Overcrowding in WA hospitals could be the real killer as the healthcare system awaits the onslaught of COVID-19

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Despite the delay in opening borders, COVID-19 is spreading in Western Australia, and I keep getting asked: are WA hospitals ready?

First, West Australians should be proud of how we kept the virus out for two years. It saved us time to watch, learn and prepare.

Hospitals have worked hard, processes are in place. Ninety percent of us are double-vaccinated or vaccinated, and our children are vaccinated. This should prevent most people from needing intensive care treatment. It is a magnificent success.

Yet I am still very nervous.

I’m less worried about COVID-19 now that we have vaccination, plenty of PPE, and multiple proven therapies.

The thing that keeps me up at night, and that COVID-19 will increase, is hospital overcrowding. I fear overcrowding in WA hospitals could kill more people than COVID-19 in 2022.

Hospital overcrowding is a strange term, I know. Sounds like I’m saying people are going to die in a physical crowd in the hospital.

What this really means is that, most of the time in WA, there are far too many very sick or injured people needing acute medical care, and not enough staff or space to provide it.

Many areas of our healthcare system are seeing almost double the number of people they were designed for. Why is it so dangerous?

Western Australia recorded its worst ambulance surge figures in history last year.(ABC News: Keane Bourke)

Reflect on your own work. When there is almost double the expected workload, how is your job performance? Are things falling apart as you try to manage the overwhelming demand?

Work overload is at risk of being misdiagnosed

With an ever increasing workload, it becomes more and more difficult to find the needle in the haystack.

The person with stomach pain could simply have indigestion – or they could have a ruptured ectopic pregnancy. A child with a fever may have a cold – or he may have sepsis. The elderly person with confusion could simply have lost their hearing aids or had a brain hemorrhage.

Without time, it’s hard to say. And without time, people die. And frontline clinicians, who may not be supported by hospitals and governments in providing a safe workplace with safe staffing levels, may also be professionally and emotionally destroyed.

Many municipal emergency services have already lost 10-20% of staff. Regional and rural hospital staffing levels are much worse.

One of the biggest problems with the Omicron wave in other states is the lack of personnel Because they have to isolate due to infection or exposure to COVID-19, burnout and resignations. If we’re already down 20%, does that mean we could lose nearly half of our staff?

But increasing capacity – more beds and more staff – isn’t easy.

A woman with short hair and a brown jacket gives a speech in front of a lectern
The WA government’s border setback has made recruitment of health personnel even more difficult.(ABC News: James Carmody)

Recently the WA government announced a significant and very welcome increase in frontline clinical staff. But most of the medical posts remain vacant, several months later. Why is it?

Well, it takes decades to train – the average age to complete your specialist training in emergency medicine is around 30.

Delay at WA border doesn’t help

The delay in opening the border has also aggravated personnel problems.

Much of our junior workforce comes from the UK and Ireland. Every state in Australia wants them to come to their state because they are desperately needed everywhere.

But now WA is the only state that will quarantine them for 14 days. In all other states, they can go straight to work – and to the beach. If I were a young doctor, obviously I would choose to work.

So what is the solution ?

We must quickly make our hospitals big enough, with enough staffed beds. The WA government promised a significant increase in the number of hospital beds.

Nurse holding syringe and vial
Local travel regulations make it difficult for UK nurses to choose WA over other states in Australia.(ABC News: Greg Nelson)

We need to have the surge capacity in our hospitals to cope with normal activities in the future. Currently, we don’t even have the surge capacity to handle a weekend, let alone a pandemic.

We need to make hospitals respiratory safe. Most WA hospitals have very limited capacity to separate non-COVID and COVID patients – especially in ER waiting rooms. That’s why we have tents out front. Every new hospital built in the future must be respiratory safe, and older hospitals must be modernized.

We must also ensure that hospitals are a pleasant and safe place to work. Working days of 12 hours in a row without breaks must come to an end.

COVID education is key

But for now, as cases increase, my message to the people of WA is, despite all of this, please don’t panic. For most vaccinated people, the Omicron strain of COVID-19 is a mild illness. Take simple precautions and follow public health guidelines. We’ve seen many presentations from people with mild COVID-19 in other states who were going to the ER just because they didn’t know what to do.

The WA government has very recently created the WA COVID Care at Home program and I encourage people with COVID-19 to refer to this resource for guidance, first. If the symptoms get worse, please come see us.

Long lines of people wearing face masks wait to be tested for COVID-19.
West Australians need to know what to do when they receive a positive COVID test.(PA: Richard Wainwright)

We know some people may be afraid that due to overcrowding and COVID-19, we won’t be there for them in a medical emergency.

To my colleagues in health care and government, as we go through this, we need to remember how it feels and use what will be the greatest challenge of our professional careers as the impetus for the whole reform of the healthcare system. much-needed health. We need us all to work together to reinvent a better way of doing things.

It seems likely that we have already had our last zero COVID day in WA. So, are we ready? As always, I reply that we are as ready as we are going to be.

Dr Peter Allely is a Perth-based emergency physician and the Western Australian Faculty Chair of the Australasian College for Emergency Medicine.

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What we know about the Omicron sub-variant with Norman Swan

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