Before the pandemic, the typical shift of a New South Wales paramedic was acutely demanding. Today, that demand has increased – seemingly exponentially, in the experience of Brett Simpson, a veteran paramedic and a delegate for his state’s branch of the Australian Paramedics Association.
A typical shift now looks something like this: Simpson will arrive at the station, prepare his ambulance, sign out the necessary drugs required for his kit. Very likely, none of the night crew will be there for changeover, and Simpson will inspect the status board to find out their location. Very likely, the night crew will be stuck in a “bed block” at the local hospital, St George in Kogarah, unable to off-load their patients. Simpson and colleagues will respond to any outstanding emergency work, then drive to St George to relieve their night-shift mates and “babysit” the patients still stuck on the ambulance ramps. Generally, by 9 or 10 in the morning, the emergency workload picks up. By early afternoon, he’s seeing the accumulation of “multiple dozens” of emergency calls left outstanding.
By now, the day’s new patients are stuck at hospitals, awaiting admission. The struggle to acquit the caseload can feel Sisyphean.
The congestion is both cyclical and demoralising.
In NSW, a “status three” alert is a declaration that the paramedic force is overwhelmed and surge measures – like calling instructors to the roads – are triggered. These used to be rare. Now, Simpson says, a “status three” alert occurs a few times a week. Covid-19 is a large contributor to the strain. “It’s taking up a lot of our resources,” Simpson explains. “At the moment, Covid directly impacting the ambulance services is probably not as high as hospitals. But where the ambulance service comes unstuck is that because there are so many Covid patients in hospital – I think we’re at 2200 today, so we’re approaching our record number that we saw back in the Delta wave – that means that there’s just so much bed block in the hospital systems that the ambulances physically can’t offload their patients into the emergency departments, so they can be available for the next job.”
A similar picture is emerging in Tasmania. This week, in light of increasing hospital staff furloughs and projections for further increases in community infections and subsequent hospitalisations during the next six weeks, Ambulance Tasmania ordered a proportion of paramedics working in the southern region be rostered full-time in hospital ramping corridors to relieve the burden on emergency departments. “We’re not happy about this,” Tim Jacobson, the state secretary of the Health and Community Services Union, says. “The problem here is that given the circumstances and cases rising inexorably, the government has gone to ground. There’s no consultation, or any emphasis upon community mitigating practices. I feel like the government is now gaslighting the community and making [Covid] their responsibility.
“We had a circumstance last year where we had a peak in demand and the government’s rhetoric was that mandatory mask wearing was there to fundamentally help control the number of presentations we might see in hospitals. And we supported that approach. Hospitals don’t have infinite capacity, and nor does the paramedic service. But that rhetoric has completely gone.”
Australia is experiencing its third wave of the Omicron variant. Queensland, Tasmania, Western Australia and the ACT are all now experiencing record Covid-19 hospitalisations. South Australia is close. In Victoria, hospitalisations have increased 99 per cent since June 22, while intensive care admissions have increased by 60 per cent. The peak for most states may still be a month away, and aggravating the strain on hospitals is the energetic re-emergence of influenza. Meanwhile, Australia is approaching 11,000 deaths with Covid-19. At time of writing, the country’s seven-day average of daily fatalities was 63.
“We know that hospitals are operating at capacity, and also factor in flu cases and very large numbers of staff off unwell,” says Paul Griffin, an infectious diseases specialist at the University of Queensland. “It’s truly concerning. We talk so much about capacity: it’s a finite resource. And there’s a finite amount of time that [healthcare workers] can go above and beyond. We do need to do more from a community perspective to reduce the burden on hospitals. When capacity is exhausted, outcomes for non-Covid issues can be compromised. We need to pay attention.”
In conversations this week with front-line medics, infectious disease experts, health union leaders and the Australian Medical Association, The Saturday Paper heard the same thing over and over: we have stopped paying attention. We have gone from extreme vigilance to a near-refusal to acknowledge the virus. There is now a divergence between the medical reality – increasing hospitalisations, a virus that mutates with confounding ingenuity – and the messages of leaders, which are often complacent or contradictory.
“Instantly and deliberately, our [political] commentary shifted from alerting and mitigation to one of reassurance,” Griffin says. “Many people had the impression that the pandemic was over. That it didn’t require ongoing intervention. Some of our problems might stem from that. [But] the pandemic didn’t end.”
After a federal election campaign in which the pandemic was conspicuously absent as a topic, Covid is now reasserting itself on our front pages and in press conferences. So, too, is the broadening gap between medical advice and the decisions of leaders. In Victoria, the acting chief health officer, Ben Cowie, recently recommended working from home where practical, and the extension of mask mandates to cover most public indoor settings. So far, the Victorian Health minister, Mary-Anne Thomas, has declined to implement these recommendations, leaving it to the discretion of businesses, institutions and individuals.
