New Zealand remains on track to stamping out Covid-19 but a second wave of the potentially deadly virus can't be ruled out and health experts fear we may not be ready.

It comes as the country has just 45 active cases of Covid-19, with no new cases reported yesterday. Of the country's 1499 total cases, 96 per cent have now recovered.

While hospitals have started ramping up all services that were put on hold during lockdown, Sarah Dalton - chief executive of the Association of Salaried Medical Specialists - said there was still a long list of unmet needs.

Dalton hinted that we may be in trouble if we were to see a second wave or new variant of the virus.

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"While New Zealand has done well to dodge a bullet, the same issues still apply.

Sarah Dalton, chief executive of New Zealand's senior doctors' union, the Association of Salaried Medical Specialists. Photo / Supplied
Sarah Dalton, chief executive of New Zealand's senior doctors' union, the Association of Salaried Medical Specialists. Photo / Supplied

"We have a lot of hospital buildings that are not well able to cope. We are still broadly under-staffed and so we have a lot of older staff who are at higher risk in terms of comorbidities and how effective they would be if they did come sick and likelihood of recovery."

Dalton said New Zealand could not afford for us to take our eye off the ball and staying focused on improving our health services was more important than ever.

"We are still seeing DHBs putting in businesses cases for big hospital rebuilds that are being capped in ways that mean if they go ahead we are going to have a building that is really expensive and not fit for purpose."

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She said now was the time for politicians and DHB bosses to be working with clinical leadership teams and while that was happening in some areas there was more work to be done in order for it to become a normality.

How at risk is New Zealand to getting a second wave of Covid-19?

Our risk of getting a second wave is present but much lower the other countries, Dr Ayesha Verrall of the University of Otago told the Herald.

Last week, World Health Organisation (WHO) officials delivered a stark warning to countries beginning to ease their lockdown restrictions, saying now was the "time for preparation, not celebration".

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Dr Hans Kluge, director for the WHO European region, said countries should use this time wisely and start to strengthen public health systems as well as building capacity in hospitals, primary care and intensive care units.

When the Spanish flu first emerged in March 1918, it had the hallmarks of the typical seasonal illness – but it then came back in an even more virulent and deadly form in the autumn, eventually killing an estimated 50 million people.

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Verrall said New Zealand's risk of a second and more deadly wave was much lower than European countries because we have had no evidence of community transmission.

"What we are at risk of is a new intrusion through our border if there is any gaps in our control or a problem with our contact isolation.

"The risk that people haven't been identified in the community is just getting lower and lower."

Dr Ayesha Verrall, an infectious diseases doctor at the University of Otago. Photo / File
Dr Ayesha Verrall, an infectious diseases doctor at the University of Otago. Photo / File

Verrall said now it was about "check, check and double-check" and ensuring we had a long-term plan for testing and contact tracing.

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She said this was a period for DHBs to reflect on what went well and what could be more effective for next time such as managing the flow of patients through hospitals.

"We know patients move through the system slower when staff are having to make new decisions. We need to make sure all the lessons have been learned from the investigations."

Government's response:

The Ministry of Health says it's not "relaxing its guard" and that 408 more ventilators have been ordered from overseas, which were due to arrive within the next six months.

A Ministry of Health spokesperson said preparations had initially been based on what we've seen occur overseas and adapted to New Zealand and the likely range of demand we could face here given the steps taken to stop Covid-19 coming into the country and, where cases do come in, to prevent any spread.

"It's important to note that ventilators are a core piece of equipment held by a range of public and private sector organisations including defence, ambulance, training organisations and private hospitals.

"If a surge in demand for ventilators was to occur, the ministry and DHBs would work with these organisations and use our supply of anaesthetic machines alongside our ICU ventilators to help meet demand."

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Currently, New Zealand has enough ICU-capable ventilators on order to equip any current gaps and the additional beds planned by August 2020, the spokesperson said.

There are 334 anaesthetic machines that could be used as ventilators in the public health system.

The number of intensive care unit beds were tripled across the country to combat initial demand projections and remained available.

As of April 28, there are 358 capable ICU beds across the country. The beds are predominantly within DHB hospitals but also include ICU beds available by agreement for use in private hospitals, a spokesperson said.

Further training in infectious diseases continues to be provided to all district health boards staff including doctors, nurses, allied health professionals and healthcare assistants.

There is an ongoing possibility of putting alert levels back up again over the coming months if Covid-19 re-emerges and can not rapidly be contained, the spokesperson said.

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