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RUBY:

From Schwartz Media, I’m Ruby Jones. This is 7am.

As Australia grapples with its biggest outbreak yet of Covid-19 - an outbreak that shows few signs of slowing - the focus is shifting to hospitalisation figures and deaths.

But even though Covid-19 wards are becoming busier, it isn’t easy to get a clear picture of just how bad things are in our hospital system.

Today, senior reporter for The Saturday Paper Rick Morton on how our two largest states are handling the current outbreak and what might happen if things get worse.

It’s Wednesday September 8.

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RUBY:

Rick, recently we saw Victoria acknowledge that getting back to Covid zero in the state was unlikely to happen and that was no longer going to be the main goal. So what is the situation like right now in the state?

RICK:

Well, even with harsh lockdown measures in place almost from day one of the first case being identified, the outbreak in Victoria is actually now the fastest growing of any covid-19 cluster in Australia.

Archival Tape: Dan Andrews at various press conferences listing case numbers as they rise.

RICK:

Now, things might not look like that because New South Wales has over well over 1500 cases a day now and Victoria is hovering around 200. But Victoria got to this point much quicker than New South Wales did. And there's few signs it's actually slowing down and that is having a flow on effect.

So data from the critical hospital resource information system, which is this amazing platform that was actually developed last year by intensive care specialists and their peak body to get a real time bird's eye view of every available intensive care bed in the country. I was given access to that platform last week, on Thursday to this point in time data. And on Thursday it showed that 391 of the 429 currently staffed and open ICU beds in Victoria, which is 91 per cent, are full.

No that's with covid-19 patients and other patients. So of the whole number, 20 are being used for Covid-19 patients. But that number is expected to increase sharply.

RUBY:

Right, and so it’s this - I suppose - deteriorating situation, that has led to a change in approach in Victoria, in terms of what to focus on?

RICK:

That's right. So last week on Wednesday, Victorian Premier Daniel Andrews announced a dramatic shift in the state's thinking about Covid-19.

Archival Tape -- Dan Andrews

“We've thrown everything at this, but it is now clear to us that we are not going to drive these numbers down. They are instead going to increase.”

RICK:

He said that the Delta variant outbreak that was seeded from New South Wales can no longer be controlled.

Archival Tape -- Dan Andrews

“These are not easy decisions to make. This is not the advice I wanted to receive. I’m sure it's not the advice the chief health officer wanted to give us but none of us have a luxury of pretending the reality isn’t just that… “

RICK:

It was a significant shift in the state because until recently the rhetoric had been very much about how successful Victoria had been at using strict lockdowns, including curfews and things like shutting down playgrounds to stop the virus spreading.

Archival Tape -- Dan Andrews

“We gotta buy time to allow vaccinations to be taken. All the while doing this very hard work to keep a lid on cases.”

RICK:

So this was an acknowledgement that things in the state were getting quite dire and a new strategy was needed. And behind the scenes, the situation was even more severe than that update allowed.

On the same day that Andrew has made his announcement. At 1pm on the Wednesday, the Royal Melbourne Hospital pushed the button on its pandemic mode operating model, which has already reached a critical point. So I obtained a copy of the hospital's covid-19 operational bed plan covering the city and Royal Park campuses of the hospital.

RUBY:

OK, and so what does that plan say about how the hospital is planning on operating?

RICK:

So they've already reached stage two of what is a three stage kind of emergency preparation plan. And that's because all eight intensive care negative pressure rooms are already full and a further three Covid-19 patients are receiving intensive care support in the hospital's ICU hot zone. A hot zone is a dedicated covid-19 area.

And I was chatting to an intensive care source at the Royal Melbourne Hospital who told me that they are now sending away patients to other hospitals and not accepting patients from hospitals for whom, and I'm quoting them here, elective cardiac surgery has not happened for two weeks, mostly due to the large numbers of ward staff who have been furloughed. We may not have space for emergencies on the wards to come to ICU immediately. They may have to sit in the operating recovery room now, they continued. We don't know what we will do when the pandemic area is actually filled. The hospital is clearling in wards now to make non ICU Covid wards as the dedicated Covid ward is full.

