Aotearoa New Zealand will remain at the red covid-19 traffic light setting, says Prime Minister Jacinda Ardern.

Ardern made the announcement at today’s post-cabinet media briefing.

She said the rolling average of cases had declined 36 percent in the two weeks since the government refined the traffic light system.

There had been early data showing an uptick since mid-March in people visiting places of retail and recreation in Auckland, as well as more people returning to workplaces, she said.

While cases were dropping in Auckland, Wellington and Tairāwhiti, others region like Canterbury, Northland and Waikato were not experiencing the same drop. Hospitalisations in some DHBs were not expected to peak until mid- to late-April.

“So for now, New Zealand will remain at red,” Ardern said.

“I know there is an eagerness to move to orange, but we are still frankly amid an outbreak and there is still pressure across our hospital network.”

Nine further deaths
The Ministry of Health today reported 10,205 new community cases of covid-19 and nine further deaths.

There are now 734 people in hospital, including 25 in ICU or HDU.

In a statement, the ministry said the seven-day rolling average of case numbers was continuing to decline — down to 13,218 from last Monday’s 16,102.

Director-General of Health Dr Ashley Bloomfield said health officials would not be looking at a specific number of hospitalisations when advising a move down to the orange setting, but would rather be considering capacity and pressure levels, which also includes staffing at hospitals.

The next review of the traffic light settings will be on Thursday, April 14.

The country will remain at the red Covid-19 traffic light setting, Prime Minister Jacinda Ardern says.

Ardern made the announcement at today’s post-Cabinet media briefing from about 4pm.

Based on health advice
Ardern said the decision today was based on health advice, and the government did not want to move too quickly and lose the progress made.

“It’s less about the case numbers and more about the hospitalisations.”

Asked why Auckland could not move to orange when cases were falling, Ardern said that while there was a decline in hospitalisations, “it is off a high base, the numbers are still relatively high, the pressure on our system is still there, we want to make sure that we’re in the best possible position and we don’t lose the gains we’ve worked so hard for.

“We’ve always said that there is the possibility of moving regions to different levels at different times … but as we’ve said, Auckland has made significant progress but we do still have a relatively high hospitalisation rate.

“We need to look after our healthcare workforce.”

The country needed to help the health system recover and be ready for the expected winter surge, Ardern said, requesting that people get boosted.

“Unvaccinated and people that are not boosted make up a disproportionate number of people in our hospitals. More than 9900 people are due their booster today, please get your booster as soon as you can.”

Looking at overall trends
Covid-19 Response Minister Chris Hipkins told RNZ Checkpoint tonight there were a range of considerations cabinet would have to take account of in its April 14 review.

“We’re obviously looking at the overall trends … how many new hospital admissions as well as those who are in hospital – but also the demographics,” he said.

Article by AsiaPacificReport.nz

New Zealand could be facing 50,000 daily omicron infections by Waitangi weekend, according to modelling by US-based health research organisation, peaking at about 80,000 each day just a few weeks later.

The Institute for Health Metrics and Evaluation (IHME) projections, updated last Thursday, predicts an outbreak in New Zealand lasting about three months, with death rates projected to total more than 400 by May 1.

Daily fatalities are predicted to spike at about 10 through mid-March.

There are also warnings this country’s ICU capacity will come under “extreme stress” through February and March.

These are of course predictions and should be viewed as such, however they have been given credence by New Zealand’s leading experts, including University of Otago professors Nick Wilson and Michael Baker: “Our impression is that this work is of high quality and should be considered by NZ policy-makers … [it’s] an organisation with a very strong track record for analysing health data (with some of the best epidemiologists, health data scientists and computer scientists in the world).”

The modelling by the IHME at the University of Washington shows the “most likely” scenarios are based on vaccinations carrying on at the expected pace, mask use staying about the same, and 80 percent of those already vaccinated getting a booster within six months — the numbers do drop if 100 percent get their booster and then again with 80 percent of people using masks whenever they’re out in public.

Under the ‘most likely’ scenario, daily infections start to rapidly take off almost immediately: by February 1 at just over 13,000, by the 9th hitting about 62,000, and peaking in mid-February at over 81,000.

Numbers drop slightly
The numbers drop slightly if everyone gets their booster shot, but there is a significant difference when 80 percent of people are wearing masks.

