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RUBY:

From Schwartz Media I’m Ruby Jones, this is 7am.
As hospitals in New South Wales and Victoria prepare to deal with an influx of Covid-19 patients, there are fresh concerns that our healthcare system might not be up to the challenge.

Hundreds of healthcare workers have been forced into isolation during this outbreak, putting further pressure on a system already grappling with the Delta strain.

Today, senior reporter for The Saturday Paper Rick Morton, on the situation in hospitals right now, and what might happen when we come out of lockdown.

It’s Tuesday August 31.

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RUBY:

Rick, last week we spoke to you about projections that you had gotten a hold of that showed hospital intensive care units could get close to capacity in the next few weeks. Since then, case numbers of Covid-19 in New South Wales have continued to go up. So what is the situation like now, a week on in hospitals?

RICK:

Yes. So cases have been steadily growing and, you know, obviously on Thursday, New South Wales hit more than a thousand cases a day.

Archival tape -- Unknown Person 1:

“There's over 600 people that are hospitalised now in New South Wales, more than 100 in ICU. And particularly at Westmead Hospital, which is the major hospital in the epicentre in Sydney's west, is really struggling to cope.”

RICK:

And it's putting a lot of pressure on the state's hospitals.

For example, last week, Westmead Hospital in Western Sydney issued an internal disaster management protocol as it reached capacity for Covid-19 patients.

Archival tape -- Reporter 1:

“With 121 staff dealing with 75 new Covid patients arriving every day, as well as managing 1,500 others, out in the community.”

RICK:

Now that hospital reduced ambulance arrivals, it transferred critical patients to other sites. And a memo went out that said it was conducting urgent reviews.

Archival tape -- Unknown Person 2:”

Capacity in certain areas is reaching levels that they have to decant patients to other areas. And my colleagues are certainly doing it tough. They're working long hours…”

RICK:

Shortly after Westmead established its emergency operations centre, Blacktown Hospital similarly stopped accepting Covid-19 patients.

Archival tape -- Reporter 2:

“Incoming covid cases are now being sent to hospitals as far away as Wollongong and the Northern Beaches.”

RUBY:

Hmm so the situation in New South Wales doesn’t sound good Rick. What is it like in Victoria, the other state facing a major outbreak? Because the case numbers there have also been steadily growing this week. Is that starting to have an impact on hospitals in the state?

RICK:

Well, last week when Victoria recorded those 80 new cases in a single day, which is its worst day since the end of the state's second wave, more than 450 health care workers attached to Royal Melbourne Hospital were also sent into quarantine.

Archival tape -- Reporter 2:

“200 staff are still in isolation at the Royal Melbourne Hospital after a case was detected there. And there is a cluster still continuing to grow and a case also at the Footscray Hospital…”

RICK:

There are also a string of small hospital clusters, including at the Royal Children's Hospital, the emergency departments that Sunshine Hospital, the Alfred and the Northern Hospital, which is kind of putting pressure on the state's health care system across the board. And it's important to note, I think, that Victoria has less capacity than New South Wales, despite having a similar population.

And it highlights another issue of vulnerability. Although states have substantially increased their supply of ventilators since the first outbreak of Covid-19, they do not have the health care staff to operate them. And the staff they do have are vulnerable to exposure and the need to quarantine, the situation can change in a single day.

RUBY:

And you mentioned last week that although we have the capacity to increase the number of ventilators that we have, that is essentially useless if we don't have the medical staff to operate them. So are there any preparations underway to try and increase the number of staff? Because it sounds like we might be needing that.

RICK:

Yeah, it's a really interesting question, and I know that at national cabinet on Friday, they discussed all of these healthcare workforce pressures, as they call them, including how they might bring staff from one state to another in the event of a crisis, assuming all states aren’t undergoing an outbreak at the same time. Potentially fly more people in from overseas under those medical worker exemptions and also moving people around within state systems to try and ease pressure at these different choke points.

So including people in ICU for reasons other than Covid-19 complications, the system in New South Wales is already at 60 percent capacity.

And that, bearing in mind, is with the cancellation of elective surgeries. So that's a huge that's a very high figure.

Victoria has half the number of ICU beds and half the expansion capacity that New South Wales has. So last week, the state announced it would fly hundreds of medical staff, mostly doctors and specialist nurses from overseas to relieve pressure on a system that has already borne the brunt of the pandemic in Australia.

RUBY:

So Rick, we are seeing the healthcare system under increasing strain, even though much of the country is in lockdown. But the NSW government is actually proposing to ease those restrictions. Can you explain their rationale?

RICK:

Yeah so, last week, New South Wales Premier Gladys Berejiklian said every state is going to have to go through this transition one way or the other.

Archival tape -- Gladys Berejiklian:

“Because once you open your borders, we can't live in isolation forever. We're one of the few nations on the planet that is still living in isolation.”

RICK:

She goes on to say, once you start opening your borders, every state is going to get case numbers. And that is why we just have to get used to the fact that our aim during the pandemic is to keep people safe and healthy, keep them out of hospital.

Archival tape -- Gladys Berejiklian:

“..But just as we tend to talk about the number of people that die from the flu in you know, when we have 80 per cent double dose vaccination, that's how we'll be treating Covid. The case numbers will be less relevant. What will be more relevant is how many people we have in intensive care and how many people, unfortunately, succumb…”

RICK:

And by succumb it’s a weird politician word where she means die. So that's all true. That's exactly what the Doherty modelling sets out. And it is a conversation we need to start having as a country.

