It is the 20th of July and like surf approaching a beach from the distance, the Second Wave of COVID-19 has been approaching my home city of Melbourne for some time now. After the enormous relief of suppressing the First Wave, the continual increase in cases each day since June has been a cause of increasing worry for us all.
Now, hundreds of patients have tested positive for COVID-19 every day for the last two weeks, and as the total case numbers climb, the inevitable is happening.
COVID-19 cases are presenting to my emergency departments. Every day. In increasing numbers and severity.
As a doctor and emergency specialist, I have closely followed the evolving medical knowledge about the SARS-CoV-2 virus and the disease it causes, COVID-19. I and my colleagues have had four to five months to learn from the experience of the rest of the world, and to prepare our health system for a challenge that has not been seen here for a century.
We dodged a bullet in March and April, but any sense of relief has been wiped away in the last couple of weeks.
There are profound differences with the second wave. The cases are coming from multiple community clusters, not overseas. Many of my nursing, medical and supporting colleagues are either having to isolate as close contacts or testing positive for COVID-19 themselves. The pressure on rosters is significant and widespread. Some hospitals have struggled to keep accepting their usual caseloads.
But the biggest difference has been in the patients coming through the ambulance bay doors. With the first wave, positive cases were noteworthy for being infrequent and surprising. Now, we are seeing multiple cases every day, and many more of them require hospital admission. My most confronting case has been a man aged 69 with dangerously low oxygen levels and severe COVID-19 pneumonia. He required immediate resuscitation, the use of a ventilator, and transfer to Intensive Care. His life hangs in the balance.
The pandemic has affected every aspect of healthcare in the community and hospital sectors. Waiting areas cannot be allowed to become crowded. Visitors are only allowed in times of absolute necessity. Telehealth has become the default form of service provision for so many. Personal protective equipment and hand hygiene have become central to every aspect of clinical work, multiple times per hour, every hour of every shift. Even tea rooms and change rooms – a place to relax and debrief in normal times – require time limits and physical distancing to minimize the risk of virus transmission.
Emergency work has also radically changed. The first question in every presentation must be “Could this be COVID-19?”. Short Stay units have become COVID-19 and SCOVID-19 (suspected COVID-19) zones, not to be entered without full PPE, and a thorough knowledge of safety protocols. The importance and professionalism of our cleaning staff has never been more appreciated and respected.
The anxiety among my colleagues, and all the patients I see is palpable. I have no doubt that in 28 years as a doctor, this is the most stressful period I have ever encountered. It is because we face enormous uncertainty in the days and months ahead. Questions range from the capacity of our health system to handle the surge in cases, through to our own individual abilities to cope with the increased risks we accept.
I’m proud to say that we are coping with the situation, despite all the challenges we face.
We turn to our training. I have worked in many countries, and I’m proud to say that Australian health professionals are among the world’s best.
We turn to each other. In each of my hospitals, I know I work with people who care deeply for me, as I do for them. We support each other through ups and downs, usually with good humour, and always with great generosity.
And we turn to the Victorian and wider Australian community. Only they can drive down the numbers of COVID-19 cases, by observing physical distancing, staying home, wearing masks, and maintaining vigilance for even the mildest of symptoms. They have done so once, and we are counting on them to do it again.
It’s a very big ask, but the stakes could not be higher.
Dr Stephen Parnis
Emergency Physician and MIGA Board Member
The status of the COVID-19 pandemic in Australia at the date of the article and immediately prior to production of the Bulletin is as follows:
In the relatively short time period between the writing of this article and finalizing the August Bulletin for production (5 Aug), case numbers in Victoria have risen from 5,942 to 13,035, an average of 443 new cases each day over the 17 day period. Our thoughts are with our members and clients in Victoria as they work to manage the rapid increase in patient load, and with those healthcare workers who have themselves contracted the virus. Despite the workplace and personal challenges you continue to provide healthcare at a standard that leads the world. Your commitment, determination and compassion is inspiring.