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RUBY:

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

As Covid-19 case numbers continue to reach record highs in NSW, so too do hospitalisations and intensive care admissions. Now, a leaked document from the National Cabinet has revealed that the state’s hospitals could soon reach a tipping point.

Today, senior reporter for The Saturday Paper, Rick Morton, on exactly who is being hospitalised with Covid-19 and how close our hospitals really are to capacity.

It’s Tuesday, August 24.

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Archival Tape -- Unidentified Speaker:

“Good morning everybody, yesterday there were 103,000 tests done in NSW. Unfortunately we had a huge increase in the number of cases of community transmission to APN last night. There were 633 cases of community transmission.”

Archival Tape -- Unidentified Speaker:

“We had 681 cases of community transmission…”

Archival Tape -- Unidentified Speaker:

“Unfortunately overnight we did see an increased number of cases 825…”

Archival Tape -- Unidentified Speaker:

“There were 818 cases of community transmission with at least 42 of them infectious on the community…”

RUBY:

Rick, every day during these outbreaks, we hear a lot about the number of new Covid-19 cases. The government does also report the number of people who are in hospital as well, though. So what is the current situation in hospitals in New South Wales, which is obviously the hardest hit state at the moment?

RICK:

It certainly is. So right now in New South Wales, the state has a total of around 860 intensive care or ICU beds, and that's where people end up when they really need the most complex clinical care. And they tend to be life threatening situations. At the moment, of those 860 beds, just over 51 percent of these are currently occupied. That's across both Covid and non-Covid patients. But the number of Covid patients in ICU is increasing every day, particularly in this last week.

Archival Tape -- Unidentified Speaker:

“In terms of cases in hospital there are currently 516 cases admitted to hospital. 85 people are in intensive care, of whom 29 require ventilation. Of the 85 people in ICU 76 are not vaccinated and the remaining have had one dose of the vaccine.”

RICK:

And we're hearing from the New South Wales government that we're far from the peak of this outbreak, but we've got less than half of our total ICU capacity remaining. So it is worrying, but I actually learnt that there are official predictions of just how bad things are going to get thanks to a sensitive document prepared for the national cabinet that I was linked to by a confidential source.

RUBY:

OK, so can you tell me more about that document, Rick? How did you get it and what does it say exactly?

RICK:

This document is marked ‘sensitive National Cabinet’, and you'll remember that National Cabinet is very secretive. So it was handed to me by a very confidential, very high-ranking source, I must admit, and I won't go into too much detail, but it lays out all of this analysis which is done for the states and territories, for the federal government about hospital capacity with Covid-19. And it's quite alarming because it has implications for the entire country. So the predictions are pretty scary. It forecasts that in New South Wales, Covid-19 patients requiring ventilators will double in just one week. And it says that intensive care admissions will rise by more than double, by about 110 percent or thereabouts in the same timeframe - in a seven day window.

RUBY:

OK, that is alarming Rick. Is there a risk that we might not have enough ICU beds in New South Wales soon?

RICK:

So, according to this document, while - and I'm quoting from it - while increasing hospitalisation and ICU rates are manageable in the short term, continued growth in the transmission of Covid-19 cases would put ICU baseline capacity under strain and that would, quote unquote, impact all patients, all patients, requiring intensive care. Now, the paper does note, and I think it's important to highlight this, that New New South Wales has the capacity to establish surge arrangements, which would more than double the number of ventilator equipped ICU beds. So that would take it from 860 odd beds now to 2,015 is what they've got capacity for. But that's just the physical beds. The paper is very careful to note that this does not include medical staff. It says, and I'm quoting again, ‘staff remain in shorter supply than beds and ventilators to meet ICU demand.’

So there may come a point where staff will have to come from across state borders. And this is actually discussed in the paper to help support hospitals, particularly if local health care workers are forced into isolation due to the outbreak. And of course, you'll remember, it's not just if they're positive that they're forced to isolate, but if they're close contacts. And we witnessed that during the second wave in Victoria last year where entire teams of health care workers were furloughed because of these close contacts or positive cases. And that's a real, real alarming point of this.

RUBY:

And so Rick, are these predictions bearing out? We have seen cases continue to rise since that document that you obtained was prepared. What does it mean for our ICU resources?

RICK:

We're certainly not seeing a backward step in the pressure on the ICU system, but the predictions made in the paper at National Cabinet haven't come to fruition yet. It doesn't mean we're out of the woods, though, because there is often a two week lag, as they note, between when you get a Covid infection and when they might end up in hospital. And then there's another lag if they're in hospital as to when they might end up in ICU. So the predictions made have not been realised yet, but they were only seven day predictions. It's just that there is now a delay. So the matter of when we hit them, they're still serious milestones is, you know, is it next week? Is that the week after? Is it in a month from now? And I guess National Cabinet will be continuously updated on that.

And that's an important thing for National Cabinet to be talking about, because right now we're seeing an almost complete flip in terms of the people who are ending up in ICU in the most intensive care. And it’s young people.

New South Wales health data actually shows, you know, to the end of July, the single largest age cohort in hospital due to Covid-19 is those aged 30 to 49, accounting for almost 30 percent of all admissions. And the reason is, according to, you know, other experts like the Australian National University infectious diseases physician, Peter Collignon, it's because vaccination rates are now inextricably linked to hospitalisation and particularly to intensive care status. Now, almost half of all hospitalisations have occurred in those with the least access to vaccinations so far, and that's people under the age of 50.

