Delta has arrived, and we’ve said goodbye to ‘COVID zero’. We remain locked-down, while we wait for vaccination rates that can support re-opening or less restrictions.
There is talk of picnics, a magical 6 million jabs, 70 per cent and 80 per cent vaccination rates and lots of discussion regarding the Doherty modelling of COVID in Australia.
New South Wales remains firmly in the grip of the latest COVID-19 outbreak. With 22,649 active cases in NSW as of September 4, each day our health system faces a new unprecedented COVID-19 caseload.
But we are not running blind.
NSW Premier Gladys Berejiklian, along with the Australian government, relies on Doherty Institute modelling. Ms Berejiklian argues that this shows it will be safe to open with a 70-to-80 percent 16+ vaccination rate, no matter the case numbers – though the Doherty modelling was based on at least ‘partially effective’ ‘test, trace, isolate, quarantine’ capacity. This appears to already have lost effectiveness.
Ms Berejlikian maintains that the health system will cope. Others say the cracks are already showing.
So, how is our health system coping, really?
We collated the experiences of 14 clinicians working at six hospitals representing the north, south, west and southwest of Sydney.
The anonymous respondents include a nurse, junior and specialist doctors, paramedics, allied health workers, and a clinical manager.
Ms Berejiklian warns that October will be the state’s “worst month”. That is the period when vaccination rates will be still too low and lockdown measures inadequate to keep case numbers at bay.
Models predict case numbers in October could reach between 2000 and 6000 per day.
NSW Health Minister Brad Hazzard says that we’ve capitalised on our 16 months of internationally-famed COVID-19 control by bolstering capacity for the inevitable surge.
Despite government messaging, some healthcare workers are concerned.
While politicians speak of more ventilators, healthcare workers ask for more skilled staff. One doctor told us, “Popular topics of discussion in the break room include the day’s COVID numbers and whatever half-baked scheme the government is trying to sell for managing the COVID wave. We despair at both”.
What staff are confronting
“The hospital is very busy COVID-wise, eerily quiet in all other aspects,” said a senior paediatric infectious diseases doctor.
A clinical manager said, “The complexity of clinical scenarios is increasing in hospitals”.
A senior infectious diseases doctor said, “It feels like what it is – a one-in-a-lifetime outbreak of an infectious disease.
“My personal experience has been that the system has been flexible and adjusted impressively.”
Information on the management of COVID patients “is changing weekly and sometimes daily,” said a clinical manager.
Changing advice weighs heavily on staff attempting to minimise risk – “doing the right thing by our colleagues and families,” as a senior emergency nurse put it.
“Processes for all patients are slowed down a bit because of the effort involved in PPE/deep cleaning rooms (e.g. theatres, CT scanners),” said a doctor. “We have had to significantly change our staffing model.”
Fatigue sets in, but no end in sight
Staff are starting to feel fatigued – long hours, no end in sight, inadequate staffing, information burnout, lack of things to look forward to.
A paramedic described regularly waiting for hours outside hospitals with COVID patients in the ambulance, unable to respond to further calls.
“It makes me so mad that Hazzard tries to act as though this is normal for us. It’s not,” they said.
Hospitals describe opening-up third and fourth COVID wards. A doctor on one of the COVID wards said, “On the ward it’s a pretty quick turnover – they’re in for one or two nights, then out and replaced by someone else.”
Besides the obvious increase in COVID cases, healthcare workers described seeing higher numbers and more complex patients needing all kinds of medical care.
A psychiatry registrar said that “healthcare workers, especially in mental health, have been dealing with significantly greater numbers of patients for the last 18 months and are tired”.
Health workers reported feeling personally safer this year compared to last, with vaccines, appropriate and in-stock personal protective equipment (PPE), and new processes.
But a senior emergency nurse said that continual changes to PPE requirements brought distrust.
“We were told for over a year that surgical masks were adequate protection in the healthcare setting, [then] told that they were never protecting us from aerosolising particles,” the nurse said.
There also is concern about summer approaching.
“Wearing PPE will become more difficult for extended periods as the weather heats up”, the nurse said, and the “volume of patients that a health worker can see each day is limited by their need to wear PPE.”
Things are ramping up
The public health service already operates at capacity outside of a pandemic.
We are now dealing with the double whammy of more complex patients who have delayed care from 2020, and a new outbreak.
“The new steady state we have reached is one of constant urgency,” a doctor told us this week.
Some locations feel the strain more than others.
For instance, an Emergency Department (ED) clinician told us that “EDs were not constructed appropriately for pandemic times”.
“There are not enough single or negative pressure rooms, not enough stations for PPE, not enough protected desks for staff to sit at, no segregation of patients in ambulant areas, not enough nurses to spread the workload, not enough time to don and doff PPE whilst providing adequate care to patients, not enough room to treat non-COVID patients,” the clinician said.
Some Sydney hospitals are currently overloaded while others are coping – all had serious concerns for the ‘surge capacity’ ahead of the predicted peak in October.
Overloaded western hospitals are transferring patients to other hospitals. NSW Health has just prepared guidelines for ICUs because doctors might need to ration ventilators to those most likely to survive.
Most health workers told us they had enough equipment, but not staff.
“If there is a major investment into more negative pressure rooms, more staffing at all hours, and more wards in the main hospital are converted into COVID wards to receive patients coming through ED, then maybe [we can meet demand],” a doctor said.
“And only then until the main hospital fills up.”
“Clinicians triaging and admitting patients are stressed,” the doctor said.
“New processes are being used to immediately discharge patients from the ambulance bay back home without stepping foot in the hospital.”
And health workers are worried they will bring COVID home to their unvaccinated children.
There was particular concern for rural and remote Indigenous communities.
“I have a real fear of the potential disastrous outcomes in unvaccinated communities with disadvantage that will be unfathomable to many Australians,” said a paediatrician.
We will write a follow-up article in October when the COVID-19 caseload is expected to hit the hardest.
Professor Alexandra Martiniuk is an epidemiologist at the University of Sydney. Joseph Freeman is a final-year medical student at the University of Sydney