New Zealand’s Director-General of Health, Dr Ashley Bloomfield, says covid-19 case numbers have passed their peak in Auckland, the country’s largest city, but that people should remain vigilant.

Dr Bloomfield said there were 20,907 new community cases of covid-19, a further 15 deaths and 1016 people in hospital in today.

He said the latest analysis showed covid-19 case numbers had passed their peak in Auckland, and were tracking down in all three district health boards.

Dr Bloomfield said that analysis also showed case numbers nationally — not including Auckland — were also slowing. They increased just 1 percent in the seven days to March 20, compared to a 44 percent increase in the week ending March 13.

The pattern did differ by DHB, with cases still increasing in the South Island, although there were encouraging signs they were peaking in the Midland region and in the Wellington region.

He said case numbers appeared to be largely now following the modelling for a high-transmission scenario. Case numbers were higher than the modelling suggested, and Dr Bloomfield said this may be because most cases in New Zealand were the BA.2 subvariant.

Hospitalisations in the northern region were also levelling off.

“We’re watching carefully and the expectation is that they will start to drop as the week progresses,” Dr Bloomfield said.

“The average length of stay for people on wards in the Auckland hospitals who have been discharged is now 3.2 days compared to just over two days last month, and the average stay in intensive care is five days.

“This increase in average length of stay reflects that we’re now seeing that people who are needing longer care, they may even be over their covid infection but they have symptoms that need to be managed, often from underlying conditions.”

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Dr Bloomfield said that even though cases in hospital in Auckland were staying high, the number of new admissions each day was dropping quickly. But because those being admitted now were sicker and required longer care in hospital, the total number of people in hospital remained fairly steady.

Emergency department admissions testing positive remain highest at Middlemore, but they had fallen from 40 percent last month to 28 percent now. Auckland Hospital was down from 30 percent to 22 percent, while Waitematā was steady about 18 percent.

Whangārei’s ED positivity rate was still increasing, he said.

“Admissions in the rest of the country are growing and we will continue to see them grow.”

Dr Bloomfield said hospitalisation rates during the delta outbreak was about 8 percent, whereas the omicron outbreak had been about 0.9 percent.

“That hospitalisation rate will appear to increase over coming weeks, because as the cases drop yet people remain in hospital we’ll see the denominator decline much quicker … hospitalisations will decline but more slowly,” he said.

“The number of deaths each day is also likely to increase and will take longer to decline.”

He said staffing shortages were a major pressure on the health system, and there was real pressure in hospitals as well as care in the community, including rest homes.

‘Covid isn’t done with the world just yet’
Dr Bloomfield said New Zealand could expect ongoing waves of covid, and looking across the Tasman was instructive.

“The number of people hospitalised with covid in New South Wales never dropped below 950 after their first omicron wave … it’s now back over 1000 as cases started to increase again.

“In contrast, in Victoria the number of hospitalisations declined down to around 200 and remained steady there … so two quite different pictures.”

He said this showed New Zealand should expect to see a residual number of cases and people in hospital.

The UK had seen increased case numbers with the BA.2 subvariant, with Scotland hit hardest.

“Case numbers there are just below their previous peak, and hospitalisation figures the highest they have been since 2020. Globally it’s likely there will continue to be further waves of omicron and likewise there will be new variants of concern.”

He said New Zealand would face these just as other countries would.

“Covid isn’t done with the world just yet.”

Looking ahead
Tomorrow the government is due to announce if it will relax mandates, vaccine passes and the traffic light system as the omicron outbreak passes its peak in Auckland. Cabinet discussed reducing the restrictions yesterday.

Ahead of the announcement, Dr Bloomfield said New Zealand was still in the middle of a global pandemic which had thrown curveballs before and would continue to.

“We need to be prepared to redeploy the measures that we already have in place or have used in the past.”

He said there was a balance between protecting the population — particularly vulnerable groups — and only using restrictions for the extent they were needed.

At the moment, total ICU and HDU beds were about 60 percent occupied, he said. Each day hospitals were looking at the number of beds available and staffing those accordingly.

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

Article by AsiaPacificReport.nz

New Zealand’s most restrictive border controls will be eased early next year, the government announced today.

Most fully-vaccinated travellers into New Zealand would not be required to go through managed isolation from early next year, Covid-19 Response Minister Chris Hipkins said.

A seven-day self-isolation requirement will take the place of MIQ.

Hipkins revealed fully-vaccinated New Zealanders would be able to travel from Australia without having to quarantine from 11.59pm on 16 January, and from 11.59pm on 13 February that would extend to fully-vaccinated New Zealanders from all countries.

From April 30, all fully-vaccinated foreigner travellers would also be able to come to this country without having to quarantine, though proof of vaccination would be required.

All travellers not required to go into MIQ would still require:

• a negative pre-departure test proof of being fully vaccinated;
• a passenger declaration about travel history, a day 0/1 test on arrival;
• a requirement to self-isolate for seven days, and
• a final negative test before entering the community.

Government ‘still cautious’
Hipkins said: “It’s very encouraging that we as a country are now in a position to move towards greater normality. I do want to emphasise though that travel in 2022 won’t necessarily be exactly the same as it was in pre-2020 travel.”

The government defended its decision not to open the trans-Tasman bubble before Christmas.

Hipkins said the government needed to remain cautious about how much risk the country was exposed to in a short period of time.

He said loosening restrictions domestically and at the border need to be staggered.

215 new covid-19 cases
There were 215 new community cases of covid-19 today — 181 in Auckland, 18 in Waikato, three in Northland and 12 in the Bay of Plenty.

Director-General of Health Dr Ashley Bloomfield this afternoon said 87 people were being treated in hospital, eight people of those in intensive care.

The Ministry of Health said 118 of today’s 215 new cases were yet to be linked.

There were 18,880 vaccine doses given yesterday — 6496 first doses and 12,384 second doses, meaning 92 percent of eligible people in New Zealand have had their first dose and 84 percent are now fully vaccinated.

Traffic-light system legislation
Legislation setting up the traffic light system — including mandating vaccinations for some workforces — has been pushed through Parliament in less than 24 hours.

Passed under urgency, the bill was opposed by the opposition National, Act and Te Paati Māori parties.

National called it secretive, divisive and unduly rushed. Act said the government had plenty of time to move it through the regular process involving greater scrutiny, and the Māori Party called it a “cruel law change” that would victimise vulnerable communities.

MPs also rejected a change to the traffic light system, which would have seen places of worship and funerals exempt from vaccine certificate requirements.

National’s Simeon Brown had put forward a proposed change to the bill.

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