It seems counter-intuitive to be in the middle of a public health crisis and to hear that one of the first financial victims of the pandemic will be our doctors and their practices.

Many GPs will be making the decision today and in the following days to close up shop because of a whirlwind of situations that has made them deeply unprofitable.

In the days before the lockdown GPs were besieged by clients seeking medications and treatments before they were confined to barracks.  The doctors worked huge hours and in many cases took on new staff to cope.

Meanwhile, they were busy investing in pandemic equipment. Perspex screens, portacabins outside their practice for Covid patients to keep them apart from others, and of course scrubs and masks and gloves.

Then there was the decision to move to virtual consulting so doctors invested in phones and laptops and applications.

And then the country shut down. And no-one went to the doctors.

30 to 40 per cent of a practice's income comes from the co-payments from you and I. So the cashflow immediately plummeted. The extra staff still need pay and the porta cabin still needs its rent paid.

So here we are five days in and doctors are falling. Financially.

It doesn't seem right, does it? A pandemic has always been predicted. They come with regularity amongst human populations. Smallpox ravaged the Roman empire killing over five million. The flu after the First World War, the TB, the polio and SARS not so long ago. We should be ready but we're not.  Pandemic preparation seems to be a no brainer for any healthcare community and yet we fail to invest time and time again.

 

This morning we heard the opinion of a French public health expert called Jean Dominique Michel. He talked about much we already know about. How no-one really tests enough, the stupidity of wet markets and the blame of modern lifestyle for creating under-lying symptoms.

If you look at Italy half the people who died had three or more other diseases. Only 0.8% had just Covid. He lays the blame of these underlying symptoms squarely on four factors. Junk food, pollution, stress and physical activity.

But he also lay much of the blame on the elephant in the economy room. Italy's shocking level of fatalities was partly due to an under-investment in healthcare facilities. There were just not enough hospital beds

He points out that Germany has 6 ICU beds per 1000 people. Switzerland 3.5. France 3. Italy had just 2. But all those nations had seen the ratio falling over the past 20 years. It's been a modern structural disease. Population has swelled but the infrastructure to care for that population has been left to deteriorate.

So to our New Zealand doctors going to the wall, I wonder why they were not prepared for a pandemic and why successive governments did not ensure an adequate pandemic plan including the provision of kit for the practices? They should not have had to pay for porta cabins and PPE.

And I don't really want to tell you how many ICU beds we have. OK I will. We have just under 5 per 100,000. Australia has just under 9. The European average is just under 12 and Germany has 30. That's embarrassing

A recent audit of our medical facilities found 11,000 to be poor or substandard. Palmerston North's operating theatres are 50 years old. That's bordering on criminal.

You can't run the sort of immigration and birth rates that we have over the past 20 years and not spend proportionately on your health infrastructure. But we did. And now we have tents in hospital carparks and GPs going bust in five days.