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Racing Against the Virus From Inside Australia’s Healthcare System Racing Against the Virus From Inside Australia’s Healthcare System
(about 20 hours later)
The Australia Letter is a weekly newsletter from our Australia bureau. Sign up to get it by email. For this week’s issue, the newsletter is written by one of our readers, Dr. Amaali Lokuge, an emergency physician at The Royal Melbourne Hospital.The Australia Letter is a weekly newsletter from our Australia bureau. Sign up to get it by email. For this week’s issue, the newsletter is written by one of our readers, Dr. Amaali Lokuge, an emergency physician at The Royal Melbourne Hospital.
When my director cut short his camping holiday on Australia Day, to come back to the emergency department at the Melbourne hospital where I work as an emergency physician, I thought he was unnecessarily sacrificing his life for the sake of his work. Covid-19 was still mainly confined to China. Italy was not yet in crisis and New York wasn’t even on our radar. But in hindsight, his return was prudent.When my director cut short his camping holiday on Australia Day, to come back to the emergency department at the Melbourne hospital where I work as an emergency physician, I thought he was unnecessarily sacrificing his life for the sake of his work. Covid-19 was still mainly confined to China. Italy was not yet in crisis and New York wasn’t even on our radar. But in hindsight, his return was prudent.
The fever clinic attendances surged. We were seeing 30 to 100 extra patients per day in an already stretched system. A coordinated emergency department and hospital strategy was required, and unfolded as if by magic.The fever clinic attendances surged. We were seeing 30 to 100 extra patients per day in an already stretched system. A coordinated emergency department and hospital strategy was required, and unfolded as if by magic.
It wasn’t magic though; If you looked closely, you could see the signs of people working way beyond their scheduled hours. Doctors and nurses and support staff were at the hospital hours before the day shift began and we would see them late into the evening shift. The tired lines around doctors’ eyes etched a little deeper each day as they rushed past at a speed just below running.It wasn’t magic though; If you looked closely, you could see the signs of people working way beyond their scheduled hours. Doctors and nurses and support staff were at the hospital hours before the day shift began and we would see them late into the evening shift. The tired lines around doctors’ eyes etched a little deeper each day as they rushed past at a speed just below running.
It wasn’t until March that the reality of what we were facing started to filter through. A hundred patients died overnight in Italy and we were speechless with grief. Was this what was coming for us?It wasn’t until March that the reality of what we were facing started to filter through. A hundred patients died overnight in Italy and we were speechless with grief. Was this what was coming for us?
We would not be able to cope with a similar onslaught. There are around 30 ICU beds in our hospital — how quickly would these be full? This is not something we have had to face before.We would not be able to cope with a similar onslaught. There are around 30 ICU beds in our hospital — how quickly would these be full? This is not something we have had to face before.
People often ask me how I cope with the stress of emergency room medicine. But the reality is, we have so many resources where I work that when patients come in sick and dying we can usually resuscitate them. People rarely die because we don’t have the facilities to help them.People often ask me how I cope with the stress of emergency room medicine. But the reality is, we have so many resources where I work that when patients come in sick and dying we can usually resuscitate them. People rarely die because we don’t have the facilities to help them.
But this disease was different. It seemed to take and take and take, until there was no more to give. We were not ready to face patients dying because we didn’t have a ventilator to help them breathe, or because we didn’t have the nursing staff to care for them.But this disease was different. It seemed to take and take and take, until there was no more to give. We were not ready to face patients dying because we didn’t have a ventilator to help them breathe, or because we didn’t have the nursing staff to care for them.
In those early weeks of March, we worked at what felt like superhuman speeds to get ready. Always at the back of our minds, the mantra we kept repeating: it’s coming, it’s coming, and we are not prepared.In those early weeks of March, we worked at what felt like superhuman speeds to get ready. Always at the back of our minds, the mantra we kept repeating: it’s coming, it’s coming, and we are not prepared.
Somewhere deeper down lingered other anxieties: Would we get sick like the health workers overseas? Would our loved ones be safe? How would we cope with so much death?Somewhere deeper down lingered other anxieties: Would we get sick like the health workers overseas? Would our loved ones be safe? How would we cope with so much death?
Everyone was worried about someone: the elderly parent; the child with an immune deficiency, which may be deadly; the sister who was currently immunosuppressed from chemotherapy.Everyone was worried about someone: the elderly parent; the child with an immune deficiency, which may be deadly; the sister who was currently immunosuppressed from chemotherapy.
To add to our anxieties, the emergency department became eerily quiet. The patients would trickle in at single digits per hour. Was this the quiet before the storm?To add to our anxieties, the emergency department became eerily quiet. The patients would trickle in at single digits per hour. Was this the quiet before the storm?
Every morning we would read the international news with dread and horror. People were dying because systems were overwhelmed. Health care workers were preparing their wills before it was too late. Families with emergency physician parents were sending their children away to safety. We devoured the information, always wondering when it was coming for us.Every morning we would read the international news with dread and horror. People were dying because systems were overwhelmed. Health care workers were preparing their wills before it was too late. Families with emergency physician parents were sending their children away to safety. We devoured the information, always wondering when it was coming for us.
Then something miraculous happened. Restrictions applied with lightning speed were curtailing the spread. People stayed home despite the chafing irritations of isolation. Everyone was doing what was necessary to look after the weak and the elderly. And in a way they were to looking after us, the health care workers, too.Then something miraculous happened. Restrictions applied with lightning speed were curtailing the spread. People stayed home despite the chafing irritations of isolation. Everyone was doing what was necessary to look after the weak and the elderly. And in a way they were to looking after us, the health care workers, too.
