2019 Novel Coronavirus Covid-19 Discussion

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#2474247 30-Apr-2020 19:22

freitasm:
I think the reason people are out and about is because they don't understand L3 still means Stay at Home.

Specifically, this. It's great to see him do it perfectly in character.

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#2474249 30-Apr-2020 19:25

sittingduckz:
Unite against Des Gorman... what a bag of misery and doom

You know it's getting better when it's time for the Monday morning quarterbacks to start coming out.

Technofreak

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#2474294 30-Apr-2020 20:26

mattwnz:

Technofreak:

He wasn't suggesting things like increasing ICU beds by a factor of 100. He did point out though that Australia had 10 ICU beds per 100,000 people, Germany 33 per 100,000 and New Zealand 3 per 100,000, that's right 3.

Source for NZs ICU beds?

This article implies about 10 ICU beds per 100,000 in NZ, based on about 500 beds https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12321390

On March 20, an updated Ministry of Health stocktake found a maximum of 563 ICU capacity beds in a total restructure of the country's hospitals.

Did you read that article?

It starts out by saying as at the 25th of February there were 173 ICU beds in the country. It then goes on to say the number is fluid depending on daily staffing levels and other criteria. The number was scraped up to 223 by including their high dependency care beds and cardiac care unit beds, with respirators.

The article doesn't say how these extra beds would be staffed but it does say ""You've only got as many ICU beds as you've got nurses, so that number does vary from 170-odd to 220-odd".

Then magically on March 20, an updated Ministry of Health stocktake found a maximum of 563 ICU capacity beds in a total restructure of the country's hospitals. Hmmm something doesn't smell right. One month they can scrape the number up to 223 and a month later we suddenly have 2.5 times the number of a month before. That also means we have increased the number of ICU nurses by 2.5 time as well. Do you think that is plausible?

173 beds is just under 3.5 ICU beds per 100,0000 and at 223 just under 4.5.

I'd say Mr Gorman's figures weren't too far off the mark.

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nzkiwiman

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#2474295 30-Apr-2020 20:29

Still too many out and about; all of these cars can't be heading to the supermarket, or the local fast food store .. Coming home from work today it was just like any regular weekday. Saw many people hanging about together who are clearly not in the same bubble.
It is clear that while most are keeping to the slightly relaxed rules, too many have taken the extreme relaxed view

Don't get me started on Winston Peters and saying that we must let Australians in for tourism; if I even had the option of leaving the country in the next 6 months I wouldn't.

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#2474303 30-Apr-2020 20:53

Technofreak:

mattwnz:

On March 20, an updated Ministry of Health stocktake found a maximum of 563 ICU capacity beds in a total restructure of the country's hospitals.

Did you read that article?

Then magically on March 20, an updated Ministry of Health stocktake found a maximum of 563 ICU capacity beds in a total restructure of the country's hospitals. Hmmm something doesn't smell right.

173 beds is just under 3.5 ICU beds per 100,0000 and at 223 just under 4.5.

I'd say Mr Gorman's figures weren't too far off the mark.

Yes I did, and as you imply, something seems odd with the numbers. But why wouldn't the MOHs figures be the most accurate, seeing they are ultimately responsible, and they are in charge of making sure that things are restructured to get as many ICU beds out of current resources as possible? This also includes enough trained staff.

So the MOH would be involved with making sure that as many beds are available as possible when they are needed, which looks to be 563 ICU beds. I am not sure if they are buying more in to add to this. I also recall hearing at one of the media conferences that they had a lot of units that had been decommissioned recently, that they would be bringing those back into use. I expect the MOHs ICU bed count would be what is available when they are needed at a particalar peak in Covid cases if another wave occurs.

