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Victoria’s quarantine hotels will soon be used to house COVID-19 patients in a bid to free up beds in the state’s struggling hospitals, news that comes amid warnings that minimum nurse-to-patient ratios are already being abandoned.
Some nurses are now caring for up to eight patients on their own – double what is mandated in Victoria – in a situation a senior nurses’ union official described as evidence hospitals were in a “desperate situation” where worst-case scenarios anticipated for the pandemic were coming to fruition.
The Age has confirmed that a system where COVID patients are transferred to hotel quarantine to reduce demand for hospital beds is to be established soon. The patients are likely to be nearing the end of their hospital stay.
The plan was flagged in minutes of a meeting between state Health Minister Martin Foley and acting Chief Health Officer Ben Cowie last week. The meeting minutes also reveal extreme testing delays were hampering people’s access to time-critical treatments for COVID-19.
At the time of the meeting on Tuesday of last week, only 30 per cent of PCR test results were being returned the day after the tests were performed. Details of the meeting were recently released under the state’s new pandemic laws.
The daily test turnaround rate has since improved to more than 50 per cent, and the average queuing time has dropped to just over an hour. Before rapid tests could be added to official figures, the average wait for testing was more than two hours.
A few days before Christmas, Victorian Chief Health Officer Brett Sutton, who is now on leave, provided the government with a range of measures he argued would slow the rate of Omicron infections so more people could receive their third vaccine dose before being exposed, reducing their risk of hospitalisation.
Just over 2000 COVID-19 cases a day were being recorded at the time. On Thursday, there were 37,169 new cases.
Professor Sutton noted “early and consistent implementation of all the measures is the best strategy to avoid more restrictive measures being necessary in the future”, and called for a ban on dance floors, fresh density caps in hospitality and restricted access to hospitals and aged care homes, among other measures.
However, at that time, only the introduction of an indoor mask mandate was accepted by Mr Foley, who argued further changes to the rules might diminish the government’s social licence to manage the pandemic and “likely contribute to community fatigue and distress”.
Cases have since surged dramatically, forcing the cancellation of most elective surgery and contributing to dangerously long delays in answering triple-zero calls. Most of Professor Sutton’s earlier recommendations have now been adopted, in addition to mandated third doses for some workers and other measures.
The new meeting notes seen by The Age said quarantine hotels were “likely” to be used for the temporary transfer of COVID-19 patients who had improved but were unable to go home.
Paul Gilbert, assistant secretary of the Australian Nursing and Midwifery Federation’s Victorian branch, said the minimum one-nurse-to-four-patient ratio was blowing out to one for every six to eight patients in some major metropolitan hospitals. In intensive care units, where a one-to-one ratio is expected, critical care nurses were overseeing up to three patients.
Some critical care nurses working in ICU are overseeing up to three patients.Credit:Penny Stephens
Chronic understaffing meant nurses were exhausted and burnt out and the quality of healthcare provided would inevitably decline.
“It means that if a nurse has to get somebody out of bed on day three after a particular operation and help them in the shower, that might not be able to happen on day three. It might not happen on day four,” Mr Gilbert said.
“This is really quite scary and frustrating for our members, but that’s the kind of thing that’s happening out there.”
At the time of the meeting between the Health Minister and senior health department officials more than a week ago, 12 hospital services in Victoria had altered their model of care and some warned they were no longer able to meet “optimal nurse-to-patient ratios”.
“These workforce challenges would only increase as more healthcare workers became infected, with recent trends suggesting an increase in the number of clinical healthcare workers with COVID-19 rising in excess of 10 per cent per day,” the notes say.
Australian Medical Association president Dr Omar Khorshid said COVID-19 patients still needing care should be in hospitals.Credit:Alex Ellinghausen
Australian Medical Association president Dr Omar Khorshid said the possible use of hotel quarantine facilities as de facto hospitals presented an unacceptably dire outcome.
“If they still require care, they should be in a health facility and these hotels are not health facilities. That would basically be an admission the hospital systems are failing to cope.
“That would be No.1 a bad decision for those individuals, putting them at an increased risk of further problems, but also it would be a reflection of how serious the situation is in the hospitals.”
But if the hotels were used to help COVID-positive patients isolate when they could not return home and no longer needed hospital care, this was not unreasonable, he said.
Dr Khorshid said one of the problems with long delays in getting test results was that people missed out on useful therapies that were only effective in the early stage of infection.
“You only have a short window in which some of these therapeutics are useful and if you’re not getting a test result in time, you can’t decide whether or not to give [them to] a potentially vulnerable person who might otherwise be eligible for these treatments. You don’t have the information you need to say yes or not.”
There are now more than 950 Victorians in hospital with COVID-19. Health officials have consistently said this number is expected to increase, although they have not said by how much.
Modelling done for the NSW government has forecast a peak of about 4700 COVID-positive hospitalisations by late January – equivalent to almost eight major city hospitals.
On Thursday afternoon, the Victorian government announced that all further tickets to the Australian Open not already sold would have to abide by a 50 per cent cap. Face masks will be mandatory for all patrons attending the tournament, except when eating or drinking.
There have been calls since late last month to consider restrictions for the event.
In his January advice, the acting Chief Health Officer, Professor Cowie, was supportive of the use of rapid antigen tests as a potential alternative to crowd restrictions but noted the shortages of tests made it challenging.
The government meeting also discussed the idea of making it mandatory for people to work from home in future (a measure currently recommended) as well as expanding third-vaccine-dose rules to more groups, including childcare workers.
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