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Our task in a world turned on its head: an Intensive Care doctor writes

Nowhere will the reality of Covid-19 be felt more acutely than our hospital ICUs. Dr David Galler on the mood at the front line.

Intensive Care is a glass half full specialty and I am a glass half full person. That helps a lot when matters out of our immediate control are thrust upon us.

These include the wide range of calamities we see affect individual patients and their families, mass casualty events like earthquakes, last year’s mass shootings in Christchurch and more recently, the volcanic eruption of Whakaari/White Island. We managed the workload associated with those previous events well but today we are in uncharted territory with the very real and imminent threat of Covid19 and the uncertainty and ever-changing circumstances that accompany it.

As of now, thanks to our government, Ministry of Health and public health colleagues, we have only 20 people identified as having Covid-19, with no deaths or evidence of community spread. At the heart of our approach has been what we are learning from those places already affected by this pandemic but with relatively low rates of community transmission: clear messaging about how individuals can keep themselves and each other safe, and at the population level by rigorously applying the basic public health principles of identification, isolation and contact tracing with a clear escalation pathway for when community spread first occurs.

The importance of a sound public health infrastructure and how we as individuals respond to the guidance we are given, will determine the ultimate impact on our health services, especially on the rate and numbers of people requiring hospitalisation and intensive care.

Evidence from other jurisdictions, notably China, Iran, Italy and now from an increasing number of countries where community spread has accelerated in an uncontrolled way, has led to their health systems hospitals and intensive care units being overwhelmed with acutely unwell patients suffering from severe infection and the hypoxic respiratory failure it causes. In those places Covid-19 has had a much higher mortality (over 5% of all of those infected) in those over 65 with long-term medical conditions with many more people requiring prolonged periods of ventilation.

Such is the threat to our people and in particular our most vulnerable, the degree of planning we are doing here, at every level, to cope with a surge in cases requiring hospitalisation and intensive care is unprecedented.

My intensive care colleagues, nurses, doctors, managers, are at the heart of that all-consuming, detailed work. Our NZ intensive care community and the team that I am part of are good; we are well-trained, and we are highly capable. We know each other, work well together and with our colleagues across the hospital, willing to flex resources to do what we need to do.

In 2003 hospital and intensive care staff managed a surge in work associated with the SARS epidemic (Severe Acute Respiratory Syndrome); and again in 2009 as a result of the “swine flu” caused by the H1N1 variant of the Influenza A virus. As busy as those periods were the workload this pandemic might create could be so much bigger and that might be our biggest challenge.

SARS and the “swine flu” taught us a lot about how best to manage these complex patients and as this pandemic unfolds every day we are learning more and more from the experience of our colleagues in those other jurisdictions where community spread has already occurred.

But despite all of that the key to controlling this pandemic and its impact on each of us, will require an extraordinary degree of cooperation and solidarity and for all of us, some degree of sacrifice. The world has been turned on its head and it’s for us together to see it through to the other side.

David Galler is an Intensive Care specialist at Middlemore Hospital and author of Things That Matter: Stories of Life and Death



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