Robyn Schofield has a greater-than-average interest in the latest wave of Covid-19 now sweeping Australia. As an aerosol scientist who has been working with respiratory specialists and others throughout the pandemic on how best to protect against the virus, the Melbourne University associate professor knows what is required to stop it spreading. Now also a patient who has just completed chemotherapy and radiation treatment for breast cancer, she is alarmed at what is not happening.

Across Australia, just as the new wave breaks, hospitals have begun winding back their mask-wearing mandates for staff and patients. Many also have not introduced measures to filter their air – which can be managed through pleated mechanical high-efficiency particulate (HEPA) air filters – despite science having now confirmed that the virus is airborne.

“There is still a resistance in infectious disease as well as infection control clinicians in this space,” Schofield tells The Saturday Paper. “There are hospitals that have embraced it, but there are many that have not.”

The initial belief that Covid-19 was transmitted through droplets – particles heavy enough to be dragged down by gravity – produced a strong early emphasis on handwashing, sanitising surfaces and keeping far enough apart to avoid inhalation. Eventually it was confirmed to be airborne, meaning its particles are light enough to float and drift for some time after they are exhaled. That new understanding called for completely different protective measures, including mask-wearing, ventilation and air filtration. Some specialists say the necessary policy and advice adjustments have not been made fast enough, if at all.

Australia’s Covid-19 strategy is now centred on vaccination. Medication regulator the Therapeutic Goods Administration approved two new vaccines last month to combat the latest XBB Omicron variant. The Saturday Paper understands the approval process is not complete and the government is yet to receive a final recommendation from its vaccine advisory body. No date is available for a rollout, nor confirmation that vaccines have been procured. In the meantime, the government insists existing vaccines stillprovide “good protection” and those who have not had boosters should get them.

The national guidelines on preventing and controlling infection in healthcare settings formally acknowledge the virus is airborne. In August, they were amended to remove droplets as a transmission method and to redefine when high-level sanitising is required – no longer when there is the “potential” for an outbreak but when one has occurred.

The guidelines specify that P2 or N95 masks should be worn. Experts confirm N95 respirator masks offer the highest-level protection and surgical masks are considered inadequate. The states and territories manage mask-wearing regulations and have passed the responsibility to individual hospitals. Many are easing back requirements for both staff and patients, including in some cases where patients with cancer and other vulnerabilities are being treated.

“It’s up to every hospital to navigate that and, of course, they don’t have the multidisciplinary team that they require to do that,” Robyn Schofield says. “And there’s no real leadership, I would say, and policy guidance around that.”

Australian Medical Association president and Australian National University professor Steve Robson is also calling for more mask wearing in healthcare settings, especially as a new Covid-19 wave breaks.

“You can do it immediately,” Robson tells The Saturday Paper. “You don’t need to install infrastructure or anything like that. You can put a bloody mask on.”

Mask wearing can be irritating and having high-grade and properly fitted masks for healthcare workers – ideally fit-testing mask types at least once a year on every staff member – is expensive. But Robson points to another complication – that the whole idea of wearing a mask has become highly politicised.

“I’ve never seen anything like it before,” he says. “No one would ever say to you, ‘Don’t wear gloves if you’re doing surgery.’ I mean, it’s extraordinary. I don’t know what it is about masks that causes such a violent political reaction from some people … It’s not an imposition on your liberty. It is a way of protecting people … It’s really important.”

Unofficially, the view within government is that Australians are fed up with masks – a legacy of the strict rules and severe lockdowns of the pandemic’s emergency period – and now would not comply with directives nor heed campaigns. Health professionals dispute this. Some believe a well-crafted social responsibility campaign could change people’s behaviour, saving lives and cutting healthcare costs through lowering infection.

“They could shape it and lead,” Schofield says.

She argues there is too little focus on indoor air quality. There are no national standards and it’s not something people think about because the particles are not visible.

