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

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