A dedicated COVID hospital in Victoria would be good for patients and staff. But we can't be sure yet it will be needed

On Saturday, The Age reported the Andrews government had been discussing the possibility of a single coronavirus hospital to treat and quarantine Victorians who test positive to COVID.

The designated hospital would aim to relieve pressure on the state’s health-care system and minimise the spread of the virus within hospitals and the wider community.

Read more: Rising coronavirus cases among Victorian health workers could threaten our pandemic response

The decision on whether to create a single hospital dedicated to COVID cases in Victoria is still some way off. And agreeing on a site and getting it up and running is even further away. But with reports the government is weighing up whether this is the right approach, it’s worth exploring the issues around this decision.

Localising risk

It’s important not to conflate the issue of whether establishing a single dedicated hospital makes sense with the issue of whether all COVID cases should be hospitalised.

These are two completely separate matters.

The question of whether all cases should be hospitalised, regardless of the severity of their infection, speaks to a broader range of issues. This article focuses on whether a single dedicated hospital makes sense for cases with severe illness.

The rationale for a dedicated hospital is primarily about giving better care to COVID patients who need medical intervention, while minimising the risk of disease being spread to other patients as well as health-care workers.

Read more: Should all aged-care residents with COVID-19 be moved to hospital? Probably, but there are drawbacks too

Putting the practical issues of costs and logistics aside, the theoretical case for establishing such a hospital is based on several considerations.

What’s the case for a designated COVID hospital?

There’s no doubt it can be a real challenge to keep health-care workers healthy during a pandemic. Melbourne has seen well over 3,000 COVID infections among health-care workers since the beginning of the pandemic. More than 70% of them were infected at work.

Cultivating a very specialised workforce, with the most appropriate facilities, who are highly competent in Personal Protective Equipment (PPE), seems like a sensible option to keep health-care workers safe. A designated COVID hospital would also make it easier to design workforce strategies to contain a cluster in staff if it were to occur.

Locating all COVID patients at one site also helps prevent patients at other hospitals from being infected with COVID while in hospital.

It’s not just health-care workers and patients who stand to benefit. Adopting best-practice infection control at a dedicated COVID hospital would also potentially limit opportunities for infections to spread back into the community from health-care settings. If we’ve learned anything over the past few months, it’s how easy it is for infections to move from the community to high-risk settings and back again.

Other issues

While this sounds very promising, a single COVID hospital would also present challenges. Implementing it would be a considerable task — including finding a suitable site and equipping it with appropriate facilities and staff.

It’s hard to know whether the cost-benefit equation would favour the proposal.

The government would need to work to ensure, after focusing many resources on such a facility, it doesn’t become overrun if there is another wave. On the contrary, it also runs the risk of becoming a white elephant if it isn’t used enough to justify the time and money.

The problem, of course, is it’s hard to make predictions about the future course of COVID in Victoria.

Read more: PPE unmasked: why health-care workers in Australia are inadequately protected against coronavirus

Things to consider

At this stage, according to the Victorian government, a single coronavirus hospital is on the table as just one of many options to help navigate this once-in-a-generation pandemic.

The fact it is being discussed, whether it is deemed appropriate or not, is a good thing. Victoria needs to be exploring all available options. We should hope for the best while planning for the worst.

As with most things, the detail of the proposal will be key to determining whether this is the right path to take. How patients and health-care staff are managed will need to be considered carefully.

We also know many COVID patients with severe disease will have a range of other illnesses too. For this reason, it will be important any dedicated coronavirus hospital has the expertise to manage patients’ full range of needs.