2019 Novel Coronavirus Covid-19 Discussion

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#2707180 13-May-2021 20:38

I guess we're ever so slowly going to discuss the issues of endemic Covid and what life will be like once we open the borders.. It's a discussion that is going to need to take place.

alasta

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#2707187 13-May-2021 20:46

DS248:

"I strongly believe that - even alongside vaccination - we may well need to lift our baseline level of public health protective behaviours as part of our move to open up to a wider group of low-risk countries - let alone beyond that," Bloomfield said.

"It may well be that we need to be more of a 2.5 level as our baseline, alongside vaccination, as part of the protections we need in place to be able to open the border.

I heard this on Checkpoint tonight and wondered if it was fake news.

Is this supposed to imply that when we open our borders we will never be allowed to have mass gatherings ever again? Or am I missing something?

I don't understand why we would open the borders at all if this is true.

alasta

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#2707189 13-May-2021 20:54

Looking at Dr Bloomfield's quote from this article I am wondering if he mis-spoke and meant to say "level 1.5".

DS248

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#2707200 13-May-2021 21:26

alasta:

Looking at Dr Bloomfield's quote from this article I am wondering if he mis-spoke and meant to say "level 1.5".

2.5 would certainly be a seismic shift from our current state. A bit hard to see that being acceptable ongoing over the medium term, or as a trade-off for partial border reopening.

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#2707201 13-May-2021 21:26

alasta:

Looking at Dr Bloomfield's quote from this article I am wondering if he mis-spoke and meant to say "level 1.5".

I don't think so.

There'll be many in vulnerable high-risk groups, some of whom won't have been able to be vaccinated, for some the vaccine won't be very effective, great care's going to be needed when opening up.

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#2707216 13-May-2021 21:54

sbiddle:

I guess we're ever so slowly going to discuss the issues of endemic Covid and what life will be like once we open the borders.. It's a discussion that is going to need to take place.

While I would like to see discussion now, the likely outcome is already fairly evident: Vaccinate enough of our country to have herd immunity (cira 70%?), then start allowing isolation free inbound travel (possibly only for vaccinated travelers and / or from low to medium risk countries to strat with).

There are still a few big unknown's:

- If we will get enough of our population vaccinated to reach herd immunity

- If vaccine resistant strains will appear before the end of the year.

- If our vaccine roll out goes according to plan

- Capacity available in our hospital system - can't really let covid-19 back into NZ if our hospitals can't take the extra workload from the virus inevitably hitting a few pocked of the population with low vaccination numbers.

Might be politically better to wait untill those answers are known before putting out a plan.

Also an anti-tourism or anti-immigration campaign discouraging vaccination in order to prevent us from reaching herd immunity, in order to keep the border closed longer would be a terrible possible outcome of setting a defined % immunized threshold for re-opening.

Should note that allowing covid-19 back into NZ will be terrifying to many. The virus has been dressed up as the boogie man (rightly I think), and is such is vary scary to many people. Transitioning from that thinking to instead understand that with vaccination in most of the population that the consequence's of the virus are within tolerable levels will be hard for many. Might be easier to see how re-opening goes in the UK, USA, Israel etc before we consider it.

This will be an extreme challenge for the government to manage. Re-opening will likely happen before approvals are granted to vaccinate younger kids (such as preschoolers), and will be a highly emotive topic for many. People who haven't seen offshore family for 2+ years at that point will be vocally in favor of reopening, while those with kids who are yet to have a vaccine approved for their age group may be vocally opposed. And of course the covid stats and every death after re-opening will be front page news.

In a positive light it may be best to wait until there is a lull in vaccination demand (Might come when say 60% of the population has been vaccinated). The re-opening announcement will likely spur many hesitant people to go ahead with the vaccination. I know of one such person. Hesitant about vaccines in general but not opposed to them. The current risk vs reward ratio for the covid-19 vaccination is not yet at the point where she would opt in, but a re-opening announcement would likely tip the balance by adding way more potential risk...

Jase2985:

GP's wont be delivering vaccinations till July

One started this Tuesday:

https://www.nzdoctor.co.nz/article/waiheke-island-takes-centre-stage-aucklands-first-gp-clinic-starts-covid-19-vaccinations

Sounds like there will be lots (but still far short of most) in the system in the coming weeks. I think this does vary by DHB.

