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!

Contact details

It seemed really obvious, really early, that robust privacy protections were needed around Covid sign-ins. If even some people expect, entirely unreasonably, that there's any chance that police could subpoena that data, then it needs to be bright-line illegal for anyone to hand that data over to police. 

The government can insist all it wants that the police wouldn't do that, but people who don't inherently trust police to do the right thing would rightly insist on stronger protection than that, and especially when Australian police have been up to dodgy stuff.

The people who you most need to be checking in for contact tracing are the ones who are nervous about the thing, because they may be in the cohorts you're going to have a hard time tracking down otherwise.

Newsroom's Sam Sachdeva says Labour is the only party opposing a rule change here. 

A push to provide stronger privacy protections for contact tracing data now has the support of four political parties in Parliament, leaving Labour as the sole holdout for legislative change.

The issue of how contact tracing data is used, and could be misused, has been bubbling away for some time and came into the spotlight again last week in relation to the Covid-positive woman who was refusing to share her movements around Northland with health officials.

When asked by Newsroom last week whether the Government would offer the woman immunity from any criminal charges in exchange for being candid about her whereabouts, Hipkins said public health officials did not use information gathered in interviews for any purpose other than eliminating Covid-19.

“The public health teams are not collecting information that’s then passed on and used in other law enforcement procedures, because to do so would mean that people wouldn’t provide the information in the first place.”

However, the standard of rules governing the use of contact tracing data has been called into question in the past, yet the Government has taken no new action to address those concerns.

In September, an open letter signed by over 100 lawyers, experts and academics said the public health order establishing mandatory recordkeeping had “insufficient" safeguards to protect against the misuse of data collected through either the Covid Tracer app or paper-based records.

Some are concerned that police or other law enforcement agencies could compel the release of the information through a search warrant or production order, while others have said the private sector could also misuse data collected through paper-based records.

The Government is legislating themselves the right to expropriate private covid testing labs, while insisting they won't use that right. 

At the same time, they're refusing to legislate against the use of covid check-in data, because they say that there's no need to because they wouldn't abuse the data and everyone should just trust them. 

Would it be crazy for someone who doesn't trust police or the government to conclude that the government's refusal to legislate here is because they actually kinda want to be able to use check-in data for dodgy purposes?

Tuesday, 12 October 2021

Further, on taking tests

On Monday, I managed to get a submission in on the Government's awful proposal to give itself the power to requisition tests and testing materials. Was a bit of a rush job, but it's a bit of a rushed legislative process. I hadn't known about it much before a hasty blog post on it on Friday

The submission alludes to a few problems in giving the Ministry of Health authority to set quality standards for testing, which the legislation also does, in addition to letting the Ministry take Rako's tests. 

My column at Newsroom, written after the submission, also goes through the problems. Currently gated. [Update: ungated]

A snippet:

If the Government wanted more testing capacity, it could have contracted for that capacity. And it still could. But over the past year, the ministry has repeatedly rebuffed Rako’s offers to provide testing. The Ministry of Health also told Rako not to maintain any extra testing capacity for the Government as its services would not be needed.

Shifting from a view that Rako’s testing was not needed, to that they are so necessary that they could warrant requisitioning, seems somewhat incoherent.

Once the Government has the ability not only to requisition materials away from prudent labs, paying only some deemed market value for the effectively stolen supplies, but also the ability to force those labs to ignore existing contracts and to provide testing for the State instead, bad things happen.

Existing clients would see the obvious threat to the security of their continued ability to undertake testing. That makes contracts less valuable. Labs can purchase sufficient supplies to tide them through shortages and international shipping delays. They cannot purchase sufficient supplies to ensure that they have enough left in the event that the Government decides to requisition all of the testing materials or all of the testing capacity.

And if the biggest thief in Wellington, whose offers are impossible to refuse, sees your prudential stockpile of testing materials as tempting, what incentive do labs have to maintain those stockpiles in the first place? After all, the Government could well instead decide to requisition someone else’s supplies on your behalf, come the crisis.

When all is done, we have a Ministry of Health that, after spending most of the past year seemingly doing its best to thwart Rako Science’s provision of accurate saliva-based, PCR Covid testing, and after telling Rako that its services would not be required for the public health effort, is now preparing simply to take Rako’s testing capacity through requisitioning powers. While saying it hopes not to need to use such powers.

It is not right. It will have repercussions for security of contracting and investing in New Zealand. And it will hinder the Covid response.

Dileepa Fonseca provides further very helpful detail in a piece today at Stuff. It's truly a must read, spectacular scoop. Leaked ESR test validation details, Ministry insider comments on the debacles. 

Here's how it starts. It goes on at length, and only gets worse for the Ministry.

A leaked study into saliva testing shows the Ministry of Health is still trying to figure out how accurate various types of saliva tests are as the Delta strain starts to take hold in Auckland.

