Emergency doctors warn about preparedness as COVID cases spiral

Emergency doctors fear the state’s hospitals will be “overrun” as COVID cases rise, saying there is a lack of detail about plans to cope but their pleas for information are being ignored.

Dec 22, 2021, updated Dec 22, 2021
Photo: AAP/David Mariuz

Photo: AAP/David Mariuz

The peak body for emergency clinicians has written to the Health Minister stressing their concerns and has told InDaily they’re being kept in the dark.

“Emergency physicians are very frustrated and quite concerned about how things are going to pan out in the next few weeks,” Dr Michael Edmonds, SA faculty chair of the Australasian College for Emergency Medicine told InDaily.

“We feel we’re not being listened to by the Government. They’re not asking us what our opinions are and when we’re offering our concerns and solutions we’re not being listened to.”

It comes as the Premier says infections in SA are higher than modelling predicted but hospitalisations are lower.

As of yesterday, there were five people in hospital, however Edmonds said that’s just a small reflection of the pressure on EDs.

“The people with COVID and the people with COVID who need admission to hospital are only a small proportion of the work,” he said.

“When they say that the hospital is doing fine, there’s only five or six people admitted in hospital, that represents a very large number of people presenting to emergency departments with possible COVID who need to be managed in the same way and have the full workup as well as all the people with COVID who don’t have to stay in the hospital.”

Edmonds said there was “no good community plan on how to assess and manage anyone who’s got concerns about whether they have COVID or when they do have COVID in terms of monitoring them at home and providing the care for them at home”.

“We’ve not seen anything about how we can effectively do this and safely get people home,” he said.

“The system is fairly convoluted and still being built around what can actually be achieved.

“Also nearly all of the investment is going into the COVID positive cases but there’s a very large proportion of people who have potential COVID who there is no systems in place for.”

Edmonds said the four dedicated respiratory clinics in Adelaide were not enough, and authorities had so far refused to provide emergency doctors with a list of GP clinics which could treat possible COVID cases.

“They say we have respiratory clinics – that’s true, there are four respiratory clinics, they are scattered around the metropolitan area but they’re not everywhere and people don’t have access,” he said.

“For instance if you’re down near the Queen Elizabeth Hospital it’s about 15 kilometres to the nearest respiratory clinic so people aren’t going to go to them, they’re going to come to emergency.

“They said they would provide a list of GP clinics and say they’re ready to see possible COVID patients but despite us prompting for over a month we’ve still not been able to get a list of where these clinics are.

“We’re concerned that we’ll get overrun because people have nowhere else to go.

“Absolutely our hospitalisation numbers are going to go up and if we don’t have sufficient systems in place that we can get people home or to alternative care then the hospital becomes the only place that we can treat them.

“Anyone who needs any level of increased care will end up in the hospital and that will just completely overwhelm us again.”

Edmonds said these concerns were being voiced by emergency physicians and trainees around the state.

“We have a lot of concerns that the broad strokes of the plans are there but the detailed implementation is not ready,” he said.

“With the increasing surges of numbers there’s a fear we are walking into something without adequately addressing it.

“We want to see what these plans are and how it’s going to be implemented and how it’s going to be rolled out, we want some input into it.

“We want to know it is actually going to fit into the workflows of emergency so we can make sure that emergency departments are still available and ready to treat everyone who needs emergency care.

“And part of that is making sure that people who could be treated elsewhere, have that treatment elsewhere.”

Edmonds said there were discussions about home monitoring facilities “yet it’s been a struggle whenever we have a positive case who can go home to have anything arranged”.

He said there had already been problems with COVID patients hospitalised so far, including ramping last weekend.

“We’ve seen long delays in getting things organised,” he said.

“Hours waiting for transport, even in people who are well enough to go home, hours waiting for transport to get to the COVID care centre when they’ve needed that level of care.

