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COVID-19 - Government Response

Dr Rosalie Woodruff MP

Dr Rosalie Woodruff MP  -  Wednesday, 10 November 2021

Tags: COVID-19

Dr WOODRUFF (Franklin) - Mr Speaker, we are pleased to have this opportunity to talk about safety in Tasmania. It is a highly discussed topic. Every person I speak to has a different perspective, whether it is getting coffee from a small business owner, speaking to people who have art shops where there has been almost no traffic, speaking to a person in the community who has a dangerous level of emphysema, speaking to another person who was immuno-compromised and another one who had a child with cerebral palsy. There are people in Tasmania with a range of experiences and a whole range of views about opening our borders. I have not yet spoken to someone who is not concerned about the state of the health system and does not have confidence that it will be able to withstand any type of shock.

I want to address the conversation about the Kirby Institute's modelling. We had a briefing from the Director of Public Health on Monday. It was a short briefing, not as long as I would have liked to have gone into the details behind that modelling. The Director of Public Health made the point that it will provide a guide to the restrictions that he will implement when the borders open on 15 December. He will keep an eye on the situation, particularly the response to the borders of New South Wales and Victoria opening and the movement of Delta around those populations.

We do modelling and we understand it does not provide real world answers but what is the point of doing modelling unless it is providing some guidance? We assume that the Government and the Director of Public Health have asked for this modelling to provide some indication of the trends. Pulling back without looking at the raw numbers, the trends are concerning for our health system and for people who may become sick and exposed. What they say is that the modelled scenarios include a range of different restrictions and a range of different public health capabilities.

The contact tracing, the testing, tracing, isolation and quarantine - the TTIQ - is critical to making sure that once Delta enters Tasmania, which it will, we can keep a handle on where it is moving and who it is affecting so that we will pre-emptively be able to put public health restrictions in place to manage the load on our health system. That is where the things are with the global pandemic. Some countries have done that effectively; other countries have failed. Public health systems in other countries have failed when they have given up on the contact tracing and said it is too hard.

The modelling in this situation looked at 80 per cent contact tracing effectiveness and 50 per cent contact tracing effectiveness. We have been able to achieve something in the order of 80 per cent so far, but the experience elsewhere, as the Director of Public Health said, shows it is unlikely we will be able to stay at 80 per cent. The modelling for 80 per cent is more than heroic. It is not useful information because it is not what Tasmania is likely to be able to achieve, said the director.

Scenarios 1, 2 and 3 all provide for a level of contact tracing we are not likely to be able to achieve, according to the director. The fourth scenario, which is for contact tracing of 50 per cent of people who have become infected and mask wearing indoors for children over the age of 12, probably gives us a sense of where we are likely to be with the number of deaths and the number of cases.

I struggle to say these words casually because each of those modelled deaths represent the potential real life experience for Tasmanians. We cannot get casual about this and it is not my intention to be. I am just reading from this modelling, which is pointing to us that with 10 per cent movement restriction, which is about where we are now, there would be 70 000 cases in the 200 days after 15 December and there would be 148 deaths. Those 148 deaths would, in the greatest likelihood, end up with people being intubated in ICU wards or a bed in hospital. Beyond that, those deaths also include people who are hospitalised but who, thankfully, do not die.

You cannot understate the fact that there will be an increasing burden on the health system. That is why we cannot support the way Mr Tucker has framed part (f). He said that 'by retaining a well resourced and prepared health system'. We do not have a well resourced health system. It is not properly prepared. People in the health system are working day and night to do everything they can. I thank them on behalf of the Greens and everyone we represent for the work they do. The quality of the work is outstanding. However, they are working with limited resources and that is the fault of the Government.

The Government has starved the health system of the baseline level of resourcing in a number of areas, particularly the hospital system and community health. We were in a situation of pandemic 18 months ago and the Government had a blinding realisation that public health is a fundamental bedrock of society. We are playing catch up but there is only so much people can do. When you do not have enough beds built because that work did not start seven years ago, it is difficult to manufacture the extra room in the emergency department, the extra room to make sure people can have their elective surgeries done on time.

