Finance Michael Pascoe: What happens next isn’t ‘freedom’ – it’s triage

Michael Pascoe: What happens next isn’t ‘freedom’ – it’s triage

Pascoe and Berejiklian
Reports from frontline healthcare workers have crushed the government's spin, writes Michael Pascoe. Photo: AAP/TND
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This is what happens next given the NSW “living with COVID” inevitability: Triage – doctors and nurses decide who receives maximum care and who does not because there are not enough maximum care givers to go round.

To a degree, triage is already happening.

And the odds are that it’s only a matter of time before what’s happening in NSW will be repeated in other states, in Victoria sooner rather than later, if we stick with the idea of opening up upon reaching national cabinet’s target of 56 and 64 per cent vaccination rates.

For all the NSW government’s attempts in the 11am media conference to sell a positive vaccination story and downplay the soaring COVID cases, the numbers and the reports from the front line have crushed the spin.

The Glad Gladys Show isn’t working. The government’s determination to be less than straight with the public for two months has white anted it.

It is foolish to expect trust after pretending the situation was under control, that numbers would come down, then could come down, and now the full backflip with smiley face to suggest we are achieving what we’ve always wanted: Living with COVID, an example to the rest of Australia.

New South Wales Gladys berejiklian august 25
The Glad Gladys Show isn’t working in New South Wales. Photo: AAP

Who do you believe when the politicians and officials tell you the health system is coping fine and will cope – Premier Gladys Berejiklian, or senior ICU nurse Michelle Rosentreter?

“We are exhausted,” Ms Rosentreter told the Sydney Morning Herald.

“Last night was brutal. We literally hit capacity … Just holding on. None of us have ever faced anything like it. Nothing in our studies ever prepared us for this, and not even the most experienced of us have ever seen anything like it.”

But when the Premier or NSW Health official was asked a straight question on Sunday about ICU or ambulance or regional health capacity, the “talking points” training kicked in with immediate deflection to vaccination numbers.

It’s all very well to try to be positive in a crisis, but not when the political spinning is so transparent as to undermine credibility and little admissions along the way point to our reality: Case numbers and hospitalisations and ICU admissions will keep rising for two months, the oft-promised freedoms “will depend on case load”.

So I checked the triage outlook with an ICU doctor who is required to remain anonymous.

I started by asking how triage would work if we’re already on the edge of ICU capacity and numbers are going to rise sharply to an October peak – would it start by excluding anyone over 90, then 80, then 70, then …?

The answer was that we’re already seeing triage – that’s what cancelling scheduled surgery and breast screening is about. We already have health inequality – some people in some areas are better looked after than others. The government is prioritising health needs, rationing resources.

In terms of being on the edge, we’re already there.

Westmead is huge, the largest hospital facility in Australia, but it had to hit “code yellow” last week. Westmead has seven wards of COVID patients and, along with Blacktown Hospital, it was no longer able to function as usual.

The doctor said he did not believe Health Minister Brad Hazzard saying ICU capacity had quadrupled since last year to cope with COVID, that the minister was “not concerned about capacity”.

The doctor said that simply had not happened. The lack of trained staff meant it could not happen.

And then there was Deputy Premier John Barilaro’s claim that regional health care had appropriate staffing levels.

Well, he would say that. He has to say that – otherwise it would be an admission that the National Party had failed its regional base after a decade in power.

The ABC reported staff from Sydney hospitals would be deployed to some regional hospitals this week to help battle the COVID outbreak there. The Rural Doctors Association of Australia said that would not solve the critical shortage.

Bringing the anonymous doctor back to when NSW would get to the stage of deciding who received full ICU care and who did not, he said he did not know but it looked mathematically inevitable.

“Everyone is hoping it doesn’t come to that, but everyone is worried that it will.”

I was pointed to the example of Lombardy last year when hospitals were swamped and the cut-off age for ICU became 70 – that’s not “old” in Australia.

Doctors in Italy’s coronavirus wards were forced to choose who needed treatment. Photo: Getty

Lombardy is an advanced, wealthy area of Italy. Around the world, administrations thought they would be different, that they would be smarter than the Italians, that it couldn’t happen to them – and one by one, it did.

Now there is greater knowledge of the virus and better treatment for those with COVID, but there’s also the worse Delta variant to deal with.

“Compared to other parts of the world, we’re doing incredibly well,” Ms Berejiklian assured us on Sunday. That’s what other parts of the world sometimes thought, too.

To use a Simpsons quote, as NSW is no longer a good example for other states, it will have to serve as a dire warning.

Vaccination is a race, a particularly dire race in regions made nonchalant by lacking cases.

That the Morrison government botched vaccine acquisition and distribution is a given, but everyone must urgently make the best of the poor situation before ending up like Sydney’s “areas of concern”.

The Delta virus will touch you. Smart states will be rushing to have better vaccination rates than the current 56 and 64 per cent goals before it gets away from them.

Or we’ll be forcing burnt-out ICU staff to make very hard decisions.

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