Tuesday, 19 October 2021

Held to ransom by the unvaccinated

It is not a pleasant calculus.

New Zealand apparently really only has 186 fully staffed ICU beds. The rest is potential surge capacity with staff who've had only short bootcamp training. 

Vaccinated people can still catch Covid, but they're very unlikely to wind up in ICU. Alberta's population is a bit smaller than New Zealand's: 4.4m to our 5.1m. They put up all their vaccine outcome stats, from their very large ongoing outbreak.


Just look at the numbers here. Let's imagine everyone were fully vaccinated. 

First off, if that happened, the number of vaccinated people winding up in ICU would drop considerably, because fewer vaccinated people would catch Covid, because there would be fewer cases around transmitting it. 

But even if you held cases constant, you'd have ICU admission rates, even among the elderly, of around 10 per hundred thousand population over a 120-day window. If an ICU stay is 20 days, divide that 10 per hundred thousand by 6. And much lower rates for younger cohorts.

It isn't good. Inflating upwards to a population of 5.1 million, and assuming that the basic age distribution is similar between here and Alberta, it's 103 people in ICU over a 120-day period, or under 18 in ICU at the same time if a stay is 20 days. 18 is about 10% of fully staffed ICU capacity. A big outbreak, if everyone is fully vaccinated, doesn't wreck everything.

But the numbers on the unvaccinated side are truly awful. 

Remember that 76.7% of Alberta's 12+ population is fully vaccinated. They took up just under 9% of ICU spaces over the past 120 days. 

An additional 9.1% of Alberta's 12+ population is partially vaccinated. They took up just under 4% of ICU spaces. 

The completely unvaccinated 14.2% of the 12+ population account for 87% of the 12+ ICU demand over the 120-day period. 

If everyone were fully vaccinated, ICU demand would have been less than 12% of actual demand. More than 7 out of every 8 people who did wind up in ICU wouldn't have wound up needing ICU. The system wouldn't be busting. 

It isn't much different in Singapore. There, 15% of the population is unvaccinated and that 15% takes up half of the ICU spaces. A lot of that 15% will be kids too young to be vaccinated and unlikely to wind up in ICU if they do catch it: a tiny proportion of adult unvaccinated people are taking up half of the ICU capacity. 

Policy restricting everyone's liberty is being set, in part, to prevent the hospitals from being overwhelmed by the small proportion of people who do not want to be vaccinated. 

Is it any wonder that Auckland Mayor Phil Goff says:

"There has to be a price to be paid for not getting vaccinated and that may be access to hospitality areas, it will be access to events and it may be access to a whole lot of jobs that are public facing." Exceptions will have to be made for people who can't get vaccinated, he said.

If every person who could be vaccinated were vaccinated, the hospital system could hold up even in a big outbreak. And a big outbreak would be less likely. But if even 15% of the population remains unvaccinated, as in Alberta, that 15% impose so much cost on the health system that you get horrible outcomes that deny hospital services to everyone, vaccinated or unvaccinated, for all the other things that send people to hospital. 

Care has to be rationed, one way or another. Surge capacity is better than no surge capacity, but the short bootcamp training will not provide care that is up to the normal standard.

Every option is terrible. Delaying and deferring cancer and other surgeries to save ICU space for the unvaccinated Covid cases is horrible too. Imagine though a rule that, if triage decisions have to be made because of those terrible capacity issues, the willfully unvaccinated are the lowest priority. It sounds horrible. Every option is horrible. But doing it this way might encourage more people to be vaccinated, and in doing so massively reduce the problem that we'll be facing. 

What other option might you suggest that you think would be more fair in allocating those scarce spaces while also reducing the burden that ICU will be facing? Don't just tell me my option sucks. I know it sucks. Give me something that is feasible and sucks less

Monday, 18 October 2021

Morning roundup

 The morning's worthies:

Thursday, 14 October 2021

No accountability in Covid-land

Dileepa Fonseca has more on the latest installment of the Rako saga.

I know I've been going on about this since last December. 

But it really matters. 

