Thread by @ozvascdoc

When @JoshFrydenberg says that “our health system is built to cope” he is not entirely wrong. But he’s also not entirely right. 🧵👇 /1 thenewdaily.com.au/news/coronavir…

It is true that we have an amazingly resilient and world class health system in Australia. We deliver some of the best outcomes in the world with a relatively meagre 9.3% of GDP spent on healthcare. /2 data.worldbank.org/indicator/SH.X…

We take for granted that high quality healthcare (excepting dental) is more or less free for all Australian citizens. You can get annoying veins, a niggly knee, or an ugly scar fixed for free – with a bit of a wait. /3 vahi.vic.gov.au/reports/victor…

Previously untreatable cancer is now treatable – even if it comes back – in a public hospital. Drugs costing >$200k/yr are available at no cost. No crowdfunding required. /4 nps.org.au/australian-pre…

There is a lot of focus on getting out of lockdown. “We can’t do this any more” we hear. “Lockdowns have to end”. “We have to learn to live with COVID”. But what does that really mean? /5

Well to begin with it means accepting that there will be a huge wave or a surge in infection amongst the unvaccinated AND vaccinated – and most of the unvaccinated (including children) will get MUCH sicker than the vaccinated group. /6

Putting aside the definitions of 50/70/80 coverage, the @TheDohertyInst model used by @ScottMorrisonMP and the National Cabinet projects that we can avoid overloading National ICU capacity with a 70% vaccination coverage. /7

But because we can’t send ICU patients all over the country, we can’t share that ICU capacity around. We need EVERYWHERE to be 70% covered to possibly achieve this. /8

So it is inevitable that there will be locations and times when ICUs will be full. That means less capacity for major surgery. No beds for sick cancer patients, or rescuing heart attacks, strokes, ruptured aneurysms, or sick babies. /9

In addition, the more unvaccinated people there are with COVID, the more regular ward beds will fill up. @TheDohertyInst estimated up to 42k ward admissions + 10k in ICU. These patients are typically in hospital for weeks-months. /10

The @aihw estimates that Australia had about 59000 non-psychiatric inpatient hospital beds in 2017-18. Worst case scenario we lose up to 88% of our National bed capacity in one go. /11 aihw.gov.au/reports/hospit…

Of course we are all hoping best case which means losing at most 16% of National bed capacity. Ideally if we can “flatten the curve” by slowing case numbers then we can spread that out over a longer period of time. Weird how what was old is new again. /12

In addition to beds being occupied, we also have to protect health care and other essential workers. That means working more slowly, taking extra precautions, limiting hospital patients and visitors. This reduces effective hospital capacity. /13

As COVID spreads through a post-lockdown community, healthcare workers will get sick. They will need to isolate. Their contacts will be furloughed. Just like the 450 staff at @TheRMH right now. /14 abc.net.au/news/2021-08-2…

We have been through this before, and we will see this again. In order to keep essential services functioning, NO LOCKDOWN DOES NOT MEAN NO ISOLATION. /15 theage.com.au/national/victo…

It also means longer waiting lists, cancelling or delaying non-urgent procedures. Operations for pain will have to wait so we can save lives. No hip replacement for you - heart surgery or cancer takes priority. /16

If things get REALLY bad then we go into reverse triage. Patients requiring high resource requirements will not get surgery, treatment or ICU beds. They get (palliative) care at home and we spend resources saving those we can. You may have no say in this matter. /17

So what can we do about this, you ask? Well step one is recognising not only that it will happen, but that IT IS HAPPENING RIGHT NOW, in the US, in Indonesia, in Iran, in Tokyo, and in WESTERN SYDNEY. Watch this video to see how bad it can get. /18 vimeo.com/582276147

So back to Josh. Will we survive? Will we cope? As a health system & a society: Yes, we are resilient. It will mean longer waits for surgery. Some ppl will miss out on cancer treatment or getting broken bones fixed. Some will die of otherwise treatable conditions. /19

Will it be the same health system we are used to? No. We will have to make sacrifices due to the expected load of severe, acute and long-COVID illness, as well as chronic illness made worse by mild COVID. We have to lower our expectations of healthcare for months to years. /20

Is there anything we can do to help avoid this? YES!
- get vaccinated 💉
- hand wash 🧼
- mask 😷 & social distance EVEN AFTER lockdown ends
- get tested with ANY symptoms 🤧
- isolate until your results are clear
- comply with intermittent lockdowns as required
/21 End 🧵

Follow up to 🧵: in case you weren’t sure, this is what it looks like when a modern, first-world health system “copes with COVID” — patients dying of commonly treatable conditions like gallstone infections. cbsnews.com/news/covid-us-…

And finally it hits home.

https://twitter.com/ozvascdoc/status/1437377853276909583

Just in case you were thinking: “Cool, we’re coming out of lockdown! This #COVID19 tsunami is rubbish.”

Well, just because you can sip a soy decaf latte in a cafe with your mates doesn’t mean people aren’t dying in hospital, and we aren’t working our butts off to save them.

https://twitter.com/ozvascdoc/status/1449499374090809344

And for all of those saying “Omicron isn’t that bad”, well let me remind you of some simple maths.

https://twitter.com/ozvascdoc/status/1473060604143300610

And here are the current #COVID19 hospitalisation numbers in NSW that bear this out.

https://twitter.com/ozvascdoc/status/1477521297475350528

Right now #COVID19Vic is decimating our healthcare workers and reserve capacity. I am getting phone calls and messages almost every day of another HCW testing positive and going into isolation.

https://twitter.com/western_health/status/1477802905629446149

Govt contact tracing cannot cope. Internal hospital contact tracing teams are flat out trying to protect inpatients and maintain even skeleton staffing in our hospitals. Even incidental #COVID19 in patients undergoing other surgery is a big deal.

https://twitter.com/inquisitivegyn/status/1477820891744509954

The tragedy is that it didn’t have to happen this way, but it has. It WILL get worse and we have been given no choice but to hold tight, buckle down, keep safe and ride it out — and hopefully learn how to prevent it next time (ie by actually listening to public health physicians)

https://twitter.com/ozvascdoc/status/1476081246971125761