Each day I weigh the pressure to prematurely discharge those in my care on the wards, against the needs of those on stretchers waiting their turn

Is it strange to feel nostalgic for 2020?

Yes, there was fear. Fear of the unknown, infection, death. Perhaps worst of all, there was fear of bringing the virus home to our loved ones.

But equally, there was hope. There was unity of purpose. We thought we saw a finish line in sight as case numbers dwindled. We looked forward to vaccines and better times ahead.

Now, two years on, resilience is depleted. As we crest our third Omicron wave this year, we are locked into a seemingly endless cycle. Collective denial takes us to the precipice, before we reach the peak and draw a sigh of relief. But, while many in the community return to “normal”, those working in hospitals are left to deal with the brutal rebound of pent-up demand. Each post-Covid surge feels more chaotic and unmanageable than the last. Meanwhile, the next wave builds. This time it’s BA.2.75. It will break in the spring. (I hope I’m wrong).

No wonder a recent study found around two thirds of Victorian healthcare workers were burnt out. Disturbingly, 46% of nurses surveyed had considered leaving the profession. A rubber band can only stretch so far.

But still, it’s amazing what humans can become used to. I can remember a time when doctors saw patients without masks and face shields. Gathering for lunch inside on a cold day, sharing a coffee in the office, debriefing over a beer after a hard day.

Now? N95 mask, face shield on. Strap in. 12 hours. Coffee breaks – rare. Lunch – take it outside. We do all these things because we know transmission is high and poorly ventilated spaces are dangerous. If we get Covid, no reinforcements are coming to care for our patients.

Working through the latest wave, not a week has gone by without members of our team isolating with Covid. They are not able to be replaced due to the shortages of clinicians. We constantly need to do more with less. Bed managers play an endless game of Tetris. I walked into the emergency department recently and was confronted by a row of six patients on stretchers, waiting patiently, supervised by ambulance crews, stuck, off the road. I shuffled off to review my vulnerable patient, now several days waiting in the emergency department. I’m becoming intimately familiar with a concept I learned about in medical school – moral injury. Each day, I try to navigate the least worst path, weighing the pressure to prematurely discharge those in my care on the wards, against the needs of those six patients on stretchers waiting for their turn.

Healthcare is a finite resource. We are a burnt-out workforce rationing our care as best we can. It is not a question of if but how much will be the cost in avoidable harms to our patients.

More than anyone I feel for our juniors, who know nothing but the overwhelming demands of this pandemic. They have missed out on so much. They don’t know normal. Or what it used to be.

The latest Covid wave has caused delays to non-urgent surgeries. Beyond the hospital walls and tragic deaths, Covid continues to reach into every aspect of our lives. At our recent peak, around 400,000 Australians isolated for seven days. Just under 10% will suffer long Covid – weeks or months to return to work and normal life.

Flights postponed. Garbage uncollected. School classes cancelled. Labor shortages stifle productivity and fuel inflation.

I can hear the confected outrage. The same breathless commentators that won’t countenance modest preventative action one day, lament the inevitable consequences the next. These voices have succeeded in reducing the debate to a binary choice between lockdowns and “let it rip”. The greatest challenge now requires a more nuanced approach if we are to thrive in the time of Covid.

Thankfully we are protected to a large degree by vaccination now. The question is – what is our goal? How do we want to “live with Covid”?

Using the least intrusive means, we should maximise human connection and economic activity, and minimise the spread of the virus.

We know the game plan: vaccines, clean air, high-quality masks, access to tests, and a safety net to isolate.

The harder part is acknowledging and confronting Covid after the collective trauma we have endured. If only wishing it were over would make it so. But it’s time to wake up. Covid is here to stay. How we live with it is up to us.

Dr Aaron Bloch is an infectious diseases physician working in Melbourne and regional Victoria