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Doctors say it is becoming harder to find beds for critically ill Victorians and patients who have undergone life-saving surgery amid rising COVID-related hospitalisations, and predict the pressure will worsen before it eases.
As Victoria reported a national daily record of 1763 new COVID-19 cases and four more deaths on Tuesday, Australian Medical Association Victoria vice-president Sarah Whitelaw said the hospital system faced mounting challenges in caring for COVID and non-COVID patients.
A COVID-19 isolation ward at the Austin Hospital.Credit:Eddie Jim
A key aim of repeated lockdowns was to stop the hospital system being overwhelmed, but Dr Whitelaw said it was increasingly likely Victoria would face that scenario in coming months.
“I think it would be fair to say everybody is saying this is escalating more quickly than we had hoped,” she said. “It’s tracking pretty much along the Burnet [Institute] modelling curve, and we are desperately all hoping for a bend in the curve.”
The modelling forecasts that in 63 per cent of simulations the state would need more than 2500 beds for COVID-19 patients by mid-December, a scenario The Age this week revealed would reduce emergency care capacity to a minimum and mean only the sickest received treatment.
Head of the Department of Critical Care at the University of Melbourne, David Story, said ICU wards in Melbourne’s major hospitals were quickly filling up with coronavirus patients, making it hard to find beds for critically ill non-COVID patients and those needing care after surgery.
“We are now very concerned about being able to provide the appropriate care for people who require critical care,” Professor Story said.
“Unfortunately, that’s a major problem that we are now facing. People will need to come into the intensive care unit with non-COVID problems and the place is full.
“We are doing our best, but the system is very strained.”
Austin Health intensive care director Stephen Warrillow said beds would always be found for patients who needed them, and that even before the pandemic this process might have required someone to stay in the emergency department receiving care before a bed was available elsewhere.
“It’s very common for us to have to reorganise ourselves to accommodate that person in entirely normal times,” Dr Warrillow said. “Everyone in the system will walk over broken glass to make that time as short as possible.”
There was general agreement among senior doctors contacted by The Age that pressure on the healthcare system was higher than ever, even before the predicted influx of coronavirus patients needing hospitalisation.
“The pressure being so consistent and persistent is causing higher levels of fatigue than we would usually see,” Dr Warrillow said. “Morale is solid, but I think people are wondering how long we’ll need to sustain this for.”
Royal Australian College of General Practitioners Victoria chair Anita Munoz said that over the past few weeks she had heard a number of “incredibly concerning” stories about the impact of the hundreds of COVID-positive patients needing hospital care.
She cited an instance in which surgery for a heart-attack patient was delayed because no ICU beds were available.
“Because the ICU was full of COVID-positive patients, the man couldn’t have the surgery that he required. He actually ended up having a second heart attack, before his surgery could be done,” Dr Munoz said.
“I also know of another person who went to a hospital with sepsis and had a similar experience. He couldn’t access an ICU bed so he had to be treated on the ward when he really should have been in ICU because of how sick they were.
“These stories are becoming more and more common and the issue is ICUs are filling up with unvaccinated COVID patients and we are seeing other patients – fully vaccinated patients – having medical conditions and they can’t access the optimal treatment because of this ongoing wave of COVID disease.”
More than 500 Victorians are in hospital with COVID-19, including 101 people in intensive care and 66 on ventilators.
Professor Story said that before the pandemic, ICUs were often “full or overflowing” but there was more scope to transfer patients between wards. As intensive care units fill up, he fears more delays to surgery are inevitable.
The least unwell patients in ICU are often moved to another ward and carefully monitored to make room for people who are sicker, but Professor Story said this could not happen with coronavirus patients, who often spent weeks in the unit.
In another sign of the health system straining under the weight of rising COVID-19 cases, elective surgeries have been cut by 50 per cent at some private hospitals as doctors are told to use greater discretion to prioritise only the sickest patients.
Things could be far worse without ongoing restrictions, according to Premier Daniel Andrews, who suggested daily case numbers would have been above 10,000 without Melbourne’s lengthy lockdown.
“We are not chasing zero, that’s really clear. We have more cases than we would like, but without a lockdown on then we would have many, many more cases and many, many more people in hospital,” Mr Andrews said on Tuesday.
The head of Monash University’s epidemiological modelling unit, James Trauer, said while it was extremely hard to predict caseloads in the next couple of weeks, Victoria was at risk of overshooting the Burnet road map modelling, which weeks ago predicted between 1400 to 2900 daily diagnoses by the end of October.
Despite the rise in case numbers, the Premier said Victoria remained on track to reopen in about three weeks when the state hit the 70 per cent double-dose vaccination target around October 26.
“I have no advice at this stage that we will have to alter anything on the road map,” Mr Andrews said. “I want to try and give people as much freedom, as fast as I can, as safe as possible.”
Mr Andrews said the state’s healthcare workforce had faced its “busiest period” in the past two years, but staff were “not as fresh as they would like to be”.
“They are as ready as you can be, they’ll open beds as they need to, they’ll work extra shifts as they need to,” he said.
Mr Andrews urged Victorians to get vaccinated and follow health measures to reduce pressure on the hospital system.
In an effort to boost vaccination rates, the state government has offered grants to 27 suburbs where first-dose vaccine rates are below 75 per cent, including Frankston North, St Kilda, Kensington, Reservoir and Epping.
Round one of the vaccination blitz will fund more than 300 GP clinics and pharmacies to increase vaccination rates in their local areas.
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