COVID-19 WA hospitals plan: Chief Health Officer outlines plan for Omicron wave in three-page memo

Hospital workers have been told what to expect when the Omicron wave peaks in WA, including non-urgent elective surgery cancellation, outpatient appointments via video calls only and ambulances reserved for patients who need them. WA Chief Health Officer Andy Robertson issued a three-page message to the healthcare workforce after Mark McGowan delayed the reopening of the border to boost the State’s third dose rate and avoid seeding hundreds of cases. Based on the experience on the east coast, WA’s health system was planning for a peak in infections about 60 days after the February 5 reopening — early April — before declining to baseline levels after three months. Since announcing the delay, the Premier has given no indication of a new date, with a review of “opening options” to be conducted within the next four weeks. In the meantime, Dr Robertson has told hospital staff that although fewer people would be travelling to WA, “it does not change the need for our health system to be prepared and ready to respond to widespread community transmission of COVID-19”. “Significant work is continuing across the system to ensure that we have the resources and policies in place to respond to the anticipated surge in COVID-19 community transmission and continue to provide excellent care to our community,” he wrote in the memo. “As outlined in previous staff updates, testing, tracing, isolation and quarantine (TTIQ) and public health social measures (PHSM), alongside vaccination, will continue to be the tools at the forefront of our defence against COVID-19. “While we can expect our health system to be treating more patients for COVID-19 in the months to come, we are confident in our planning, preparedness and system capacity.” ELECTIVE SURGERY At a time to be determined by the CHO, all elective procedures in public and private sector medium and large hospitals would be reduced to only essential category one and two cases for about eight weeks. “The proposed 8-week reduction aligns with the length of the expected COVID-19 peak. This is consistent with the experience in the Eastern States,” Dr Robertson wrote. “WA Health will take these actions proactively so there are fewer disruptions to bookings and cancellations, noting this will be inconvenient for patients seeking elective surgery. “More information regarding the start date for these reductions will be provided once available. Until then, current elective surgery policies should remain.” TELEHEALTH Dr Robertson said all outpatient services should now move to using telehealth — video calls — where possible. From January 31 — next Monday — all appointments must be delivered via telehealth unless there was a “critical reason” why the patient needs to physically attend hospital. AMBULANCES Staff were told that at the point of widespread community transmission, all patient transport activities “should utilise standard models of transport”. Transport via ambulance would be reserved for those patients “who clinically need it” and all other patients could be transported by their regular means, “with appropriate protections in place, such as masks for the driver and the patient”. HIGH-RISK EXPOSURE A definition of being exposed to a COVID patient in a high-risk setting was defined as : *Staff who were not wearing airborne precautions PPE (N95/P2 masks, eye protection, gowns, and gloves) where aerosol-generating behaviours or procedures have been involved; *Have had at least 15 minutes face-to-face contact where both appropriate mask and eyewear were not worn by an exposed person and the case was without a mask; or *Greater than two hours within the same room with a case during their infectious period, where appropriate masks have been removed for this period. FURLOUGH Health staff deemed to have been exposed to a COVID patient in a high-risk setting must: *Quarantine for seven days since last contact with COVID-19 case; *PCR/RAT self-test on day one and six, then return to work day seven if a negative result is returned and they are asymptomatic; *Undergo further RAT self-tests on days eight, 10 and 12. MASKS Masks are mandatory at all hospitals, with N95s required in all emergency departments, while workers in other clinical areas must wear surgical masks. Non-clinical staff must wear their own personal masks and exchange these for surgical masks if they enter a clinical area. “The effectiveness of particulate filter respirators (PFRs), including P2 and N95, relies on a satisfactory seal being achieved between the PFR and facial skin. Wearing facial hair, even a few days’ growth, will prevent a good seal being achieved and reduce the protective benefit of a PFR,” Dr Robertson wrote. “The WA Department of Health requirement for wearing a PFR is that no facial hair is present between the wearer’s skin and the PFR, in accordance with Standards Australia and the manufacturers’ instructions for use.” LEAVE REQUESTS All leave should continue to be taken under the relevant Industrial Award and with approval from the appropriate delegated authority. STUDENTS Students can continue to attend facilities for training placements but formal teaching sessions would be unlikely once cases rise. “Students may be deployed to support the response in appropriate ways; however, they must be vaccinated, PPE trained and fit tested prior to attending health sites,” the document said. VISITORS Hospital visitors will be permitted, with limits placed on the number of visitors for each patient. It will also be mandatory for all visitors to be vaccinated from January 31. Volunteers will continue to be welcomed, providing they are vaccinated and have received PPE training.