Recently, a former Prime Minister (who also once served as Health Minister) was quoted as declaring “the Morrison government’s Covid response as a ‘grotesque overreaction’ to a ‘relatively mild pandemic’”.
Presuming the quotation is accurate, this incorrect and irresponsible comment needs to be debunked by some facts. These facts derive from World Health Organisation statistics on the deaths of healthcare workers (HCWs) world-wide, the impact of the pandemic on the lives of those workers, the deaths of elderly people in Australian nursing homes, and the long-term consequences of the pandemic including impacts on the training of healthcare workers and delays in diagnosis of cancer and other diseases through lack of access to care.
It may be that in this frightening pandemic Australia fared relatively well compared with other nations. If this proves to be so, it could explain but not justify the cavalier comments of the ex-PM. Until the current Commonwealth funded inquiry being conducted by an expert panel is completed (due in September 2024), judgement must be reserved. I look forward to the report of the inquiry as it may answer the following questions. If we did fare well, was this because Australia is a remote island; or because of prompt and difficult calls made by appointed medical officers backed by courageous politicians; or because our public hospitals were well-prepared; or perhaps because mutations of the Covid-19 virus resulted in less virulent versions of the virus reaching our shores? This last possibility deserves close attention given the devastating statistics about the deaths of doctors in Italy, UK and India. These statistics reveal how far off the mark was our ex-PM. I also look forward to seeing evidence that Australia’s preparation for this pandemic was informed by the two excellent Canadian reports (here and here) on the short-lived 2003 SARS-1 pandemic.
Deaths of healthcare workers world-wide
In October 2021 the WHO estimated that between 80,000 and 180,000 HCWs had died from Covid. In Italy as at June 2020, 150 doctors and 40 nurses had died. At around the same time, there was mention of 50 doctors dying in England. In India, the first wave of infection led to 757 deaths of doctors and the second wave killed another 839 doctors. To my knowledge there has been only one death from Covid in a HCW reported in Australia; a male nurse who worked in disability care.
The impact of the pandemic on the lives of healthcare workers
Nurses, paramedics and doctors working at the ‘front-line’ of Australia’s healthcare system experienced extreme additional stresses, especially in the first phase of the pandemic until an effective vaccine became available from late February 2021. Few of these people would be likely to agree that Australia experienced a ‘relatively mild pandemic’. A valuable survey of the experiences of over 700 Australian junior doctors was published in May 2022. In addition to the expected anxiety over risks to self and family came the difficulty of working long hours while wearing personal protective equipment, the negative impact of that equipment on communication with patients, stigmatisation by non-medical friends who saw junior doctors as a possible source of infection, interruption of postgraduate training, and lack of access to usual self-care activities such as daily exercise.
If the above study does not provide the reader with insights into the stress levels in hospitals engendered by the Covid pandemic this book describing the daily life of a junior doctor working in a London hospital at the outbreak of the pandemic surely will.
Deaths of elderly people in Australian nursing homes
As at 13 April 2024, there have been 11,853,144 cases of Covid reported in Australia with 24,414 deaths. Many of these deaths have been in the frail elderly or in people with serious underlying medical conditions. The relatives of those elderly people who died in nursing homes are also unlikely to regard the pandemic as ‘relatively mild’. The largest numbers of Covid cases have occurred in NSW and Victoria and these two states have had the largest numbers of deaths.
During a second wave of the virus Victoria saw a large spike in deaths, the majority occurring in nursing homes. Many explanations were offered for this outcome with critics suggesting that it should have been preventable. During this second wave, the fatality rate was higher than in the first wave, a phenomenon previously observed in influenza pandemics and believed to be part of the pattern of viral mutation (p 53).
The longer-term consequences of the pandemic on the Australian health care system
The impact on the training of junior doctors has already been identified. Medical student clinical experience was also interrupted. Still unfolding issues include the impact of the pandemic on access to diagnostic tests for cancer and to cancer screening programs; delays in diagnosis may result in higher mortality rates for some conditions. Only time and more data will reveal the extent of this impact.
Kerry Breen AO is a retired physician and past President of the Medical Practitioners Board of Victoria and of the Australian Medical Council. His interest in wrongful convictions was sparked via research for a biography of noted forensic pathologist.
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