If you can't get accurate test results quickly back to people in a pandemic, you're always going to be well behind the curve. Contact tracing is a mess of too-little capacity. Pinning down cases quickly makes that job easier. Fast results, and especially if collection is unobtrusive, reduces test hesitancy. If you have to self-isolate for days on waiting for a result, and getting a test is inconvenient and a bit painful, you'll be less likely to go do it for a sniffle than if you just have to drool in a spoon and get results same day (or overnight if it was later in the day). 

And the government has absolutely messed this up. 

Rako had offered to scale up its testing to help in the public health effort. The Ministry told them to piss off. 

Now the Ministry's threatening to expropriate Rako via requisitioned testing. 

This is fifty different kinds of stupid, but here's one of those flavors of awfulness. 

Suppose you had a testing company, and you knew you could make an investment that would 8-fold increase your capacity. 

Would you make that investment early, knowing it would wind up being needed for the public response once the Director General of Health pulled his head out of his arse, so you'd be ready to run?

How would that calculus change if the government threatened to just steal all your stuff?

If you make the investment early, increasing capacity, the government can just take it at the price the government sets, and you have to fight them in the courts about it.

If you know that they are giving themselves that power, well, it would be stupid to invest in more capacity. They can't steal what you don't have. But you might be able to work it into future negotiations, so you don't get wiped out for having made the investment before the bandit comes calling. So it's then better to wait. Even in a big outbreak where a pile of testing is needed. 

Someone on Twitter said that NZ right now is like the first people showing up at Fyre Festival. Would be nice if those who'd been warning about this lack of preparedness all year weren't being dragged along for the ride. 

Morning roundup

 Ok. It's down to one Chrome sheet. The worthies!

Sellotape IT systems and covid testing

I'd struggled to understand why the government would be blocking Rako's access to the Covid test tracking system. Surely, even if they hated Rako, they'd want to get results reported in for their own tracking purposes. 

Dileepa Fonseka has a potential explanation. The IT systems, like most government IT systems, are a disaster.

The Government is struggling to meet its existing border worker testing obligations, allegedly thanks to IT systems “held together by sellotape”.

There have been growing calls for border workers to be tested more frequently than once a week in response to the more infectious Delta strain of Covid-19. Yet a recent move to saliva testing has highlighted a significant IT issue standing in the way of more frequent testing.

...

The problem was exposed during the saliva testing roll-out, because workers were required to be tested twice a week.

The mish-mash of IT systems, and other delays within the testing regime, meant the deadline for a border worker’s next saliva test could pass before they were asked to take their next one.

One source close to the problem said the whole system was “held together by Sellotape, and it should have been replaced 15 years ago”.

Wednesday, 13 October 2021

Morning roundup

There are 5 different Chrome windows, each chocka. I can't do every bit justice. So, a roundup while I try closing maybe 2 of them.
The last month has been utterly mad. There was an old Roger Douglas line about the reforms in the 1980s moving too fast for opposition to them to mount. Labour's basically doing that again, but mostly in the wrong directions, in the middle of a pandemic, while not being appropriately on top of the pandemic stuff. 

It's not ideal. 

Google and the provision of public goods

Anything that makes the Android operating system more valuable to users is good for Google. More people taking up the Android platform means more people in the Google universe, using their apps, seeing the ads that they sell. 

They have rather decent inventive to do awesome things for the platform.

Yesterday, about 2.55pm, I got a push notification on my phone. It made a sound I'd never heard before. I looked over and it noted that there'd been an earthquake, estimated magnitude 5.6, about 100 kilometers away off shore. I'm going from memory here as I didn't screenshot it. 

By the time I remembered that Google had added earthquake warning functionality into the Android OS, and remembered David Hood's skepticism about it, the room started shaking. Somewhere between 3 and 10 seconds. I should have started counting. 

Had the number on the phone been bigger than 5.6, I'd have gotten under the desk. And I've had had time to do it too. 

I kinda hate earthquakes. But now, I'm kinda looking forward to the next minor one. I want to count it down, like the gap between lightning and the thunder. 

Thank you Google!