Nāku te rourou nāu te rourou ka ora ai te iwi.
With your basket and my basket, we will sustain everyone.
"Don't panic. It's the first helpful or intelligible thing anybody's said to me all day.” ― Douglas Adams, The Hitchhiker's Guide to the Galaxy.
COVID-19 will become endemic in the New Zealand community at some point in the future.
Hopefully we will have another 3-6 months before this starts, maybe longer, and hopefully we will have a significant number of our population vaccinated so that the number of cases is kept to a minimum, but it is very unlikely that we are going to be able to contain all cases of this highly infectious airborne disease in managed isolation or quarantine facilities the way we do now.
The modelling work published 23 September by Te Pūnaha Matatini at Auckland University give us as close a prediction as we are going to get to the potential number of cases, hospitalisations and deaths we will see following an outbreak.
In the best case scenario, where there are ideal public health measures in place, and our vaccine is highly efficacious, and 95 per cent of the population over 5 years of age are vaccinated, case numbers may be around 532.
In a more likely scenario where we have 85 per cent of the population over 5 years of age vaccinated, around 2,176 cases per year, 124 hospitalisations, 13 deaths and 3 episodes of peak hospital occupancy. (Figure 1)
How does this help the “don’t panic” message above?
By knowing the likely scenarios we can, and are, planning for the services that will be needed, to manage.
At the national level the Primary Care Clinical Leaders Forum has been advocating along with the RNZCGP and GPNZ for a national clinical group to be set up to take resources such as those we developed last year and the Ontario resources shared so eloquently and generously by Prof Dee Mangin to nationalise and make these more useful and more available.
The group has now formed and is working on further adapting HealthPathways, adapting the Border Control Management System and decision support tools into templates that can be used to help manage patients in the community.
Work is being done to develop templates that will support management within our PMS systems.
There is also work beginning at each DHB to develop community supported isolation and quarantine (SIQ) services, ensuring the public health, whānau ora, clinical and other wrap around services are available to our patients.
Proposals are being considered around funding which depends significantly on development of the right model of care.
It is a bit scary.
It only takes a brief Google search or a chat to a recent medical immigrant, if you can find one, to find horror stories from the trenches of overwhelmed health services in Brazil, Italy, South Africa and the United States.
I am confident that we will not lose the advantage we have gained over the past year and a half of border restrictions and “go hard go fast" lockdowns, and that we will be able to cope with endemic COVID-19.
If you want more detailed information about potential pre-hospital treatments use DynaMed to look at the evidence.
Think about how you would manage a daily “phone ward-round” of 5-10 patients with COVID-19 who were being monitored for 10-14 days after symptom onset. The Ontario experience suggests you might need 2-3 pulse oximeters per 1,000 patients to loan out for telemonitoring, having a similar number of thermometers and sphygmomanometers might be a good idea.
Rest assured the planning is happening to provide extra resources and support, but (like Rachel Hunter’s hair...) this won’t happen overnight, but it will happen.,
View Jo's September 2021 Waikato Postgraduate Medicine Inc presentation and video recording on this topic here.