How to respond to surging COVID hospitalisations

The hospital system is at risk of breaking under the pressure of rising COVID cases. Hospitals are understaffed due to thousands of workers in isolation. Patients are being treated in corridors. Elective surgery has been cancelled. Emergency departments are overflowing with patients, without enough beds and staff to treat them.

Most recently, NSW nurses protested to raise attention of the seriousness of these issues – it’s not just about an exhausted workforce, it seriously impacts patient outcomes.

But what to do about it? On the Grattan Podcast, Peter Breadon, Health and Aged Care Program Director, and Owain Emslie, Senior Associate, join host Kat Clay, to discuss how to respond to surging COVID hospitalisations in the Australian health system.

Transcript

Kat Clay: The hospital system is at risk of breaking under the pressure of rising COVID cases. Hospitals are understaffed due to thousands of workers in isolation. Patients are being treated in corridors. Elective surgery has been cancelled. Emergency departments are overflowing with patients without enough beds and staff to treat them.

And most recently, New South Wales nurses protested to raise attention of the seriousness of this issue. It’s not just about an exhausted workforce. It seriously impacts patient outcomes. But what to do about it? Here to talk about how to manage surging COVID hospitalizations in the Australian health system is Peter Breadon, Health and Aged Care Program Director, and Owen Emslie, Senior Associate.

Peter, this health system crisis feels a little bit like déjà vu. It wasn’t so long ago that we were raising the red alert about hospital capacity as COVID cases rose, and yet we find ourselves doing the same thing a year later. What’s brought us to this crisis point?

Peter Breadon: Yeah Kat, I agree it can feel a bit like a recurring nightmare that keeps coming back.

So, what’s happened? You remember we had these very restrictive lockdowns late last year? And then, we found, you know, we can’t suppress this highly, transmissible Omicron variant completely. So, we’re going to have to open up and just keep it tamped down with a range of measures to avoid hospitals being overwhelmed.

That was the national consensus, and we opened up accordingly. Then we had these new Omicron variants emerge, BA4 and BA5. And they were better able to get around the vaccine and they were more likely to re infect you, even if you’ve had COVID before. So, both forms of protection from, from, from both vaccination and, and prior infection were less effective.

and so that’s what’s led to the relaxing of restrictions, the emergence of new and more contagious and immune invasive variants. That’s what’s led to this, this new surge in cases. The surge has been quite dramatic. So, in the last month alone, hospitalizations with COVID have shot up by 75%.

They’re at about 5, 000 nationally as we record this. And we can expect them to keep going up and set new records. It’s important to acknowledge though that, a hospitalization with COVID today is a bit different to a hospitalization with COVID in prior waves. So that’s because, people are better protected by vaccination.

You know, many of those people in hospital will have some protection, whereas in, in previous years, less of them will have, but also there’s more COVID circulating in the community. So that means some of these people in hospital will just have COVID that’s unrelated to the condition they’re in there for.

It’s not causing their hospital admission. In fact, they might even be totally asymptomatic, and it’s just picked up when they get tested in hospital. Now, there aren’t, to my knowledge, currently, Australian data released to show that proportion. There was some work done on New South Wales hospitalizations in the first part of the year, January through to mid-April, that found that over 80 percent of the hospitalizations where people had COVID were for the COVID.

But that number will be declining, and in England now it’s less than half. But having said that, the spike is high, the numbers are big, but it’s not and so it is having a big impact.

Kat Clay: You’ve just said that there’s a huge impact here. I mean, what is the flow on impact of the rapidly increasing COVID hospitalizations?

Peter Breadon: So, to put it in perspective, we’re getting to the point where about eight or nine percent of hospital beds, public hospital beds nationally, have people with COVID in them. and in some states, it’s much higher. Now, even with the caveat that I mentioned before, where some of these will just be incidental COVID cases as they’re called, where it’s not the main reason people are in hospital, which is having a big effect on the ability of the hospitals to care for other people.

What we’re really doing is, we’re having a trade-off here Sort of allowing that level of transmission, those levels of hospitalization. We’re seeing states reduce the volume of other kinds of treatments, you know, particularly, less urgent elective surgeries. So, if you were told by a doctor you needed to get, maybe a cataract fixed or tonsil removed, things like that.

those things will be put off and as the numbers go up and hospitals get under more and more strain, they have to delay and defer increasingly urgent categories of care. So, that starts to have a big impact on the rest of the community. The other thing it does is. It creates this backlog of that care that we then have to catch up on.

