No excuses for hospitals to be seriously underprepared

Before premiers meet for national cabinet on Friday to bemoan the inadequacy of their respective health systems to deal with a renewed Covid-19 outbreak, they should look deeply into the mirror and ask why this has been allowed to be the case. One of the certainties of the largely uncertain pandemic has been the fact hospital care will be the last line of defence for many. Experience from overseas has been that hospitals are quickly overrun and the burden of dealing with Covid has had knock-on effects in other areas.

The initial justification for locking down citizens and removing freedoms was to provide time to “flatten the curve” and to stop emergency departments from being overwhelmed while sufficient resources were put in place. It always has been known that the demands of Covid will be in addition to normal hospital loads, which already strain the existing system to capacity.

Citizens have shown themselves prepared to play their part, often at great personal cost. With Covid case numbers sharply on the rise again in Melbourne and with Brisbane in a precarious position as it faces the reality of the Delta variant having breached its tightly closed border – as was always going to be the case – it is reasonable to ask what measures have been taken to prepare. The answer, it would seem, is not enough.

As health editor Natasha Robinson reports on Friday, state health ministers have warned that the system is in crisis. The states have united to call for urgent structural reform and a resourcing overhaul to transfer the care of thousands of patients to the home and community, bolster the health workforce through fast-tracked migration schemes, deploy general practitioners to emergency departments, and fund primary care to operate after hours and on weekends to address the indirect impacts of Covid-19 on the hospital system.

Robinson reports that national cabinet will be presented with a plan for hospital intensive care unit and Covid ward surge capacity drawn up by federal bureaucrats, but there’s frustration among the states at a lack of recognition that the entire hospital system is buckling under the strain of the pandemic, with routine and urgent patient care being compromised.

As Robinson reports exclusively, state health ministers and top bureaucrats called an urgent roundtable meeting on September 17 to discuss the hospitals crisis. A confidential discussion paper drawn up by senior health officials from Victoria, NSW, Western Australia and Tasmania warned that it was not only the direct pressures on ICU and frontline Covid-19 patient care that was stressing hospitals, it was also the indirect effects caused by deferred care, rising emergency department presentations, workforce burnout and diversion of frontline staff to testing and vaccination centres. Elderly and disabled patients have had to stay in hospital for up to a year because of limited community support, occupying badly needed beds. The Australian Medical Association warns that many people will die because they cannot access timely care with Covid-19 diverting resources from elective surgery and placing pressure on emergency departments.

At this stage of the pandemic, with state governments responsible for health, attempts to shift blame for under-preparation to the federal government is unseemly but not unexpected. The reality is, however, that pressure on state hospital systems is likely to get worse before it gets better. On Thursday Victoria reported a surge in case numbers to 1438 but said cases had yet to peak. Premier Daniel Andrews has left the door open to a pause in the road map to opening, adding to the mental and financial stresses of a worn-out state. Already there have been reports of ambulances being forced to queue to deliver patients to public hospitals. Mr Andrews said it would be irresponsible for him to rule out modifying the road map out of lockdown “if noncompliance continued to drive case numbers”. Queensland has reported 11 local cases as part of four “separate and unrelated” outbreaks. It is possible the Sunshine State could be at the beginnings of a surge in Delta cases, as has been experienced in NSW and Victoria.

The long-term solution for hospitals is to do everything possible to increase rates of vaccination to reduce the severity of illness of those who are infected with the Covid-19 virus. Epidemiologist Tony Blakely said high rates of vaccination among 12-15-year-olds was likely to slash the number of hospitalisations for Covid-19 by 20 per cent once the country started opening up. Professor Blakely said if Australia began to open up at 80 per cent of everyone aged over 16 vaccinated, hospitalisations from Covid-19 would be about 4000 a year. If 80 per cent of the population aged over five years were vaccinated, hospitalisations would reduce to 1000. With 80 per cent of those over 12 vaccinated, the number of hospitalisations might be about 3200.

In the meantime, better hospital facilities with adequate resourcing clearly are needed. Long-suffering citizens who have endured lockdowns and other deprivations are entitled to ask whether state leaders have squandered the opportunity they were given to prepare adequately.