RNZCGP - Medical Director update

This update provides you with the best information we have right now.

Kia ora, I wanted to share my thoughts on where general practice is at the moment as we enter the third year of the COVID-19 pandemic.

Once again, we have fallen into an uncertain time with COVID-19 and the rising cases of Omicron. As general practitioners we have been at the forefront of the COVID response continually over the last two years.

I am hopeful that we may be seeing the final act of the pandemic and in the next six to 12 months we will start to return to a new normal. But this does require a change in mindset about how we think about COVID in the future.

Since the beginning of the pandemic, we have worked to eliminate COVID-19 and keep community transmission as low as possible. Now as we enter the third year of the pandemic, we need to show that we can still manage what's going on with COVID, but we also need to mentally prepare for a shift towards living with, instead of fighting COVID-19, and focus on other health issues and illnesses that are waiting in the wings.

There has been a fair degree of scaremongering about COVID-19 in the media and it is interesting to note that at this point, the increase in COVID-19 positive numbers has been fewer than anticipated.

Government projections estimated there would be 1,000 cases a day, two weeks after we reached 10 positive cases in the community. One to two weeks after that, the low estimate was a sustained 1,000 cases a day, moderate estimate was 1,000 to 5,000 a day, and the high estimate up to 50,000 a day. That is a big number but could be entirely plausible when you look at the New South Wales experience of going from 34,000 per day to 215,000 cases per day within the space of two weeks.

In New Zealand, we haven't gotten to those figures yet. We are averaging around 200 per day. This is either due to our very high vaccination rate, something general practitioners have played a huge role in (we told them so!), or alternatively the mitigation factors of mask wearing, and restricted gatherings, which are helping to flatten the curve.

And while Omicron is less dangerous to the individual in most cases, due to its infectious nature it may be more dangerous to the overall health system. We know there'll be deaths from Omicron. However, it's certainly not on the level that we saw with the Delta variant.

Omicron has relatively fewer hospital and ICU admissions because it mainly sits in the upper respiratory tract. However, it poses a potential threat due to the large number of positive cases in a relatively short period of time. Looking at international experiences, peak cases tend to last between four to six weeks before we start to see a reduction.

Looking ahead There are more concerning issues on the horizon. As we have learnt, COVID-19 is a respiratory illness that is not seasonal, it can occur at any time of the year, unlike Influenza which tends to strike in the winter months.

While figures vary from year to year, it is thought that there are several hundred deaths a year in New Zealand caused by the flu, mainly in elderly and those who have other underlying health issues. Not a winter goes by without hospitals filling up and going into code black, general practice being at capacity, and people being away from work.

Next Wednesday an opinion editorial I've written on this topic will be published in the Herald. I've included a small excerpt below: "For most of us, COVID-19 will be no more dangerous than the common cold or flu, but it is potentially more infectious. Walk past someone who has it, and you may contract it. We are starting to see this with the increase in daily case numbers.

Most people will be able to manage COVID-19 at home like they would with the flu. For those that are elderly, isolated, have co-morbidities or live in areas of high deprivation we know this can be difficult and it is crucial that the necessary support is in place and that the appropriate medical care is available if it is required.

Over time we will all have to adapt. COVID-19 will become endemic around the world and how we deal with flu outbreaks and how we deal with COVID-19 outbreaks will look quite similar: staying home, using over the counter pain relief such as paracetamol, keeping hydrated, and resting will be the norm, as is having the reassurance that medical care will always be available."

COVID-19 will eventually be endemic throughout the world and part of our background respiratory virus that circulates through the community.

Immunisation may or may not have a role to play in future in ameliorating the risk from COVID-19. It is likely, much like bird flu and swine flu, that it will be something we cope with in a routine year.

COVID-19 will eventually be endemic throughout the world and part of our background respiratory virus that circulates through the community. Immunisation may or may not have a role to play in future in ameliorating the risk from COVID-19. It is likely, much like bird flu and swine flu, that it will be something we cope with in a routine year.

However, we need to get through the next few months. We posed three questions for general practices to consider recently, and I think it is worth repeating them.

As a practice:

1. If demand increases, at what point would the practice put in place more telehealth capacity?

2. Consider at what point you will reduce or restrict some business-as-usual services and how you will communicate this to your patients 3. Is there a point where you would move completely to a temporary 'acute service' to deal with increased demand?

This last point is important and could become a reality. There was a period during the bird flu outbreak in 2009 where some practices halted business-as-usual services and only provided acute services for several weeks to deal with the numbers of patients suffering from acute respiratory illness.

I hope it doesn't come to this because we have a responsibility to our patients to think this through and put the necessary plans in place. Our patients and their health are our priority. It is important to note that even if we were to compromise business-as-usual services, there are several things we absolutely cannot afford to stop: •

• •

Influenza vaccinations. It's entirely possible that as the border opens up and influenza enters the country that we will have a large outbreak based on the fact we have been largely influenza free for the last two years Childhood immunisations. The number of six-month-old immunisations have dropped to 74 percent, and our situation will worsen if we were to have a measles or whooping cough outbreak High risk cervical screening and cancer screening

We need to think through what an acute service delivery looks look at our individual practices and what services would stay in play, and how these would be managed.

There is uncertainty in the modelling data we read about, so we might find that these worst-case scenarios don't come to fruition, and we get through this like any other prolonged winter illness.

What we have learned over the last two years in general practice is infinitely adaptable and regardless of the demands I know we can rise to the challenge. We will get through the next few months and continue to service our patients and communities.

So, let's keep calm, keep healthy and more importantly encourage our patients to get vaccinated and boosted. In the end we will get there and back to our 'new normal'.

Your wellbeing Remember to take care of yourselves whenever the opportunity arises. You are all doing fantastic work, but we can only keep this up if we are well. Reach out to whoever you need to if you need extra support.

The College has mental health resources for our members and will fund EAP sessions too if you need to talk or work through issues.

Stay strong.