Modelling the impact of the Omicron BA.5 subvariant in New Zealand.

New Zealand experienced a wave of the Omicron variant of SARS-CoV-2 in early 2022, which occurred against a backdrop of high two-dose vaccination rates, ongoing roll-out of boosters and paediatric doses, and negligible levels of prior infection. New Omicron subvariants have subsequently emerged with a significant growth advantage over the previously dominant BA.2. We investigated a mathematical model that included waning of vaccine-derived and infection-derived immunity, as well as the impact of the BA.5 subvariant which began spreading in New Zealand in May 2022. The model was used to provide scenarios to the New Zealand Government with differing levels of BA.5 growth advantage, helping to inform policy response and healthcare system preparedness during the winter period. In all scenarios investigated, the projected peak in new infections during the BA.5 wave was smaller than in the first Omicron wave in March 2022. However, results indicated that the peak hospital occupancy was likely to be higher than in March 2022, primarily due to a shift in the age distribution of infections to older groups. We compare model results with subsequent epidemiological data and show that the model provided a good projection of cases, hospitalizations and deaths during the BA.5 wave.

Modelling the impact of the Omicron BA.5 subvariant in New Zealand.

New Zealand experienced a wave of the Omicron variant of SARS-CoV-2 in early 2022, which occurred against a backdrop of high two-dose vaccination rates, ongoing roll-out of boosters and paediatric doses, and negligible levels of prior infection. New Omicron subvariants have subsequently emerged with a significant growth advantage over the previously dominant BA.2. We investigated a mathematical model that included waning of vaccine-derived and infection-derived immunity, as well as the impact of the BA.5 subvariant which began spreading in New Zealand in May 2022. The model was used to provide scenarios to the New Zealand Government with differing levels of BA.5 growth advantage, helping to inform policy response and healthcare system preparedness during the winter period. In all scenarios investigated, the projected peak in new infections during the BA.5 wave was smaller than in the first Omicron wave in March 2022. However, results indicated that the peak hospital occupancy was likely to be higher than in March 2022, primarily due to a shift in the age distribution of infections to older groups. We compare model results with subsequent epidemiological data and show that the model provided a good projection of cases, hospitalizations and deaths during the BA.5 wave.

The concentration of complexity: case mix in New Zealand general practice and the sustainability of primary care.

Introduction New Zealand general practice and primary care is currently facing significant challenges and opportunities following the impact of the coronavirus disease 2019 (COVID-19) pandemic and the introduction of health sector reform. For future sustainability, it is important to understand the workload associated with differing levels of patient case mix seen in general practice. Aim To assess levels of morbidity and concomitant levels of socio-economic deprivation among primary care practices within a large primary health organisation (PHO) and associated Maori provider network. Methods Routinely collected practice data from a PHO of 57 practices and a Maori provider (PHO) of five medical practices in the same geographical area were used to compare a number of population health indicators between practices that had a high proportion of high needs patients (HPHN) and practices with a low proportion of high needs patients (Non-HPHN). Results When practices in these PHOs are grouped in terms of ethnicity distribution and deprivation scores between the HPHN and Non-HPHN groups, there is significantly increased clustering of both long-term conditions and health outcome risk factors in the HPHN practices. Discussion In this study, population adverse health determinants and established co-morbidities are concentrated into the defined health provider grouping of HPHN practices. This 'concentration of complexity' raises questions about models of care and adequate resourcing for quality primary care in these settings. The findings also highlight the need to develop equitable and appropriate resourcing for all patients in primary care.

An investigation into the digitalisation of New Zealand general practice services during COVID-19.

