The memo, sent to all nurse unit managers and directors in Tasmania’s northern health region, was short and shocking.

On March 25, just five days before a passenger from the Ruby Princess cruise ship died at the North West Regional Hospital in Burnie, a state infectious prevention and control unit nurse manager wrote to hospitals under the subject line: “Collection of used P2 masks”.

“During COVID-19, it is important hospitals have adequate resources to deliver services effectively,” the memo said. “To assist in this, investigations for the safe decontamination and reuse of P2 masks and the refilling of alcohol hand gel bottles are being undertaken … All used, undamaged and unsoiled P2 masks are to be collected in a clear plastic bag in each department.”

It was an alarming message because, as hospital staff knew, P2 masks are single use. No health policy recommends reusing disposable masks.

When the directive was issued, there were 34 confirmed coronavirus cases in Tasmania. Five days later, when a Tasmanian woman in her 80s died from the disease, the numbers had almost doubled to 61 cases.

They would balloon again in the days that followed, largely due to a “super-cluster” in the state’s north-west, where at least 49 healthcare workers were left sick and in quarantine at the North West Regional Hospital and its private counterpart.

The outbreak, in a region that is “older, sicker and poorer” than almost anywhere else in Australia, seemingly took authorities by surprise and forced the dramatic closure of both hospitals.

On Easter Monday, Tasmanian Premier Peter Gutwein told the media that such an “extreme measure … has never been done before in 100 years”.

Almost 5000 people – including 1200 hospital staff, healthcare workers and their families – were immediately quarantined. In one stroke, 5 per cent of the north-west’s total population was locked down.

Health workers from the Australian Medical Assistance Team and medically trained members of the Australian Defence Force were called in, arriving this week in a bid to quickly reopen the accident and emergency wing of the public hospital.

Meanwhile, investigators are looking closely at the passengers from the Ruby Princess who are thought to have seeded the Tasmanian outbreak, but that alone cannot account for why the two Burnie hospitals turned into so-called “super-spreaders”. Nor, for that matter, can a rumoured dinner party involving hospital workers, the source of so much speculation this week.

Conditions inside both hospitals long before the outbreak may be a key factor. The Saturday Paper can reveal that top levels of the state’s government were warned about a severe lack of personal protective equipment (PPE) in hospitals across Tasmania. In a letter written on April 8, four days before the total lockdown was declared, one woman with knowledge of working conditions at the North West Regional Hospital laid bare the situation.

“Someone needs to get in there and do this better,” she wrote. “This cannot be described as unfortunate, it is extremely poor management and is putting lives at risk. Staff are being used as guinea pigs.

“Why are staff told to ration PPE? Why are staff who have had contact with Covid-19 patients now being asked to work in wards? What the heck is happening to nursing training if staff do not know infection control?”

Dozens of interviews with current healthcare workers, union officials, residents and people affected by the historic shutdown have painted a picture of a healthcare system that was “complacent” and unable to cope when infections spiralled.

Dan Jones, a surgical theatre technician at Royal Hobart Hospital (RHH), told The Saturday Paper that he spoke out ahead of the north-west lockdown because he saw worrying signs that equipment had run out at the state’s largest health facility.

“We have a shortage of yellow gowns [with full-length sleeves],” he says. “After 15 years of yellow gowns being compulsory for patients with superbugs, we are now told to just use a short-sleeve gown, which puts staff and patients at risk.”

Jones supplied photos of wards at the RHH, which had run empty of hand sanitiser and the iso-wipes used by staff to clean medical equipment.

His experience accords with that of Tim Jacobson, the Tasmanian state secretary of the Health and Community Services Union, who says supplies had been “stripped” from some parts of hospitals to plug gaps in more exposed areas.

“A number of non-clinical units had stock raided,” according to Jacobson. He says the W. P. Holman Clinic, a specialist radiation on-site cancer treatment centre at RHH, had its sanitiser taken and put on the wards at the hospital.

“No one has said this overtly, but we clearly have national shortages of personal protective equipment,” Jacobson says. “Masks, gloves, the protective jumpsuits: they have all been very, very difficult to source. It is all being rationed. We have seen mixed messages going out to staff over the last three weeks. Reuse your masks, you need to keep your masks, that sort of thing…”

The closure of the two hospitals has had knock-on effects for other procedures, as well.

