Medical Journal of Australia editor Nick Talley says the Morrison government has botched its messaging on COVID testing as case numbers hit record highs.
"I just cannot believe we're in this situation," the University of Newcastle laureate professor and John Hunter Hospital staff specialist said on Thursday after the Prime Minister scrapped PCR testing requirements.
Mr Morrison said Australia had "no choice but to ride the wave" of the omicron outbreak and anyone who tested positive via an at-home rapid antigen test could contact their GP.
Professor Talley, the 2018 NSW Scientist of the Year, said this approach was suitable for young people but not for Australia's legion of retirees.
"If you're a healthy young person, I think it's sensible to assume you've got COVID if you've got symptoms," he said.
"Obviously, preferably get a RAT test and make sure you isolate and do all the right things for the time periods that are recommended.
"That's relatively straightforward, and almost everyone in that category's going to do well.
"If you're an older person, very old or immunosuppressed or with serious illness, that's a different ball game. And that's a lot of people, a huge percentage of the population.
"There, the advice has been to contact your GP, but the poor GPs don't seem to have been well organised, either, in terms of what to do and how to support cases at home."
Professor Talley said there was a danger in not linking older COVID-positive people quickly with medical help.
"What worries me is early intervention for people at high risk of developing serious problems with COVID. That's going to be interfered with with this process.
"You need a PCR test to be positive to be able to qualify for anti-viral therapy, for example, and that needs to be given really early. It can't be given a week later.
"We are in the situation where potentially some people are going to have a bad outcome because of these policies, and no one seems to be talking about that."
He said evidence from overseas suggested omicron was sweeping through younger populations but increasingly affecting older age groups.
"We don't know what that means in terms of the outcomes, but presumably some older people and people with other serious conditions are going to do much worse, so we may seek a spike in mortality.
"This disease tips people over if you've got heart failure or kidney failure or some other major problem."
The rising hospital admissions have prompted Premier Dominic Perrottet to flag that NSW could suspend elective surgery again and turn to private hospitals to help manage the case load.
"During the delta outbreak, and the year before, we suspended elective surgery for a period of time," he told 2GB radio on Thursday.
"That is certainly something we are looking at now."
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NSW COVID hospital admissions increased 115 per cent in both of the past two weeks and 81 per cent in the week before that.
Hospital admissions peaked at 1268 and ICU numbers at 242 during the delta peak on September 21.
Professor Talley feared NSW was heading for tent hospitals as government policy settings were "locked in" to the virus spreading "right though the community, including nursing homes and other places".
"I'm really worried about the hospital system. That I'm really concerned about," he said.
"The numbers in hospital keep going up, and the trends look exponential, which means we're going to have a more dramatic increase down the track.
"And I'm still worried about the children. Overseas stories [are] of paediatric hospitals filling up.
"We still don't know severe it will be, but the young children are still unvaccinated."
It's a difficult time for the system, and, while I think they can adjust to a certain extent, they're going to really need to think about the field hospital model the way this is going.Professor Nick Talley
He said cancelling elective surgery was "bad news" for those on waiting lists.
"The next group who will be affected are those with acute illnesses coming through emergency departments.
"It's a difficult time for the system, and, while I think they can adjust to a certain extent, they're going to really need to think about the field hospital model the way this is going."
Mr Morrison's direction to stay away from PCR testing stations seemed to have little effect on people's behaviour as long queues again formed at drive-through sites across the Lower Hunter.
"I think the lack of clear messaging by government has been incredibly poor," Professor Talley said.
"I'm flabbergasted that we don't have clear messaging for the general population about what to do and when.
"There should be ads on TV about this is what you do if you start to feel any of these symptoms.
"It seems to me pretty clear that basically we're going to have to be looking after ourselves in this crisis, and that means, because it's so hard to get a PCR test now, using rapid antigen testing."
Professor Talley said he had been disappointed with the Prime Minister's recent media conferences.
"It's been more about the politics than the health issues," he said.
Mr Morrison also announced that about 6.6 million concession card holders would be eligible for 10 rapid antigen tests at no cost over the next three months after days of pressure from medical and charity organisations to make the tests free.
The tests are known to return false negative results, especially in the early days of infection when people can pass the virus on to others, though their positive results are accurate.
The lack of PCR testing will make it much harder to track the incidence of COVID-19 in the community, though NSW is working on a system of reporting positive at-home tests to health authorities.
In Victoria, where the government estimates one in 20 people in their twenties has the virus, positive RAT results must be reported to the Department of Health online or by phone.
The Belmont vaccination hub did a brisk trade on Thursday as people rushed to get their booster shots, which Professor Talley said would provide "significant protection" against hospitalisation.