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RUBY:

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

Confidential documents leaked to The Saturday Paper show that hospitals remain a key area of coronavirus transmission.

It comes as doctors and nurses in Melbourne complain that they’re still not getting access to proper protective equipment.

Today, Osman Faruqi on how the handling of hospital transmission is contributing to the length of Victoria’s second wave.

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RUBY:

Os, let's start with what we know about cases of Covid-19 in health care workers. How many doctors and nurses are catching the virus in Victoria?

OSMAN:

Well, according to the latest figures from the government, 3,408 health care workers have been diagnosed with Covid-19 in Victoria since the start of the pandemic, and that includes workers in aged care, hospitals and other healthcare environments.

RUBY:

Osman Faruqi wrote about hospital transmission of Covid-19 for The Saturday Paper.

OSMAN:

But the really worrying thing now is that healthcare workers are making up a growing proportion of daily Covid cases and that proportion has been steadily growing now for months. At the start of August, for example, health care workers were only 11 per cent of new infections. Last week, they made up 37 per cent of new cases. And right now, health care workers, aged care residents and their close contacts make up 69 per cent of all new cases.

That's a big, big problem, not just in terms of the health and well-being of those who acquire the virus, but it's a problem because it shows that while the incredibly strict lockdown of Melbourne has helped curb the spread in the community more broadly, there's this continuing tail in really high risk settings like health care workplaces.

RUBY:

OK. So as all of these health care workers have been getting sick, what has the Victorian government been saying publicly about the problem?

OSMAN:

So at the same time we were seeing this big increase in health care workers acquiring the virus, the Victorian government was actually downplaying the risk for doctors and nurses at work .

Archival Tape -- Jenny Mikakos:

“...roughly about 10 to 15 per cent of those cases are believed to have been acquired in the workplace.”

OSMAN:

At the start of August, Victoria's Healthcare Minister Jenny Mikakos told a parliamentary committee that only 10 to 15 per cent of health care worker Covid-19 cases were actually being acquired in the workplace.

Archival Tape -- Jenny Mikakos:

“It is possible that people are bringing the virus into a workplace setting and then colleagues are infecting other colleagues, perhaps, in a tea room type environment where people might take their mask off and be in a more relaxed frame.”

OSMAN:

So if the minister's numbers were right, it meant that healthcare workers were socialising and breaking lockdown rules at a much higher rate than the rest of the population, which doesn't make sense.

I mean, this is a pandemic and we're in a lockdown. So that's just so obviously not what was going on. Instead, doctors and nurses were seeing firsthand how the virus was spreading and it was happening in their workplaces.

RUBY:

OK. So did the Health Minister, did she just have it wrong? What was going on here?

OSMAN:

Yeah, well, two weeks later, the Victorian Government totally reversed its position. It released a report showing that 86 percent of healthcare worker infections in the second wave were due to workplace transmission.

Archival Tape -- Unidentified Man #1:

“So as of the 23rd of August, 2,692 cases of health care worker infections have occurred in Victoria.”

OSMAN:

So it's basically a complete inverse of what they were saying earlier.

Archival Tape -- Unidentified Man #1:

“If we just take that through in more detail, about 70 to 80, sometimes around 70 to 80 per cent of the workers have obtained their infection at work in this second wave.”

OSMAN:

Every day in August, while the government was still claiming that infections were occurring in the community and that's how health care workers were getting them, an average of 34 of those workers were being diagnosed with the Coronavirus.

RUBY:

And so Os, until now, we haven't actually known exactly which hospitals were having these outbreaks, right?

OSMAN:

Yeah, that's right. Doctors and nurses working on the Covid-19 frontline have been calling for a full breakdown of cases in healthcare settings to be released by the Department of Health and Human Services. It's the government department that is releasing all the other Covid-19 data.

Archival Tape -- Unidentified Woman #1:

“My view is that transparency around data is important because it gives people a better understanding of whatever the problem is.”

OSMAN:

They want to know which hospitals have outbreaks, how many cases they have and what's being done to keep them safe.

Archival Tape -- Unidentified Woman #2:

“The continuous recommendations to improve transparency and improve communication to staff seem to not be followed.”

OSMAN:

So far, the government has only given really sporadic, limited information on that.

Archival Tape -- Unidentified Woman #2:

“And we don’t feel like we are aware of this transparency and good communication about what the plans are.”

OSMAN:

There's been a couple of hospitals named where there are active outbreaks, but we don't have that full set of information that shows every hospital or healthcare setting with Covid-19 outbreaks.