I am guessing the other numbers are a snapshot in time based on how things are normally setup in hospitals prior to COVID19, and how many beds are currently being used. If you look at the UK they have now added a significant number of ICU beds, and also setup new hospitals, adding to ICU capacity, and bringing in retired and additional staff. But their normal ICU bed count would likely be a lot less than what it currently is. the UK were getting Dyson to make more, but apparently have now cancelled these, because the current demand for ICU beds is less than they expected. Maybe NZ could get hold of some of these https://www.bbc.co.uk/news/business-52409359

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#2474307 30-Apr-2020 21:03

nzkiwiman:

Still too many out and about; all of these cars can't be heading to the supermarket, or the local fast food store .. Coming home from work today it was just like any regular weekday. Saw many people hanging about together who are clearly not in the same bubble.
It is clear that while most are keeping to the slightly relaxed rules, too many have taken the extreme relaxed view

Don't get me started on Winston Peters and saying that we must let Australians in for tourism; if I even had the option of leaving the country in the next 6 months I wouldn't.

I can't see how this NZ - Oz bubble can happen without quarantining at one end or the other, or without both countries being declared COVID free by the WHO. NZ is now supposed to have a Gold Standard tracking system. But if we go into the same bubble as Oz, how is that tracking going to work, without a combined tracking system? Also Oz expects to be in lockdown for 6 months minimum and they don't even discuss elimination as their approach, they are just about flattening the curve and slowing it down so their health system can cope, until / if a vaccine comes along.
Also NZ doesn't even have a tracking app, while Oz does, but it apparently only has 10% uptake so far, so not likely to be much help. It looks like we are heading towards herd immunity / flattening the curve, rather than elimination, if NZ goes down that route with a country that hasn't eliminate it. THe COok Islands, and other pacific countries don't want to take that risk with NZ. I didn't spend 5 weeks in 'Level 4 Elimination', to then undo all that hard work and let the virus back in via tourists coming in from Oz.

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#2474310 30-Apr-2020 21:08

Press release:

Minister of Health Dr David Clark has announced a Contact Tracing Assurance Committee (CTAC) to further strengthen oversight around a crucial piece of New Zealand's response to COVID-19.

Dr Clark has announced Sir Brian Roche as inaugural chair of the CTAC, along with members Dr Philip Hill, Warren Moetara, Dr Marion Poore and Liz Read,

"I am delighted with these appointments. The members will be well placed to advise the Government on the appropriateness of contact tracing capability in New Zealand. It's a well-balanced committee with outstanding skills and experience.

"We've all recognised the ongoing efforts of the Ministry of Health and public health units in ramping up the on the ground response to contact tracing during the outbreak, such as standing up the National Close Contact Service and bringing in hundreds of additional staff to track and trace cases and contacts.

"This new committee will advise me on how the Ministry is making further improvements to the tracing system, as recommended in Dr Ayesha Verrall’s audit report, including advice on any national changes required to strengthen national contact tracing.

"Sir Brian brings extensive governance and management experience and a strong understanding of health system challenges as the former Chair of the Ministerial Advisory Group for Health and a member of the Health and Disability System Review. He also served as Chair of the New Zealand Transport Agency and as Chief Executive of New Zealand Post Group and PricewaterhouseCoopers New Zealand.

"Dr Hill is a highly experienced medical practitioner with specialisations in public health and infectious diseases and separate qualifications in epidemiology and is the first holder of the McAuley Chair in International Health.

"Mr Moetara (Ngāpuhi, Ngaitai, Te Whānau ā Apanui) has a demonstrated track record in delivering frontline public health and community services with and for Māori, and is a former police officer of 22 years. He brings a strong understanding of health equity, te ao Māori and tikanga.

"Dr Poore is an experienced public health physician who has served as a Medical Officer of Health, a frontline primary care physician, and was a key member of New Zealand’s response to the SARS outbreak.

"Ms Read is a highly experienced public health nurse with extensive leadership, management and service delivery expertise across a range of roles at Hawke's Bay District Health Board. She is also the current Operations Lead for COVID-19 in the DHB’s Public Health Unit.

"The establishment of this committee is another step to ensure we have a gold standard response to any future surge of COVID-19 cases.

“We recognised early that contact tracing would be a key line of defence in the battle against COVID-19. It is vital to identifying the source of any cases, containing them and preventing further spread.

