26 Mar 2020

Covid-19: Does NZ have enough ICU beds, ventilators?

From Checkpoint, 5:38 pm on 26 March 2020

What happens if New Zealand's intensive care units are swamped with Covid-19 cases? Who or what will decide which patients get priority? 

A mixed committee of doctors, ethics, intensive care and infectious disease specialists and lay people are working on a 'triage tool' that could be ready as early as next week.

The tool will help doctors decide how to prioritise cases if intensive care units become overwhelmed due to an influx of patients suffering acute symptoms of Covid-19.

A Ministry of Health (MOE) audit showed there were currently 153 intensive care beds in public hospitals and that could be expanded to just over 560 by co-opting space from other units. 

Dr Andrew Stapleton from the AUS/NZ Intensive Care Society Covid-19 group told Checkpoint's Lisa Owen: "What we have to bear in mind is the current beds available in New Zealand ICUs aren't empty and waiting for patients to get Covid-19, they are 80-90 percent full at all times so the amount of spare, available beds is low. 

'If people don't follow the rules, if the disease does spread and we get a group of patients all coming through at once we will very quickly exhaust that capacity." 

Dr Stapleton said whilst there was currently enough specialist staff to tend to the ICU beds available in New Zealand, "once we start expanding beyond our normal numbers we have to change the ways we provide care".

However, he said that stopping elective surgeries, whilst not ideal, had freed up staff who were used to dealing with unconscious patients safely in surgery or recovery rooms.

 They would be directly supervised by an ICU nurse.

"We have a great advantage in New Zealand because other people have had it so hard, countries who didn't know this was coming or have taken a different approach to us have been overwhelmed very quickly in the ICU and we are doing everything we can, helped by the prime minister, to avoid that scenario."

Dr Stapleton said if more than 3000 or 4000 patients in New Zealand within the same time period required ICU treatment, current capacity would be overwhelmed. 

If that happens "we make beds throughout the hospital, change staffing, we use staff who are not used to looking after ICU patients and we have to begin to triage patients as they come through the doors, which no one wants to do.

"Overall, we have towards the lower end of the OECD in terms of ventilators per 100,000 of population."

An MOE audit showed the DHBs had access to 520 ventilators.

"The 520 ventilators in the audit includes repurposing anaesthetic machines which have ventilators built into them, which are perfectly appropriate, then we can match the number of beds to the number of ventilators."

Dr Stapleton said some ventilators would be repurposed as hospitals always had to have the equipment to do emergency surgeries.  

A "triage tool" to assist physicians at hospitals to make decisions on who had access to services if resources got tight was being worked on by a committee of ethicists, intensive care and infectious disease specialists as well as a lay person and a Māori representative.  

Dr Stapleton said the criteria were almost ready and that hard decisions would not just be made by one doctor - it will be a group of two or three.

"It is just a tool, it just produces a ranking, a machine is not deciding who lives and who dies, that decision will always be made by a doctor or three onsite.

"We hope we never get to that position, we continue to reinforce the message to those New Zealanders who may think this is overblown or exaggerated, it really isn't. Please follow the guidelines that have been set out by the prime minister."

"What infuriates me about that behaviour is it's not them who they are putting at risk as they are probably young and well, when they spread the virus it won't be them who are most affected by it. 

"But it might be their parents or their grandparents so they should think twice."