In New South Wales’s desperate battle to stop its hospital system being overwhelmed and curb case numbers Gladys Berejiklian has been forced to adopt measures she only last week said were unnecessary.
Here are a few numbers to contemplate. This Friday: 470 people in hospital, 80 people in intensive care and 27 who require ventilation.
Friday two weeks ago: 304 people in hospital, 50 in intensive care and 22 ventilated.
There are about 500 ICU beds across the state’s public health system, but these are also dealing with heart attacks, strokes and other emergencies, which don’t stop during a pandemic.
And in rural and regional NSW, high-level care is not as available with hospitals already stretched to the limit.
As Richard Totaro, the director of intensive care at Royal Prince Alfred hospital, explained at a recent press conference, Covid-19 is a particularly difficult disease to treat and patients spend roughly twice as long in intensive care as most other patients.
It means that the specialist intensive care beds will fill up and that staff, working in full PPE, will rapidly become overwhelmed and exhausted, particularly when inevitably there is transmission in hospital that sends whole health teams into isolation while they are tested and the outbreak managed.
On Friday, Berejiklian was forced to do what has seemed inevitable to many NSW citizens. She tightened the restrictions to try to break the trajectory we are on.
Has she dithered? Yes. Has she delivered a confusing picture of what’s happening in our state? Yes. But now there is little choice.
Berejiklian’s inclination has always been to try to limit restrictions, and even the police commissioner, Mick Fuller, said on Friday that he hadn’t seriously contemplated some rules like curfews until recently.
“It has been a progressive lockdown based on the numbers, based on whether we have compliance in areas and the spread of the virus. In hindsight, do I wish that I raised the curfew from day one? Probably, but you would have laughed me out,” Fuller said.
The new restrictions fall into two groups: those aimed at making the police’s job easier and those aimed at curbing the spread.
Curfews will work to assist police in dealing with people breaking the existing laws such as having illegal parties or visiting other households when they shouldn’t. But why the government has decided to apply the curfew only to the 12 hotspot local government areas is a mystery.
The chief health officer, Dr Kerry Chant, gave an example on Friday of a gathering at Maroubra (in the LGA of Randwick, which is not a hotspot), where all 11 attendees later tested positive. Fuller gave an example of two people from a hotspot being challenged for being out at night in Drummoyne (not in a hotspot).
Masks outdoors are aimed at stopping fleeting transmission, and given NSW’s huge number of unlinked cases this seems a sensible precautionary move. We have no real data to say how much transmission has occurred this way. It will also renew the visual signal for us all to stay away from each other.
The real problem facing NSW is the same problem: how to curb the spread in a population that keeps essential services going.
Workers doing essential jobs are then bringing the disease into multigenerational households. Too often it is spreading to other related households because visits are still occurring.
This is a much more challenging problem, which requires some tough decisions and a full court press of identifying cases quickly, stepping in to manage infected families and providing financial, medical and social support as soon as possible.
There are also new powers for Fuller to lock down apartment buildings and to require all members of a household to present for a roll call to ensure everyone who should be is quarantining.
Fuller revealed that in some cases when a person tests positive, other household members are escaping before the health authorities arrive to avoid being put into isolation. This is just horrific but also points to some financial desperation and an ongoing lack of understanding in some communities.
There are also some serious systemic problems emerging.
Chant acknowledged on Friday what the numbers were indicating: that pathology labs were overwhelmed and it was taking way too long to alert positive cases that they were in fact positive.
So among the blizzard of changes is a new rule about rationing testing in the hotspot LGAs to those who have symptoms. Authorised workers who work outside those LGAs and have been required to get tested every three days will now either have to have had one dose of vaccine or get a rapid antigen test organised by their employer.
“At the moment we have to trade off those difficult priorities and prioritise symptomatic testing so that we can get that turnaround time. Because of the slippage,” Chant said.
Woolworths, Coles, many building sites and some other worksites have introduced rapid antigen testing, but this could result in some real hardship for workers at smaller food outlets, freight businesses and factories.
Then there is the long overdue closure of hardware and garden shops, which must move to click and collect only – at least in hotspot LGAs. Tradies can still go to the store. Bunnings announced immediately it would close all its stores to the public Sydney-wide except for click and collect.
Unless NSW can bring the reproductive rate of Covid-19 cases below 1 – on Wednesday we were told it was 1.3, which means every person with the virus is infecting more than one person – the numbers will inevitably go up.
It’s going to be very difficult and I just feel for the hospital staff who are watching this calamity unfold up close.
The NSW government has a contingency plan to quadruple the number of ICU beds if needed. NSW Health told the Guardian there are enough ventilators for each of these beds. But the issue will be skilled staff to look after a flood of patients. It just doesn’t bear thinking about.
