“Covid-deniers” and “anti-vaxxers” should opt out of care in the public health system if they catch the virus as Victoria reopens, says the Victorian branch of the Australian Medical Association.
The AMA Victoria president, Dr Roderick McRae, said those who do not believe Covid-19 is real or a threat should update their advanced care directives and inform their relatives that they do not wish to receive care in the public health system if diagnosed with the virus.
From Friday, many restrictions will lift across the state as it has exceeded 70% full vaccination of those aged over 16. Though Victoria is still recording high daily case numbers, with 2,232 new cases reported on Thursday, high vaccination combined with lower than predicted length of stays in hospital has given the government confidence the health system will cope with measures lifting earlier than first anticipated.
But McRae, who is an intensive care physician and an anaesthetist, said health care workers were fatigued from lockdowns, Covid-19 outbreaks, and pressures on the health system, including staff shortages that existed before the pandemic.
“Within the public hospitals, the knees are knocking as restrictions ease, because the situation is stressed to the point that tents are going up outside of the public hospitals to facilitate the removal of ill patients from ambulances, so those ambulances can go and get the next patient,” he said.
Health workers would also be grappling in coming months with a backlog of patients who had been forced to delay their elective surgery because private hospitals and staff were being redirected to treat Covid patients.
“So these patients continue to suffer some pain or disability for a longer period of time, and they’re often patients who’ve been double vaccinated, they’re elderly, and they’ve done everything right, but their knee replacement is being delayed and the public hospital waiting lists are growing,” McRae said.
“We’re all juggling everything the best we can to avoid and prevent deaths. We know as we reopen it’s the unvaccinated who are going to get Covid, and they are going to get great hospital treatment with many new experimental drugs, even though they think the vaccine is ‘experimental’.
“A whole lot of these people are passionate disbelievers that the virus even exists. And they should notify their nearest and dearest and ensure there’s an advanced care directive that says, ‘If I am diagnosed with this disease caused by a virus that I don’t believe exists, I will not disturb the public hospital system, and I’ll let nature run its course’.”
Victoria’s deputy premier James Merlino rejected McRae’s comments.
“I can understand the sentiment but that’s not the way we operate. We need to care for every single Victorian,” Merlino told ABC radio on Friday.
The AMA’s national president, Dr Omar Khorshid, also cited the association’s code of ethics which requires doctors to provide care impartially.
“Doctors will always provide care to patients considering their right to make their own decisions, even bad ones like not getting #vacced,” Khorshid tweeted.
McRae urged Victorians eager to make the most of restrictions easing by visiting places they had missed, including bars and restaurants, to wear a mask and be cautious.
“We strongly advise people not to undertake any activity that may lead to inebriation and the requirements for medical care,” he said.
“Now is not the time you want to fall over or get injured, because the hospitals are full. Don’t get too excited about the horse winning the Melbourne Cup if you’re on the brink of having a cardiac issue. Because if you call an ambulance in coming weeks, you may have to wait. There’s no question the hospital will do what they can, but we’re not able to provide the standard of care that we once did because of all of the resource constraints.”
Associate Prof Natasha Smallwood, a respiratory physician and head of Monash University’s chronic respiratory disease laboratory, said lockdowns had been tough on healthcare workers too, who were often managing remote learning and childcare, while worrying that they or their family members may be exposed to Covid, forcing the household to isolate.
She said while she and many other health workers were feeling relief that children were returning to school and they would have more freedoms when trying to take a break between shifts, “as the restrictions ease we will obviously start to see a rise in our case numbers and our modelling suggests that we will hit our peak in January and February”.
“I’m very excited the restrictions will ease but cautious and concerned about what that actually means for myself and other healthcare workers in terms of the volume of Covid-19 patients, both in the community but also in the hospital system, and how we continue to manage that workload,” Smallwood said.
She co-authored a study just published in the International Journal of Environmental Research and Public Health which reported findings from a survey of 6,679 frontline health workers, conducted between 27 August and 23 October 2020. They were asked about the main challenges they had faced with the pandemic.
One emergency department worker told the researchers about “not having breaks and having to work 7–10 days straight and also the increased frequency of working shifts and night shifts. I often came home feeling defeated and too tired to take care of my own physical and mental health”.
Another said: “The healthcare workforce felt a bit like being in the army, and I’m not up for that. I feel like my strengths weren’t put to use, I didn’t have a voice, and was expected to ‘step up and step in line’.”
Smallwood said the study found the pandemic had exacerbated pre-existing workplace stresses and created new challenges for frontline health workers including unfamiliar tasks outside their usual scope of work practice, disruption of established teams, rapidly changing policies and procedures, often managers who did not appreciate the stresses placed on staff.
“Things were pretty challenging last year but that is only much, much worse now given that we actually have many more patients who are affected, and we also have a much younger population as well,” Smallwood said.
“People often say ‘but you have vaccination now’, and while obviously being protected is really important, the ongoing mental health impacts, the occupational challenges, and the disruption and changes the pandemic has generated for health care workers means the conditions for them are much worse now.”
Appropriately paying health workers, especially nurses, for their sacrifices “rather than sending them a link to an online wellbeing video, or giving them a chocolate frog” would go some way towards making health workers feel valued and strong enough to continue working as restrictions ease, she said.
“Many of us have to deal with patients who say that they don’t believe in Covid, or their family members who call the hospital ward and say that they don’t believe Covid is what their loved one has, and that also sometimes leads to threats of occupational violence.”