Some experts believe Australia’s health system could be overrun by COVID-19. Picture: Jason Edwards
Some experts believe Australia’s health system could be overrun by COVID-19. Picture: Jason Edwards

‘Nightmare scenario’ Australia must avoid

Experts have warned Australia could start running out of ICU beds in less than two weeks if the coronavirus cases continue on their current trajectory.

ABC presenter and physician Dr Norman Swan warned hospital beds could run out in NSW by April 10.

"If this hockey stick (the sudden rise in cases) doesn't change that much, we'll be out of ICU beds in New South Wales - Victoria will be behind that - by April 10," he said on Q&A this week.

"And in that case, ICU physicians will be faced with some very difficult decisions. And overseas, 30 per cent to 40 per cent of ICU beds are filled with young people."

That is the fate Italy is now grappling with, with hundreds of people dying each day and doctors forced to make the difficult decision of who gets priority.

But just how likely is that worst-case scenario to hit Australia, and what would it mean for our health system?

WHAT AUSTRALIA WILL DO AS INFECTIONS RISE

Queensland University of Technology's School of Public Health Emeritus Professor Gerard Fitzgerald says the current number of COVID-19 cases in Australia does not yet challenge our health system.

"At the moment, we've got 90,000 hospital beds. 2700 cases is manageable within that infrastructure," he told news.com.au.

Prof Fitzgerald's main worry is that health personnel are already being stretched through various involved tasks, such as undertaking contact tracing to figure out how the virus is spreading, collecting data and implementing enhanced infection control procedures.

He also noted there would be a lot of respiratory people who are - quite justifiably - feeling anxious and seeking medical attention when they're more likely to have a cold or influenza, further straining that system.

 

 

But while there are concerns about the coronavirus overriding our health capabilities, Prof Fitzgerald says we're still on the lower - or milder - end of the scale.

He explained there are four broad categories into which you can divide the response of a country's health system to a disease outbreak.

The first relates to a relatively small epidemic, by which health systems will seek to concentrate care into a small number of facilities. This might mean special hospital wards set up for COVID-19 patients to be kept in isolated intensive care.

The second tier involves health facilities creating additional internal capacity. This might see patients sent to other facilities, elective surgery cancelled, or patients being discharged from hospital early if it's unnecessary.

Australia, he said, is currently hovering between these first two categories.

The third tier involves creating new capacity, through putting money into opening up closed hospitals or taking over alternative facilities such as hotels. We're seeing this play out in small parts of the country, such as parts of Victoria and South Australia, but not on a large scale.

The fourth and worst tier is when a system is completely overwhelmed. This is the fate Italy is currently suffering, and this is where you start to hear horror stories about health workers having to prioritise one life over another.

"In this circumstance, very hard decisions will have to made about relative benefit to preserve the health system's capacity for people who are more likely to survive.

"To support this, we would need to identify and communicate what is known as 'Crisis standards of care' so that there is a consistent, system-wide approach. The legal and ethical aspects of this will need agreement not only by medical authorities but more broadly in the community."

While this last scenario is a chilling one, Prof Fitzgerald doesn't believe Australia will reach the same fate as Italy.

"I think evidence is emerging that we're getting under control. Italy has more than one case per thousand people. People are being turned away from hospitals and they're basically saying you can be over age 75 with chronic disease and you're not taken into ICU," he said.

"To compare that, we have about one in 10,000. So we're nowhere near that level yet. The message coming through from central authorities is still that the overwhelming majority of patients have been overseas or had immediate contact with people who got the disease."

In a worst-case scenario, he said up to 400,000 Australians could die from the virus, with around 12.5 million infections - or half the population.

But he stressed that such a scenario was unlikely, provided people were "calmly determined" and continued to self-isolate.

178,000 TESTS CARRIED OUT IN AUSTRALIA

More than 178,000 coronavirus tests have now been carried out in Australia, with testing ramping up across states and territories.

Experts have repeatedly said frequent testing combined with self-isolation on the part of individuals is the best way to minimise the spread of the coronavirus.

Deputy Chief Medical Officer Paul Kelly said 10,000 tests a day is the capacity Australia is at now.

"There are new tests that have come on the market and I just want to really address that," he said.

"We are not at the stage of people being able to do their own tests at home, so-called point of care test, or a rapid test.

"Although, there are rapid tests that will be coming into Australia - indeed, some have already arrived and are undergoing the very important quality, safety and efficacy testing."

 

He said Australia was likely testing more on a per population basis than anywhere in the world.

"It is, for example, over 25 times as many on a per capita basis as has happened in the US. In the US at the moment, 53 per cent of those tests are positive, which demonstrates that they have a long way to go to have enough testing being done in the United States," Prof Kelly said.

"Here, our positivity rate is just under 2 per cent now and that again demonstrates, firstly, that we're doing a lot.

"Secondly, it convinces me that we're finding the ones that we need to look for."

Originally published as 'Nightmare scenario' Australia must avoid


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