“We've backed this with $15 million which went to PHUs in March for contact tracing. In April, Cabinet approved up to $55 million in additional investment.

“Alongside the hard work and dedication of the Ministry and PHUs, the Contact Tracing Assurance Committee will help provide additional oversight on how we are managing our capability around contact tracing, globally recognised as a key weapon against COVID-19," said Health Minister David Clark.

The appointments announced today are for one year.

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#2474314 30-Apr-2020 21:22

Daily Beast: Fox hydroxychloro-queen Laura Ingraham trashes promising new treatment

Fox News host Laura Ingraham, who spent weeks endlessly promoting the anti-malarial drug hydroxychloroquine as a possible coronavirus cure, downplayed data on Wednesday night that found another antiviral drug has shown actual promise as a treatment.

Noting that top infectious disease expert Dr. Anthony Fauci declared on Wednesday that results from a National Institutes of Health study into the Ebola drug remdesivir show a “clear-cut positive effect in diminishing time to recover,” Ingraham said that while it “certainly sounds encouraging” she’s not sure why Fauci wasn’t as bullish on hydroxychloroquine.

She went on to question the safety of remdesivir ... and cost-effectiveness

..Ingraham then welcomed on frequent guest Dr. Ramin Oskui, who she recently brought with her to the White House to sell President Donald Trump on hydroxychloroquine. Grumbling that the NIH results on remdesivir haven’t been peer-reviewed yet, Ingraham conceded that the initial analysis shows the drug cuts down on coronavirus recovery time.

...Ingraham, along with other Fox News stars, touted hydroxychloroquine for nearly a month as a potential miracle cure with “Lazarus”-like effects. The network, along with President Donald Trump, backed away from hyping hydroxychloroquine in mid-April after several studies showed the drug had no real benefits in treating coronavirus.

https://www.thedailybeast.com/laura-ingraham-trashes-promising-coronavirus-treatment-remdesivir-to-promote-hydroxychloroquine

kingdragonfly

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#2474316 30-Apr-2020 21:28

Statsnews: Hospital demand for hydroxychloroquine to treat Covid-19 patients is waning

The ongoing uncertainty over whether hydroxychloroquine can successfully treat Covid-19 appears to have eroded demand considerably among hospitals, according to new data. At the same time, anecdotal evidence suggests that patients with lupus, a condition for which the drug is approved to treat, are having an easier time filling prescriptions for the first time in weeks.

...The rush occurred even as evidence was lacking that hydroxychloroquine — and a related drug called chloroquine — might be effective in thwarting the novel coronavirus. The picture was further muddied by a growing number of small studies – especially from France and China – that offered tantalizing suggestions of efficacy, but widely criticized for being poorly designed.

Consequently, a growing number of physicians and public health experts cautioned that the tablet should not be embraced as a salve until more data is obtained from several trials under way. Toward that end, the FDA last week issued a cautionary note to health care providers because the drug may cause irregular heart rhythm
...
https://www.statnews.com/pharmalot/2020/04/28/covid19-coronavirus-hydroxycholoroquine-lupus-trump/

Technofreak

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#2474323 30-Apr-2020 22:23

mattwnz:

Yes I did, and as you imply, something seems odd with the numbers. But why wouldn't the MOHs figures be the most accurate, seeing they are ultimately responsible, and they are in charge of making sure that things are restructured to get as many ICU beds out of current resources as possible? This also includes enough trained staff.

So the MOH would be involved with making sure that as many beds are available as possible when they are needed, which looks to be 563 ICU beds. I am not sure if they are buying more in to add to this. I also recall hearing at one of the media conferences that they had a lot of units that had been decommissioned recently, that they would be bringing those back into use. I expect the MOHs ICU bed count would be what is available when they are needed at a particalar peak in Covid cases if another wave occurs.

