Flat White

Melbourne’s medical nihilism in the time of Covid

21 January 2022

4:00 AM

21 January 2022

4:00 AM

Victoria has activated state-wide Code Brown emergency measures for the first time in its history on January 18. This means that all Melbourne public hospitals and major regional facilities will prioritise Covid patients while ceasing or reducing non-urgent clinical services.

The reason? An average of more than 4,000 medical workers are unavailable across the state each day due to Covid isolation requirements. Furthermore, administrators expect hospitalisation for Covid to increase to beyond 2,500 in the next month.

However, the cause for pessimism is puzzling. Victorian case numbers, despite the addition of rapid antigen testing to the system, have been steadily falling since January 11. The case numbers hit nearly 42,000 at that point before dropping to 20,769 on January 19 – a reduction of 50 per cent.

A recent study from America – confirming previous research from South Africa, the UK, and Denmark – also showed that the risk of hospitalisation for Omicron (the dominant strain in Victoria) is 0.5 per cent, which is less than half that of Delta. Even when hospitalised, the median duration of stay is 3.4 days shorter than for Delta, representing a 70 per cent reduction. Back in October of 2021, despite a peak of just over 2,000 daily cases (less than a tenth of the current number), hospitalisations reached more than 850 (versus 1,173 now), and ICU cases peaked at 163 – more than any time during this new wave.

What is more alarming than the logic behind the decision is the continued fixation on Covid at the expense of everything else. While Covid has been linked to the deaths of over 1,700 people in Victoria, the number needs to be examined in context. For instance, the median age for those who died from Covid in Australia is 86.9 years. This is older than the average life expectancy of Australians, which sits at around 83. Furthermore, the statistic being the median means that half of those who died from Covid were even older than 86.9 years.


This is not to make light of the deaths of the elderly, but it is to raise the question of priorities. For instance, most of us would instinctively conclude that the death of a child is more tragic than that of someone who passed at dotage. Uncomfortable though it is, what must be asked next is this – what can we conclude about a society that has decided to prioritise saving the lives of the very old at the expense of the young? For this is the result of Australia’s current policies. It is made even more acute as the virus does not even make the top 30 causes of death in the country.

In the fields of public health and health impact assessment, the notion of disability-adjusted life years (DALY) is used to measure how many otherwise good years of life are robbed from someone by illnesses. In Australia, as in much of the developed world, half of the DALY burden comes from just four diseases – cancers, cardiovascular diseases, musculoskeletal conditions, and mental and substance use disorders. The harsh pandemic restrictions, including the Code Brown, are linked with an exacerbation of these conditions.

An analysis by the Heart Foundation of the Medicare Benefits Schedule data saw a 96,000 drop in visits to the GP in March 2020 compared to the same time in 2019. A study estimated that 2,530 cancers went undiagnosed in Victoria during just a seven-month period in 2020.

Attempted suicide rates among Victorian teenagers over a six-month period from December 2020 to May 2021 jumped 184 per cent. Another report found that almost a tenth of Victorians seriously considered suicide, while a third reported symptoms of anxiety and depression.

Ambulance call-outs for alcohol-related harms rose by 9 per cent in 2020, representing thousands of extra cases, as alcohol intake rose significantly in the state during the lockdowns. No doubt thousands of elective surgeries, such as for knee and hip replacements, were delayed throughout the pandemic – as will be the case again during this Code Brown period.

While the media attention has solely been on Covid for almost two years, a lot of the harms caused by the various pandemic policies are silently accumulating and metastasising, like a bad debt, and will continue to manifest over years to come.

Two years into the pandemic, with the gentlest strain yet predominating, the blinders of Covid is still strapped firmly on the faces of policymakers, as shown by the Code Brown implementation.

Their policies are forcing medical practitioners into therapeutic nihilism, a trap mentioned in the modern Hippocratic Oath that doctors have vowed to avoid. The increased DALY as a result of these policies means that for tens of thousands of Victorians, they have been and still will be robbed of a millennia’s worth of quality life. And as the data show, tragically, this is not necessary.

Not only therapeutic nihilism, these policies reflect nihilism in general.

Policymakers have forgotten the wise words of Victor Hugo, who wrote that, ‘It is nothing to die. It is frightful not to live.’

 

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