Under huge strain, GHA urges public to heed Covid advice
The rising number cases of Covid-19 locally is placing great strain on the Gibraltar Health Authority, with one in 10 nurses in isolation or testing positive, stretching the workforce, acting Medical Director, Dr Krishna Rawal, has confirmed.
The surge in cases struck staffing numbers just as there has been an increase of Covid hospitalisations, meaning that the remaining staff need to cover this extra ground while taking precautions to prevent a spread.
As cases soared on Wednesday, with 180 new Covid cases reported, the impact was felt by the GHA, which now has 12 positive cases in the Covid-19 Ward and a further three in the Critical Care Unit, as well as five in Elderly Residential Services.
But the issue is that those in the CCU need “high intensity nursing” at a time when there are fewer nurses available.
In total, 68 nursing staff are either in self-isolation or have tested positive, nine staff in mental health services are isolating, and in Elderly Residential Services there are six positive members of staff and 29 in isolation.
“That’s very significant, can you imagine any particular unit looking after patients, particularly the really, really front line… can you imagine if you took away 10% of their staff?” Dr Rawal said.
“Reduce their effectiveness by 10% in a department that is not only looking after Covid patients, but looking after patients who are very unwell for all the other medical reasons that clearly haven’t gone away.”
“We have departments and staff who are stretched and doing their best.”
“We have departments and staff who have been working since February and March and are exhausted and, on top of that, we have now reduced their numbers because they are either in isolation or positive.”
CCU patients need round-the-clock monitoring and care, they need at least one or two nurses per patient.
Currently the CCU can accommodate 13 patients and, on Wednesday, eight of these beds were occupied, three by Covid patients.
Last summer, the GHA established some triggers of what should happen if the hospital were to reach saturation with Covid patients.
“We are very close to those triggers, in terms of the numbers in the Intensive Care Unit, at three of more and we are very close to those numbers in terms of our Covid Ward,” Dr Rawal said.
“We tend to work much more on anticipating because the numbers today tell us what was happening 10 days or two weeks ago. We always have to be one or two steps ahead of the game.”
“We had already predicted that these numbers would perhaps go up so we have already allocated some more beds from the Day Surgery Unit which can be used as the ‘clean’ intensive care unit.”
“These are for non-Covid patients so we can then expand the number of beds in intensive care to look after more Covid patients as we need to and at the same time protect those patients who come in after an accident or have had a heart attack.”
Six beds have been cleared from the Day Surgery Unit to provide for this ‘clean’ CCU ward if Covid cases needing critical care continue to rise.
The Victoria Ward, now known as the Covid Ward, has space for 34 beds – of which 12 are currently in use.
“One person in the Critical Care Unit requires a whole team of medical and nursing staff,” Dr Rawal said.
But moving the CCU patients into the Day Surgery Unit is not just a matter of empty beds, the GHA needs to have enough staff to care for them.
“When we start increasing our number of Covid patients in intensive care from three to, say, four or even five, some of these may be very unwell and require high doses of oxygen, lots of monitoring or even ventilation,” he said.
“You are now using not only high intensity in terms of nursing staff but you are using up some of the isolation rooms, which means some of the other patients are potentially exposed.”
Dr Rawal explained that the hospital works by “cohorting” staff, meaning that some may only work with Covid patients and others will work on Covid-negative patients, so the risk of transmission between staff to patient is reduced.
For Dr Rawal, this year has been a “very long road”, but he said the increase is not surprising and viruses can adapt, resulting in second and third waves.
In an online video, he pleaded to the public to heed public health advice and pick up phone calls from the Contact Tracing Bureau.
“This year has been a difficult year for all of us, and on many days it has been really easy to forget that there is life other than Covid, but we at the GHA have not forgotten,” he said.
“Every day we care for those with Covid, but we also care for other medical conditions, with the same staff, the same teams and the same dedication to this community.”
“But we can’t do this without your help.”
“I’m asking each and every one of you to help us slow the transmission of this virus so we can all prevent people from getting sick and needing hospital care due to Covid.”
“Then we at the GHA can carry on providing medical care to everyone in this community, from a GP appointment, to major surgery, to a cancer diagnosis and treatment – the GHA is here for you, for all of it.”
“It’s easy to help the GHA. Follow the public health advice, wash your hands, wear a mask in public places and respect social distancing.
“And please, I am asking you, answer the calls from the Contact Tracing Bureau, it may be a number you don’t recognise but answer these calls and follow the advice they may give you no matter how inconvenient, frustrating or infuriating it may seem.”
He added there have been reports of people not picking up calls from contact tracing to avoid isolation and this has been an issue.
“If you are a close contact or positive, you have to go into isolation,” he told the Chronicle.
“It’s the only way.”
Dr Rawal confirmed he expects the Covid vaccine developed by Pfizer and BioNTech to arrive in Gibraltar in the seven to 10 days in January and the vaccination campaign will begin within a couple of days of its arrival.