Te ara tika o te hauora hapori Journal of the New Zealand Medical Association Vol 134 | No 1538 | 9 July 2021 Bumper Issue COVID-19 pandemic studies of relevance to Aotearoa New Zealand Te ara tika o te hauora hapori Publication information published by the New Zealand Medical Association NZMJ Editor NZMA Chair Professor Frank Frizelle Dr Alistair Humphrey NZMJ Production Editor NZMA Communications Manager Richard Beer Simon Bradford Other enquiries to: To contribute to the NZMJ, first read: NZMA www.nzma.org.nz/journal/contribute PO Box 156 © NZMA 2021 The Terrace Wellington 6140 Cover photo and editorial thumbnail Phone: (04) 472 4741 courtesy of the Ministry of Health To subscribe to the NZMJ, email [email protected] Subscription to the New Zealand Medical Journal is free and automatic to NZMA members. Private subscription is available to institutions, to people who are not medical practitioners, and to medical practitioners who live outside New Zealand. 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Individual articles are available for purchase by emailing [email protected] NZMJ 9 July 2021, Vol 134 No 1538 ISSN 1175-8716 © NZMA www.nzma.org.nz/journal conTENTS EDITORIALS 68 9 Making sure the New Zealand Bumper issue of COVID-19 border is not our Achilles heel: pandemic studies of relevance to repeated cross-sectional COVID-19 Aotearoa New Zealand surveys in primary care Nick Wilson, Jennifer A Summers, Kyle Eggleton, Nam Bui, Leah Grout, Michael G Baker Felicity Goodyear-Smith ARTICLES 77 An NP-led pilot telehealth 18 programme to facilitate guideline- Deficient hand washing amenities directed medical therapy for heart in public toilets in the time of failure with reduced ejection the COVID-19 pandemic: fraction during the COVID-19 a multi-regional survey pandemic Nick Wilson, George Thomson Andy McLachlan, Chris Aldridge, 28 Mary Morgan, Mayanna Lund, Ruvin Gabriel, Valerio Malez Māori and Pacific people in New Zealand have higher risk of 89 hospitalisation for COVID-19 Empty waiting rooms: Nicholas Steyn, Rachelle N Binny, the New Zealand general practice Kate Hannah, Shaun C Hendy, Alex James, experience with telehealth during Audrey Lustig, Kannan Ridings, the COVID-19 pandemic Michael J Plank, Andrew Sporle Geraldine Wilson, Olivia Currie, 44 Susan Bidwell, Baraah Saeed, Higher perceived stress and Anthony Dowell, Andrew Adiguna Halim, Les Toop, Ann Richardson, exacerbated motor symptoms in Ruth Savage, Ben Hudson Parkinson’s disease during the COVID-19 lockdown in New Zealand 102 Rebekah L Blakemore, Maddie J Pascoe, Emergency COVID-19 funding to Kyla-Louise Horne, Leslie Livingston, general practices in early 2020: Bob N Young, Beth Elias, Marie Goulden, lessons for future allocation Sophie Grenfell, Daniel J Myall, to support equity Toni L Pitcher, John C Dalrymple-Alford, Vanessa Selak, Sue Crengle, Campbell J Le Heron, Tim J Anderson, Matire Harwood, Samantha Murton, Michael R MacAskill Peter Crampton 52 111 Life during lockdown: COVID-19 and the impact on a qualitative study of low-income urology service provision at Capital New Zealanders' experience during & Coast District Health Board the COVID-19 pandemic Simon Lambracos, Lance Yuan, Kimberley Choi, Namratha Giridharan, Andrew Kennedy-Smith Abigail Cartmell, Dominique Lum, Louise Signal, Viliami Puloka, Rose Crossin, Lesley Gray, Cheryl Davies, Michael Baker, Amanda Kvalsvig NZMJ 9 July 2021, Vol 134 No 1538 ISSN 1175-8716 © NZMA 3 www.nzma.org.nz/journal conTENTS 120 139 Impact of the COVID-19 Teleophthalmology in the pandemic lockdown on public post-coronavirus era sector ophthalmic work by Francesc March de Ribot, New Zealand’s ophthalmologists Anna March de Ribot, Daniel A R Scott, Peter W Hadden, Kelechi Ogbuehi, Ruth Large Graham A Wilson 144 VIEWPOINTS COVID-19 serology: use and interpretation in New Zealand 128 Gary N McAuliffe, Timothy K Blackmore Addressing structural discrimination: prioritising people CLINICAL CORRESPONDENCE with mental health and addiction 148 issues during the COVID-19 Dangers of a single pellet pandemic Jeong Ha, Olga Korduke, Helen Lockett, Ashley Koning, Megan Rodney, Peter Stiven Cameron Lacey, Susanna Every-Palmer, Kate M Scott, Ruth Cunningham, 100 YEARS AGO Tony Dowell, Linda Smith, Alison Masters, Arran Culver, Stephen Chambers 150 Notes on a Case of 135 “Brodie's Abscess” or How were medical students “Circumscribed Abscess” of the from Christchurch, Lower End of the Left Femur New Zealand, involved in their 1921 COVID-19 response? Matthew J Cowie, Cicely V M Barron, Anna G