This week, the federal chief medical officer, Paul Kelly, described the new subvariants of Omicron as a “significant” threat. He encouraged those eligible to take up their second booster and also recommended the wearing of masks indoors to slow virus spread and reduce the burden on healthcare workers. Like Victoria, the federal government has insisted on leaving this to the discretion of the community.
In a press conference this week, Prime Minister Anthony Albanese suggested that mandates might not be effective anymore. “The truth is that if you have mandates, you’ve got to enforce them,” he said. “And the mandates, like when I spoke to the New South Wales premier last week, he indicated that whilst there are mandates on public transport in New South Wales, not everyone is wearing a mask … People have looked after each other. And I’m confident that they’ll continue to do so.”
At the start of the pandemic, governments across Australia confounded expectations: they listened to experts. Given the novelty of both the virus and the crisis, there was a degree of improvisation to public policy, as there was friction between various states and the federal government in their approaches. There were also conspicuous failures. But leaders largely deferred to medical advice, messaging was consistent, and announcements were made alongside members of expert panels.
At Christmas, that changed. The NSW government announced relaxations of Covid-19 restrictions, just as the Omicron strain was emerging. Hospitals were soon strained. “I’m not sure we saw the full McCoy there, in NSW, regarding the changes,” says Chris Moy, an Adelaide GP and the vice-president of the Australian Medical Association. “They said they had taken the health advice, but I don’t know. It was [politically] filtered.”
National cabinet followed, redrafting the rules of the pandemic, redefining close contacts and reinterpreting the infection numbers the country had been watching for two years. Omicron had arrived at the same time as an election was due, and the public had naturally tired of restrictions. Morrison promised a return to normality.
“We had an election where no one wanted to mention it,” Moy says. “We’re like frogs being boiled slowly, and getting used to the death rates. Then we walk into another wave. At the same time, we cut back pandemic leave, and telehealth consultations, and they say we’re not going to continue free RAT tests. Let’s just say that’s some seriously mixed messaging and mixed actions.
“This is a great contrast with a year or two ago, when governments got the health advice first, and then we would see their response. Now it’s the opposite. The politicians have gotten ahead of this, and now it’s the tail wagging the dog. There’s this disconnect between the messages and actions of governments, and the reality of the virus. And I’m speaking with bewildered and upset front-liners about this constantly. About what they face. They’re under huge pressure and they’re angry. This is why we need an independent centre for disease control, and health advice that’s not filtered.”
UQ’s Paul Griffin reinforces this point: “Masks is the No. 1. We should have been encouraging ongoing mask wearing and our goal should have been sustained behavioural change. Also reinforcing simple things like social distancing, hand hygiene and improving ventilation. But recommendations have been inconsistent. Clear, consistent communication would help.”
In most conversations, experts preface their comments with an acknowledgment of public fatigue about the pandemic. The sum of that exhaustion is not perfectly measured but can be sensed in the alarming spikes in demand for mental health services these past two years. Inevitably, compliance with various public health measures will wane commensurately with exhaustion.
But the prevailing frustration expressed in these discussions was that there was too great and sudden a leap from messages of vigilance to reassurances about a return to normality – and it has created irreconcilable muddles in public health advice. It has also helped contribute to abnormal stresses on front-line medics. “As a society we were best when we came together … Public health measures are about the whole and about others,” Moy says. “Those working in our hospitals now are angry and scared. They’re full and they’re rearranging the decks. So, why rule mask mandates out, off the bat? It’s the opposite of where we started, which was education and encouragement.”
It is awful to contemplate, but not only are we not past this, we do not know what the future holds. The virus mutates quickly, cleverly and confoundingly. The natural history of a virus is typically one of increasing contagiousness and lowering virulence, but it’s an arc that may only manifest in the long-term – or not at all. There’s no guarantee. Not yet.
“I think the public health response [in Australia] has generally been pretty good, but after a while people get tired,” says John Mackenzie, a former professor of tropical infectious diseases who sat on the World Health Organization’s International Health Regulations emergency committee for Covid-19.
“I can understand that fatigue. People get fed up. But we’re in a situation we haven’t been in before. It’s more serious than we first thought. It’s mutating. I can understand the public view, but at the same time we do need to take more care. Masks are very much a major issue. They’re still important indoors.
“Two-and-a-half years ago there was real consternation when there were two or three deaths. Now we’ve had 10,000 deaths but there’s more complacency. It’s a strange change of tune or public feeling. But 10,000 deaths worries me; it’s a big number.
“It can mutate so readily, it’s quite scary in a sense. Will future strains have the same virulence? We don’t know. We’re walking in a minefield. We can’t foresee what will happen next. It’s so novel. It’s a puzzle.”
This article was first published in the print edition of The Saturday Paper on
July 23, 2022 as “Next wave: ‘ The government is now gaslighting the community ’”.
A free press is one you pay for. Now is the time to subscribe.