For four days the footy ground in Mildura in north-west Victoria has been the central coil in a slow-moving snake of cars inching bumper-to-bumper through kilometres of gridded streets, waiting to be greeted by health staff in PPE wielding coronavirus swabs.
It is the most visible sign of a regional health system experts say has been pushed to its limit attempting to smother a spot fire of the global pandemic that landed on its doorstep.
The effort, by all accounts, has been phenomenal, but cracks in the system started to show early. The limited surge capacity of regional healthcare – one of the weakest links in a chain of protections separating regional Australia from what New South Wales MP Helen Dalton nervously called “a tonne of trouble” – was soon on display.
On Sunday, local health staff in Mildura woke to the phone call many had been dreading since the pandemic began. After 15 months without a coronavirus case in the town, a man who had attended the footy game at Melbourne’s MCG with a positive Covid case had visited the local hospital and later tested positive himself.
Staff rapidly assembled a drive-through testing site and over five hours tested 464 people for coronavirus. But the small team was quickly overwhelmed, with cars banked up waiting for a test, and the city in gridlock.
Six staff at Mildura Base Public hospital were sent into isolation to await the results of coronavirus tests, the first in a growing pool of healthcare staff who would be taken off the frontlines.
By Wednesday, 55 staff from the hospital were in isolation, along with staff from the peak Aboriginal health service, mental health and family violence support staff, aged care workers and frontline health staff from outlying towns more than 100km away.
While only some workers had come into direct contact with the positive case, others had attended a growing list of exposure sites in the small and close-knit town. More had been sidelined by extra-cautious policies around the highly contagious Delta variant of coronavirus.
The hospital was forced to close walk-up clinics and some surgery to keep high-level elective surgery, chemotherapy, dialysis and antenatal programs going, Mildura Base Public hospital chief executive Terry Welch said.
Mallee District Aboriginal Services temporarily cancelled appointments and closed its doors. Mental health and family violence support shifted to remote contact, while calls for help increased.
Across the border, the NSW government sent in extra supplies and extended testing hours at Wentworth, after the hospital ran out of swabs on Monday.
The Rural Doctors Association of Australia CEO, Peta Rutherford, said surge capacity in regional towns was “limited”, particularly when there were outbreaks in other parts of a state.
She called on the federal government to implement a “register of appropriately qualified health professionals” who can support local teams in disasters.
“There is some capacity [for commonwealth surge support],” she said. “But what happens if there’s another site of a similar size to Mildura?”
In a statement, a spokesperson for the health department said the Victorian government had access to a “pandemic sub-register” of 28,000 registered health professionals “who can provide surge workforce capacity to assist in the Covid-19 response”.
Officials were keeping a close eye on towns around the state this week, with one third of close contacts located in regional Victoria on Monday. Remote locations such as Nhill in western Victoria listed their first exposure sites of the pandemic.
“The reality is, when you’ve got breakouts in multiple sites you’ve got limitations,” Rutherford said.
Anxiety around exposure sites in the town was heightened by what appear to be low vaccination rates.
Local GP Dr John Dyson-Berry said he noticed people were “running around trying to get [vaccination] appointments” on Monday, and said demand had been strong at his clinic, Lime Medical.
Exact vaccination rates in the area are unclear. A spokesperson for the federal health department, which captures vaccination data across the country, said vaccination data by local government area was “not currently available”.
As of Monday, the three main vaccination providers in the town had given around 5,000 first and second dose jabs to a regional population of about 50,000. These figures do not include 17 smaller providers offering coronavirus vaccinations in the area.
Locals have reported difficulty accessing vaccinations after the main provider, Sunraysia Community Health Services (SCHS), closed off bookings for Pfizer vaccinations on 6 July due to “lack of supply”.
A spokesperson for the Victorian government said an additional delivery of 500 Pfizer doses arrived in Mildura on Monday on top of regularly scheduled deliveries. As of Friday, SCHS had 1,600 people booked in, each of whom will need two jabs.
Back at the testing sites, teams from Bendigo and Goulburn Valley arrived on Sunday and Monday to help manage demand. Local businesses delivered coffee, scones and heaters to keep workers warm.
By Wednesday, 2,670 Covid tests had been completed and services began to scale testing back. With no new cases or exposure sites listed in the region, authorities appeared to be bringing the situation under control.
But as testing demand stabilised, staffing levels at local health providers remained low.
By Wednesday, Mildura hospital had managed to source 13 staff from Swan Hill, Bendigo and a private agency to fill in for 55 sidelined staff who would have to isolate for 14 days after returning a negative result.
Meanwhile, some remaining staff at Mildura Base Public hospital worked 16-hour double shifts to keep services running.
“Health professionals … go above and beyond to provide care to their community, but [working double shifts is] certainly not sustainable in the medium to long term,” Rutherford said.
“There’s no question we need [the extra staff],” Welch said.
In a statement, a spokesperson for the Victorian health department said: “We’re working closely with Mildura Base hospital and other health services in the region to provide additional staffing for the hospital and prioritise testing for staff.”
Although the current situation was stabilising, Dalton said she remained nervous health services wouldn’t be able to contain a larger outbreak.
“I am incredibly fearful every day listening to the updates. I’m just hoping and praying that it doesn’t get to us because we will have needless loss of life,” she said.
“[The NSW government is] on a wing and a prayer the whole time, just hoping the gods will look after us or it won’t get into rural communities.”