Now some of those who work through Victoria's second wave and its aftermath so traumatised and exhausted that they may never come back. Certainly some have already refused.

RUBY:

Mm. So how big of a concern is that? Is Victoria now at risk of not having the health care workers that it needs to be able to cope with this predicted influx?

RICK:

I'll just give you an example. So last year, about 170 nursing and health care staff were trained to help expand the ICU capacity. They had been approached to serve again, but only five have expressed an interest in returning.

So my health source told me we were strained last year. However, in many ways, this year is worse because we are all tired. Last year we had an umph to get this done, they said. Now we see this as a never ending struggle, they continue. I cried when I got home yesterday. We are all in for a very rough time, not just the staff, but the community.

Now, this is not an isolated refrain. I'm hearing it from people working in New South Wales as well.

Archival Tape -- Brett Simpson

“I don't want to be alarmist, but like someone, if not already, someone will die because of the current pressure. Oh unmistakably, People have already. Without question. Yeah, yeah, without question.”

RICK:

New South Wales paramedic Brett Simpson said he and his colleagues have grave concerns that there have already been avoidable deaths in New South Wales as a result of the system buckling.

Archival Tape -- Brett Simpson

“There is definitely a burden on the health system that the. Extra requirements that these patients need. There's definitely a big burden on the system.”

RUBY:

Right. OK, can you tell me more about that, Rick? What is happening in New South Wales right now?

RICK:

It's bad. And again, the unofficial information is much more alarming than what is being said publicly. So in New South Wales, I've discovered that the Covid-19 hospitalisation rate is actually three times higher than has been reported by the Premier, Gladys Berejiklian.

RUBY:

We'll be back after this.

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RUBY:

Rick, we're talking about hospitalisations for Covid-19 in New South Wales. Now, you've said the rate is actually three times higher than what the New South Wales government is reporting. So what's going on?

RICK:

So on Tuesday, last week and indeed the week before that, and that's important in the timing of this. So we're talking the final two weeks of August. Premier Gladys Berejiklian said that the most recent figures she had seen for the rate of hospitalisation was 5.5 percent in terms of cases converting to hospitalisation.

Archival Tape -- Gladys Berejiklian

“For example we’ve had intensivists tell us now, the rate of hospitalisations, which is a figure when it's updated we'll be happy to release. The most recent figure I have for the rate of hospitalisation was 5.5% in terms of cases converting in hospitalisation.”

RICK:

Now the real figure, however, is about 15 per cent, and that's according to medical experts and a briefing provided to national cabinet. So the actual numbers have been masked. But also, if you see the hospitalisation rate as being a useful statistic to tell you what the health system capacity is, then there is another element that has not been publicly reported properly.

And that hospital in the home and it's now 2200 people who are in hospital in the home in New South Wales. And that's a key detail when you need to understand the impact across the entire system.

RUBY:

Mm okay so what exactly is the Hospital in the Home program Rick, and what does it mean that there are over 2000 people being treated in that system right now?

RICK:

So Hospital of the Home is an amazing programme. It allows people to stay in their own home to get treated as if they were in a hospital. In fact, the the guideline from the New South Wales government says if hospital in the home care were not available, the patient would be admitted in hospital.

Now, I'm not making the argument that 2200 people should be in hospital. In fact, for many of them, it's better that they are in the community. But the mere existence of these large numbers of people with Covid-19 in hospital in the home means that the people, the doctors and I spoke to one of them over the weekend, actually, the doctors who are looking after them, there's about six looking after 1500 people just in the kind of western area attached to Westmead Hospital. They could only do it by telehealth. And so they're trying to monitor the status of people with the Delta variant.

When something goes wrong, they have to rely on the ambulance service to go to these homes. And we receive testimony from paramedics that they are swamped.

So taking all these things together, I was speaking to health system workers and they believe that clinical care is already being compromised in New South Wales outbreak, not because people are in hospital, in the home on their own or because they're in hospital beds, but because we're actually struggling to get to all of them, particularly when they need help.