The problem then becomes, of course, what number you're willing to accept in terms of serious illness, injury or death. And again, we don't know the complete reality because models are models. And the Doherty Institute people are the first to say that, you know, their model has drawbacks. So that's where the conversation is turning. And we need to have a really kind of clear and concise discussion about how that unfolds, I guess, in reality.

RUBY:

We'll be back after this.

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RUBY:

Rick, we're talking about the strain that our hospitals are under right now, we're charting a course as a country to opening up further at 70 to 80 percent vaccination rates. What do we know about how that will look for hospitals? Do we know how many people are likely to end up in ICU at that point? And do we have the capacity to handle that?

RICK:

The short answer is no, we don't know. We do have a model that forecasts. So the Doherty modelling does talk about, I want to be really clear, it talks about opening up more. This is a transition. We are not just going to throw the entire country out of lockdown and have no more restrictions. That's not what is being countenanced.

But even so, at 70 and 80 percent, there will be fewer restrictions envisaged than there are certainly now in Sydney and Melbourne. The models are very clear that their assumptions underpinning this project and the vaccine coverage threshold are just their uniform. They don't account for the unevenness in Australian society and the inequality in Australian society. All these different variations for disadvantaged communities, people with disabilities or others with underlying health concerns, they're actually going back to do that work. They haven't done it yet.

But in any case, the model forecasts are cumulative 1,338 intensive care admissions among unvaccinated people in a six month period if a Delta outbreak is ceded at the 80 percent vaccination threshold.

They also model that there would be 673 deaths among those unvaccinated people. Again, they're not doing this modelling for, you know, what would it look like if Western Sydney got 80 percent? What would it look like if Wilcannia got to 80 percent? They're assuming that the averages across the country add up to 80 percent vaccination, and that is crucial when we come to discuss those levels that we're prepared to accept.

RUBY:

Mm hmm. Rick, in a sense, though, inequality has been built into our vaccine rollout. It hasn't been broadly accessible to anyone, and that's largely because we haven't had enough supply. Young people have been the last to get access. We spoke about that last week. Are we continuing to see that reflected in more young people in hospital and in ICU?

RICK:

Yeah, we are so, you know, we're seeing younger people in intensive care, they're staying there for longer. They're getting care that can only be done on the ICU wards and they're on breathing machines, their own heart, lung machines right.

And more interestingly than that, even I found that one quarter of all ICU patients in New South Wales are now aged 40 and under, the vast majority of people in ICU have not been vaccinated at all. A handful have received just a single dose. But not a single one in ICU has been fully vaccinated.

And the fact that so many young people are in intensive care is a function of both the fact that they have had very little access so far until very recently to the vaccination programme and also perhaps, you know, some of the qualities of the Delta variant itself, which makes it slightly more dangerous, a higher viral load in the respiratory tract and things like that. But the combination of those two things, if you're unvaccinated and subject to Delta, things are not looking good for you.

So that's really important. And, you know, whatever the future may look like with Covid-19, there is this kind of unanimous agreement that vaccinations are the best shot at normalcy. And, you know, right now, as Kerry Chant said on Tuesday, they are also the key hope to preventing health systems from buckling under the burden of infection.

Archival tape -- Kerry Chant:

“Obviously, when we see those case numbers going down and vaccination levels going up, that will allow us to be more confident, we have got control…”

RICK:

Vaccinations are seen as, they're not miracles, they're not silver bullets, but they are the best thing we've got. And Kerry Chant kind of finished up, last week saying in New South Wales in particular, we are in here for the long course.

Archival tape -- Kerry Chant:

“Let's be clear. The impact of vaccination takes a while. It takes at least two to three weeks for vaccines to work..”

RICK:

We are not actually expecting to see the full impact of the kind of large numbers we've been vaccinating in New South Wales until mid-September.

Archival tape -- Kerry Chant:

“This big push in South-Western Sydney. we're not expecting to see the impact of that until mid September. And so that is why it's so critical that we work so hard now as a community.”

RICK:

And that's because it takes two to three weeks for the kind of efficacy of the first shot to kick in.

This is so much worse than the Alpha strain. And it's still causing this absolute chaos in one of the best health systems in the world.

So, it's really a race against time for particularly New South Wales at this point in time to get as many of those vaccines to full effect as possible to keep the health system from falling over.

RUBY:

Rick, thank you so much for your time.

RICK:

Thanks for having me once again.

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RUBY:

Also in the news today,

New South Wales recorded 1,290 new local cases of Covid-19 on Monday, with more than 80 per cent of new infections in NSW occurring in Sydney’s west and south-west.

The state recorded four deaths, including an Aboriginal man who died in hospital in Dubbo. They were the first Aboriginal or Torres Strait Islander person recorded to die with Covid-19 and it’s the first death recorded in regional New South Wales.

And Virgin Australia has followed Qantas in announcing it is introducing mandatory vaccinations for all of its 6,000 employees.

The chief executive of Australia’s second biggest airline says the company is hoping to resume international flights by Christmas.

I’m Ruby Jones, and tomorrow on 7am we’ll be airing the first episode of our new investigative series Everybody Knows. It’s examining the MeToo movement in Australia.

You can listen to it right here, or by following Everybody Knows in your favourite podcast app.

See ya then.

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