2019 Novel Coronavirus Covid-19 Discussion

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#2775607 9-Sep-2021 18:41

Technofreak:

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

I agree, but that was never known yonks ago. There have been many such events, MERS, SARS, Ebola, Nile etc etc etc All were contained. This one is different, no one could foresee that. I can recall seeing SARS on CNN, thats all I can recall as it was a non issue. Today its different, and from what we have found NOW, yes, we do need to consider all options. Thats could be masses of ICU that sit empty year after year. Or we build dual purpose MIQ that we can commandeer when needed.

Its a whole.new.ball.game

tdgeek

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#2775608 9-Sep-2021 18:43

Ge0rge:
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...

Yes, and MIQ is not China (sorry China) if anyone expects a rushed MIQ to be Fort Knox, sell your shares

tdgeek

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#2775609 9-Sep-2021 18:47

afe66:

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.

Excellent extra thoughts. 18 months ago, you would had been tarred and feathered, but now, all of that is today's reality. The task now is to stem Covid in NZ and manage an opening, but long term, Covid does need to be a budget item as is social welfare and roads. With no Covid, its a waste, but it will happen again

Fred99

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#2775611 9-Sep-2021 18:51

tdgeek:

This one is different, no one could foresee that.

Oh nope - it was certainly foreseen - even to the extent of identifying a highly transmissible novel coronavirus, probably originating from bats as one of the likely diseases to cause the global pandemic we're in the midst of.

One of the things saving our sorry backsides is that SARS and MERS prompted research on coronavirus vaccines, then forgotten about or unable to continue due to lack of funding, because SARS just "went away" (and people simply forgot the huge effort made that caused it "go away").

Handle9

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#2775614 9-Sep-2021 18:55

tdgeek:

Thats could be masses of ICU that sit empty year after year.

Nope. NZ runs out of regional ICU capacity most years. It's been inadequate for quite some time.

tdgeek

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#2775637 9-Sep-2021 19:08

Fred99:

Oh nope - it was certainly foreseen - even to the extent of identifying a highly transmissible novel coronavirus, probably originating from bats as one of the likely diseases to cause the global pandemic we're in the midst of.

One of the things saving our sorry backsides is that SARS and MERS prompted research on coronavirus vaccines, then forgotten about or unable to continue due to lack of funding, because SARS just "went away" (and people simply forgot the huge effort made that caused it "go away").

So in Jan 2020, we shroud have foreseen the horror that we have seen since? It was a 1 in 100 year event.

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#2775639 9-Sep-2021 19:10

Handle9:

tdgeek:

Thats could be masses of ICU that sit empty year after year.

Nope. NZ runs out of regional ICU capacity most years. It's been inadequate for quite some time.

Ok, I'll accept that. How much do we need to increase that? To cater for the normal needs, or to cater for the expected outbreaks? Not a dig, just a query.

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Handle9

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#2775640 9-Sep-2021 19:13

tdgeek:

Handle9:

Nope. NZ runs out of regional ICU capacity most years. It's been inadequate for quite some time.

Ok, I'll accept that. How much do we need to increase that? To cater for the normal needs, or to cater for the expected outbreaks? Not a dig, just a query.

~50% to reach the same level as the UK, ~100% to reach the same level as Australia.

Building the units is the easy bit. Finding and retaining the staff is harder.

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#2775643 9-Sep-2021 19:21

Handle9:

~50% to reach the same level as the UK, ~100% to reach the same level as Australia.

Building the units is the easy bit. Finding and retaining the staff is harder.

Thanks. In the context of things 2020/2021 that seems doable. Not instant, but doable.

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#2775646 9-Sep-2021 19:33

Handle9:

tdgeek:

Thats could be masses of ICU that sit empty year after year.

Nope. NZ runs out of regional ICU capacity most years. It's been inadequate for quite some time.

The fundamental issue is that our healthcare system has been underfunded since the '80s after the major structural reforms started and every successive government since is just as responsible for the failings that exist today.

blackjack17

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#2775647 9-Sep-2021 19:33

Gurezaemon:

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.

Two months ago my mum fell out of a bus and gashed her head open and ended up with a 10 cm open wound.

She got taken to Middlemore by ambulance and arrived at 2pm. She was finally stitched up at 2am after waiting 12 hours in the A&E room. This is a 65 year old women with a head injury.

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PolicyGuy

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#2775657 9-Sep-2021 20:07

A massive increase in ICU bed availability would be a very long term (i.e. more than one parliamentary term) and extremely expensive project.

ICU doctors, nurses and ancillary staff take years to train and you can't instantly double the throughput of the training programmes because the trainers also take a long time to train and the training facilities must be built - and no, they mostly aren't just 'classroom blocks'.
Intensive care ward blocks would have to be planned (most hospitals don't have a lot of spare real estate), designed, consented, contracted, built and commissioned. This will take years. For sure, you can put up some temporary field hospitals in a dire emergency, but running a tented ICU in a car park in a Canterbury winter or Wellington equinoctial gales would be stressful and not long-term viable.
The specialist staff are in worldwide demand and command significant salaries.
A modern high-tech, seismically resistant, properly insulated low-energy-use Intensive Care facility is going to be (WAG) low millions of dollars a bed to build. IIRC the new ICU facility in Christchurch was downsized at the design stage because the budget would not accommodate the number of beds the clinicians thought justified.

All in all, we are talking about needing a sustained very, very expensive multi-year programme of workforce and physical infrastructure expansion in a hospital system that has already been identified as needing billions of dollars spent over the next decade just to fix up roofs; seismic strengthen risky buildings; replace dodgy plumbing, wiring and fire safety issues; and so on.
And hey, maybe we won't have a worse ICU crisis than this one we've just coped with in any current Minister's political lifetime. It'll be a hard argue at the Cabinet table to spend hundreds of millions of dollars on ICU beds and staff when the Minister of Education says we need half a dozen new schools, and the Minister of Conservation says we must replace all the urban transport diesel buses with FC/BEVs to meet Climate Change imperatives, and so on.

It's long-term strategic politics.
That means somewhere between real hard and next to impossible

Edit: Correct fact

Oblivian

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#2775667 9-Sep-2021 20:17

No so many changes on the guideline pages today. Few cosmetic hyphens removed. And some stray bus use bits removed.

Entirely new Skiing under level 2 section added however.

mattwnz

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#2775708 9-Sep-2021 21:46

Oblivian:

No so many changes on the guideline pages today. Few cosmetic hyphens removed. And some stray bus use bits removed.

Entirely new Skiing under level 2 section added however.

How do people get the guildelines on the page changed? It almost seems like it is all being done on the fly, and someone goes, hey how about skiing, or golf or whitebaiting / fishing, and things get changed.

clinty

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#2775719 9-Sep-2021 22:17

New case at Middlemore ED

Self discharged, but isolating
Staff had PPE and inpatients are isolating

A person who presented to Middlemore Hospital’s Emergency Department on Thursday has tested positive for Covid-19.

The patient came to hospital with a non-Covid issue and did not have symptoms, but was tested.

They left the hospital before receiving their result, but are now isolating, the Ministry of Health said in a statement on Thursday night.

https://www.stuff.co.nz/national/health/coronavirus/126339918/covid19-patient-at-middlemore-emergency-department-tests-positive

Clint

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