COVID and aged care: preventable and neglected

EVERY death in aged care due to COVID-19 is a preventable death, says a leading expert in the field.

Professor Kathy Eagar, Director of the Australian Health Services Research Institute at the University of Wollongong, told InSight+ that “the current situation in aged care with COVID-19 is largely preventable”.

“People in aged care are in the last phase of their lives,” she said. “They have the right to live their best life until they die of natural causes.

“We should therefore regard every death from COVID-19 as a preventable death or a potentially preventable death.

“That’s not to say they’re not going to die of something else but that gasping for breath from COVID, without their family being there to hold their hands – I think we should regard all of those deaths as tragedies.”

At the time of writing, the latest available report from the Australian Department of Health and Aged Care said that at 8 am on 15 July 2022 there were “7947 active COVID-19 cases in 857 active outbreaks in residential aged care facilities across Australia”.

“Of these, 5212 cases are in residents and 2735 cases are in staff.”

A total of 3104 elderly Australians have died in aged care facilities since the start of the COVID pandemic. But that number is likely a significant underestimate of the total number of Australians over 80 years who have died from COVID.

Professor Eagar told InSight+ that 59% of COVID deaths were people aged over 80 years.

“There have been 6423 deaths of people aged over 80 years,” she said. “And deaths in aged care are 3104. That’s just a bit less than half of all the deaths in people aged over 80.”

The rest are senior citizens who are still living independently, or who are receiving some help from their families or some other care funded privately or by the Commonwealth. Others live in facilities that are classified as “retirement villages providing aged care services”.

“Those kinds of facilities are actually regulated under housing legislation, not aged care legislation,” said Professor Eagar.

“That’s a really important part of the story. There is a growing sector of ‘independent living’, ‘retirement living’, ‘over 50s’ etc. Facilities like that don’t report their COVID-19 numbers at all.

“There’s about a million people getting community care at home. Six to 700 000 of those are getting a program called the Commonwealth Home Support Program. There’s no data collected on them at all.”

Professor Eagar recently tweeted her eight-point plan to keep aged care COVID-19-safe:

1. workforce reform — fewer casuals, more permanent staff, including more registered nurses and allied health practitioners;
2. better pay and conditions to attract and retain skilled staff;
3. better infection control – “up until COVID-19, there were not even infection control standards for aged”;
4. mask requirements for staff and visitors – “this is a no-brainer”;
5. a mandate of a minimum of two vaccine doses in the previous 6–12 months for staff and all visitors – “we have to stop saying that ‘fully vaccinated equals two doses – it doesn’t. Why are we not saying ‘a vaccine every 6 months is what you need’? That’s what we do for flu routinely”;
6. ensuring all consenting residents have four vaccine doses plus regular boosters after that;
7. high quality air filtration in all aged care homes; and
8. stakeholder (residents, families, staff, aged care management, experts, government) engagement to develop a shared view on what a new normal for aged care looks like and an evidence-based plan for how to achieve it.

“There’s a real dilemma for government, because, on the one hand, they are getting advice about the need to control COVID-19,” said Professor Eagar.

“On the other hand, they are getting advice about social cohesion. Managing COVID-19 has become a beacon for the far right – nobody wants to see the return of the violent antimask protests that Melbourne experienced.

“When you look at their reluctance to mandate there are two rationales at play, I think. One is the social cohesion argument, the other is the argument about the economy, that we’ve all got to get back to work.

“The economy argument is a false economy, because what we’re seeing now is major workforce shortages in major industries.

“And that’s what happens when you don’t manage COVID-19.”

Dr Michael Bonning, President of the Australian Medical Association’s (AMA) New South Wales branch, told InSight+ that governments’ “laissez-faire approach” to messaging about masks and other mitigation efforts was complicating an already complicated situation.

“The AMA has been consistent in recognising the importance of mask-wearing – it’s the least restrictive [of mitigation measures] and has a high level of evidence of benefit,” he said.

“The difficulty of mandates is that they do not result in people accepting mask-wearing or complying. What we need is consistency of messaging from governments.

“We want to see every member of government, whenever they’re in public or on the television, wearing a mask, setting a new standard of normal. If they don’t, it’s an implicit undermining of mask-wearing.

“If we saw a high level of mask wearing, we would not have the caseload burden or the disruption that we have.

“There is an invisible tsunami of delayed or deferred health care, and that affects everyone, not just people with COVID-19.

“There have to be respected members of the community giving the repeated message that wearing a mask is important, and easy, and will do the world of good for those around you.

“We hope that the question, ‘who will you give it to’ weighs on peoples’ minds.”

Dr Roderick McRae, President of the AMA Victoria branch, and a candidate for the federal AMA presidency, told InSight+ that “as a community we need to provide our elderly with comfort, care and dignity”.

“But what we have is an almost impossible conundrum,” he said. “It’s a very difficult balance because you can’t generalise the care.

“The Victorian government, at least currently, won’t countenance the word ‘mandate’ even though when mask-wearing was mandated morbidity and mortality were reduced, and wearing a mandated mask got many over the line to do so and reduce illness burden and ultimately people’s survival.

“The economy has been given too much weight, certainly in Victoria at this time in the depths of winter.”

The current public health messaging from the state government had been confusing for many, he said.

“We have a new Health Minister who is on the record as having received advice from her Acting Chief Health Officer and rejecting it.

“Mask mandates work, vaccine mandates work, and anything else is wishful thinking. We’ve been pandering to too many with interests other than the health of other Victorians, including those with differing views from the mainstream, related to anything to do with COVID. They’re always going to be there regardless, and will contribute to ongoing harms, so we have to go to the max with rational public health messaging.”

Professor Eagar said the time had come for a widespread community discussion about what “the new normal” for aged care, and immunocompromised populations looked like.

“A lot of the commentary about COVID-19 has almost had a eugenic undertone,” she said.

“It raises very important issues for us as a community.

“We have said, go and get your vaccination, take off your mask and live your life normally and get back into the economy.

“There are a group of people, not just old people, but a lot of younger people, too, who are immunocompromised. And in a sense, we’ve just said, ‘well, look, you’re on your own, if you don’t feel safe, you stay inside’.

“We have an opportunity, led by clinicians, rather than politicians, for community dialogue about what the new normal is going to look like.”

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