Talking Point: Why is nobody taking responsibility for North-West tragedy?

A catalogue of inept management and failures is clear for all to see, says Martyn Goddard

HEALTH CRISIS: North West Regional Hospital in Burnie, pictured when it was closed. Picture: AAP

Nobody, according to the Health Department’s investigation of itself, needs to take responsibility for the tragic fiasco in the North-West. Nobody’s to blame. Hey, things happen!

Things sure did. The entire region was put into lockdown.

Some 5000 people who’d worked at the North West Regional Hospital and their families were ordered to self-isolate with three hours notice. The North-West, with 0.4 per cent of Australia’s population, has endured 14 per cent of its deaths. Twelve people have died there and only one in the rest of the state. No deaths are mentioned anywhere in the department’s 28-page report.

By April 21, 114 people had been infected. Of those, 73 were staff, 22 were patients and 19 were other contacts.

To grasp what occurred, we need to understand what happens in the few days after someone is infected. After a virus first establishes itself in a person, it reproduces quickly and exponentially until the amount of virus, called the viral load, increases to the point at which it is shed in coughs and sneezes. At that point, typically two or three days after initial infection, the person is infectious but has not yet developed symptoms.

Those don’t appear, on average, for another two or three days. The main index case, from the Ruby Princess cruise ship, was admitted to the NWRH on March 19.

Seven days later, symptoms showed up in another patient, one who did not have the disease before entering hospital. So that person is likely to have been infected only a couple of days after the first Ruby Princess case was admitted. A second patient from the ship was admitted on March 26, but by then the outbreak was already on its way. Other cases swiftly followed. By the time an outbreak was finally notified to the department’s public health specialists — 15 days after the index case was admitted and almost a fortnight after new infections began — 13 people had developed symptoms.

Ten of those were staff, six were patients and one was an outside contact. A further 30 people are likely to have also been infected but had not yet developed symptoms.

This outbreak need not have happened. What made it almost inevitable was not the neglect of staff or even, mainly, the admittedly scandalous lack of protective gear. It was the lack of testing. Those first days in mid-March, when staff and patients were unknowingly being infected, were crucial. If staff in contact with known cases had been tested for the virus before they developed symptoms, they could have been isolated and not have passed the infection on. But they did not qualify for testing — not then, and not even when they developed mild respiratory symptoms.

Although testing is now available to people with mild symptoms, there is no special category for nurses, doctors and other hospital workers who bear a far greater risk.

Until this policy is changed, the danger remains. There is no compelling reason such an outbreak could not still occur in any of the state’s other hospitals.

Unions report protective equipment was rationed in the outbreak’s crucial early phase and, in some cases, refused to staff. Inadequate training meant protective gear was not always used safely. Many thousands of gowns and masks were finally sent from the Royal Hobart Hospital, but arrived only three days before the NWRH and Burnie’s private hospital were closed.

The Health Department report says nurses working in both the NWRH and the private hospital were the probable source of outbreak in the second institution. This is likely to be a direct result of the casualisation of the nursing workforce, which has meant nurses needing to work in more than one hospital to get enough work to live on.

A substantial minority of staff continued to work while having mild respiratory symptoms, which they did not attribute to COVID-19.

They had not been ordered to stay home and were aware there was often nobody else to do their job. The obsolescent computer systems in Tasmania’s public hospitals were blamed for making the outbreak worse.

“The continued reliance on paper systems, including clinical records, rosters, and other records of staff and patient movement, hampered the timely management of potential close contacts,” the report said. Routine and necessary shift handover meetings were in places where personal distancing was impossible. This, the report said, contributed to the outbreak. New infectious diseases have emerged in recent decades: Ebola, SARS, MERS, H1N1 flu, AIDS, Legionnaires and many more.

But there was no plan for what to do if one landed here.

This is a catalogue of inept management, poor policy, inadequate training, failure to give crucial protection to staff and patients, insufficient resourcing, and a lack of basic preparedness.

But nobody has to take responsibility.

Hobart’s Martyn Goddard is a public policy analyst specialising in health.