Health care workers in Tasmania's North-West have been stoic in the face of the COVID-19 pandemic.
They have worked tirelessly to bring a terrifying outbreak under control.
And yet it's not hard to see why these people - our protectors - are afraid, too.
Afraid of what might happen when the state's borders reopen.
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Afraid that a second wave of the deadly virus could batter the region.
Afraid of retribution for speaking up about the outbreak that threatened to bring the North-West undone.
The outbreak, which closed the North West Regional and North West Private hospitals, also affected the Mersey Community Hospital and aged care homes and resulted in Tasmania having the highest coronavirus death rate in the country, is believed to have started about April 3.
It's thought its source was one or possibly two COVID-19-positive passengers from the Ruby Princess cruise ship who had been admitted to the NWRH.
By April 21, 114 people had tested positive for COVID-19 as a result of the outbreak: 73 health care staff, 22 patients and 19 other people.
The Australian Defence Force and an Ausmat team were deployed to oversee a deep clean of the NWRH. About 1300 staff were quarantined for 14 days, as well as between 3000-4000 of their household members.
It was an experience North-West Tasmanians won't soon forget.
Premier Peter Gutwein has promised an independent inquiry into how the outbreak started, and the subsequent response to it.
It's unclear when the inquiry will start. Attention in the health sector has now turned to what needs to be done to prevent a repeat of an episode that brought the North-West to its knees.
Australian Medical Association president John Burgess wants the inquiry to be commenced as a matter of urgency with its findings publicly disclosed as quickly as possible.
He believes an inquiry led by a retired judge or Senior Counsel could gather evidence and give people "the confidence they need to speak frankly about what happened".
"We need an independent inquiry to understand exactly what occurred in the North-West - what guidelines were in place, what level of training and staff support was available and whether the public health and health system response was timely in the face of the emerging outbreak," Professor Burgess explains.
"The North-West is a vulnerable community and this was definitely a vulnerable hospital system.
"For the future, we must learn deeply from what happened and how it happened so we don't have a repeat."
An interim report on the outbreak, compiled by Tasmania's Health Department, found that transmission was likely enhanced by a number of factors.
These included hospital staff continuing to work with respiratory symptoms and holding meetings in confined spaces, possible "shortcomings" in infection control measures, insufficient contact tracing, high frequency of staff movement between health care settings and transfer between facilities of undiagnosed infectious or incubating patients.
The North-West is a vulnerable community and this was definitely a vulnerable hospital system.Professor John Burgess, Australian Medical Association Tasmanian president
The report made 17 recommendations, all of which the state government has committed to implementing.
Professor Burgess believes there were systemic shortcomings that led to the outbreak.
"There appear to have been inadequacies in precautions, processes and personal protective equipment at various levels - from how the virus entered the state despite border quarantine processes, to the virus escaping containment in the hospital environment, to its propagation amongst healthcare workers and into the local community," he said.
"The critical factor here is a structural one - how do you run a sustainable health care service across the North-West given the dispersed population centres, the complexity of services required, and an Australia-wide problem with recruiting and retaining health care staff in regional and rural communities?"
Health and Community Services Union assistant secretary Robbie Moore met NWRH workers on Thursday and said they remained unhappy and morale was low.
"They are back at work but no-one is being honest with them," he said.
"They are reluctant to talk openly for fear of reprisals and from fear they will be targeted like others who have tried to speak up."
HACSU delegate and intensive care paramedic Simone Haigh conceded that the pandemic was a stressful time for paramedics who, unlike other health workers, were not required to go into quarantine.
"The whole system would have failed if we had been in quarantine," she said.
"It was a bit like we were the canary in the coal mine."
The pandemic led to longer shifts for ambulance staff who picked up the slack when the two Burnie hospitals closed - especially through transporting patients, including some with COVID-19, to the Launceston General Hospital.
"We had the same anxieties as everyone else - we were pretty stressed but had enough PPE in storage which we distributed carefully," Ms Haigh said.
Ms Haigh tells of abuse and the dirty looks she received when she was in uniform going to and from work.
"In some places they wouldn't serve me, they just ignored me," she said. "I wouldn't have gone out if I thought I was infected."
Ms Haigh's biggest concern is how her colleagues will cope in the wake of the outbreak.
"The stress of contracting COVID and/or inadvertently infecting your family along with the fatigue of long transport times puts people's mental health at risk," she said.
"The job is already stressful but then you add this and it is worse down the track."
An aged care worker, who did not wish to be identified, was in quarantine for two weeks and said it was a disconcerting experience.
"I was anxious for my family, my friends and co-workers," he said.
"If the virus got into the aged home, no ifs, buts or maybes - lives would have been lost."
HACSU delegate Elaine Smith has worked in aged care for nearly 28 years.
Her children didn't want her to go to work during the outbreak so she took a month's leave.
"There was a level of anxiety and worry for everyone," Mrs Smith said.
"But everyone has done a wonderful job and are very careful.
"Most of the residents were fine - we had more staff to provide one-on-one care and of an evening and weekends they were able to Facetime with their families.
"Everybody's done such a good job in these unprecedented times."
