2019 Novel Coronavirus Covid-19 Discussion

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Mad Scientist
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#2474338 30-Apr-2020 23:38

while their hospitals are losing money and laying off staff (inc doctors and nurses)

https://www.npr.org/sections/coronavirus-live-updates/2020/04/23/843012119/u-s-hospitals-hit-by-financial-triple-whammy-during-coronavirus-pandemic

tdgeek

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#2474356 1-May-2020 07:09

Handle9:

New Zealand has done well at limiting COVID19 but at a massive economic cost. If the country had been better prepared could that cost have been significantly less? If New Zealand wants to just pat itself on the back then this has all been for nothing. It will just happen again and at significant cost.

There is much to be proud of and even more to do better.

New Zealand - we're not as crap as Spain!

Sounds like something to aspire to /s

Fair enough. The way I see it, we had one shot. A poor country generally, an under resourced health system. Im not sure what we could have done to avoid the massive costs. To do that you don't go to L4 or even L3. Everyone was banning travellers from China and then Italy, as those two countries and Iran were out of control. China as the epicentre, Italy who leaked the lockdown so many fled to infect everyone else, and Iran has no control. It would be a big call then to place a full lockdown of all incoming travellers, all of whom would need to go onto an enforced quarantine. Somewhere, no idea where. Seems an obvious call now though.

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#2474357 1-May-2020 07:22

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 see there was a funeral, 10 invited, 100 just turned up. L3 is L4 with fries, stay at home, yes you can go to work. Maybe we here are in our Geekzone bubble, we follow the virus, we watch the updates. its OBVIOUS what L3 is. Maybe the masses just see it on the news, and dont really know much or see" no lockdown now" and a couple of cases and its over? Maybe they should have done these updates at 6pm news on all FTA channels? Either Kiwis are lethargic to this or they dont know?

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#2474364 1-May-2020 08:30

mattwnz: But why wouldn't the MOHs figures be the most accurate,

Ha! I have worked for a couple of DHBs, including doing some of the reporting to MoH.

I can tell you that *every* report to the MoH is "gamed". Counseling for smoking cessation, for example, is a key performance stat. If a DHB doesn't meet the criteria they lose funding. To be fair, this gaming is also because MoH set stupid criteria (90% of patients "counselled", IIRC). So the DHBs added a section to every discharge summary with a couple of mandatory checkboxes and they now have 100%. No extra staff, no training. Just another hoop for the junior doctor doing the discharge documentation. I subsequently had a hospital stay at a 3rd DHB, and my smoking status wasn't discussed, but the checkboxes on my discharge summary were ticked.

So, long story short, I expect that MoH was providing extra funding for ICU beds for covid-19 patients, and I have no doubt that the DHBs have gamed the ICU reporting as well. Maybe the question was "How many ICU beds do you have?", not "How many resourced ICU beds do you have? ".

MileHighKiwi

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#2474365 1-May-2020 08:39

tdgeek:

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 see there was a funeral, 10 invited, 100 just turned up. L3 is L4 with fries, stay at home, yes you can go to work. Maybe we here are in our Geekzone bubble, we follow the virus, we watch the updates. its OBVIOUS what L3 is. Maybe the masses just see it on the news, and dont really know much or see" no lockdown now" and a couple of cases and its over? Maybe they should have done these updates at 6pm news on all FTA channels? Either Kiwis are lethargic to this or they dont know?

It doesn't help when the PM says "we have achieved our goal" and uses words like eliminated, which apparently does not mean eliminated! we've also been told by Bloomfield that there's no 'unaccounted' CT.

You can see how some people will be thinking, well what are the chances of getting this?

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#2474367 1-May-2020 08:46

MileHighKiwi:

tdgeek:

I see there was a funeral, 10 invited, 100 just turned up. L3 is L4 with fries, stay at home, yes you can go to work. Maybe we here are in our Geekzone bubble, we follow the virus, we watch the updates. its OBVIOUS what L3 is. Maybe the masses just see it on the news, and dont really know much or see" no lockdown now" and a couple of cases and its over? Maybe they should have done these updates at 6pm news on all FTA channels? Either Kiwis are lethargic to this or they dont know?