But I was leaked a confidential government document that shows for the first time where every health care outbreak has occurred throughout the pandemic in Victoria. And there's been a lot of them.

And after I reported on this for The Saturday Paper last weekend, a number of doctors got in touch to say that actually, they didn’t know that the hospitals where they worked had positive Covid cases in the past few weeks until they read about it in the paper.

And just in the last few days, I’ve been given more leaked documents that show more cases have been reported to the government in hospitals in the past week, and some of those also haven’t been disclosed publicly.

RUBY:

So why the secrecy? Why aren't all hospitals sharing their information with their staff? And also, why is the Victorian government not making all of this public?

OSMAN:

It's a really good question and we don't actually know the answer to that. I've asked the Victorian government why they won't release this information like they do, for example, for all aged care facilities that have got Covid-19 outbreaks. And they've just refused to tell me.

But health care workers are really worried. You know, one doctor I spoke to, Dr Sara Whiteclaw, who represents emergency physicians to the Australian Medical Association, said that the hospitals where health care workers did have transparency and did have information that the morale of staff there was much higher than at institutions where there just wasn't any clarity.

Archival Tape -- Dr Sara Whiteclaw:

“There is still room for significant improvement in terms of communication processes and transparency for health care workers and for the community in general to understand what is being done to address health care worker infections.”

OSMAN:

Another doctor said that they were begging for this kind of transparency because it would help them agitate for the things that they need to stay safe. Like better high quality PPE and improved infection control processes.

And the thing is, is there's a real consequence to this lack of transparency and this inability to protect our health care workers.

Thousands of these doctors and nurses acquired the virus and work, and if we could have stopped those outbreaks happening in the first place there would have been less overall spread.

And we could have limited the transmission of the virus into the broader community.

RUBY:

We'll be back in a moment.

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RUBY:

Os, because of these confidential documents, we now know that there have been Covid-19 outbreaks in a number of hospitals, which means that it is spreading in the workplace. So what do we know exactly about how that spread is happening?

OSMAN:

So back in July and August, a team of infectious disease researchers were monitoring outbreaks at the Royal Melbourne Hospital. And that research has given us a really fascinating case study of how exactly Covid-19 is spreading in health care settings.

So back in July, when we were seeing these big outbreaks occur across the aged care sector in Victoria, geriatric wards at the Royal Melbourne Hospital started to receive this influx of Covid-19 positive patients from those aged care facilities.

After that, cases among hospital staff escalated rapidly across all the six geriatric wards that were receiving patients from the aged care sector. And the researchers found that the reason why there was such a rapid spread of the virus was to do with the size of the wards and a lack of adequate ventilation. Many patients were in multi bed wards where they couldn't be distanced from one another. And patients also had a high level of delirium which led to their wandering around the hospital shouting and other behaviors that increase the risk of transmission.

So as case numbers started to steadily rise amongst Melbourne hospital staff, more and more of the workers were furloughed. They were basically told to stand down. And that meant that the remaining staff there very quickly were overwhelmed by the work they had to do and ended up with a majority of the wards being closed down and patients moved to other hospitals.

The hospital's divisional director of medicine and community emailed staff at the time and acknowledged that the infrastructure on most of their wards was never set up to care for Covid-19 positive patients.

RUBY:

So how has the Victorian government tried to address outbreaks and I mean this in a practical sense, what are they doing?

OSMAN:

So once the government finally accepted that health care staff were actually acquiring this virus at work, it then sought the advice of a health care infection prevention and wellbeing taskforce made up of doctors and nurses to bring together all the different knowledge from the frontline.

Archival Tape -- Daniel Andrews:

“There are 251 healthcare workers who are active cases. We send out our best wishes to them.”

OSMAN:

And they announced a series of measures to try and bring infection numbers back under control.

Archival Tape -- Daniel Andrews:

They are true heroes and we are all indebted to them.

OSMAN:

At the time, Dan Andrews said the government needed to look after its health care workers.

Archival Tape -- Daniel Andrews:

Those who are working shifts as we speak in hospitals across the state, we are deeply grateful to them. And every single thing that can be done to keep them safe is being done.

OSMAN:

Hospitals and other health care settings would have to be required to develop Covid safe plans that would ensure that everyone working there was socially distancing in break rooms and tea rooms and more PPE would be rolled out, along with more training for hospital staff on things like infection control.

But the problem is that that announcement was made nearly a month ago and there are still cases emerging in health care sites. And doctors I've spoken to say that the government still isn't acting fast enough to keep them safe.