“It’s a case of being out of sight, out of mind,” Schofield says, contrasting the vigilance around smoke hazards during bushfire season with a creeping complacency about Covid-19. “You know, my phone rings off the hook when we’ve got a bushfire, and then everyone’s like, ‘Oh, no, we’re good now, we can breathe again.’ ”

In a reply to written questions, a federal Health Department spokesperson noted the chief medical officer’s announcement on October 20 that Covid-19 was no longer considered a communicable disease of national significance.

“The Australian Government continues to balance public health and social measures against the health risks of COVID-19 to ensure our response remains proportionate, whilst protecting those most at risk,” the spokesperson said.

Among six recommended measures to avoid transmission, including staying at home when infectious, avoiding high-risk settings, practising good hand and respiratory hygiene, and maintaining physical distancing where possible, the suggestion to “elect to wear a mask in indoor public environments” was last. The spokesperson emphasised that vaccination was the best way to guard against severe illness.

However, vaccination does not stop transmission and Australia’s vaccination rates have fallen away, with few people having boosters. Combined with the fact that those who were infected more than six months ago will have little residual immunity remaining, that makes this wave potentially more lethal than the last. The most current published national figures show hospitalisations for Covid-19 rose 17.5 per cent in the week to October 24.

Advocates for those most at risk from the new Covid wave – cancer patients, those with other serious underlying conditions or compromised immune systems and people with disabilities – question Labor’s pre-election pledge that nobody would be “left behind”.

David Berger, who works as a doctor in various country locations across Australia, believes the collective level of government encouragement on masks is “weak”.

“It’s just gestures, meaningless gestures really,” says Berger, who believes governments are acting as if putting vulnerable people at risk is “acceptable”.

“It’s kind of ‘tough shit’, you know?”

Craig Wallace, policy head for the Canberra-based Advocacy for Inclusion, says immunocompromised people feel abandoned.

“We are very concerned about the narrative that only people with underlying conditions are being affected, like that is an acceptable level of collateral damage,” Wallace says.

Wallace wants mask wearing strongly encouraged in disability group homes, and acute, allied healthcare and aged-care settings, along with clean air and a clear information campaign.

Berger says the absence of consistent data is part of the problem. “There isn’t any attempt, really, to safeguard hospital patients,” he says. “There’s no nationwide attempt. There’s no auditing … Let’s measure, let’s have a look. Let’s see the data. But they won’t measure it.”

The Burnet Institute’s chief health officer for emergencies including Covid-19, Associate Professor Suman Majumdar, says the new wave warrants more active measures, and it should not be a binary choice between personal responsibility and government edict. He also argues better data would help significantly.

“There is a sensible approach in the centre where there is recognition, advice, transparent data and people are informed,” he says, suggesting current and future pandemic responses should be non-restrictive, including clean indoor-air strategies, widely and quickly available vaccination and accessible testing and treatments.

While some other data is patchy, national statistics are still being collected on infection rates in residential aged care. In the past month, the number of outbreaks in residential aged care has leapt from 148 to 254 and the number of individual cases more than doubled, from 733 to 1575.

Only a few state-and-territory jurisdictions are collecting data on hospital-acquired Covid-19 and there is no national database. Victorian data from last year, made public through a freedom-of-information request recently, revealed 10 per cent of patients who contracted Covid-19 in hospital were dying from it.

Robyn Schofield calls that figure “horrific”, especially given she undertook chemotherapy to lower her recurrence risk by 6 per cent.

“I didn’t want to do chemo, but when faced with a 6 per cent [risk] I was like, ‘Okay, I have to do chemo.’ And when faced with a 10 per cent risk, while being immunocompromised, of dying if I catch Covid, I wear a mask and I want everyone around me to be wearing a mask – particularly those professionals that are treating me, who are doing an amazing job.”