AIM: This study investigates the digital transition initiated by the onset of the COVID-19 pandemic and the factors that enabled the digitalisation of general practices (GPs) in New Zealand. METHOD: Using a multiple case study design, we conducted 86 in-depth interviews with staff from 16 GP centres in New Zealand. RESULTS: The critical enablers of digital transition in response to the pandemic were support from the community, agility and adaptability of GP medical centres and the ability to pragmatically create external operational processes to ensure business continuity and to meet patient expectations. Major barriers to digitalisation at the early stage of the COVID-19 pandemic (28 February to 30 August 2020) included lack of organisational leadership, financial support availability, systems management collaboration, and patient and staff knowledge and preferences. Digitalisation was characterised by the GP centre's ability to provide telehealth services using existing systems and technology, embracing e-prescription, e-referrals, e-lab and video-only consults. CONCLUSION: The decision to adopt digitalisation had a significant impact on GP centres, disrupting the norm but also allowing continued access to health services to patients who were the most vulnerable during the pandemic. The pandemic forced GP medical centres to change to digitalisation and led to significant changes in GP medical centres' business models. However, it remains to be seen how the rapid change effected at this time correlates with patient satisfaction and how the digitalisation capabilities that have been built impact on future primary care services. This study suggests that changes brought about by COVID-19 may pave the way to an expansion of GP telehealth services, which has the potential to permanently change the primary care landscape.

Teleclinics for the management of diabetes in pregnancy during COVID-19-maternal satisfaction and pregnancy outcomes.

AIMS: Diabetes in pregnancy (DiP) rates are increasing worldwide. Pasifika, Indian and Maori peoples have high rates of DiP any improvements in clinical care may be beneficial for these populations. During COVID-19 lockdowns, the DiP service in Counties Manukau Health (CMH) South Auckland switched from face-to-face appointments to teleclinics. This study aims to: determine satisfaction of pregnant people with teleclinics for DiP; compare clinical outcomes and attendance for those receiving care through teleclinics versus standard care; and compare rates of clinic attendance between face-to-face and teleclinic appointments. METHODS: A standardised questionnaire was completed by those who had attended a teleclinic. The primary outcome was a high score (4-5/5) for satisfaction and future use. A separate, retrospective study of clinical outcomes, and the number of appointments scheduled/attended were compared between all DiP patients who were scheduled an appointment during lockdown, and all of those who were scheduled appointments the year prior. RESULTS: Of the thirty-five participants who completed the survey (response rate 37%), 89% scored the clinic highly for satisfaction and future use. There were 179 patients scheduled to clinic during the period where teleclinics were the default model of care, and 187 patients scheduled to clinic the year prior. No differences in clinical outcomes were observed. Those receiving care during lockdown were offered more appointments, although attendance rates did not differ. CONCLUSION: Teleclinics for DiP are acceptable to the people we surveyed, but should be developed further so they better support the needs of those using them.

Evaluation of community-based CT abdomen for acute abdominal pain during COVID-19.

AIM: The purpose of this study was to determine the utility of community-based imaging to reduce use of inpatient surgical resources and enforce social distancing at the outset of the COVID-19 pandemic. METHOD: A prospective evaluation of community-based CT for patients presenting to Christchurch general practitioners with acute abdominal pain from April to November 2020. Eligible patients were discussed with the on-call general surgical team, and then referred for CT abdomen rather than hospital assessment. The positivity rate of CT scans, the 30-day all-cause hospital admission rate, and the proportion of patients where community scanning altered management setting and the number of incidental findings, were all assessed. RESULTS: Of 131 included patients, 67 (51%) patients had a positive CT scan. Thirty-nine (30%) patients were admitted to hospital within 30 days, 34 (87%) of whom had a positive CT scan and were admitted under a surgical specialty. Ninety-two (70%) patients did not require hospital admission for their acute abdominal pain, thirty-three (35%) of whom had a positive CT scan. There were three deaths within 30 days of the community CT, and the setting of the community CT did not contribute to the death of any of the cases. Forty patients (30%) had incidental findings on CT, 10 (25%) of which were significant and were referred for further investigation. CONCLUSION: Community based abdominal CT scanning is a feasible option in the management of acute abdominal pain. While trialed in response to the initial nationwide COVID-19 lockdown in New Zealand, there may be utility for acute community-based CT scanning in regular practice.