The first stated objective of the leaked Institute of Environmental Science and Research (ESR) study is to compare different PCR saliva testing methods used on border workers by Asia Pacific Healthcare Group (APHG) and its partner laboratories.

However, it is the second objective of the ESR study that has people like Yale school of public health saliva testing expert Anne Wyllie worried.

That objective is “to generate clinical sample testing validation data from Covid-19 volunteers for the testing laboratories as requested by IANZ [International Accreditation New Zealand]”.

Wyllie was leaked the data by concerned scientists, and says there are no circumstances under which data gleamed through the study should be used to validate saliva tests.

“This is a preliminary, exploratory study. If APHG is basing their clinical diagnostic claims off of this – this is not at all robust or reliable, and not true validation.”

A spokesman for APHG wouldn’t comment on whether the data from this study had been used for validation purposes, or as part of their previous public statements on the accuracy of their saliva tests.

“We are not interested in commenting further on clinical validation except to say that our labs have had our work on that recognised by IANZ.”

...

“Why is there no clarity in the data that was used for validation? Why no clarity on which tests are being used for saliva? Why all the secrecy,” Wyllie says.

“Every lab in the US has to tell all its patients which test it is testing with and all that data is publicly available.”

The Ministry of Health argues testing validation data is the property of private laboratories and there is no requirement such results be published.

The Ministry of Health set the RFP for saliva-based PCR testing. 

The Ministry of Health could easily have set a requirement that any provider have a validated test, or get its test validated, and provide all data from that validation. 

The Ministry of Health chose not to do that. 

And then the Ministry of Health says "Oh, well that data is property of the labs so we can't ask for it." 

The Ministry of Health absolutely should not be able to set standards on Covid testing. 

Dileepa continues:

The authenticity of the documents, which were published just last month, have been confirmed by a senior Government official, who claims the whole saliva testing roll-out has been mismanaged by Ministry of Health officials right from the start. The official has requested anonymity.

All of this is part of a long-running saga with Rako Science, which was the first to achieve diagnostic validation for their saliva test, but was passed over for a $60m border worker saliva testing contract in favour of Asia Pacific Healthcare Group, which hadn’t been similarly validated at the time.

“They’ve got themselves into a situation with Rako [Science] and I don’t think they know how to manage their way out of it,” the official says.

An IANZ spokesman said it would normally assess things like Covid-19 tests against a fixed set of international standards, however these standards had been modified by the Ministry of Health’s clinical advisory teams.

”We do not set the accreditation criteria, we simply assess the labs against the criteria that are provided to us.

“Because of the rapidly changing nature of the Covid-19 testing environment, these criteria have been informed/modified by MOH clinical advisory teams composed of experts.”

And on the Ministry's competence in setting standards:

The Covid response bill before Parliament will allow the Ministry of Health to requisition testing supplies, and unilaterally set standards, something a senior government official says is equally worrying.

An official who spoke to Stuff sees the new law as dangerous because of the lack of understanding about this type of testing within the Ministry of Health itself.

“There just seems to be so many individual commercial interests now ... it’s hard to find somebody who is not conflicted.”

The official believes ministry officials didn’t understand what they were procuring when the saliva testing contract went out to tender. That meant officials focused on more easy-to-understand issues like the number of collection points available.

“It’s unconscious incompetence. It’s the people at the Ministry of Health in charge of a large procurement programme,” the official says. 

Friday, 8 October 2021

Taking tests

The least-bad potential explanation for what the government is up to, in its rushed legislation that would give it the power to expropriate Rako Science's testing setup, runs as follows.

Suppose that, as Director General of Health, or the Minister of Health (who knows where this came from), you finally FINALLY figured out that most of your advisors on saliva-based testing are, in fact, utter idiots. They have led you astray for almost a year. All that stuff about saliva PCR testing not being that reliable was wrong, even if DG Health announced it as truth from the podium of truth. It's just that your idiot advisors couldn't figure out how to make it work themselves so spent the past year trash-talking it. And suppose you also figured out that there really only is one game in town if you want to scale up to a ton of testing that meets international ISO standards. And you've finally FINALLY figured out that you actually need a metric shit-ton of testing capacity. Because you only decide to do anything about an outbreak when there is an outbreak. Not before.

When you finally realise that you need to contract for tons and tons of testing capacity, and the only possible reliable supplier of an international-standard validated test in New Zealand is the company you have been utterly screwing over for the past year, well, you might just be a bit worried that prices could be higher than you'd like. 

In that case, having backstop ability to requisition testing from them at a price that you deem fair is a bit like the public works act, but worse. But you hope not to have to use it and that some negotiated contract could work. 

That would be the least-evil explanation for the powers the government is giving itself. 

There are, of course, more evil explanations. But I don't think there are less-evil ones. 

