We live in strange times. So the latest issue of my newsletter [sign up here!] is dedicated to COVID-19 and related mortality. It may seem morbid, but before you shut your device, think of this. It is extremely reassuring to look at this international crisis through the lens of mortality.
When we look at these trends, we can ask the right questions – and find much reassurance. Deaths from COVID-19 are tragic but can remain low – if we get the settings right.
At the time of writing, Australian hospitals have smatterings of patients suspected of being infected with COVID-19. Using trajectories based on disease incidence here and patterns in Europe and China, epidemiologists predict pressure on Australian Accident and Emergency departments will be felt from early April. Deaths will follow as respiratory symptoms develop.
In response to this, Australia is increasing the number of ventilators from 2,000 to 4,000.
The economic impacts at this point are incalculable and these will have physical and mental health consequences.
How the crisis plays out from now will depend, largely at this point, on Australians embracing protective measures.
Deaths in younger adults
We mentioned in our explainer of 5 March that flu in Australia typically causes 3,500 deaths per year, much higher than Australia’s deaths so far from COVID-19. See https://good-grief.com.au/coronavirus-mortality-explainer/. This is still true.
But there is an important point that needs to be added. It’s been estimated that every person with COVID-19 will go on to infect another two-and-a-half people. We are starting to see what that looks like in those countries that are a little ahead of us in this, such as Italy.
For World Health Organisation discussion on the early spread of the disease, go to:
“That means the new coronavirus is about twice as contagious as influenza,” said Infectious Diseases specialist at Australian National University, Dr Sanjaya Senanyake.
This means the infections could rise exponentially, the reason health officials are working so hard on social isolation and self-distancing strategies.
For more of Dr Senanyake’ discussion, go to: https://www.abc.net.au/news/health/2020-03-20/how-coronavirus-covid-19-compares-to-flu/12073696?section=health
The latest fact sheets released by the Federal Department of Health to cover the care of the elderly, are now being released regularly:
- Resources for Senior Australians, developed in conjunction with the Council of the Ageing (COTA)
- Guidelines for workers in residential aged care
- Information for families and residents regarding visitation
In Australia today, the largest concentration of deaths have been at the Dorothy Henderson Lodge aged care facility in Macquarie Park.
This local experience combined with other local factors and experience from overseas has prompted strategies to protect the elderly. Many nursing homes are moving to complete lock-down. This is not in response to positive cases, but in response to shifts in patterns of contagion.
Some aged care facilities, especially in more remote and low results areas, are maintaining the strategy of restriction to visitors.
In a typical nursing home last week, visitors:
– were restricted to a limited time frame
– the frequency of visits by each individual was limited to only one a day and only on a number of days a week.
– were restricted to immediate family only. All social and religious observances are cancelled.
– were questioned about their travel history
– temperature was monitored.
– Hand cleaning, either with soap and water or an alcohol-based hand rub were to be followed.
Adaptations of this model may still occur.
It should be noted that some aged care facilities are saying that in the event that a consumer is classified as palliative or at end stage, variations to these restrictions will be made, on a case by case basis.
We will investigate these strategies further.
We note that the challenge of maintaining the best standards of psycho-social care for the very elderly and the dying needs to be maintained, despite the emergence of COVID-19.
How do we protect the elderly from death but give them the warm social life they so richly deserve in this more socially isolated environment? And how do we ensure a compassionate supportive palliative care experience for those who are dying. Our plan is to explore this further.
New York’s story of a 92-year-old whose family were unable to visit because of the risk of COVID-19 challenges us not to lose our humanity. For more on this story go to: https://www.nytimes.com/2020/03/19/nyregion/coronavirus-nursing-home.html?action=click&module=RelatedLinks&pgtype=Article
Australia’s ABC 2 TV news reported on Friday 20 March that Italy, ahead of Australia in the COVID-19 experience, has reported distressing stories of elderly people with COVID-19, dying without their loved ones around them to support them. This is tragic. Let’s hope we find a better way to manage this problem when the pandemic hits here.
This comes at a time when widespread social media reports suggesting Italy had stopped treating its elderly have been described as false. For more on that fact check, see:
This photo of my elderly father and young grandson was taken on our last visit, last week. Neither of us knew this would be our last visit for some time. It was a very sad moment for me, as I know that Dad’s interactions with his family are crucial and that a shut-down to his aged care facility could be imminent.
To support the need to do our bit to stem the increase in COVID-19 cases, we will observe the lock-down respectfully.
I wrote a personal reflection on Dad’s nursing home lock-down here: https://good-grief.com.au/this-is-a-cry-from-the-heart/