One of the loudest voices in WA’s efforts to control COVID-19 has been that of the Australian Medical Association WA president.
MF: Many West Australians follow your advice and believe you have been a consistent voice during the COVID-19 pandemic. Was that a gap you felt you needed to fill?
AM: I speak to hundreds of experts on the ground every month and hear from many more. The emergency response to the pandemic was necessarily command and control at the outset, but in our culture where people cooperate more if reasoning is explained to them, that left a vacuum. There was a real thirst from the community for explanation and context that the government was unable or unwilling to supply in a timely manner.
Our members were, for the first time in their careers, going to work not knowing what the risk to them and their families would be, and they had a lot of issues with the response and lack of information. Still do. If we had not been in a position to put their point of view openly and honestly, then there would have been a lot more anxiety, and if there had been a large outbreak it would have been an unmitigated communications and implementation disaster, as we have seen around the world.
Governments, no matter how well intentioned, just have no idea what it is like, or what will work, at the coal face.
MF: There has been a review of the hotel quarantine program in WA and the State Government has conceded to changes. Do you remain concerned that this is still an area of significant vulnerability?
AM: The (Tarun) Weeramanthri report is excellent. He is the first Australian government expert to take the issue of airborne spread seriously; to call it out for what it is and recommend changes to prevent it. It was always our view that ‘hotel quarantine’ is an oxymoron, but with appropriate administration, workforce and engineering changes to ventilation, buildings that used to be run as hotels can be repurposed with sufficient resources and will. We have COVID-19 variants of concern, some that may even evade the first vaccines, and we are having an increased number of COVID-19 positive returning passengers so quarantine will remain our Achilles heel for a
long time.
MF: We need good uptake of COVID-19 vaccines but there is still some hesitation among sensible people. What do we need to do to get them over the line, and would you ever support a punitive approach?
AM: There are three main groups in my view – those who will always have a vaccine, those who never will (less than 2% are true antivaxxers) and the hesitant. Usually emphasising the enormous success of previous vaccines, the safety profile that is growing rapidly in the real world with the new vaccines is helpful, but the reality that COVID-19 infection is a much worse option is the main point. This is a nasty virus and a growing group of ‘Long Covid’ patients is showing that death is not the only bad outcome from the infection.
MF: Are you concerned that many people don’t really understand what the currently available vaccines can do – which is to limit serious disease – with many wrongly believing the vaccines prevent infection?
AM: It is a scientific nuance that the disease can still be spread by the vaccinated and as such not many lay people understand this or the importance of it in a partially immune population. This especially holds true until we have children vaccinated. What we hope is that time will show the vaccinated spread the disease a lot less than others, while protecting the vaccinated, and the mRNA candidates in particular look promising in that regard.
MF: Are governments putting too much weight on vaccines as the way out of the pandemic?
AM: No, the vaccines really will be our way out of COVID-19, but they are making some assumptions that will be tested over time. We hope most people in Australia will comply soon with common sense as usually they do, but some safety incident or supply problems with the program could slow that down.
WHO estimates that it will take seven years at least for most of the world to have some sort of COVID-19 vaccine and in that time variants of concern will continue to arise as will long-haul infected patients. Some of these will evade the early vaccines so a successful long-term vaccine strategy will be required, hopefully with local manufacturing of a wide range of effective and nimble vaccines. Some sort of vaccine passport will also be necessary as an administrative aid to travel and employment.
MF: Are you concerned that other aspects of health care are languishing while all eyes are on COVID-19, creating a “syndemic” or perfect storm for rising rates of non-communicable diseases such as obesity and type 2 diabetes?
AM: The excess death rate measure in countries that have large COVID-19 outbreaks shows higher mortality from all the non-communicable diseases as a flow-on effect. We would expect that here we will do better, of course, but we are no doubt building up a larger long-term burden of disease as a result of the distraction of the pandemic.
GPs will again bear the brunt of trying to care for this, even as the MBS review cynically tries to reduce their resources by targeting dollars without addressing outcomes. The narrative of the doctor scamming the system needs to be forgotten and community practice valued for the amazing asset that it is in Australia.
MF: There is an argument that WA has not so much dodged the COVID-19 bullet by its hard border approach but merely delayed the inevitable. What is your view?
AM: The political tussle between NSW and the border control/elimination states has moved to a new footing with the arrival of vaccines. The roll-out is simply being used as another lever by NSW to posture about border control. As it stands, hopefully the vaccine program will be effective enough on both transmission and disease to keep us safe for the medium term from big case numbers, which is just as well as our state health system would collapse quickly into lockdown in those circumstances, just like Victoria did in 2020.
MF: What remains WA’s greatest weak spot when it comes to COVID-19?
AM: Quarantine arrangements and ports are our weak entry spots, along with the lack of PPE and ventilation required to prevent airborne spread in all the places it happens in large outbreaks. We have good fomite and droplet controls, leaving airborne as the weak transmission point. We need to fix this, starting with quarantine but also in aged care, which has all the other issues of staffing too, healthcare, and all workplaces.
Our previous slack workplace safety culture in healthcare has left us very vulnerable. No mine site would be allowed to operate the way we run healthcare. We need health and safety reps, proper training, hierarchy or risk controls and literacy in occupational health and hygiene in all facilities. Carbon dioxide monitoring with readings under 600ppm are the modern version of the Nightingale wards, where the windows would always be open to fresh air.