2019 Novel Coronavirus Covid-19 Discussion

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#2775576 9-Sep-2021 16:55

frankv:

JPNZ:

Level 4 costs the country $290 million dollars a day. I'm pretty sure funding some ICU beds would be a LOT cheaper and easier.

What's the economic value of a life?

Thats the basic question.

But, whats your opinion on the way forward then?

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frankv

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#2775577 9-Sep-2021 16:56

Senecio:

However, I don't want to live like this forever. I want to go to bars, cafes, restaurants and meet up with friends and enjoy life like I used to. I want to be able to travel from NZ and for people to be able to travel to NZ to explore this wonderful country. I want to be able to stand in a crowd of 40,000 other Rugby fans at Eden Park and cheer on my team again.

If lockdowns are still part of our 2022 strategy then I can assure you, the vocal minority won't be much of a minority for long.

You have a short memory... you could do any of those things a month ago. Given a bit of luck, you'll be able to do those things. The price of this is (a) restrictions on people coming into NZ, and when that fails, (b) an occasional lockdown. The alternative, right now, is thousands of Kiwis dying.

Yes, I'd really like to go overseas again (and not have to worry about 2 weeks MIQ on return). But, actually, right now I'm happy to not go overseas into a sea of covid. Yes, I'd like visitors to come here too, but not if they're going to bring covid with them.

Oblivian

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#2775579 9-Sep-2021 16:57

sen8or:
Dare I say it, but we need the likes of google / microsoft / facebook or apple to develop the passport, they seem to have the resources and their systems are widely used worldwide (and well, google and facebook certainly have the data already).

It will only be a mess because parties with vested interests will poke holes in anyone elses implementation that means they won't get their slice of the (very substantial) money pie.

It's google passes API. And it's already a thing as of july/aug.

I believe the covid dudes are looking into it once the dbase is finalised.

Technofreak

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#2775581 9-Sep-2021 17:03

frankv:

If that were the only cost, you would be right. ICU beds cost up to $10,000/day. But for every ICU bed, you need about 20 hospital beds at $3,000/day, because only 5% of hospitalised cases go to ICU. So each covid ICU bed actually costs $70,000 every single day whether they're occupied or not, so $25M/year. Round numbers, if we lockdown for less than a month of the year, ($8.7B), we could spend that on 341 ICU beds (and 6,800 hospital beds).

But you're assuming that we can actually control covid so that only 341 people at a time need ICU. Because *every* time you exceed 341, someone dies. And half of the covid patients who go to ICU die anyway. What's the economic value of a life?

And then there's the nightmare scenario where your extra 6,800 hospital aren't enough, at which point you have a 10% death rate. We came perilously close to that back in March/April 2020. New York and northern Italy and Spain and India have all been there.

Then there's the cost of people not being at work because they're sick, or their kids are sick.

Then there's long covid, the ongoing health costs for those who survive.

Remember, these are *extra* hospital resources, because hospitals have been cutting and paring for decades to give the level of health care we get today.

And, finally, where are you going to get the doctors and nurses to staff your new hospital wards?

Yes, we did come close back in March/April 2020, but we didn't have the vaccine then. I think in reality we would never need close to 6800 beds and all the attendant support that goes with that. If we do, our vaccination strategy and any other protective measures we implement (Covid passports, all traveller to be vaccinated, etc, etc) will have gone badly awry.

I do think Covid has taught us we need to spend a serious amount more on our health system as the cost to the country can be more than not having that improved health system

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wellygary

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#2775582 9-Sep-2021 17:03

Technofreak:

JPNZ:

Koornneef said the Ministry of Health was designing the digital vaccination certificate to be compatible with emerging international standards, so it can be recognised by as many countries as possible."

That the MOH is involved in designing this doesn't bode well IMO.

AT least there is a central vaccination database to draw from...

in the US there is NO CENTRAL VACCINATION REGISTER AT ALL... you either wave the paper card you were given when you got your shots... call your local state or ring the pharmacy or walmart where you got vaxxed and ask for proof...

https://www.theatlantic.com/health/archive/2021/05/america-covid-vaccine-honor-system/618891/

Handle9

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#2775585 9-Sep-2021 17:13

Technofreak:

JPNZ:

Koornneef said the Ministry of Health was designing the digital vaccination certificate to be compatible with emerging international standards, so it can be recognised by as many countries as possible."

That the MOH is involved in designing this doesn't bode well IMO.

In fairness the vaccination program, while very slow to begin, has delivered a very functional booking system and has ramped up to nearly delivering 200% of the planned capacity.

They have done well with this.

Ge0rge

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#2775592 9-Sep-2021 17:48

mattwnz:. Using makeshift quarantine facilities in the form of hotels with ventilation systems not designed for this, is a major problem.

