No one knows what will happen at hospitals in New South Wales and Victoria in the lead-up to Christmas and beyond after we open up. But with modelling suggesting hospitals stand a good chance of being overwhelmed with mostly unvaccinated COVID-19 patients, Australians have cause to be concerned.
Italy’s hospitals were catastrophically overwhelmed early in the pandemic, and the entire US state of Idaho has begun rationing treatment according to “crisis standards of care” after its hospitals were overwhelmed.
The usual way Australian hospitals decide who gets treated is either randomly (first come, first served) or when resources are too stretched for that, prioritising patients based on acuity or the immediately life-threatening nature of the patient’s condition.
Note the word “prioritising”. While it may not always seem this way when you’re in a public hospital waiting room at 2am with a sick toddler, the triage system doesn’t decide who will and won’t receive care, or the quality of care. It just lines you up in order of urgency and seriousness to eventually receive what in our health system is a gold standard of care.
The alternative is crisis standards of care. These can include:
- Receiving care in a hospital room that was previously used as a classroom, or in a hallway or tent
- Deferring elective surgery requiring postoperative ICU or high-dependency unit care
- Less qualified and/or fewer nurses and doctors taking care of more patients
- Waiting many hours for care or being transferred to a distant hospital to receive it
- Giving a staffed ICU bed or a ventilator to someone else deemed more likely to survive. In some Australian hospitals, this could be coupled with other exclusion criteria, such as preferencing those who are not obese or alcohol- dependent.
In NSW, we’ve seen the pressure on hospitals lead to queues of ambulances waiting to discharge patients. Ambulance response times are down in Victoria, and both states have delayed misleadingly named “elective” surgeries — which include heart and cancer operations — leaving Australians to witness their loved one’s quality of life or odds of survival drain away as the intensive care they need is prioritised to COVID patients.
At the start of the pandemic, it might have made sense. COVID patients can be acutely ill. None had any way of not catching the virus or becoming seriously ill, and many of us assumed deferring critical care to prioritise them was temporary.
But by the time Australia opens up, perhaps in December, this will no longer be the case. The pandemic will be almost two years old, and not only do we have a free, safe and effective vaccine, but governments should have ensured that every Australian who wants to be inoculated gets the information and outreach they need to readily access the vaccine recommended for their age and health situation.
As we’ve seen in Israel, the US and the UK, when countries open up, cases surge. For the unvaccinated, hospital admissions do too. The more unvaccinated people in a society, the more likely hospitals will be overwhelmed. This leads to the crisis standards of care that can leave vaccinated people unlucky enough to need hospitalisation for COVID or some other serious illness without an expertly staffed ICU bed.
Is this even remotely fair? If what we mean by “unvaccinated” are not those with a legitimate medical exemption but what I will call the “voluntarily unvaccinated”, I think not.
In fact, once Australians are confident that everyone who wants a vaccination or requires an exemption has been provided for, what we are left with resembles the mob-like assemblages of neo-Nazis, right-wing extremists and agitated union members demanding their rights while shrugging off responsibilities as they hurled bottles and plastic crates and kicked in the glass entrance of the CFMMEU headquarters in a violent protest in Melbourne on Monday, and then another vicious protest in Melbourne on Tuesday.
Angry, ignorant and entitled or — as former AWU national secretary and former Labor opposition leader Bill Shorten memorably described them — “hard-right man-baby Nazis”. These are the people who are or could displace your obese aunt, your best friend with cancer, or you in an acute-care queue that could be coming to a Melbourne or Sydney hospital near you when, as is inevitable, such voluntarily unvaccinated catch COVID, get seriously ill and swamp hospitals.
Unless we say no, because that way of distributing scarce resources is unjust and unfair.
No one who has done the right thing by themselves, their family, health workers and the community by getting vaccinated should have their care delayed or be turned away from receiving timely, standard hospital care because the beds are full and nurses are too busy caring for those more than happy to bet our lives that COVID wasn’t real.
There has to be another way.
Do you agree with Cannold? Let us know your thoughts by writing to letters@crikey.com.au. Please include your full name if you would like to be considered for publication in Crikey’s Your Say column. We reserve the right to edit for length and clarity.
One thing I haven’t seen put forward yet is a Medicare levy for those remaining unvaccinated. Seems both fair and reasonable given what those who remain unvaccinated will (at a statistical level) burden Australia’s healthcare systems.
