About a year ago, Victorians were very concerned that COVID cases could overrun our hospitals. The virus was spreading wildly through the community. There was no vaccine. Lockdowns were the answer.
Unfortunately, we are almost at the same point again today. The main difference is that now there is a vaccine. But the bungled federal government vaccine rollout means not enough of us are vaccinated to stop the spread of the virus.
The answer is obvious, and always has been: vaccinate, vaccinate, vaccinate. Easy to say, but supply is still the issue, especially supply of what is now the vaccine preferred by many, Pfizer.
Less than one-third of Victorians are fully vaccinated, way below the 80 per cent plus of all Victorians needed to achieve so-called “herd immunity”, where the virus will not be able to spread so easily and hospitalisations will be maintained at low levels. With vaccination rates lower than 80 per cent, governments still need to monitor the number of cases and be wary about reducing restrictions before cases have plateaued and started to trend down.
Hospitals are facing burgeoning demands from COVID cases, exacerbated by the reality that they were stretched before the current outbreak. We have already been hearing stories for weeks about the stress hospital staff are under.
Victorians have watched with horror as NSW hit triple figures – more than 1000 new cases a day. The resultant demand on hospitals in south-west Sydney from people with serious illnesses overwhelmed their emergency departments. Hospitals responded by creating temporary makeshift capacity in tents outside to triage patients. Victorians don’t want the same here.
Victorian hospitals will be dusting off their emergency plans to help them face the foreshadowed deluge of COVID-related cases. The big concern is the shortage of capacity in intensive care units. This is not a problem that can be overcome easily. It is not a case of simply pulling more ventilators out of a cupboard – the equipment needs to be monitored by appropriately trained staff.
This is the key bottleneck and it is not an easy one to fix quickly. But temporary solutions include using staff from operating theatres – which of course creates shortages there – and using nurses from other parts of the hospital supervised by fully trained ICU staff.
The hospitals’ emergency plans should include a number of steps.
Firstly, hospitals should ensure full personal protective equipment is readily available for all staff, at all time. State governments should also mandate vaccinations for all hospital workers, to reduce the risk of infections and help to reduce the risk of staff being off work. This is already the case in NSW. Staff should also be screened daily prior to starting a shift using rapid antigen tests.
Secondly, hospitals – both public and private – need to be ready to reduce temporarily the number of elective procedures they perform, to free up capacity in ICUs and acute wards. Private hospitals should face significant penalties if they attempt to bypass public health orders and continue to perform low-priority procedures, as appears to have happened in 2020. And the state government should contract private hospitals to perform high-priority elective procedures on public patients.
Thirdly, hospital should again ramp up use of alternative sites of care, such as hospital-in-the-home, as occurred in 2020. Getting people out of hospital as quickly as possible helps both the patient – by reducing the risk that they might be infected while in hospital – and the health system, by freeing up capacity in that hospital for the next patient.
Fourthly, as happened last year, hospitals should draw on the retired workforce to backfill where possible as other staff are redeployed to the pointy end of care, or are taken out of the workforce because they are infected or sick.
But it’s not only up to hospitals to ensure that the Victorian health system will cope.
As difficult as lockdowns and restrictions are, the public needs to continue to support government in fighting the virus, and protecting hospital capacity, by maintaining restrictions, especially for the unvaccinated. A good way of showing that support is to get vaccinated as soon as possible.
Every one of us might potentially need hospital care – for COVID or other reasons – and it is in all of our interests to make sure the hospital system has capacity and can cope.
The good news is the Health Department, which is monitoring the spread of the virus, appears to have joined up the dots and reached the obvious conclusion: that increased cases brings increased risk of hospitalisations which means the hospitals have to be ready to cope with those cases in the very near future.
The state government should introduce into its daily reporting clear measures of how well the hospital system is going – not just how many COVID patients are in ICUs, but how much capacity is available for the next patients who will require intensive care.
Being open and transparent – as the government generally has been all along in the pandemic – including on the steps being taken to ensure our health system will cope, helps to build public confidence and support. That confidence and support will be all the more necessary in Victoria in the coming weeks.
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