Victorians should brace themselves for a much higher death toll — which could be twice as high as the current numbers — one expert warns as the state deals with fallout from its outbreak.
While Victoria appears to have turned a corner on its daily case numbers, the state announced a record 19 deaths on Monday and the toll is set to rise.
University of NSW Professor Mary-Louise McLaws, who is a member of a WHO advisory panel on COVID-19, told news.com.au deaths could increase substantially.
The coronavirus is particularly lethal among older patients and has had already had devastating impacts in aged care homes in other states.
Prof McLaws pointed to the experience at Newmarch House in NSW, where about 50 per cent of the 37 residents who got infected, died.
“It’s very tough,” Prof McLaws said. “But that was in a small facility so you can’t necessarily assume this is going to happen again.”
However, figures from overseas showed the death rate in aged care facilities could be anywhere from 25 to 62 per cent, she said.
So far about 12 per cent of Victorian aged care residents infected with the coronavirus had died.
“Sadly it could go higher,” Prof McLaws said. “It could be twice as high.”
RELATED: Follow our live coronavirus updates
Victoria’s outbreak has seen 1061 residents in at least 122 aged care homes infected with the coronavirus, and 125 of these have died, she said. These numbers don’t include staff or other cases linked to aged care outbreaks.
“It’s just the sheer numbers … the case load is high,” Prof McLaws said.
She said at this point it was difficult to predict with any certainty how bad it would get without knowing what level of illness residents were experiencing and whether it was mild, moderate or severe.
Deaths in the state have already increased by more than 100 in less than 10 days. Unfortunately as cases go down, deaths will still increase because patients take up to 30 days to recover or die.
Australia’s deputy chief medical officer Professor Michael Kidd warned more people would die because of the “devastating effect” on aged-care facilities.
“This is the tragedy of COVID-19 and the tragedy of the high numbers we have seen in Australia over the past few weeks,” Prof Kidd said.
“We will also continue to have significant risk of COVID-19 infection for senior Australians, receiving care in both residential aged care facilities and at home.”
SCATHING ASSESSMENT OF AGED CARE SECTOR
On Monday, a royal commission investigating the aged care sector’s response to the coronavirus, heard that Australia had one of the worst rates in the world for the proportion of COVID deaths coming from aged care.
Counsel assisting Peter Rozen, QC, delivered a scathing assessment of the sector’s readiness, telling the commission “we should not be surprised” that residential aged care has been the site of such tragic scenes.
He said 68 per cent of all deaths from COVID-19 in Australia came from residential aged care: “one of the highest rates in the world”.
“While there was undoubtedly a great deal done to prepare the Australian health sector more generally for the pandemic, the evidence will reveal that neither the Commonwealth Department of Health nor the aged care regulator developed a COVID-19 plan specifically for the aged care sector,” he said.
The commission also heard that the aged care watchdog took four days to alert the Federal Department of Health about an outbreak at St Basil’s Home For The Aged in Fawkner, which has now been linked to 169 cases and at least 20 deaths in Victoria.
‘IT’S TOO DANGEROUS’
Prof McLaws gave expert evidence at the commission and told news.com.au she believes the government should be thinking about routinely moving residents who test positive into purpose built facilities, such as a hospital.
Victorian Premier Daniel Andrews has expressed reluctance in the past to shift residents pointing to how disruptive it was for them.
But Prof McLaws said most aged care facilities were not built to be “proxy hospitals”.
“To assume that shared homes can be turned into hospital and keep elderly residents who are negative, to remain negative is unrealistic,” she said.
Newmarch House was forced to take a “hospital in the home” approach, with only two positive residents being transferred to hospital, and the rest remaining in the facility, the commission heard on Monday.
In contrast, Dorothy Henderson Lodge, which successfully contained its outbreak to 16 positive cases, were able to transfer almost all of their COVID-positive residents to hospital.
Prof McLaws acknowledged some experts had warned about the impact of moving on residents, especially those suffering from confusion.
“But confusion shouldn’t be the only reason they are not moving them,” she said.
“There is a risk to all other residents.”
Part of the problem is the difficulty in maintaining proper infection control in aged care facilities. These venues have seen infections in up to 40 per cent of residents, depending on the environment.
“It’s too dangerous,” Prof McLaws said.
In order to make them safe spaces, Prof McLaws said proper airflow and dedicated bathrooms for positive patients were required.
Staff also needed separate areas to put on and take off personal protective equipment (PPE) so clean clothing was not accidentally contaminated.
“Most aged care functions at close to 100 per cent occupancy but you can’t have a positive patient next to a negative patient,” she said. “The negative patients need to be at the other end of the building.”
“Staff would have to be separated too, as well as cleaning equipment,” she said.
“There are so many issues that need to be considered. It’s too difficult and not best practice.
“A resident’s family may want them to stay there but it is not best practice for other residents.”