An assessment of burnout in New Zealand orthopaedic resident medical officers.

AIMS: Burnout and fatigue are common in the medical profession. The primary aim was to assess rates of burnout in trainee and non-trainee orthopaedic registrars in New Zealand. A secondary aim was to establish which specific factors are associated with burnout. METHODS: In 2021, a 53-question online survey was sent to New Zealand trainee and non-trainee orthopaedic registrars. The survey included questions addressing demographics, modifiable factors known to lead to burnout, information on respective orthopaedic departments, and how respondents had fared with COVID-19. Registrars also completed the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS MP), a 22-question validated survey that is designed to assess the frequency and intensity of perceived burnout among medical personnel. RESULTS: Fifty of 62 (80.6%) trainees and 66 of 70 (estimated number) (94.3%) of non-trainees completed the survey. Trainees and non-trainees both exhibited moderate levels of burnout. The trainee mean score emotional exhaustion (EE) 22.5, depersonalisation (DP) 8.8, personal achievement (PA) 35.9; non-trainee mean score EE 22.4, DP 8.9, PA 35.9. Fifty-two point two percent of trainees and 50% of non-trainees scored in the severe range for at least one of EE or DP. Factors shown to reduce burnout are the presence of a senior colleague (P<0.001), participation in professional assistance (P=0.049), working in a department with a full complement of staff (P=0.020) and being able to attend health maintenance appointments (P=0.050). CONCLUSION: Our study shows that approximately half of both trainee and non-trainee orthopaedic registrars are exhibiting signs of burnout. This is comparable to other developed nations with a similar healthcare system.

Presenting characteristics, length of stay and oxygen use among COVID-19 cases at a single tertiary hospital in Auckland, New Zealand, using retrospective medical recorded data.

AIMS: The purpose of our current study was to analyse demographic and presenting characteristics of COVID-19 patients, including assigning clinical severity scores, and analyse with respect to oxygen utilisation and hospital course. METHODS: This was a retrospective observational study of COVID-positive patients presenting to the Emergency Department at Middlemore Hospital in Auckland, New Zealand. Data were collected between 1 August 2021 and 1 November 2021. They were followed through 20 December 2021. Data were obtained from both the EMR system and paper charts for all eligible patients during the study period. RESULTS: There were 171 patients included, with 187 patient presentations. Oxygen data were collected on 123 admitted patients and showed that 47% of admission time was spent off oxygen. Of the total presentations, the median length of stay (LOS) was 4 days. The severity of presenting illness was associated with disposition and predictive of LOS. CONCLUSIONS: Approximately half of the admitted patient's hospital time involved no oxygen use, which suggests that we may be able to further risk stratify in order to decrease the number and duration of hospital admissions going forward. As expected, clinical severity scores were associated with oxygen utilisation, disposition and LOS.

Asian New Zealanders' experiences of racism during the COVID-19 pandemic and its association with life satisfaction.

AIM: Racism is an important social determinant of wellbeing. This study describes New Zealand Asians' experience of racism and the association between their racism experiences and their impacts on life satisfaction during the COVID-19 pandemic. METHOD: This study collected 1,452 responses by the cross-sectional online survey conducted in 2021. Descriptive and logistic regression analyses yielded the prevalent types and settings of racism, identified subgroups exposed more to racism and its association with life satisfaction. RESULTS: Results show that nearly 40% (37.7-42.9%) of participants experienced racism, mainly in public places, social media and mainstream media. Verbal attacks and microaggressions were predominant types of racism. Younger, student, temporary visa holding, and rural area participants were more likely to experience racism. Associations between not experiencing racism and high life satisfaction were significant. CONCLUSION: This study identified two under-represented subgroups, students and migrants, who were disproportionately exposed to racism. It also revealed that experiences of COVID-era racism are associated with life satisfaction. These findings inform us where anti-racism interventions are most needed, and that such interventions are needed to ensure the wellbeing of Asian communities in a COVID-19 world.

