Australia has an opportunity to learn from what is happening in Italy as that is likely to be us in one month. One hopes that the Government and health departments understand the impact of the disease on hospitals
Once the demand soars for hospital services, a number of things will need consideration.
can we keep corona and non-corona cases separate ?
how can we optimize the use of whatever resources we have here to manage the care of patients.
In Australia we have a private and public system and this means that taken as a whole, our system has much more excess capacity than a purely public system such as France or Italy. Negotiating fair terms with the owners of those facilities is best done before the crisis hits. The Covid-19 cases in Italy requiring hospitalization have generally needed high level care; many intensive care and have had long hospital stays
To properly understand hospitals, it is important to understand equipment and staffing. A typical surgical or medical ward looks like this
although this ward is empty, there is capability for some simple monitoring (such as pulse and oxygenation, maybe blood pressure) some oxygen supplementation and an infusion or two. A nurse may look after 4 patients
Contrast this with ICU
In this example there are syringe driver pumps, infusion lines, a ventilator, a dialysis machine and many monitors. A general ward cannot do the same function. ICU will have one to one nursing.
shows that NSW ICU occupancy is already at 90% in the winter months. Although cancelling all elective surgery would free up significant numbers of beds in ICU it would likely only increase availability by 20%. Around 40% of ICU admissions come post surgery but much of that surgery would be emergency
It may be possible to convert private hospital recovery
or operating theatres
into makeshift ICU or high dependency beds (as is being done in Italy) but this will require negotiation with private hospital operators and importantly will require large numbers of staff to be recruited / redeployed / upskilled
One of the ideas to address a likely forthcoming workforce crisis is that of getting retired doctors back to work. The Victorian manifestation of this idea is not novel. Boris Johnson floated the same idea in the UK
The State and Commonwealth Governments now have no easy way to contact let alone recruit these practitioners. The roadblocks to them working again include
No current registration and no easy and quick method to re-verify and re-credential original training
Current standards do not allow doctors out of practice for more than 12 months to practice without an approved plan http://cybersecurity.sarossy.com/medical-recency-of-practice-registration-standard/
Medical practitioners need by law to participate in Continuous Professional Development. These programs are administered by the relevant colleges. It is near certain that retired doctors would have allowed these memberships to lapse as membership is very expensive
Doctors who have retired and triggered the Run Off Cover indemnity scheme find it very costly and difficult to regain indemnity insurance
In short, although it is possible to re-recruit retired doctors to the workforce, it is something that requires careful thought and planning and involvement of many departments and organisations.
If it is a serious suggestion, the time to enact it is now.
There are a large number of claims about how the virus that causes covid-19 : the SARS-CoV-2 virus can or cannot survive under certain conditions
For example, can it survive in the sun, on metal, in water etc
Unlike testing for the presence of the virus – which is done with detection of viral RNA, testing for the viability of virus is very much more difficult. Most of the claims – if based on fact at all -are extrapolation from what is known for poliovirus – the standard test virus
To test SARS-CoV-2, it is necessary to culture the virus. consider the question “can the virus survive in swimming pool water?”
To test this we would put a known quantity of virus into standard swimming pool water, and then at some later stage attempt to grow the virus in a cell culture. It can be grown in the Vero-E6 line
It is hoped that a vaccine can be developed for the virus quickly. That may not be so easy
There are some early results suggesting that antibodies to the spike protein of the virus have some promise in protecting cells against infection. Translating this into a vaccine which is safe to administer to millions of healthy people will not be quick
Development of any pharmaceutical needs careful development. Progress occurs through phase 1 (safety) studies, through phase 2 and 3 (efficacy) studies. Research to refine the target population and the optimum dose is required.
Rushing such a thing can lead to problems. It is widely thought that immunization for the “swine flu” in 1976 caused an outbreak of Guillain-Barre´ s syndrome. There were issues with the testing and manufacture in response to the pandemic
The gold-standard test for Covid-19 is qRT-PCR. This stands for quantitative, reverse transcriptase polymerase chain reaction. In essence this converts viral RNA to DNA and then amplifies the DNA for detection.
There is much written about the shortage of “kits”. These are now available
Unique to a kit is the specific primers to identify the viral gene and the positive control for the disease.
The test subject must first be swabbed and the hope is that if the subject is affected by the disease:
He or she will be shedding virus onto the membrane that is swabbed
That the swab will pick up the virus
That the virus will survive the transport to the lab
Then the RNA needs to be extracted from the swab using a protocol similar to
The cotton tips were stored in 350 µL phosphate buffered gelatin saline (PBGS). For the extraction, the cotton tip was lifted out of the PBGS and placed in a clean microcentrifuge tube. The extraction was conducted using the RNeasy Plus Mini Kit (QIAGEN) following the manufacturer’s instruction for tissue samples.
Habarugira, Gervais, et al. “Mosquito-Independent Transmission of West Nile virus in Farmed Saltwater Crocodiles (Crocodylus porosus).” Viruses 12.2 (2020): 198.
The extracted RNA needs to be processed in a qRT-PCR machine using the kit. Machines are available as 96 or 384 well devices – this is the number of simultaneous tests that can be done.