Please also then add a levy for smokers, drinkers, the overweight and those that eat fast food and clog their arteries… Its impractical and just not how the health system works!
Funny you mention those given the sin tax (I ment levy) that is applied on many of those, and the lobbying done by health groups to put further taxes on unhealthy items not yet covered.
I remember being treated as a smoker for my life insurance by default (event though I wasn’t) and paying a premium for that until I sorted it out. Plenty in this world already puts a price on “bad” behaviour. Even in driving, we put fines on speeding, not wearing a seatbelt, or driving drunk. The risky behaviours are fiscally published…
Indeed. My favourite is paying higher car insurance as a young driver because you’re a higher risk…but then subsidising older people with health insurance because they’re at risk. Go figure!
It’s a fair point Beth, but smokers and drinkers have already paid for their health care the very substantial taxes on both products. I don’t particularly like the argument, put forward many years ago by Paddy McGuinness, but it has the problem of being largely true.
No body should be denied care regardless of their choices. Governments had 18 months to 2 years to improve capacity at hospitals and invest in additional infrastructure.
The fact is the vaccine is highly highly effective against severe disease, but its efficacy against infection is dropping with new variants. What started as 90-95% is often in some instances to 40% against infection after a few months and studies showing against Delta natural immunity being better than the vaccine. Yes a booster will aid in addressing this.
Lets have a hypothetical. If we assume everybody got it from 2 year and up and the efficacy rate is 60% from infection an 8% vaccine hesitancy rate it is not going to have that big an impact, it would drop our hypothetical to 55% overall efficacy against infection. Importantly though vaccines have a high rate against hospitalisation 90%, but if we assume 8% don’t vaccinate and an 80% rate of hospitalisation then 6.4% would be their contribution to total hospitalisations, yet for the vaccinated 9.2% will be hospitalised (90% of 92%).
We have never made the flu shot mandatory. A vaccine with a efficacy rate of between 40-60% and we’ve had flu seasons put pressure on the hospital system in the past. Yes, we are in the middle of a pandemic and this is different scenario, but the resources involved in policing and denying access to services, employment and potential medical care is absurd and personally violates human rights. You may resent the unvaccinated, but how far do we go and if we’re going to punish them why not punish others for their poor choices in life that lead to hospitalisations, too much sugar, smoking etc?
The fact is we ae not all in this together. We’ve not raised taxes on those that have done exceptionally well out of the pandemic, we have not addressed insecure work, not addressed overpayments of JobKeeper into the billions. We ae still just as divided as ever any good will from coming together has evaporated.
PS I’m fully vaccinated.
A triage consideration should place the deliberately unvaxed at the end of the queue
You make some great points here, Mr J – particularly in relation to the ugly proposition of denying medical care to those who make ‘poor life choices’. There are many of these, and yet the most fierce vitriolic attacks are saved solely the unvaccinated.
If logic followed, the following groups would all be sent to the back of the queue, at best, or denied treatment entirely, due to their ‘poor life choices’.
Fortunately, while triaging is, and always has been, a necessary part of any busy hospital, it is not carried out on the basis of the patient’s ‘poor life choices’.
Yes its weird that all of a sudden unvaccinated folks are the worst of the worst yet smokers, drinkers and the obese put far more pressure on our health resources in the much longer term. There is definitely a loss of perspective going on here!
Jab scabs are worse than smokers, alcoholics, the obese, etc. Smokers, alcoholics and junk-food eaters do not infect others and spread the problem. Plus they have a strong mitigator: tobacco, alcohol and junk-food have been heavily promoted and inculturated for generations.
Anti-vaxxers have no such defence. They have made a conscious choice that their personal “freedom” trumps a social responsibility that has been made very clear to anyone that has not lived in a cave for the last 18 months.
Well said, addicts are different from anti vaxxers.
The vaccinated can still spread Covid. It is a virus. The vaccine reduces the likelihood of infection and serious illness it is not a silver bullet. Just like the Spanish flu we will be living with this until some miraculous cure. In all likelihood we still will have close to 10% of the population hospitalised at some point even if fully vaccinated, but there are better people than me at modelling and looking at these issues. The unvaccinated would simply make up a larger proportion the hospitalised.
It’s not like MMR vaccines that have a 90 to 99.9% efficacy against infection.