They brought the legislation 29 September, without telling Rako. Rako found out about it on 5 October. Submissions close Monday. The government is giving itself the power to steal all of Rako's kit: requisition their materials, requisition tests. 

I wrote it up as this week's Insights column.

There’s an old saying that makes the rounds now and again, with various attributions. “First they ignore you, then they laugh at you, then they fight you, then you win.”

I wonder how this one is going to end for Rako Science. I desperately hope it ends well. If it does not, it will be an utter travesty of justice.

The Initiative has long been keen on better Covid testing methods. They featured again in my report, released this week.

The University of Illinois’s SHIELD protocol saliva-based PCR testing rolled out very successfully in August 2020.

By late 2020, Rako Science had brought it here, under licence. By January, Rako was providing accurate and rapid PCR testing for private clients under contract, with a test validated to ISO15189 standard.

Rako had offered its testing services to the Ministry of Health in December 2020.

First they ignored Rako.

When Rako’s deployment spread through early 2021, the Director General of Health made erroneous statements, perhaps through simple mistake, at 1pm briefings about the accuracy of saliva-based PCR testing.

Then they laughed at Rako.

When it became increasingly obvious that it was impossible to scale up nasal swab-based testing in any practicable way, the Ministry of Health set a procurement process for saliva-based PCR testing. That process is the subject of a complaint by Winston Peters to the Auditor General.

And, for months, according to Rako, the Ministry ignored or denied requests from Rako to link Rako’s test results into the nationally integrated reporting system.

Then they fought Rako.

Last week, on 29 September, the Government introduced the COVID-19 Public Health Response Amendment Bill (No 2) into Parliament.

Rako found out about it on 5 October. Submissions close Monday 11 October.

Section 11 of the Bill provides the Government with the ability to requisition Rako’s materials and services, compensating the company at a deemed “market price”. Existing contracts with private hospitals for testing might need to be voided, come the requisition order.

On a charitable and optimistic interpretation, the Government has finally realised that it needs to contract for a massive amount of testing and does not want to have to negotiate with the provider of the only test validated to the appropriate ISO standard.

On a more frightening one, the Government is preparing to quasi-nationalise the provider they fought for so long.

Let’s hope Rako wins this one. If they don’t, we all lose.

BusinessDesk also has it, because Pattrick there has been the single best journalist in the country in following this file. Here is a snippet, you should subscribe. 

How else to explain parts of the COVID-19 Public Health Response Amendment Bill (No 2), tabled in Parliament last week, which would give the health ministry remarkable new powers to commandeer the use of private laboratories’ testing capacity? 

The bill proposes that the director general of health have power to make an order – and provide compensation – to a private laboratory to “undertake testing solely for the purposes of the public health response to covid-19 while subject to the order ... whether or not the laboratory is contracted by the Crown for that purpose”.  

It proposes the ministry be able to demand that any and all private test results be available for its national database.  

This sort of draconian drafting doesn't happen by accident and has the potential to produce results that could be both highly ironic and commercially damaging, depending on your perspective. 

Imagine, for example, if the Ministry of Health were effectively to commandeer the saliva testing resources of Rako Science to ramp up the national testing effort, having fended the company off by any means possible ever since its highly accurate saliva test became available last year. 

Rather than contracting for the service, the ministry would simply be obliged to "compensate" such a provider for their trouble. Watch this space.

Jonathan Milne at Newsroom also has it here. He quotes Rako's Leon Grice:

"There is other legislation where the Government can come in and expropriate or requisition private property – that's the Public Works Act. But that has more protections, like a process to determine a market rate that the Government must pay.... They can just insist we give up our stock and our reagents and our premises that we need to do our work."

If you care about the rule of law in New Zealand, and about the Covid response, you might consider submitting

If you haven't time to do anything else, just telling them that it is wrong to propose stealing the testing system that they spend months and months deriding might be nice. 

If you have more time, reminding them that they ought at least be indemnifying Rako against all of the breach of contract messes that will result if the government steals Rako's testing capacity, taking testing capacity away from the private hospitals and others who have paid for this service, causing a breach of contract, after having told Rako repeatedly not to reserve testing capacity for any government need and not to scale up for it - well, that could be a nice addition too. 

On a straight-econ side, even the least-evil explanation above is terrible. 

If investing in testing capacity is high risk, because the government will spend a year crapping all over you, telling people not to contract with you, telling media at the 1 PM Podium of Truth sessions that your testing system isn't reliable, because you're not their preferred supplier - and then the government FINALLY figures out that they might need to get a ton of testing from you? 

Well, at least some return on that risky-as-hell investment is in order if you want anybody to be willing to take similar risks in future. 

None of the international corruption indices understand how New Zealand works.

I'll be submitting on Monday. I'll probably write more on this for next week's Newsroom column. It stinks. 

Friday, 3 September 2021

The cost of xenophobia

Radio New Zealand has been tallying the numbers on health workers stuck in our immigration system. 

