Paediatrician Dr Paul Bauert is in lockdown, like millions of Australians, although he is working more remotely than most. From his home in Sydney’s inner west, he’s joining daily telemedicine meetings at the Royal Darwin Hospital and offering consultations to paediatric patients in remote Aboriginal communities in the Northern Territory and Queensland.
“There have been a few glitches,” he says, “mainly due to satellite connections … but at the moment they are few and far between. It’s always at the back of the mind … is everything going to be overloaded? It might implode like the Centrelink network. But it hasn’t happened yet.”
Bauert is one of the lucky few who are connected to the national broadband network (NBN) by pure fibre optic cable, which runs all the way into his home. We spoke after he had joined a weekly radiology meeting at Darwin hospital via a Zoom video conference. “It worked brilliantly,” he told me. “MRIs, X-rays, an ultrasound… They all came up really well.”
Normally, Bauert would operate on a fly-in fly-out basis, but now consultations are being done remotely to protect Indigenous communities from what he describes as a “potentially catastrophic” outbreak of Covid-19.
During one of these remote consultations, Aboriginal health workers or remote area nurses will check the child’s vital signs and can conduct examinations or adjust medications while being supervised by Bauert. The community clinics connect to the NBN via satellite.
As a federal councillor for the Australian Medical Association, Bauert has been part of a lobbying effort to ensure telehealth consultations by doctors and other allied health professionals can be bulk-billed for all patients regardless of whether they have Covid-19. But he is well aware that not everyone has an internet connection as robust as his own – including most doctors.
Only about 20 per cent of Australian households have a pure fibre optic connection like Bauert, those who were connected to the NBN before the Coalition won power in 2013. Since then, the rest of the network has been rolled out across the country using increasingly unreliable old pay-TV cables (HFC), fibre to the kerb, fibre to the node (FTTN), fixed wireless or satellite connections.
Last Sunday, federal Health minister Greg Hunt announced $669 million in new spending to provide Medicare-subsidised, whole-of-population telehealth services. From their own home, Australians will be able to phone or video call their GP and access everything from mental health treatment to chronic disease management, pregnancy support counselling, after-hours consultations and nurse practitioners.
In a joint ministerial statement, Hunt said the telehealth arrangements would run until the end of September and “take pressure off hospitals and emergency departments and allow people to access essential health services in their home, while supporting self-isolation and quarantine policies”.
But technology experts are worried the NBN may not cope well with the inevitable increase in demand from a surge in telehealth – especially as the network is already under enormous pressure as millions of Australians work, study and entertain themselves at home.
Microsoft’s giant Azure cloud service behind video-conferencing app “Teams” has started to strain. Netflix and YouTube have agreed to reduce streaming quality to ease network pressure. Telstra has urged its customers to ration their internet use and has fast-tracked a half-billion-dollar investment in 5G, while telecommunications industry body Communications Alliance this week asked broadband subscribers to consider ways to lower data traffic during peak hours such as not sending large files.
Amid all of this, the coronavirus pandemic has served as a stark reminder that telehealth was one of the main reasons for building the NBN in the first place. Telecommunications consultant Paul Budde, who was involved in the original discussions that led to the NBN, says when he began arguing for major public investment in superfast broadband infrastructure 15 years ago, “the only reason I was listened to by the government of the day was because I was talking about the social and economic benefits”.
“I was not talking about the entertainment internet, or the games internet. I was talking about telehealth, tele-education and teleworking,” he says. “That was the reason why I thought that the government could afford to spend money in the national interest – to build a network that could handle that. Anything else on top of that, fine, charge for it.”
With the pandemic, says Budde, “We are now starting to understand the national importance of the NBN, rather than [whether] it makes a profit or not. These are the lessons that, I’m 100 per cent sure, we are going to take on board once we get over this crisis.”
The NBN is 95 per cent rolled out, due to be completed midyear at a total construction cost of $51 billion. But some parts are nearly redundant. In February, Telstra announced it would no longer offer 100-megabits-a-second plans over FTTN. Junior telco TPG reported that dropouts on the HFC network had doubled. And this was before the pandemic struck.
In a sign we’re in extraordinary times, the government this week convened a special working group of the NBN and the top five telcos to “share information, coordinate strategies to manage congestion and take other steps to address significant demand changes caused by the Covid-19 pandemic”. The temporary arrangement had to be ticked off by the Australian Competition and Consumer Commission because such a group would normally be considered anti-competitive.
Co-operation between competitors is now required, it seems, because of the unprecedented increase in demand caused by Covid-19.
The virus has been billed as the NBN’s biggest test because, for the first time, many households will be seeking to upload content to the internet, not just download it. According to the NBN’s own data, up to the end of February – prior to the pandemic outbreak – the average weekday traffic was about five terabits a second (Tbps) across the NBN between 9am and 5pm. Peak traffic, which typically occurs between 8pm and 10pm every night, when everyone is streaming video, is about 10Tbps. That means the network has enough capacity for daytime usage to double at least.
But already records have been broken. The latest figures show traffic in business hours has increased by 21 per cent to 9Tbps, while peak evening traffic has jumped by 25 per cent – last Friday evening, the NBN handled a record 13.8Tbps of data. The company expects daytime traffic will continue to rise during lockdown by 70 per cent. To create more headroom, the NBN agreed to provide internet retailers with an extra 40 per cent peak capacity, free of charge, for three months.
John Parkin, the NBN’s acting chief network engineering officer, told The Saturday Paper that while the peaks sounded large, the network was “built to handle event-based spikes and sustained growth in data demand. Data demand has been doubling every four years, and we have accommodated and will continue to provision additional capacity ahead of that growth.”
However, trying to meet growing demand in the past few years hasn’t been easy for the NBN. During this time, consumer complaints have soared, and the most recent speed tests found Australia has the fourth-slowest broadband in the OECD. Earlier this month, the telecommunications industry ombudsman, which sent its own workers home to self-isolate, reported it was struggling to deal with a rush of “pandemic-related” customer service complaints.
Laurie Patton, vice-president of telecommunications industry body TelSoc, says the extra capacity the NBN is offering won’t be much help to those on the wrong side of the digital divide created by the network, particularly people using the lower speed plans connected by FTTN or fixed wireless. He has written to the prime minister and premiers, calling on the government to use some of the fiscal stimulus spending to urgently upgrade the slower parts of the network, rolling out more fibre and employing thousands of retrenched workers.
“My biggest concern is for the mental health of those unlucky souls battling with a dud broadband connection. It makes it harder for them to send files back and forth with the office, school or university and between colleagues and classmates – and, of course, it makes video conferencing difficult,” he says. “It’s frustrating enough when your movie buffers, but what about if it happens when you’re trying to send in an assignment or a report to the boss who has been hounding you for the last hour?”
For telehealth in particular, a poor internet connection could be a matter of life or death. Dr Bauert believes the pandemic will mark a permanent shift in the way doctors and other healthcare workers use telehealth.
“It’s going to change the way we do business, actually. I think there will probably be a lot more telephone or video consultations after the dust has settled from Covid-19,” he says. “It’s important for the government to think about that and plan for that, because there definitely are advantages to doing it this way.”
This article was first published in the print edition of The Saturday Paper on April 4, 2020 as "Viral internet".
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