Scenario 3 - Severe Pandemic in New Zealand
It is mid-July. About eight weeks ago, H5N1 pandemic influenza achieved an explosive breakout from South East Asia, appearing in Europe, North and South America, Africa and India within a couple of weeks. The disease is impacting heavily on all age groups, but particularly on younger adults. The case fatality rate is about 3% over all age groups but up to 8-10% for people under 30. The pandemic disease has a high reproductive rate and spreads very rapidly once the first few cases have appeared in any country or region.
International trade and travel is more or less at a standstill as all impacted countries attempt to adjust to the new situation. Very limited amounts of airfreight are still moving, but flights are arranged more or less as required, rather than to a timetable, and even so it is very difficult to find aircrew willing to fly to some countries. Very few passengers are being carried.
Merchant ships at sea on the way to New Zealand when the pandemic broke out, have either turned around and gone home, have berthed and are unable to leave, or are remaining offshore, waiting to assess the onshore situation before berthing. One of the ships that turned around was a tanker carrying a large shipment of petrol, and there has not been a petrol delivery at Marsden Point for over six weeks now.
Despite strenuous border control efforts, pandemic influenza appeared suddenly in one urban area a bit over four weeks ago. Efforts at containment were abandoned, as many other cases were reported throughout the country over the next week. Health authorities shifted efforts to attempt to ameliorate the impacts of the pandemic.
Medical Officers of Health have directed all crèches, kindergartens, schools, colleges, universities, public libraries, video stores, game arcades and casinos to close indefinitely. Public gatherings are prohibited, and people are advised to avoid crowded places as much as possible. Wherever practical, people are working from home, or have taken leave - either paid or unpaid.
So far, the epidemiology of the disease in New Zealand appears much the same as in other countries, with the heaviest impact on young adults. Over 100,000 people have become ill since the development of the pandemic in New Zealand, and nearly 3,000 have died. About 2,000 of these are under the age of 30. Case numbers are still increasing very fast. Initial forecasts indicate that this wave could involve up to 40% of the population, implying that there may be another 1.5 million people becoming ill over the next six weeks or so, with a peak in about another 2-3 weeks. Given the current epidemiology, this may result in between 30,000-35,000 deaths in total.
The Ministry of Health has directed DHBs to release their PPE supplies to hospitals, the primary health care sector (in previously agreed locations), and to local services to support first responders.
The Ministry of Health has released the national reserve of anti-viral medication for use. The medication is being distributed through about 80 special temporary facilities. It is strictly prioritised to people who meet clinical criteria for influenza and time since onset of symptoms. After several incidents at the distribution stations the Ministry asked for Police or Defence Force assistance with security as civilian security firms could not manage this.
Anti-viral medication has been allocated for all health services, Police and Defence Force, and staff from some other organisations providing direct pandemic responses. This guarantees treatment for any staff from these services that become ill. Despite this, there is a degree of absences in both the health sector and Police force that is not related to direct illness. Between 10%-15% of the Police force is not available for duty. The overall absence rate is still increasing, and may reach about 40%-50% in a few weeks time - around the expected peak of the current pandemic wave.
The Army has about 10% of its troops not available for duty from illness, and the Air Force about the same. The Navy has one frigate on its way back from the Persian Gulf, and doesn't have enough crew available to man the other, currently moored in Auckland. Navy volunteers are assisting health services in Auckland.
Primary health services in most districts are shifting priorities, as case numbers climb, and are mostly still functioning although increasingly in a directive and support role. Secondary hospitals and DHBs in most affected areas are moving to a coordination and logistic supply role for primary and volunteer groups while attempting to maintain hospital services as much as possible.
Hospitals are hampered by very high rates of sickness and absences among their staff, and are down to between 50% and 60% of their normal capacity. Hardly any influenza patients are being admitted to hospitals. It is probable that things will get worse for hospitals before they get better.
Health services in the most affected urban area and much of the surrounding region are no longer functioning in a co-ordinated manner. Here, the primary and secondary health workforce has been very heavily impacted, with only about 40% of the normal staff available for duty. The pandemic is developing very fast in some population sub-groups, and there have been a large number of deaths. A number of very young children have been orphaned by the deaths of both their parents. Several hundred bodies are in freezer storage in the district, and more containers are being brought in.
People of all ages who live alone, and solo parents with small children, are especially vulnerable, as the disease comes on suddenly and is extremely incapacitating. Sufferers can do very little for themselves for several days. People who have few supplies or resources at home, or who have no support, are quickly in dire straits. Some very young children are attempting to look after their sick parents with little or no support. A number of people have died alone in their homes, and it is feared that many more may follow.
In all affected areas people are at home looking after sick children and spouses, and in many cases friends and neighbours in their homes. Some areas have quickly organised networks to support this initiative, but in others people are working as individuals with little coordination or support.
Many people in the most affected urban area have moved to rural areas. Rapidly increasing case numbers are being reported from these districts. Health service capacity in these areas is very limited, and cannot manage anything remotely approaching the demand now being experienced.
Availability of supplies varies across the country, but everywhere there are shortages of fuel and some foodstuffs, partly as a result of people buying up large quantities of basic foods in the early days. Anybody with reserve food or petrol is hoarding it for an uncertain future.
Telephone, text and email communication is heavy as people try to keep in touch with each other and keep checking on their friends and relatives in New Zealand and overseas. So far, water, electricity, gas and sewerage systems are still operating, although some are becoming more vulnerable to breakdown and interruptions because of unusual demand patterns and a progressive lack of routine maintenance, as staff availability dwindles. Postal services have stopped providing daily deliveries because so many staff are absent, and courier services are severely handicapped by shortages of fuel.
Many New Zealand citizens and residents overseas are stranded, unable to return to New Zealand. People who were overseas on holiday have run out of money, and businessmen overseas are in great difficulty as their incomes have often dried up completely. They are appealing to the government for assistance.
About 150,000 tourists and other transient people are stranded in this country. Many are out of money, or their currencies now have virtually no value. International electronic banking is still mostly operating, as are telecommunications and media links. However currency fluctuations are extreme and nobody knows what their money will be worth tomorrow.
Many of the tourists and transients are living more or less on the goodwill of moteliers and accommodation suppliers, who are now vociferously demanding the government "do something" to help the critical business situation developing in the sector from both the downturn in normal business and accommodating people with no funds.
Around 100,000 overseas students are likewise stuck. Although most have enough money to last a while, they are mostly not normally eligible for publicly funded health services in New Zealand, although they are in an age group that is being heavily impacted.
Outline of Health Sector Actions
Generally, the health sector is shifting from provision of direct care to the coordination, direction, logistic support and assistance of care provision by volunteers, community groups and individuals caring for sick family members.
Nation-wide, direction of release of PPE to primary and secondary sectors occurs when Code Red alerts are issued.
The health sector will be providing direct care to only a very small proportion of all people who get sick.
Anti-virals will be released to the general population early in the wave, but there will not be sufficient to provide treatment for everybody who gets sick in a large wave. It is possible more stringent prioritisation may be adopted (in this case likely to be age-based), which may exacerbate issues around the distribution of the medication.
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