What does ventilation look like?

Transcript: AMA Queensland President, Professor Chris Perry, ABC Gold Coast Weekend Breakfast, Saturday 4 September 2021

Subjects: Hospital readiness for COVID outbreaks

BERN YOUNG:   A four-year-old girl now has tested positive to COVID-19, right on the doorstep of the Gold Coast, that’s at Mt Warren Park. A child care centre there and the Windaroo State School aftercare are now the subject of who’s been where and when, every family associated with those two times and days will now have to quarantine for the next couple of weeks and of course, at any time, we’re wondering: “do we get the Delta outbreak that the southern states have had?”. ICU nurses are telling us here at ABC that they feel perhaps the public hospitals are not quite ready for what could be coming. Has there been enough focus on upskilling, is the preparedness there?

We did ask Gold Coast Health about the training that they’ve been doing. They say that they’re continually planning the next phase of “what if”, as they call it, as part of our COVID-19 response to keep Gold Coasters safe.

READS FROM STATEMENT:

“This is now part of our business as usual and happens continuously throughout most areas of the health service. This training ranges from correct use of PPE right through to clinical simulations, ensuring we have adequately trained staff to work in the COVID-19 ward, provide vaccinations, do COVID-19 testing and contact tracing, as well as upskilling staff in our work in intensive care.”

It’s a lot for staff to do, isn’t it? Is it enough? Professor Chris Perry is the AMA Queensland President and joins me this morning. Hi Chris.

CHRIS PERRY:   Good morning Bern.

BERN YOUNG:    We know we’re waiting for 80 per cent vaccination as some kind of golden target but we still know from all of the modelling that’s being done that by no means is anyone out of the woods at that point, so what should be happening right now at a hospital, let’s say JCUH?

CHRIS PERRY:   Well, obviously they’ve got to prepare for people on ventilators a lot more than they normally have, and when people get ventilated for COVID, they need to be ventilated for more than a month, whereas the average person needs to be ventilated for a day or two after a craniotomy, a neurosurgical procedure, or a serious cancer operation or maybe a heart attack. So one COVID patient will take up the bed of 15 to 20 regular intensive care people who need that intense nursing to stay survive.

BERN YOUNG:   So that’s a message. Maybe you could give us a bit of an idea of what someone being on a ventilator actually requires in terms of the intensity of the staffing around that? Because thankfully, I can say that I’ve never had to be a visitor of someone in ICU on a ventilator. I have been into an ICU before but not with a ventilator, and I don’t know if we really understand just how much pressure is on the staff at that time. So what goes on?

CHRIS PERRY:   Being on a ventilator means you’re anaesthetised. Instead of half an hour to have your tonsils taken out, you’re there for potentially a month. You’re unconscious, you’ve got a tube in your mouth or your nose going into your lung. You’ve got another tube feeding your stomach, you’ve got lines in your arteries sometimes, for your oxygen levels, and your veins. You are incontinent, so you need to be cleaned up. You’ve got a catheter in your bladder.

BERN YOUNG:    So there’s an enormous amount of this day-to-day care, literally every function of the body requires care, and every bit of care requires people?

CHRIS PERRY:   And constant drugs going in, and making sure the patient doesn’t have pain, even though they can’t tell you they’ve got pain.

BERN YOUNG:   We absolutely want to put faith in our hospital system, and so when they say that they’ve been continually planning for this next phase of what if, and that is now part of business as usual, have you got any evidence either of the fact that preparations are there and that we can have faith in it, or have you any evidence to the contrary?

CHRIS PERRY:   Well, we hope so. Gold Coast Hospital is one of the five or six COVID hospitals for Queensland. They do a very good job, good university hospital, tertiary referral. We don’t have the same panic of a year ago. We have enough ventilators. We’re going to hit 80, 85 per cent vaccination rate, we think, in two or three months. Will it get to be overwhelming intensive care in two or three months? That’s unlikely, but they’re preparing now. They’re getting the staff up and running. But the staff are in short supply.

BERN YOUNG:   What’s happening with staffing? Is there actually a staff shortage as such?