These are the two public health controls taken into account, so the modelling does not include other measures in place, for example, under New Zealand’s red setting; the different responses around the world vary considerably and compliance would be difficult to accurately gauge.

After peaking in mid-February, infections are projected to fall back to around 50,000 by the first week of March, then tailing off through the rest of that month and April.

The government has been preparing for up to 50,000 cases a day and this week unveiled the “three phase” response, under which testing, contact tracing and isolation requirements will change once cases start to rapidly increase.

There was much political debate late last year about ICU capacity and these latest figures should sound the alarm.

In the face of criticism the government had failed to increase the number of fully resourced ICU beds, Health Minister Andrew Little said there were 289 ICU or High Dependency Unit beds available, insisting that could be increased to up to 550 under surge capacity if needed.

Strongly challenged
That was strongly challenged by clinicians and ICU experts who said the extra capacity was more like 67 — totalling 356 — mainly due to an acute shortage of highly skilled ICU nurses

At the peak of the outbreak, in early March, the modelling estimates 458 ICU beds could be needed, and occupancy could come under “extreme stress” for a number of weeks.

Experts from the University of Otago summarised and analysed the findings, saying the government should take heed and consider police settings accordingly.

They noted socio-economic status and ethnicity were not taken into account, so the modelling would not highlight potentially disproportionate impacts on Māori, New Zealand specific data is incomplete, if delta cases start emerging again and we end up with a “dual variant” outbreak the numbers could be worse, and ICU capacity — outlined in classified Across Government Situation Report leaked to Māori Television — may be underestimated so the predicted pressure on the healthcare system may be even greater.

The authors also draw attention to the “high uncertainty” in the data, for example “the number of cases in hospital might peak at 2790 in early March 2022 … but the 95 percent confidence interval around this 2790 figure is large at: 120 to 9,070”.

“As well as considering the strengths and weaknesses of this IHME modelling, policy-makers will need to consider the potential social and economic disruption from an Omicron outbreak,” they conclude.

Stronger border approach
They also call for a stronger approach at the border, as a key area of vulnerability.

“The NZ government is obviously taking this threat seriously with a recent suspension of future places in MIQ. However, this change will not have an impact on arriving cases until March 2022.

“Therefore, substantially reducing the risk now will probably require a rapid and marked reduction of incoming international flights from some countries (ie, until their outbreaks subside in coming weeks).”

Professor Baker also says the phased opening of the border, due at the end of February, should be pushed out, and the time between the second vaccine dose and booster reduced from four to three months.

This article is republished under a community partnership agreement with RNZ.

Article by AsiaPacificReport.nz

As New Zealand readies for more covid-19 cases, warnings about the ability of public hospitals to cope are escalating.

There are 289 intensive care unit (ICU) or high dependency unit (HDU) beds at the moment, with Minister of Health Andrew Little insisting that could be ramped up to 550 if needed.

But that has been roundly questioned by opposition MPs, clinicians and ICU experts, including a recent New Zealand Medical Journal article concluding fully staffed, extra capacity would be more like 67 beds.

It describes New Zealand’s “comparatively low ICU capacity” as a “potential point of vulnerability” in the covid-19 response.

Intensive care
There is a reason it is called intensive care.

Patients there are so sick, each one has a nurse with them around the clock.

Those there because of covid-19 are usually struggling to breathe, their lungs unable to give their body all the oxygen it needs to function.

There are doctors, physios, pharmacists who come and go to give vital care but it is the nurses who are the constant.

That’s why the shortage of ICU nurses is at the heart of the debate.

New Zealand’s intensive care was already in a perilous position long before covid-19, with one of the lowest number of beds per capita in the developed world.

Doctors and nurses have been asking for help for 10 years, failing to make meaningful traction with successive governments.

The small community pulled together, pooled resources, when crises like the White Island eruption and the mass shooting in Christchurch hit.

But covid-19 is different. It is here for longer and will hit everywhere.

Political football
Little is “assured that we will manage and we will cope”.

High vaccination rates will mean fewer people will actually end up in hospital and “the vast majority who then get infected will be able to be cared for in the home with appropriate sort of monitoring, the stuff we’re putting in place at the moment”, he says.

