What has the COVID-19 taught us, and what do we still need to learn? Infectious diseases physican Dr Michael Watson considers the answers.

When something as dramatic as COVID-19 occurs, it’s always tempting to lament about all the bad things that have happened. That’s why I deliberately chose the title ‘The Good, the Bad and the Ugly’.

Let’s start with the ‘good’ that has come from COVID-19 as there has actually been much good in recent times.

Well it’s every ID physician, public health physician and microbiologist’s dream to hear that there has been so much hand washing and hand sanitising in the community that we ran out of soap and hand sanitiser!

So did all the hand washing make a difference?

It certainly looks like it. If you look at VirusWAtch, (an integrated viral syndromic and laboratory surveillance system I helped set up in 2007 before the last pandemic), you will see something quite remarkable. Influenza simply disappeared from the state this winter and other respiratory viral activity is also way down.

Not only respiratory viral admissions to hospital were way down but gastroenteritis admissions too.

I think it was also fantastic to see democracy in action, with robust lobbying from grassroots medical people with the support of the AMA. I think without that lobbying, the outcome for WA may have been quite different.

Industry lead

I was also impressed that industries such as mining were so proactive in protecting their workers (and one of WA’s most essential industries), that they were able to lobby successfully for increased testing for SARS CoV2 and the availability of PPE.

The lobbying for health worker safety I think has paid off and although there have been significant health-care worker infections with COVID-19 in Victoria, these appear to have been reasonably well investigated (unlike other countries) and steps are now being taken to mitigate risks so when the almost inevitable 2021 winter epidemic of COVID-19 occurs (if an effective vaccine is not implemented) we should be much better prepared.

The price of petrol is down and greenhouse gas emissions around the world are in retreat. Unnecessary business travel has been almost eliminated. Working from home is becoming the norm and is starting to provide social dividends for many (but not all) families and outdoor family activities are on the rise which is also brilliant for our community.

I think we are also much more aware of just how vulnerable our critical supply chains are for basic medical supplies (PPE), but even more concerning were simple things like staple foods such as flour, pasta, rice and milk and also the basics such as soap and toilet paper. I have put this under ‘good’ in the profound hope that everyone (government, business and individuals) will learn from this in the future and mitigate the risks by always ensuring they have sufficient stock on hand in case the supply chains are interrupted in the future.

I guess we have to talk about the bad.

Doing it tough

The loss of jobs and the damage to people’s livelihoods around the country has been heart-wrenching. This will inevitably translate into poorer health outcomes in the future. Although WA was spared the pain in at least some sectors, many people are still hurting.

I was disappointed with the lack of communication and consultation of decision makers in government (you must remember that during a pandemic only a small handful of individuals are responsible for decision making) and I think this showed in some of the decisions being made.

It was clear that private pathology was able (often with the help of the mining industry) to rapidly adapt and increase supply of nuclear acid amplification (NAT) testing, not just for COVID-19 but also for the other respiratory viruses.

The COVID clinics I think were a mistake and (although understandable because of a failure of government to provide adequate resources to public pathology services), the testing in COVID clinics for SARS CoV2 alone (rather than the full range of respiratory viruses) was unwise and needs to be urgently rectified before winter 2021.

There were also lost opportunities to rebuild VirusWAtch and expand this sentinel GP surveillance system to include all general practices willing to participate and to bring back to WA all of the respiratory viral testing. The government needs to urgently re-invest in WA’s state pathology system to ensure that they will cope with whatever the 2021 winter throws at us.

Protecting GPs

If the VirusWAtch system had been fully active and comprehensive, it would have provided the reassurance to patients that general practices were safe to visit. Patient avoidance of visiting their general practices through unfounded fears, may have contributed to the dramatic increase in chronic disease-related illnesses that we are now seeing in our hospital system. It would be great if more research could be done on this to elucidate the extent of the problem.

Fortunately, I think the ‘ugly’ of COVID-19 was a rare event. Some unpleasant scenes of people squabbling over toilet rolls caught media attention and the temporary incarceration of people in high-rise public housing in Victoria was quickly dealt with through democratic processes.

Domestic violence was of course the unseen ugly side to COVID-19 and highlighted the importance of government in continuing to invest more in this area.

Overall, I think we did well as a nation. I think it was clear that we are a country which values Respect (empathy and compassion i.e. understanding and kindness) and that we care for our citizens. It’s now time to fully restore democracy and stand down the emergency response.

We now need to find the new normal for Australia through democratic processes of negotiation and innovation and this process needs to be based first and foremost on Respect.