With the figures from the AMA report card, and the evidence on the Government's own dashboard, where we stand at the moment is that only 29 per cent of emergency department patients were seen on time in August. That is a truly appalling figure, and it is the worst one this state has ever recorded.

Under the Liberals' watch, under this Government, we have now reached the bottom of our level of statistics of people being seen on time in the emergency department at the Royal Hobart Hospital. Only 36 per cent of patients with an imminently life-threatening condition and 90 per cent of patients with a potentially life-threatening condition were seen on time. They were devastatingly low numbers, and they are truly distressing when you reflect on the experiences of people with life-threatening conditions who have been waiting to be seen, and have not been seen in a timely fashion.

The emergency department staff are doing their absolute best. People in the hospital, nurses, people in Ambulance Tasmania and paramedics are working so hard, without enough people to help them to balance their workload and have enough nurse and midwifes on the wards. This is not an insoluble situation. There is no doubt that there are problems that we cannot quickly return from, that the Government has made, but there can be more investment in nursing and midwifery staff. There can be more commitment to doing what the ANMF has been asking for - putting the money and commitment now into the equipment and retention that is required for nursing and midwives over the long term. However, it has to start with the commitment, and it has to start first and foremost with bringing the nurses into the system to fill the gaps that are there.

The ANMF is very clear that there are existing gaps in the system, which requires the casual nursing pool to be overused. It means that nurses in Tasmania continue to do double time overtime and work longer hours than they want to, because of their passion and devotion to their work, and their commitment to their teammates and other staff - and obviously, first and foremost, their care to look after patients.

The Minister for Health has opportunities. There is the $300 million that the Premier talked about in the state election budget. That $300 million budget was sitting there, he said, to be available for the sort of contingencies that we have now. The last thing we want to do is to hold that money back, when there is something we could be doing today in preparation.

We have to have a plan for nurses, doctors and other healthcare staff who become infected with COVID 19 and are not able to work. Although it is true that double-dose vaccination for the coronavirus does dramatically and substantially reduce the risk of people becoming hospitalised and dying from COVID 19, it does not completely protect a person from becoming infected - and potentially infectious as well. If a person who has the double-dose vaccination becomes infected, they must be removed from the staff. They will not be available to work in the hospital.

We asked the minister the other day - and I still have not heard a response, minister, and I have written to you about this because it is really concerning. Many conversations have been had amongst Liberals about plans; we would really like to know what modelling has been done. There has been a lot of modelling work done on the impact of staff losses and absences because of COVID 19 infection, and the two-week-plus period that people would be off work while they were infectious or sick, for replacement staff in that period. You cannot whistle people up at the last minute and I am not convinced there is a plan for this; I have not heard anything yet.

The minister has written a long opinion piece in The Examiner about COVID 19 and all the actions the Government is doing, but there is radio silence on the issue of supporting nursing and, particularly in the long term, putting that investment in now. The pandemic, COVID 19, will be with us for an indefinite time, and those staff take time to recruit.

I also want to make a point about the third vaccination dose. It would be great if someone from the Government could provide some information about what proportion of our healthcare staff will have received a third dose by 15 December. I have spoken to doctors who are working, and who were double-dose vaccinated back in April; there was a rollout that started in April and May. There are certainly people who have been double-dose vaccinated for many months now in the healthcare system, but the laggards were only finally required to do that on 31 October.

There is a spread before people will have their third dose. The evidence from the international literature, and experience in Israel, the United Kingdom and the United States is that vaccination efficacy drops off quite rapidly after a month, and then there is a decline. It is pretty clear that we need to have a third dose to get proper vaccination coverage for COVID 19.

If the minister, or someone else from the Government, could provide an answer to that, I would appreciate what the plan is for the third doses. We have no problem with supporting the Labor amendment that is proposed.