At a state parliamentary budget estimates hearing in New South Wales two weeks ago, the state’s chief health officer Kerry Chant revealed NSW had no statewide statistics on hospital-acquired Covid deaths.

“We don’t actually know the exact mortality associated with Covid,” Chant said. “All I can confirm is that we are conscious of taking every step we can to minimise the risk of transmission.”

Asked about ongoing protective measures, Chant urged people who were ill to stay home and especially not visit hospitals or aged-care or other health facilities. Her only advice on masks was not that people should wear them, but to be kind to those who do.

Steve Robson says it’s an odd message when masks are simple, cheap and effective. “The message from that is, ‘You’ve got something wrong with you if you’re wearing a mask, but we’ll accept your faults and we’ll be nice to you.’ ”

Craig Wallace says mask wearing must become the norm again, and that immunocompromised people are increasingly fearful of infection, even when attending medical appointments. “I know people that are contemplating doing their own dentistry,” he says.

Steve Robson agrees that millions of extremely vulnerable Australians are being sidelined. “I don’t think we’ve put nearly enough brainpower or effort into how to keep those people safe in the long term. And I think for many, many people it’s very, very frightening … They see in the community a very laissez faire approach to infection control.”

He adds that the absence of active guidance on mask wearing, especially in high-risk settings, potentially contradicts the charter of healthcare rights, which declares that all patients should expect to be safe when accessing care.

Robyn Schofield says people are prepared to take all kinds of measures to prevent illness or injury in other areas, and mask wearing should be the same.

“We’re sun smart,” she says. “We wear a seatbelt … There’s many inconveniences that we tolerate for the good of others.”

She wants the same levels of regulation around safe air as exist for food and water.

Radiation oncologist Dr Bronwyn King, whose advocacy work against smoking has led her into the field of air quality, also argues for mandatory ventilation standards as “a basic health requirement”. She says policy should change with knowledge, pointing to increasing evidence on the impact of repeat Covid-19 infections and confirmation that clean indoor air reduces risk.

“We shouldn’t be doing the same thing that we were doing a few years ago because now we just know so much more,” King says. “We know that long Covid is a significant risk. We know that everybody is at risk of long Covid and we know that the outcomes for many people with long Covid are very poor … If we put all of that together, I think that we should be more ambitious in protecting people from Covid, and educating them so that they understand why it’s much better for them to protect themselves and demand clean indoor air.”

Schofield argues governments everywhere should be actively engaged in education and data gathering studying the impacts of this pandemic. “It’s about resilience for the next pandemic,” she says.

The federal government’s year-long national inquiry into management of the pandemic, announced in September, is designed with an eye to that, although it has been criticised for not having the powers of a royal commission and appears unlikely to hold public hearings.

This week, the terms of reference were quietly tweaked to add an explicit authority to examine the most controversial of anti-Covid measures: lockdowns. After the change emerged, Health Minister Mark Butler suggested it simply reflected what he had always envisaged. Butler said he had indicated in September that it should examine health response measures through the pandemic and this would “obviously” include school and border closures, social distancing and lockdowns.

“It would be extraordinary for an inquiry not to examine the operation of those measures,” he said. “And so that’s been made clear by the inquiry committee.”

But he added this did not mean the inquiry would “go through every one of the thousands and thousands of decisions that individual state governments took”.

Craig Wallace questions the political will in an atmosphere of moving on.

“We’re not post-pandemic, we’re still in it,” he says. “We’re managing the consequences of it and in some ways, they’re getting worse.”

Steve Robson hopes the inquiry is an opportunity to “reset a bit of this and rethink our messaging”. He is not backing any return to lockdowns and not advocating either for or against more mask mandates, but he notes that wearing masks stops transmission while vaccination does not. He says the main issue is to ensure people remain conscious that Covid is still a major threat and “taking lives every week”.

“We’re continually having new waves and our response to it is getting more and more feeble,” Robson says. “We need to really think about what is important for us as a community and to work on that.”

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