The point of all these measures and lockdowns and urgency for the roll out is to reduce the risk of the health system being over run and unnecessary excess death. All those other other choices you’ve listed put pressure on the same health system. Yes, spreading it is a key issue and ideally the vaccine hesitant should change their minds, but regardless if you have any symptoms test and quarantine that will reduce the spread.
It’s a slippery slope in denying people rights and we’re simply allowing governments to pass on their responsibilities of ensuring services by constantly allowing the vilification of various groups in society.
You are not absolutely correct anymore than the vaccine is 100% perfect. No it’s not a silver bullet. However, the vaccine reduces by a significant degree: 1) the likelihood of infection by; 2) the viral load of; 3) transmission of infection of; 4) the likelihood of hospitalisation for; and 5) the possibility of death caused by CoViD-19.
Less about denial of rights rather than just putting them at the back of the queue, which is not the same. It happens all the time in government decisions, the rich are always at the front of the handout queue (JobKeeper), the poor are always at the front of the punishment queue (robodebt).
Unsound analogy.
To improve “capacity at hospitals and invest in additional infrastructure” requires more than two years. For a start, a nursing degree takes three years.
The flu vaccine is mandatory for many workers in the health and aged care sectors.
That’s one aspect of it, but there’s lots to consider.
You can engage the private sector to build infrastructure as the ACT did with Aspen medical for 51 additional beds dedicated to COVID, though I believe this facility does not have ICU capacity so they are transferred back to the main hospital. You invest in further HEPA.
On the staffing front you retrain existing nursing staff up. You increase their wages to encourage take up of this training, You bring back retired staff but pay them well.
You can be very clear on alternatives to emergency departments for other health services and ensure availability.
We’ve got a long way still to go but we can get rapid testing up and running and freely distributed. You test positive you quarantine and the government could contribute by ensuring an allowance for those without sick leave or a wage subsidy for employers affected when quarantined. This will help the vaccinated and unvaccinated.
I have no doubt that governments are doing this sort of stuff and more. I’m no expert, but you can do a lot in 18 months?
You can expect an increase in the flu as well as Covid when we open up, encourage or mandate that vaccine?
Yes some occupations will demand people to be vaccinated, and this needs to be clearly articulated.. Unvaccinated children are denied access to childcare for example. But we don’t limit access to healthcare for these children.
I just think vilifying the unvaccinated is unproductive and they’re given too much media, when it looks like they’re only about 8% of the population.
Thanks for the discussion.
Just to add what’s worse an unvaccinated person or someone who has Covid, knows it and doesn’t abide by health requirements? We need to encourage people to do the right thing there as well. Stay at home. As a society we’ve encouraged the sick to soldier on and this needs to stop.
That would include those antivaxxers who urinated on the Shrine of Remembrance
Your maths is ok there Mr J, but missed a beat here or there. Was wondering where you got the 9.2% of hospitalisation from (90 of 92%), then worked out you meant to say 9.2% (10% of 92%).
Other extrapolations are shaky but I get the point. Comparisons with flu however are not, for 2 reasons. First, we all have some antibody resistance to flu, we have all been exposed. It is only seasonal mutations that cause a problem and our body only has to tweak existing templates to fight it. For Covid it’s a whole new class of defences that is required, which takes time.
Secondly, the flu kills thousands every year, but it doesn’t kill otherwise healthy people, and even younger drinkers, smokers and obese are not really likely to die from flu. It really only kills older people or the seriously health compromised.
Equally, I don’t think there is sufficient data to say that 10% of the vaccinated will end up in hospital ( rates of efficacy against this are quoted as 92%, 94%, Moderna I think is 96%).
The issue is that the unvaccinated are very likely to be rather cavalier about other aspects like wearing masks, hand washing and social distancing, as witnessed at recent “freedumb” rallies in Melbourne. I’ll still be wearing a mask when shopping even though double dosed, and I won’t be the only one. Not for my health, I’m in pretty good shape for a man in late 50s, but because not spreading the disease is a social good that I am happy to sign up for.
Just poking a few holes here and there, not disagreeing with the general thrust. A poster the other day referenced 20% of hospitalisations in this round were vaccinated. I pulled him up on it, it was completely wrong. It is closer to 2 or 3%, but at the time on raw numbers THAT DAY, it was a bit under 15%. You can’t dismiss the thousands of unvaccinated who have since been discharged from hospital (or died).
