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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:
- workforce reform — fewer casuals, more permanent staff, including more registered nurses and allied health practitioners;
- better pay and conditions to attract and retain skilled staff;
- better infection control – “up until COVID-19, there were not even infection control standards for aged”;
- mask requirements for staff and visitors – “this is a no-brainer”;
- 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”;
- ensuring all consenting residents have four vaccine doses plus regular boosters after that;
- high quality air filtration in all aged care homes; and
- 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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Wholeheartedly agree with Jane Andrews and Ian Hargreaves. As a GP caring for nursing home residents, I am constantly pulling down my mask so that my hearing impaired patients with dementia can see and hear me. (It has certainly been eye opening in terms of realising how many rely to some extent on lip reading). The very elderly residents just want to see their families and be allowed to go out with them. Having carers unrecognisable behind masks, face shields and gowns is demoralising for residents and carers alike.
My wife and I were having Mother’s Day lunch with my 86 year old mum when I developed myalgia. The initial thought was a hard restaurant chair, but the rapidly increasing deltoid ache at the 10 day old booster site was pathognomonic. We hurriedly left. Quad vaxxed, mum didn’t catch it, despite sitting with 2 of us with Covid for a couple of hours.
Of course, she lives independently, as presumably Prof Eager would not permit her to break out of her RACF, and dine (shock, horror, unmasked!) with as many as 2 people! In a public restaurant in a Westfield complex, swarming with filthy humans!
Solitary confinement is a punishment we reserve for the worst criminals like Martin Bryant. And, in most of the country over the last 3 years, old people. “They have the right to live their best life until they die of natural causes”, but for most people that best life includes hugging their grandkids (and cute but germy little snotty great-grandkids), even including the 2 granddaughters who are schoolteachers or the anaesthetist grandson, who are high risk spreaders. I remember when RACFs would take a whole minibus of unmasked people to the beach, where they could enjoy the views and have fish and chips (deep fried in trans fats, no-one cared). Wheelchairs were pushed along the esplanade in the sun and sea air. Back in those days the story of ‘The Man in the Iron Mask’, locked in solitary, face permanently hidden from view, was a horror story.
Unless the good Prof is impugning President Xie, Covid would seem to be a very natural cause of death. Whether artificial bioweapon or natural 100% vegan organic, Omicron is the most infectious disease ever known to science. It has made it to Antarctica and Pitcairn Island. Attempts to avoid it are futile, while there may be an argument for slowing spread to keep hospitals functioning, there is also an argument for getting it over with, as future Ypsilon or Omega may be more lethal. Slowing the spread also prolongs the mutation time.
As Dr Hamlet might muse to Nurse Horatio, over Mr Yorick’s Covid bed: “Go and tell my ex-girlfriend. Even if she wears N95s 2.5cm thick, she’ll still eventually catch it.”
Sorry to disappoint you Max. I’m not sure what my agreement with VAD has to do with my views as outlined in my previous post!
Tilting at windmills?
As an octogenerian, I agree with Prof Andrews.
Would love to see the Venn diagram showing the overlap of those who are fervent advocates of Voluntary Assisted Dying legislation with those who favour the sorts of mandatory measures outlined in this article.
I suspect a high level of congruence based on the usual shopping list of political leanings.
And a high level of cognitive dissonance in those very advocates if the two issues were juxtaposed for them.
Thank you Jane for your clear headed assessment .The idiocy of lock- ups/the head in the sand view that no one can die in NH’s/ now every NH transports dying pts to hospital to offload responsibility for a death!
Thank you RC.
I am still( just) servicing 125 NH pts after 30 yrs activity.
I see no reference in this article to enhancing the availability & provision of good end-of-life/palliative care in aged care! Supporting GPs and nursing staff to provide the basics is vital, regardless of what the cause of death might be.
Dr McRae gets closest when he says “as a community we need to provide our elderly with comfort, care and dignity”.
I agree that there may be things worse than death in a pandemic, such as the awful prospect of dying alone and unsupported.
Weighing up competing ethical standpoints is difficult but we surely need to do better at the bedside, rather than from the academic or bureaucratic office!
How many triple vaccinated in nursing homes died from (rather than with) Covid?
How many had their dementia and life expectancy reduced by being isolated from family and friends for months at a time?
How many died in a lonely room because family were not allowed to be with them?
Despite being up to date with vaccination, I was barred from seeing my vaccinated 94 yo mother for 6 months during which time her mental and physical state deteriorated because of “government regulations”. She was also denied simple elective surgery that would have made her life more comfortable.
Any rules need to be carefully considered to make sure we are not just prolonging the dying process and making patients and families lives miserable. We need protection from naive bureaucrats. We can’t live a full life in a “safe” world. Life is inherently dangerous and none of us are going to get out of ot alive
I think the author should fact check some statements and be less emotive. We all have to die of something – if an elderly resident of aged care we’re to see family/ friends and happen to get infected that is not necessarily a bad outcome. By nature of being in a RACF people are likely to be nearing the end of life.I am not saying we should kill then – but Covid may not be the worst thing that could happen. And mostly those who are vaccinated do not die breathless. Also why mandidate a vaccine every 6 months – where is the evidence.
So what does one consider “natural causes”? From the perspective of an Emergency Physician, the short, sharp death of a severe infectious disease looks preferable to the slow, inexorable living death of progressive heart failure or lung disease to the point of not being able to blow out a birthday candle.
As a GP I have provided care to RACFs for 35 years.
I totally agree with Jane Andrews.
I agree wholeheartedly with Professor Jane Andrews
There are many competing interests in society. Infection control is one of many. Personally I would have thought a mature debate through which you are trying to alter behaviour to achieve better infection control would best be conducted without calling people that have a legitimately different view far-right eugenicists. According to Professor Eagar, apparently not.
The expert forgets to share the data on the usual survival time of people after admission to RACF… it is not long on average, people don’t go to RACF because they are fit and healthy with many years ahead of them – they are 10x more likely to die in any given year than age and gender matched comparators (data published BEFORE the pandemic) – so this non-sense, emotive phrase saying they should avoid covid at all costs so they can “die of natural causes” is just silly and unhelpful to making logical data-driven decisions. AND we should stop treating covid like the plague – the case fatality rate is now VERY low even in the elderly and vaccination (reguarly) is a no-brainer….. many eldeleryly would rather see their friends and family even if it gave a greater risk of death – living longer in isolation is not their preference….. I ask them and it is not the answer i get… they are entitled to make more choices on their own.