Expressions of interest from skilled migrants for residence visas have been paused since March last year.

Hundreds of doctors and nurses are among those waiting for news.

The association said the current approach created frustration and angst. It raised concerns about the residence delays in June, writing to the Immigration Minister Kris Faafoi.

But its executive director, Sarah Dalton, said there had been "zero response".

"Overseas doctors caught up in this delay say the uncertainty makes it difficult," she said "They feel they can't buy a house, settle their families, or put down roots, and are being forced to reconsider their futures in New Zealand.

"We have one of the heaviest reliances on overseas trained doctors anywhere in the OECD, more than 40 percent of our senior medical workforce trained in another part of the world and then for various reasons chose to come and live in work in New Zealand."

What should those workers do in the meantime?

The immigration minister Kris Faafoi said the government acknowledged the disruption that suspension of Expressions of Interest selections for the Skilled Migrant Category has had.

"We are working through advice on when and how to re-open EOI selections, and will have decisions to announce soon," he said.

Doctors and nurses were likely to be eligible for temporary visas while they waited for EOIs to be selected, he said.

That would be fine, except that Labour has made living in New Zealand as a non-resident very costly. It's clear that non-residents are very much second class. They have no access to the border system if they need to travel and are forbidden against buying a home. If you're a mid-career professional who has moved to New Zealand to work in medicine, being told you're banned from buying a house in the place where you live and that there is no expectation that the immigration system will even begin thinking about giving you residence so that you might do so - it's amazing that so many have stayed here. Australia is just a jump away and pays a lot more. 

And it's all the more insane when staffing is the critical constraint in expanding ICU capacity in a pandemic. They don't have the staff to run more ICU beds. Auckland is already, in a tiny outbreak, sending non-Covid ICU patients to other places and seeking staffing help from elsewhere. What hope would we have in any real nationwide outbreak? 

And here's more from Gill Bonnett at RNZ:

New figures show the numbers of doctors and nurses waiting to apply for residence has balloooned to almost 3000.

Figures released under the Official Information Act show the numbers of doctors who have submitted an expression of interest (EOI) for skilled migrant residence (SMC) has tripled to 675 since May and nurses have more than doubled to 2231.

The Association of Salaried Medical Specialists this week described the process as shambolic,

GPs and specialists are thinking of leaving the country or have already left because they can't get residence.

A consultant radiologist in Hawke's Bay, Phillip Clarke, is worried for the new doctors arriving, including four overseas consultants in his hospital department.

"We've got a new radiologist from Britain, and a radiologist from the States. We've got a radiologist from Germany, who's been with us about a year and we've got a nuclear medicine physician from South Africa. All of these people are on the essential list, and none of them have got residency. None of them have got any idea of when they're going to get residency.

"You're talking about people who are in the mid 30s at the youngest. They've got partners, they've got families, they've got a life. You really are trying to build the rest of your life on no surety whatsoever, and it's very very unsettling.

I know people get upset when I say that Labour just hates immigrants. They want to put it up to incompetence at Immigration New Zealand, or capacity issues, or anything else. It jars with the image they have built of what the Government is like. 

From what accounts one can gather in Wellington, half of Labour's caucus just hates immigrants. They see low unemployment numbers recently, credit the closed border, and are very happy that current policy is chasing non-residents out of the country. They believe that migrants steal jobs.  

If you don't think that Labour just hates immigrants. you've gotta really ask yourself how we can otherwise have gotten into a spot like we're now in. New Zealand has really really low ICU capacity by OECD standards. Health staff is a critical and binding constraint. We could see the pandemic coming from February 2020. For nineteen months, nothing has been fixed in the immigration system. Incompetence or lack of capability in Immigration New Zealand could explain perhaps a few months of this. Be generous and say it might even explain a year's worth of nonsense, and start the timer at the end of last year's lockdown when Immigration NZ wasn't able to process anything. It is still broken with no hope in sight. 

Does Labour really hate immigrants so much that they're happy for the health system to lose critical capacity in a pandemic? All signs so far point to yes. 

Thursday, 2 September 2021

Test test test

This week's Newsroom column made the case for freeing up rapid antigen testing for use at essential workplaces during outbreaks and Level 3/4 restrictions. 

There's something like half a million essential workers and perhaps a hundred thousand in Auckland. The government maintains no register of them, and it would be impossible to run daily testing of a hundred thousand essential workers during Level 4 through current testing systems anyway. The PCR swab regime has been buckling under demand and is providing very slow results. Saliva-based PCR testing is far better and far more scalable, but may not be able to get to a hundred thousand tests a day - and may not be cost-effective for broad surveillance testing in lower-risk essential workplaces.

