Introduction by Croakey: In the first of a two-part series investigating safety in health and aged care in the era of COVID-19, Jennifer Doggett speaks with consumers who have recently experienced unsafe conditions when accessing healthcare, and the owner of a general practice clinic who has taken action into her own hands.
Jennifer Doggett writes:
A recent outbreak of COVID-19 at Canberra Hospital has shone a spotlight on the transmission of COVID in health and aged care settings.
Like many health and aged care services in Australia, Canberra Hospital had moved away from the COVID infection control measures imposed during the pandemic, removing its mask mandate in February this year.
In response to this outbreak, it has now reinstated mask mandates and introduced other measures, such as restricting visitor numbers to two per patients.
The Canberra Hospital outbreak did not come as a surprise to many advocates who have for some time been warning authorities of the risks of relaxing their approach to the prevention of COVID transmission.
These advocates, including patients and health service consumers, have been strongly advocating for a continuation of stringent infection control measures in health and aged care settings, including a focus on improving indoor air quality.
Reducing COVID-19 transmission
Reducing COVID-19 transmission in health and aged care settings is important for consumers, healthcare workers and the broader community. People receiving care in health and aged care settings are likely to already have an illness or disability which makes them more susceptible to severe illness from COVID-19. If infected, this can cause additional harm and exacerbate their existing conditions.
While vaccinations continue to work in reducing severity of illness from COVID-19, recent reports indicate vaccination rates in some priority populations including aged care residents are lagging, highlighting the importance of a multi-faceted approach to managing and preventing COVID-19.
Health and aged care workers are likely to be exposed to infected individuals more often than the general population and therefore have a higher risk of contracting the virus. Stopping transmission within health and aged care settings protects both the workers themselves and the patients they care for, reducing workforce shortages and pressure on the system.
Health and aged care settings can also act as potential amplifiers of the virus. If transmission occurs within these settings, infected individuals may subsequently spread the virus to their communities, exacerbating the overall COVID-19 burden.
Impact on consumers
Staff, patients, residents and their families continue to be put at risk of COVID-19 infection when they access care, often taking COVID-safety precautions into their own hands.
The inconsistent approach to preventing COVID-19 transmission across different settings was so concerning to Amy Lewis that she co-founded the Cleaner Air Collective with Sue Jennings to advocate on this issue.
Lewis told Croakey that over the past 12 months she has visited three emergency departments within Melbourne, all with different COVID infection controls, and has taken it upon herself to keep family members safe in hospital.
In one ED she saw HEPA filters in each of the consultation rooms and staff and visitors were masked; in another there was a HEPA in the corridor but not in the consultation rooms. She also saw a patient being repeatedly encouraged to remove their mask, despite the fact there were confirmed COVID patients present in the ED.
Lewis’s husband has had a double lung transplant and is at particular risk from COVID. She says he now thinks twice about seeking healthcare and does everything he can to avoid going to hospital.
“At-risk patients deserve a standard approach to clean air across all the health services we access – including ventilation, HEPAs and a positive attitude to masking. The knowledge that there’s not a conscious approach to clean air in hospitals and other health services has a massive impact on how and when patients access healthcare,” she said.
Lewis argues that the current haphazard approach to safety in healthcare means that people who are at higher risk are largely left to advocate for themselves. She feels that this is unfair, given that unlike other social outings, people have no choice about accessing healthcare.
She highlights the inconsistent implementation of the National Safety and Quality Health Service Standards, contrasting them with other areas of infection control.
“We would be horrified if hospitals all took their own approach to sterilising their equipment or handwashing – so why isn’t there a standard approach to clean air?”
Lewis urges leadership from government on this issue, and a focus on interventions that don’t have a high burden, like ventilation and HEPAs. She also calls for increased education about risks from COVID, particularly for high-risk people, and the steps they can take to prevent transmission.
“There’s a huge opportunity to let the community know that in between lockdown and doing nothing there are a range of measures in between that work – it’s not an all or nothing approach.
“Some solutions are very simple – like opening a window – it’s about developing new habits as much as anything else. People became very adept at sanitising their hands from the start of the pandemic because we were told by our health departments that this would prevent transmission – now we need to get better at focussing on clean air.”
Healthcare rights
Craig Wallace, Head of Policy at Advocacy for Inclusion, an independent not-for-profit advocating for the rights of all people with disability in the ACT, told Croakey that currently a close family member is in ICU at Canberra Hospital and “has just come off a ventilator after catching COVID-19 in a rehabilitation setting”.
Wallace said they were placed in a shared room in the facility with poor ventilation where they were exposed to COVID.
“Before contracting COVID, they were about to come home,” Wallace said.
Wallace, who has lived experience as a person with a disability and as a family member of a person with a disability and a carer for an older person, told Croakey that over the past few months visiting his family member in hospital he has observed “the lack of basic infection practices there”, including minimal mask wearing and air filtration.
“This is unacceptable. Clean air should be a right in healthcare settings and from what I have seen this is not happening. You should have a reasonable expectation that you can go into a modern hospital without contracting a serious disease that will leave you worse off than when you went in,” Wallace said.
