Health experts say Australia’s hospitals are already operating at capacity and there is no room for coronavirus surge
Government plans contemplate successive waves of pandemic reaching Australia and spreading throughout the community
Globally, there have been more than 83,000 confirmed cases of coronavirus, leading to more than 2,800 deaths. The vast majority of infections and deaths have been in mainland China, though fast-spreading outbreaks have emerged in Iran, South Korea, and northern Italy.
Corona virus vaccine at least 18 months away
Up to 70% of Australians could be infected in the event of a severe pandemic
Australia potentially faces widespread Covid-19 infections doctors say, warning that chronically overstretched public health systems could be overwhelmed in the event of a severe pandemic. Governments and health professionals have stressed that most healthy people will only experience the illness as a mild to moderate cold.
Government plans contemplate successive waves of pandemic reaching Australia and spreading throughout the community. Quarantine, self-isolation and social distancing measures could be encouraged or enforced in order to slow the spread of the virus through the community.
Prof Raina MacIntyre, head of the biosecurity program at the Kirby Institute at the University of New South Wales, said sustained transmission may result in anywhere from a quarter to 70% of the Australian population being infected.
Covid-19 – the disease caused by the Sars-CoV-2 virus – has a case fatality rate of between 2-3%.
Covid-19 – the disease caused by the Sars-CoV-2 virus – has a case fatality rate of between 2-3%.
“To put it in context, the case fatality rate of the 1918 flu pandemic was 5%, and the 2009 pandemic, 0.01%,” said MacIntyre.
“So, a case fatality rate of 2-3% is high. In China, we know that in addition to the people who died, 5% needed to be in ICU and 14% needed a hospital bed.”
MacIntyre said Australia had done an excellent job, so far, of preventing sustained transmission in the country, but that the country was now moving to the next phase of response: managing a pandemic outbreak.
“If 50% of Australians – 13 million people – became infected that is up to 400,000 people dying, almost 2 million people needing a hospital bed and 650,000 people needing an ICU bed.
“These are total numbers over the whole epidemic, which may last one year.”
Raina said in Sydney, there were an estimated 16,000 public hospital beds, and 6,000 private beds.
The Australian government’s plan – the health sector emergency response plan for Covid-19 – involves an escalating series of responses, from self-isolation of suspected cases, enforced quarantining of known infectious patients, up to the closure of schools, cessation of public transport and advice – even orders – for people to work from home.
Under complementary state government pandemic plans: sports stadia may be sequestered as quarantine sites, police could be ordered to guard critical medical supplies, and governments may order entire suburbs, cities or groups of people to undergo mass vaccinations (once a vaccine is developed).
Prof Nigel McMillan, director in infectious diseases and immunology at Menzies Health Institute Queensland, Griffith University said many pandemic models of the disease’s spread were inaccurate because “we don’t know two important things: how many people get infected [infection attack rate], and how many get sick [clinical attack rate]”.
“That is, we suspect there are a large number of people who aren’t identified as having Covid-19 because they have a mild cold. We can make guesses, but it will take time to get this information.”
McMillan said a vaccine was likely 18 months away and would be useful only after the virus had gone pandemic.
“We have previously modelled the number of daily beds required in an epidemic scenario for a different infection, which shows that capacity for beds could be rapidly exhausted in a severe epidemic.”
Part of the pandemic plan “activated” by the Morrison government on Thursday – of which some elements were already in operation – involved preparing “surge capacity” in hospitals, including dedicated fever clinics, for the possibility of a high number of cases presenting.
This was met by warnings from doctors that hospitals – and medical staff within them – were already operating at capacity, and there was no room for any additional surge.
“Part of the pandemic plan is ‘hospitals opening their surge capacity’. Now, I don’t want to alarm anyone, but there is no surge capacity. It’s all open … we are full everyday. We’ve been saying this for years,” past president of the Australasian College for Emergency Medicine, Dr Simon Judkins said.
“That capacity will be created through other means [cancelled surgery/outpatients] But, there are no excess beds or staff. If there were, our EDs wouldn’t be bursting, our ambulances ramping, and our staff burning out.
“Australia’s health system will manage this well, due to the hard work of healthcare workers. My point is that we operate our system at or over capacity and to pretend there is ‘surge capacity’ is wrong.”
“It will eventually become just another cold/flu type virus we have to deal with and that mostly kills old and very young people.”
He said media reports sensationalising the impacts of the virus would become problematic if a pandemic occurred, which now appeared likely as the disease spread in several countries.
“We don’t wish to induce panic food or petrol stockpiling etc when for 95% of the population, this will be a mild cold.
“Travel bans will no longer be useful or make sense and so health authorities need to prepare for the next phase. This includes preparing our hospitals for a large influx of patients, stockpiling any antivirals [some appear to work to slow the virus], and advising the public that when the time comes they will need to think about things like staying at home if ill, social distancing, and avoiding large gatherings.”
Virologist Ian Mackay, associate professor at the University of Queensland, said it was unrealistic to expect that the virus could be contained to certain regions, and all countries should prepare for managing an influx of cases.
“If the virus can’t be put back in its box worldwide, then it has the tools to become an endemic human coronavirus [we already live with four of those – HCoV-229E, -OC43, -NL63, and -HKU1]. Not today. Not tomorrow. Sometime in the future.”
