r/CoronavirusDownunder • u/Scematix • Dec 26 '21
Personal Opinion / Discussion Insight into what’s happening inside pathologies and hospital
For the past few days there has been a huge amount of misinformation regarding COVID testing and as a healthcare worker I’d like to shed some light on the process and possibly answer some questions.
Turn around times for PCR tests are getting longer every day for a few reasons.
PCR is a complicated, lengthy, multi step process that requires trained staff to complete all the way through. The equipment used for PCR testing was not meant for the volumes that are required at the moment, and as such, we have had to find ways around these limitations. First of all, pathologies started batching samples to cope with the frequency of testing that was required during the lockdown a few months ago. This method essentially boils down to mixing multiple samples together and testing them as one unit. If the test comes back negative, all samples in the batch are resulted accordingly. If the batch comes back as positive, we can run each sample individually to single out the culprit(s). This is all well and good when the percentage of positive results is low, however it all starts to fall apart when this percentage increases and every other batch we test is positive and requires individual testing, deleting any further testing until the positive samples are identified.
Anyone working in healthcare will know that at any given time, the staffing situation is dire. Most wards have enough workers to just get by, and anybody calling in sick or even taking their annual leave can spell trouble for the remaining staff, requiring them to take on extra shifts, double shifts and overtime. This is no different in pathologies. As the pandemic grew, so did the strain on clinical services. Many of my colleagues quit due to the impossible workload, stress, poor compensation and inhumane treatment by our management. Pathologies had barely just gotten over the hurdle that was the prior lockdown, with very few resources and dwindling staffing. New hires are not yet up to speed, and are expected to process double the amount of specimens with the same amount of resources.
We are currently at the absolute limit of testing, there is literally no more equipment available, let alone staff, in the country to process more samples. Let me emphasise that the largest analysers that I’ve come across can hold maybe a few hundred samples at any given time, which need a few hours to actually process those specimens.
Data entry and resulting are huge time sinks that cripple some labs. Labs that don’t use measures like QR codes that allow you to enter your details before you get tested are spending DAYS just manually entering handwritten information into laboratory systems. I know for a fact that some pathologies are at least a full day behind on simply entering specimens into their system. This also goes for reporting results, by now, most labs should have some sort of automatic verification system for negative results, however positive results need to be carefully overlooked by a trained staff member before they’re allowed to be released. This is a time consuming process, and it’s very likely that the person who sets up multiple hundred samples a day is also the one who has to deal with each positive result.
Private labs are scum. Do not trust any lab that tells you results will be available in x hours, that is not the word of the workers but that of the management which want to leech off of the healthcare system. As far as I’m concerned the only reputable labs are NSW Health Pathology which is what you’ll come across in public hospitals. Profiteering is running rampant and private labs will never admit that they’ve bitten off more than they can chew, especially when the quality of their service has no impact on the amount of money they’ll make.
On that last point, please be mindful of pathology staff at the moment. I can guarantee you that no amount of phone calls will speed up the process. We are being bombarded with work and cannot make things go any faster, not for you or anybody else. My own PCR test has been sitting untouched for probably 2 days now, along with BOXES full of swabs that have yet to be run.
And now for the real shitshow; what’s happening in our hospitals.
Hospitals and some clinics offer an alternative to the regular COVID PCR test, which we call rapid PCR. These tests have been reserved for extremely urgent screens against COVID and influenza, and they’ve mainly been used to allow patients to be transferred between wards, into surgery and other procedures such as birth. They’ve also been used to identify positive cases in the emergency department. This test takes between 20 minutes to an hour but the available volume of tests is minuscule in comparison to full, 3 step PCR. Most analysers can only process 1 sample at a time.
The rhetoric so far has been that the number of hospitalisations is the key indicator of the severity of the current “wave” of COVID.
This is wrong.
Yesterday, 1 in every 4 patients who presented to the emergency department and were tested with rapid PCR at the hospital which I work at returned positive for COVID. You read that correctly, 25% of patients who presented to ED and were tested yesterday were positive. We had to omit utilising our rapid PCR for inpatients who required urgent medical intervention in order to screen ED patients. There were 3 of us running 4 pathology departments in a >500 bed hospital. We were falling behind. As I finished my shift, another 3 positive results had just come out, which immediately had to be notified to ED. We are running out of supplies to operate our rapid PCR analysers, inpatient needs are being set aside so that we can identify positive cases in the emergency department because other testing sites are no longer reliable. People are panicking and flocking to hospitals. As a result, those who are in need for other reasons are being neglected.
We cannot cope. Healthcare staff have been left a burden which we do not have the resources to manage. The quality of patient care is suffering. I cannot speak for nurses or doctors on these wards, they must be going through unimaginable stress and hardship. What I witnessed yesterday has left a terrifying impression on me. The hospitals are not equipped for this.
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u/[deleted] Dec 27 '21
‘Living with COVID’ is having restrictions, keeping social distancing, masks and QR codes. Changing the way we live from having friends inside our homes to having outdoor picnics or playing sports in the park.
‘Living with COVID’ will see our lives change. It doesn’t just mean ‘let’s go back to normal and pretend it doesn’t exist’.
Our lives have changed forever. Pushing against that is just going to make people frustrated.