Health policy hazard: Covid is here to stay, so where is the plan?

Jan 7, 2022
vaccine covid coronavirus
Wealthy countries need to help speed up the vaccination rates in poorer countries. (Image: Unsplash)

It is a pipe dream to imagine that living with the variants will be seamless. This pandemic will be keep throwing up new challenges for a while yet.

Just when you thought the worst was over along comes Omicron. Who would have thought the 15th letter of the Greek alphabet would turn out to be so much trouble.

From Sweden – very relaxed Covid response – to Singapore – not so relaxed – swathes of restrictions have returned. Masks, distancing, hand hygiene, capacity limits, vaccinations, tracing, isolation are all back in vogue. Even lockdowns have made a comeback – at least in the Netherlands.

And now, not very surprisingly, Australia is replicating infection rates in Europe and North America. The Covid numbers in Victoria and New South Wales have gone up like a hot air balloon on steroids over the past month as Omicron takes hold.

Vaccines were the hope of the side six weeks ago. Everyone was sighing with relief as Australia reached 90 per cent adult vaccination rates. We thought we could look forward to a return to relative normality. It all looked good when vaccinations halved the risk of catching Delta and the risk of serious disease and death by tenfold.

Now it’s clear even double doses of vaccines are much less effective at preventing the spread of Omicron. Omicron is probably more than four times as infectious as Delta.

Even if Omicron leads to only a third of the hospitalisations of Delta, with a twenty-fold increase in cases – as is happening in NSW and Victoria – we could get around a six or seven fold increase in hospitalisations.

As it is, while the hospitalisation rate lags the case rate by about two weeks, we are already seeing a significant increase in hospitalisations.

The Australian Covid hospitalisation rate has tripled since the middle of December and the ICU rate has nearly doubled. We are now at the hospitalisation peaks reached at the height of the September Delta outbreak that led to widespread lockdowns in Sydney and Melbourne.

Can the hospital system cope?

On current trends Australian case rates and hospitalisations could again double and reach the per capita rates currently experienced in Europe.

Our big teaching hospitals have about 700 to 800 beds. So the equivalent of one major hospital is already taken up with Covid in Victoria and NSW. It looks like the trend will continue to increase and 10 to 20 per cent of hospital beds could be filled with Covid patients in the next month.

That puts an enormous strain on a system that is already running hard. Inevitably less urgent cases have to be deferred. There are now thousands of patients waiting long periods for joint replacements, hernia repairs and cancer screening. The number is increasing every day.

Many hospital staff have already moved from their normal duties to work on Covid wards and they are tired. As omicron spreads, more health staff are catching it and have to take sick leave. Many have been in this situation for over two years.

Staff are tired. All this is happening over the holiday break. There are already acute staff shortages in aged care. The risk is that they will begin to quit if there is no relief.

If that happens, things will get really ugly. Overflowing emergency departments, ambulance ramping, temporary hospital wards, more stressed staff, more waiting for non-urgent care, and increased death rates. None of this is certain, but the data suggests it is wise to immediately put in place all the tried and true public health measures short of lockdowns – and they may yet be necessary as parts of Europe are finding.

We need a better plan

What is surprising is that Australia has repeatedly been late in anticipating and planning for what might happen. We were slow and disorganised with border restrictions, quarantine facilities, protecting aged care and disability facilities, basic public health information campaigns, contact tracing and isolation, procuring vaccinations, rolling out vaccinations, protecting Indigenous communities, and putting in place sanctions and incentives for vaccinations.

And now we are late and disorganised with the booster program, we failed to anticipate the possibility of a new variant and the current testing crises, we failed to purchase and distribute rapid antigen tests and our planning for the use GPs and the primary care system to look after mild to moderate Covid patients is rudimentary and disorganised. This was all highly predictable months ago. Everyone knew that more infectious variants could emerge.

The federal government’s dreams of a smooth transition back to an open and booming economy are in tatters. Everything points to the need for fundamental medium to longer term change to manage Covid. It is a pipe dream to imagine that living with Covid will be seamless. This pandemic will be keep throwing up new challenges for a while yet.

Most pressingly, much more effective national planning, co-ordination for health and aged care is needed. Why isn’t there a powerful, overarching joint Commonwealth and state taskforce to plan and co-ordinate action to back up the national cabinet? Why haven’t we got a co-operative, national consensus for managing this pandemic based on analysis and risk assessment rather than partisan politics?

We will need ongoing vaccination programs, targeted testing and isolation, community-based treatment and support for Covid, focused public health restrictions and ongoing risk monitoring for new variants and other problems that may emerge. We are also going to need a plan to address the massive waiting lists that have already built up for non-urgent care. All this means things have to be done differently in the medium to longer term.

Whatever else happens, it is likely we will need 20 million vaccinations every six months (40 million boosters a year) for a while yet. A coherent, medium to longer term vaccination  program is needed.

If, as seems likely, the number of Covid patients with mild to moderate disease will be a feature for the foreseeable future, we will have to find ways of looking after people who don’t need intensive care at home to take pressure off the hospital system.

Community-based teams of GPs, nurses and allied health staff are needed to take the pressure of hospitals.  At the moment planning for these arrangements is confused, fragmented and chaotic.

Add to that the current testing, isolation and reporting chaos. A new, much more streamlined and robust system will have to be put into place.

Older people and those with disabilities are most vulnerable. Critical staff shortages in residential and community-based aged care and disability services have to be addressed. Personal care staff are paid about the same as fast food workers and about a third have no relevant qualifications. The Commonwealth has yet to commit to paying these staff properly or putting in place a proper training and career structure.

More broadly, while it’s risky to make definite predictions, it looks like Covid is likely to continue to have a major impact on social and economic life for at least the next year. Short-term measures are going to have to give way to medium-term structural adjustment programs for Covid-exposed industries such as travel, tourism, hospitality and entertainment. Ongoing rearrangements of work and education are likely to be required as well.

Again, it is as though the idea of longer term, coherent risk-based planning hasn’t occurred to the federal government. Instead, they have muddled along in crisis mode hoping Covid will fade away.

So far we have been lucky. But our luck may be running out and the crisis over the festive season has demonstrated that we are a long way from being ready. The current national co-ordination and management arrangements are not working – time for a rethink.

 

 

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