It doesn't help when the PM says "we have achieved our goal" and uses words like eliminated, which apparently does not mean eliminated! we've also been told by Bloomfield that there's no 'unaccounted' CT.

You can see how some people will be thinking, well what are the chances of getting this?

Yeah, but I dont buy into the elimination issue, that was explained early on. Reduce it then hammer the expected small outbreaks. My issue is that the PM and others call L3 the end of lockdown. For the many that dont read every word of every article, where the virus is a big news item and no more, end of lockdown is pretty black and white. And 2 or 3 cases in the whole country. Cool

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#2474370 1-May-2020 08:54

Scott3:
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.

Wasn't it also realised that one ventilator could work for 2 patients instead of just one? So adding tee junctions effectively doubled the number of ventilated beds.

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#2474372 1-May-2020 08:56

https://www.newshub.co.nz/home/politics/2020/04/coronavirus-sir-john-key-calls-on-government-to-open-the-economy-more-while-in-lockdown.html

Extract from the above:

Former Prime Minister Sir John Key believes the Government should change how it structures business activity at alert level 3 in order to have a more open economy.

"I don't think the Government should wake up every day and say are we in level 3 and I'll let you know in a couple of weeks if we move to level 2. I think they should get up every single morning and say what could we do, how could we get the economy growing faster, how could we get people back into work and into their businesses and do that in a safe way."

"Instead of [the Government] saying what we can't do… I think they've got to say to themselves what can we do."

Compared with Australia, he claims three states there have had similar case rates as New Zealand, but "they've had a lot more freedom" in terms of the number of businesses that could open and operate.

I quite like John's attitude to this, after all we have two crises at the moment, covid-19 and the possible collapse of large numbers of businesses. I know that you can't bring people back who have died from the virus and that you can recover from business failures, but a balance has to be struck between virus control and having a more open economy.

Fred99

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#2474375 1-May-2020 09:04

frednz:

https://www.newshub.co.nz/home/politics/2020/04/coronavirus-sir-john-key-calls-on-government-to-open-the-economy-more-while-in-lockdown.html

Extract from the above:

Former Prime Minister Sir John Key believes the Government should change how it structures business activity at alert level 3 in order to have a more open economy.

"I don't think the Government should wake up every day and say are we in level 3 and I'll let you know in a couple of weeks if we move to level 2. I think they should get up every single morning and say what could we do, how could we get the economy growing faster, how could we get people back into work and into their businesses and do that in a safe way."

"Instead of [the Government] saying what we can't do… I think they've got to say to themselves what can we do."

Compared with Australia, he claims three states there have had similar case rates as New Zealand, but "they've had a lot more freedom" in terms of the number of businesses that could open and operate.

I quite like John's attitude to this, after all we have two crises at the moment, covid-19 and the possible collapse of large numbers of businesses. I know that you can't bring people back who have died from the virus and that you can recover from business failures, but a balance has to be struck between virus control and having a more open economy.

John Key isn't qualified to comment - and neither does he have access to the data that's needed to make such comparisons or give policy advice.

That's the Key "attitude" you should be concerned about - he is far from an impartial observer.

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#2474376 1-May-2020 09:07

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

Depends how they were counted.

Yup. Perhaps every ventilator was supposed to have another ventilator in reserve, in case the first one failed. Just removing that requirement could double the number of ventilators available. And, if they fail rarely, then changing this rule would have a minimal impact on fatality risk. I.e. maybe one in a million die due to ventilator failure with no backup available, but more patients survive because there are ventilators available.

Possibly there's some kind of preventative maintenance scheme, where (say) one in 10 ventilators is being serviced at any one time. Deferring that maintenance (for a short period) would increase capacity by 10%.

Fred99

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#2474380 1-May-2020 09:17

frankv:
Wasn't it also realised that one ventilator could work for 2 patients instead of just one? So adding tee junctions effectively doubled the number of ventilated beds.

I believe that there's also been a change in patient management guidelines, mechanical ventilation has poorer outcomes than expected with C-19, oxygen combined with careful patient management better than expected - so efforts made to keep patients off ventilators. Not really relevant to NZ at the moment - AFAIK there are no NZ cases on mechanical ventilation.