The impact of COVID-19 on lung cancer detection, diagnosis and treatment for Maori in Aotearoa New Zealand.

AIM: The purpose of this article is to examine disparities in the impact of the COVID-19 pandemic on access to lung cancer diagnosis and access to clinical services between Maori and non-Maori. METHODS: Using national-level data, we examined age-standardised lung cancer registrations, diagnostic procedures (bronchoscopy) and lung surgeries separately by ethnic group for the years 2018-2020, as well as patterns of stage of diagnosis. RESULTS: We found a trend toward a reduction in rates of lung cancer registration in Maori (but not non-Maori/non-Pacific) New Zealanders in 2020 compared to 2018 and 2019, but no apparent shift in the distribution of stage at diagnosis. We found a trend toward a reduction in rates of bronchoscopy for both Maori and non-Maori/non-Pacific patients, with the largest reduction observed for Maori. Rates of lung cancer surgery appeared to have reduced for Maori patients, although this was based on a small number of procedures. CONCLUSIONS: We observed disparities between Maori and non-Maori/non-Pacific patients in lung cancer registration and bronchoscopy as a result of the COVID-19 pandemic.

Hospital based specialists' perspectives of teleconsultation use during the COVID-19 pandemic.

AIMS: Teleconsultation has been widely utilised during the COVID-19 pandemic. It allows clinicians to provide healthcare social distance restrictions. This study investigates its safety and limitations in different specialties and the possibility of incorporating telemedicine into future practice. METHODS: This was a qualitative study of 151 hospital-based specialists in New Zealand. An electronic questionnaire was sent via email addresses. These included participants' demography and their experience of using teleconsultation during the pandemic. The safety and suitability of teleconsultation were assessed with time efficiency, data security concerns, missed clinical information and specialist's ability to examine patients. RESULTS: This study found that 92.7% of hospital-based specialists used teleconsultation during the pandemic. More specialists reported the efficiency was similar or greater with teleconsultation and most patients could be seen via teleconsultation appointments. Limitations of these were due to poor physical examination and poor non-verbal cues sensing. There is a general preference for physical consultation. CONCLUSION: Teleconsultation is used widely across many specialties during the pandemic. Despite limitations identified with teleconsultations and preference for physical consultation, doctors are prepared to provide teleconsultations in the future beyond the pandemic. In appropriately selected patients, especially in non-procedural specialties, teleconsultation will have an increasing role in healthcare.

Feasibility and acceptability of telehealth and contactless delivery of human papillomavirus (HPV) self-testing for cervical screening with Maori and Pacific women in a COVID-19 outbreak in Aotearoa New Zealand.

AIM: To determine the feasibility and acceptability of a telehealth offer and contactless delivery of human papillomavirus (HPV) cervical screening self-test during the 2021 COVID-19 Level 4 lockdown in Auckland, New Zealand. METHODS: A small proof-of-concept study was undertaken to test telehealth approaches in never-screened, due or overdue Maori and Pacific women enrolled in a local Primary Health Organisation (PHO). Study invitation, active follow-up, nurse-led discussions, result notification and a post-test questionnaire were all delivered through telehealth. RESULTS: A sample of 197 eligible Maori and Pacific women were invited to take part, of which 86 women were successfully contacted. Sixty-six agreed to take part. Overall uptake was 61 samples returned (31.8%) and uptake of all contactable women was 70.9%. Six of the 61 HPV self-tests (9.8%) were positive, all for non 16/18 types, and were referred for cytology. Three had negative cytology results, and three with positive cytology results were referred for colposcopy. CONCLUSION: The offer of HPV self-testing during COVID-19 lockdown was both feasible and highly acceptable for Maori and Pacific women. Importantly, HPV self-testing via telehealth and mail-out, alongside other options, offers a potential pro-equity approach for addressing the impact of deferred screens due to COVID-19 and other longstanding coverage issues.

