In August 2020, staff at the Menarock Rosehill aged care facility in Melbourne told Kam Atkins that his 92-year-old mother had contracted Covid and was very unwell.
But they could not tell him where she was.
After phoning nearby hospitals, Atkins eventually found that his mother, Norma, had been admitted to the Epworth hospital in Richmond. It was there, at 9pm on 30 August, that she died.
In those chaotic weeks as the virus swept through aged care homes, staff and residents became sick, management struggled to create makeshift Covid wards, and overwhelmed hospitals were filled with elderly patients.
There were no vaccinations or treatments. A lack of staff meant basic care – feeding, bathing and medications – was neglected in many aged care homes, even for those without Covid.
Norma’s death was not the end of her family’s nightmare, as the unprecedented stress spread beyond the health system to other essential services.
Staff at the crematorium were working until 4am to manage all the bodies coming in, mostly people who died from or with Covid.
“They lost her body,” Atkins says. “They just told me, ‘We can’t find her,’ and it wasn’t until three weeks later I received a call to say, ‘We found her.’ I didn’t get a proper explanation but apparently she got taken to the wrong crematorium after her body was released from hospital.”
Norma, who loved painting her nails, listening to country music and watching TV with her friends, and who was adored by her grandchildren, was one of about 900 deaths from Covid-19 in Australia in 2020, even amid lockdowns and restrictions.
As the country passes 10,000 Covid deaths, the paradox is stark. There have been more than four times as many deaths in 2022 as in 2020 and 2021 combined, yet the confusion and fear of the early months of the pandemic have largely subsided, as has engagement from political leaders and the media.
The rise in deaths was not unexpected, given the reopening of borders and lifting of almost all public health restrictions. But as Australia surges past another milestone that would have seemed shocking two years ago, the lessons of the pandemic are still coming into focus.
Lives cut short
Australians have been inundated with numbers during the pandemic – daily cases, hospital and ICU admissions, deaths, vaccination rates, vaccine doses secured.
State governments are still publishing this data and the media occasionally reports it, but those numbers no longer determine whether people might be imminently locked down, out of work or separated from family and friends. What those numbers mean – 10,000 new cases, or even 10,000 deaths – is not the same.
Australians are now one of the most highly vaccinated populations against Covid-19 in the world. Healthcare systems, while still struggling, are no longer dealing with a sudden influx of residents from aged care facilities. Before vaccination and treatments, death often came more swiftly, ravaging the heart and lungs of the most vulnerable.
Now, deaths are still disproportionally affecting vulnerable and disadvantaged people. But within those groups it is those who are unvaccinated, who have not had their booster, or have significant co-morbidities such as diabetes or advanced cancer, who are most likely to die.
The severely unwell may stay in hospital longer, or may recover from Covid but die a short time later due to the existing health conditions that Covid exacerbated. It may be difficult to establish whether someone died of or with Covid, but that does not reduce the pain for the families of those whose lives were cut short.
When Atkins celebrated his mother’s 92nd birthday with her, the day before her nursing home went into lockdown and just days before she contracted Covid, he said: “We’ll be celebrating your 100th one day.”
“I understand life is moving on and people want to get back out there,” Atkins says now. “I know our losses haven’t been as much as the losses in other countries. But the carnage left behind from the deaths we have had in Australia is still horrific.
“Ten thousand people. For the families of those people, there are questions and pain that won’t go away even with the development of vaccines and treatments and all of that.”
Moving beyond the numbers
Some deaths in Australia may have been preventable if early treatments that prevent Covid from becoming severe were more accessible, and if more investment had been put into the health system, which was struggling long before Covid.
But many health workers, including epidemiologists, clinicians and nurses who worked through the pandemic, say the numbers need to be put into the context of the global experience.
The head of Royal Melbourne hospital’s department of respiratory and sleep medicine, Dr Megan Rees, who also works in the hospital’s post-Covid clinic, recalls watching with alarm the high number of deaths among health workers overseas.
“Our hospital hasn’t had any staff members die from Covid,” Rees says. “The US Thoracic Society had an international meeting last year, and they opened it with a list of all the respiratory physicians who died from Covid. It was very sad. Healthcare workers here are exhausted but we did have a lot more support than those overseas.”
The director of Doherty Epidemiology, Prof Jodie McVernon, says reaching 10,000 deaths only now highlights the success of the strategy to delay reopening borders and keep restrictions in place until high vaccination rates were reached.
In countries that reopened before vaccines were widely rolled out, deaths are not only higher and continuing to rise, but are occurring in different demographics. In the US, Covid deaths have exceeded 1 million. As Omicron spreads, and rates of both vaccinations and booster shots remain low in many states, young and previously healthy people are dying at alarming rates.
“I think if we learn anything from our 10,000, it must be the advantage of our strategy which has been essential for minimising the impact and burden of death,” McVernon says. “Those deaths are tragic, but we’re seeing very different and worrying scenarios in countries that did not have the same strategy we did of buying time.”
While other countries still struggle to raise vaccination rates or even to access vaccines, concerns for Australia include the availability of early treatments that prevent vulnerable people from becoming severely unwell, and the potential for long-term effects among those who have had Covid.