Ah brilliant, you found the source of the leak! Have you informed the MoH of this? Last I checked, they were still looking...

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kyhwana2

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#2775595 9-Sep-2021 17:50

JPNZ:

afe66: See above

With 90% total population vaccinated and open boarder with 10 actives cases per day entering country.

Over 2 years 11,000 hospitisations cases and 1030 deaths estimated...

Around 500 deaths per year from Influenza in New Zealand, so that over 2 years looks ok imo

That will be ON TOP of Influenza and those hospitalisations will push the health system over the edge..

andrew75

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#2775596 9-Sep-2021 17:58

afe66: It's in addition to influenza and many will die in icu units.

Many hospitals currently have issues with icu bed shortages and this will create significantly more pressure.

No icu beds mean no elective cardiac surgery increased risk in frail people needing operations, people who crash their cars. Increased mortality to those groups who currently survive because we gave icu units.

The answer of course is to increase the number of icu beds which we need to be honest will cost and must fund for this.

When reading opinions on effects of covid, I don't think the public appreciated the effects on increasing sick people filling the hospital and blocking elective and emergency care.

If you are young and well civid might not affect you directly but if the hospitals are in crisis, your dad might not get his elective heart surgery delayed or mum's cancer chemo septic shock not managed optimally or your mate who has a car crash might be flown to other end country to find icu beds.

This is all very insightful, I don't think the NZ public really understands what is going happen to the NZ health system when we have the inevitable widespread breakout of Covid 19 in our community. Unless our vaccine uptake is very high (but I don't know what that means in terms of exact numbers), the health system is likely to be overrun. This means hospitals full of people with covid and very limited room for all the other important things that hospitals do -- and this is what I don't think the NZ public really have a good understanding of. It is hard to get across just how much slower things are trying to look after people under full infection control protocols, and when you have staff off or in isolation. As for ICU beds - the issue is only partly $ -- you can't just 'magic up' trained ICU personnel of of nowhere.

I'm a GP in my day job. At the moment we are going hard out vaccinating as many people as we can. But we are starting to see the start of demand drop off. At some point we are going to run into the vaccine hesitant and hard core anti-vaxxer group.

From what I've seen recent stats out of Australia suggest a 1:10 hospitalization rate in the unvaccinated. In the context of the NZ health system this is frankly frightening with the delta variant where case numbers can explode rapidly. What happens in the next few months in Australia is going to be very interesting.

afe66

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#2775599 9-Sep-2021 18:12

JPNZ:
afe66: It's in addition to influenza and many will die in icu units.

Many hospitals currently have issues with icu bed shortages and this will create significantly more pressure.

No icu beds mean no elective cardiac surgery increased risk in frail people needing operations, people who crash their cars. Increased mortality to those groups who currently survive because we gave icu units.

The answer of course is to increase the number of icu beds which we need to be honest will cost and must fund for this.

Level 4 costs the country $290 million dollars a day. I'm pretty sure funding some ICU beds would be a LOT cheaper and easier.

Icu units are very complex areas with highly trained specific trained staff and its not an issue that cannt easily be solved in short term.

Ie The standard is 5.5 specialist nurses per bed and the beds are physically separated much more than normal wards for infection reasons. We wound need several hundred specialist nurses at least plus specialist intensive care drs

Physical space is a problem in many of our hospitals.

Building hospitals is usually done with limited real world expansion capacity because its cheaper. Many are multi storied which limits expansion options

We could convert wards but they won't have the infrastructure built into them. Power water ventilation systems are different in icu units.

If we convert wards into mock icus where are the patients those wards were servicing going to go? A previous government solution to hdu bed shortages was to turn them into icus...so where do hdu patients go? Hdu were setup to avoid people going to icus

Covert operating theatres to icus but limits operations

Let's use anaesthetists to staff icus. Ok some skill overlap but then we deplete anaesthesia provisions for other operations. Recovery nurses or cardiac nurses into icu nurses which then depletes those services.

We would also have to massively increase emergency departments. Ok move nurses from wards to ED then wards not staffed.

There are just some difficulties. Potentially manageable but not without significant consequences.

Just thought I would add a few extra thoughts which I don't often see raised.

tdgeek

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#2775600 9-Sep-2021 18:17

wellygary:

Although its quite clear its going to have a very "sticky" long tail...