Scott3

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#2707223 13-May-2021 22:17

sbiddle:

It's possible Hipkins may have either misunderstood the question or didn't provide a 100% correct answer, but a few weeks ago he said that our entire vaccine supply would be by the end of Sept which is why we're planning the huge ramp up of vaccinations across Sep/Oct which is when we plan to vaccine the greatest number of people during a ~7 week timeframe.

The would be awesome if true. Wonder if have enough ultracold freezer space the size of deliveries that would be needed for that... Of if they will be doing just in time deliverers to the cold chain fridges in pharmacies, medical centers and vaccination centers with the exaction that they use the entire stock before it expires in 5 days time...

There would be a lot to be said for having a massive sprint for a couple of months for most GP's and pharmacies it would just be like flu jab season on steroids... A short sudden surge may mean that many clinic staff will be willing to do a lot of evening / weekend overtime to get the injections done, and the surge will be winding down before they get badly burnt out...

wellygary:

That and the whole EU-AstreZeneca Barney that was playing out... and Pfizer worked and was available...

But looking back these things were moving blindingly quick,

We only announced the first Pfizer agreement on 12 October 2020, (Coverage for 750K)

we only got to national coverage when we announced Janssen on 12 November 2020, ( and even then the first deliveries weren't expected will Q3 2021.... (I understand this was on the hope that as a single shot vaccine the national campaign could be much quicker)

In December 2020 we signed up Astra Zeneca and Novavax - I am assuming the spread the risk on Janssen not passing muster...

Then on 8 March (just over 2 months ago) we went all in on Pfizer- probably as you said because they had been reliably delivering delivering an effecting vaccine around the world ...

Then the whole blood clot thing blew up

(and officials in the Ministry of Health all looked at each other and said - geee we just dodged another bullet )

Yes absolulty. That was the time the Europe and the UK were having a tiff over the AZ vaccine, and Europe was threatening to block exports (as india has now done). Given Pfizer was delivering consistently and ahead of schedule, and with great trial results to boot, ordering more would have seemed like a great idea.

In hindsight we got super lucky and dodged a massive bullet with the whole blood clot thing with the AZ and J+J vaccines... Went from being way behind aussie to quite a bit ahead of them because of our 2nd pfizer order being placed fairly eairly.

My complete uninformed take of the original procurement is:

- 750k courses pfizer: Expensive but early availability - for border workers, first responders, health workers, rest homes etc.

- 4.25m course AZ: cheaper 7 perhaps more ethical due to association with covax. Plan A for the rest of the population.

- 5m course J+J: Hedge against either of the above failing essentially plan B. Much slower. Single dose nature having the potential to cut logistical effort in half if it did great at stage 3 trials.

-5m course novovax: Hedge against the above 3 in general, but especially against them not stopping transmission. By far the slowest, but the only vaccine in the list to be able to stop the growth of covid-19 cells in primates noses. Hence the strongest candidate to stop transmission. Was absolutely the dark horse of covid-19 vaccines in late 2020...

Subsequently we know Pfizer is acceptable at stopping transmission, great at stopping hospitalization, and is reliably available.

AZ & J+J are tainted by rare blood clots issues.

Novovax is still not yet available, and its unique selling point is no longer unique.

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Fred99

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#2707231 13-May-2021 22:44

Scott3:

The would be awesome if true. Wonder if have enough ultracold freezer space the size of deliveries that would be needed for that... Of if they will be doing just in time deliverers to the cold chain fridges in pharmacies, medical centers and vaccination centers with the exaction that they use the entire stock before it expires in 5 days time...

That's been revised in EU (and US?), can now be stored in standard pharma freezers (-25 to -15 deg C) for two weeks.

Scott3

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#2707238 13-May-2021 23:21

Fred99:

Scott3:

The would be awesome if true. Wonder if have enough ultracold freezer space the size of deliveries that would be needed for that... Of if they will be doing just in time deliverers to the cold chain fridges in pharmacies, medical centers and vaccination centers with the exaction that they use the entire stock before it expires in 5 days time...

That's been revised in EU (and US?), can now be stored in standard pharma freezers (-25 to -15 deg C) for two weeks.

The two week regular freezer thing has been around for a while, and it seems NZ is willing to use it:

https://www.stuff.co.nz/national/health/coronavirus/124983350/pfizers-temperature-change-helps-primary-care-in-rollout-but-questions-remain

But two weeks isn't very long when it comes to holding the vaccines in stock. Currently we have about 4.5 weeks of stock on hand... Still would need managing as a rapidly perishing good.

