Working as a doctor, fear is not uncommon. I was afraid on my first night shift knowing that help from a senior doctor was a gruelling 30-minute wait away. I was afraid during the third hour of a surgical case when we were running out of options to control a patient’s catastrophic bleeding. I was afraid waiting for updates about a colleague who had fallen asleep at the wheel after her sixth 13-hour shift that week. But none of that prepared me for the fear I have been feeling at work lately and that I see in the faces of my colleagues.
As of 23 August, there were 18,231 COVID-19 cases recorded in Victoria. Of these, 2,693 are health care workers, representing nearly 15 percent of cases. Although there is generally a paucity of centralised data around the number of health care workers who have contracted or died from the disease, a study of the first global wave of the pandemic using data from 41 countries has put the global median of health care worker infections at 10.04 percent. Multiple countries have transmission rates far lower again with several studies confirming a reduction of health care worker infection rates to 0 percent in countries such as Taiwan, Korea and, more recently, China and Italy. 
Since the initial phase of the outbreak in Australia, healthcare workers have had to face criminally unsafe working conditions. In the worst of the resource shortage during the first wave, when masks were under lock and key, myself and other younger staff members at my hospital would routinely step up and provide care in high risk areas, knowing we had inadequate protection, in order to shield our more vulnerable colleagues. 
As we learn about COVID-19, the true cost of these practises becomes clear. The acute effects of the disease are harrowing themselves, severe enough to cause the death and long-term intensive care admission of otherwise healthy patients in their 20s and 30s. What is potentially worse, however, is the research that shows irreversible and potentially devastating damage to the cardiac, respiratory and neurological systems in previously well patients diagnosed with COVID-19, resulting in significant morbidity and mortality long after the initial infection. 
The persistent prioritisation of the economy and business over the lives of health care workers and the community has turned our fear into anger. Despite the evidence from overseas of its effectiveness, the government is still refusing to implement what’s known as the precautionary principle. This essentially involves prioritising caution and the adoption of the safest work practices, from the universal usage and mandatory fit testing of P2/N95 masks (the high grade masks that protect the wearer as well as those they have contact with) to a massive upscale in the cleaning of surfaces and equipment within hospitals. 
In August, while the Victorian outbreak was in full swing, a survey of 677 physicians found that 20 percent of those working in public hospitals have had to source their own personal protective equipment (PPE), while 45 percent across public and private hospitals have limited or no access to P2/N95 masks. The Infection Control Expert Group, the federal governments advisory body, continues to drag its feet, claiming that evidence for aerosol spread is not substantial enough to recommend P2/N95 masks as the default. And as a further slap in the face, it insists that the data on healthcare worker infection is too weak to assume that the virus is being contracted in the workplace rather than the community. A colleague of mine who tested positive to COVID-19 after working a 93-hour week in an acute ward was told the contact tracing was inconclusive and the source of their infection unknown. The ward they work on has not changed its policy and still does not mandate P2/N95 masks. 
Decades of neoliberalism and privatisation have crippled the health care system such that it is unable to provide consistent and safe care. Business as usual involves routinely offering unwell patients a referral to expensive profit-driven providers or discharge to threadbare community services only to have them fall through the cracks with devastating consequences. 
These fractures in the system have been even more starkly exposed by the crisis brought on by the pandemic. For example, while privately run community pathology services are laying off staff due to the fall in their non-essential business, the public labs are so overrun that COVID-19 tests can take up to a week to return results, even for fast tracked health care workers. There are now in-house rapid tests in hospitals that can return a result in two hours. However, due to the high cost and the understaffing of our lab, in my hospital we are only authorised to access two of these tests per day. In practice this means that for high risk procedures, such as an aerolysing general anaesthetic, the non-rapid tests that we are ordering on patients are used for retroactive contact tracing rather than to prevent further transmission. On my last shift we performed two high risk procedures on patients with pending COVID-19 swabs knowing that if they were positive, we were pretty much guaranteed to contract the virus. 
Furthermore, despite 35 percent of the nation’s hospital beds belonging to the private sector, including 27 percent of intensive care beds, many private hospitals are still refusing to care for COVID-19 patients, diverting anyone who has tested positive or exhibits any symptoms to the public system. 
Rather than making up that by treating more public patients with non-COVID conditions, and helping to take the pressure off the public system, the private hospitals have instead chosen to maintain their profit margins by shutting down entire wards and forcing the workers that normally staff them to take their annual leave, withdrawing work previously offered to those on casual contracts and even placing some on indefinite unpaid leave. The contradictions of capitalism are laid bare – in the middle of a globally devastating pandemic and the worst understaffing of hospitals seen in decades, we have empty hospitals beds, nurses underemployed and the community suffering the consequences. 
The COVID-19 pandemic offered a significant opportunity to recognise the devastation that successive governments have wrought on our health care system and trigger a reorganisation of the sector’s resources based around prioritising human life and dignity rather than profit. Instead, the working conditions and lives of healthcare workers have been used as a buffer. The government is unwilling to even rhetorically prioritise our safety, with the NSW and Victorian health ministers refusing to agree to demands from doctors and nurses to implement a target of zero health care worker deaths. 
Frontline workers are not heroes. We are unwilling martyrs who have been needlessly sacrificed to bolster a system that cannot support its own greed. It is vital that we organise collectively, not only in healthcare but across all other industries, to challenge the oppressive and predatory logic that brought us to this point, and beyond that for a world run democratically by workers where society’s ample resources can be used to meet human need. Our lives depend on it.