The surge did not occur when it was supposed to. We worked so hard, filled the hospital to capacity with extra staff and equipment, wrote guidelines on treatment and made plans for the influx of patients, all within days. But the patients failed to arrive. The wave never swelled to a tsunami.The surge did not occur when it was supposed to. We worked so hard, filled the hospital to capacity with extra staff and equipment, wrote guidelines on treatment and made plans for the influx of patients, all within days. But the patients failed to arrive. The wave never swelled to a tsunami.
We are now caught in a limbo of waiting. People aren’t dying in the numbers we predicted when observing the disease in other countries. The tragedy has, so far, failed to unfold.We are now caught in a limbo of waiting. People aren’t dying in the numbers we predicted when observing the disease in other countries. The tragedy has, so far, failed to unfold.
Economists have started to write about the cost of this strategy in terms of money spent per human life years saved. People question the wisdom of Australia’s harsh social distancing restrictions, which will have repercussions for years to come.Economists have started to write about the cost of this strategy in terms of money spent per human life years saved. People question the wisdom of Australia’s harsh social distancing restrictions, which will have repercussions for years to come.
But as I think of what we might have faced — the sheer sadness of so many lives lost in so short a time, the trauma of being helpless in the face of a disease we don’t know how to control — I am so grateful that my country may be spared what others have had to suffer.But as I think of what we might have faced — the sheer sadness of so many lives lost in so short a time, the trauma of being helpless in the face of a disease we don’t know how to control — I am so grateful that my country may be spared what others have had to suffer.
Updated June 5, 2020Updated June 5, 2020
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
The tyranny of distance and the shocking bushfires that kept the tourists away delayed the inevitable spread of virus in Australia, enabling a brief glimpse into our possible futures. This has meant that we were able to choose the path of humanity — and not economic rationalism — to deal with this disease.The tyranny of distance and the shocking bushfires that kept the tourists away delayed the inevitable spread of virus in Australia, enabling a brief glimpse into our possible futures. This has meant that we were able to choose the path of humanity — and not economic rationalism — to deal with this disease.
We will have to pay for our response for years to come. But my hope is that we will still be whole, and free from the scars of failure and grief.We will have to pay for our response for years to come. But my hope is that we will still be whole, and free from the scars of failure and grief.
Do you have a story to tell about the way your workplace has dealt with the current situation? Let us know at nytaustralia@nytimes.com.Do you have a story to tell about the way your workplace has dealt with the current situation? Let us know at nytaustralia@nytimes.com.
Here are this week’s stories.Here are this week’s stories.
People Are Talking About ‘Travel Bubbles.’ But Could They Work? Australia and New Zealand floated the idea of a regional alliance that would let those inside travel but keep the coronavirus out. But in other parts of the world, establishing one would be tricky.People Are Talking About ‘Travel Bubbles.’ But Could They Work? Australia and New Zealand floated the idea of a regional alliance that would let those inside travel but keep the coronavirus out. But in other parts of the world, establishing one would be tricky.
The Best Movies and TV Shows New to Netflix, Amazon and Stan in Australia in May Our picks for May, including ‘Hollywood,’ ‘Upload,’ ‘Billions’ and ‘Hannah Gadsby: Douglas’The Best Movies and TV Shows New to Netflix, Amazon and Stan in Australia in May Our picks for May, including ‘Hollywood,’ ‘Upload,’ ‘Billions’ and ‘Hannah Gadsby: Douglas’
China Mounts Aggressive Defense to Calls for Coronavirus Compensation Beijing has adopted a “no-holds barred” diplomatic push to quash criticism of its handling of the outbreak and to fend off efforts, including by President Trump, to hold it financially accountable.China Mounts Aggressive Defense to Calls for Coronavirus Compensation Beijing has adopted a “no-holds barred” diplomatic push to quash criticism of its handling of the outbreak and to fend off efforts, including by President Trump, to hold it financially accountable.
A Scramble for Virus Apps That Do No Harm Dozens of tracking apps for smartphones are being used or developed to help contain the coronavirus pandemic. But there are worries about privacy and hastily written software.A Scramble for Virus Apps That Do No Harm Dozens of tracking apps for smartphones are being used or developed to help contain the coronavirus pandemic. But there are worries about privacy and hastily written software.
Samin Nosrat Wants Us to Make Lasagna Together The “Salt Fat Acid Heat” author has long gathered people around a table. But what will happen when the festivities move to that sometimes-terrible place, the internet?Samin Nosrat Wants Us to Make Lasagna Together The “Salt Fat Acid Heat” author has long gathered people around a table. But what will happen when the festivities move to that sometimes-terrible place, the internet?
How Long Will a Vaccine Really Take? Experts say at least 18 months. Here’s how to shorten the timeline.How Long Will a Vaccine Really Take? Experts say at least 18 months. Here’s how to shorten the timeline.
How to Stay Optimistic When Everything Seems Wrong Optimism isn’t about ignoring negative feelings. It’s about being hopeful about the future, even when the present seems wholly negative.How to Stay Optimistic When Everything Seems Wrong Optimism isn’t about ignoring negative feelings. It’s about being hopeful about the future, even when the present seems wholly negative.
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For more Australia coverage and discussion, start your day with your local Morning Briefing and join us in our Facebook group.For more Australia coverage and discussion, start your day with your local Morning Briefing and join us in our Facebook group.