Further to that poster, to say someone is fully vaccinated you really have to only count those who have had at least two and preferably 3 weeks since their second dose. Today a woman in her 80 s was reported as dying, but she had two doses, the second dose only days before. That ISN’T fully vaccinated.
A bit off topic maybe, but the UK has had its ‘freedom day’, yet there were over 36,000 cases and 184 deaths yesterday (roughly equivalent to 12,000 and 60 here). Why isn’t their health system overwhelmed?
At its peak on January 28 this year, the death count was ten times 184, yet cases were barely above 36,000. Vaccine is the answer, or a big part of it, plus the switch of Delta to younger age ranges.
Who says it isn’t?
They have a high rate of fully vaccinated citizens and while some of this group may still get mild -moderate CoViD most of them don’t need hospitalisation.
They also have high numbers of people who have antibodies from actually getting it. Boris’ herd immunity, working at last.
The only relevant question is why is our hospital system unable to cope? We know their will be a surge. Where is the planning for it? Where are the extra facilities? Where are the temporary field hospitals, for example, that can be dismantled after the surge? Where are the short sharp training courses for medical skills required in this surge?
Watch our pollies milk every political point they can when this predictable event happens.
B/S Most from the mickey most degree factory, do not have a clue re ICU. No practical hands on experience nor total hygiene skills as by Operating theater, Barrier nursing, ICU nursing and are a danger to themselves and other staff! let alone the patient!
I agree with the author. If you’ve had the opportunity to get vaccinated but choose not to and then get sick from Coivd – too bad, you can look after yourself. If you are eligible to be vaccinated but decide not to (and I’m not referring to those with a legitimate medical reason) then you should go on a “do not treat list” and be turned away from hospitals.
There is such a huge line-up here in SA that I won’t even get my first dose until October. I take all precautions that I can in the meantime, but should I suffer due to a lack of access?
Only if it is a deliberate decision to remain unvaxed,and not because you have not had access to the vaccine.
So it’s taken you months to decide to get a jab and now you want others like me (vac last April/June) to stay in lockdown while we wait for the likes of you?
A woman in a shop today informed me she was not getting vaccinated because she was healthy and drank a lot of water, and it was against her religion.
And as we know the business of religion is a tax exempt business they do not contribute to the health system they do not pay tax
Fine as far as it goes, except that religious institutions run a lot of health services. I received excellent treatment for lymphoma in St VIncent’s Hospital, run by a Catholic organisation.
And did Medicare cover all of that? Our taxes at work, unlike the religiously manic cult shows
Very harsh, some of the antivaxxers are seriously compromised in their intelligence quotient, possibly through no fault of their own. They should at least be sent home with a double dose of either Ivermectin or hydroxychloroquine, and a handy booklet on the health benefits of oxygen.
Or chemical castration so they don’t breed
Agreed. Every antivaxxer death raises the national IQ a fraction.
Piggy Muldoon™ ®.
There’s a fascinating and pertinent article on the Slate website now “The Unbelievable Grimness of HermanCainAward, the Subreddit That Catalogs Anti-Vaxxer COVID Deaths: This is not a forum that attempts to change minds. It’s much darker.”
I would post a link but that always sets off the modbot. I would really like to know how others post links here.
Copy the link you want to post then either click on the comment box if you are using a computer or press the screen on the comment box for a few seconds release your finger and select paste
There’s no problem composing a comment that includes a link. The trouble starts after clicking on ‘post comment’. That’s when it disappears into the modbot limbo. Every time.
Cheers SSR, I think it’s a bit random. I tend not to include links but haven’t had trouble when I do. But then I do. No rhyme or reason to it.
https://slate.com/technology/2021/09/hermancainaward-subreddit-antivaxxer-deaths-cataloged.html
Thank you Ratty, a fascinating article.
A cut and paste of the first section of the title into Google brings it up.
Sure is:
Subscriptions to the HermanCainAward subreddit are increasing exponentially,… If that rate is any indication, rage is growing toward anti-vaxxers deliberately prolonging the pandemic out of an anti-social and deadly understanding of their rights.
“anti-vaxxers deliberately prolonging the pandemic out of an anti-social and deadly (incorrect) understanding of their rights.”
I’m more afraid of the vaccines than I am from covid.. I know 14 people who have had covid and not 1 hospital visit for it between them. Yet know of 8 people with side effects which resulted in 6 hospital visits from these vaccines and 3 cases of myocarditis (very serious illness).