When I do my ward round on my patients with Covid, I don’t ask them why they aren’t vaccinated. I don’t ask them how they caught Covid. My role is to provide caring, compassionate non-judgmental care. But sometimes people tell me unprompted and the reasons leave me feeling sad and frustrated for the inequality in our health system.
Many of my patients don’t speak much English, and since I am monolingual, we rely on phone calls with family members to help us communicate. We always ask how everyone else in the household is. One patient told me they live with seven people and all have Covid. In our hospital, there are multiple families with more than one person who has been admitted.
Some spread of Covid has been blamed on illegal social visits between households. Many older adults who don’t speak English are reliant on their family members to navigate the world. Families have been unable to access childcare and put in the position of making impossible choices between work and schooling. I doubt that the people in the wealthy suburbs are visiting their families any less than the people in low-income suburbs, they just had a chance to get vaccinated first, so no one is getting sick.
Covid is an infectious disease that has a huge advantage in finding new human hosts, because people are particularly contagious before they develop symptoms. Using labels like “illegal” creates a barrier to getting a Covid test for fear of repercussions. It also drives a narrative that people who catch Covid are reckless, and that the answer is virtuous behaviour, further driving shame and stigma.
For people working on the Covid ward we now have daily saliva testing and fit-tested N95s. This year there have been no staff infections from within our Covid ward. But the vast majority of in-person workers outside the healthcare system are not so lucky. People turn up to the jobs they need to do to pay the rent. They share air with others, they spread the virus to others before they know they are sick.
Sometimes people do wait a few days after developing symptoms to be tested. Early symptoms of Covid are usually mild, subtle and variable. I have patients with nausea, muscle aches, lethargy and diarrhoea who can’t quite believe they have Covid, because they don’t have the respiratory symptoms which can come a few days later. In our study last year of older adults who caught Covid in hospital or residential care, and who were observed for the entirety of they illness, almost half never had a fever over 37.5. Public education about mild, early symptoms would go a long way to getting earlier diagnosis so people can make safe choices and get community support.
All my patients are eligible for the vaccine – some have been eligible for months. The majority have had no doses, with few having had one dose. They are not anti-vaxxers. Many want to know how long after they recover until they can get vaccinated. Some already had made a vaccine appointment which did not come in time. The reasons for not getting vaccinated are varied, but all are upsetting. Some tell me they had conflicting information from healthcare practitioners, some tell me that they thought it was OK to wait. Some people are homeless.
For people who speak a language other than English, have low literacy and irregular shift work, the barriers to vaccination have been insurmountable. A policy that does not account for barriers to healthcare is a form of discrimination. So many people in hospital with Covid are from non-English speaking backgrounds, and this is a tragic failure of accessible health advice.
Last year, we saw the same suburbs of Melbourne have high rates of Covid, yet the vaccine rollout strategy did not account for this. Now we have vaccinations divided along socio-economic lines. A report from the Australian Institute of Health and Welfare states that in the first year of the pandemic, there were almost four times as many deaths due to Covid-19 for people living in the lowest socio-economic group compared with the highest socio-economic group, and age-standardised mortality rates were 2.6 times as high. Even before the pandemic, people in the lowest income quintile had twice the risk of premature mortality as those in the highest quintile.
My patients are not careless, reckless rule-breakers, they are humans who caught a virus going about their lives. People who were at higher risk because Australia has a terrible problem with health inequality and a health system that is failing those who need it most. It’s easy to blame the Covid outbreak on individuals breaking the rules, to turn citizen against citizen in mistrust, to wag fingers at people gathering on the beach or in parks. This creates fear and conflict, rather than unity and is a distraction from the real causes of rising Covid spread.
Working in a public hospital, the impact of poverty on health has always been obvious to me, but now maybe it will be obvious to everyone else too. I can only hope this is the wake-up call we need to make our health system equitable for all.
• Dr Kate Gregorevic is a doctor at a Melbourne hospital
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