Second open letter from Australian doctors to Australian federal and state governments regarding COVID-19

Listen to this podcast interview of Dr Greg Kelly which explains the thinking behind the open letter in more detail.

Second open letter from Australian doctors to Australian federal and state governments supporting strong COVID-19 response to save the lives of Australians
source
To: Australian Prime Minister Hon. Scott Morrison MP
cc: Australian Health Minister Hon. Greg Hunt MP, Australian Chief Medical Officer Prof. Brendan Murphy, State Premiers and Health Ministers

ADDENDUM 26TH MARCH 2020

Australian doctors, healthcare and emergency workers applaud the difficult decisions that have been made by governments this week alongside comprehensive economic measures. However, we are critically concerned that these measures remain inadequate to contain the transmission of COVID-19.

We support the immediate introduction of maximal measures. This means dramatic limitation of physical contact, by requiring all people to stay home, and a shutdown of all services that are not absolutely essential to provide for the necessities of life and functioning of the healthcare system.

We note that Australia is now an outlier amongst other nations that have moved to maximal shutdowns including the UK, New Zealand, Spain, France and Italy. These restrictions are inevitable, as at this stage of the pandemic they are the only way to avoid the disastrous loss of life and profound economic damage seen in Europe and the US. The demonstration of community transmission in NSW and Victoria now means that the virus has not and can not be contained. We need to urgently move to minimise the impact COVID-19 will have on the health system and our community. Despite efforts to increase the capacity of intensive care units across Australia, it is clear from international experience that a surge of critically ill COVID-19 patients can overwhelm even the best health systems and result in much higher death rates. We remain on track for this catastrophic outcome in Australia.

We explicitly endorse the Group of Eight advice of 22nd March commissioned by the Chief Medical Officer, that recommended a “go now, go hard, and go smart” strategy as the best way to “increase the likelihood of a speedier move to a national social and economic recovery phase.” While there will never be perfect information, the risk of further delays is simply too great to wait any longer.

We further explicitly endorse the call from the Australian Academy of Science that the data underpinning COVID-19 decisions in Australia be made public to enable scrutiny of key assumptions and input from frontline health care and emergency workers.

Finally, we are continuing to experience alarming shortages of personal protective equipment at the front line. This equipment is vital to protect the lives of healthcare and emergency workers and our families, as well as reduce transmission to the general community. We acknowledge government efforts in this area, but request urgent, ongoing attention to increasing supplies of personal protective equipment.

Tuesday 24th March 2020

Dear Prime Minister,

We, the undersigned Australian medical doctors, write again to express our grave concern regarding the rapidly escalating threat that Novel Coronavirus (COVID-19) poses to the lives of all Australians. We support the strong measures that Federal and State Governments have already taken to contain its threat and, additionally, support the even stronger measures that we know will be required in the days ahead.

We request:
1. The immediate shutdown of all non-essential services in Australia and strict social isolation to limit the spread of COVID-19;
2. Continued strong support for health systems to prepare to face a surge of COVID-19 patients; and
3. Further attention to the risks for Indigenous, rural and remote Australians.

Each of these points is addressed in more detail below.

When 7,000 Australian doctors wrote to you on the 17th of March we made alarming predictions regarding the rate of increase of COVID-19 infections in Australia that have since proved conservative. Worryingly, our prediction of 1,500 cases by today was realised a day early. Italy has continued to suffer very high mortality rates and other developed countries including the United Kingdom, United States, Spain and France are all now suffering from hundreds of deaths as severe COVID-19 cases overwhelm their health systems. We are very concerned that Australia, with 1,700 cases but thankfully few deaths, is currently in a similar situation to the UK's of 14 March, when they had 1,100 cases and 21 deaths. Now, as you know, the UK has had 5,500 cases and 280 deaths. Given our current rate of case increases and the fact that it takes infected patients some time to develop critical illness, we are very concerned that we are little more than one week from a comparable situation. We commend that Australia has performed more COVID-19 testing than most other countries and that faster testing kits are arriving, however, this does not change the current numbers nor the trajectory. Hence, the time to act is now.

We appreciate that Federal and State Governments are giving the situation their full attention and resources, and attempting to balance health risks against severe social and economic ones. We applaud the measures that you and State Premiers have announced in recent days in suspending non-essential gatherings, and note that further measures have been flagged. However, we are concerned that these measures are not being implemented soon enough to slow or halt transmission. Therefore, we support immediate, further action, including a national shutdown of non-essential services and enforcement of strict social distancing. Although these measures will be challenging for us all, implementation needs to happen now to give Australia the best chance to minimise the human and economic toll from this disaster.

Last week, we requested that our health systems urgently prepare for a surge of COVID-19 patients. We appreciate the leadership and resources that have been dedicated to this issue in the last week. Healthcare workers and systems are now clearly focusing on these preparations. However, we need more time and resources at the front-line. Preparations remain incomplete. These include obtaining adequate supplies of personal protective equipment (PPE), training to use it properly and environmental changes to minimise the risk to staff from COVID-19. Also, measures to increase our capacity to care for critically ill patients are lagging - many hospitals are still performing elective surgery, repurposing of areas remains incomplete and vital equipment has yet to arrive. We need more time for this preparation. Hence, reducing the rate of COVID-19 transmission remains critically important. Recent experience from Italy shows that poorly-protected healthcare workers are at substantial risk from COVID-19. It also shows that the mortality rate from COVID-19 can be as high as 4% when health systems are overwhelmed, compared to 1% when they are not.

Finally, we appreciate the attention that has so far been paid to ensuring the health of Indigenous, rural and remote Australians in this crisis. We support ongoing measures to limit transmission in these areas, build capacity and support Indigenous, rural and remote health workers and healthcare.

With these strong, immediate measures, Australian doctors stand ready with their communities to face COVID-19. We cannot do this alone. We need the help and support of the Australian people, and of our representatives in government, to give us the best chance of saving the lives of your loved ones and to protect ourselves and our families too.

Yours sincerely