I've read that in Sweden ICU level care is rationed based on age and comorbidity - you don't receive ICU care if you're over 60 with two comorbidities or over 70 with with one. It's probably much the same elsewhere - but not talked about much as a method to keep the system from saturation you sacrifice those least likely to survive. It seems cold/callous, but it's just the way it has to be.

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#2474392 1-May-2020 09:37

tdgeek:

I see there was a funeral, 10 invited, 100 just turned up. L3 is L4 with fries, stay at home, yes you can go to work. Maybe we here are in our Geekzone bubble, we follow the virus, we watch the updates. its OBVIOUS what L3 is. Maybe the masses just see it on the news, and dont really know much or see" no lockdown now" and a couple of cases and its over? Maybe they should have done these updates at 6pm news on all FTA channels? Either Kiwis are lethargic to this or they dont know?

That's just crazy - not only breaking rules but the photos seemed to show very poor distancing to minimise risk.
Given the extreme measures being taken by other communities to protect their most vulnerable, it's very disappointing to see that in the news.

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#2474399 1-May-2020 09:45

Fred99:

tdgeek:

I see there was a funeral, 10 invited, 100 just turned up. L3 is L4 with fries, stay at home, yes you can go to work. Maybe we here are in our Geekzone bubble, we follow the virus, we watch the updates. its OBVIOUS what L3 is. Maybe the masses just see it on the news, and dont really know much or see" no lockdown now" and a couple of cases and its over? Maybe they should have done these updates at 6pm news on all FTA channels? Either Kiwis are lethargic to this or they dont know?

That's just crazy - not only breaking rules but the photos seemed to show very poor distancing to minimise risk.
Given the extreme measures being taken by other communities to protect their most vulnerable, it's very disappointing to see that in the news.

I just cannot comprehend why this is, stories like this seem to be common and its just been days. It seems well past the usual slack portion of th population that we saw in L4

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#2474402 1-May-2020 09:51

Fred99:

John Key isn't qualified to comment - and neither does he have access to the data that's needed to make such comparisons or give policy advice.

That's the Key "attitude" you should be concerned about - he is far from an impartial observer.

As Chairman of ANZ, I think John Key is extremely well qualified to comment on the business crisis, which now seems to be even greater in NZ than the virus crisis.

Remember that, in 2017 Sir John also received Australia’s Companion of the Order of Australia for advancing the Australia-New Zealand bilateral relationship.

NZ has done very well in controlling the covid-19 crisis and the Government is receiving praise for this all around the world. That's why people are relaxing big-time and wanting to get on with things as before. You can't really blame people for this when the Government is saying that we are doing better with controlling the virus than most other countries and that it's almost been eliminated.

I realise that we could get a second wave of the virus and that extreme care is needed to continue to suppress it, but I think we also need to listen to highly qualified business people on how we can deal with the business crisis.

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#2474403 1-May-2020 09:54

neb:
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.

It does depend on how they are counted but the over riding factor is the number of ICU nurses available.

I've read in more than one place the number of ICU beds is dependent on the number of nurses available. That was one of the reasons given why the original numbers back in February fluctuated between 170 to 220. The numbers changed depending on the number of nurses available on a particular day.

Provisioning beds is easy but without nurses to staff them they cannot be counted as ICU beds that can be used.

Let's look at some approximate nursing numbers. ICU means one nurse per patient/bed. Conservatively there needs to be 4.5 nurses employed per ICU bed allowing for weekends, sick leave etc. If we take the higher February number (220) that means we had 220 X 4.5 nurses, giving a total of 990 ICU nurses in February. I suspect the actual number was likely less and more in line with 170 beds.

A month later we apparently have 563 ICU beds. 563 beds will require 2533 ICU nurses.

If we are generous and say the private hospitals contributed another 50%, 110 beds, 500 nurses, above the original 220, that still leaves over 1000 nurses that need to be trained to ICU standard. Doing that in one month isn't possible.

This article on the 18th of March is still quoting the 170 to 220 ICU beds. The MOH was refusing to answer questions about ICU capacity yet 2 days later we apparently have 563 ICU beds. https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12317275

I'm sorry I find it hard to believe the MOH figures on this occasion.

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