South’s long-term virus battle plan taking shape

The Covid-19 pandemic is not over, but Southern health officials are already planning for how to deliver health care when the coronavirus has become an endemic disease, health reporter Mike Houlahan finds.

Gooing to the family doctor was a regular and familiar ritual for New Zealanders, until the advent of Covid-19.

But after that, rather than sitting in the waiting room leafing through an old National Geographic, patients instead had to wait in the cars for their trusted family doctor to emerge, swathed in protective robes and a full-face mask.

Protocols were equally as rigid at hospitals, almost nobody being admitted unless it was an emergency, and only then if clinicians were clad in similarly intimidating protective clothing.

While little was understood about Covid-19 in the early days of the pandemic, one thing scientists had swiftly discerned was that the vulnerable and the elderly were most at risk of the potentially fatal disease ... people overly represented at medical centres and hospitals.

A year and a-half on, who is most at risk of from Covid-19 has not changed, and with the advent of the much more transmissible Delta variant of the virus their peril has only deepened.

However, a vaccine is now being rolled out which is proven to be an effective shield against Covid-19, in a similar fashion to how scientists developed a vaccine against influenza.

The Government has this week talked up the possibility of a 90% vaccination rate across New Zealand, a laudable target but one which still leaves thousands of people susceptible to Covid-19, and who will most likely seek treatment from GPs or at a hospital emergency departments.

While doctors will always treat the critically sick on the spot, a person with suspected Covid-19 will most likely find themselves sent home again.

Primary health organisation WellSouth, public health, primary care, rural and urban hospitals and St John Ambulance staff are now working on developing a safe and effective local response in case of a southern Covid-19 outbreak in which people are not able to be transferred to managed isolation facilities in Christchurch.

WellSouth also has draft plans in place for Otago and Southland medical centres and GP clinics for how they will handle Covid-19 cases, based on best practice overseas.

That is likely to be something similar to what has happened in Ontario or Sydney, where people have been cared for while safely quarantined in their own homes and had hospital services in place when needed.

‘‘We are working through how we would manage a future where Covid-19 becomes part of the ‘new normal’ in New Zealand next year and beyond,’’ WellSouth medical director Dr Carol Atmore said.

‘‘While we plan for many scenarios, we know the most important thing that WellSouth and general practices can do in practical terms is to support the rollout of the Covid-19 vaccine and to continue to provide ready access to Covid testing across the district.’’

The South is more prepared for Covid-19 patients in the community than most regions as it has already had to deal with them this year, after the arrival of several cases aboard the container vessel Mattina when it arrived in Bluff.

‘‘WellSouth clinicians, led by our director of nursing, Wendy Findlay in Invercargill, were among the team to help care for crew of the Mattina,’’ Dr Atmore said.

‘‘This included providing testing, monitoring equipment and attending virtual ward rounds to support the care of these mariners.’’

However, the Mattina cases also showed up shortcomings in the system, such as when sick crew members arrived at Southland Hospital only for it to be discovered that the emergency department did not have secure anterooms for them to be isolated away from the rest of the hospital.

It was a hard lesson well-learned, Southern District Health Board chief medical officer Dr Nigel Millar said.

Hospitals already have a ‘‘stream’’ system prepared, where non-Covid and Covid-19 patients are taken to separate wards by separate routes so as to minimise the risk of cross-contamination.

That and other temporary patient management and triage systems might well become permanent, Dr Millar said.

‘‘We will have another pandemic, we have to redesign things so that these events are in mind because they won’t be every 100 years.

‘‘We have had several dry runs at this, we have had H1N1, Sars, Mers, which have all sparked but not gone the whole way that Covid-19 has ... we need to have a whole-of-system approach to this.

‘‘With good PPE staff are pretty safe but the big challenge for us is ventilation ... as long ago as Florence Nightingale, she said patients should be nursed in a warm, well-ventilated room, and she was spot on.’’

One thing on the South’s side is that a large new hospital is in its planning phase, and architects have already incorporated changes inspired by the latest knowledge of how Covid-19 spreads.

Retrofitting older buildings or reconfiguring medical centres not built with aerosol transmission and social distancing in mind, will be harder but no less essential.

‘‘There are things we can do with available equipment and facilities and we should do them,’’ Dr Millar said.

‘‘We already have a screening system; symptoms are important and if we see people with symptoms we have to isolate and test them until we have the results, and we will get better at that.’’

Like Dr Atmore, Dr Millar said worldwide vaccination was the key to success.

‘‘The more people who are vaccinated, the lower the rate of transmission, so the overwhelming number of patients is less likely to occur.’’

Testing and vaccination would continue to be the Southern health system’s top priorities for some time to come, Dr Atmore said.

‘‘Southerners are doing very well getting vaccinated thanks to the distributed model implemented here that uses general practices, Maori health providers and community pharmacies to deliver the vaccine,’’ she said.

mike.houlahan@odt.co.nz