Covid 19 coronavirus: Dr Nick Chamberlain - what will our new normal look like?

Whatever our new normal looks like let's hope we remember the good things we've learned and achieved during lockdown. Photo / Michael Cunningham

We are publishing letters written by Northland DHB chief executive Nick Chamberlain to all Northland DHB staff, primary and community care providers, Māori providers, aged care and home and community support providers as well as iwi and social sector and council leaders. He describes them as letters to those who will become our "war heroes" as they fight to save lives and keep the rest of us safe. This letter was sent on April 16.

My 7-year-old son was talking to me the other day about various animals that are introduced into a country, how they can initially wreak havoc, and then how the natural balance is eventually restored.

We will all be wondering about our new natural balance, our new normal; whether level 4 will be lifted in a few day's time, and what "life after lockdown" will be like. The Government website gives some broad guidance, but there are likely to be regional differences depending on Covid-19 outbreaks and hot spots, so it's hard to pick what's going to change, if anything.

It's so difficult to see the future clearly, when we struggle to understand our past. Which of the lockdown measures have been the most effective and which ones can safely be lifted? We have clearly achieved suppression, but will we achieve the elimination of Covid-19 from New Zealand. Is it possible?

A very quiet Ruakākā Beach during lockdown. Photo / Michael Cunningham

Are we looking at a future of serial intermittent lockdowns until we have a vaccine, with several cycles (sine wave)/smaller peaks in Covid-19 cases or can we find a balance with some of the lockdown restrictions remaining and ongoing low rates of Covid-19 infections?

What does that mean for the health system and our reconfigured hospitals and virtual care and Telehealth solutions? How can we go back to a full capacity hospital delivering a "balanced" mix of planned and acute care based simply (it has never been simple) on prioritisation of patients' need rather than benefit of treatment versus risk of transmission of Covid-19.

• Covid19.govt.nz: The Government's official Covid-19 advisory website

Why has NZ done so well in not just stemming the number of cases, but literally "stomping" on them? One reason is undoubtedly the various government interventions, another is our relative isolation, but a significant reason that is not as widely acknowledged is our public health system.

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Globally, integrated health systems with strong public health and primary care response are doing better than hospital-based systems such as some of the large, highly respected hospitals across the US and parts of UK and Europe.

Our public health units, medical officers of health, public health nurses, healthcare assistants, kaimanaaki and other carers working in the community are again making a huge difference identifying cases and contact tracing and isolating all close contacts. Over the past few years, we have seen this a number of times in our local battles with measles and various strains of meningococcal disease.

We were the first in NZ to establish all our seven testing centres and the support we have had from DHB staff, Māori providers, general practices and iwi have meant we have managed to achieve a high and equitable testing rate for the number of cases. We still need to test more, and this week, we will begin mobile testing to get to some of our harder to reach communities.

Northlanders are sticking to the rules during lockdown. Photo / Michael Cunningham

When I acknowledge our workforce, I'm always going to miss some. It's not that any of you are forgotten. Our midwifery and maternity teams working in Te Kotuku and the community need a special mention as babies show no respect for the lockdown or Covid-19.

Given a few minutes, I could probably also name all of our more than 40 professions that make up our scientific, technical and allied health staff. Still, I want to acknowledge a few of the larger teams while not forgetting any of you. Laboratory, radiology, physiotherapy and pharmacy teams, OTs, dietitians, social workers, anaesthetic technicians and many, many others are all continuing to provide care while also exploring new ways of working.

It's scary coming out of your bubble - look at what it's like in supermarkets these days. People rush around, fearful of each other, minimal eye contact and conversation, and very few smiles or laughter. In fact, three weeks into lockdown, many of us are probably suffering from a sense of humour failure. Even the memes aren't as funny any more.

Over Easter, I posted three photos to a group of friends - they were of my guilty pleasures during lockdown - so that your imaginations don't run wild; they were of some craft beers, a dartboard after fluking three triple 20s, and my pool table. I challenged my friends to do the same and ended up with photos of them cleaning or cooking! Not funny at all.

In the long run, if we are to retain our sense of humour and strong relationships, video catch-ups, even virtual games and dinners etc, cannot and must not replace face to face (at least 2m apart) interaction, and being able to do fun stuff together.

Post Covid, post lockdown, there will be a new normal both in the way we use technology for social interaction and virtual healthcare. We need to lock in the good things we've learned and achieved over the past month, but there will always be a need for physical contact with friends and whānau, and to enable healing and caring. The warmth and humour that comes from this type of contact cannot and will not ever be lost.

I'm going to recklessly use the Q word because for once we don't want our health system and hospitals to be quiet. Like me, many of you will be concerned about how quiet general practice, and our hospitals and ED have been. I didn't think I'd ever say that, but the concern is our patients are delaying presenting until it's too late or until they are really sick.

We need to encourage the public to see their GP or come to hospital if they need us. We have created different zones within our health centres and hospitals (red and green) to ensure patients with respiratory/Covid-type symptoms can be managed safely and kept separate to all our other patients.

One thing is certain out of all this uncertainty. Balance will eventually be restored. The courage and innovation and can-do attitude you've all shown in redesigning our health system will ensure our new normal continues to deliver world-class healthcare to our population.

As we work through our fourth week of lockdown and wait for a bit more certainty, stick to the lockdown rules, continue to be patient and kind to those in your work and home bubbles, hold on to your sense of humour, and please, please, do not send your friends photos of you cooking and cleaning!

Ngā Mihi