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.