As you mentioned, hospitals are pretty much decimated by the, the staff absences, like many other industries, plus the cumulative impact of people working really long hours, cancelling leave to deal with the pandemic burden. So, what we’re doing now is building up this backlog of cases and then we’re going to probably expect hospitals to, you know, work at above 100 percent after this wave to try and catch up as fast as they can.

So, it’s storing up some problems for the future.

Kat Clay: So, Peter, how has the hospital system responded so far and could some of these impacts have been avoided?

Peter Breadon: Hospitals have done a lot to try and manage this. new demand from COVID. There’s been a whole range of measures taken throughout various points in the pandemic.

Private hospitals have been activated to step up and share the load in various ways, coordinating with the public system. You’ve seen different kind of workforce models to try and spread the thin workforce as far as it can go. And examples like students, nursing students, medical students doing more than they would normally do.

So, there’s been a wide range of measures taken. there’s also been. Hospitals sort of coordinating more, working out who’s going to bear the COVID load and who’s not. There’s been hospitals working in partnership with primary care, with, with GP clinics and community health to monitor people outside hospital to make sure they don’t deteriorate and have to come into hospital.

So, there’s been a lot of changes, to practice, and, to, to treatment in order to, I guess, maximize the efficiency of hospitals. to make sure they can absorb as much of this new demand as possible. so, a lot’s been learned, and I think, hospital systems are now pretty good at turning on most of those measures, when a surge arises.

But it doesn’t mean that, that they can avoid, cutting off other care. Because we’ve seen in recent days that, Victoria, Queensland, for example, have said that they’re stopping certain types of elective surgery.

Kat Clay: So, Peter, I mean, they’re cancelling elective surgeries. Won’t this have a negative impact on the people who don’t Do you need those surgeries and have been waiting already?

Peter Breadon: That’s right Cat, for at least some of them it will. so, these are, these are surgeries obviously that doctors have recommended, and patients have, agreed to and scheduled often. And pushing them out, sometimes it’s fine, but sometimes those patients will get sicker. And it is a real impact and cumulatively across the whole period of the pandemic where care has been disrupted.

I think we’ll look back and see this as one of the bigger impacts. And sometimes people can have some risks they face that aren’t associated with the condition. I mentioned cataracts before, so if you don’t get your cataract removed, you obviously got a quality-of-life issue in the meantime with your site, but you’re at more risk of falls.

And you know, you, you can have that, have a serious health impact, and then need to, need to go into hospital. So that’s just one example and there are more urgent categories of care that have been deferred before in peaks of hospital demand. So, the risks are real.

Kat Clay: And I mean not only that, but we did also see people avoiding treatment altogether during the pandemic and you and you saw that with the people avoiding treatment for everything from dental health to things like cancer.

So, it can be kind of detrimental to see these COVID cases rising in the hospital, right?

Peter Breadon: Yeah, I think that’s right. I mean, my hope is we’re sort of past the point where people are skipping all kinds of care. You know, we didn’t touch on this, but it is important to acknowledge that the risks of infection are way lower than they were, as long as you’re up to date with your vaccinations.

So hopefully people are getting the care they need, and it’s a really important message that if you’re really worried about COVID because you’re immunocompromised or at a high risk, or you’re just anxious about it, you know, there are also, for many kinds of care, telehealth options and video conferencing you can do.

but you should definitely. Get in touch with your health care provider, they might be able to reassure you that it’s safe for you to come in or find another way.

Kat Clay: So actually, when I had COVID recently, I got treatment through a specialised plan and it was actually quite a nice and helpful thing that they were using the technology to check on my symptoms as I was progressing, which was then monitored by a nurse.

So, I thought that was quite good. Oh, I’m just turning to you. What? Do people need to do to bring infection rates down? I mean, we hear the term flattening the curve come out again. What do you think we need to be doing right now?

Owain Emslie: Well, Kat, the first thing I’ll talk to you about is vaccination, and in particular, boosters, so third and fourth doses.

Those extra doses are really important, and they’re not just a sort of optional extra. what we find is, some UK studies have shown that about six months after getting a second dose, The vaccine effectiveness against hospitalizations is measured at about 56 percent and someone getting a third dose at that point, that effectiveness jumps up to 90 percent and it stays above 80 then for about three months or more.

