JOHN DWYER. Health care professionals want a lockdown now.

Mar 31, 2020

In sharper focus than ever this week is the danger health professionals experience in caring for seriously ill patients infected with COVID-19.

In Spain the number of medical personnel infected with COVID-19 is approaching 6,500 representing 13.6% of the country’s 47,600 cases. The World Health Organisation’s director-general this week called reports of large number of infections among health workers truly alarming. “Even if we do everything else right, if we don’t prioritise protecting health workers, many people will die because the health worker who could have saved their lives is sick,” he told journalists. In Italy, nearly one-tenth of more than 74,000 infections are among medical workers and 33 doctors have died.

Infected patients fighting for their lives need intensive ‘one on one’ care. Apart from their struggle with lungs so badly damaged that they need a pressure ventilator to help them absorb oxygen, many patients experience extreme nausea and vomiting and of course need help with toileting. We now know that the virus may be present in faeces. Even with state of the art protective gear such intimate contact over a prolonged period makes protection difficult. When you have exhausted staff in an overwhelmed ICU or even worse, a ward or corridor totally unsuitable for the provision of the needed care, the risk to the carer is extreme. Understandably, the longer the demand and the greater the volume of patients one treats, the greater the risks

Based on modelling of our local epidemic we expect to see enormous pressures descend on our hospitals and their staff in the next few weeks, it could last for months .While every effort is made to provide sufficient protective gear and ventilators, its our job to do everything we can to reduce the number of seriously ill patients needing care to protect our health professionals and, of course, ourselves.

There is another major concern for our acute care hospital clinicians; the real possibility that huge COVID-19 demands will collide with a bad Influenza winter. It is not unusual for patients with Influenza to need 30,000 hospital beds and hundreds of ICU beds. That situation, they fear, could see them faced with the distressing ethical dilemmas their international colleagues face as they determine who will and who will not get treatment. The government has accepted advice that influenza vaccinations should start early this year but there is not enough discussion with Australians re the imperative that everyone gets immunised asap. That’s why many of us have suggested that ,“flu” shots for people aged 5 to 65 should be free this year

Are we doing enough?

In the last week new restrictions appear to have resonated with Australians and social distancing is much more in evidence. Of course not everyone has accepted the personal responsibility required and we can see anything but safe distancing in e.g, huge queues for Centrelink.Why are there no marshals at the offices reminding people of inter-personal distancing requirements, perhaps distributing hand sanitiser? There are plenty of people looking for casual jobs. Same question could apply when considering the need to limit the number of people in our supermarkets to one that makes social distancing possible. How disappointing to still see scenes of large groups picnicking on the lawns above Bondi beach.

Importantly however there are new realities to deal with.

No longer is our epidemic fuelled by Australians and others entering Australia infected with COVID-19. We are seeing more virus spreading among the resident population. We have documented 550 such cases and that heralds a new and more dangerous phase of our epidemic. This means that we must have hundreds, of Australians, many of whom may have few symptoms, spreading the disease and not being detected in our current testing regimens. Our latest tally of new infections shows a reduction in the doubling time for confirmed infections. That is obviously good news but needs cautious interpretation. It’s possible, indeed likely, that the interpersonal spreading we are now observing will see numbers increase again. Let’s hope not but certainly not relax our infection reduction strategies. Indeed should we have the enemy on the run lets try and finish him off!

While we need to do more testing and our capacity to do so with better testing tools is welcome, our only chance of significantly reducing the growth of new infections depends on the success of our determination to keep away from each other. What is becoming increasingly troubling however is that even if we had fantastic compliance with current restrictions the largesse associated with those restrictions still leaves us with numerous opportunities for continued community spread.

Many have commented when the subject of a “Lockdown” arises that, surely, we have already embraced that strategy! We have not, we have just been dribbling out restrictions moving us in that direction. Prime Minister not every job is an essential job. We still have too many working in non-essential jobs where social distancing is difficult (e.g; the construction industry). The recommendations re hairdressing would have been laughable if the matter was not so serious. Extending contact time (which should have been zero) to three hours sent a really bad message. Understandably many, anything but essential, small and large businesses are trying to stay open to minimise losses in our economic calamity. But the thousand still in work include many who could infect others. Myer closed its stores to protect their employees, others should follow their example.We have not done all that we can. In the UK the list of essential jobs is thoroughly and accurately documented.

I can understand why so many health professionals have contacted me re their fear, indeed panic, that the truly distressing scenes in overwhelmed hospitals in Spain, Italy and the US may be reproduced here. While looking for support for the equipment and beds they will need, they are ready to put themselves at risk to help their patients. But I am very confident that I am representing the wishes of our front line health professionals in saying that they want us to move, immediately, to the “Lockdown” stage many other countries have implemented. We will be full of useless regret if a deteriorating situation has us introducing a lockdown in a few weeks. No more vacillating, we need to act today so that at least we can say that at this point we did all that is possible to minimise the spread of the virus, the need for hospital care and the loss of life.

Professor John Dwyer. Immunologist and Emeritus Professor of Medicine UNSW

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