So that's quite different to what we've seen at previous stages of the pandemic. You know, before we had access to vaccines, we saw older people who were more vulnerable. They had more underlying conditions and they were much more likely to end up in hospital, in ICU, than younger people. That's no longer the case. And so now we have this cohort of younger people who are paying the price for the slow vaccine rollout. And it's an incredibly dire situation that is nowhere near reaching its zenith at this point.

RUBY:

We’ll be back after this

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RUBY:

Rick, young people, those aged between 30 to 49, seem to be the most likely to be hospitalised as a result of this Delta outbreak in New South Wales. And that's because, as you've said, they're the least likely to be vaccinated. Does that suggest that it was a mistake to not include that age group earlier on in the vaccine rollout?

RICK:

This is a real interesting question and I was speaking to the University of New South Wales epidemiologist, Mary Louise McLaws, about this.

Archival Tape -- Rick Morton:

“We really do need to start thinking about vaccinating young people first…”

Archival Tape -- Mary Louise McLaws:

“It’s really, that was the no-brainer. I mean I’ve been…”

RICK:

Now, Professor McLaws, who was also a member of the World Health Organisation's expert advisory panel on the global Covid-19 response, she's been arguing since the end of last year that Australia ought to be vaccinating its most mobile, its most socially connected residents.

Archival Tape -- Mary Louise McLaws:

“We constantly think about protecting the elderly, but we sometimes fail to remember who's spreading it.”

RICK:

She said that the pattern in Australia, which wasn't too different from anywhere else in the world even last year, was that twenty to thirty nine year olds were having most of the infection. They were not necessarily the biggest group in hospital last year, but they were having most of the infection.

Archival Tape -- Mary Louise McLaws:

“WHO told me that that framework could be adjusted to anything, that the member state wanted”

RICK:

Now, she said that the WHO told her that the vaccination framework that they had developed through the Covax facility could be adjusted to anything that any member state in the world wanted in terms of their own vaccination programme.

Archival Tape -- Mary Louise McLaws:

“So I then started to push the idea of an epidemiological framework that would be able to ring fence those that are at risk, such as, you know, the immunosuppressed, etcetera, because it's the young transmitting it and the elderly dying from it.”

RICK:

And the other thing to remember as well about this is that something that doesn't seem to have been factored into the rollout planning is that it's these younger people who are far more likely to be essential workers and on the front lines of this outbreak. We know that's where the virus is spreading. And for some bizarre reason, we left them until the very end.

Now, there was always a compassionate framework, is what they call it, which was we must protect our most vulnerable and we must kind of give them a chance to beat the virus. But at the same time, we could have and should have had our act together, been vaccinating the people who were most mobile as soon as we knew that transmission was impacted by these vaccinations Which was pretty early in the piece.

RUBY:

Hmm. OK, so we should have known it the whole time, but there's absolutely no doubt that we definitely know it now with these young people in hospital. So are we likely to see a change in the way that this is approached now?

RICK:

Well, we will by the end of this month, the advice actually changed literally last Thursday, late last Thursday...

Archival Tape -- Scott Morrison:

“We agreed today and the cabinet also met today to affirm that we will be moving to opening up a 16 to 39 year old for the balance of the programme.”

RICK:

Scott Morrison's actual cabinet, the cabinet of the Commonwealth, met and agreed to open up access to Pfizer and Moderna for people aged 39 and under.

Archival Tape -- Scott Morrison:

“So 8.6 million extra getting access to the programme at the end of August.”

RICK:

Previously, there was no opportunity to pivot the vaccine strategy because the nation's rollout, which purported to prioritise the most vulnerable groups, was plagued by critical supply shortages from day one. And as you and I both know now, it's beyond clear that not even the priority groups were adequately protected. In fact, they haven't finished that job. It's almost September.

RUBY:

And so, Rick. Should we not have been spending the past 18 months boosting the capacity of our hospitals and our ICU’s to kind of help us if we did end up in this situation, has that happened at all? Have we funded any new ICU beds since the outbreak began?

RICK:

Look, I mean, I haven't covered every single state government budget. And no doubt, every year, they've got increases in recurrent expenditure. But the Covid-19 situation has put strain on every element of the healthcare workforce. You know, on testing alone, we're spending something like ten million dollars a week in NSW. And, you know, this paper that was leaked to me from National Cabinet, they're looking at commandeering the private hospitals or at least some private hospitals in New South Wales if there's a major outbreak in an aged care home. Yes, we bought a whole lot of ventilators last year that were never actually used because thankfully we avoided the worst of what the world saw last year. And we do have the space and the capacity to increase the number of beds with ventilators in this state in New South Wales. But we don't have the staff.

What we do need to do, I think, a lot of serious Soul-Searching about the way the health system is set up for the future, because there are many lessons here. And we're on the precipice now in New South Wales, where some of those decisions may need to be taken in the next month or two.

RUBY:

Hmm. Rick, thank you so much for talking to me about all of this.

RICK:

Thanks for having me again.

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RUBY:

Also in the news today…

Prime Minister, Scott Morrison, has urged Australians to prepare for life after lockdowns once the national vaccination rate hits 80 percent. Speaking at a press conference in Canberra on Monday, Morrison said that lockdowns were not sustainable, and that state and territory leaders should stick to the targets agreed to by National Cabinet.

And New Zealand’s Prime Minister Jacinda Ardern has suspended Parliament as the Delta outbreak in the country continues to grow. The decision followed an announcement that 35 new cases of COVID-19 had been found in the community on Monday, bringing the total size of the outbreak to over 100 cases.

I’m Ruby Jones, this is 7am. See ya tomorrow.