CHRIS PERRY:   Yes, there is. We’re coming up to school holidays. It’s the end of winter so there’s winter ills. We saw when COVID hit a couple of people in Brisbane, 450 doctors were locked down. The same will happen at the Gold Coast. There’s a shortage of the casual workforce in nursing because of the vaccination clinics and the testing places. There aren’t unemployed nurses waiting around to get a job. There never really were. So when they’re doing other things and aren’t available to fill in, the hospitals don’t have backstaff.

BERN YOUNG:   What can you do about that now though? How would you stop that gap?

CHRIS PERRY:   Well, you have to upskill some of the people. So if we do have a bad COVID outbreak, and it’s unlikely it will be terribly bad, routine surgery will stop so the staff in the routine wards will need to be upskilled. Sure, they can wash a patient, they can give drugs at the right dose, but to be able to adjust the settings on a ventilator and monitor a patient who’s anaesthetised by themselves, with doctors around but you know, a doctor looking after 10 people and a nurse looking after one, it requires upskilling.

BERN YOUNG:   Can I just go back to something you just said before, you just said if we do have a COVID outbreak, did you just say it’s not likely to be too bad? What are you basing that on?

CHRIS PERRY:   Well, it takes a few months for it to build up. It’s been a couple of months in New South Wales. Also in New South Wales, it’s not controversial to say the lockdown wasn’t real for a while. And it was allowed to escape too much. Queensland won’t have that. Generally, there’s a smaller population in Queensland of people who doubt COVID is a disease to be concerned about, so people tend to do what they’re told.

When we had the issue in Brisbane in Indooroopilly, it was a suburb of people with good education, they did what they were asked to do. When the police went around to 2,500 households on a number of different days to see who was staying at home and obeying the rules, they found on one day two out of two-and-a-half thousand, on another day three out of two-and-a-half thousand who weren’t at home. They do what they’re told.

BERN YOUNG:   Do you feel though, Chris, that there’s been somewhat of a shift, that there’s been a growing anger and frustration with lockdown though? I sense it a little bit more here perhaps on the Gold Coast, because we’re right on a border community, and there’s been such great frustration around the non-existence, essentially, of the bubble, even though technically there’s a bubble but there’s not much room in the bubble for movement. Do you think we can really rely on the fact that people have always done the right thing in the past in Queensland? Because it does seem to be a shift in the frustration from anger to sometimes rage.

CHRIS PERRY:   Yes, it’s right, you don’t blame them. AMA Queensland has been lobbying, as has the Queensland Government, for the New South Wales Government to get a bubble going south of Griffith St. It needs to go down to a moat like the Tweed River, preferably the Richmond or the Clarence River.

We know from sewage studies that the virus probably isn’t that close to the border just yet, but it could be there tomorrow, it could be there today. And it would be so much easier for the citizens of New South Wales and southern Queensland, if they could move more freely like people in Brisbane do. We walk down the streets in Brisbane without masks, we need a mask indoors in certain situations. We don’t want to go into harsh lockdowns and be locked in our homes. It would be much more sensible if the New South Wales Government did take the bubble down. People are getting sick of it.

The good thing though, is with 80 per cent or we get up towards those percentages, COVID is a disease ravaging the unvaccinated. The vaccinated people get a mild illness mostly, but they do spread the disease, they can spread the disease, usually asymptomatically or unknowingly or mildly. So once we get to that good level of vaccination, the disease won’t overwhelm our hospitals because they won’t need to go to hospital. If they do, they won’t need to go into intensive care and they certainly won’t need to be ventilated, and they won’t die.

BERN YOUNG:   Yeah, there’s a lot of ifs still in all of that, hence why GC Health said the planning is always for the next stage of “what if”. The “if” is if everybody does go and get all those vaxes. We do know that the vaccination hub here at Broadbeach has now extended its hours until late at night every night, they’re hoping to get several thousand extra through that way every week, is my understanding, so that will make a difference. It’s good to talk to you, Professor Chris Perry, the AMA Queensland President.

4 September 2021