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When Dean's* father was rushed to hospital with a bad case of gastro in February, he assumed he'd be back on his feet in a few days.
Instead, he caught COVID, probably in the emergency department at the Monash Medical Centre, a major hospital in Melbourne's south-east. His 79-year-old dad became so unwell, so quickly, that Dean — who visited him in the infectious diseases ward wearing an N95 mask — was terrified he wouldn't survive.
"He was as sick as I'd ever seen him," said Dean, who was shocked that his father's COVID infection seemed to trigger symptoms of Huntington's Disease, a neurodegenerative condition he'd been diagnosed with many years earlier. "I'd say it was very touch-and-go. I've seen people with cancer a few days before they've died, and there was a look in his eye and he was completely emaciated. He couldn't speak, couldn't communicate — he was just croaking."
Dean was also shocked that most of the hospital staff were wearing surgical masks, some on their chin. It bothered him, he said, because surgical masks are much less effective at preventing COVID transmission than N95 respirators. "No one seemed to give a hoot about protecting themselves or the patients," he said. "From what I know about COVID, I believe all the staff in an infectious diseases ward should be wearing respirators … the fact that it is not standard is just bamboozling."
But perhaps he shouldn't have been so surprised. For months doctors and public health experts have been warning that too many patients are catching COVID in Australian hospitals with sometimes devastating consequences — though timely statistics are difficult to access because health departments do not publish them.
Now, new data shows thousands of patients caught COVID in Victorian public hospitals in the past two years — and hundreds died — fuelling concerns that hospitals are not taking strong enough precautions against airborne viruses, and calls for stronger leadership from the Department of Health.
Almost one in 10 patients who caught COVID in hospital died
Documents obtained by ABC News under Freedom of Information laws reveal at least 6,212 patients caught COVID in hospital in 24 months — 3,890 in 2022 and 2,322 in 2023. Of those, 586 died — almost six per week, on average — with men dying at a higher rate than women (11 per cent vs 8 per cent).
Though hospital-acquired infections and deaths declined in 2023 — in line with COVID mortality trends in the broader community — the proportion of patients who died after catching the virus in hospital hardly budged, dropping from about 10 per cent in 2022 to about 9 per cent in 2023.
It comes following the release of new research that shows screening hospital patients for COVID and staff wearing N95 masks can substantially reduce infections and deaths, saving the health system potentially hundreds of millions of dollars in the long term. Experts say the findings should spark a paradigm shift in the way hospitals approach COVID infection prevention — that's if the latest indicators of illness and death don't.
"The numbers indicate that there is a big problem here — these infections and deaths are potentially preventable," said Associate Professor Suman Majumdar, chief health officer for COVID and health emergencies at the Burnet Institute. "We're talking about a specific setting where people are sicker, more vulnerable and more at risk. We need to drastically reduce the risk of people catching COVID in hospital when they don't come in with it. I think we can all agree we can do better — that should be the starting point."
Alarmingly, the proportion of hospitalised COVID patients who caught the virus in public hospitals was much higher last year than in 2022 — up from 13 per cent to 20 per cent, on average — coinciding with a reduction in COVID screening and healthcare worker mask use across the state. Most Victorian hospitals began scaling back infection prevention measures in late 2022, when pandemic public health orders were revoked.
Now, because hospitals determine their own COVID policies, there is wide variation in how they approach the issue. For instance, in the past fortnight several health services — including St Vincent's in Melbourne and Barwon Health — announced they were no longer requiring staff to wear masks in clinical areas because community transmission had fallen (the latest available data shows it's increasing). Others dropped masking and scaled back testing months ago, while some still insist on routine testing and surgical mask use in particular wards.
With golden staph, 'we aim for zero'
"There's no consistency between health services," said Stéphane Bouchoucha, president of the Australasian College for Infection Prevention and Control and associate professor in nursing at Deakin University. "And there doesn't seem to be leadership from the Department of Health, saying, 'We want to reduce COVID infections in healthcare, therefore … we need to do universal testing, we need to mandate N95 masks for healthcare workers'."
