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An official state government document reveals that Victorian hospitals would be forced to ration care in emergency departments to a minimum level and turn away all but the sickest COVID patients if a predicted rush of cases hits the system in mid-December.
The document released by the Premier’s office says if more than 2500 COVID patients are admitted to hospital – a scenario seen in 63 per cent of road map simulations conducted by the Burnet Institute – the system would come under “unviable workforce pressure”.
A staff member on the Austin Hospital’s COVID ward.Credit:Wayne Taylor
The result would be that only a minimum level of emergency medical care could be provided in an “indicative scenario” outlined in the government briefing document.
A peak in COVID-19 cases is predicted to arrive around mid-December after key restrictions are scrapped, allowing Victorians to have people in their homes, dine out and hold large weddings.
But the document also suggests that hospitals could be forced much sooner to make big compromises to the care they provide. When more than 1000 COVID patients need care, it is expected that category-one elective surgeries, which should be performed within 30 days, would need to be paused.
There are already almost 500 COVID patients in hospital, and the government’s briefing document suggests that once this number hits 600, alternative staffing arrangements might have to be considered, more patients cared for at home and further “non-urgent” elective surgeries delayed.
The latest revelations came as Melbourne became the most locked down city in the world on Monday, having endured a total of 245 days in lockdown, with at least another three weeks before restrictions ease.
However, Chief Health Officer Brett Sutton blamed Australia’s slow vaccination rollout, saying the state had “no choice” but to “have a lockdown to manage potentially catastrophic numbers and catastrophic numbers of deaths”.
“The difference of vaccination is really going to be our pathway out of here,” Professor Sutton said.
The state recorded 1377 new daily cases on Monday and 498 people in hospital with COVID-19, of whom 96 are in ICU and 59 are on a ventilator.
As hospitals attempt to keep up with the demand, The Age can reveal that some government policies designed to take pressure off the system are, in fact, putting patients at risk, according to a physician.
One such policy, known as “rapid offloading” now requires certain non-COVID patients who are transported to emergency departments to be placed in a chair to await treatment, while patients with COVID and suspected COVID are assessed and treated as a matter of priority.
In theory, paramedics transfer the patient, while triage nurses and doctors determine whether they are “fit to sit”. However, Mya Cubitt, the Victorian faculty chair of the Australasian College for Emergency Medicine, said a lack of department clarity over this measure was creating “some dangerous situations for patients and unnecessary conflict between staff.”
“While there might be a spare chair, there’s not necessarily a nurse or a clinician to care for that patient and keep them safe while they’re in their chair,” said Dr Cubitt.
“The rapid offload policy is a deeply understandable solution to a ramping crisis, but it will lead to a patient being offloaded into an increasingly overcrowded emergency department, and it may unintentionally put patients at risk and increase the chance of an emergency department COVID-19 exposure.”
It is another example of the intense strain already being felt by burnt out staff as rising COVID cases add to record demand on the health system. Last week a Melbourne hospital in a COVID hotspot reported its highest ever number of emergency department presentations, while calls to triple zero reached levels not seen since the 2016 thunderstorm asthma event.
Of concern, Victoria’s daily cases are still tracking within the range that’s been predicted by the Burnet Institute, which estimated weeks ago that there would be 1400 to 2900 daily diagnoses by the end of October.
But the experts behind this modelling, including co-author Professor Margaret Hellard, said Victorians still have the power to change this trajectory, reduce the severity of the peak and thereby the impact on the hospital system, by getting vaccinated, getting tested if they have COVID symptoms and abiding by restrictions.
Ambulances at the Northern Hospital in Epping.Credit:Paul Jeffers
Professor Hellard cautioned that the modelling wasn’t able to predict the future, but instead outlined what cases could look like under certain circumstances.
Other scenarios modelled show that relatively small changes to behaviour, such as more vaccinated people coming forward to get tested for COVID if they had mild symptoms, could ultimately lead to a drastic reduction in cases numbers and hospitalisations – in some cases, by the thousands. That is because people with COVID who are not tested would be less likely to isolate and more likely to spread the virus to others.
The Burnet’s Nick Scott said it was possible that as COVID became more widespread people may actually be more likely to continue testing.
“In the preliminary data, people are still testing when they’re vaccinated, so it’s quite plausible that that will be the outcome,” Dr Scott said.
In the government’s outline of the impact of COVID cases on health system capacity, there are five different levels of response. The first and current stage, for when hospital patients are up to 600, involves changes to elective surgery and an increase in home-based case.
Elective surgery would be reduced to a minimum at stage three, between 1000 and 1500 cases, and there would be reduced access to emergency care at stage four, between 1500 and 2500 hospitalisations.
Stage five, described as an “indicative scenario only” when the number of patients in hospital with COVID exceeds 2500, would result in hospitals only treating the sickest COVID-19 cases, minimal emergency department access and “unviable workforce pressure”.
A spokeswoman for the Health Department said patients were always treated in order of clinical need, including those needing surgery and presenting to emergency departments.
“This has not changed during the pandemic and will continue to be the case,” she said.
“Planning is well underway to manage the impacts the peak hospitalisation scenario would have on our health system – including developing appropriate pathways and working with our private hospital partners.”
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