Since the start of 2020, we have known that the year would be defined in medical terms, globally, by a novel coronavirus, SARS-CoV-2, the cause of a disease with which we are now all too familiar - COVID-19.
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The brightest minds in Australian virology, epidemiology and public health are working furiously to limit the spread of COVID-19. We are now moving into a different phase, as case numbers continue to grow. The next line of response - the emergency medical community - is booting up in preparation.
Many in our community have close professional and social ties with our international offsiders, in countries in the middle of their worst health crises since the last world war. We have no misconceptions about the challenges that face us as a profession, or as a country. To simply assume that the impact of COVID-19 on our healthcare system will be favourable, that our response will be adequate merely because it is Australian, is a form of magical thinking, favoured by lovers of flags and lapel pins. Medical responses to disasters based on hope exclusively have a tendency to fall over very quickly.
I am a hospital emergency department consultant and I have been involved in mass gathering medicine, disaster management and the medical response to terrorism for two decades.
This will be a very bad year - for everyone. We do not have a choice as to whether things will be bad; we may have a choice as to how bad we let things become, if we are quick enough. We do not have a choice as to whether we will need to spend money, we only have a choice as to how and when we will need to spend certainly billions of dollars, to protect our health and our economy.
If you are infected, we will do what we can to keep you alive, within the resources we have available. The less overwhelmed the healthcare system, the more likely those resources will be available to you or you loved ones.
Public commentary suggests a fundamental misunderstanding as to how COVID-19 is going to hurt us (there is no longer any debate as to whether it will). On its own, any single given case, in any individual, might reasonably be expected to have a good chance of survival. If you can be the sole focus of attention for the very best healthcare providers in Australia, you have a pretty good chance of surviving anything that can be survived. The issue is the numbers.
When preparations for COVID-19 first ambled into the spotlight, the number "18,000" was bandied about, as being the number of cases that we might be asked to deal with. The doubling time - the time that it takes for case numbers to double - has until recently been tracking at between three and four days. If the interventions that have been implemented to date are not adhered to by at least 80 per cent of Australians, that could mean we are looking at thousands, maybe even tens of thousands more.
We have about 2500 ICU beds in Australia, give or take. They will be occupied quickly, if this disease progresses in Australia as it has in every other country in the world. We may be able to cobble together some overflow, but that too will soon be overwhelmed. From there, overflow will fill our emergency departments, and then any acute space that we can make available. We are building an ED in a field in Canberra, in anticipation.
The entirety of our healthcare capacity risks being overrun by a single medical condition. This is where the problem lies for younger Australians, who might feel that this is the problem of another generation. They are less likely to succumb to COVID-19; but every other medical condition that might afflict them is far less likely to receive the attention that they might expect. With our hospitals soon overwhelmed, truly overwhelmed, those that need treatment for another otherwise trivial disease will die of conditions that nobody has died of for decades.
We are facing two possible problems in our response, one official and one societal. Concerns that some of the medical recommendations internally being made to government are being filtered have been further exacerbated by the suggestion that medical colleagues publicly commenting on policy should be considered in some way unpatriotic, deviating as they were from the formal classic Antipodean narrative of "she'll be right". Chatter about "herd immunity" is bafflingly ill-informed, when we still know so little about the virus. Any suggestion regarding lifting the very measures that were needed to get us off our original curve is irresponsibly premature, at least until we have had time to ensure we are prepared for the eventuality of a "second wave" of community transmission.
The Academy of Science has requested further clarity, and the Group of Eight universities have provided an alternative approach. Modelling provided by government is more sanitized than that provided overseas, but confirms some of the possible consequences we fear so deeply. For now, this seems to be the best we can expect on this front.
That which we can do something about - that we must do something about - is that which has already been recommended, and is still being ignored by some. It may be that the cultural background of Australia makes it more difficult to comply with instruction regarding social distancing and quarantine, yet we must. This is not about ruining people's fun. This is about keeping people alive.
As medical professionals, we will be attempting to fill the enormous boots vacated by the Rural Fire Service in the last few months. We know that our own lives are at risk - many emergency doctors, nurses, paramedics and other healthcare workers have already died around the world in the care of patients suffering from COVID-19. In an environment of extremely restricted resources, it is inevitable that our ethical approaches to allocating resources will be forced to change.
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A utilitarian approach - "the greatest good for the greatest number" - is unavoidable. The degree to which this will be required in Australia, at this stage, is entirely up to the Australian public.
My emergency colleagues are my second family - doing the work that we do, day in, day out, makes it impossible to see them in any other way. They will put their lives on the line to look after your loved ones. When this is over, colleagues that I know personally will be dead. In all likelihood, someone you know, maybe even someone you love, will be dead too.
Understand this.
There is currently no cure. If you are infected, we will do what we can to keep you alive, within the resources we have available. The less overwhelmed the healthcare system, the more likely those resources will be available to you or you loved ones. There may be a vaccine one day, but not this year.
Emergency departments are not the "front lines" of the battle in which we are about to engage. We will hold the line that is drawn for us by our leaders, and the Australian public.
The front line in this ordeal is your front door. What you choose to do as a population in the coming days - not weeks - will determine whether 2020 is merely bad, or worse.
- Dr David Caldicott is an emergency department consultant and a clinical senior lecturer at the ANU College of Health and Medicine.
- For information on COVID-19, please go to the ACT Health website or the federal Health Department's website.
- You can also call the Coronavirus Health Information Line on 1800 020 080
- If you have serious symptoms, such as difficulty breathing, call Triple Zero (000)
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