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Healthcare Resources At Alert Level 3 – Expert Reaction

New Zealand will move to Alert Level 3 in less than one week’s time, with various implications for the healthcare system.

One of the key criteria for moving to Level 3, established by the Government last week, was that New Zealand must have “capacity in the health system”.

The SMC asked experts to comment on whether we have met that criterion.

Associate Professor Mark Thomas, School of Medical Sciences, University of Auckland and Auckland District Health Board, comments:

“We certainly have capacity and resourcefulness in the healthcare system. There have been huge adjustments made to the way we work, whether in general practices, or in hospitals, and I see no evidence of people being overwhelmed by the challenges at present.

“No doubt there will be delays and shortages of equipment, whether for personal protection or for laboratory testing or other aspects of care. However, the health system is very used to making do, and can be relied on to continue to provide an excellent service for all who need help. A more sensible approach to limiting precious resources would be appreciated. Health care workers should not be encouraged to wear PPE just because it makes them feel more comfortable. PPE should be used correctly when necessary, not used incorrectly, and not used at all when not necessary.”

No conflict of interest.

Dr Michael Maze, Respiratory and Infectious Disease Physician, University of Otago, comments:

“The time spent in Level 4 lockdown has been extremely useful for hospitals. In the last month, major changes have occurred to the systems in hospitals to prepare us for COVID-19. We now are much better placed to manage a surge in COVID-19 cases, and to prevent transmission within our hospitals.

“A good example of this is the development of hospital COVID assessment units, where patients can be quickly assessed, and acute care given in a safe environment where other patients and staff are at minimal risk. These simply didn’t exist a month ago. Similarly, detailed plans around expanding capacity in response to a surge in cases have been made. The preparation time that has been afforded to the health system by the Level 4 lockdown has been vital.

“The move to Level 3 is critical if we aim to eliminate COVID-19. One aspect that has not had a lot of attention is the implications of an imperfect diagnostic test on community spread during Level 3. We know that the nasal swab PCR test will not pick up every case of COVID 19 – it picks up more like 70 out of 100. In medical jargon, we would say the test has a sensitivity of around 70%. Ideally we would have a test with a sensitivity of close to 100%. This low sensitivity for a number of reasons, but mostly because sometimes the virus is infecting the airways in the lungs but not in the nose.

“The implication of a diagnostic test with a low sensitivity is that some people with COVID-19 will test negative and be told they don’t have it. Doctors are alert to this, and so the ‘probable’ cases we see on the MOH website are when doctors remain suspicious despite the negative test. However, doctors judgement is also not perfect.

“So how does this relate to Level 3? In Level 3 we are likely to see some spread through the community, and in time cases may be identified who can’t be easily linked to a known case. So if you or I have a flu-like illness (snotty nose, achey muscles, fever etc) we need get tested (of course), but also stay home until we feel well again – even if the test is negative. This is a critical message to spread, as there will be a lot of pressure on small business owners in particular to get their business up and running, and not to stop for a ‘cold’.”

No conflict of interest.

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