Over the next few weeks, West Australians will find out whether the state's health system has managed to hang on through the worst of COVID-19.
WA is now expected to reach its peak number of daily infections on Monday, with modelling suggesting about 10,000 people will test positive.
The week or two following that peak hospitals are expected to be put under the greatest pressure, with about 443 general beds and 56 ICU beds predicted to be occupied on the busiest day.
But the health system is beset by an increase in ramping, delays to elective surgery and confusion around when people should be getting PCR tests.
According to the state's peak medical lobby, everything should be able to hold on — but only if the state keeps on the same track that has been modelled.
Any significant increase in case numbers or hospitalisation could result in the system being "flooded or overrun," in the view of Australian Medical Association WA president Mark Duncan-Smith.
With staff put under growing strain from an increase in critical COVID-19 cases, Dr Duncan-Smith said the death rate from other non-coronavirus related events such as accidents, heart attacks and maternity emergencies could also be expected to rise.
Elective surgeries face the chop
Even then, Dr Duncan-Smith said, it would only cope by cancelling elective surgeries.
After already being delayed once, a "temporary scale down" for non-urgent multi-day elective surgery will begin on Monday at public hospitals, and a week later in some larger private hospitals.
"That will free up a number of those beds and get people moving through the wards," Health Minister Amber-Jade Sanderson explained yesterday.
It will come at a cost though, because despite their name, elective surgeries are necessary procedures.
"Diseases progress, other problems arise, and these are the sorts of problems that we get if we delay elective surgery, and it's important that we only do that if necessary," Dr Duncan-Smith said.
As of last month, there were 28,571 elective surgery cases on a waiting list, with almost 4,000 of those beyond the recommended waiting time for that surgery.
The pause is expected to last for two months, but Dr Duncan-Smith hopes if hospital numbers continue to track below expectations, private hospitals can be spared.
"That's where the majority of elective surgery is done in this state," he said.
Ambulance ramping surges
In March last year, ambulances spent an average of 132 hours a day ramped outside of hospitals.
After dropping to 120 hours a day in January, the figure so far this month sits at 175 hours — the highest it has been since October.
The Health Minister said that was down to a number of factors, including measures put in place to limit the spread of the virus in hospitals.
"PPE has to be donned and doffed and changed, we're screening people at the EDs, we're triaging them, people are having RATs," Ms Sanderson said.
She acknowledged the situation was only expected to get worse as pressure on hospitals increased.
But Dr Duncan-Smith said there were other causes at play.
"It's also due to the fact that we only have a certain number of beds, and the number of beds we have has not significantly increased," he said.
"Demand is still going up at 3 to 4 per cent per year, but our bed stock is not going up by 3 to 4 per cent per year, and hence ramping will get worse, regardless of COVID."
Opposition Leader Mia Davies said it was something the government needed to look at closely.
"There will need to be some significant work done when we are through this Omicron peak to ensure that we return the balance of funding to our hospitals," she said.
Confusion around PCR tests
Yesterday's record of 3,594 new WA cases came from a huge 17,258 PCR tests, the most swabs taken in a single day since at least the start of December.
But it is against a background of growing confusion around PCR tests, with reports of some testing sites turning away people who are asymptomatic, or who have returned a negative RAT.
"I've clarified with PathWest that that will not be occurring, and people who do turn up are tested," Ms Sanderson said.
"There are privately-run clinics that the state does not have necessarily management of. We request they still test those people."
But the opposition was clear that at this stage of the pandemic, those issues should not be happening.
"With the time the government has had to prepare, we should see a finely oiled machine responding to issues like this at this point in the situation," Ms Davies said.
"We call on the government to ensure that these processes are clear and that their communication both online and at a hospital level are consistent."
Ms Sanderson said the official advice was that a PCR was not needed to confirm a positive RAT, but that people could choose for themselves if they wanted to get the result confirmed with the more accurate test.
New close contact rules to lead to more cases
In announcing new close contact rules for critical workers, as well as school students and teachers, Education Minister Sue Ellery acknowledged they could allow for greater spread of the virus.
But Dr Duncan-Smith agreed it was a necessary step to keep essential services operating.
He stressed businesses needed to only use the rules when there were no alternatives.
"The whole of society needs to follow the restrictions that are in place," he said.
"As long as they're asymptomatic and [return] a negative RAT, it's a low risk for an increase or spike in cases."
Over the next week, WA will begin to see how those rules play out, and a little later, how hospitals fare against the wave of infections on their way.
By the end of the month, the Premier hopes to be able to ease restrictions.
