Finance Michael Pascoe: What really happens after Code Yellow

Michael Pascoe: What really happens after Code Yellow

vaccination Gladys Berejiklian, Michael Pascoe
The much-hyped promise of more freedom in NSW has become only an aspirational target, warns Michael Pascoe. Image: TND
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Another day and the prospect of Australia “opening up” upon hitting the government’s magic vaccination numbers recedes a little further.

The much-promoted national cabinet “plan” now seems to exist only in Scott Morrison’s rhetoric as state and territory leaders back away from it.

New South Wales Premier Gladys Berejiklian continues to promote the “70 and 80 per cent” numbers (actually 56 and 64 per cent), but they’ve become aspirational targets rather than promises of “freedom”.

In the same way Ms Berejiklian has sidled up to each shift in her government’s COVID policy, the signs are there that the two laudable milestones will be reached and passed without making a great deal of difference.

Despite all the talk about 70 and 80: “Please know that NSW is working towards a roadmap as to what that 70 per cent looks like,” Ms Berejiklian said on Monday, after announcing another record number of infections and more COVID patients in ICU.

(“Please know” has replaced “an abundance of caution” on the COVID bingo card, complete with Remix).

Mr Morrison announced on August 6 national cabinet had “fully agreed to the four-step National Plan” with its pledge of “moving to Phase B once 70 per cent of the Australian population 16 years of age and older is fulling vaccinated”.

So more than three weeks later, the state in COVID crisis is “working towards a roadmap”.

The only certain thing from Monday’s media conference is that Phase B freedoms won’t be for the 44 per cent of the population who won’t be fully vaccinated at that time.

“My strongest message is, if you are not vaccinated, do not expect to have freedoms,” Ms Berejiklian said. “Please know, those freedoms will be extended to those that are vaccinated.”

And there is good reason for that.

Opening up with so many unvaccinated people would see COVID take off. Few children might require hospitalisation, but they would help rapidly spread the virus to the 30 per cent of adults who are not vaccinated, resulting in the inevitable hospitalisation and ICU outcomes.

Scott Morrison and Josh Frydenberg may find reopening anything but automatic upon reaching vaccination targets. Photo: AAP

Which is why NSW will end up joining the other states in marking the magic number with not much, whatever threats Prime Minister Morrison and Treasurer Josh Frydenberg might make.

The present strains on the hospital system mean “opening up” can’t happen until hospitalisation numbers are sharply and sustainably falling.

With infections expected to increase over the next two months, that’s not happening soon.

NSW Health updated its intensive care pandemic response plan last month. It spells out what is meant to happen as the pandemic worsens, how triage comes into play, how ICUs are meant to “surge”.

It states that NSW had 592 commissioned adult ICU beds last month spread across 39 public and 22 private hospitals.

When Australia’s biggest hospital complex, Westmead, went Code Yellow last week, it meant its ICU was “approaching maximal operational capacity”. That’s not a matter of beds, but of beds with adequate staffing. It was as full as a hospital ever wants to be.

The next stage, Code Red, is “overall demand for critical care exceeding ICU operational capacity”.

That’s when ICU patients are serviced out of ICU – in recovery wards, in operating theatres, in emergency rooms. At that stage, the experienced ICU nurses and doctors are supplemented by the inexperienced.

The final stage, Code Black, is when ICU “significantly exceeds organisation-wide capacity”. You never want to get there.

Triage, to the extent of cancelling surgery and breast screening, is already happening.

The NSW Health document says triage will be enacted at the same level across the state “to promote equity of access of patients to intensive care”.

“It is important that the triage principles to maximise access to ICU are used for all potential admissions, not just infection-related admissions,” the document states.

“The process of triaging intensive care resources includes both the process of allocating resources and the process of withdrawal of resources, for all patients that may require intensive care during a respiratory pandemic.

“Complex ethical and clinical treatment issues can occur, it may be necessary at some point to begin prioritising limited critical care resources to those with a need for treatment and those who are most likely to survive. Such prioritisation decisions would need to take account all patients’ probability of survival, as well as the availability of limited critical care resources.”

That is the simple reality of managing available resources with surging demand. It means the worst and the least worst patients who would normally be in ICU would not be.

The stories from the front line now are bad enough.

No government would want them getting worse, but that is what the NSW government is foreshadowing as caseloads rise.

Beyond worsening, beyond more Code Yellows to be managed, no vaguely rational government would want to risk Code Red.

Which is why Scott Morrison can say 70 and 80 as much as he likes – the numbers mean little compared with hospitalisations.

But hospitalisations are state government matters once the federal government can claim it has achieved its vaccination goals.

And if NSW has problems at present, spare a thought for Western Australia. It has a hospital crisis without any COVID at all.

No, we’re not opening up at magic numbers.