Page 35 - ISAKOS 2021 Newsletter Volume 1

Patients still have the fear of what may happen to them during surgery, and both patients and staff continue to take precautions regarding spread.
The major differences in our lives have been social. Children are home. Restaurants are closed or only allow limited outdoor seating. Many individuals are working from home or are unemployed. There is very little traffic because of these circumstances. The beaches are pretty full as many continue to look for enjoyable ways to spend their time. We are optimistic and look forward to life returning to what we remember 6 months ago. My suspicion is that this will take another year. Hopefully, next summer will be different as normal activities are resumed, people return to work, world travel picks up, and the family unit returns to normal.
Julian A. Feller
In terms of the COVID-19 pandemic, Australia has been fortunate compared with many other countries. Being an island, we were able to close our borders relatively early, and, with only medium-density living conditions, even in the cities, outbreaks never reached the levels seen in other countries. In addition, our health system is well developed and was relatively easily ramped up to deal with an influx of patients that fortunately never arrived.
So things should be good. Indeed they are, at least in some parts of the country. But government responses are going to leave an enormous economic burden, and it may be that the “cure” may end up being seen to be worse than the disease. COVID-19 has exposed some interstate rivalries and jealousies that are deeper than many had realized and that go far beyond the banter of interstate sporting rivalries. Australia is a federation of states. Health and education are state, not federal, responsibilities, whereas aged care is a federal responsibility. So there is plenty of room to shift the blame when needed.
The early governmental response in February and March of 2020 may come to be seen as excessive, especially when compared with the current position of countries such as Sweden, which took quite a different approach. But it was understandable and certainly not unreasonable given the uncertainty as well as the dire predictions from some modelling, and it may have been a factor in our limited caseload. Case numbers and fatalities never soared and settled quickly.
But here in the state of Victoria, a so-called second wave (or “phase” to use the currently preferred term) arose out of poorly conceived and poorly implemented protocols and procedures in quarantine hotels. This factor was compounded by the fact that many of the security personnel came from lower socioeconomic backgrounds and local communities that were very susceptible to spread of the virus. This situation subsequently led to outbreaks and, not surprisingly, increased fatality rates in aged care facilities.
The state government reacted with what can only be regarded as a panicked response. Not willing to admit their role in making the decisions that ultimately allowed the second phase to occur, they became obsessed with driving the numbers of cases to unrealistically low levels, such as 0 daily new cases. This approach led to a second round of restrictions and lockdowns. Compulsory wearing of masks away from home, a curfew from 8 p.m. until 5 a.m., 1 hour of exercise per day (which has now been increased to 2 hours per day), no leaving home for other than a few reasons, no travel beyond 5 km from home, no visiting other houses or meeting friends, no attendance at schools or universities, no sporting activities, and essentially no elective surgery. The police presence is high, and fines for breaching restrictions are steep. Some have questioned how our civil liberties appear to have evaporated so easily and with so little outcry. People have become polarized in their views, and it is all too easy to be labelled as being in one camp or another.
As I write this, we are in the eighth week and our average number of new cases per day is in the low 30s (yes, 30s, not even 300s, despite the fact that Victoria has a population of 5.7 million). Hospitals have 50% bed occupancy, with only a handful of COVID-19 cases, and operating staff are looking forward to next week when we can at last recommence some elective surgery. People want to be able to work.
The effect of this second lockdown has been profound. While we accepted the measures the first time around, there is growing anger and resentment this time, especially when life in other states is quickly returning to normal. We have become a pariah state, with strict border closures imposed on us, in part driven by parochial politics and upcoming state elections. Quite apart from the impending economic destruction, the community is losing its spark. People are becoming less motivated, and depression and anxiety are on the rise. It is particularly difficult for those living on their own and those with young children living in confined spaces. Obesity (so-called COVID fat) is visibly increasing. Selfishness is growing, not lessening. Young people wonder how they will find employment. Few can contemplate the enormous financial cost and the level of debt that governments now carry, perhaps 10 times levels previously thought unacceptable. And for many rural communities, this comes on top of the devastation of last summer’s severe bushfires.
In orthopaedics, this year’s crop of final year trainees are unable to look forward to overseas fellowships, but there are no obvious jobs for them here next year. Surgeons in their early years of practice feel like they are back at the start. Those in sports surgery can’t expect to see any sports injuries in the next 6 months. Surgeons nearing the end of their practice may find that retirement comes just a little bit earlier than anticipated.
CURRENT CONCEPTS
ISAKOS NEWSLETTER 2021: VOLUME I 33