Dr Nick Coatsworth voices his opinion on controversial aged care COVID-19 questions

Standing as the last line of defence for Australia’s most vulnerable throughout the pandemic, aged care staff across the country are continually asked to endure and conform while being assured that any of their concerns will be addressed by the government at a later date.

This feeling of perpetual uncertainty has also taken a toll on the well-being of seniors, who – as the aged group most vulnerable to COVID-19 – have spent the last two years being bombarded with messaging that leveraged fear to drive up vaccination rates and encourage compliance with government medical advice.

This polarised large sections of the population and turned mild sceptics into non-believers.

Many of the concerns voiced by aged care staff and seniors on the HelloCare platform over the last two years were branded ‘too controversial’ by industry figures and medical experts who were approached for this article.

However, infectious disease expert and common-sense COVID-19 communicator, Dr Nick Coatsworth, recently sat down with HelloCare and assured us that no question was off-limits.

Returning to work unvaccinated

Many of the aged care staff who were forced to stand down for failing to comply with vaccine mandates did so hoping that there would come a time when they can return to work, regardless of their vaccination status.

With chronic understaffing currently plaguing large numbers of aged care homes across the country, one obvious question is: Is understaffing more of a risk to the wellbeing of aged care residents than having unvaccinated staff return to the workforce?

“Even though the evidence around COVID-19 vaccinations decreasing transmission is quite weak, it’s low-quality evidence. The experience that I’ve had in healthcare settings is when you’ve got a vaccinated healthcare worker and a vaccinated patient who’s COVID-19 positive, the transmission – even with very prolonged contact – is reduced.

“And we’ve got some unpublished data on that from my own hospital.”

When asked if he can foresee a time when unvaccinated Australians would be allowed to work in aged care, Dr Coatsworth’s forecast did not bode well for those hoping to return to the workforce.

“It’s still my view that for health and aged care the mandates probably do still need to remain for the moment. But, honestly, I think this is going to set a bit of a precedent for COVID-19 vaccination for the hospital and aged care workforce,” said Dr Coatsworth.

“I can’t foresee it being wound back in 2022. Maybe there’ll be discussion next year, but I think it’s probably here to stay for the foreseeable future.”

PPE is OTT

Although well-versed in infection control procedures before the pandemic, aged care staff across the country have now endured strict PPE protocols for more than two years.

With the arrival of Omicron, which Dr Coatsworth describes as being “intrinsically more mild” than earlier COVID-19 variants, the good doctor believes that it might be time to doff the masks and face shields for good.

“I think they should only be used when you’re caring for a confirmed positive [case] or in a situation where your nursing home has got a significant outbreak.” 

While wearing a mask and face shield is an uncomfortable inconvenience for staff, it also restricts the ability of some residents and staff members to communicate with one another due to the muffling of sound and masking of facial cues.

These limitations can impede an aged care resident’s ability to have meaningful interactions.

“My dad died of dementia in 2012, and communicating was hard enough as it was,” shared Dr Coatsworth.

“I certainly think, in aged care, it would be lovely if we saw a recommendation come out that unless there was an outbreak, you could dispense with the masks and just get on with caring for people.”

Adverse reactions

At the beginning of the vaccine rollout, large numbers of our audience took to our social media pages to voice their frustration at being forced to choose between the vaccine and their job.

The most common reason for vaccine hesitancy was a lack of available information on the new vaccines and fear of adverse reactions.

With the announcement by the Australian Technical Advisory Group on Immunisation (ATAGI) in February that three doses of a COVID-19 vaccine are required for the residential aged care workforce to be up-to-date, some aged care and health care staff who had the primary course of two vaccine doses revealed that they would choose to leave their industry before having their third dose.

An apparent rise in heart attacks and people reporting to the hospital with chest pains is the elephant in the room that continues to go unaddressed. The lack of available information regarding these perceived increases continues to fuel distrust among the vaccine-hesitant.

Whether these increases are a result of COVID-19, sedentary living during lockdown or adverse vaccine reactions, findings – like new peer-reviewed research which indicates a 25% increase in heart attacks for people under 40 – are concerning and needs to be addressed.

In an attempt to quell these fears, we asked Dr Coatsworth to give us his perspective on this taboo subject.

“I think the important thing, regardless of what it is, is that if people think that they’ve had a vaccine-related adverse event, they must get their GP or themselves to report it through the TGA. Because the only way that the TGA can actually work it out is if everybody who gets the adverse effect reports it,” said Dr Coatsworth.

“That said, I think out of all the reporting systems in the world, the TGA has got one of the best of them. So you know, if they’re not detecting it, then it’s probably just [a] coincidence”.

This topic has proven to be so controversial, that footage of Queensland Health Minister Yvette D’Ath talking about a 40% increase in heart attacks last month has been pulled from mainstream news outlets and can now only be found on less reputable platforms.

“The TGA is now reporting on the age-specific rates for myocarditis in males, which is really good. So, it just won’t bother females, they aren’t getting the myocarditis just as blokes never got the blood clots with AstraZeneca”.

“Myocarditis is a known side effect, that’s not a coincidence. But similarly, the [reporting] systems are so good that they managed to detect a side effect that only had a frequency of one in 100,000, which was the blood clots with AstraZeneca.

“If the systems are that good that they can detect a one in 100,000 side effect, but they’re not detecting any increase in [other potential adverse reactions] then I reckon I’m pretty confident that most of the things people are associating with the vaccines are just a coincidence.”

Seniors in the workforce

As multiple industries across the country struggle with labour shortages, National Seniors Australia is lobbying for a change to pension rules to help lure retirees back to the workforce to fill record numbers of job vacancies. 

The proposed changes would see employed Australians who receive the pension have their work income exempt from pension means testing, which currently rules that every dollar earned over the $480 threshold results in a 50-cent reduction to their fortnightly pension.

A return to the workforce by seniors would also come with an increased risk of exposure to COVID-19, which some seniors have flagged as a key deterrent.

However, Dr Coatsworth believes that seniors should feel comfortable returning to work if they have followed recommended government health advice.

“Provided that they themselves have had their full vaccination course – which, now the recommendations extend to a fourth dose – then I would encourage it,” said Dr Coatsworth.

“Particularly, if they feel as though they’re fit, able and they want to. It’s going to be important for their own mental health and overall wellbeing to get back into the workforce, and I think it is a safe time to do it.”

Those against the prospect of seniors returning to work continue to make the claim that welcoming younger, unvaccinated people back into the workforce would be at less risk of serious illness than seniors who are fully vaccinated.

While data is still too limited to provide a definitive answer to this question, Dr Coatsworth feels as though the assertion is probably correct.

“It’s probably fair to say that if you’re older than 75, and you’re fully vaccinated, your risk is still higher than a healthy, unvaccinated 25-year-old. I think that’s probably accurate, based on what we know,” said Dr Coatsworth.

Dr Coatsworth continued, “But the caveat to that, from the perspective of a 25-year old, is that you’re still rolling a dice by exposing yourself to a pandemic virus that your body has never seen before, so I’d still recommend that the unvaccinated 25-year-old go and get their primary course.

“I always recommend we shouldn’t stop trying to convince people. But we should stop hardening their views by not letting them go back, by keeping these mandates going.”