Introduction by Croakey: The Omicron variant is creeping into Western Australia despite the State Government’s decision to continue its hard border lockdown to contain the community transmission of COVID-19.
Case numbers remain low – but so does the testing rate, leading to concerns that undetected cases in the community may be skewing the actual numbers.
Perth emergency physician Dr Peter Allely this week told the ABC he was worried about the impact of an Omicron outbreak on current overcrowding in Western Australian hospitals and existing staff shortages in emergency departments.
“I fear that overcrowding in WA hospitals could kill more people than COVID-19 in 2022,” said Allely, Western Australian Faculty Chair of the Australasian College for Emergency Medicine. “Currently, we don’t even have the surge capacity to cope with a weekend, never mind a pandemic.”
Western Australian so far has recorded nine deaths from COVID-19 compared with 2,054 in Victoria and 1,449 in NSW. While West Australians have generally supported tough measures to keep them safe, many now want to know the actual date when the border will reopen and the plans for the healthcare system and workforce to cope.
Perth GP Jane Ralls wrote two weeks ago to Premier McGowan and Health Minister, Amber-Jade Sanderson, calling for better planning in primary care, hospitals and mental health and for “WA to make some compromises in the name of kindness and inclusion”.
Jane Ralls writes:
Dear Premier McGowan and Health Minister Sanderson,
Firstly, I want to acknowledge the fantastic work the WA State Government has done over the last two years in keeping WA safe from Covid-19.
I am a triple vaccinated metropolitan General Practitioner of 30 years’ experience. I have done vaccine clinics from the start, and have inched many “vaccine hesitant” people gently over the line. I have seen patients face to face throughout the pandemic so far, which is my strong preference going forward, while I continue to work hard to keep myself, our staff, and my vulnerable patients safe.
My closest loved ones are luckily in Perth, and I have no need nor desire currently to travel elsewhere in Australia nor internationally, nor receive visitors. That is due to pure luck, and means I have as little conflict of interest expressing an opinion re border closures as anyone can have right now.
While I see people for all their medical needs, at all ages and stages in their lives, and have many immunocompromised patients, I specialise in mental health and do a lot of perinatal work. This colours my perspective.
Compassion – a victim of the pandemic
While it is really good to hear plans to increase compassion from February 5th in the G2G pass system, I strongly believe the situations mentioned in the [Premier’s January 20] press conference should have, and could have been safely accommodated from the start. I have been very disturbed by the stories I have heard from patients and friends regarding the system, and the families kept apart by it.
I have very recently witnessed patients extremely unwell with post-natal depression having to choose between returning to their extended families abroad for much needed support, or staying isolated in Perth with their partner who has to stay for work. It really does take a village to raise a healthy child and forcing such a choice is inhumane. That is only one example of the lack of compassion in the current system – I could give you many more, but I chose that one as it will impact the health of future generations.
The delay in border opening
I can understand the decision to continue the “hard border” beyond 5th February given the apparent lack of serious health planning leading us up to this point. We should not be in the situation we are in, particularly given the surplus in the State budget. If a lot more financial resources had been provided to our hospital sector over the last six months it would have been possible to improve morale, keep healthcare staff in the sector and, importantly, clear a substantial amount of elective surgeries currently waiting. Then we would be as ready as we can be. Human resources are what matter, but they need financial support. This is why we pay taxes, not to have it kept as a surplus.
I understand that WAPHA [Western Australian Primary Health Alliance] and the RACGP [Royal Australian College of General Practitioners] are still awaiting advice from WA Health regarding the WA model of care for managing COVID positive patients in the community. This backs up what I mean when I say there is a lack of serious health planning.
I have a very personal story to share here as I have just had “elective” surgery myself, being lucky enough to afford private health insurance and the gaps that go with it, and have it done relatively quickly in the private sector. My hip became extraordinarily painful over the last 2 months, and, while I continued to work and provide vaccine clinics, I became only able to walk at all with a crutch, despite being normally very fit and active.
It has been an exhausting and humbling experience, and I was only able to continue working by reducing available appointments significantly and because of all the public holidays over the Christmas period. (Most GPs in our practice take holiday over that time, and I cover them). I share this story because I am horrified at the idea that people who cannot afford private health insurance (this includes many healthcare workers) would normally have to wait for many months for their surgery (for example, hip replacement), even with the level of pain I was experiencing. There are many other situations where surgery is deemed “elective” but is actually quite urgent.
To glibly state that “elective” surgery can and will be postponed, before we even have significant COVID-19 here, is to invalidate the suffering of thousands of West Australians. That is not a “plan”, it is an extreme measure to be considered in the future only if absolutely necessary.
Sadly, the current situation is showing that it is impossible to keep the Omicron variant of SARS-Cov2 out, and slowing it down in WA will have serious adverse effects.
The further we delay, the greater the chance of a peak in cases in the winter, which I, as a GP, call “snotty kid season”, and which is also “ambulance ramping” season. The adverse consequences in primary care as well as in the hospital sector of this timing cannot be understated. While we struggle to triage and work out who to see safely face to face and how, health workers’ immunity from boosters may wane. While I certainly don’t believe we should “let it rip”, there are many other nuanced solutions that could be implemented to try to prevent a peak mid-winter.
Planning ahead
I believe WA needs a very definite date, preferably before March this year, that will be adhered to by the State Government for some sort of border opening. This date should clarify when people no longer have to justify their reasons to travel in or out of WA. Rules can and should be put in place for travellers (for example, avoiding crowded indoor venues for 7 days after arrival), in addition to testing prior to travel and in WA maybe Days 2 & 6. Going forward, RATs should be available for this. There can and should be different rules for the vaccinated and the non-vaccinated, but the latter should not be excluded.
It is time for Australia to come together more as a nation and for WA to make some compromises in the name of kindness and inclusion. For example, a 14 day isolation period is not necessary for people who have received their second or subsequent vaccine within four months, and having different rules across Australia is becoming confusing and inequitable. However, regardless of Federal decisions, within WA RATs should be made available for free with very clear instructions when to use, and what to do given a negative or a positive result. There is plenty of experience in the UK and elsewhere in the world we can draw on, and these will save the WA economy money going forward.
My last point I would like to make is that anti-vaxers are humans, too. While I and the science do not agree with them, they do have a right to their opinions, and while it is right to exclude them from situations where the risk of passing SARS-Cov2 to vulnerable people is significant, we must not completely exclude them.
Yours sincerely
Dr Jane Ralls MBBS MRCGP (UK) DCCH
Dr Jane Ralls is a Perth GP. Croakey has published Dr Ralls’ letter with her permission. She is awaiting a reply from the Premier and Health Minister.
