Hospitals say in worst-case scenario, ICUs may struggle to meet influx of seriously ill coronavirus patients

This article is more than 5 months old

This article is more than 5 months old

A body representing 80 Australian hospitals has warned health minister Greg Hunt that “unclear and convoluted” information from governments and a dire lack of equipment is hampering emergency preparations for the pandemic, and may force staff in these non-profit hospitals to make “difficult decisions” about which patients they can treat.

All hospitals across the country are readying themselves for the pandemic’s peak, which, in a worst-case-scenario, could leave Australia’s intensive care units swamped and struggling to meet the influx of seriously-ill Covid-19 patients.

Modelling released by the Medical Journal of Australia suggested the nation’s ICU capacity of 2,200 beds could be exceeded at around 22,000 Covid-19 cases “sometime around April 5 if public health measures fail to curb the rate of growth”.

MJA (@theMJA) NEW: Modelling shows Aussie ICUs will be over-capacity by 5 April ... #preprint #openaccess #COVID19 ... "we may face the same fate as Italy, or worse" ... https://t.co/Q6yevkwO5L pic.twitter.com/sArNwFaEKG

Australia is attempting to double its ICU capacity and dramatically increase stocks of ventilators in preparation, and intensive care experts believe the number of beds can quickly surge to 5,000.

Important regional facilities like Wagga Base Hospital are developing plans to double ICU capacity, while in Sydney, the Royal Prince Alfred Hospital has prepared a dedicated and specially-designed Covid-19 intensive care unit.

To relieve the pressure, plans are being drawn up for major hotels to be potentially used as wards, and in Victoria, the government is developing plans to convert the Melbourne Convention and Exhibition centre into a hospital and morgue.

Health services are also planning how they might make the types of extremely difficult decisions forced on doctors in Italy – where a shortage of equipment and beds left frontline staff deciding who lived and who died.

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Canberra Health Services, which gave Guardian Australia an insight into its preparations, is developing a plan for how it will make treatment decisions if there are more patients than clinicians or equipment to treat them.

“Clinicians have to make these decisions all the time,” chief executive Bernadette McDonald said.

“We haven’t developed that yet, we’re looking at it but we’re very keen to make sure we get the voice of the consumer and carers into our discussions around that.”

Non-government hospitals are also beginning to enact their emergency preparedness protocols as Covid-19 presentations increase and are expanding their testing capacity to try to reduce the burden on state-run facilities.

Private health insurers have warned that non-government hospitals will need to take spillover from state-run facilities.

But a letter seen by the Guardian shows one of the largest grouping of non-government hospitals in the country – Catholic Healthcare Australia – has told the health minister it holds “grave concerns” about convoluted government communications and barriers to accessing stocks of masks and gowns through the national medical stockpile.

“We fear if we continue to face these barriers in access to vital supplies, particularly [personal protective equipment], the result will be reduced access to hospital care for the community at a time when access to medical treatment is most critical,” its chief executive, Pat Garcia, wrote.

CHA represents 80 non-government hospitals that between them have more than 10,000 beds, including 2,700 public beds.

Its own supply chains of PPE are under immense strain amid the global pandemic, and hospitals are now urgently trying to access equipment stored in the national medical stockpile through state and territory governments.

That has caused huge difficulties, because a single hospital organisation that spans state boundaries has to deal with multiple governments.

It is complicated further still by “unclear and convoluted” information about access, Garcia said.

He urged the government to plan its pandemic response in a way that used government-run and non-government hospitals as “one seamless network in the fight against Covid-19”.

“You would be aware that PPE is a vital component of infection control, protecting clinicians and patients from transmitting the virus,” he said.

“Without it, clinical staff will need to make difficult decisions about what services they can provide and which patients they can treat.”

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More broadly, hospitals are preparing by training staff to resuscitate patients while wearing protective equipment, conducting simulations of how to deal with particular types of Covid-19 positive patients, such as women in labour, and ethical planning if the number of patients exceeds available resources.

At Canberra Health Services, a taskforce is meeting daily to discuss critical issues – supplies, logistics, clinical care (particularly emergency department and intensive care) clinical advice, screening and testing.

David Caldicott, an emergency department consultant in a Canberra hospital and a lecturer at the Australian National University medical school, said emergency doctors around the globe were talking regularly about what was happening in each of their countries and different approaches to the crisis.

“One of the fundamental rules of disaster response is plan for the worst-case scenario,” he said.

“We might hope things turn out a certain way but we also have to plan for the possibility they turn out considerably worse. That’s just sensible disaster planning.”

He added that Australia’s trajectory would depend on how well the majority of the population adhered to social distancing measures.

“The frontline is at your front door,” Caldicott said.