Victorian public hospital doctor

We healthcare workers aren't heroes. We're unwilling martyrs

“Thank you for coming to work.” These words started the first, but certainly not the last, all-in team meeting to discuss measures being put in place to mitigate the biggest challenge to the Australian health care system in living memory.
The faces around me were pale, grim and determined. We have all been watching the crisis unfolding overseas with increasing alarm. And nobody could have missed the line of patients, wearing an assortment of masks, stretching for a block outside the entrance to the emergency department. As doctors in a public hospital we were all too familiar with the state of the current Australian health care system. We know what is coming for us and we know we are not prepared, not even close.
According to the most recent statistics from the Australian Institute of Health and Welfare, we have 62,000 beds in our public system. Only 1,485 of these are intensive care unit (ICU) beds. If you take into account private hospitals, the numbers go up fractionally: 95,100 beds and 2,023 ICU beds.
Because we are in the early stages of the epidemic in Australia, and the government’s emergency response has thus far been highly changeable, the exact trajectory of the virus in Australia is unknown. Epidemiologists estimate the likely infection rate will be 20-70 percent of the total population. Even using the most conservative estimate, that would mean as many as 252,000 concurrent ICU admissions. With full access to intensive care facilities, the death rate from the COVID-19 virus is currently around 1 percent. However, as we have seen in the countries worst affected, the death rate in an overwhelmed system without access to intensive care balloons out to 3 percent or more.
As harrowing as the figures are, it is important to note that they presume we will be able to function at full capacity. There will be a significant loss to the workforce from staff members in quarantine, those who are carers to vulnerable populations and who are taking leave to minimise secondary transmission, and those who are unable to work following the potential closure of schools. With junior doctors already routinely working upwards of 60 hours a week, even with the cancellation of leave and an increase in overtime, this loss will realistically mean a decrease in already inadequate functional hospital capacity.
We only need to look overseas to discover how devastating the consequences of this shortfall could be. Patients with COVID-19 will compete with those who need intensive care following car accidents, heart attacks and haemorrhages during child birth. In Italy, this reality has required instituting the most brutal and seemingly utilitarian approach. If you are over 65, you don’t get a bed. If you have ever had cancer, regardless of whether you are in remission, you don’t get a bed. If you have had an organ transplant, regardless of age, you don’t get a bed.
The risk to personal safety for health staff should not be understated. In China, the epicentre of the pandemic so far, health workers as young as 29 have been killed by the virus. This is because of the compounding factors of being exposed to more viral particles due to repeated and prolonged exposure, a shortage of personal protective equipment and, finally, the compromised immune system that results from a lack of sleep, adequate nutrition and the stress of overwork.
When you consider the broad age range and health conditions of medical staff, and that one of the contingency plans is to reintroduce retired nurses and doctors to bolster a flagging workforce, it is no exaggeration to say that we are being asked to put our lives on the line.
It is particularly jarring to be expected to accept the pittance being offered to us by the Morrison government, both in terms of resources and leadership. There is a nationwide shortage in both virus testing kits and masks that can prevent transmission. This has resulted in health guidelines being based on the availability of resources rather than scientific evidence. Masks are such a precious commodity in my hospital that they are being stored in the same locked cupboard as the morphine.
Despite confirmation that we have reached the community transmission phase of the pandemic in Australia, only people who travelled internationally in the 14 days before getting sick or who had close contact with a confirmed case of COVID-19 qualify for testing. Meanwhile, our universities, schools and many large businesses have continued to operate, vastly increasing the likelihood of an exponential rate of community transmission.
Consistent and clear information has been coming from both the World Health Organisation and our overseas medical colleagues advising against this sluggish response. But without a national centre for disease control and with a government more focused on the economy than public safety, our underfunded and atomised public health system has been unable to respond. Doctors are receiving guidelines and recommendations from upwards of three sources simultaneously. And with significant differences in policy between states and between hospitals, the medical response has been confused and uncoordinated.
Decades of attacks on our health system have taken a toll; it has taken a pandemic to lay bare just how ill-prepared our system is. While our politicians continue to harp on about protecting businesses, secure in the knowledge that resource shortages will not affect them, the rest of us will be left to fend for ourselves. If we are to survive first the health crisis and then the economic consequences that will surely follow, we will have to organise collectively and hand the bill to the politicians who have spent decades laying the groundwork for the carnage that at this point seems inevitable.

We healthcare workers aren't heroes. We're unwilling martyrs

I'm a public hospital doctor. We're not prepared

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