And a Sydney study recently showed that having a booster dose, having a third dose gave about 65 percent greater protection against COVID 19. Hospitalization and death than just having the 2 doses. So, the 3rd dose is really important and one of the things in Australia we have not been, we have not done so well at rolling out the 3rd doses.

We ended up getting about 95 percent of eligible people getting a 2nd dose. and that figures only about 70 percent for 3rd doses. So, and given that eligible people is, basically those over 16, that’s about 54 percent of the population. That number is absolutely flatlining, each, each successive week we’re delivering less, fewer and fewer 3rd doses, so.

That number is kind of showing no, no, indication that it’s really going to get any higher. We’re behind many of the countries that we would, compare ourselves to Canada, UK, France, Germany, Korea, Japan started off behind and has gone well ahead. All of those countries have sort of 60, 70 percent of the population with a third dose, which is a lot higher than we’re at.

What’s worse, in Australia is that it’s quite uneven who has the third dose. So, we’ve seen that, people living in more advantaged areas, about 80 percent of the eligible population have, a booster, and that, that equivalent figure is less than 60 percent in the most disadvantaged areas. That’s a real concern.

Some sort of data that’s been published recently indicates that more disadvantaged people are already more likely to, to die from COVID. Some data published that indicated that the poorest, one third of Victorians, were 2. 7 times more likely to die from COVID than the, the wealthiest one third. So, yeah, you’ve got a group that are already, already more vulnerable and less likely to, to have that booster shot.

So, it’s really important that we can get, you know, get, get as many boosters out there as we can.

Kat Clay: And we’ve talked about this on the podcast before with you, Peter, as we have often done, we encourage you to seek out your booster shot wherever possible. Thank you. Apart from vaccination, what else can help here, Owen?

Owain Emslie: There’s a few things that can have an immediate impact today on how likely you are to contract COVID or pass it on if you have already contracted it. Mask wearing is, is, is a big thing. People working from home where that’s, you know, where that’s workable, particularly over this, this period of the high wave of cases over winter.

And particularly, for people who are sick, staying at home, as much as possible when you’re sick and testing during the rats or PCR test where if you’re exposed or you have symptoms. those things are really important, and it’s worth noting that for all those things, a lot of the reason for doing them, it might not be for you personally, like, a lot of people might think, oh, given my age and risk factors and vaccination status, COVID’s not likely to affect me as much, and you may well be right, but in some cases, but that may not be true for the person you might pass it on to, who could be either someone you know, or someone you, you know, don’t know.

Walk past at the shops or whatever, or the person they pass it on to might not, yeah, might not be as, as well protected as you and they can end up, having a bad experience being hospitalized, which is really bad for them and also, you know, bad for the, the problems with the hospital system that Peter’s talked about.

If we all do what we can, that, you know, that can make, make a real difference.

Kat Clay: So, Peter, I mean, governments have a role to play here too. How can they support all of these things that Owen’s just been talking about?

Peter Breadon: There’s a few things they can do, and there’s some good news to start with that things are moving a bit.

So, you will have seen that, the Prime Minister and the Premier’s caught up recently and they’ve come out with some sort of pretty clear and robust, proposals. Messaging about what we should be doing in line with all those things that Owen was just covering off. So that leadership in communication is a good start.

There is some broader eligibility for 4th doses now and while, as Owen said, the 3rd dose vaccination rate has pretty much stalled. The 4th doses are sort of picking up with that new eligibility. There’s broader, eligibility for the antiviral treatments, which are really effective, and which older people and other people at risk are eligible for.

So, all that’s good. And there has been an announcement of a bit more, of a communications campaign from the Commonwealth government about, third doses in particular. So that’s all great. But I do think, as you said, the hospital system is under great strain, and we haven’t even touched on the broader impacts of high rates of infection, such as, you know, people being away from work.

illness and long covert, et cetera. So, with these spike in infections and spike in hospitalizations, it would be good for the government to do more. So, the 1st thing I’d say is, while the campaign about vaccination is good, we probably need that really robust, sustained, nationally coordinated campaign about promoting all these covert safe behaviours.

