Multi-tiered Triage and Treatment Strategy to battle a tsunami of COVID-19 cases

The fifth wave began to peak in February. Hong Kong public hospitals faced an extraordinarily challenging situation with a tsunami of cases in the community triggered by the highly transmissible Omicron variant. The number of confirmed COVID-19 cases surged to over 10,000 a day, while the Accident and Emergency (A&E) Departments had handled up to 1,500 people a day pending for admission. Cases at Caritas Medical Centre (CMC) involved mostly elderly people in a serious condition, placing a heavy burden on its facilities and staff.

A&E Chief of Service (COS) of CMC Dr Gordon Lee and A&E Department Operations Manager (DOM) Wendy Ho say the greatest challenge was handling both COVID and non-COVID patients at the same time. At their height, COVID admissions were 10 times higher than on normal days, and patients had to be placed in hospital beds outside the A&E and in the car park. To avoid cross-infection, non-COVID patients were put in the Family Medicine Clinic and continued to be taken care by A&E colleagues, while the A&E treated COVID patients only. A&E colleagues were therefore separated into different teams. Even worse, some were infected or classified as close contacts of infected persons which further tightened the manpower situation very difficult.

It was the seamless cooperation of staff that most impressed Gordon and Wendy when throwback to last few months. Because of the sheer number of patients waiting for admission, two areas were converted into holding sites with healthcare staff from other departments making ward rounds. DOMs and colleagues from other specialties in PPE saying "let's help you" then moved the patients indoors. The Administrative Department set up tents to receive patients in the space in just one afternoon. "The communication broke down the boundaries between departments," Wendy recalls. "I had never seen anything like this in my 10 years of service."

Colleagues from other Kowloon West Cluster hospitals also lent a helping hand. "In the early stage of the fifth wave, batches of patient were transferred to CMC by ambulance. COSs from cluster hospitals told us 'we are here for you'" Gordon says. Patients were then diverted to other hospitals, so that CMC would take a breath.

Wendy was deeply moved by the attitudes of patients, and fights back tears when she recalls feeling an elderly patient’s freezing hands as she moved her inside. Wendy apologised to her for making her wait but the woman replied, “you don’t need to apologise. You’ve all tried your best. Thank you.” Family members of patients even asked medical staff what they could do to help. The care and love shown by everyone fought the cold, Wendy reflects.

The Hospital Authority (HA) adopted a Multi-tiered Triage and Treatment Strategy to achieve the goal of reducing mortality, critical cases and infections. Patients in a critical or serious condition are prioritised for treatment and admitted to designated hospitals or other public hospitals. Meanwhile, patients who are relatively stable will be admitted to Treatment Centre for COVID-19 at AsiaWorld-Expo or North Lantau Hospital Hong Kong Infection Control Centre. Asymptomatic patients or patients without medical need will be admitted to Community Isolation Facilities or holding centres for elderly. Infected persons can book designated clinics for medical consultation, or call the enquiry hotline for medical support.

HA Director of Quality and Safety Dr Chung Kin-lai says the fifth wave required a general mobilisation with every colleague working tirelessly. “Initially, there was resistance to the setting up of designated hospitals but we had to free our hands to find a way to deal with the extreme situation. Without the support of our frontline staff, we could never have done it. Fortunately, we are now gradually seeing results after implementing these measures.”