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It’s not Covid that’s broken our health system, it’s years of neglect | A Victorian doctor

Recently, I was doing night shift in an emergency department and every single patient I treated tested positive for Covid. But that was not the reason they had presented to hospital. It was routine testing that picked up their infection.

This is the reality of working in an Australian emergency department over the last month. This week it has become especially stressful as the volume of Covid-positive presentations has increased – at least two-to-fourfold. The staff on whom it places strain include cleaners, nurses, administration workers and doctors.

Covid-19 has added a new dimension to all emergency departments in Australia. The advent of the Omicron/Delta wave of late 2021-22 has put immense strain on these sections of the health workforce due to sheer patient load.

Although inpatient hospitalisations and ICU Covid-19 numbers have only begun to rise (these are people with moderate to severe Covid, who mostly require constant oxygen therapy as a minimum), these numbers mask the hundreds of patients presenting to emergency departments across Australia who are positive on an RAT or a PCR test.

Unfortunately, due to the insane virulence of Covid Omicron, a large proportion of Australians is becoming infected very quickly and even though a small proportion of those infected will require hospitalisation, that number of patients on top of a consistent 95-99% bed capacity of most health organisations puts the hospital at breaking point.

I have witnessed these added presentations breaking the souls of many healthcare workers who cannot deal with the stress.

The increase in patient loads these health services are experiencing has led to patients waiting a long time and health services requesting patients with mild Covid or seeking a Covid RAT or PCR not to attend an ED as they will be turned away. This breaks my heart.

Most will be fine and survive (albeit the clinical studies surrounding long Covid do not make for comforting reading) but there are some unlucky few who will deteriorate, require ICU care and may die.

We are now two years into the Covid-19 pandemic: from flattening the curve, to lockdowns, to a Covid-free summer, to vaccines plus boosters, to RAT shortages, and finally to living with Covid. We have all lived through these phases but the reality for the burned-out healthcare worker has not changed.

We are still donning and doffing PPE constantly, we are testing, crying, covering extra shifts, considering quitting, restricted from taking annual leave, stepping outside our comfort zone, breaking bad news, speaking with families by phone rather than face to face, and hoping it all goes away – all the while knowing that Covid is now the new normal.

It’s not just ICU bed numbers that demonstrate the extra burden Covid-19 adds to the healthcare system, despite what some politicians and commentators would like you to believe.

It’s the sheer number of patients with confirmed or suspected Covid at the moment. This gives an additional layer of complexity that must be considered by every health worker on top of often already medically and socially complex patient presentations.

Alongside this, it’s the constant concern by health workers that they will pick up the virus at work and pass it on to their child, elderly parents, pregnant partner, immunocompromised friend.

We are now seeing significant numbers of colleagues isolating due to being sick and this is all escalating to a point where healthcare workers, particularly in Victoria, are exhausted from two years of these worries.

It has become normal to speak to a colleague at work who has made plans to move from emergency departments to work that allows them to have time away from the constant pressure the health system is under.

It is unfortunately also not uncommon to find distressed colleagues at work.

The most important thing I want to convey is that it’s not Covid that’s broken our health system. It’s decades of a broken health system, run by overworked, exhausted and often underpaid people.

The solution to most of these issues is structural governance reform at both state and federal levels.

Our healthcare system is a precious resource and one of which many who work in it in Australia are proud.

The Covid-19 crisis we are experiencing now puts this system at major risk and along with it the health of all Australians.

This piece is written by a doctor working in a hospital in Australia during the Covid-19 pandemic

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