Staff shortages in one of Sydney’s best-resourced hospitals have sent nurse-to-patient ratios plummeting as new data shows the share of Covid patients occupying intensive care beds has shot up from one in five beds to one in three in just one week.
The high dependency unit of the hospital, which treats almost two dozen patients not yet sick enough to need intensive care, has about one fifth of its nurses absent because of Covid, according to a senior nurse who requested anonymity because of a ban on speaking to the media.
New South Wales may soon record as many as 100,000 new Covid cases a day as people taking rapid antigen tests report their positive results. Even though the Omicron variant is less virulent than the Delta strain, the explosion in cases means even if a small proportion get very ill that number threatens to overwhelm the hospital system.
Unlike in previous Covid waves, the hospital’s HDU is now housing Covid-positive patients even though it does not have specialised air treatment to filter out the virus.
“We’ve got a few patients with literally no immune system,” the nurse said. “They can die if they got [Covid] pretty instantly.”
Fresh figures from the Critical Intelligence Unit of the NSW health department show that as of 9 January the share of staffed ICU beds occupied by Covid patients across the whole state stood at 33%, up from 19.9% on 2 January.
The average length of stay of admissions for the week ending 10 January was 4.5 days, up from 3.6 days for the previous week, the data shows. For those in ICU, the average stay was 4.7 days compared with six days a week earlier.
As of 9 January, NSW had 4,941 healthcare workers in isolation, up from 2,457 on 3 January, the data shows.
Senior medical staff were told on a conference call on Wednesday that Westmead, one of Sydney’s biggest hospitals, was now treating 350 Covid patients while the Royal Prince Alfred hospital had 150, a senior doctor told Guardian Australia.
The strains on the state’s health system were “dire”, the doctor said, adding that staff were again told not to speak to the media.
“We’re pretty much at full capacity,” the senior nurse said. “From what I understand, our ICU is basically completely full.”
Staff with Covid at the nurse’s hospital who had previously been required to isolate for 14 days, with tests every three days, had now been reduced to seven days’ isolation.
The nurse said the halving of isolation was “absolutely ridiculous” because some people can still be “quite infectious by day seven”.
“In the workplace environment, the moment you remove your gown … before you put on another one, you will still be touching other equipment,” the nurse said. “So imagine that this particular person who got asked to come back to work as Covid positive, who happened to spread it to everyone in the workplace … the whole HDU will crumble.”
Having Covid patients in the HDU was also complicating the work because of the onerous wearing of “hazmat” level personal protective equipment.
A patient needing resuscitation would typically require a team of eight staff in normal times. Such work was now being done by two to three staff.
“Basically, one of them is responsible for compression, one for airways and other one medication, and all the others they have to stay outside” to give advice to a crew “already under a lot of stress”, the nurse said.
Normally the HDU would have a minimum of one nurse per three patients. That ratio had now risen to one to five on occasions, and may reach six or seven.
Such a level would be “very, very dangerous”, the nurse said. “It defeats the whole purpose of having more close and more intensive monitoring and observation.”
Staff had been told to minimise their exposure to the virus by wearing masks, maintaining social distance and washing hands, the nurse said.
“But you were in a hospital situation. You can’t maintain social distance when you’re in a place like giving an injection to a patient,” the nurse said. “It’s not a dart. Just you know, stand outside the door and grab the patient’s arm, it doesn’t work like that.”
The dearth of rapid antigen tests had also affected the hospital, the nurse said. Staff were supposed to test every second day, but could not get access to a test even at the hospital.
“In my particular HDU, we haven’t have received any RAT tests at all,” the nurse said. “Staff members were literally asked to go buy the RAT test or order some from some other units.”
NSW Health has been contacted for comment.
Do you know more about pressure in the healthcare system? Contact peter.hannam@theguardian.com. You can remain anonymous.
