Health workers and vulnerable patients pay the price for nefarious “COVID normal” narratives - MJA Insight

During the COVID-19 pandemic, the health system stretched and stretched and stretched. So did the people in it. We must resist the inevitable urge of funders and policy makers to assess that this was the true system capacity all along, writes Jillann Farmer …

THE first article I wrote for InSight+ came from a space of believing we could do better in the coronavirus disease 2019 (COVID-19) response. The start of 2023 seems an appropriate moment to reflect and consider where we are. There is no shortage of excellent pieces analysing our pandemic response, its shortcomings, its missed opportunities, the disappointment that there was not a reset with a change of federal government, and the emerging reality of repeating waves of infection without the “holy grail” of herd immunity emerging. The current Australian wave is lower than the preceding winter and spring waves, but it is a summer wave – we must look northwards, to Canada, the United States and the United Kingdom, to get a sense of what winter might bring, and it is not pretty.

We are at an interesting time in Australian medicine. We are now three years into the COVID-19 pandemic, so we have interns who have just started work who have had three years of training affected by the extraordinary conditions that the pandemic created in health services. We have registrars starting work in their roles who have never worked in a “normal” health system. We have newly qualified consultants who have spent the past three years carrying the enormous burden of pandemic work and trying to study for Fellowship examinations. And we have the grizzled warriors – the senior staff who have stayed the course and provided support, teaching, mentoring and guidance throughout, all the while carrying workloads and burdens that would be unthinkable to most people.

New variants continue to emerge. Immune evasion continues to evolve. The prominence of “ hybrid immunity” language has likely contributed to poor vaccine booster uptake. Somehow, a message of “get infected to prevent getting infected” took hold and language that infection was “necessary” was promulgated even by public health officials. But getting infected does not permanently protect you from subsequent infection, and those subsequent infections can have escalating consequences in terms of COVID-19 complications, so the pain is likely to continue for some time yet. Based on what I see in the US, Canada and the UK, the end is not in sight (here, here and here). Not just because of the nature of the virus and its behaviour (which is, in fact, shaped by human behaviour), but because of the current policy settings that seem certain to skew in favour of transmission if that is the price to be paid for “normalcy”.

Those of us in health care knew (and continue to know) that the “nothing to see” narrative was not true, and that the veneer of normality has been maintained by extraordinary efforts of the people who work in health care across all sectors, including general practice, outpatient care, hospitals, aged care, disability care and mental health. No part of the health care system has escaped the impacts of COVID-19, and many continue to bear them. People who are using the health care system experience it, but those who enjoy the privilege of not needing to engage can remain oblivious and live happily in a world that they believe to be unaffected by COVID-19 – but it is.

The efforts of health care workers are now taken for granted. It’s just expected — this is the “new normal”. The ongoing marginalisation and isolation of vulnerable populations is also just taken for granted, expected, and part of the “new normal”. Is this really the future we choose for ourselves? Community awareness is gone. Public health messaging is absent, and government seems very comfortable to continue with the status quo.

One of my reflections, looking back, is that at the height of transmission, I found that I felt strangely disconnected from the general public. They were being fed a narrative (and believing it) from government that all was well, that this was “expected”, and even “necessary”. Attitudes and acceptance of ongoing morbidity and mortality were being shaped by ensuring a perception of “otherness” in those who succumbed — the constant emphasis in reported deaths of people who were elderly, infirm and had underlying conditions. The normalisation of COVID-19 has been a resounding success. The public are nowhere near adequately informed, with national cabinet decision making opaque, and failure to release modelling and advice upon which decisions are made. Part of me understands that this was inevitable, but another part of me longs for a world where government is a little more honest, and, by at least trying to reduce transmission, shows a little respect for the health professionals who are propping up the system.

It is possible that this lack of respect is one reason for the accelerated pace of the crisis currently facing general practice. General practice was singled out for particular and targeted disrespect by state and federal governments during the past three years, while operating under difficult circumstances perhaps not appreciated by our hospital colleagues. The narrative of “slack GPs refusing to see patients” definitely gained some traction, and this image would be unattractive to potential GP registrars. COVID-19 brought increased costs of operation to practices, and an increased need for self-funded sick leave for doctors, perhaps also accelerating the shift away from bulk billing.

I doubt it is coincidence that there is a rising percentage of junior doctors and medical students, whose attitudes and perceptions were shaped during the pandemic, who are not choosing general practice.

We need a few reset points. We need to reset policies about damping down transmission — France has just announced air quality standards for day care and schools. Schools across the US are starting to do projects to make Corsi–Rosenthal boxes (a cheap, do-it-yourself HEPA filter solution), and Amazon in the US sells a package of filters and duct tape for making these, all you need to add is the fan. World leaders in air quality engineering and the public health benefits are here, in Australia, but their message is not gaining traction. These discussions don’t seem to be happening in mainstream Australia, because it’s over. But it’s not. Perhaps recognising the terrible toll that repeated infections in children have on the children themselves, but also on the entire family, federal and state governments have started to fund improvements to ventilation and filtration in schools, but are still not educating the public about the importance of these measures and the risks of crowded poorly ventilated spaces. This dichotomy is perplexing.

We need a reset in what is considered normal and acceptable. The system stretched and stretched and stretched. So did the people in it. But we all accepted reductions in standards of care and professional behaviour. This is not a criticism; it is simply an inevitable consequence of the shortcuts that had to be taken to spread a workforce across impossible demand. We just need to strongly resist the inevitable urge of funders and policymakers to assess that this was the true system capacity all along.

Amongst the “normal and acceptable” that we must not accept is hospital acquired Covid-19 infection, and occupationally acquired Covid-19 infection. Somehow, hospital acquired infection has become passe, acceptable and just the cost of doing business. This is the price we’re paying for “normal”.

We also need a reset in the perceptions of general practice – the negative rhetoric that emerged during the pandemic has been deeply damaging, and that, combined with the increasing pay and conditions gap between GPs and hospital-employed doctors, creates a definite and valid question of “why would you?”

I hope for better days for our healthcare system, but, in particular, for the junior doctors whose early careers have been shaped in such awful circumstances. Those of us whose careers pre-dated the pandemic, who have more years of experience outside it than in, must hold that space for our junior colleagues, in the hope that we can one day return to, and they can experience, a healthier health care system.

Jillann Farmer is a Brisbane based physician currently working in emergency medicine. She lived in New York during the first wave of COVID-19.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.

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2023-01-22 07:10:24Z
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