Rapid antigen tests give results in about fifteen minutes. They are not likely to catch cases with low viral loads but are decent at high viral loads - the people who would wind up being infectious. Having workers run a self-test before starting shifts would add an additional layer of protection. But no rapid antigen test has been authorised for use in New Zealand. It is unclear whether MedSafe has even considered any - I have a request in with them for more information. 

The Newsroom column is also available on our website, where all my links to sources are preserved. 

A snippet:

Antigen tests are not as sensitive as PCR tests overall but are reliable when a person is infectious. For high viral loads, the Abbott BinaxNOW test proved as accurate as PCR tests in one assessment but missed one person whose low viral load was only caught by PCR. The test costs about $5 (more in the United States) and gives results in about fifteen minutes. Other antigen tests are broadly available in Europe, at less than a dollar per test. The Canadian government has been distributing packs of tests to small businesses for employee testing, for free.

These kinds of tests make more sense for broad population screening. If there is no reason to suspect someone has the virus, but you want to prevent infectious people from boarding an airplane, a rapid and low-cost test that can be administered in the departure lounge before boarding makes a lot of sense.

The New Zealand government’s testing regime is almost exclusively swab-based PCR tests. The system very obviously cannot keep up with the amount of testing required in major outbreaks. It takes too long to collect samples; samples must be collected by a limited number of trained professionals; it takes too long to process tests; it takes too long to return results to those who have been tested; and, it is rather expensive.

The University of Illinois’s saliva-based PCR test has been available in New Zealand on a private basis since January, thanks to the University’s New Zealand partner, Rako Science. Rako has advertised that it can test up to ten thousand people per day. Its collection method does not require scarce nurses for sample collection and can be scaled up much more readily. Depending how long it takes to get samples to the lab, it can provide results in about four hours. The Ministry of Health, for months, inexplicably refused to consider adding this option to the government’s testing regime.

But the real testing job is an order of magnitude larger still, if we want to turn Delta into Iota.

The Ministry of Health has reported transmission among essential workers in Auckland. This type of transmission has made it difficult for New South Wales to control its outbreak.

The government could, today, order a couple million rapid antigen tests. They are broadly available. It could distribute those test kits to every essential workplace in Auckland and require that every essential worker be tested every day before starting work.

It could be a condition of a Level 4 modified to suit Delta.

Within about fifteen minutes, each worker’s result would be available. Infectious workers could be sent to government testing stations for confirmation. And workplace transmission would be sharply reduced.

Why are employers not doing this on their own as part of normal health and safety prudence? The tests are currently prohibited in New Zealand. In April 2020, the government banned all point-of-care tests unless they are approved by MedSafe, and MedSafe has not seen fit to approve any tests. Pedants might argue that this does not constitute a ban, but banning anything that has not been approved while deciding not to approve any options sounds an awful lot like a ban. It is unclear whether MedSafe has even evaluated any options.

Friday, 27 August 2021

Afternoon roundup

It's been a busy week of lockdown. On Monday, we released my report looking at cap-and-trade solutions for freshwater quality. Yesterday, Matt and I sent in our submission on the Commerce Commission's inquiry into supermarket competition

Don't think the computer's shut down this week. The browser tabs....

Monday, 23 August 2021

Lockdown accountability

Newsroom provides an excellent we-told-you-so this morning. 

Here's Jo Moir:

While the source of the Delta outbreak that plummeted New Zealand into a Level 4 lockdown is all but confirmed, how it got into the community is a work in progress.

Investigations are now homing in on a public walkway that shares the same airspace as the exercise area at the Crowne Plaza managed isolation facility.

In July Newsroom raised the issue of the public thoroughfare, which is the only access to a busy office block in downtown Auckland and requires passing directly beside the exercise yard via an un-roofed walkway.


The photo shows the obvious problem. The 'outdoor' area is anything but. It's enclosed on so many sides that you'd probably not be able to run it as an outdoor smoking area if you were a pub: there's a roof and walls on two sides, and the open side at the end is awfully small.  

The Ministry of Health recently consulted on its definition of an 'open area' for outdoor smoking areas for bars and pubs. Smoking is banned indoors but not outdoors. What counts as outdoors though? Does an awning make something indoors? How about an awning and a wall? This caused a lot of problems when different liquor enforcement officers would come to different views. 

The Ministry of Health's preferred option, in that consultation, was Option B. Any outdoor seating area that met this description would be prohibited from allowing smoking, because of the risks to passers by. 

Option b: Define it as an area that is completely or partially enclosed with a roof or overhead structure of any kind, whether permanent or temporary. This means that if an area has any roof or overhead structure, regardless of how much the roof or overhead structure encloses the area, it will meet the definition of an internal area.

I bolded the relevant bit. If you had a roof over the smokers, and then a minor bit of unroofed area, Option B would prohibit its use as an outdoor smoking area. 

The photograph obviously shows that the MIQ 'outdoor' recreation area has at least some kind of roof or overhead structure. Passers-by had to be right next to them, though there was a minor barrier. 