As you know, we all want to put covert out of our mind. and people do need to be reminded, and you do need reinforcement to get behaviour change and gradually. change those norms over time about staying home if you’re sick, about wearing a mask when you can in, in, in crowded places. So, I think that big push on communications would be good.

The other thing Owen touched on is the, the real disparities in the rate of uptake of vaccinations across different communities, which is really disturbing. We know from repeated experience throughout the pandemic, big settings, national targets, mass media campaigns, they’re all great and a big part of the solution, but you also need to do local outreach to local communities.

And so, we’d like to see that happen, bigger emphasis on that and with a sense of urgency. So that could take the form of setting targets for local areas that are underserved and pushing towards those. It could be paying primary health networks to achieve increased rates of vaccine coverage in those areas and do the things that experience shows work.

Just calling people, reaching out to people, working with community and faith leaders, making vaccination visible and accessible and convenient. So, I think we need to work on the equity part, not just the big national story there for vaccination. And you will have heard in the last few days, particularly a really hot debate about mask mandates.

So that’s something that the Australian Medical Association has proposed. A lot of epidemiologists have said we need. And I certainly think it’s time to consider it very seriously. If governments aren’t willing to do it now, I think they should talk about at what level of projected hospital COVID demand, would we pull the trigger on mandates?

When would we bring it in? Start preparing the community for what governments think is the proportionate point at which you’d pull out that tool from the toolbox. And, you know, as part of that discussion, it’d be great to see the modelling, you know, where. How much of an impact would those kind of measures have?

How many hospitalizations and deaths would it alleviate that way? The community can be more informed. We can understand the trade-offs. We can have the debate. and it can be a fact-based debate about when to take those measures. Because even if you don’t think it should happen now, there will be a point, or there is a theoretical point of hospital demand, where I think, most people would support bringing it in.

Kat Clay: Having those mandates and those levels and those targets that we hit before we bring in mask mandates and things like that, it’s actually helpful as a communications tool as well, because people know where they stand. I think there’s sometimes, some confusion about, should I be wearing a mask or not?

What are the rules now? And having those really clearly defined, would be helpful to the public as well as preventing the spread of COVID. Now, Peter, you’ve talked about kind of what we can do in the very near term. What about the longer-term picture here? What else can we be doing?

Peter Breadon: One thing I touched on before was that importance of the sustained messaging about the behaviours that we want to see.

And I think that needs to be a long-term thing, not just a burst. And so that’s to say to people. You know, we’ll have these debates about mandatory settings and rules, but over the long term, the real gains are going to be from choices that people make, on their own volition. And we should give them all the information and prompts and awareness they need to make the best choices.

So that’s a kind of COVID literacy campaign that we need to sustain over months, and maybe even years. The second sort of medium- and longer-term thing that will be really important is ventilation. This is an airborne pathogen, and we can clean up the air, in, in high-risk settings, in workplaces and schools.

And there’s been lots of work in that regard. There’s been work done in various states and schools. There’s some new grants that states are putting out for small businesses, but it would be really good to get a national strategy here. convene the experts, work out the return on investment for a range of measures, of like what we do in terms of setting standards for new buildings, in terms of what we do about retrofitting, where we prioritize, and how we resource it.

So, I think there’s pieces of the puzzle there, but we need to get the big strategy for ventilation in place. And that’ll work for COVID, but it’ll work for future pandemics and for flu, and even for productivity by people having cleaner air. it helps us all think and do a better job. So, they would be a couple of big things.

The other thing that the Commonwealth government has talked about is the review of the pandemic. And I think that’ll be great. it’ll be good to understand what form that will take, be it a Royal Commission or something else, because there’s a range of lessons. We’ve talked, just in our discussion today, we’ve talked about the different ways that hospitals can respond, the different triggers that we should have for public health restrictions, and how we best do communication to convey to people the risks that they face in their own lives.

to help them make the best choices. And in all those areas and more, we should take the opportunity to look back, work out what we’ve learned, and prepare for the future.

Kat Clay: Thank you so much, Peter and Owen. I really appreciated you coming on the podcast and to talk to us about the surging COVID hospitalizations and what role all of us can play in helping flatten that curve.

If you’d like to talk to us more about this podcast or any of our research, please find us on Twitter at Grattaninst and on all other social media at Grattaninst. Especially because it’s winter here in Australia and things are going around, please take extra care with yourselves. If you haven’t got your vaccination, get it done.

And thanks so much for listening.