Covid is appropriately moving from centre stage to backdrop
Jodie McVernon, epidemiologist
McVernon says deaths and case data is now more complex to interrogate. Early in the pandemic, before vaccination and treatments existed, it was more straightforward to identify what Covid was doing to the body, and to determine whether someone died from or with the virus. Nearly all infections were being captured, giving researchers are clearer idea of how the virus behaved. The data was more meaningful.
“As numbers become more overwhelming, and vaccination is added in, it’s harder and harder to know what exactly causes what, and what’s linked to what, and to even capture all cases and deaths,” she says.
She says it is important to go beyond the bald figure of 10,000 to ask what is known about those who died. What were their existing medical conditions, if any? How many vaccinations had they had? What treatments were they offered? This data is crucial to understand the current burden of disease and to plan for what might happen next.
Having provided the federal government with modelling to plan its pandemic response, McVernon is now working on models to explore where population immunity in Australia is headed, given that most people now have a hybrid mix of vaccination and infection.
“What would be the impact of variants on that hybrid immunity?” she asks. “How do we plan for that? We are now trying to do some of this forward thinking. We are also trying to train people globally to have the skills to ask these questions and prepare. We are working to take evidence and turn it into knowledge to guide infectious disease policy and preparedness.”
She says the move away from daily reporting of case numbers and deaths is not necessarily a bad thing.
“Covid is appropriately moving from centre stage to backdrop.
“So, OK, it’s still there, but so are many other challenges and conditions we need to respond to. We have changed infection control and procedures throughout our health system. How has this affected the delivery of other health services? How are we able to look at what we have learned and implemented during Covid and use that to respond to those other challenges?
“I think we’re necessarily standing back and looking more broadly now. I think it’s the time for that.”
‘Don’t minimise the trauma’
Aaron Deane can no longer handle hearing about Covid numbers and deaths. He switched off all his Covid news alerts. Deane, a nurse who lives in Sydney, travelled to Victoria to help nursing homes struggling to cope with Covid outbreaks in 2020.
I went back to Sydney and people were not wearing masks at all ... it was just like the most surreal feeling
Aaron Deane, nurse
Deane felt furious when he would read news reports quoting politicians including the then prime minister and health minister saying that those who died from Covid were “palliative” or “elderly”.
“I just thought, ‘Have some respect.’
“Don’t minimise the toll, don’t minimise the trauma of deaths, and everything everyone went through at the same time as those deaths, like being locked in their homes. It was just awful.”
In Victoria Deane saw elderly people with festering bedsores and infections, their wounds having been left untreated for days. He and other staff struggled to provide the care they knew residents deserved, all while wearing heavy PPE for hours at a time, on low wages.
“I could barely afford my rent,” Deane says.
He also recalls the difficulty trying to keep the few uninfected residents away from the infected ones.
“There was one lady with dementia and she didn’t have Covid but she was so confused and distressed, all of her routine was gone and I was trying to stop her from wandering into the infectious areas of the home. And she loved music. So sometimes to distract her, I would put on music and just dance with her to stop her from wandering away.”
At the end of gruelling shifts he would go back to his hotel alone, living under lockdown.
Once he finished helping in Victoria, he worked with outreach teams at St Vincent’s hospital in Sydney to find and vaccinate homeless and other vulnerable people.
“It was so traumatising because I was in that hotel by myself in Melbourne to deal with what I was seeing at work, and I would look out the hotel window and everybody in Melbourne had masks on and were only really allowed out during the day.
“Then I went back to Sydney and people were not wearing masks at all, walking around the streets in groups, and it was just like the most surreal feeling of dissociation because it was a completely different world. Of course, Covid then spread in Sydney as well.”
Deane is struggling to move on from Covid. He has left clinical nursing and will soon start working for a pharmaceutical company.
“I just couldn’t do it any more,” he says. “My body started to collapse because I wasn’t coping mentally and emotionally. There was no resilience left or ability to bounce back, because I was still facing these demons of what I worked through every day.”
Deane is not alone. A study led by the Melbourne psychiatrist and lawyer Dr Marie Bismark, published in June, reveals the results of a survey of healthcare workers conducted between August and October 2020. Of the 7,795 workers who responded, 262 (3.4%) reported frequent thoughts of suicide or self-harm in the preceding two weeks.
The death toll from Covid in Australia may seem enviable to other countries with deaths in the millions.
But the trauma felt by families and health workers, many of whom are leaving a stressed and breaking health system, remains.
More deaths, including preventable ones from causes other than Covid, are inevitable without significant investment in preventive healthcare.
A vaccination nurse in Victoria who worked throughout the peak of the pandemic but who has since left her job due to exhaustion, says: “Ten thousand deaths, while not wishing to diminish that number, should not be the focus.
“Everybody is sick to death of reading about Covid numbers, and people are just desperate to do some normal activities like travel, and I don’t blame them. I think we have to move on from the numbers now, we really do.
“We need instead to ask hard questions about what we’re doing to invest into our health systems, invest in prevention, and especially invest into aged care so that we keep our populations healthier and are better able to stop preventable deaths, no matter the cause.”