It looks like the Ministry of Health's preferred protection measures to guard against outdoor second hand smoke at pubs are stricter than the Ministry of Health's preferred protection measures to guard against Covid. 

And this is absolutely par for both courses for this player.

And we have wound up in a spot where a couple of guys out on jetboats on the weekend will wind up charged for breaking Level 4 restrictions, when the only harm they imposed was a potential one to rescue crews if they wound up in trouble, but none of the officials who decided it was a great idea to put this recreation area up next to a walkway will be up on charges, despite this now being the most likely candidate for how we wound up in lockdown and despite its having been an obviously recklessly stupid idea and despite their having been warned about it back in July. 

Thursday, 19 August 2021

Police safety

The police union regularly asks to be armed. A few years ago, I included a chapter on our unarmed constabulary in a piece arguing that New Zealand really is the Outside of the Asylum

Policing in New Zealand is, all things considered, safe – even without firearms. Auckland University of Technology criminologist John Buttle tallied the figures for 2008–09, a high point in assaults against police. He found police reported being assaulted 2,481 times that year – out of 1,221,823 incidents attended by police. In the 123 years from 1886 to 2009, 29 officers were killed by a criminal act in the line of duty.
If loss of life at work is a measure of how dangerous an occupation is, then policing comes quite far down the list of hazardous jobs. This raises the distinct possibility that it is more dangerous being a farmer than it is a police officer.
Farmers do not carry sidearms to guard against enraged livestock.
Peter Kelley points me to an excellent OIA request he made for police injuries over the past several years



Injuries include not categorised; exposure to biological factors; chemical substances; contact with cold objects; sharp objects; noise; radiation; falls from height; being hit, struck or bitten by an animal, insect or spider; rubbing and chafing... there are a lot of categories. 

The one that is most obviously something that might be avoided by being armed would be "Hit, struck or bitten by person (Assault)". But they helpfully list the proportion of assaults among the other categories as well. Unfortunately, it looks like they didn't count being spat at until 2017. And I'm not sure that that's something where an armed response makes the most sense anyway. 

It's hard to see any obvious case in here for arming police. Or at least there is no surge in injuries from assaults. Thomas Lumley put together some charts on it:

Vaccines for children

Good news! Cabinet has decided to end its prohibition on vaccinating children aged twelve and up. From 1 September, parents will no longer be banned from protecting their children against Covid. 

At least if their children are at least 12 years old. 

The Prime Minister framed it at the press conference as a difficult decision, because they're talking about other people's children.

But they've shown absolutely no similar concern about banning parents from vaccinating their children. 

I could understand her framing it as she did if she were talking about mandating vaccination for children. And I can see a very good case for mandating vaccination. But that isn't what she was talking about. She was talking about removing a prohibition that currently prevents parents from getting their kids vaccinated. 

Medsafe approved the vaccine for those aged 12 and up back in June. The FDA approved it on 10 May. We've known it's safe for over three months. Cabinet has just not seen fit to allow it to be used. There is no medical reason for it. 

I expect that the main problem has been a lack of vaccine supply. 

Because of the lack of vaccine supply, it has been convenient to consider those aged 12-16 as ineligible. All the comms on New Zealand's terrible vaccine roll-out have been around vaccination as proportion of the eligible population. One easy way of juking that stat is by artificially restricting the number of people considered eligible. If you don't have enough vaccines to go round anyway, then you can make a terrible figure look marginally less terrible at low cost. 

The ban continues for children younger than 12. 

The trials on the younger cohort are still continuing. If the FDA doesn't give a ruling on it until October, then we might not have a MedSafe determination before November, and then Cabinet extending to younger kids in December?

Given that we continue to tapdance on landmines in MIQ, and there is Covid in the community, might we consider allowing emergency authorisation for vaccinating kids younger than 12 if there is strong medical reason for it?

While risks for children on average are lower than for others, pediatric wards in the US are filled with kids with Covid. If might not make sense to make an 11 year old with co-morbidities wait the extra few months for her birthday, where the vaccine risks for 11 year olds are going to be awfully similar to the risks for 12 year olds, and delta's risks for kids seem kinda high. 

Wednesday, 18 August 2021

MIQ's Aristocracy of Pull

This week's column at Newsroom went through the problems in allocating MIQ spaces by political pull. Unfortunately, Newsroom's version strips out the links; the version on our site has them. 

A snippet:

The surest way to a space in MIQ, for the past sixteen months, has been political influence. Those with political influence get spaces. Those without it are forced into a broken room booking system. Getting a room through that broken system seems to be a full-time job all on its own: some would-be travellers have even hired people to sit at a computer and hit the refresh button, all day long, on their behalf.

But for those with political pull, things are a bit easier.

Last August, in the leadup to an election, the Provincial Growth Fund considered horse racing tracks to be vitally important pieces of infrastructure. An all-weather track in Cambridge needed specialist workers from overseas.