He said that people need to be aware that “people with a disability have no choice about needing to access health services. If we can’t make the whole community safe for people with disabilities, we can at least make it possible for us to access essential services safely.”
Wallace told Croakey that policy and regulatory settings are required in healthcare settings to protect people at high risk of severe illness from COVID-19.
He urged governments to “stop sending the message that COVID is over and that it’s acceptable to remove masks in healthcare settings”.
For people who are immunocompromised and highly vulnerable, the risk of COVID is very much part of their daily lives, Wallace said.
End the radical inconsistency
Wallace also called for an end to “the radical inconsistency within the same healthcare setting”.
“In Canberra Hospital ICU there are people dressed in full PPE, negative pressure rooms and pretty extreme measures to contain the two people there with COVID to ensure it’s not spreading. But outside of the ICU masks were optional. This makes no sense – either it’s safe to be around COVID or it’s not,” Wallace said.
Referring to the current outbreak in Canberra Hospital, Wallace said they “have zig zagged back to mask requirements” and limitations on visitors.
“This is sensible but it also tells us the authorities know that it’s not safe to be around COVID and that the current inconsistent and ad hoc strategies are failing as we lurch from outbreak to outbreak,” he said.
“A more consistent and precautionary approach is urgently warranted.”
Wallace suggested that a “serious public education campaign” is required to show the “human consequences of a failure to act on clean air”, including disability and disease from long COVID in addition to potential longer term impacts.
Guidelines are welcome, he said, but there’s no need to wait for them. “The evidence that COVID is airborne is in and we should be acting on it now. I don’t know how this is controversial.”
Wallace told Croakey “people like me are not calling for lockdowns – people keep saying this and it is hollow spin and deflection by people refusing to acknowledge the current approach is a house of cards falling down in front of our eyes”.
Instead, they are “calling for sensible measures beyond the vaccines to start getting on top of COVID, limit its spread, deal with long COVID and to keep vulnerable safe, supported and included socially and economically with some quality of life as this drags on.”
Taking action in general practice
Some providers, frustrated with the lack of movement by governments, have taken action into their own hands.
Anna Davidson owns a large GP Super Clinic in Nelson Bay, NSW. She questions why more is not being done to protect our most precious and scare health system resource – the health workforce.
“It’s not rocket science. An infection with COVID-19 is an aerosol-based transmission event and we know that improving air quality reduces viral load and the risk of transmission,” she said.
“The health workforce is already under significant pressure – after three years of the pandemic, health professionals are sick, exhausted and burnt out. Far too many are leaving, reducing their hours or not returning to their professions after illness. Given that we know demand for healthcare will increase in the future due to the ageing of our population and also the additional chronic disease burden from long COVID, why aren’t we doing more to protect the health workforce we have left?”
Davidson is disappointed that general practice has not been given more support from the government to implement infection control measures to protect staff and patients.
“I’ve spent more than $30,000 to ensure the people working in and visiting the clinic are protected from the risk of COVID-19 infection. Not to mention the ongoing cost of providing quality masking and other measures to add layers of protection. This cost is extremely difficult to manage, given the ongoing under-funding of general practice.
“General practice was already under significant stress before the pandemic and this has made the situation much worse.
“Why haven’t all general practices been given $3,000 per consult room, staff room and patient waiting areas to fix this? This would be money well spent if it meant 10 percent of people who otherwise might get COVID were still in the workforce. Surely we should be doing everything possible to increase GP availability, given that everywhere under pressure from the shortage of GPs?”
Davidson also has experience of a family member contracting COVID-19 in a healthcare setting when her aunt was taken to hospital after “what looked like a stroke”.
She spent 48 hours in the ED before getting a bed and caught COVID in hospital, “either in the ED or on the ward – which was not a surprise given that the hospital was full of sick people not able to get into see their GP and there was very inconsistent masking among staff,” Davidson told Croakey.
“This isn’t their fault – the message we have from Government is that COVID is over, which is clearly not true. We need a clear message from political leaders about the need for ongoing infection control measures and mandates for masking and clean air.
“If you cannot be safe while receiving healthcare, if your healthcare is impinged by receiving healthcare, there is something fundamentally wrong.
“Failing to prevent COVID transmissions in healthcare settings also makes no sense from a systems perspective. Because of her infection, my aunt is not in rehab for her stroke but is now taking up a bed in hospital with COVID. If doctors and other general practice staff are off sick, who is going to look after their patients?
“If general practice collapses – then what? If the government thinks hospitals are in a bad situation now, they won’t know what has hit them when general practice falls over.
“This is a failure of leadership. The Prime Minister and Health Minister need to sit down and look at the evidence and lead in the same way the government has done before on HIV, smoking, asbestos and other public health threats.
“We all know about the importance of clean water when we visit places like Bali but we haven’t yet got the message about clean air. We need to tell people that if they think about how they clean their teeth in Bali then they need to think in the same way about the importance of clean air in indoor settings,” Davidson said.
Croakey is approaching Canberrra Hospital to respond to concerns made in this article.
The second article in this series, to be published later this week, will examine calls for a national and consistent approach to clean air in health and aged care.
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Croakey thanks and acknowledges donors to our public interest journalism funding pool who have helped support this article.
