From intense preparations and initial COVID-19 waves in early 2020; to the hard lessons and experiences of Victoria’s protracted second wave; to some relative COVID normalcy in late 2020/early 2021; to resurgences of COVID-19 cases, and stringent restrictions in Australia’s two most populous states, as well as the Australian Capital Territory and Aotearoa New Zealand, COVID-19 is set to remain part of our lives for the foreseeable future.
Thoughts and best wishes once again extend to colleagues and communities grappling with large numbers of COVID-19 patients, the personal hardships of protracted lockdowns, and the persisting issues of access block, all of which are still so frustratingly present across so much of our nations.
While it has been good to see redoubled efforts from some jurisdictional and national authorities to promote and encourage vaccination uptake, several related issues clearly require concerted attention as we travel down the precarious path to a slightly more open existence.
The first is a strong focus on promoting greater equity of vaccination access and coverage across both of our countries, including in rural, regional and remote areas, as well as metropolitan areas where vaccination rates may be lagging. This is particularly important for Indigenous communities, as distressing outbreaks in western New South Wales, and South Auckland Aotearoa New Zealand, have clearly illustrated.
As we seek to collectively and progressively ‘open up’, our systems and societies must be prepared to deal with more COVID cases. Greater, and more consistent vaccination coverage – an additional layer of protection both in relation to the health of individuals, as well as the already strained healthcare systems in which we all work – is one urgently needed component.
So too is ensuring healthcare systems, including hospital emergency departments, are properly supported, with collaborative planning, staffing and resourcing arrangements, to encompass both COVID-19 and our “business as usual” ED presentations, which we know will not abate, as we confront this next difficult phase. This requires a whole of healthcare system approach.
Widespread systemic issues still to be resolved across both countries have meant that many hospital emergency departments were already struggling under immense demand pressure prior to the most recent COVID-19 outbreaks.
These lingering systemic issues, which have continued to play out in relatively COVID-free jurisdictions, when combined with significant pandemic-associated pressures cause enormous stress in locations grappling with significant outbreaks. For the jurisdictions that remain relatively COVID-free, as I am sure you know, it is not ‘if’, but ‘when’ delta comes to you.
In the public domain, there has understandably been a significant focus on ICU capacity, staffing, and ventilator numbers, given the recent growth in COVID-19 cases. We certainly support our intensive care colleagues in advocating for the sickest of patients and their staff. However, ICUs admit just 2.5 per cent of COVID patients.
It is just as important to ensure entire healthcare systems, already under massive pressure, are properly supported and equipped to manage and treat a potential influx of COVID-19 positive patients. This must include the point where people with COVID-19 first interact with the healthcare system, and first enter hospitals via emergency departments. Around 12 per cent of COVID patients require inpatient care, and many, many others require assessments in EDs and community settings.
Governments, department heads, senior health administrators and hospital executives must listen to the staff on the frontline and do everything in their power to plan and prepare to mitigate the impacts of potentially catastrophic pressure on the healthcare system if a significant wave of COVID patients lands on our already over-stretched EDs.
As the pandemic continues to generate seemingly endless new challenges, amid rapidly evolving circumstances, the College continues to devote much time and effort to providing as much clarity and certainty as these most uncertain times allow.
This is particularly the case in relation to College examinations. While we must acknowledge the severe disruptions and immense uncertainty the pandemic has presented to trainees, the College’s commitment to making every effort to allow examinations to proceed is unwavering. We acknowledge the stress experienced by those who recently had their OSCE postponed. We will continue to communicate regularly, and with as much notice as rapidly-changing circumstances allow.
Another very important piece of recent work, involving the significant efforts of many among our membership, as well as College staff, is our follow up accreditation assessment as part of the College’s re-accreditation with the Australian Medical Council and the Medical Council of New Zealand.
With meetings recently conducted between various College representatives and members of the team appointed to conduct the follow-up accreditation assessment, we have received some positive preliminary feedback as we await a draft report for the College to comment on in late-September/early October.
Further information will be shared as soon as the College is able, and in the meantime, my sincere thanks go to all involved in this significant undertaking, so crucial in allowing ACEM to continue with its core business of training emergency physicians.
As we approach the next phase of pandemic life, it is fitting – particularly with ACEM Wellness Week having occurred just last month – to reiterate the importance of taking care of yourself, each other and your loved ones.
Times are difficult, but we will continue to support each other through. For anybody who may need assistance, a range of resources are available through the College.
On this theme, I also encourage you to consider a nomination for this year’s ACEM Wellbeing Award, that celebrates the initiative(s) of an individual member, group or emergency department that have resulted in the enhancement of wellbeing for emergency department colleagues.
Despite many challenges, there is still much to be proud of, and hopeful for, within our field of emergency medicine, and I encourage everyone to look for and celebrate the positives.
Thank you, once more, for all that you do. The efforts you make every day are appreciated.
Dr John Bonning