Thread by @AIlancheran

As NSW prepares for it’s grand re-opening tomorrow & VIC abt 2 wks behind, I wait cautiously with bated breadth. As I write this thread, the backup area for COVID pts in one of the places I work at has hit capacity. The docs are apprehensive at what the night will bring 🧵1/n

& tomorrow, we will execute the next stage in our surge plan. I want to talk to u abt #Moral_injury. As a HCW in this pandemic, I have been thru the highs & lows of everything my state has borne witness to thru the lens of my work. 2/n #Covid19Vic
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I have worried, angry, hopeful & now concerned. Everyone deserves to come out of lockdown & continue with their lives in the new COVID normal. We have sacrificed so much, Victorians more than any other for the gains we hope to reap in a few weeks. 3/n abc.net.au/news/2021-10-0…

Those infinitesimal changes to social rules that allow us to meet, to socialise; so we can empathise all that we have sacrificed. For my colleagues & I though, it means our challenging work is about to get a whole lot harder. The virus, with an R0 btwn 4-8 is already running 4/n

rampant in lockdown, it will truly be unleashed when restrictions ease. 70% of the eligible population of 16+ vaxxed means 56% of the total VIC population (a whopping 44% at risk still). 5/n
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This will mean that our hospitals will be swamped with increasing cases needing care. It means finite ICU beds will be under immense duress. It means that to meet the need, all “routine” care is likely to cease. In my work, there is occasionally a need for a routine ICU bed. 6/n

When resources are scarce, more often than not, “routine” care gets deferred. It means that Victorians that have otherwise been waiting months for a big operation needing ICU might not get that chance. We have increased capacity in preparation for this but manpower is finite, 7/n

compounded by stretched staff & likelihood of furlough with rampant community transmission. This might, if things do not go right, potentially lead to an Italy style triage system at play. We might need to allocate scarce resources to those that will benefit the most from ICU 8/n

This is the #Moral_injury that staff will face. “He was too old”, “She has too many co-morbidities”, or worse, “He is a drug-user, non-compliant”, “She is overweight, she doesn’t have anyone who can look after her”. 9/n
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We have been so lucky in this country to have the benefits of Medicare & deliver the best healthcare to anyone, regardless of wealth, race or creed in the public health system. We make decisions based on a patient’s needs, not what they can afford. 10/n

I have never had to deny care in my work to date, due to the lack of resources. I understand this privilege & will defend it to the end, as it encompasses what I can contribute to a pt’s care without those impediments. 11/n
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As we open up, HCWs & the healthcare system will be under enormous strain. My colleagues & I will be faced with many difficult decisions in the coming weeks, mostly about someone else’s loved one or family member. That we might be in a position not to be able to provide the 12/n

absolute best standard of care will cause some of us immense moral distress. I hope that for them, there are avenues to reach out to, supportive colleagues, supportive work environments & most importantly, a kind & forgiving public that understands the challenges we are 13/n

about to face in this once in a hundred year pandemic. We are not safe till all of us are safe. Please take cautious steps as we re-open & let’s give everyone who needs care, the equity of access they deserve. Pls #GetVaccinated END. independent.ie/world-news/cor…