A Chatbot to Support Young People During the COVID-19 Pandemic in New Zealand: Evaluation of the Real-World Rollout of an Open Trial.

BACKGROUND: The number of young people in New Zealand (Aotearoa) who experience mental health challenges is increasing. As those in Aotearoa went into the initial COVID-19 lockdown, an ongoing digital mental health project was adapted and underwent rapid content authoring to create the Aroha chatbot. This dynamic digital support was designed with and for young people to help manage pandemic-related worry. OBJECTIVE: Aroha was developed to provide practical evidence-based tools for anxiety management using cognitive behavioral therapy and positive psychology. The chatbot included practical ideas to maintain social and cultural connection, and to stay active and well. METHODS: Stay-at-home orders under Aotearoa's lockdown commenced on March 20, 2020. By leveraging previously developed chatbot technology and broader existing online trial infrastructure, the Aroha chatbot was launched promptly on April 7, 2020. Dissemination of the chatbot for an open trial was via a URL, and feedback on the experience of the lockdown and the experience of Aroha was gathered via online questionnaires and a focus group, and from community members. RESULTS: In the 2 weeks following the launch of the chatbot, there were 393 registrations, and 238 users logged into the chatbot, of whom 127 were in the target age range (13-24 years). Feedback guided iterative and responsive content authoring to suit the dynamic situation and motivated engineering to dynamically detect and react to a range of conversational intents. CONCLUSIONS: The experience of the implementation of the Aroha chatbot highlights the feasibility of providing timely event-specific digital mental health support and the technology requirements for a flexible and enabling chatbot architectural framework.

Tracing the international arrivals of SARS-CoV-2 Omicron variants after Aotearoa New Zealand reopened its border.

In the second quarter of 2022, there was a global surge of emergent SARS-CoV-2 lineages that had a distinct growth advantage over then-dominant Omicron BA.1 and BA.2 lineages. By generating 10,403 Omicron genomes, we show that Aotearoa New Zealand observed an influx of these immune-evasive variants (BA.2.12.1, BA.4, and BA.5) through the border. This is explained by the return to significant levels of international travel following the border's reopening in March 2022. We estimate one Omicron transmission event from the border to the community for every ~5,000 passenger arrivals at the current levels of travel and restriction. Although most of these introductions did not instigate any detected onward transmission, a small minority triggered large outbreaks. Genomic surveillance at the border provides a lens on the rate at which new variants might gain a foothold and trigger new waves of infection.

Radiology and Te Whatu Ora - Health New Zealand in 2022. Why we should all care.

Radiology is a key enabler of clinical activity and has been shown to be highly cost effective. Demand and activity have increased over time, with demand for computed tomography (CT), magnetic resource imaging (MRI) and ultrasound (US) growing faster than population growth. Complexity has also increased over time. Resources in the public sector have not kept up with demand, exacerbated by the COVID-19 pandemic. A reliance on an overseas trained workforce has resulted in critical shortages. Waiting times for CT, MRI and US across Aotearoa New Zealand remain well below targets and have not improved over 10 years. Robust links between clinical activity and radiology resourcing are needed to address the deficits and thereby maintain clinical safety.

The effect of COVID-19 on orthopaedics in Aotearoa New Zealand-a survey of orthopaedic surgeons and training registrars.