Bergin, Noella N Farrell, India G Hansen NZMJ 9 July 2021, Vol 134 No 1538 ISSN 1175-8716 © NZMA 4 www.nzma.org.nz/journal SUMMariES Deficient hand washing amenities in public toilets in the time of the COVID-19 pandemic: a multi-regional survey Nick Wilson, George Thomson This study found major gaps in the way New Zealand public toilets are designed and serviced that could contribute to the risk of infectious disease transmission. This issue is relevant to helping with control of any COVID-19 outbreaks but also other diseases such as the more common norovirus infection. Nevertheless, hand hygiene may only be of relatively minor importance for COVID-19 control when compared to reducing aerosol transmission via improved ventilation, mask use and physical distancing. Māori and Pacific people in New Zealand have higher risk of hospitalisation for COVID-19 Nicholas Steyn, Rachelle N Binny, Kate Hannah, Shaun C Hendy, Alex James, Audrey Lustig, Kannan Ridings, Michael J Plank, Andrew Sporle We use data on cases of COVID-19 in Aotearoa New Zealand up to September 2020 to estimate the risk of hospitalisation for different age and ethnicity groups. After controlling for age and pre-existing conditions, we find that Māori and Pacific people face significantly higher risk of hospitalisation with COVID-19. Our work focuses on the likelihood of hospitalisation given infection, but other risk factors may mean that Māori and Pacific communities also face greater risk of infection. Higher perceived stress and exacerbated motor symptoms in Parkinson’s disease during the COVID-19 lockdown in New Zealand Rebekah L Blakemore, Maddie J Pascoe, Kyla-Louise Horne, Leslie Livingston, Bob N Young, Beth Elias, Marie Goulden, Sophie Grenfell, Daniel J Myall, Toni L Pitcher, John C Dalrymple-Alford, Campbell J Le Heron, Tim J Anderson, Michael R MacAskill This manuscript describes findings from a study conducted during New Zealand’s strict and relatively successful lockdown period to contain the SARS-CoV-2 virus. We surveyed our Parkinson’s disease (PD) and healthy control cohorts who are part of our established PD longitudinal study at the New Zealand Brain Research Institute. Here we report strong evidence of an association between higher levels of perceived stress and worsening of PD motor symptoms and higher perceived stress in PD than controls since the lockdown began. This report highlights the close interaction between stress and altered movement function in PD, indicating that monitoring and minimising stress levels during the pandemic may be an important adjunct strategy to improve motor function in PD. NZMJ 9 July 2021, Vol 134 No 1538 ISSN 1175-8716 © NZMA 5 www.nzma.org.nz/journal SUMMariES Life during lockdown: a qualitative study of low-income New Zealanders' experience during the COVID-19 pandemic Kimberley Choi, Namratha Giridharan, Abigail Cartmell, Dominique Lum, Louise Signal, Viliami Puloka, Rose Crossin, Lesley Gray, Cheryl Davies, Michael Baker, Amanda Kvalsvig This research explores the experience of 27 low-income New Zealanders during the COVID-19 pandemic lockdown. Life during lockdown was challenging for study participants who were fearful of the virus and experienced mental distress and isolation. Participants were also resourceful and resilient including using technology, self-help techniques and support from others. New Zealand’s welfare state ensured participants had access to health services and welfare payments, but there were challenges. Despite welcome increases in welfare payments these did not fully meet participants’ needs, and support from charitable organisations was critical. Participants were overwhelmingly positive about the Government’s response and advised the Government to take the same approach in the future. An early and hard lockdown, the welfare state, compassion and clearly communicated leadership were keys to a successful pandemic response for the low-income people in this study. Making sure the New Zealand border is not our Achilles heel: repeated cross-sectional COVID-19 surveys in primary care Kyle Eggleton, Nam Bui, Felicity Goodyear-Smith This is paper presents a primary care perspective on border openings in the context of the COVID-19 pandemic. The study itself is part of an international collaboration designed to analyse and disseminate concerns of primary care in relation to the pandemic. Results from this study show that primary care has expressed repeated concerns about opening the border and see the border as being an ‘Achilles heel’ in our defence against COVID.