Police Association of Tasmania president Colin Riley is relieved that despite 101 officers being quarantined none contracted the virus.
One officer tells of being quarantined after attending the NWRH the day before it closed.
"I had been sent there to assist security, and [my partner and I] ended up being there for seven hours as they only had two people working, instead of the required four," he said.
The fear of being exposed to the virus took its toll.
"The hardest thing I found during this time was going to bed each night, wondering whether the next morning was going to be the one where I woke up sick with coronavirus," he said.
"I had a sore throat for a few days, so I arranged to have a COVID test. The result came back negative within 48 hours, and my sore throat magically disappeared shortly thereafter.
"I'm pretty sure it was psychosomatic."
New responsibilities for police during the pandemic included meeting the Spirit of Tasmania and incoming aircraft. They also attended cases of people breaching directions from the Public Health director.
Australian Nursing and Midwifery Federation delegate Sarah Hill, a registered nurse who works at the MCH and occasionally the NWRH, said while she believed hospitals on the North-West Coast were ready to respond to a potential second wave, there was still a level of anxiety among staff.
"We're all a bit on edge because if you do happen to work with somebody with corona, you still do have that doubt in your mind of 'will I get it?'," Ms Hill said.
Hospitals in the North-West have long relied on locum staff. Ms Hill said this and the "casualised workforce" were factors that put the system "at risk" in the event of an infectious disease outbreak.
"If you have a non-permanent pool and casualised labour, they just don't know the system as well as a permanent staff member," she said.
While she herself hasn't been the subject of public abuse, Ms Hill said she knew of workers who had had comments directed at them or been given "a wide berth" in the street or in shops.
"It's not necessarily words and abuse as such, but you do feel sometimes like a leper," she said.
Supply of, and access to, PPE has been a significant issue during the pandemic, not just here in Tasmania but around the world.
It's not necessarily words and abuse as such, but you do feel sometimes like a leper.Sarah Hill, ANMF delegate and registered nurse
ANMF secretary Emily Shepherd said there had been a lack of "clear communication" around what PPE needed to be worn and when.
She said national PPE guidelines were regularly updated over the course of the outbreak, further complicating the situation for staff.
"That became really difficult in the midst of a significant outbreak at the NWRH and the NWPH when our clinicians were extremely busy as it was. Trying to keep across all of those changes to PPE requirements was difficult."
"Certainly there was concern in relation to access to PPE in some clinical areas at different times throughout the pandemic."
Ms Shepherd said her members had been "very much reticent" to publicly discuss the outbreak - and still were.
"Clearly, they were very concerned about how that would reflect on them, given the myths and mistruths that were perpetuated through social media and other forums," she said.
Hospitals in the North-West grapple with recruitment issues, Ms Shepherd said - something that was highlighted amid the outbreak, as the reliance on locums became increasingly evident.
"There's no doubt that the North-West at times does struggle with recruitment and retention of health care workers and we know that, from a nursing and midwifery perspective, it is difficult at times to fill positions," she said.
Independent Murchison MLC Ruth Forrest, herself a former midwife, said the inquiry into the outbreak needed to proceed on the basis that Tasmanian Health Service staff would be able to offer their views "frankly" and without fear of retribution.
"There needs to be protection for the witnesses, whether it's the nursing staff, the medical staff; anyone who wants to come forward," she said.
"You need a panel that is made up of people with expertise in infection control, in epidemiology, even in other areas of management of a disease outbreak.
"I believe they need to be from the mainland. Not because we don't have expertise here but because we're a small state ... so you want people that can be completely dispassionate and then it is truly independent."
Ms Forrest accused the government of "gaslighting" the North-West health workforce by saying there was sufficient supply of PPE.
"When ... nurses ... [and] medical staff as well are raising these concerns about a lack of suitable PPE to care for the patients ... and they raise these concerns and then they're told point blank by the minister and the Premier and the senior health bureaucrats and even senior management at the hospital 'no, you're wrong', it's like they're not being believed so they don't feel respected," she said. "They don't feel valued."
Health analyst Martyn Goddard is adamant management shortcomings are to blame for the outbreak.
"Many thousands of gowns, masks and so on were sent from [Hobart] to the North-West but these didn't arrive until three days before the NWRH was shut down.
"That these were not available at all four major hospitals by the end of February at the latest is frankly scandalous.
"There was no testing of staff until it was far too late to change the course of the outbreak.
"Staff continued to meet in small rooms where distancing was impossible: a number of infections took place in these settings. This is a failure not only of local management but of the system as a whole. That incompetence and neglect at many levels has cost lives and livelihoods."
Health Minister Sarah Courtney said the government was continuing to work on the recommendations from the interim report and was committed to a wider investigation.
"Important progress so far has included the appointment of the first ever infectious diseases specialist for the North-West, the development of new training in PPE and contact tracing, a new outbreak management plan, and the implementation of stronger screening processes in our hospitals," she said.
"By the end of June we are expecting all recommendations bar one will have been delivered, with implementation to be complete by the end of August."
Ms Courtney said the state was "prepared" for a second wave "but it is critical that we get the easing of restrictions right".
She said the inquiry would be undertaken by relevant experts after terms of reference were agreed upon.
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