The big question is do they believe that they can continue to see a reduction in case numbers under Level 3 restrictions.... which lets a lot more workplaces ( particularly construction) operate

I have a feeling that unless we a well under 10 cases by Monday they will push out level 4 in Auckland until Friday.. or maybe another full week

[mind you I though they would keep level 3 for the whole country for another week... so maybe I'm just being paranoid]

I agree. Lets take the recent cases, around 20 or less a day. That means "probably" there are 100 cases over the next week. Thats better but its no where near level 3.

tdgeek

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#2775601 9-Sep-2021 18:21

ezbee:

S'pore's Covid-19 fight: No good options going forward, so it is a matter of choosing the least bad one
https://www.straitstimes.com/singapore/health/no-good-options-going-forward-so-it-is-a-matter-of-choosing-the-least-bad-one

""
Singapore recently crossed a milestone, having fully vaccinated more than 80 per cent of its population.
""
Unfortunately, the way things have panned out, reaching this target no longer spells the end of pandemic woes.
""
But now that more than 90 per cent of the eligible population is fully vaccinated, the MTF, instead of opening up, has decided to prolong the current regime by a couple of weeks and is putting even more measures in place. Why?
""

Also Singapore has started its vaccine , and 4 tests with home isolation system to allow free travel to and from Germany.
https://www.straitstimes.com/singapore/transport/fully-vaccinated-travellers-can-travel-to-germany-and-back-without-serving-shn

So there will be much to learn, as this progresses.
I expect that Australia and NZ will create compatible systems vaccine cert once we are ready.

Thats the thing. Many here and elsewhere bag our response, but its buying time. Not that eventually we will capitulate, but the more knowledge that is out there, the better we can respond, and the lesser the effect on Kiwis. Boris took a punt, NZ will better those odds

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#2775604 9-Sep-2021 18:28

andrew75:

This is all very insightful, I don't think the NZ public really understands what is going happen to the NZ health system when we have the inevitable widespread breakout of Covid 19 in our community. Unless our vaccine uptake is very high (but I don't know what that means in terms of exact numbers), the health system is likely to be overrun. This means hospitals full of people with covid and very limited room for all the other important things that hospitals do -- and this is what I don't think the NZ public really have a good understanding of. It is hard to get across just how much slower things are trying to look after people under full infection control protocols, and when you have staff off or in isolation. As for ICU beds - the issue is only partly $ -- you can't just 'magic up' trained ICU personnel of of nowhere.

I try to get people to understand this, but that argument is longer than the bumper-sticker type of length message that distressingly many people are comfortable listening to.

I had to take a kid to A&E in the middle of last year's big lockdown - he was seen straight away for something extremely painful but not life-threatening. If Covid had been rampant at the time, he would have been shunted out to a waiting room with some Panadol, or told to come back in a couple of weeks.

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tdgeek

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#2775605 9-Sep-2021 18:34

mattwnz:

NZ is really in a 'wait and see' stage, to see how vaccines work out, and how the virus progresses. We should have been building up our ICU and hospital system over these last 18 months because with just a relative small number of cases, Auckland hospitals are stretched. The only reason we have had this lockdown is because it leaked through MIQ. Using makeshift quarantine facilities in the form of hotels with ventilation systems not designed for this, is a major problem.

Sorry, that's rubbish

So, on 26 March 2020, we decide to build 30 purpose built MIQ facilities??? And it ends up like SARS, very few got infected or died. I get miffed when hindsisght is used. But lets build 30 MIQ facilities in the whop whops for the future?

OK, on 26 March onwards we won't use hotels. What will we use from then?

Fred99

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#2775606 9-Sep-2021 18:36

andrew75:

From what I've seen recent stats out of Australia suggest a 1:10 hospitalization rate in the unvaccinated. In the context of the NZ health system this is frankly frightening with the delta variant where case numbers can explode rapidly. What happens in the next few months in Australia is going to be very interesting.

It was 11% in NSW a week or so ago - and that included whatever the vaccinated rate in the hospitalised population was at that time. (IIRC Bloomfield noted a week or two ago that hospitalisation rate in NZ was about 7% - but that was possibly lower than Aus because the daily cases had been relatively high - there's a lag between getting diagnosed and getting really sick).

As for claimed "flu deaths of 500" in NZ, I don't take that at face value, that's about 5x the usual rate of confirmed flu deaths in Australia, was IIRC based on a study where flu was assessed as "probably" contributing to death. If someone dies 12 months down the track probably or possibly from some sequelae from Covid, is that going to be reported as stroke or kidney failure or any of many possible COD - or covid? In the UK COD is only attributed to Covid if they tested positive by PCR within 28 days of death. I don't think comparisons with flu mortality are of much value, especially when used to say "well 1,000 covid deaths a year isn't so bad then". It is bad - even though it could be worse.

Trivial fact: the last recorded death in Australia attributed to flu was in July 2020 - over a year ago. As that article mentions - that presents another problem - "what happens next with flu?".

NSW has 1200 people hospitalised as of now, more than 200 in ICU, and IIRC more than 70 on mechanical ventilation, and despite just managing to hold new case numbers at ~1400 / day, those numbers are growing. I think NSW has 1200 ICU beds, 900 public, 300 private. The ratio of ICU beds per head of population is higher than NZ, but IIRC only about 30% higher.

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