Viruses are strictly intracellular and use the host cells for replication. Their structure is very basic and consists of a segment of nucleic acid surrounded by a protein shell. Even though they are structurally simple, they have efficiently utilised their nucleic acid in creative ways to increase their functionality and optimise their survival. Genetic mutations are a virus’s natural way to adapt quickly to pressure. Fundamentally, a “good” virus is one that survives. Once a virus has entered a host cell, viral replication is underway. The process becomes a race between host survival and virus survival. If the host wins, the virus is cleared through innate and adaptive immune responses. If the virus wins, large-scale virus replication results in host tissue destruction and disease, and possibly death of the host. Clinically, the immune responses mediated by cytokines result in symptoms such as fever, headache and myalgia. However, some viruses can cause tissue damage in the absence of an inflammatory response. That leads to asymptomatic infection and shedding of the virus which complicates case detection and disease control but is a survival advantage for the virus (1).
COVID-19 is the type of disruptive event we don’t often see in health. New Zealanders recently learnt that the first COVID-19 patient death occurred in Greymouth Hospital. What has been most revealing for local clinicians is the effect on our workforce.
The New Zealand Rural General Practice Network is a membership and support organisation for rural health professionals. Based in Wellington, the Network’s national membership and advocacy includes both rural practices and individual members covering more than 1800 doctors, nurses, practice managers and students. As part of our business operation we are contracted by the New Zealand government to provide a rural locum support and recruitment service which we do under the NZLocums brand, recruiting health professionals nationally and internationally.