Hospitals ready to move to Covid-19 red alert

In hospitals across Sydney, wards are being converted to accommodate an expected influx of Covid-19 patients.

Emergency Registered Nurse India Wells, director of surgery Tony Grabs and director of intensive care Priya Nair at St Vincent’s Hospital, Sydney. Picture: John Feder

Hospitals in NSW are preparing to suspend elective surgery as the number of people admitted with Covid-19 grows, with people in intensive care climbing to 18 as doctors warn that the numbers of critically ill patients will continue to rise.

In hospitals across Sydney, wards are being converted to accommodate an expected influx of Covid-19 patients and administrators are revising surge plans to expand the number of ICU beds.

There are 63 patients currently hospitalised in Sydney with Covid-19, a figure equal to about one in 10 of the 678 positive cases recorded since NSW’s Delta outbreak began. Four patients in ICU are on a ventilator.

One patient in ICU is in their 20s, one in their 30s, one in their 40s, five in their 50s, six in their 60s, and four are aged over 70.

A COVID-19 positive patient being cared for in St Vincent’s Hospital. Picture: Supplied/St Vincent’s Hospital

None of the patients in hospital – aside from five elderly residents from the SummitCare facility who were admitted for observation – was vaccinated.

NSW chief health officer Kerry Chant said some patients admitted to hospital had comorbidities, but others had no underlying health issues before becoming severely ill with Covid-19.

“I can say that you don’t need to have an underlying health con­dition to be in hospital with Covid,” she said. “Covid is a serious disease and is associated with hospitalisation and death.

“Twenty-five people admitted to hospital at the moment are under the age of 55 and 14 are under the age of 35. That is dispelling the notion that you are not going to get sick from Covid if you’re young.”

A St Vincent’s Hospital ICU staff member cares for a COVID-19 positive patient. Picture: Supplied/St Vincent’s Hospital

Elective surgery has already been decreased in southwestern Sydney local health district in a bid to free up staff as case numbers surge.

NSW Nurses and Midwife general secretary Brett Holmes said Covid wards were already opening up in Liverpool Hospital in preparation for a wave of cases. “They are putting in place a wave of strategies to try to make sure they have enough access to beds and staff,” he said.

 

“We know nurses working in intensive care units around the state have been under significant pressure. If patient numbers in ICU continue to grow and the normal workload does not ease with a reduction in surgery, staff will potentially have to be moved around to pick up the ICU numbers.”

At St Vincent’s Hospital in Sydney’s inner east, five patients are in ICU and doctors are preparing for more. St Vincent’s infectious diseases physician David Andresen said Sydney hospitals might have to forgo non-urgent medical treatments if case numbers surged.

Dr Andresen said the healthcare system might be forced to cancel elective surgeries to make space for a wave of Covid-19 cases if the outbreak were to get out of control.

The hospital was closed down to all non-essential visitors by NSW Health a few weeks ago amid growing concerns the Delta outbreak could put patients and staff at risk.

Besides treating the five Covid patients in intensive care, St Vincent’s is also treating 10 in ward beds and monitoring 30 out­patients in the community for any signs of deterioration.

Dr Andresen said preparations for this outbreak began weeks ago, with staff undergoing training for correct PPE use. The hospital is now considering a staggered approach of postponing non-urgent medical procedures to make space for Covid patents and reduce the strain on the system and its staff.

It is expected non-elective surgery such as joint and hip replacements will be postponed first.

Dr Andresen said it was not a “doomsday scenario” but he was worried about the longer term implications on the health system.

ICU staff care for COVID-19 positive patients in St Vincent’s Hospital in Sydney. Picture: Supplied/St Vincent’s Hospital

“I am anticipating we are going to have a statement from NSW Health with what they want us to do with non-elective surgery in the next few days,” he said. “I suspect it won’t be an all or nothing thing, it might just be a tweak, saying you can do the urgent and semi-urgent surgeries but the minor ones you can switch off.

“Postponing these surgeries has a real human cost. You could be waiting months with chronic knee pain and if we have to put off the surgery, the person is living on pain killers for months longer. For the healthcare system, there is an additional backlog and strain after the outbreak is contained.”

Dr Andresen said authorities could consider switching off elective surgery in localised areas in southwestern Sydney where the hospitals might be under strain, or implementing a temporary pause for a week to give the system time to “find its feet”.

NSW Health could also begin to move Covid patients to hospitals under less strain. “We are already feeling stretched in terms of our intensive care capacity to support normal amounts of elective surgery and we need a bit of a breather,” he said.

During a two-week lockdown in Melbourne in late May-early June, non-urgent elective surgery was suspended, as it was for the whole of the country for several weeks during lockdowns at the beginning of the pandemic.

The suspensions caused elective surgery waiting lists to balloon: there are about 88,000 patients on the waiting list for elective surgery in NSW, a drop from a record 100,000 in June 2020.

If case numbers surge, hospitals will have to turn entire hospital wards into “Covid zones”, a process called “cohorting” and where staff must wear PPE at all times.

Dr Andresen says St Vincent’s Hospital was “on the cusp” of converting whole wards to treat Covid patients, but staff had been on high alert since the beginning of the recent outbreak.