Will be interesting to see if many clinics buy freezers. I doubt any have to date as the government hasn't told them what is going on. While regular domestic freezers (without auto de icing) can meet the temperature requirements. They will need to have some kind of temperature monitoring device inserted to ensure the integrity of the cold chain. I think most clinic's opt to use special cold chain fridges (with built in temp logging, and the ability to lock in a power cut), rather then cheap domestic fridges and logging devices.

I guess that most Pharmacies & GP clinics will just be taking frequent deliveries from the ministry of health, using their cold chain fridges, and getting the doses into peoples arm's before they expire 5 days after thawing. Will mean a lot of cold chain chilly bins on priority couriers, but should work logistically fine. Ministry starts packing does at 5pm on sunday that the three I think central deports, for couriers to pick up at midnight. They then do line hall distribution, and deliver to clinics between 7am and noon Monday. The clinics will then work really hard to ensure their ordered doses are used up by 5pm Friday when they expire... Clinics running weekend sessions could order a 2nd shipment to turn up Friday morning.

I am guessing that the ministry is on top of the ultra cold freezer space thing. We had enough freezers for 1.5m doses turn up in 2020, and said they were going to purchase more.

https://www.tvnz.co.nz/one-news/new-zealand/ultra-cold-freezers-1-5-million-covid-19-vaccine-doses-arrive-in-auckland

I think the ultra cold freezers are the cheap and easy bit of the roll out. Good bet they have ordered enough we don't need to run just in time systems and carry the associated risk.

Handle9

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#2707296 14-May-2021 03:31

Fred99:
alasta:

Looking at Dr Bloomfield's quote from this article I am wondering if he mis-spoke and meant to say "level 1.5".

I don't think so.

There'll be many in vulnerable high-risk groups, some of whom won't have been able to be vaccinated, for some the vaccine won't be very effective, great care's going to be needed when opening up.

The uncomfortable truth is when NZ opens up there will be deaths.

The equally uncomfortable truth is that opening up likely provides a greater overall benefit to society as a whole than remaining closed.

NZ isn't ready for that discussion but you can see that is where the government is heading softly softly.

Fred99

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#2707344 14-May-2021 08:36

Handle9:

The uncomfortable truth is when NZ opens up there will be deaths.

Yep.

And that may happen on the cusp of availability of treatments which may be (or may have been) very effective in preventing those deaths.

sbiddle

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#2707347 14-May-2021 08:41

Handle9:

The uncomfortable truth is when NZ opens up there will be deaths.

The equally uncomfortable truth is that opening up likely provides a greater overall benefit to society as a whole than remaining closed.

NZ isn't ready for that discussion but you can see that is where the government is heading softly softly.

It's been interesting this week to see the differing messages from the PM.

Earlier in the week we announced space being allocated in MIQ facilities for essential workers for the next 10 months (until the end of March 2022). This fits in with the current funding of MIQ until the end of June 2022 which is the closest we have to an "opening" date for the border right now.

Yesterday we had her discussing how people who are vaccinated may be able to travel here.

The simple reality is an elimination strategy has always been a technically flawed approach, it is one that's only possible while we remain fully closed off to the world and put everybody through quarantine. In the coming years we are going to have to learn to live with endemic Covid in society in the same way we live with other illnesses right now.

Australia is also starting the very same discussions this week.

Fred99

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#2707352 14-May-2021 08:57

Scott3:

The two week regular freezer thing has been around for a while, and it seems NZ is willing to use it:

It's quite possible that normal (2-8 deg) fridge storage period will also be extended. Moderna limit is 30 days, Pfizer indicate on the website that under time pressure to get the product approved and to to market that they used conservative safe practice which is under constant revision.

Anyway, NZ started planning / setting up before the "normal freezer temperature" extension was approved, getting supplies of the vaccine is the bottleneck - not storage and distribution.

DS248

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#2707353 14-May-2021 08:58

sbiddle:

...

Australia is also starting the very same discussions this week.

Probably not a coincidence.

Fred99

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#2707364 14-May-2021 09:18

sbiddle:

The simple reality is an elimination strategy has always been a technically flawed approach,

We had an eradication strategy - never elimination. The terms have been used interchangeably so much it's pointless arguing, unless you're saying that our "eradication" strategy was technically flawed. It certainly wasn't - and was also morally and ethically the right thing to do.

C-19 pandemic is a fluid ever-changing situation, sometimes it changed for the better, sometimes for the worse. You can't know what you don't know, so they "can talk about it", but not yet make firm commitments.

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