‘No plan’ for overflow as COVID chokes emergency wards

Undiagnosed COVID patients are being left sitting in hospital waiting rooms with admitted cases likely to spill across metropolitan hospitals within days and “no plan” to deal with surging demand, an emergency doctor has warned.

Jan 05, 2022, updated Jan 05, 2022
Photo: Tony Lewis / InDaily

Photo: Tony Lewis / InDaily

Dr David Pope, immediate past president of the SA Salaried Medical Officers Association, told InDaily about 10 cases a day were being diagnosed at the Lyell McEwin Hospital where he works in the emergency department.

He said most of them weren’t diagnosed until after they had been waiting for lengthy periods in busy emergency departments next to other patients and staff.

“It varies enormously but potentially six to eight hours people are waiting in crowded waiting rooms, sometimes in spaces next to other vulnerable sick people with chronic illness,” he said.

Pope blamed the delays on a lack of rapid antigen testing resources within hospitals.

He said not all patients were tested – only those staff had suspicions about – and that at the Lyell McEwin, only one staff member on shift was responsible for the testing.

“It would be much, much safer for everybody if we had capacity to do the rapid antigen testing as soon as people arrive but so far we haven’t been resourced to do that,” he said.

Pope said the hospital was seeing a number of unwell babies and toddlers who later tested positive to COVID.

“They are having symptoms to the point that they are attending hospital – things like fever, vomiting, being flat, not eating and drinking; a lot of those are turning out to be COVID cases,” Pope said.

He said their parents were often asymptomatic but also tested positive.

“We’ve had a number of staff especially working in the paediatric areas of the department who have tested positive,” he said.

Premier Steven Marshall this afternoon told reporters 271 SA Health staff currently had COVID, with a further 535 “furloughed” – most of whom he said were still able to work remotely from home.

Pope said: “It’s clear that we need screening of people with rapid antigen tests as they enter the hospital so we can separate out the positive cases and the negative cases so we can prevent the spread of COVID in the hospital itself.”

He said once a patient tested positive “we try to move them into a cubicle space that has a door – and there’s limited numbers of those – so they can be isolated”.

“But we can’t really do anything about the previous exposures in the waiting rooms,” he said.

“There’s also limited resourcing for determining who was sitting next to who.

“It’s certainly overwhelming staff. We don’t have the necessary space or staff to deal with the numbers of people that need to be isolated.”

If patients need hospitalisation, they are transferred to the state’s dedicated COVID hospitals – the Royal Adelaide Hospital for adults, Women’s and Children’s Hospital for children and Flinders Medical Centre for pregnant women.

Marshall said as of today there were now 125 people with COVID in hospital, up from 102 yesterday. The number of cases in ICU remained steady at 12, with one on a ventilator.

But Pope expects those hospitals will soon be full and others will have to start accepting COVID patients.

“Based on the current numbers, there’s probably only another week or two before those sites are completely overwhelmed,” he said.

“And then the difficulty is there is no planning to have other hospitals start to admit COVID patients.

“You haven’t got designated areas, you haven’t got trained staff, you haven’t got many of the things you are going to need so it will have to be put together on the fly.”

Marshall told reporters he was “very confident that we have the right capacity” within hospitals to cope.

He said that since announcing an extra 392 beds and treatment spaces to prepare for COVID, the Government had also cancelled non-urgent elective surgery to free up even more resources.

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“We’ve got a much greater flex-up now because we’ve been working with the private hospitals in South Australia removing elective surgery which increases our capacity within the public hospital system as well as taking some of that extra capacity within private hospitals,” he said.

“So I’m very convinced that we’ve go the right capacity, we’re well within that at the moment.

“We’ve got to marry that up with what the demand is likely to be and we’ve got some further presentations on that later in the week.”

Asked what the peak in cases was likely to be, Marshall said authorities did not yet have a “final number”.

In a statement, a spokesperson for SA Health said “we are engaging with all elements of the health sector to ensure South Australians with COVID-19 can receive the care they need in the right settings”.

The spokesperson said less than one per cent of the state’s 19,250 currently active cases were hospitalised.

“The management and care of acute COVID-19 patients in the hospital forms a key part of our overall COVID-19 health system response, where it was expected approximately 95 per cent of cases are managed in community home based care or supervised COVID care facilities, and five per cent in the acute hospital setting,” the spokesperson said.

“As we deal with the recent impact of Omicron and a significant number of cases in South Australia, our hospitals and health services are continuing to explore options to ensure we can safely and effectively respond to the acute care needs of the expected increase of positive patients, whilst continuing to deliver high-level non-COVID acute care.

“Each hospital has their own protocols in place to manage people presenting to the Emergency Department with COVID symptoms, and since the beginning of the pandemic have been agile in their continued planning and response.

“Following the recent commencement of Rapid Antigen testing being used for those presenting with COVID symptoms, the Lyell McEwin Hospital has introduced a dedicated resource in the Emergency Department to coordinate the testing to allow patient flow and transfers of positive patients.”

It comes as two of four Clinpath COVID testing clinics that closed yesterday without warning due to staff shortages were reopened today.

The Aldinga and Gepps Clinics were back in operation this morning, but the St Mary’s and Smithfield sites remained shut, with Clinpath yesterday saying they would be closed “indefinitely”.

The Health Services Union, which represents staff at Clinpath and other testing clinics, warned test wait times would continue to rise unless rapid antigen testing was made much more available.

Billy Elrick, HSU SA branch secretary, told InDaily “with the sort of numbers that we’re seeing at the moment it’s impossible to staff this effectively just through PCR testing alone”.

“That’s why the HSU is advocating very strongly for free rapid antigen testing or at least cheaper rapid antigen testing,” he said.

“Until we get something like that, the pressures on these pathology services is only going to go up and up.

“We have members across Australian Clinical Labs, Clinpath and SA Pathology and while we saw a lot about Clinpath yesterday the other employees are suffering just as much.”

Elrick said exhausted Clinpath staff were caught out by yesterday’s closures.

“Staff weren’t really told that the sites were closing on the morning,” he said.

“Some people rocked up to the sites expecting to start their shifts there and were told by text message they had to go to other places and that’s what primarily led to the closure.

“They didn’t have enough staff to man those testing sites because they had to use some people for aged care and there’s also some staff members to my understanding out with COVID.”

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