Coronavirus, or more accurately COVID-19, has without a doubt taken centre stage in Australian healthcare. It is not the severity of the disease that is the issue. The majority of people will make a full recovery. The seriousness arises from the rate of spread that is stretching and will stretch even further our health services well beyond capacity to care for those not in the lucky majority.
We’ve heard our politicians talk about activating “surge capacity” in our hospital system to manage this pandemic. This refers to having the staff, space and supplies to manage the increase in demand for healthcare. COVID-19 is about to reveal dramatically that the Australian Healthcare system has very little “surge capacity”. We have seen headlines about overflowing Emergency Departments, ambulance ramping and long elective waiting lists well before this current event. It is already common for doctors to need to ring around to find available Intensive Care beds.
The Victorian and NSW Governments announced the intention to commence an elective surgery blitz to reduce the elective waiting list before the peak of pandemic arrives. Victoria are injecting $60 million into this initiative. Whilst the sentiment has good intention, it is much more likely to be a health bomb that will explode any surge capacity our system has. And frankly, it’s too late.
A key component of “surge capacity” is staff. Anaesthetists and operating theatre nurses are our next best line of staff for ventilated beds after existing ICU staff. Our Emergency Department staff are already operating beyond capacity. An elective surgery blitz will inevitably and unnecessarily expose anaesthetic staff and other theatre staff to COVID-19 whilst making little headway in elective surgical wait lists.
A surgical blitz not only reduces our staff capacity for managing an increase in number of COVID-19 cases, but reduces our medical and equipment supplies. We already have a shortage of appropriate masks and childrens’ panadol in our hospitals and our community.
Elective surgery is not without risk. There will be adverse events that will prolong hospital stays or lead to the need for re-admission further reducing space in our healthcare system. We will need every ounce of capacity during the coming weeks to continue to manage emergency presentations and category 1 surgical cases, including cancer cases whilst managing this pandemic.
In Italy it took less than a month for the number of cases to go from 1 to over 21,000 with more than 1500 people in severe or critical condition. Services in northern Italy have been so overwhelmed that war-like triage is now taking place to determine who will and who won’t be ventilated. Victoria as of the 15th of March had 57 confirmed cases. 18th of March this was 121, 22nd of March 296. Based on graphs from other countries with similar measures in place as Australia to stop the spread, we have about 2 weeks at most before we are at level where demand for hospitalization may well be beyond existing capacity.
It is highly likely a large proportion of our healthcare workforce will be exposed and/ or infected removing them from service. We do not need to increase exposure risk nor fatigue our workforce in advance.
An alternative would be to immediately limit all operating to Category 1 elective cases and emergency cases. Use the short space of time available to start setting up operating suite ventilators to provide extra ventilated beds, ensure supplies and equipment are onsite, upskill appropriate staff and work out rostering. This may involve pooling resources from various health services together in a designated number of locations whilst keeping selective facilities COVID-19 ‘free’ for urgent surgical interventions. Some health services have started with these measures including Monash Health where I work.
Elective, non-essential surgery also needs to stop in private facilities too. Whilst our public healthcare facilities are moving to implement the measures above, out-sourcing to private sector is still occurring. We need to be reserving ALL supplies and staff across the board. Private facilities have great potential in caring for vulnerable patients away from the major public hospitals and in helping to provide for sick children who will need admission during the coming winter months.
Mr Andrews and Ms Berejiklian, as a surgeon, we’d love the money for more operating but please confirm we are saving it for after the worst of this pandemic has passed.