SOAPBOX

POOR PUBLIC HEALTH PLANNING NO EXCUSE

BY DR ANTON VAN HEERDEN

The pandemic and our response to it has impacted all facets of life. In particular, the sweeping bans on elective surgery have had a devastating impact on community health, none more so than cataract surgery. As we know, this is a quick, highly effective means to reverse blindness.

The most recent ban on elective surgery was called due to a rapidly escalating COVID crisis in Victoria. The aim was to avoid hospitalisations, ICU admissions (from day surgery) and to redeploy staff away from day surgeries into COVID specific facilities. A ‘Code Brown’ was called by the Victorian Government in anticipation of this crisis.

The projected number of hospitalisations thankfully never eventuated. Meanwhile, the public and private surgery facilities lay dormant, the staff unoccupied and the degree of public health pathology rapidly escalated due to the compounding number of elective surgery bans over the last two years.

Cataract surgery is performed as a day surgery procedure in most cases. It is extremely rare for patients to require an overnight hospital stay and patients almost never require ICU admission. Ophthalmic trained staff have specific skills in eyecare and would have to be re-trained to be of use in COVID facilities and therefore would probably be the last medical personnel called upon to fill a gap in the COVID response facilities. The closure of all cataract surgery facilities therefore contributes nothing to the COVID response.

The pointless and arbitrary nature of the ban – and the ignorance of the government – was highlighted by the knee-jerk reaction to recommence IVF surgery in response to an emotional social media post and media pressure. Taking nothing away from the plight of patients undergoing fertility treatments, but why should a procedure with a relatively low success rate take preference over patients with crippling arthritis, prostate cancer or visual impairment?

The latest available national data shows wait times for ophthalmic procedures increased by 6.5 weeks in 2020-21 compared to pre-pandemic levels and have more than doubled to 172 days for cataract surgery. That will likely be much worse now with the latest shutdown, not included in the reporting period.

But the backlog of patients requiring cataract surgery since the start of the pandemic will be impossible to know. The public hospital waiting lists are not an indication of the real problem as these lists only reflect the number of patients who have had an appointment at the public hospital and are waiting to have their surgery. The out-patient clinics have also mostly been on hold during this time, so the true backlog of patients in the community requiring surgery will be drastically understated.

The number of patients with advanced pathology and blinding cataract will also be unknown. A small sample of patients I saw at a recent public hospital clinic had blinding cataract. These patients have had their clinical appointments repeatedly delayed and postponed.

They were desperate to have cataract surgery, however, were deemed to be category 2A and therefore unable to have their surgery during the indefinite restriction period. Shutting down the private system was even more absurd. These facilities are reliant on income from surgeries. And with staff generally not allocated to help with the COVID-19 response, there was little for them to do as their facilities sat idle.

Did the Victorian Government’s reliance on private hospitals to manage their COVID patient load influence its decision making? One can only suspect the private hospitals put pressure on the government to disallow competing day surgery facilities to function while their facilities were filled with COVID patients.

Future COVID waves are coming. There will be new variants and surges in hospitalisations. The government knows this and should plan accordingly. Recently built quarantine facilities which are no longer part of the COVID response are just a small example of government-run facilities that could be used to manage future COVID patients rather than rely on private hospitals to carry the load.

Blanket restrictions on elective surgery are unnecessary, have a devastating impact on public health and should not be an excuse for poor government public health planning. n

Name: Dr Anton van Heerden Qualifications: MBChB (Stell); FRANZCO; FCOphth(SA); MRCOPhth(London) Business: Royal Victorian Eye and Ear Hospital (RVEEH), Armadale Eye Clinic and Mornington Peninsula Eye Clinic Position: Surgical Ophthalmology Services head (RVEEH) and private clinic director Location: Melbourne Years in profession: 14 IT IS EXTREMELY RARE FOR [CATARACT] PATIENTS TO REQUIRE AN OVERNIGHT HOSPITAL STAY AND PATIENTS ALMOST NEVER REQUIRE ICU ADMISSION.