals are unvaccinated, so the message is very clear, vaccination stops hospitalisation, it stops you needing a ventilator and it stops you dying.
Once 80 percent of the total population are vaccinated, we need to come out of lockdown in a controlled and careful manner. We will continue to need social distancing rules and masks will need to be worn. Testing and contact tracing will still be needed, and we must look at rapid antigen testing in workplaces. If we throw the doors open, as they have done in the UK, then we will be seeing increased COVID deaths. In the UK, there are 90 COVID deaths a day.
Prison release
Associate Professor Megan Williams
Change laws and use existing laws and policies to release people from prison, prioritising those with existing health issues, imminent release and safe options in the community.
This is to acknowledge the burden on staff in correctional centres to be holding people in isolation in prison, trying to vaccinate and in light of families’ fears.
Income support
Dr Kim Webber
Managing the virus in Australia requires a whole-of-government approach that considers policy responses beyond health systems.
With the right policy settings, governments can reduce people’s exposure to COVID, and enable them to safely isolate if they are exposed, by broadening the eligibility for income support payments so that everyone has a liveable income and can afford to stay home if they need to.
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