Entry into MIQ was then relatively simple.

Minister Faafoi’s spokesperson assured everyone that officials made the decision without input or advocacy from politicians.

And he was surely right.

No such advocacy was needed.

Criteria for entry always prioritised workers essential to the continued operation or construction of critical infrastructure. As soon as a horse racing track was considered critical infrastructure, the system’s gears turned and spaces for those workers were available as priority.

Horse racing, before last year’s election, had political pull. So horse track workers could use the MIQ express lane.

The America’s Cup was also a government priority. The government had already provided a substantial subsidy for the boat race and did not want it to fail for want of spaces in MIQ.

Because the government made a boat race a priority, all officials then needed to do was follow the rules. Over seven hundred entry visas followed for the racing crews, technical support, family of the syndicates, and even a nutritionist for one of the teams.

International film projects have political pull. So even Kirsten Dunst’s nanny was deemed an essential worker.

The Wiggles’ fan base gave them political pull. When the normal channels did not lead to a space, the Prime Minister’s suggestion that a space should be found seemed to do the trick.

The rules make it harder to get into MIQ if you are not a New Zealand resident. Political pull can turn a stalled immigration process into a fast-track so you can travel abroad and be eligible for MIQ for your return.

And political pull meant some four hundred MIQ spots are being saved for bureaucrats, businesspeople, and performers heading to a trade expo in Dubai in October. In 2017, the National-led government had committed over fifty million dollars for a pavilion for that expo. The government has considered it a priority. Once it is a priority, there will be spaces. That is how the system works.

Families split by the border and a lack of MIQ spaces cannot compete with any of that. The rules ensure that those with political pull can find a way through. Longstanding insiders have political pull. More recent migrants who have not seen their families for a year and a half do not.

The system seems corrupt – but not in any bribe-taking sense. Instead, it is corrupt in what seems a particularly Kiwi sense of the term. No money changes hands. No officials or Ministers are bribed. None need to be. The corruption instead is baked into the rules of the system providing a fast-track for those with political pull.

Officials follow the rules of a game that was rigged from the outset.

Tuesday, 17 August 2021

Dunedin lessons for the Christchurch Stadium

Newsroom put up a superb piece last week on all of the messes that Dunedin got itself into by spending stupid amounts of money on a stadium

I knew it was bad but hadn't known it was this bad. It was "Let's divert money from the CCO that runs the local lines company, deferring maintenance and leading to outages" bad. 

The judgment reads: “Aurora accepts it failed to exercise the skill, diligence, prudence and foresight to be reasonably expected.”

Between 2010 and 2016, Aurora failed, “without adequate justication”, to spend $37 million of forecast expenditure replacing and renewing assets. This led to a significant proportion of network assets “being at or near the end of their lives”, the judgment said.

The timing of this scandalous neglect was no coincidence, says whistleblower Richard Healey, of Dunedin, who exposed Aurora’s potentially harmful problems in 2016.

While a backlog of dangerous power poles weren’t being replaced across Otago, Aurora and sister company Delta paid $30 million in “subvention payments” – shifts within a corporate group, between profit-making to loss-making companies, for tax reasons – to Dunedin’s stadium.

“There were other factors and decisions related to maintenance that made sure we were always going to end up in this mess,” Healey says. “The key to the whole proposition is the fact that that money, which should have been used for the rebuild of the network, was portrayed by various people within council as some magic pot of gold that could be shifted across to fund the stadium – and it wasn’t.

Go read the whole thing. 

Yay, Sportsball and blackouts. 

Lunches

Well, we're very likely to be heading into another lockdown on the basis of a community case in Auckland.

Back in July, we found that the government had blown a pile of the emergency Covid money on the free school lunch programme. 

The free school lunches programme draws on special Covid recovery funds for another two and a half years, despite Treasury's misgivings about depleting the emergency money reserved against a resurgence of the virus.

The Covid-19 Relief and Recovery fund (CRRF) is a $50 billion pot of money that was established in the early days of the pandemic to respond to the health emergency and its economic fallout.

It's been tapped for a wide range of Covid-19 related expenses, but the Government has also used it for a range of increasingly tangential "Covid recovery" spending, and just $5.1b remained in the kitty at last tally.

Shame that the cupboard's a bit bare.

What did it the school lunch programme buy us? Last week Wednesday, Ministry of Ed dropped the evaluation of the school lunch programme. That evaluation has a cover dated May 2021, so draft findings would have been around before the budget was set.  

What did it find?

The programme had large effects on the proportion of lunches with at least one vegetable, and also reduced the proportion of lunches with sweet snacks. 

It provided a tiny and statistically insignificant decrease in the proportion of kids hungry after lunch. 

But kids who were often hungry after lunch, before the pilot, had larger increases in "being full", and in reported mental wellbeing.