AIM: This study aimed to assess the impact of COVID-19 on orthopaedic practice in New Zealand, with a focus on training and mental health. METHODS: An online survey was sent to the 385 consultant orthopaedic surgeons and registrars in New Zealand registered with the New Zealand Orthopaedic Association (NZOA). The survey consisted of 27 questions relating to demographics, the effects of COVID-19 on orthopaedic departments, on training, on mental health and the utilisation of telehealth and online teaching. RESULTS: In total, 189 of 385 NZOA members (49%) completed the survey. Of the 51 orthopaedic registrars surveyed, 55% felt that their training had been moderately affected, while 17% felt it had been significantly affected. Of those surveyed, 65% felt the pandemic had at least a mild effect on their mental health. Seven percent of registrars described a significant impact on their mental health compared to 2% of consultants (p=0.029). Overall, 46.5% felt they were more burnt out because of the pandemic, which was significantly higher in registrars compared to consultants (51% vs 44%, respectively; p=0.029). CONCLUSIONS: Despite the comparatively low number of COVID-19 cases, hospitalisations and deaths, the effects for orthopaedic surgeons and training registrars have been significant.

Learning from healthcare workers' experiences with personal protective equipment during the COVID-19 pandemic in Aotearoa/New Zealand: a thematic analysis and framework for future practice.

OBJECTIVES: Safety and welfare are critical as pandemic-related demands on the healthcare workforce continue. Access to personal protective equipment (PPE) has been a central concern of healthcare workers throughout the COVID-19 pandemic. Against the backdrop of an already strained healthcare system, our study aimed to explore the experiences of healthcare workers with PPE during the first COVID-19 surge (February-June 2020) in Aotearoa/New Zealand (NZ). We also aimed to use these findings to present a strengths-based framework for supporting healthcare workers moving forward. DESIGN: Web-based, anonymous survey including qualitative open-text questions. Questions were both closed and open text, and recruitment was multimodal. We undertook inductive thematic analysis of the dataset as a whole to explore prominent values related to healthcare workers' experiences. SETTING: October-November 2020 in New Zealand. PARTICIPANTS: 1411 healthcare workers who used PPE during surge one of the COVID-19 pandemic. RESULTS: We identified four interactive values as central to healthcare workers' experiences: transparency, trust, safety and respect. When healthcare workers cited positive experiences, trust and safety were perceived as present, with a sense of inclusion in the process of stock allocation and effective communication with managers. When trust was low, with concerns over personal safety, poor communication and lack of transparency resulted in perceived lack of respect and distress among respondents. Our proposed framework presents key recommendations to support the health workforce in terms of communication relating to PPE supply and distribution built on those four values. CONCLUSIONS: Healthcare worker experiences with PPE access has been likened to 'the canary in the coalmine' for existing health system challenges that have been exacerbated during the COVID-19 pandemic. The four key values identified could be used to improve healthcare worker experience in the future.

Lockdown Level 4 V2.0: different trauma patterns in Auckland in 2021?

AIMS: Coronavirus disease 2019 (COVID-19) resulted in the implementation of public health restrictions to reduce transmission. These restrictions have reduced trauma-related admissions to hospitals. Auckland, New Zealand, had two periods of Level 4 lockdowns, in 2020 and 2021. In the 2021 lockdown, Aucklanders were generally less compliant with the restrictions. Therefore, we hypothesised that trauma-related activity would be greater in the 2021 lockdown compared to 2020. METHODS: A retrospective descriptive study of trauma admissions to Auckland City Hospital (ACH) during 2020 (26 March to 27 April 2020-33 days) and 2021 (18 August to 21 September 2021-35 days) lockdown periods was performed. RESULTS: Trauma admissions and trauma call activations increased from 97 to 105 (8.2%) and from 35 to 46, respectively, in the 2021 lockdown compared to 2020. The numbers of males and road related injuries requiring admission were increased from 49 to 66 (p = 0.077) and from 21 to 28 (p = 0.439), respectively, in 2021 compared to 2020. Major trauma admissions increased from 13 to 23 in the 2021 lockdown compared to 2020. CONCLUSIONS: Trauma-related presentations to hospital were higher in the 2021 Auckland lockdown compared to 2020. Lockdown fatigue and reduced compliance in 2021 may have contributed to this finding, suggesting that future lockdowns may be less effective.