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Covid-19 clinic sign at North West hospital
North West Private and North West Regional hospitals in Burnie were closed and staff and families ordered to stay home for 14 days after more than 110 cases of coronavirus were found. Photograph: Simon Sturzaker/AAP
North West Private and North West Regional hospitals in Burnie were closed and staff and families ordered to stay home for 14 days after more than 110 cases of coronavirus were found. Photograph: Simon Sturzaker/AAP

Search for answers after coronavirus strikes at heart of Tasmania’s north-west

This article is more than 3 years old

Dozens of health workers were infected and thousands quarantined, stretching medical resources. But how did it spread so quickly?

More than 1,000 Tasmanian health workers in mandatory quarantine following a Covid-19 outbreak in two hospitals are preparing to return to work – but they are no closer to understanding how the virus spread so rapidly.

The secretary of the health and community services union, Tim Jacobson, said the morale of the workers had plummeted since the quarantine began on Easter Sunday, when staff from the North West Private and North West Regional hospitals and their families were ordered to stay home for 14 days following a cluster of more than 110 cases. The lockdown represented almost 5% of the region’s population and removed a significant proportion of its workforce, leaving GP clinics to fill the gap.

While a passenger from the Ruby Princess cruise shop is thought to be the origin of the north-west outbreak, it does not explain how the infection then spread so rapidly and widely throughout the hospitals between staff, patients and wards, Jacobson said.

“It’s been difficult for us to determine when it was known there was a virus outbreak at the hospital and to find out which work areas people contracted it in,” he said. “There has been a significant level of secrecy around this from the department and the government.

“As we move closer to reopening the hospitals people are confused about the circumstances about getting back to work, even simple things like rostering and the provision of personal protective equipment haven’t been communicated, or the cleaning that’s to be undertaken in their work areas.

“It’s shameful and disgraceful that the department hasn’t put the systems in place to ensure those workers sent home receive information, or even a courtesy call from managers to ask how they are and if they need anything.”

Lockdown continues

Guardian Australia contacted the state’s health minister, Sarah Courtney, for comment but did not receive a response. On Thursday the premier, Peter Gutwein, said four more cases connected to the north-west outbreak had been identified overnight. More than 200 cases have been confirmed across the state since the pandemic began. Tighter restrictions in the north-west as a result of the cluster, that were due to be lifted on Sunday, were likely to remain in place for an extra week, Gutwein said. Schools are unlikely to reopen as planned. The testing threshold is also lower in the region.

The state’s public health unit told Guardian Australia an interim epidemiological report of the outbreak was almost complete.

“Epidemiological and microbiological analyses are expected to provide further understanding of the sources and patterns of transmission of coronavirus in this outbreak,” a spokeswoman said. “This is a complex process and does take time to deliver accurate findings.”

The emergency department of the public hospital reopened on 17 April, but is not admitting patients. The maternity ward will be reopened next, with a date not yet confirmed. Patients in the two hospitals were transferred to the Mersey Community hospital. Most new patients requiring admission are in the meantime being sent to Launceston hospital or, if they need high-level care, Hobart. But it takes more than 1.5 hours to drive from Burnie, where the north-west hospitals are located, to Launceston, and almost four hours to drive to Hobart.

“Massive distances are now being covered by ambulance,” Jacobson said. “There is also a major problem with ambulance resourcing. There was a rescue package allocated to the ambulance service but we don’t have the bodies on the ground to pick up all those extra shifts to cover the workload in north-west. Paramedics from the south and north are working overtime where they can to meet the north-west paramedics along the route and take over. Fatigue is an issue.”

Old, poor and sick

Tasmanian senator Jacqui Lambie says the region of Burnie is home to people most at risk to coronavirus. ‘We are among the oldest, poorest and sickest in the country.’ Photograph: Mick Tsikas/AAP

Senator for Tasmania Jacqui Lambie says it is likely several factors will be found to have led to the devastating cluster.

“How did it get out of control in the first place and what procedures should have been in place that weren’t? What happened between the Ruby Princess passenger becoming sick and being in hospital?” Lambie said people in the region of Burnie were particularly vulnerable to the virus, with a large elderly population and people in poor health.

“We have a fairly high unemployment rate, we have fourth-generation welfare recipients, and we know people on welfare often don’t have the best health outcomes,” Lambie said. “We are among the oldest, poorest and sickest in the country.”

Infection control procedures will be examined as part of the public health investigation into how the virus took hold. Golden staph infections acquired in hospitals are one of the indicators health departments use to examine how strong a hospital’s infection control procedures are. While private hospitals are not required to report this data, Australian Institute of Health and Welfare data for 2018 show Tasmanian public hospital infection rates were well below the national benchmark of two cases per 10,000 patient days. The North-West Regional hospital has the lowest rate in the state.

Questions over spread

However, there have been serious concerns raised about how some hospitals have handled aspects of the Covid-19 pandemic. In late March, a unit manager from Launceston general hospital told staff in an email to “collect all used, undamaged and unsoiled P2 masks” so the masks could be investigated for reuse. But P2 masks are recommended for single use only.

It wasn’t until Sunday, almost three weeks later, that the Tasmanian health service issued a notice to all staff clarifying the masks were being collected as part of a trial to see if they could be successfully decontaminated, but were not to be reused, and that there was sufficient mask stock.

Australian Nursing and Midwifery Federation Tasmanian branch secretary, Emily Shepherd, said “it does appear there was a miscommunication in terms of the rationale for collecting the masks”.

“That’s now been very firmly clarified,” she said.

But Jacobson, from the health services union, is sceptical. “We raised the issue weeks ago and it’s only after media attention the email went out clarifying what the masks were to be collected for, so that makes me suspicious and cynical,” he said. “Again, there has been a lack of clarity.”

Shepherd and Jacobson both say doctors, nurses, paramedics and other health staff have been through a traumatic time. Blame incorrectly assigned to the health workers by the prime minister added to this distress. Away from their workplaces and left to manage their entire household in isolation, health workers are still unclear on what the return to work will look like or how the hospitals will be progressively reopened.

“I don’t know if we will ever be clear about how this outbreak started,” Jacobson said. “Lessons need to be learned and processes put in place to make sure this doesn’t happen again. The government needs to come clean and say ‘here’s what we uncovered, here’s what went wrong, this is why we had this outbreak’. Simply cleaning the hospitals and putting in place new standards and procedures when staff return doesn’t tell the story.”

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