“There’s people who are in home quarantine who don’t have COVID who can’t access healthcare anywhere other than coming to an emergency department because they obviously can’t go to a GP clinic and there’s no resources in place for them.

“There’s a great concern that there will be undetected spread and the cases we will be seeing are going to be the tip of the iceberg, they are going to be a proportion of the people that are out there with this infection.

“It makes it hard to predict how much demand or where the peaks in demand are going to be.”

Edmonds wrote to Health Minister Stephen Wade in August and again last week but said he had had no response.

“The Health Minister hasn’t engaged with us for a number of months,” he said.

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In his most recent letter, seen by InDaily, Edmonds told Wade the college was “concerned that the health system is insufficiently prepared to manage the potential incidence of significant COVID-19 case numbers”.

“Systems have not been supported with sufficient resources to ensure service provision, workforce, and staff and patient safety in this setting,” he wrote.

His letter listed a number of concerns including:

  • Lack of communication with emergency clinicians on the details and implementation of the state COVID-19 plan;
  • Insufficient ‘hospital in the home’ systems for managing a predicted 85 percent of cases;
  • Inadequate systems for assessing and managing a much larger number of concerned and 
symptomatic people in the community with suspected COVID-19;
  • Insufficient access to respiratory or respiratory-ready clinics;
  • Limited consideration of managing suspected COVID presentations at sites other than the Royal Adelaide Hospital (RAH);
  • Inadequate plans for management of non-COVID presentations in patients in home quarantine; and
  • Ongoing workforce furlough, losses and shortages, many of which cannot be replaced by new 
graduates when they become available.

Premier Steven Marshall told reporters this morning that infections were higher than modelling had predicted for SA but hospitalisations were lower – and he was expecting updated modelling this afternoon.

“I think what we can see is now we have actual data,” he said.

“Before we had a model and that model it would seem has got some inaccuracies in it.

“For example we are seeing a much higher infection rate with Delta and now with Omicron but a very much lower hospitalisation rate that was in that original Doherty Institute modelling.

“That’s being recalibrated. We will get a report today and we will be able to provide further details later in the afternoon.”

Marshall said he was hopeful National Cabinet would today agree to bring forward booster vaccinations from five to four months after second dose.

“That means we’re going to have to flex up our vaccination clinics, that’s precisely what we will do,” he said.

Responding to criticisms about the decision to close the bulk of the state’s vaccination centres over Christmas, including Wayville, he said: “If we need to open it up, if we get that green light then we will certainly be minimising any closures whatsoever.”

Authorities yesterday announced interstate arrivals would no longer need to be tested on day one and six, to reduce demand on overburdened clinics.

However, the HealthCheck SA app was still telling people this morning they had to be tested.

The Government this afternoon advised updates had been made and said the correct information should appear in people’s accounts over the course of the day.

SA Health has also updated its website, saying that interstate visitors will only need to get a day six and 13 test if they come from a high risk area.

In a statement, a State Government spokesperson said “South Australians can be assured that the state’s hospital system is COVID-ready”.

“We are delivering record investment in health and we will continue to provide the investment required to respond to the COVID-19 pandemic,” the spokesperson said.

“Our $123 million COVID-Ready plan includes opening the equivalent of nearly 400 beds, and we are recruiting up to 1920 health staff to ensure South Australians have the care they need, when they need it.

“Local Health Networks are already reporting positive impacts from these COVID-ready beds coming online.

“We have seen significant improvements in the time ambulances are spending on the ramp and patient flow at our hospitals in recent weeks.

“SA Health has consulted extensively on its COVID response strategies and the Acute Care Response Strategy is publicly available on the SA Health website.”

In a statement, a spokesperson for SA Health said “we have undertaken significant planning to ensure South Australia was COVID-ready when borders opened on 23 November”.

“Over the last few months we have been working with GPs and hospitals, and have consulted with a number of stakeholders, including ACEM, on how the South Australian health system is prepared to deal with an expected increase of COVID-19 cases within the community,” the spokesperson said.

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