- Coronavirus hospitalisations reached 717 in Victoria on Monday, up from 459 a fortnight ago, driven by the highly infectious Omicron sub-variants, BA.4 and BA.5 which are now dominant in Victoria.
- The newly appointed Victorian chair of the Royal Australasian College of Surgeons, neurosurgeon Patrick Lo, warned it is now increasingly probable non-urgent category-two and -three surgery might have to be delayed at hospitals dealing with high volumes of coronavirus patients in the coming weeks.
- In a significant shake-up in the management of the pandemic, the state government has released some control of elective surgery levels back to individual health services, allowing hospitals to manage their own surgical lists.
Victoria’s public hospitals are preparing to suspend parts of their elective surgery programs to cope with a surge in coronavirus hospitalisations as patient numbers reach their highest level since January’s Omicron wave.
Neurosurgeon Patrick Lo, the newly appointed Victorian chair of the Royal Australasian College of Surgeons, has warned it is now increasingly probable non-urgent category-two and three surgeries might have to be delayed as hospitals deal with high volumes of coronavirus patients in the coming weeks.
Victoria’s public hospitals are bracing to reinstate pauses on elective surgery to cope with a surge of coronavirus hospitalisations projected to increase pressure on emergency departments and intensive care units.Credit:Fairfax Media
The warning comes as Victoria’s ambulance union reports that up to half of the state’s advanced life support paramedics, needed for the most life-threatening callouts, are currently unavailable on any given shift, in a worrying trend the union said is being fuelled by staff furloughing and record demand.
Coronavirus hospitalisations reached 717 in Victoria on Monday, up from 459 a fortnight ago, driven by the highly infectious Omicron sub-variants, BA.4 and BA.5 which are now dominant in Victoria. These sub-lineages better evade immunity from previous infection, leading to a high risk of reinfection.
Lo said the most urgent category-one surgery and emergency procedures continued to be undertaken across the state, despite a growing workforce crisis.
“But there is a real sense that unless something changes we are just going to be drowning,” he said.
“The only thing that we can truly change is holding off on a lot of the category-two and -three surgeries.
“It is really looking like we are heading towards a situation where only category-one and emergency surgery will be going ahead again at some of the major hospitals.”
In a significant shake-up in the management of the pandemic, the state government has released some control of elective surgery levels back to individual health services, allowing hospitals to manage their own surgical lists and postpone procedures based on their own furloughing demands.
The change means the responsibility now largely sits with hospitals to make individual decisions about how many surgeries each health service can safely conduct, rather than in previous coronavirus waves, when the government enforced blanket statewide bans on surgery.
Category-two surgeries are procedures that need to happen within 90 days and that can cause significant pain or disability, but are unlikely to escalate to an emergency. This could be something like a standard heart valve replacement. Category-three surgeries include procedures such as hysterectomies and hip and knee replacements.
Ambulance Victoria reported its seventh code red in as many months on Sunday due to extreme demand for emergency care in metropolitan Melbourne, prompting Victorian Ambulance Union secretary Danny Hill to warn that up to 10 to 15 highly skilled Mobile Intensive Care Ambulance (MICA) vehicles are now unable to respond to calls daily in Melbourne.
There are 30 MICA vehicles across Melbourne and up to half of those could be unavailable over any 24-hour period, Hill said, noting night shifts were often the hardest hit.
“When you hear the Advanced Life Support crew calling for MICA backup and MICA backup is not available, and the ALS are dealing with a very sick patient alone … that’s the sort of thing that should only happen in a genuine code red event, but we’re seeing it happen very regularly,” Hill said.
“You have to wonder whether we’re abandoning our MICA capability in Victoria. That’s very disturbing if that’s the case because it is a trajectory that’s getting worse.”
Hill said ongoing shortages in MICA units, meant to be reserved for the most gravely ill patients, had been a rarity pre-pandemic, but were now a common occurrence.
On any given day, more than 1500 public hospital staff are currently unavailable to work due to COVID-19 infections alone.
The eligibility of fourth dose vaccines opened up for all Australians over 30 on Monday, just as the rate of Omicron sub-variants BA.4 and BA.5 detected in wastewater rose to 70 per cent of all strains in the two weeks to July 8, putting people at greater risk of reinfection.
Australian Medical Association Victorian branch president Roderick McRae said several hospitals in Melbourne had already cut back the number of elective surgeries in recent weeks.
“Nobody wants things like mask mandates, but the evidence is clear that the current approach is failing,” McCrae said.
Lo said despite the workforce challenges, the overwhelming majority of category-one surgery was still being undertaken within the recommended 30 days.
He said the state government’s new chief surgical adviser was working with a surgery recovery taskforce to provide clinical expertise on if and when any pauses on surgery may be required at hospitals.
At the moment, major metropolitan hospitals, including the Royal Melbourne Hospital and The Alfred, are still undertaking category one and more urgent category-two procedures. A spokeswoman for the Royal Melbourne Hospital said less urgent category two and three procedures were also being scheduled as day cases if there was capacity.
The state’s elective surgery waiting list surpassed a record 89,000 patients in March, but doctors warn more people are waiting for an operation than the official figures suggest.
Vascular surgeon Susan Morris said elective surgery for her private patients was now rarely being delayed.
However, Morris said public patients were facing increasing waits, including one patient she recently referred to a public hospital who needed surgery because they were unable to walk due to blocked arteries in her legs.
“She couldn’t get in for an outpatient appointment because the hospital was so overloaded,” Morris said.
Australian Medical Association Victoria vice president and surgeon Jill Tomlinson said there might still be instances, including if hospitalisations escalated beyond a certain point, where the state government could still step in and roll out widespread pauses on surgery.
She said she was “very concerned that during July and August there are going to be increasing problems in getting elective surgery done.”
The state’s hospital crisis came to a head again last week after a one-year-old baby girl infected with coronavirus died at University Hospital Geelong. The death, which is being investigated by the Coroner and Safer Care Victoria, occurred amid staffing shortages at the hospital and reports of almost 12-hour wait times in the emergency department.
The Victorian Health Department has warned of rising COVID-19 cases and hospitalisations, mirroring similar patterns occurring globally due to the spread of the new Omicron sub-variants.
“Just like other healthcare systems around the world, our system has been under unprecedented pressure and we’re investing billions to get it back on track as quickly as possible,” a spokesman said.
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