RUBY:

How so? What are healthcare workers saying to you?

OSMAN:

One of the key issues has been this rollout of N-95 masks that are more expensive than surgical masks. But they were found to have helped control outbreaks at the Royal Melbourne Hospital. The Victorian government at the end of August ramped up its rollout of those N-95 masks

But that's not the end of the problem. For the N-95 masks to work effectively, they need to fit properly, and different brands and makes of the mask have different sizes. And if they're too big, they just don't prevent the particles spreading.

Archival Tape -- Unidentified Man #1:

“It really makes health workers feel of no value— cannon fodder and exposed to a threat, a menace, that can be mitigated.”

OSMAN:

Doctors told me that they don't understand why fit testing isn't being rolled out everywhere in Victoria as soon as possible, because it is being mandated in Western Australia and it's happening in all public hospitals in New South Wales.

Archival Tape -- Unidentified Woman #1:

“We're not doing enough to give reassurance that we're trying to do absolutely everything we can to keep our people safe.”

OSMAN:

The day after my story in The Saturday Paper was published, the health minister actually publicly announced that fit testing would become compulsory in all covid-19 wards and hospitals.

That’s been welcomed by healthcare workers but because all those healthcare settings are still really risky locations for transmission, some of them think it doesn’t go far enough, and they want fit-testing right across the board.

RUBY:

So Os, if these issues are ongoing, then that would mean that there is a continued risk of more outbreaks and health care worker infections. So what does all of that mean for Victoria's roadmap out of restrictions, which relies on daily case numbers dropping?

OSMAN:

Well, last week on Wednesday, Melbourne finally hit the trigger for the next scheduled easing of Covid-19 restrictions, which is the 14 day average of less than 50 new cases every day. But the question remains, Ruby, whether the numbers will continue to drop or whether they'll plateau as a result of this persistent health care worker and aged care infection outbreaks that we're seeing.

And the biggest contribution now to that really highly watched daily number of cases is health care workers, residents in aged care and their close contacts. Once you remove all of those groups from the calculations, that Wednesday figure of just under 50 dropped to an average of 20 cases a day. And that's the point that these health care workers themselves are making, that we need to stop those outbreaks to get the overall case numbers to drop.

And that is what one doctor, Alicia Dennis from the University of Melbourne, told me.

Archival Tape -- Alicia Dennis:

“If we don't get the health care worker infections under control, we were never going to get the numbers of new cases a day down fast enough.”

OSMAN:

And remember that, you know, that trigger of less than 50 is just the first easing of restrictions. To lift the stay-at-home orders and the curfew, we need to get to less than five cases a day on average.

RUBY:

Os, all of these health care workers that you've been speaking to for your story - what sense have you got from them about how they feel about this situation? Because I suppose for them, there's two levels, right, they are personally, more at risk. But they're also health professionals, and so they must be extremely confronted by the health crisis that's unfolding before them.

OSMAN:

Yeah. They're really disheartened and confused. And I think they now don't want to be seen as the reason why families can’t interact with one another and workers can't go back to their jobs.

And, you know, on one hand, they're seeing all this praise from politicians in the community. And on the other hand, they feel like they just haven't been given the right amount of resources and they've been abandoned.

Archival Tape -- Unidentified Man #1:

“And that, to me, is wrong, defeatist and basically throwing the health care workers to the wolves.”

OSMAN:

And others said to me that, you know, they're regularly referred to as heroes who are going into battle, but they're not soldiers in a war. They're the health care professionals. And there shouldn't be a kind of acceptable rate of casualties among them.

And look, of course, you know, even though there's always gonna be a risk in these kinds of settings, and they know that, they're just asking for the best possible protection and transparency.

You know, as one doctor said to me, how did we end up in a situation in Victoria where the government can afford to have police and soldiers patrolling low risk settings like parks, but nurses on Covid wards don't have the highest quality PPE?

That contrast is just really, really stark. And I think it says a lot about priorities we have as we try to contain this virus.

RUBY:

Os, thank you so much for your time today.

OSMAN:

Thanks heaps, Ruby.

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RUBY:

Also in the news today;

The Queensland government has announced the easing of some of its border restrictions next month, to allow residents of 41 NSW postcodes into the state.

It comes as the NSW Premier, Gladys Berejiklian, flags the possibility of opening that state’s southern border to regional Victoria.

Meanwhile the Victorian Premier Dan Andrews has said that Victoria is absolutely on track to take its next step out of lockdown this Sunday, with the state recording 28 new cases of coronavirus yesterday.

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

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