In any emergency, need outstrips supply. That’s one of the definitions of an emergency. Our Intensive Care Unit beds in NZ are few in number. In Northland for example, there’s a little ICU in Whangarei that is said to have 7 beds. But beds don’t save patients, nurses do. To get an ICU nurse requires many years of training and experience and money.
They don’t grow on trees, and there aren’t enough around to staff all these ICU beds we say we have. ICU patients are often 1-to-1 nursing. Do you think we have 7 nurses in Northland available to staff 7 ICU beds across three shifts a day, 7 days a week? Fuggedaboutit.
The reality is of the 334 ICU beds NZ MOH says we have nationally, we don’t have anywhere near enough nurses to operate the vents, turn the patients, give the medicines and fluids, and suction the breathing tubes. I would be surprised if we had robust, 24-7, Covid-ready staffing for half of those number of beds.
Even more unrealistic is when the ICU number is boosted from 334 to 450 or so, by adding in all the spare ventilators we can find, magicking up the idea that the anaesthesia machines used in theatre for surgery, can be turned into ICU ventilators for dying Covid patients. Yes, technically they can do double duty, but you need anaesthetists and theatre nurses to operate them 24-7. And out supply of theatre nurses is challenged even during the good times, let alone the bad.
Are there ways around this: yes, but we must learn to accept compromises. You could call it substandard care, but if you’re dying of a pandemic surge and can’t get a staffed ICU bed, I’d call it a godsend.
There is no willingness by politicians and administrators to confront awful truths–better to slip into a catastrophic emergency ‘accidentally’ pretending that “no one could have seen this coming”…you see it with wildfires and the absurdly-named “100 year floods” that strike us every few years now. It’s a charade of denialism. It seems to be what politics operates on: pure theatre.
We should be doing some very sobering things: preparing to distributing thousands of cheap fingertip pulse oximeters to patients, so we can send all the quite sick-but-not-dying Covid patients home rather than overwhelming hospitals. We need to be honest with people in creating information sheets explaining we are sending them home because we don’t have enough room and that they should come back for oxygen levels that are consistently dropping below 94%. By the time we are hit, it will be too late to buy these $50 units that could decompress our hospitals.
We need to prepare tents that we can decant our hospitals into. The idea that we are taking respiratory infectious patients and putting them in waiting rooms, and indoors in rooms at all, is illogical. Ventilation is the key, and in a country gifted with mild weather, we should have moved our clinics, urgent cares, and fast tracks to semi-open tents and shelters long ago. My son was swabbed in a semi-open empty warehouse with four enormous garage doors open for cross-ventilation, while we sat in our car. Why isn’t more of our care done in sweep-ventilation systems like this? Why is my patient’s McDonalds junk-food given to her more safely in the drive-thru than her asthma treatment?
We should have oxygen concentrators ($500-$1500) and CPAP machines and bottled oxygen caches set up around the country: whether Covid, RSV, or pandemic influenza, this is worthy preparation. There will just not be enough of these lifesavers to go around.
We need to prep our staff with N95 masks caches and PAPRs ($2000) (clean air blower/filter hood devices that staff can work comfortably in). One doctor in a PAPR can stay safe and run an entire ward. Just like they do in the islands, just like they might well need to do here. (Or as they have in London, Milan, New York and elsewhere at various points over the past 18 months.)
He tangata, etc is on all our DHB walls as a value, but what will the tangata breathe when the hospitals are full of Covid? Our current plan is taking people off duty if they’ve had sick contacts, stripping some units of most of their staff. What about when the hospitals are overwhelmed, like in Israel currently, a country that has vaccinated 75% of its population compared to our…what?…27%
We need to plan for when our staff are sick and infected, our wards are full, and we’re desperately putting two to four people on a single ventilator, managed by not an ICU nurse, but a regular ward nurse who doesn’t know what she’s doing (because we’re not taking the time to upskill her now or at any other point in the past 18 months), assisted by a junior doctor who feels they know nothing, but is now managing the mini-ICU set up in the surgical theatre recovery room in the basement of the hospital. We need to be practicing for worst-case scenarios, not best case scenarios. We don’t ever talk about a real state of emergency, because like death and child abuse, we don’t want to go there until we are forced to go there.
At some point we’ll get a big bad outbreak, and even if we someday get as well vaccinated as Israel (we likely won’t), we’ll still be in a world of trouble, despite having been gifted more than an entire year to prepare for it.
Dr Gary Payinda 