A young woman, who did not wish to be named, told The Saturday Paper she was due to have a caesarean for her first pregnancy last Wednesday in Burnie but was told by phone on Monday this was cancelled and would be rescheduled for Launceston General Hospital (LGH) on the Thursday.

“The doctors I’ve seen from Mersey hospital [in Latrobe] have both agreed that I needed a caesarean due to my placenta’s placement,” the woman says. “When the LGH rang on Monday they asked me to get another scan to triple check that I still need a caesarean, which I had done yesterday.”

Following the scan, a doctor from Launceston General Hospital rang the woman and said he “didn’t think” a caesarean was necessary. The surgery was cancelled, to be reassessed later.

“I’m honestly worried that it has been a decision to maybe reduce the number of surgeries or something,” she says. “I’m quite worried as the complication I’ve had could have very bad consequences for myself or the baby if they have made the wrong decision.”

These are not isolated cases.

Burnie councillor and local GP Themba Bulle says his practice was “requested to open” last Monday to “alleviate the pressure” of the closures.

“This is a huge thing that has happened,” he says. “Anxiety has risen and there is a lot of anger. The response has, at times, been shambolic. I think we were cautiously hoping that we would be saved but we were not. The numbers kept going up.”

Anita Smith Johnson, a nurse at the North West Regional Hospital, told others on social media just days before the shutdown that “the troops at the hospital are working above and beyond”.

“It’s not their fault it is rampant,” she wrote before the Easter long weekend. “We are all trying very hard to follow protocol and procedures that have been put in place, it’s just a step ahead all the time.”

Federal independent senator Jacqui Lambie, who lives in Burnie, is furious.

“I am pissed off,” she said. “I think it’s disgusting. They [politicians in Hobart] are lying their arses off down there. We need information and we need to be reassured because we have no idea what the outcome is going to be in the north-west over the next 10 to 14 days.”

Jacobson, from the health services union, says the “chickens have come home to roost” for the state’s healthcare system and a “decade of austerity”.

The issues in Tasmania underscore issues elsewhere in Australia. The National Medical Stockpile, first established in 2002 for national emergencies and security threats, contains only surgical and P2 masks. There are no other items, such as goggles, gloves, aprons and gowns. A spokesman for the federal Health Department said those were being purchased.

One primary healthcare nurse, who works in a GP clinic in regional NSW, told The Saturday Paper staff there have been reusing single-use masks for a week at a time. “They have been advised to spray them with metho overnight,” she says.

“I don’t know where that advice is coming from, but it’s certainly not best practice. At some point, this becomes a safety issue for staff. It’s so, so shit.”

Another GP in Tasmania told The Saturday Paper she was down to her last five P2 masks and was told by the local Primary Health Network, a federally funded body, there were plenty of surgical masks. One glaring issue with that distinction is this: surgical masks will stop a healthcare worker spreading the virus, or infecting a patient on the operating table, but only P2 masks provide protection to healthcare workers from becoming infected.

The president of the Australian Primary Health Care Nurses Association, Karen Booth, says workers are being told by their bosses to spray used masks “with Glen 20 or soak them in bleach”.

“The implications of this are disturbing,” she says.

In a statement, the NSW Department of Health was clear about its own protocols.

“Staff should ensure that any item which is not reusable is not cleaned and used again,” a spokesman said.

The experiment in Tasmania has been aborted as new supplies flow in to the state, but it was abandoned too late.

“It is a mystery as to how this thing spread from what seems to be the surgical and medical wards right across the hospital,” Tim Jacobson says of the outbreak at North West Regional Hospital. “This didn’t just infect medical staff, but cleaners and people in other positions. Now, why are they being so secretive about that? What did they know about the extent of the spread and what procedures did they put in place to deal with it?”

Tasmania’s north-west, a historically underfunded region affected by poverty and poor health, has been shattered. It will be years before it recovers.

Correction: An earlier version of this article incorrectly stated that Tasmania's hospitals, including the North West Regional Hospital, have some of the highest rates of golden staff infection in the country. In fact, they have some of the lowest rates. The article has been amended to correct this error.

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