“So it’s really important that we find, test and isolate the ill to slow the spread and give hospitals plenty of time to prepare and manage cases without being overwhelmed. Many countries probably can’t trace, test and isolate as well as China, Singapore, Hong Kong have.”
Peter Harcher SMH’s international editor
Sydney specialist pathologist Dr Adrian Cachia was on a skiing holiday in Japan with a bunch of other doctors last week when the coronavirus got to him. His nerves, mostly.
Cachia grew alarmed when the Japanese government declared its socalled ‘‘basic policy’’ – even if you feel unwell, don’t go to the hospital unless you have a fever of 37.5 degrees or more sustained for four days. Just stay home.
Why? ‘‘Because it meant that they had given up on trying to contain the virus and had moved to manage the enormous strain on their healthcare system,’’ says Cachia, who has 25 years’ experience as a pathologist. He points out that more than 80 per cent of people infected will have only mild cases, or show no symptoms at all. ‘‘But if that’s not you, and you need a ventilator for a few days, there may not be enough to go around if there’s a sharp peak in infections.’’ He pulled the plug on his trip and headed home when his roommate developed a cough.
But Cachia’s concerns didn’t end when he set foot in Australia last Thursday, the same day the Morrison government announced that it was activating its pandemic response plan. He worries that Australia is surrendering a big, natural advantage
– its ability to easily control its borders to prevent infection. He points out Turkey has banned arrivals not only from China and Iran but also from Italy, South Korea and Iraq.
‘‘Obviously, we in Australia have been reluctant to take the same measure, even though it’s a lot easier for us to control our borders than it is for Turkey,’’ says Cachia, who works for a major Australian pathology firm but is speaking in a personal capacity. ‘‘This is a very serious misstep and a premature.
On Sunday, the Home Affairs Minister, Peter Dutton, said arrivals of foreign travellers had been banned from Iran in particular – and not Italy or South Korea – because of doubts about the trustworthiness of Iran’s reporting. If the trustworthiness of reporting were the main criterion, Canberra would put immediate travel bans on not only China and Iran but also Indonesia and dozens of other nations.
Chief medical officer Brendan Murphy gave a different answer yesterday when a reporter asked him for the advice to the government on whether to impose travel bans on Italy and South Korea: ‘‘It’s no longer possible to absolutely prevent new cases coming in, given the increasing changes in epidemiology around the country,’’ he said. ‘‘So in the case of Iran, there’s such a high risk that a travel ban is worth doing because it will slow down the number of cases …
‘‘At the moment, the medical advice was that the situation in Italy and South Korea, where they have large outbreaks but they’re confined and being localised, the risk – the proportionality – of putting in a travel ban wasn’t justified in terms of its benefit to the health protection of the Australian community.’’
Cachia decodes this: ‘‘It implies that they may be resigned to a major outbreak in Australia.’’ Murphy is telling us that there are two critical concepts being applied to Australia’s border policy. First is that it’s now all about slowing the spread of the virus – not preventing it. ‘‘Travel bans are – at this stage, when we have an outbreak in many countries – a way of delaying the burden of new cases coming in,’’ he said.
If we’re inevitably going to get a major outbreak, why is slowing the rate of infection so important? In Cachia’s explanation, the aim is to slow the rate to keep the number of severe cases below the ‘‘key resource constraint – the number of mechanical ventilators in Australia’’.
Standard treatment of severe cases is to put them on ventilators for a few days until the infection passes, he says. In effect, Australia is engaged in disease rationing to match ventilator supply. But Cachia has an objection. He points up an inconsistency. Where people in Australia are found to have the virus, authorities are conducting ‘‘contact tracing’’ to find anyone they might have infected. ‘‘What’s the point of contact tracing while your borders from places that have declared states of emergency are still wide open?’’
This brings us to Murphy’s second key concept. The word he used was the ‘‘proportionality’’ of applying a travel ban. Its proportionality was not ‘‘justified in terms of its benefit to health protection’’. But a cost-benefit analysis weighs benefit against cost. What would be the cost of widerranging travel bans? This is where the consideration – unspoken – of economics comes in.
The more countries listed, the greater the damage. With a widespread outbreak already inevitable, the net benefit of banning another country’s travellers is weighed against the net cost to the economy. The Australian economic modeller Warwick McKibbin estimated in a 2006 paper that a moderate to severe global flu pandemic with a mortality rate up to 1.2 per cent would cut the GDP growth of the world’s developed countries by up to 6 per cent. This would be a massive global contraction. To date, the mortality rate of the coronavirus worldwide – excluding China – is about 1.5 per cent, closely matching McKibbin’s assumptions.
So it’s no longer about preventing an Australian outbreak. Australia is now figuring out how to live with COVID-19, rationing the virus to the capacity of the health system, preserving as much economic activity as reasonably possible in the process.
Cachia got his test results yesterday, by the way. He tested negative. He had mixed feelings. Relief, yes, but he says it might be better to get infected and develop immunity, giving his nerves some comfort. Which recalls the Cold War movie, Dr Strangelove. To adapt its subtitle, ‘‘How I learned to stop worrying and love the bomb’’, Australia may be beginning to ‘‘Learn to stop worrying and love the virus’’.
Peter Hartcher is SMH’s international editor.