And none of it cashed out into higher attendance rates at school. And improvements in school functioning (paying attention and such) were not statistically significant.

It's not immediately obvious that this pilot warranted expanding for broader rollout. There were existing food-in-school programmes before the government's programme, targeted at hungry kids. So effects weren't ever going to be huge: they'd have to come from kids that those programmes missed, or from improvements in what might have been on offer. 

And regardless of your views of the merits of scaling the thing up, I don't know what the word misappropriation even means when they're able to use emergency Covid spending on school lunch programmes. Might as well fund them out of the Defence vote if you're going to stretch things that far. I mean, some of those kids could be soldiers some day maybe. Is it more of a stretch than doing it out of the Covid budget? And what's the point of doing a pilot if you're just going to ramp the thing up to 11 regardless of whether the pilot shows it to be a good idea? Does anything mean anything anymore?  

Monday, 16 August 2021

Dosed

Driving home from Palmerston North last night around 6pm, a man was waiving a Covid-19 Vaccination Centre banner on the median of the road outside of the Onslow Medical Centre. 

We rolled down the window. They had end-day extra doses and wanted to get them into arms.

So the cats had to wait an extra half-hour for their dinners, and we got dosed. 

All went very smoothly. 

On checking in, I offered my NHI number but they didn't need it - they pulled it from name and date of birth.

About five minutes later Susan and I got jabbed. They wouldn't jab the kids, unfortunately. While MedSafe has approved the vaccine for those aged 12+, there is currently no way in New Zealand for a 13-year-old to be vaccinated. And the 11-year-old certainly isn't allowed, though I'd have very happily given her my dose.

We were told to book in for the second dose, along with a workaround for an issue they were having with the website for second-dose bookings. 

Great that they're getting any spare doses into arms. The banner on Moorefield Road was far more welcome than the set of antivax placards outside of Otaki.

Saturday, 14 August 2021

Covid costs and quarantine costs

I don't like New Zealand's film subsidy regime and generally view it to be a good thing when an international film company chooses someone else's subsidy regime instead.

But it looks like Amazon's shifting Lord of the Rings production to the UK isn't just about the subsidy war. 

However, a crew member, who asked to remain anonymous, told Stuff they understood New Zealand’s Covid-19 border restrictions and the requirement that international cast and crew spend 14 days in managed isolation upon arrival was part of the problem.

...The crew member told Stuff that while there was “a general feeling of surprise” over the decision, some saw the Amazon project leaving New Zealand as an opportunity, because Amazon was holding up some of Auckland’s prime studio space for a year before season two was even planned to go into production.

But those opportunities would only eventuate if international productions decided to film here, and MIQ restrictions might turn them off, the crew member said.

“Unless we change MIQ, there’s no other productions,” they said.

Other production staff told Stuff they were disappointed, but not surprised, to be among the last to hear that production was moving to the UK. They said they heard about the move from media, and received confirmation via an email on Friday morning.

A year ago, I wondered whether NZ might be particularly attractive for international film production even without subsidy because the costs of set disruption with a Covid case can be substantial. Shutting down filming for a while because someone's turned up infected is costly. 

This crew member could just have been wrong on stuff reported here. Maybe the UK just offered a pile more money, and NZ really shouldn't be in those bidding wars anyway. 

But whatever advantage NZ has had in offering a Covid-free filming experience now seems outweighed by the combination of MIQ time costs and whatever the difference in subsidies might be. 

MIQ costs will not have changed substantially over the period, although expectations of ongoing MIQ costs may have - I do not know how much easier it is for film types to access rooms at their preferred times of travel, but I expect that it's easier for them than for the rest of us. They should be expecting that MIQ restrictions would be easing considerably next year for fully vaccinated and tested cast and crew, though there would always be risk of restrictions resuming. 

But the risks and costs of Covid cases among a vaccinated crew will be much different from the risks and costs of Covid cases in crews before vaccination was available. Running a tight ship - mandating 100% vaccination among crew and maintaining regular testing - may be sufficiently close to the experience of working in a Covid-free place that the certainty of two-weeks' delay in getting cast and specialist crew in just isn't worth it. 

All else equal, is the combination of MIQ restrictions plus low risk of Covid cases better or worse for international film productions than the combination of no MIQ restrictions plus higher risks of cases and outbreaks, now that vaccination is becoming the norm? We can't disentangle it from whatever's going on in relative subsidies. I would *love* to know more about this assessment on Amazon's side. It would be impossible to get a straight answer because it would get into subsidy detail that's probably confidential. But I still would love to know more about it. 

You can find the UK's arrival restrictions, along with everyone else's, at the IATA site. It looks like vaccinated travelers to the UK from the US only need to complete two Covid tests after arriving, on days 2 and 8, and fill in forms with location details - presumably so they can be found if someone on their flight turned up positive, or if they fail to show for their required tests.