And time and time again, health care workers have made the point to me that it is not just Covid-19 patients who are affected by the system pressure. It's everyone who needs medical attention.

RUBY:

Hmm. OK, so as a result of all of this, the pressure on the health care system is at such a high level that other people, other patients are also going to see a decrease in the level of care that they can receive because there's just not enough available.

RICK:

And and that's already happening. So take this story, for example, which was told to me by NSW paramedic Brett Simpson.

Archival Tape -- Brett Simpson

“You know, a patient, a 50 year old man fell three metres off the roof of his house with severe leg injuries.”

RICK:

And after half an hour when the ambulance just simply hadn't turned up, his wife dragged him to the car and drove him to Liverpool Hospital on her own.

Archival Tape

“And this is happening more and more and more often. And the injuries were substantial.”

RICK:

And at the moment, he said, we are seen HotJobs, which is lights and sirens, emergencies, sitting in the queue, waiting over an hour for an ambulance even to be dispatched, let alone to get a paramedic crew arriving at the scene.

Now, the most telling example he gave me was that they dispatched a car, lights and sirens from Bateau Bay on the Central Coast, which is 100 kilometres away from South Granville, where they were dispatched to and they were going to give oxygen to a family with Covid-19 who was struggling to breathe.

So that is the flow on effect when we're managing people in the community, as well as managing our hospital resources, which are attached to hospital in the home. You can't isolate those elements. You have to look at them as a whole.

RUBY:

Mm, and Rick, you've been reporting on the situation in hospitals for the past few weeks as these outbreaks have been getting worse in New South Wales and in Victoria. We keep hearing that things aren’t likely to get better any time in the near future. So what does that mean for our health system, which is clearly under strain?

RICK:

So this is really important to get right. Now on Wednesday, Gladys Berejiklian told reporters at the worst time for hospitalisations in New South Wales is likely to be in October.

Archival Tape -- Gladys Berejiklian

“We also know from the information we have the accumulation of cases and also the number that is still unvaccinated, that October is likely to be our worst month in terms of pressure on the system.”

RICK:

Now nursing staff and doctors are worried about what happens between now and then when she says that things are going to get bad in October. It's absolutely true. But we're not getting the full picture now about the kind of connectedness of the system, because as Brett Simpson, the New South Wales paramedic, said to me, the hospital system is set up like dominoes

Archival Tape -- Brett Simpson

“When one falls over and it all just shifts onto the next one and the next one falls in, the next one falls on the next one.”

RICK:

So, yes, there are hospitals already in crisis, Westmead being one of them. Obviously, Liverpool is struggling, Nepean, because they are accepting covid patients. But now the flow on effect is starting to fill up other hospitals. And I know St George is having particular issues, having spoken to some people there.

And so everything is finally calibrated that the staff who are on the front line are extremely worried.

Now, we're not saying that people aren't going to see a doctor at some point if they need it. But what is likely is that there are implications for care.

Things will change. And will you get to see the right doctor at the right time for your illness, whether it's Covid or not. Already the paramedic response times suggest no. And as one source put it to me, it's it's the total shit show.

RUBY:

Hmm. Rick, thank you so much for your time.

RICK:

Thanks, Ruby.

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RUBY:

Also in the news today…

Prime Minister Scott Morrison has defended his decision to give 200,000 extra doses of the Pfizer vaccine to NSW, after facing criticism from Victorian Premier Daniel Andrews.

The vaccines were distributed to the hot spot area of south-west Sydney during the state’s current outbreak.

Morrison confirmed on Tuesday that future Pfizer doses will be allocated on a per-capita basis.

And in Victoria, former party leader Matthew Guy has retaken the leadership of the Victorian Liberal party after toppling Michael O'Brien on Tuesday.

The new state opposition leader has made a "pandemic pledge" that city and statewide lockdowns would not exist under his government once a 70 per cent double-dose vaccination target was reached.

I’m Ruby Jones, this is 7am, see you tomorrow.