He acknowledges any move to surge up would mean deferred operations for things like hip and knee replacements, and people needing a lower level of care getting it somewhere other than a hospital.

“The impact will be on non-covid patients who can be safely referred to other places for their care and recovery at the hospital.”

National Party MP Shane Reti says there are simply not enough specialist ICU nurses.

“Five point three nurses [needed per ICU] bed, it’s orphaned out and what we know from specialists … is that instead of the hundreds of beds that Andrew says we’ve got we’ve probably only got about 67 to surge to.”

Not wanting to sound like a “political caricature”, Little, however, lays the blame at the feet of the previous National government.

Heath underfunded
“Our ICU capacity – if we’re talking about just designated ICU wards, and ICU beds, yep, that’s been a long standing problem … the reality is health has been underfunded for a long time, particularly when it comes to health facilities and buildings,” he says.

He is confident any outbreak can be managed, saying expanding to 500 or so beds would require an increase to about 200,000 covid-19 patients across the country.

However, Reti says that the May 5 public sector pay freeze has impacted on staffing, with some going to Australia, and that New Zealand’s now competing with the world for ICU nurses with an immigration system that’s not friendly to them.

Nursing shortage
Even with the known nursing vacancies, New Zealand’s needs could be met with the training of about 1400 more nurses to work in ICU under supervision, Little says.

Through May 2020 till mid August this year, there were no new, resourced ICU beds in Auckland DHB, but the ICU nurse headcount dropped from about 250 to just over 212.

Reti says the nursing shortage is a major obstacle.

“When Minister Little says, ‘I’ve trained up 1400 ICU nurses’ — no you haven’t, what you’ve done is you’ve given them half a day’s online training and half a day on a mannequin.

“In no shape or form is that an ICU nurse — they’ll be valuable, don’t get me wrong — but valuable for turning patients in ICU?”

Auckland has the biggest ICU unit in the country, and needed to find nurses from across New Zealand on September 1 when eight active cases arrived there, he says, showing just how thin the margins are.

On the ground
Vice-president of the Australasian College of Intensive Care Rob Bevan says right now intensive care is coping well.

That is due, in large part, to high — and rising — vaccination rates and the fact that Auckland’s been in lockdown.

Quieter lives mean fewer car accident and workplace falls, while hospitals have delayed many of the planned operations which might involve ICU recovery.

But Dr Bevan, a specialist at Auckland’s Middlemore Hospital, says more beds will be needed next year when covid-19 is in the community and life was comparatively back to normal.

“There is going to be a burden of covid that people will need hospitalisation and intensive care for that we need to add onto what we were doing before,” he says.

“And acknowledging that our intensive care bed capacity before was still not enough to care for everybody without resorting to the deferment of planned care on occasion.”

Many who work in intensive care say the government and health bosses are wrong to count physical beds (and the equipment that comes with them) when there are not enough nurses to use them all.

Shocked by ‘training’
When they said they were training other nurses to help in ICU, the nurses organisation kaiwhakahaere Kerri Nuku said she was shocked to learn what that meant.

“Four hours online training — to go and support in ICU. Those decisions about what’s in the best interests of nursing have not been made for nurses,” she said.

Indeed, specialist ICU nurses say they would have to spend time supervising the online trained back-ups, adding more work to an already very challenging job.

And Bevan says surging up to more than 500 beds is not a realistic picture.

“That is a crisis, short term, and largely unsustainable model that we would have had to have moved to had we been overwhelmed like they have been in other parts of the world,” he says.

“But that would most likely achieve worse outcomes for all patients in ICU than they have in other parts of the world compared with our best model of care that we’ve been able to provide to date.”

The message is starting to get through to those who made decisions, he says.

Intensive care meetings
Intensive care bodies are meeting with the Ministry of Health twice a week and there is work underway to try to recruit more nurses from overseas, he says.

But it has to go beyond talk and into action, first to sort the short term problem but then to keep building on that over the next several years.

“The next pandemic is inevitable … it might be in 10 years, it might be in 100 years, but it is coming,” Bevan says.

Little says he has also asked for decisions on three DHBs proposals expanding ICU capacity to be “accelerated”, but even then, those “will be some months away — they won’t be instant”.

This article is republished under a community partnership agreement with RNZ.

Article by AsiaPacificReport.nz