The number of ICU beds per population in New Zealand has fallen steadily over the last 20 years, with the country now well behind comparable countries, including Australia.
The Ministry of Health has acknowledged the current capacity might not meet demand for a widespread Covid-19 outbreak and on Tuesday announced a $32 million boost, though experts question if it will be enough to bridge the gap.
Globally the virus has infected nearly 200,000 people, and killed nearly 8000. New Zealand has had 20 confirmed cases.
According to infectious diseases expert Dr Siouxsie Wiles, about one in every five or six people will need to be hospitalised if they contract Covid-19, and about five per cent will need intensive care.
About one in 100 are expected to need a ventilator to help them breathe.
The percentage of those who could catch the virus is highly variable, but many estimates fall around 40 to 60 per cent of the global population.
According to the Ministry of Health, New Zealand has 176 intensive-care unit beds and 57 high-dependency/cardiac care beds spread across the country's 20 DHBs.
Based on those numbers, about 4660 cases could overwhelm New Zealand's health system - provided all of those beds were available for Covid-19 patients, and assuming they all contained the necessary equipment (some HDUs cannot be equipped with mechanical ventilators necessary for severe respiratory illnesses).
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According to international studies, New Zealand's capacity in this area is well behind comparable counties.
The rate of ICU and HDU beds per 100,000 people is about 4.7 - a substantial decrease from 5.5 in 2007, and 6 in 2000.
A 2010 study - using 2007 data - found Australia had 8.9 ICU and HDU beds per 100,000 people.
In Europe the average is about 11.5, with Germany having close to 30.
In Italy, where sick people are being turned away from hospitals, the rate is 12.5.
According to the Australia and New Zealand Intensive Care Society, including private ICUs in the data, New Zealand still lags well behind, and the capacity has been falling.
Between 2011 and 2018, the rate per 100,000 people declined from 5.98 to 5.14, whereas in Australia it increased from 8.50 to 8.92.
Capacity concerns were raised back in 2005 in a Ministry of Health report which noted due to the ageing population and greater surgery demand such services needed to be increased, and estimated 70 extra ventilated ICU beds were needed to bring the country up to Australia's standards.
In a statement, a spokeswoman for the Ministry said it "acknowledges that current ICU and HDU beds may not meet the potential demand should Covid-19 become widespread in the community".
Tuesday's funding was "anticipated" to increase the capacity, and provide for alternative levels of care.
"Additional capacity could be sourced from the private sector, and the ability to change a limited number of beds into higher-level care.
"This would also include additional training and support for a cohort of nurses to provide the higher level of care."
The Herald has requested further comment and information from the Ministry on the number of available ICU beds, ventilators and respirators and any plans about increasing capacity, but has been told due to the number of queries they were receiving they were unable to respond.
Association of Salaried Medical Specialists executive director Sarah Dalton says the extra funding sounds promising but the problem would be staffing them.
"There is absolutely no fat in the system in terms of extra staffing and you can't just conjure up more doctors overnight," she says.
"The situation will be exacerbated if hospital doctors themselves fall ill or are forced to self-isolate.
"Senior medical professionals are fully committed to caring for people with all disease, but in the case of a major Covid-19 outbreak, we have ongoing concerns about the pressures they and hospital services will be put under, and the ongoing effects of burnout and fatigue."
Director of Public Health Dr Caroline McElnay said in a media update on February 25 the Intensive Care Network of Clinical ICU Directors had met to set up and plan for how the ICU/HDU and negative pressure beds across the country were managed.
The Ministry also declined to comment further on these plans for this article, citing the number of queries it was receiving.
College of Intensive Care Medicine committee chair Andrew Stapleton said regardless of the number of ICU beds, staffing would be a major issue.
"You need one nurse to one patient at all times in an ICU so no nurse equals no ventilated patient, no exceptions."
Not all ICU beds had ventilators either - the "life support" or "breathing" machine – attached to them, especially at smaller centres.
But there were more ventilators in a hospital than ICU beds, meaning the health system could rapidly expand the ICU capacity if need be, provided the staff were available.
How ICU beds were counted across the globe varied, but New Zealand was not fundamentally different to Australia.
"In business-as-usual times there is a clear relationship between this and the cancellation of elective surgery – fewer beds, less elective surgery, which you can see clearly versus Australia.
"In times of Covid-19 the much more important question is how much you can 'scale-up' your ICU response, ventilated ICU bed numbers.
"We are in an advanced state of planning and believe we can scale up quickly and significantly."
Hospitals were tallying up how many operating theatres could be used to boost the number of ventilators if needed if elective surgery stopped, he said.
Dr John Bonning, the first Kiwi to be elected to head the Australasian College for Emergency Medicine, said while he had not been directly involved in New Zealand's preparations he'd spoken to many colleagues and there was a "lot of work going on".
Despite the lower rates of ICU beds, Bonning said there was a lot of planning going on and he had faith in the health system.
To manage increase in demand Bonning said New Zealand could see elective surgeries shut down and hospitals bring in extra resources, such as converting theatres to ICU wards.
People taking greater precaution against flu - getting jabs early - could also decrease demand for emergency care, he said.
New Zealand was at the "low part of the curve", meanwhile Australia was much further ahead with cases spiking from less than 30 at the start of March to 368 as of Monday, when 71 cases were reported in one day. Six people have died.
"We need to be prepared for the onslaught," Bonning said.
"In Australia I have seen hundreds of people lining up outside emergency departments waiting for swabs.
"From what I am aware of there is a huge amount of work going on [in New Zealand]. The Government is getting criticised for doing too much or too little, but I want New Zealanders to have faith in the health system."
Bonning believed as many as 80 per cent of New Zealanders could get the virus, the majority a very mild version, but the key was flattening the curve to reduce pressures on emergency services for more severe cases.
He believed the border controls were the right call, and didn't agree closing schools right now would help as grandparents could be brought in to assist with childcare.
Along with self-isolation, reducing social contact and practising good hygiene, Bonning said the public needed to remain calm and not give in to hysteria.
"The main symptoms are a fever and a cough - if you don't have those it is highly likely you won't have it, and will just need to stay home and not visit a hospital.
"What we don't want is people queuing up outside hospitals with a minor sniffle without having contacted their GP or healthline."
In Australia Bonning had witnessed hysteria mounting as the number of cases has increased.
"A colleague there decided a person did not meet the criteria for a swab, which included having a fever, a cough and travel contact.
"But the person demanded to be tested, and when they were refused they ripped the face mask off the technician and spat in their face. This is the sort of behaviour that happens with disease hysteria."
The victim was uninjured and ran for help to a nearby house to phone police.