Will our health system cope with more COVID-19 ICU patients?
Written by Tom Varghese
According to data from worldwide outbreaks, around 5% of people who test positive for COVID-19 end up requiring intensive care. Intensive care services are fundamental to delivering healthcare. Lessons learnt from this global crisis should help inform future strategies in dealing with large-scale disasters.
The New Zealand health system is still poorly resourced to deal with large disease outbreaks such as COVID-19. As we entered the pandemic, the provision of intensive care beds (per capita) in NZ was less than 1/3 of the average among 22 OECD countries. NZ was in 21st place, followed only by Mexico. Although there has been some expansion over the last year, this is likely to be modest in comparison with the countries that have been grappling with many thousands of patients.
Building more ICUs in a matter of weeks or months to deal with the pandemic isn't feasible. Instead, we have to slow the spread enough to give the medical system a chance. In 2020, the MoH undertook planning to support surge ICU capacity. This planning found that additional ICU capacity could be brought online if necessary, resourcing other beds to be ICU-capable and using beds in private hospitals. This would lift overall ICU capacity to more than 550 beds. If NZ does have an outbreak of sufficient size and pace, then ICU capacity could be quickly swamped. The other pinch point is the lack of ICU nurses.
The perils of running out of ICU capacity have been demonstrated most graphically in Italy, where doctors have been issued guidelines by the Italian College of Anaesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) to help them choose who to treat when they can't help everyone.
Experts have proposed two strategies to optimise resources. These are a New Zealand wide ICU strategic network and the creation of an electronic ICU dashboard. The countrywide network would incorporate aspects of intensive care medicine from standards and protocols of care, through to staffing, training and equipment procurement. It would also contain the pooled knowledge gained from these current and previous crises. The dashboard concept would allow ICUs countrywide to share up-to-date information about bed capacity, patient acuity and available resources in ICU facilities. A real-time indication of surge capacity in the event of a localised or national disaster would be available to help guide patient movements and resource allocation.
Our hospitals have often been dangerously stretched, even by routine winter outbreaks of influenza. In the winter of 2022 or 2023, a region in New Zealand could experience a large outbreak of COVID-19, at the same time as influenza is leading to many hospital admissions. There needs to be a review of health system capacity and management systems for dealing with large outbreaks of COVID-19. This should include consideration of medical ward capacity, equipment for non-invasive ventilation, and intensive care facilities.
