Entire hospitals could be dedicated to Covid-19 patients if the virus spreads in New Zealand, leaving nearby facilities clear for other medical care.
The Herald understands high-level contingency planning has considered moving most non-coronavirus treatment out of one or more hospitals, should the number of cases needing hospital care surge.
Health Minister David Clark confirmed that possibility.
"Some countries facing more cases of Covid-19 are dedicating some hospitals to treating the disease, and keeping others clear for other medical care. That approach could be used here as well, but no decisions have been taken at this stage.
"The aim of the level 4 measures is to reduce the risk of transmission, to keep people safe and keep the pressure off our medical services. Most people who contract Covid-19 will experience only mild to moderate symptoms. We have just seven cases that require hospital treatment.
"A huge amount of planning [is] going on across the health system for a range of possible scenarios. That includes working with private hospitals about how we can make the best use of their capacity if the need arises. Those discussions are ongoing."
If most of a hospital was dedicated to treating Covid-19 it's likely patients would be sent to private and nearby public facilities. Auckland's major hospitals include North Shore, Waitakere, Auckland City and Middlemore, and other facilities such as the Manukau SuperClinic and Greenlane Clinical Centre.
Stopping Covid-19 from spreading within a hospital is essential to protect other patients and staff. If the latter fall sick then workforce shortages and burnout can quickly become a crisis.
Some DHBs have ordered around-the-clock building work to construct more negative pressure facilities, which use lower air pressure to stop internal air from reaching the rest of the hospital, allowing patients with infectious conditions to be isolated.
Sarah Dalton, executive director of the doctors' union, the Association of Salaried Medical Specialists, said it made sense to designate as much of a hospital as possible for coronavirus patients, if the situation demanded it.
"If people are known to be unwell but not with Covid, where possible it's much better to be able to put them somewhere else. It's much better for the health staff as well."
The complexity of health services means it's unlikely all non-Covid 19 care could be shifted from a hospital. However, an unprecedented shift of surgeries is already taking place as hospitals send patients to private facilities.
Hundreds of elective surgeries are being postponed, including for hip and knee replacements. Others that can't wait are being sent to private hospitals.
Richard Whitney, president of the Private Surgical Hospitals Association, said New Zealand's 39 private hospitals were stopping elective surgeries to create capacity to take public patients.
"A number of DHBs have already commenced referring their non-discretionary surgeries, such as cancers and the like, to private facilities for them to do on their behalf. Others are in discussions with DHBs to do similar," said Whitney, also chief executive of Mercy Hospital Dunedin.
Private hospitals have 174 operating theatres, 31 procedure rooms, 37 ICU beds and 44 high-dependency unit beds.
The public system's intensive care units already run at about 80-90 per cent capacity, without Covid-19 cases. That means few beds are available to cope with any influx caused by the virus.
Using private ICU beds for non-Covid public patients would free-up capacity in public hospitals. Huge efforts are also under way to treble the number of ICU beds in the public system, with staff including anaesthetists preparing to work in intensive care.
Some have chosen to live away from their families for the foreseeable future to limit the threat of transmission, and Auckland DHB and others are looking at providing accommodation.
New Zealand has 283 confirmed or probable infections. Seven people are hospitalised and are stable.
The Australian and New Zealand Intensive Care Society has pleaded with Kiwis to respect the level 4 restrictions, to avoid a rapid increase in those numbers and people who will need hospital-level care.
The society has led work on how Covid-19 patients needing care should be triaged. That includes using special Kiwi-designed software to score patients and help doctors decide who would get an ICU bed if there aren't enough available. That software is already being used in Italy, where some hospitals have been overwhelmed.
"We have many advantages - we have a good head start, we are far away so [Covid-19 has] been slow to get here, the Government has listened to the scientific advice it has had, and we are very pleased with their response," said Dr Andrew Stapleton of the intensive care society.
"Most of us are going to get Covid and be fine. But we mustn't all get it at once, because the few resources we've got will be overwhelmed. And then people who could have been saved, won't be saved."