As for the number of people catching COVID in hospital, Dr Bouchoucha said: "I think any hospital acquired infection is concerning". There isn't an "acceptable" number of golden staph or tuberculosis infections — "we aim for zero", he said. "So why don't we do that with COVID?"
He's not the only one asking that question. Staphylococcus aureus or golden staph bloodstream infections can be life-threatening, which is why hospitals track and report them and aim to prevent them using hand hygiene strategies — it's part of hospital accreditation standards and there are targets in every state. But there are no targets or reporting requirements for COVID, Dr Majumdar said.
As a point of comparison, he said, there are about 600 staph aureus bacteraemia infections in Victoria each year, with a similar death rate to COVID hospital-acquired infections. "So why aren't we applying the same mindset and measures for airborne infections such as COVID and influenza?"
At the hospital level, there are several possible answers. Many health services, under huge financial pressure, have rolled back COVID mitigations to try and save money — sometimes against the advice of their own infection prevention leads. Many hospital executives also subscribe to the myth that COVID is "just a cold" and does not warrant taking serious action against, while others have acted on complaints that staff are "sick of wearing" masks.
"Many people are telling me they're tired of wearing masks and some patients are saying they're tired of seeing their carers in masks, as well," Professor Rhonda Stuart, director of public health and infection prevention at Monash Health, told staff at an employee forum in February.
Professor Stuart pointed to a UK study that found removing a surgical mask wearing policy in some hospital wards did not significantly affect the rate of nosocomial COVID infections, or those caught in hospital. "I think we're starting to see that possibly happening across Monash at the moment," she said — "that maybe masks aren't making the difference in hospital-acquired infections".
Testing and N95s save lives and money
But the findings of a new preprint study pose a serious challenge to that claim. For the study, researchers from the Burnet Institute and the Victorian Department of Health, which funded it, used a mathematical model to simulate outbreaks in a hospital with various combinations of interventions in place: different kinds of masks worn or admission testing performed.
They also calculated the statewide financial costs of each intervention — N95 vs surgical masks, PCR vs rapid antigen testing (RAT), and patient bed costs and staff absenteeism — as well as the health outcomes for infected patients.
The results were striking: compared to staff wearing surgical masks and not screening patients on admission, the combination of wearing N95 masks and testing patients using RATs was the cheapest, saving an estimated $78.4 million and preventing 1,543 deaths statewide per year. Staff wearing N95s and screening patients with PCR tests was the most effective option, saving $62.6 million and preventing 1,684 deaths per year.
In other words, testing and wearing N95s to detect and prevent COVID can save lives and money because it reduces the costs of keeping patients in hospital for longer and replacing furloughed staff.
"I think it provides a very persuasive rationale that doing small things to reduce infections can add up to big positive impacts and cost benefits," said Dr Majumdar, a co-author of the study. "It then becomes an issue of how practical it is for hospitals to implement these interventions and change behaviours. We know improving ventilation, testing and wearing masks has been effective during the pandemic, so I don't think there's an argument to say it's not feasible or not worth figuring out how to do."
The Victorian Department of Health did not respond directly to questions about whether it would be acting on the study's findings, or if it was comfortable with current rates of illness and death in hospitals. "Since the pandemic began we have assisted health services to respond to increased impacts of COVID-19 — a roadmap to guide hospital responses was introduced and has remained in place since June 2022," a Department spokesperson said. "Modelling is one of many tools used when developing and evaluating healthcare policy."
Managing 'masking fatigue'
But hospitals don't always follow that "roadmap". Associate Professor Caroline Marshall, head of the Royal Melbourne Hospital's Infection Prevention and Surveillance Service, said her hospital uses a "hierarchy of controls" to prevent COVID transmission — strategies honed in the grim early years of the pandemic when patients and staff were infected in dizzying numbers.
Today, every patient is screened for COVID on admission with a PCR test — which few hospitals still do. COVID patients are generally cared for in single-bed negative pressure rooms by staff in N95 masks. Air purifiers are stationed around the hospital, an old building with not-so-great ventilation.
