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Hospital Staff At Risk In The War Against Covid -19

The war against Covid-19 will not be won in the desolate streets of New Zealand but in the trenches of our Hospitals.

In war, the front line always has the most casualties and our Hospital doctors ,nurses and patients will ultimately bear the brunt of this contagion.

Much of the "worst-case" death toll modelling done to predict the scale of the COVID-19 pandemic has included the death toll statistics in Italy.

What is emerging is that hospital transmission of the virus and other secondary hospital infections is to blame for the disproportionate number of people dying in Italy from COVID-19.

Bergamo doctors wrote their letter to the New England Journal of Medicine, stating that they had more cases of COVID-19 than any other province in Lombardy.

"If we have to identify a spark, it was the hospital. While those suspected of infection go to hospitals, the hospitals themselves are not safe " Bergamo Mayor Giorgio Gori told the New York Times.

The Bergamo doctors, in their letter, have identified hospitals as a particular risk with COVID-19.

"We are learning that hospitals might be the main COVID-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to uninfected patients," they wrote.

One New Zealand Governmental advisor conducting statistical modelling of the projected death rate due to COVID-19 in New Zealand has stated that Italy’s hospitals are much worse than New Zealand.

However this is not true.

The World Health Organisation statistics show that the Hospital Acquired Infection (HAI) rates are 6.7% for Italy and 12.0 % for New Zealand.

The New Zealand Government puts the HAI rates at 10%. So, what does this mean in practice?

A day before my 70th birthday my good friend Sir Graeme Douglas died of a Hospital Acquired Infection.

He had gone into hospital for simple non-life threatening elective surgery but contacted pneumonia in an Auckland Hospital.

According to the World Health Organisation, New Zealand has the second-highest rate of Hospital Acquired Infections in the developed world at 12%. Nearly twice that of Italy.

There is also another “silent” killer in Hospitals which is the most common life-threatening infection in hospital Intensive Care Units (ICU), and that is Ventilator-Associated Pneumonia (VAP).

A metastatically review of the scientific literature suggests that aged patients receiving mechanical ventilator treatment to assist their breathing have between a 20% - 80% chance of contracting life-threatening lung infections, including pneumonia.

However, an Audit of the Ventilator Acquired Pneumonia (VAP) rate at Middlemore Hospital Auckland revealed a VAP rate of 90% when patients received ventilatory support for more than three days.

The longer a patient is receiving mechanical ventilation treatment, the higher their chances of acquiring life-threatening pneumonia.

Many of the hospital deaths attributed to COVID-19 may in fact be due to airborne bacteria such Streptococcus pneumonia associated with pneumonia infections caused by inadequate hospital air filtration systems and infections caused by medical staff not wearing the correct Personal Protective Equipment (PPE) and transferring the virus patient to patient.

I have designed pharmaceutical and medical device facilities and hospital biocontainment facilities in African and Asia for over thirty years. Now we are in lockdown; I believe the government should turn its attention to looking after our frontline troops going into battle.

I have the utmost respect for all our healthcare workers.

For them, it is not just a job to look after the sick and the lame or the Friday night drunks that front up at A&E, but a life's work.

They have to fight for fair pay, and we are sending them into the trenches with inadequate Personal Protective Equipment (PPE) and a hostile environment where their lives are at stake.

A few days ago, Dr Stephanie Ulmer, a general surgeon at Middlemore Hospital, was told by her hospital bosses that her use of enhanced Personal Protective Equipment was making other staff feel anxious. She was told she would be stood down if she continued to use her PPE to protect her and her patients from preventable infections.

However, she says hospitals should provide PPE to everyone coming into close contact with patients and believes the Ministry of Health Guidelines are not stringent enough.

Stephanie is 100% correct.

At the Starship Hospital, there is a state of the art surgical suite with a brass plaque on the wall: “This facility was donated by The Douglas Charitable Trust”.

Sir Graeme Douglas, in his lifetime, did so much to improve the healthcare outcomes of ordinary New Zealanders and should not have died of a preventable Hospital Acquired Infection.

I suspect it was an ordinary day in the hospital when he acquired the fatal pneumonia infection. On an ordinary day our hospitals have almost twice the regular rate of Hospital Acquired Infections as Italy so just think what may happen if our Hospitals have an influx of covid -19 and Flue patients.

Many of our regional hospitals have suffered decades of neglect. They are not fit for purpose for the biocontainment of infectious diseases and staff are not trained in pandemic containment procedures or issued with FDA approved Personal Protective Equipment appropriate for the management of a pandemic.

Much of the Governments COVID-19 initiatives talk about flattening the curve to make sure that our hospitals are not overwhelmed with patients, but with New Zealand’s flu season on the horizon, this may be a hard ask.

In Italy, going into hospital is a death sentence. More than ever, we need to focus our attention on improving our hospital's infrastructure and providing our hospital staff with the appropriate PPE and biological infection prevention training to manage a pandemic.

In my professional opinion, the current Ministry of Health hospital PPE recommendations are negligent and do not meet FDA Personal Protective Equipment standards to protect nurses and doctors from contracting COVID-19 and more importantly preventing the spread of the virus and bacterial infections to non-infected patients.

I would like to see some transparency regarding what the Government is doing to reduce our appalling Hospital Acquired Infection rates. I would like to see what procedures the Government is putting in place to protect our frontline Doctors and Nurses from COVID-19 infection.

Our doctors and nurses should have all the protection they need, so they can do what they do best. Save lives.

Sir Ray Avery GNZM

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