Pandemic response shrinks as COVID-19 pressure builds

The Victorian government is dismantling its central pandemic bureaucracy at the same time the health system confronts a deadly surge of COVID-19 and influenza inflections, with a workforce of more than 1500 people reduced to about 260 full-time positions by the end of the month.

The wind-up of COVID-19 Response – a pandemic-specific workforce created at the peak of our 2020 lockdown – signals Victoria’s abandonment of mass contact tracing, testing and enforcement of public health rules in favour of a more decentralised, community-based pandemic management.

Melburnians queue for testing on Russell Street in the CBD last year.Credit:Justin McManus

The reshaped response elevates the role of public health units embedded in suburban and regional hospitals to contain local outbreaks of COVID and other infectious diseases, while maintaining a centralised data and intelligence unit to monitor mutations in the virus through genomic testing and wastewater screening.

The Australian Medical Association has expressed concern that the bureaucratic downsizing – in the absence of prominent public health campaigns promoting the use of masks and importance of third and fourth-dose vaccines – sent a mixed message about the point we have reached in the pandemic.

“We are seeing the hospitalisation and deaths of too many Victorians who haven’t had a third dose of vaccine, yet the signal is going out that she’s fine,” AMA Victorian president Roderick McRae said. “There has to be much more education for the general community about why we are withdrawing everything.”

Health Minister Martin Foley confirmed the changes this week in an interview with The Age.

“What we have got in place, in a highly vaccinated environment and a much more appropriate focus on primary care, is a more appropriate model of what an enduring public health response looks like,” he said.

However, Foley indicated that it was likely that Victoria would still require binding pandemic orders to compel people with the virus to isolate and protect hospitals and other sensitive settings. This suggests it is unlikely that Premier Daniel Andrews will lift the pandemic declaration next month, when the current one expires.

“The pandemic is not going to miraculously end on the 12th of July,” Foley said.

At the start of this year, about 3000 staff were contracted to COVID-19 Response, the pandemic bureaucracy led until recently by Jeroen Weimar and run out of the Health Department’s Lonsdale Street headquarters. As of Friday, about 1560 people were still employed with the response. By June 30, that number will reduce to about 360 people, or 260 full-time-equivalent positions.

Throughout 2021, COVID-19 Response Commander Jeroen Weimar led Victoria’s central pandemic bureaucracy.Credit:Justin McManus

The changes coincide with Victoria’s health system entering another difficult pandemic winter, with a virulent strain of influenza circulating at the same time as more than 500 people are hospitalised with COVID and an average of 20 people are dying each day with the virus.

Chief Health Officer Brett Sutton’s public health team estimates the peak demand on the health system will be felt earlier than normal this winter because of the combination of COVID and flu.

But the timing of the bureaucratic overhaul has less to do with epidemiology than budgetary considerations. Victoria’s surge workforce was mostly hired on fixed-term contracts that expire at the end of the month.

Elsewhere in government, other largely redundant COVID bureaucracies are being disassembled before the end of the financial year.

The newly constructed quarantine centre in Mickleham is being reduced to 25 per cent capacity.Credit:Paul Jeffers

In the Department of Justice, about 1500 people contracted to industry, engagement and enforcement operations – teams of compliance officers hired last September to enforce COVID restrictions on construction sites and across other industries – will receive their last paycheck before June 30.

COVID-19 Quarantine Victoria is being steadily whittled down, with the newly constructed $580 million quarantine facility at Mickelham, formally known as the Centre for National Resilience, to be reduced from 50 per cent to 25 per cent capacity. By June 30, a maximum of 250 beds will be available at the lightly used quarantine centre.

University of Melbourne epidemiologist Tony Blakely said Victoria’s “population immunity” peaked about two months ago following the summer Omicron wave and earlier take-up of third-dose vaccines. But vaccination rates have since fallen.

Only two-thirds of eligible adults have had a third dose of a COVID vaccine in Victoria and fewer people received a jab in May than in any month since the start of the vaccination program.

South East Public Health Unit director Rhonda Stuart.Credit:Justin McManus

Blakely said higher vaccination rates would “help immensely” to ease pressure on the health system.

“We can and need to do more on the COVID front to make it easier this winter,” he said.

Deakin University epidemiologist Catherine Bennett welcomed the bureaucratic overhaul. She said Victoria didn’t need an army of contact tracers and authorised officers for a virus that was too infectious to stop.

She said the bureaucracy currently being dismantled was designed for a different stage of the pandemic.

“The reason they scaled up is because we were managing it through contact tracing. We can’t do that any more. Even if we were starting from zero base again, it moves too quickly. That doesn’t mean we don’t need a health response but it has changed.”

Opposition health spokesperson Georgie Crozier said a “chaotic” public health message was creating confusion about Victoria’s pandemic response.

COVID-19 Response will cease to exist from July 1. In its place, a COVID dedicated team will be established within the public health division of the Health Department. It will have four areas of focus: data and intelligence; targeted outbreak management; vaccination and testing; and policy and strategy.

The front line of our pandemic response has already shifted from the Health Department into eight local public health units established at the end of 2020.

Rhonda Stuart, the director of the South East Public Health Unit based at the Monash Hospital in Clayton, said her team was working closely with local residential aged care facilities and other high-risk sites to contain potentially dangerous outbreaks.

“It has been a gradual transition across, firstly for COVID and then for other communicable diseases,” Professor Stuart said. “By 30 June the majority of things for COVID will be done in the local public health units. What we do now is very different to what we were doing 12 months ago.”

The reshaping of Victoria’s pandemic response is being overseen by Department of Health secretary Euan Wallace with input from Sutton and infectious disease experts from the Doherty Institute.

As part of this work, Wallace is also compiling a “playbook” – a public health manual intended to contain the lessons from this pandemic and guide Victoria’s response to the next one.

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