"To me … any sort of nosocomial infection is a disaster," Dr Marshall said. "So we do our utmost and we're not always successful, but we do as much as we reasonably can [to prevent them] based on the evidence we have and the factors we have to take into account."
One of those factors is the impact of masking on healthcare workers, who Dr Marshall said are "sick of wearing" N95 respirators because they're uncomfortable. At the moment Royal Melbourne Hospital staff must wear surgical masks in clinical areas unless they're caring for COVID, transplant or haematology patients, when N95s are required.
The decision to use surgical masks is influenced by a few things, Dr Marshall said, including the prevalence of COVID in the community, the severity of circulating variants, population levels of immunity and a new tolerance for risk among staff. "If a staff member wants to wear one for whatever reason, they can," she said. "But I think the reality is, at a practical level, you cannot continue to get staff to wear N95 masks forever."
Other infection prevention control experts disagree. For Dr Bouchoucha, masking fatigue is a challenge to be "managed", not succumbed to — including because addressing healthcare workers' concerns about respirator use improves compliance and patient safety. "It's definitely something to take into account," he said. "But we can mitigate it."
Catching COVID made Ruby sick and derailed her care
Many patients feel similarly. When Ruby* caught COVID in hospital earlier this year, she was fully prepared to feel terrible for a few days — but she didn't expect it to completely derail the care she was there to receive.
Ruby was admitted to Upton House, the adult psychiatric unit at Box Hill Hospital, in late January after experiencing family violence and a decline in her mental health. When she tested positive to COVID a few days later, she wasn't surprised: other patients with COVID were allowed to roam freely through the ward without masks, she said, and staff were either in surgical masks — many "below their nose" — or no masks at all.
"It made me really sick," said Ruby, who suffered mostly from gastrointestinal symptoms, brain fog and low mood. "I was pissed off that I'd caught COVID but I didn't realise it would affect my care as much as it did, and I was really shocked at the drop-off in psychiatric support as soon as I had it."
A doctor who prescribed Ruby antivirals dramatically reduced her dose of psychiatric medication without consulting her, she said, which triggered unpleasant side effects. Having COVID also meant her psychiatrist visited her less frequently than he was supposed to, she said, and if she went to the nursing station to ask for paracetamol, she was instructed just to go back to her room. "I also wasn't allowed to go to the kitchen for meals and my food was generally brought to me an hour late, cold, without cutlery," she said. "So most of the time I didn't eat."
Ruby was relieved to be discharged even though she was "in limbo" psychiatrically — feeling much worse than when she arrived — and still testing positive to COVID. "I can't imagine how hard it is to work in a psychiatric unit," she said, adding that the nursing staff were clearly very busy. "But there was a total lack of empathy and then as soon as I had a medical problem [COVID], absolutely no attention or compassion. Something as simple as not being able to get any Panadol was almost traumatic — even though I was in there for more severe trauma issues."
A spokesperson for Eastern Health told ABC News they were unable to comment on Ruby's case but said if a COVID outbreak occurs, "additional measures are put in place including requirements to wear N95 masks, reduced movement and access to certain wards and clinical areas, increased hand hygiene, taking breaks outside and meeting virtually where possible."
Monash Health also would not address specific questions about Dean's father's admission. "Monash Health provides N95 and surgical masks as part of its infection prevention precautions to protect its patients, visitors and staff," a spokesperson said. "Monash Health cares for COVID-positive patients … in single rooms with negative pressure or negative flow, in addition to requiring staff and visitors to wear appropriate PPE including N95 masks."
At least that's not what Dean observed. He's still upset that the hospital didn't alert him when his father tested positive to COVID, and that his dad blamed himself for catching it in the emergency department in the first place.
"In the whole time of his admission I only saw one staff member … wearing a respirator — I felt overdressed," Dean said. "I'm just horrified that vulnerable people go into a place where they expect to be safe and cared for but are given something that, in this case, potentially nearly kills them and there's no apology — not even acknowledgement."
ABC News requested interviews with infection prevention and control experts at Western Health, Barwon Health and Alfred Health — all declined.
*Names have been changed to protect patients' privacy.