I am guessing the other numbers are a snapshot in time based on how things are normally setup in hospitals prior to COVID19, and how many beds are currently being used. If you look at the UK they have now added a significant number of ICU beds, and also setup new hospitals, adding to ICU capacity, and bringing in retired and additional staff. But their normal ICU bed count would likely be a lot less than what it currently is. the UK were getting Dyson to make more, but apparently have now cancelled these, because the current demand for ICU beds is less than they expected. Maybe NZ could get hold of some of these https://www.bbc.co.uk/news/business-52409359

Normally I'd agree with you regarding the accuracy of the MOH figures, however I am highly sceptical in this instance. The number may well have been in excess of 220 ICU beds but I very much doubt the 563 figure as at the 20th of March. My scepticism is due mainly to two things.

The massive increase in just one month which I find totally implausible.

According to the NZ Standards for Critical Care Nursing Education a nurse wanting to become a Critical Care (ICU) Nurse must among other things complete 600 hours of work in a critical care area for the duration of the critical care training programme. At 60 hours per week that requirement on it's own is 10 weeks work.

Up until about the 20th of March all usual surgery was still taking place. It wasn't as if there would have been a surplus of staff to send off for ICU training.

The number of ICU beds is limited by the number of nurses available to staff them. Having 563 beds available without having the nurses doesn't mean you really have 563 ICU beds.
There would have been significant pressure from both within the government and the MOH to be able to show we had plenty of ICU beds. When there's pressure like that numbers tend to get massaged in the desired direction.

I agree with your snapshot comment. However that same comment would also apply to the Australian and German figures quoted in that article. Therefore the numbers are still relative. The comments from Mr Gorman were about our preparedness, not what we may or may not have scrambled to achieve since this pandemic started.

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Scott3

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#2474333 30-Apr-2020 23:17

Regarding the Jump in ICU bed numbers, my understanding is it was caused by the following:

The inclusion of facilities (such as operating theaters) that don't operated as ICU beds, but have sufficient equipment and staffing to do so in the even that surgeries are canceled.
The inclusion of facilities in the private sector. (mostly falling into the above bullet point).
The inclusion of facilities that could be rapidly converted to ventilated ICU beds - by for example using the ventilators that had recently been replaced, but not yet disposed of.

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#2474334 30-Apr-2020 23:18

mattwnz:

... Also NZ doesn't even have a tracking app, while Oz does, but it apparently only has 10% uptake so far, so not likely to be much help. ...

The Oceania CEO has asked my Australian colleagues to install this app & support this government effort.

I really want to see how effective this will be. Singapore results are apparently also not great. The Freakonomics podcast, episode #146 talks about "internalizing the externality." Me having to install the app is a negative externality. Michael Bazzell from The Privacy, Security, & OSINT Show talks about this in episode #167-This Week In Privacy & OSINT.

For more context (emphasis mine):

What kind of incentive problem?
LEVITT: This is a classic case of what economists call a negative externality. The costs of me going out on the street when I’m asymptomatic are all borne by other people, right? I infect other people; they get sick. But if I don’t have symptoms— and sometimes the last thing I want to do is go get tested all the time, which is a hassle. Maybe I have to go stand by people who are sick to get tested. And then if I test positive, then I’m quarantined and maybe I lose my job if I’m quarantined. Maybe I can’t afford— you know, I have to pay the rent.

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#2474335 30-Apr-2020 23:32

Technofreak: The massive increase in just one month which I find totally implausible.

Depends how they were counted. If the initial assessment was of active ICU beds in public hospitals and a later one was a more in-depth one including newly-provisioned ones, reactivated ones previously in storage/mothballed/converted from other uses, along with private hospitals and clinics and every other possible place that could approximate an ICU, you could get a sudden jump in numbers.

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#2474336 30-Apr-2020 23:33

half of America reopening https://www.nbcnews.com/news/us-news/reopening-america-see-what-states-across-u-s-are-starting-n1195676

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#2474337 30-Apr-2020 23:34

Batman:
half of America reopening https://www.nbcnews.com/news/us-news/reopening-america-see-what-states-across-u-s-are-starting-n1195676

Gotta make sure Russia doesn't pre-empt them from the number one spot, they've been moving up through the ranks quite quickly in the last week or two.

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