If we have to live with COVID, why is the health system not being prepared?

We’re being told that we have to live with the virus. But the people telling us this are doing, and have done, next to nothing to prepare our health system for the consequences.

We are now more than eighteen months into the pandemic, and very little has been done by governments to improve the public health system and to prepare public hospitals for outbreaks. Now we are told that we should essentially let it rip once we get to vaccination levels that have proven to be thoroughly inadequate in other countries.

Scott Morrison, Gladys Berejiklian and Daniel Andrews all talk about “living with COVID” and have committed to the Doherty Institute’s modelling, which suggests relaxing border controls when 70 percent of over 16-year-olds are vaccinated, and largely abandoning lockdowns after 80 percent are vaccinated. This is a reckless, pro-business approach that will lead to many more deaths.

In response to this, both the Australian Nursing and Midwifery Federation (ANMF) and the Australian Medical Association (AMA) have publicly criticised the roadmap. The ANMF is calling for vaccination targets to include everybody, not just the deceptive “over 16” number. They are also calling for research and modelling into the effects of the Delta variant on children, who are being completely ignored in the current roadmap.

The AMA, for its part, is urgently sounding the alarm regarding hospital capacity and funding. “Even pre-COVID, emergency departments were full, ambulances ramped, and waiting times for elective surgery were too long”, AMA President Omar Khorshid said in a letter to to the prime minister, state premiers and chief ministers. “The AMA is calling for national cabinet to urgently commit the necessary funding to prepare our hospitals.”

The reality is that governments (Labor and Liberal, state and federal) neglect healthcare. And it’s something they’ve done for too long. They know that the system is in crisis, and they’ve known it for years. It’s not a secret.

If politicians want us to “live with COVID”, rather than die from it, they need to massively increase funding to the public healthcare system. Give us hospitals with adequate ventilation and ample intensive care capacity. Give us all of the tools that we are asking for to fight COVID. And pay healthcare workers the danger money that we deserve.

This is an urgent task. It always has been but is now more than ever. And it matters far beyond the next few months or years.

There has been much talk among epidemiologists and virologists in recent decades about the likelihood of more pandemics in the twenty-first century. The threat has grown with increasing urbanisation, international travel and especially the advent of industrial-scale animal farming.

The close proximity of animals in industrial farms, and the constant back and forth of viral transmission makes it inevitable that viruses will mutate and jump into human populations.

In fact, this has already happened on several occasions. Once in 2009-10, with the swine flu pandemic that killed between 150,000 and 575,000 people globally. And several times with smaller bird flu outbreaks from the mid-1990s until 2019. It is the threat of the latter that has epidemiologists most worried.

The H5N1 strain of bird flu, for example, has a mortality rate approaching 60 percent in humans. Luckily, it is not very contagious, and no outbreak has ever surpassed 400 cases. However, in 2013, the US Centers for Disease Control and Prevention conducted laboratory experiments showing that it was theoretically possible for H5N1 to mutate “naturally” into a highly contagious airborne pathogen. And all of the preconditions that could facilitate this mutation have only since compounded. This is but one example of a potential pandemic threat, among many.

There is also the impact of climate change. A 2010 article in the journal Nature, “Impacts of biodiversity on the emergence and transmission of infectious diseases”, argues:

“In recent years, a consistent picture has emerged—biodiversity loss tends to increase pathogen transmission and disease incidence ... [C]onnections between biodiversity and disease are now sufficiently clear to increase the urgency of local, regional, and global efforts to preserve natural ecosystems and the biodiversity they contain.”

But since 2010, there has been very little effort to “preserve natural ecosystems”. Quite the opposite. We are arguably entering into a period where pandemics could become more frequent and more dangerous. In light of all this, we need to set the bar high with our response to COVID.

When the HIV/AIDS pandemic started tearing through the United States in the 1980s, the Reagan administration ignored it for years, unbothered by the fact that it seemed to be affecting only gay men and people in Africa. It took years of activism by groups such as ACT UP (AIDS Coalition to Unleash Power) before the government and medical researchers put any money into developing treatments.

This activist movement eventually led to the development of antiretroviral drugs, which have undoubtedly saved millions of lives. It took protest, disruption and a huge amount of public pressure and shame for governments and the pharmaceutical industry to take the AIDS pandemic seriously. Larry Kramer, one of the organisers of ACT UP said it best:

“The government didn’t get us the drugs. No one else got us the drugs. We, ACT UP, got those drugs out there. It is the proudest achievement that the gay population of this world can ever claim.”

COVID, just like the ongoing HIV/AIDS pandemic, has highlighted the reality, yet again, that the realm of public health is a fiercely contested political space.

So we need to fight for better health care—much better health care. More research, more funding, permanent contact tracing operations, better hospitals and more staff. But also a range of healthcare measures in society more generally, including proper ventilation systems in workplaces and schools, for example.

In fact, there should be contact tracing efforts for all contagious diseases. Why should we try to prevent only as many COVID deaths as possible? We should also try to reduce as much as possible deaths from all transmissible diseases.

All of these things take money and funding. But it is a question of priorities. Prime Minister Scott Morrison announced last June that the government would spend an extra $270 billion on the military over the next ten years.

Yet we watch our hospital system bursting at the seams, wondering what facilities we could have with an extra $270 billion. As healthcare workers prepare for months and maybe even years of increased stress, the likelihood of mass infection of hospital staff, and workloads with massive backlogs, we can’t give in to the idea that any of this is normal and inevitable. It is not. A better healthcare system is entirely possible and worth fighting for.