14 Oct 2021

GPs 'not quite' ready for care of high-risk Covid-19 cases

From Checkpoint, 6:07 pm on 14 October 2021

Pockets of Aotearoa will have large numbers of Covid-19 cases making health professionals "extraordinarily busy", one of the country's leading doctors says.

President of the Royal New Zealand College of GPs, Dr Samantha Murton, told Checkpoint, while the majority of cases across Aotearoa were expected to be relatively mild, not enough health workers were in the right places to deal with high-risk communities.

Daily new Covid-19 case numbers are rising in Auckland. The Ministry of Health's worst case scenario could see a peak of 5300 Delta cases a week next year. And that is just in Auckland and the northern region.

That modelling is based on 90 percent of people being fully vaccinated. But it is estimated just 30 cases a week would require hospitalisation, with the rest recovering at home.

There would be regular health checks and some might need a device that monitors oxygen levels.

Who is going to do all the monitoring and care? General practitioners and nurses working in community surgeries, as well as pharamcists.

Murton said pockets of Aotearoa would experience "quite large numbers" and health professionals in those areas would be "extraordinarily busy".

"I think we are expecting that most people will have a fairly mild case of Covid disease. So with 90 percent of vaccination there'll be a lot of people who may get the disease that will be mildly affected by it," she said.

"The ones that we need to worry about are the people that have comorbidities, or are more vulnerable. We will have to monitor them more closely to see if they do need to go into hospital.

"The things that put you into high risk are if you've got other health conditions, if you're over 60 for a [NZ European], if you're over 50 for Māori or Pacific - it may be actually a lower age for Māori and Pacific.

"So there's quite a few reasons that you may be put into a higher risk category, but we're not expecting it to be huge numbers.

"However, there will be pockets of the community where it is actually quite large numbers, and those doctors and nurses and health professionals working around them will be extraordinarily busy."

Dr Murton said work would be carried out to bolster over-the-phone health services available all hours, and that there would be more online work involved to monitor people with the virus. 

"But then there'll be people that you do need to have a consultation with. You might need a video connection or something to make sure that things are fine," she added.

"Often people deteriorate in an evening, overnight, on the weekend ... there's always a deterioration when it's out of hours, and that's where we need to have some really good services available."

Dr Murton said there would be extra staff needed in areas with low numbers of GPs, or very high density populations that have high needs.

"So I can imagine South Auckland will be in desperate need. And we'll need to be thinking really clearly about how we bolster the services that are there." 

Other areas like Tairāwhiti and Porirua could need extra support, she said.

Another major concern is, while the country may achieve 90 percent vaccination, it might not be 90 percent coverage for those vulnerable communities. 

"We need to have a plan, because at some stage we do need to be looking after opening up the borders, getting back to work, doing our normal work and trusting the fact that most of our population are vaccinated.

"However I think this has been expedited because of what is going on in Auckland. 

"We have had to step up very fast to be able to manage the fact that there are more cases going on in Auckland and the MIQ facilities are going to run out of space."

It has come earlier than hoped, Dr Murton said. 

"We'd all like to have a large number of the population vaccinated, and also have had made an enormous effort and inroads into getting at our Māori and Pacific population vaccinated." 

We are "not quite" ready, she said. 

"As GPs, we step up, take the baton and run with it. All of us are really dedicated to our patients and making sure that they get the best of care.

"So, there will be a lot of hard mahi for the doctors and the nurses. This is a perfect time when we need to look at the health system as a whole process and have lots of people working around us.

"The services for families in their home - for food, for childcare, for transport if they need it - all those other things that need to happen. That needs to wrap around really rapidly as well.

"So it's going to be an all-of-team effort and a whole-of-health effort, as well as social services, to be able to make this work."


Dr Murton said in order to meet the needs of Covid and other chronic health conditions, the number of people working in the community needs to be stepped up. 

"Whether that is carers and allied health professionals, getting nurses in from overseas, getting other doctors in people in from overseas as well.

"If the hospital services aren't doing as much work because they're a little bit shut down [with Covid cases] then having new staff working out in the community as well, will be really important."