The serious shortfalls in our COVID response give me no confidence our hospitals will cope
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When the world first paid attention to COVID-19 last year, World Health Organisation executive director Dr Michael Ryan was asked what he had learned from the African Ebola outbreak. His answer was clear and chilling. “Be fast,” he said. “Have no regrets. You must be the first mover.” If you failed to move decisively, “the virus will always get you”.
So, how is NSW going eight weeks into its third wave? Our system of test, trace and quarantine has been partially successful. But did we move fast enough? The answer is an emphatic no. Active cases have almost doubled in 12 days and continue to rise. Data indicates that about 5 per cent of infections requires hospitalisation and 15 to 20 per cent of this group need ICU admission. The number of patients on ventilators has nearly doubled in the last week.
ICU beds are filling up with COVID patients.Credit:SMH
We have been repeatedly reassured the health system will cope. As an experienced respiratory doctor at a major western Sydney hospital, I disagree, and so do many of my colleagues. We believe it likely that projected patient numbers will soon be overwhelming. Tragically, their ranks will include many frontline health workers such as paramedics and nurses. From Westmead to Liverpool and Blacktown, ambulances now routinely line up in hospital carparks, unable to discharge their patients. What exactly is going on?
At any hospital, the priority must be keeping COVID contained. Already, we have seen multi-fatality clusters where it is not. But only the newest hospitals are equipped with a handful of negative pressure rooms, engineered to stop spread of airborne infection. Some wards have been transformed into safe zones, using glass or tight-fitting plastic doors, along with best-practice air filters. However, these modifications are barely keeping up with new cases as they present.
Hospitals under stress have reacted out of necessity on their own, moving to cancel non-urgent surgeries and pivot other services to smaller local hospitals. However, there has been no central coordination to implement COVID-safe wards by NSW Health. No guidelines, no standardisation to share COVID patients equitably across all of Sydney’s hospitals, and apparently no ministerial oversight.
Hospital administrators and clinicians are making it up as they go along. An estimate of the number of COVID-safe wards in Sydney is anyone’s guess. Even as governments canvass easing lockdown restrictions based on Doherty Institute modelling, hospitals are yet to receive localised patient number projections, so crucial to create secure capacity and roster nurses and doctors in coming weeks. The only meaningful projections that are available on the ground come from invested but external epidemiologists and statistical wizards.
Imagine if during last year’s bushfires, brigade captains were not informed where fires were moving and what resources might be required. This is exactly what is happening now. Spot fires have turned into roaring blazes of the virus.
I know of a young child with a suspected foreign body in their upper airway who waited hours to be transported from south-western Sydney to an ear nose and throat surgeon, due to ambulance ramping. With the coming deluge of cases, it is possible ambulances will not reach people suffering heart attacks or strokes as quickly as they should.
New cancer diagnoses fell by one-third during the worst of the crisis in Britain. Clearing their backlog of outpatient clinic appointments will take years. If replicated here, it’s not hard to guess which patients, from which part of Sydney, will be most affected.
What can be done? The present head-in-the-sand approach must end. The NSW command-and-response headquarters, the State Health Emergency Operations Centre, must be beefed up so it can communicate in real-time with all hospitals on the pandemic frontline. It is running way behind where the action is. Incredibly, hospital response teams are not being approached directly and asked what they need. Experienced nurses are being pulled from under-pressure wards in western and south-western Sydney to deliver vaccines. Let this important work be done instead by medical students, allied health volunteers or nurses from further afield.
Most importantly, please rapidly expand COVID-safe wards at all major Sydney hospitals. Those in less affected areas won’t, unless centrally directed. More COVID-safe wards means ambulances have more places to take patients quickly – and will prevent hospitals collapsing domino-style.
A final word about vaccination. Forget 6 million jabs, treats and rewards. More than one in three people aged over 16 remains unvaccinated. Nearly two in three are not fully vaccinated and remain at significant risk of infection.
These numbers are sobering. And discussion of children’s jabs, the need for a booster program, and the implications of long-COVID for hospital capacity in NSW has barely begun. It’s time to stop the backslapping and resource our health system for what lies ahead.
The author works in a western Sydney hospital but has asked to remain anonymous due to area health service restrictions on employees providing commentary.
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