‘We are absolutely in crisis’: Sydney’s health workers on whether the system is coping under Covid

·6 min read
<span>Photograph: Lisa Maree Williams/Getty Images</span>
Photograph: Lisa Maree Williams/Getty Images

We spoke, promising anonymity, to health professionals across Sydney ranging from managers to doctors, nurses, allied health and paramedics. They work in emergency departments (ED), Covid-19 wards, regular wards and allied health (eg physiotherapy, social work). We asked them how the health system is coping.

Currently, there are 1,207 active Covid-19 cases in New South Wales hospitals with 236 requiring support in intensive care units (ICUs). The effective reproduction rate is currently less than 1, signalling the likely decline of the curve (while restrictions remain).

More than half the 16-year-old plus population is fully vaccinated in NSW. New data from the US shows that unvaccinated people are at 11 times higher risk of death from the Delta variant, 10 times risk of being hospitalised, and fives times risk of being infected than unvaccinated people.

Related: Roadmaps out of lockdown: why NSW and Victoria are taking different paths to Covid normal

As vaccination rate rises, hospitalisation rates will decrease. This means that case numbers won’t be the only important indicator for opening up. However, we are still expecting a surge on hospitals in late October and November, and it’s likely to last for months because loosening of restrictions means a larger number of Covid cases overall (vaccinated and unvaccinated).

Here we share what health professionals we spoke to said they are experiencing:

Freedom looming

“It does make me feel angry when I see some of the media terminology for ‘Freedom Day’ which suggests the pandemic is over, but health will be continued to be overwhelmed with Covid-19 for months through Christmas and into next year with the overwhelming majority of those critically unwell in ICU unvaccinated.”

There are not enough hospital staff

“Wards are needing to be opened to admit Covid-19 positive or close contact patients and there are inadequate staff to care for them.”

“It’s all hands on deck and stressful as staff move to new environments which they are not familiar with and may not be optimal for patient care.”

“We are completely overwhelmed. To be honest, we were overwhelmed before this current wave of the pandemic hit. Staff are past breaking point. Bullying and job dissatisfaction are at an all-time high. The pressure has never been so intense. Patient care is being rushed/hurried/compromised to meet targets or to avoid us ending up in the media again. Moral injury is spreading, and burnout is evident amongst the best-intentioned staff.”

Healthcare students impacted

“There is massive disruption to undergrad/postgrad training with many clinical placements unable to proceed.”

“The 2020 graduates required much additional support in their intern year to enable them to carry out expected duties. This was stressful for both them and their supervisors. Some of our future health workers will not be as work ready or highly trained.”

Clinical care

We spoke with clinicians who felt the health system was coping, considering we’re in a pandemic.

“I think your really sick patient is likely to get similar care. I think a subtly unwell patient might run in to problems.”

“[Hospital] is still working really collaboratively and well together and in the swing of managing the pandemic with appropriate resources.”

“[Hospital] is moving to a catastrophic phase right now with escalating Covid-19 admissions (more than 95% from outside of Local Health District (LHD), and now opening to max ICU beds.”

Usual patient care is suffering

Unfortunately, non-Covid-19 patients are also affected.

“Other wards are being forgotten. Acute wards are not being staffed, our nursing colleagues are being deployed to the Covid-19 wards and the staff to patient ratios are breaking down.”

“Working in full PPE is exhausting and seeing young patients with few comorbidities die even more so.”

“Health outcomes will suffer. Patients that should be seen in hospital for workup of time critical conditions such as cancer are not being seen to free up hospital capacity pre-emptively for Covid-19 admissions. People will die.”

“People who may have lived with high levels of function are going to die or become disabled. We will spend years trying to catch up with the devastation this has caused.”

Would you depend on an ambulance and hospital for yourself?

When asked how they would feel about calling an ambulance for themselves or a loved one currently we heard: “I would be very worried about the capacity of an ambulance service to respond, and when it arrives at ED there are likely to be long delays and difficulties accessing specialists.”

“I’d be pretty devastated at their exposure risk, and their likely wait times for even ‘simple’ things like imaging or basic pathology. It’s not that the Covid patients are taking priority, it’s that the critically ill have to take priority.”

Is the clinical load being shared in hospitals?

We heard that load is being shared across hospitals. But we heard frustration that the workload is not being shared within hospitals.

“My current ED is overwhelmed by Covid-19 patients and cannot adequately manage routine presentations. Why aren’t the general surgeons in ED working up abdominal pain presentations from scratch? Neurosurgeons reviewing back pain and headaches? Cardiology reviewing chest pains? The inpatient teams, whose workload has dramatically reduced, remain on the wards or in ivory towers, expecting ED to provide them with the same neatly packaged patients as always.”

We heard that the majority of burden is being felt by adult (as opposed to paediatric) services, ED, Covid wards and ICU. “Inpatient specialists continue to work Monday-Friday 9am-5pm.”

Staff shortages

“I think the main thing that’s a crisis right now is the staff. None of the frontline staff want to do overtime and all the pen pushers are covering up smoke.”

Messages to the NSW premier from health professionals

“I understand the premier and the prime minister want to ensure the public have faith in the healthcare system and trust us, but we are absolutely in crisis.”

“Be honest with people about how dire the bed-crunch is, it might make how seriously they take this disease change a bit.”

Related: Don’t believe the Covid coping spin, those on the road know the health system is in meltdown | A paramedic

“Please don’t forget our overwhelmed health work force as you plan our way forward. The health services will need improved funding for years to come to support ongoing Covid-19 admissions, but also catch up on the care so many have failed to access during this pandemic crisis.”

“Develop vaccine producing capacity in Australia rather than being reliant on production from outside Australia.”

“[The current pandemic] is going fine. Please fix the wider issues that are exposed by Covid-19 such as access block to hospitals. Systems and investment are key.”

How you can help

Currently, we are balancing vaccination rates and lockdown measures with hospitalisations and deaths. For those holding out, the vaccines are safe and effective – which intensive worldwide research is showing, with a very high level of consensus among professionals. Vaccinate for society, but also for yourself as the chance of being infected is likely to become very high as Australia re-opens.

Please keep attending healthcare for all usual ailments, whether it be chest pain, breast lumps, or shortness of breath – our health systems are ready to accept you. Be kind to yourself.

• Joseph Freeman is a final-year medical student in Sydney

• Alexandra Martiniuk is a professor of epidemiology at the University of Sydney

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