Covid-19 Victoria: hospitals advised to reduce elective surgery as doctors warn of overcrowding – The Guardian

Victorias public hospitals have been advised to remain at 75% levels of elective surgery as senior doctorswarn that there are not enough hospital beds to meet a surge in demand, and that conditions are placing health workers at a higher risk of contracting Covid-19.
Guardian Australia understands work is under way to deliver equipment needed to treat extra coronavirus patients in hospitals, and it is hoped a further 400 ICU and critical care beds can be added throughout the state.
Almost two dozen healthcare workers and patients have been diagnosed with Covid-19 in recent weeks in Victoria, including doctors, nurses and paramedics. During the first wave of the virus that prompted a national lockdown in March, non-urgent elective surgery was put on hold to make room for suspected and known Covid-19 patients.
But because it seemed Australia had Covid-19 under control by early June, hospitals began filling up again with other patients and some wards and beds put aside for Covid-19 were reallocated to general patients.
Now, a senior doctor working in one Victorian hospital has told Guardian Australia that there is no free, or surge bed capacity, at the moment.
Just yesterday on my shift we had no cubicles in the emergency department and we had patients waiting for 24 hours to go to the ward and doctors were having to see people in waiting rooms again, which is where we were six months ago in the first few weeks in the pandemic, said the doctor, who did not want be named. We only had three beds available for Covid or suspected Covid patients. Thats scary. The Australian hospital system is always at 100% capacity. There arent a lot of spare beds.
She said a patient came into the fever clinic recently who was coughing but there was nowhere to put him. I was able to fast-track something in the end, but these people should not be in waiting rooms. I would have thought another hard stop on elective surgery is needed. We also have crowding in some emergency departments and thats risky for health workers. Just having PPE is not enough.
Guardian Australia has contacted the Victorian health minister, Jenny Mikakos, for the latest surge-capacity databut did not receive a response to that question. However, a government spokeswoman said while hospitals were starting to see an increase in presentations, people could be assured the health system was ready and able to meet additional demand if necessary.
Well continue to monitor the situation closely to ensure our hospitals and staff are supported, she said. Due to an increased risk of transmission of coronavirus in certain geographical areas of Melbourne, staff in public-facing areas across all metropolitan health services are strongly encouraged to use appropriate PPE to maximise protection. It is also advised that patients wear face coverings in this environment.
Prof Rinaldo Bellomo is the director of intensive care research at Austin Health and said because his hospital is outside of hotspot zones, staff there feel prepared and equipped. But he said there was a significant difference between increasing cases at the beginning of the pandemic compared to the increasing cases now, namely that a higher proportion of cases previously came from returned travellers. That meant levels of community transmission were lower previously than they are now.
On 22 March, just before Australias national lockdown, there were 67 new cases of Covid-19 cases in Victoria and a total number of 296 cases. Three cases were thought to have been acquired through community transmission. However, 191 cases were announced in Victoria on Tuesday 7 July, the highest increase throughout the pandemic, and all of those were a result of community transmission.
This is bad, Bellomo said. In case someone hasnt appreciated that, this is serious stuff. I just dont know how to put it aside from that. Now, hopefully because weve locked down that will come down rapidly. But this is much worse, this is not just simply a return to what we had in March.
He added that he was concerned given the level of community transmission there would be cases among Victoria police, who on Saturday surrounded nine public housing towers in Flemington and North Melbourne en masse without wearing masks. However, police at the scene have been wearing personal protective gear since then.
I was watching the police surrounding these areas of high viral presence and I just thought about how much they are at risk of becoming infected, he said. When they went to those buildings, they were spectacularly exposed with no defences. The risk for Joe Bloggs and Mary Jane walking down the street is much, much greater now than before the previous 22 March lockdown.
Bellomo said he expected some hospitals would be more challenged than others, with those in hotspot zones facing the biggest challenges in the coming weeks.
Four patients and a staff member of Brunswick private hospital in Melbournes north were among the new Covid-19 cases announced on Wednesday. Nine cases have been linked to the Northern hospital in Epping, made up of eight staff and one household contact of a staff member. Three paramedics have been infected as part of the latest outbreak. Two health staff at the Alfred hospital and one staff member at the Royal Melbourne hospital, where five patients were in intensive care as of Wednesday, also have the virus.
A group of researchers connected with Royal Melbourne hospital looked at health workers infected as a result of the previous outbreak in March and found almost all of them were infected not through work in hospital, but in the community, he said. Its still difficult at the moment to know how all of these recent health workers got the virus and whether in these cases, they caught it in their hospitals.
The Victorian government did not reveal data on how many recent infections in health workers came from their workplace, but said of the 279 Victorian health care worker cases since the pandemic began, around 13% acquired the virus at their workplace.
Australasian College of Emergency Medicine president Dr John Bonning said the initial and ongoing response to Covid-19 showed that the concerns of frontline healthcare workers must continue to be heard, acknowledged and acted on as part of official decision making and responses.
We remain in regular contact with government and colleagues across other medical specialties as part of efforts to calmly and methodically address the ongoing challenges, he said.

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