NZ hospitals brace for delta wave
The government warns that case numbers will increase sharply in the coming weeks and most Covid-positive cases will need to start isolating at home
Mōrena and welcome to The Bulletin for Friday, October 15, by Justin Giovannetti. Presented in partnership with Z Energy.
In today’s edition: Illegal gatherings in Auckland driving case increases; NZ battery project moves closer to construction; Wellington approves downtown density; but first, are the country’s ICUs ready for a surge in cases?
The government and ICU specialists can’t agree on whether the system is ready (Sudok1/Getty)
Preparing for the next phase of the delta outbreak. Cases numbers in Auckland are expected to double over the next fortnight, to around 140 a day, as the delta resurgence in the city is on track to surpass the outbreak’s August peak. Caroline McElnay, the director of public health, issued a sober warning yesterday that the country’s contact tracing system will begin buckling once daily cases surpass 170 a day. As those numbers continue to climb, and pressure mounts on the health system, what will begin to matter more is the number of intensive care beds that are in use and available. Auckland’s vaccination rates have plateaued around 87% for first doses, shy of the number needed to achieve widespread immunity. Officials at the Beehive and the country’s DHBs are now focused on preparing the health care system for what’s to come.
The end of elimination means a pivot away from hospital care. Bridie Witton reports for Stuff that modelling for the Ministry of Health now warns that up to 5,300 cases a week, around 740 a day, could be reported in the Auckland and Northland regions next year as restrictions ease, even with a 90% vaccination rate. Most positive cases are now going to quarantine-facilities established for returnees from overseas. To take stress off a border system that would be overwhelmed, the government is now preparing to manage up to 95% of future Covid cases at home. Nurses and GPs could monitor patients remotely, but the days of quarantine at dedicated facilities for community cases is nearly over.
Speaking with the NZ Herald, Covid-19 response minister Chris Hipkins said low risk positive cases can self-isolate from today. The move likely means a faster than expected change to border facilities, where the minister said the vast majority of returnees are Covid free. Coming at the end of two weeks of extensive tinkering with the Covid-19 strategy, it’s another dramatic change to how the country is handling the virus.
The health minister is confident ICUs can handle a coming wave. Andrew Little said yesterday that only 0.2 to 0.4% of delta patients will be sick enough to need ICU care and the system will cope. According to RNZ, ICUs are now running at roughly two-thirds of capacity in Auckland and 16% of ventilators are being used. Of the 133 ICU and high-dependency unit beds across Auckland’s hospital network, about 90 are currently occupied, five by Covid-19 cases. Little said that the number of ICU spaces can be surged to about 550 beds nationally. To prepare, DHBs have followed guidance from the UK’s National Health Service. They have given nurses a crash course in ICU work and drawn up plans to move other patients out of hospitals as more ICU beds would take up much more room, possibly taking over operating theatres.
The real measure of ICU is not available beds, it’s all about the staff. ICU spaces are staffed by highly-trained nurses around the clock, especially when ventilation is required. The number of staff and patients is generally around one for one. According to the NZ Herald, doctors are challenging the minister’s assertion that about 100 new ICU beds have been staffed since the pandemic began and the system is ready. Two of the country’s senior most ICU specialists told Newshub last week that they’re concerned the system could be overwhelmed in an outbreak “We have a limited ability to flex. We will keep going until we run out of breathing machines,” one of them said.
The biggest problem can’t be fixed in time. While the government can buy beds and ventilators, it can’t buy staff—although it is planning to allow more doctors and nurses through the border system eventually. An ICU nurse needs up to five years of specialist training, while a doctor needs nearly a decade. Significant underinvestment before the outbreak meant that Australia has twice as many ICU beds per capita as New Zealand. The UK has nearly 50% more beds, per capita, as New Zealand. The College of Intensive Care Medicine of Australia and New Zealand warned in August that while health staff were preparing for an outbreak, “New Zealand does not have the buffer of empty beds or staff that other countries may have had, but we have learned many lessons from our colleagues overseas”.
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Indoor gatherings in Auckland are causing cases to spike. That’s the deputy prime minister’s message, according to RNZ, after 71 cases were detected yesterday in the city. With few infections happing in workplaces open under level three, Grant Robertson said that people getting together indoors is causing the virus to spread. No single area of the city is to blame as infections have been detected across the width of Auckland. “Now is not the time for complacency,” Robertson warned. In return, some Aucklanders have called for more clarity from the government around the rules.
The Covid numbers: There are 33 cases in hospital and 5 in ICU/HDU. There are now 599 active cases in New Zealand, 71 new community cases were reported yesterday, all in Auckland. 68,787 people were vaccinated on Wednesday.
The Spinoff’s Covid data tracker has the latest figures.
Wait, why did Stuart Nash take his shirt off? The Spinoff’s Mad Chapman called the government minister to get a straight answer on his shirtless vax picture. The vaccine portrait is usually done afterwards with a smile and thumbs up. Sometimes it’s taken during the jab, with a stoic expression. Nash did things different. After hurting his back at the gym, the minister rolled up to his second jab in a tight business shirt, and then one thing leads to another.
New Zealand’s giant battery is moving closer to reality. Several companies have been given contracts to study the feasibility of the government’s plan to turn Lake Onslow into a giant liquid energy storage system, according to the Otago Daily Times. The idea is to pump water up into an enlarged lake when power is cheap and let it flow back through a turbine when needed. Similar systems exist around the world and they are increasingly essential as we rely more on renewable power. Studies will now ensure the concept would work at Onslow.
The Spinoff is now accepting applications for The Next Page, a new mentorship programme for three emerging feature writers to work full-time for 23 weeks in 2022 across a range of publications. Nau mai, haere mai!
As part of the programme, The Spinoff is also hosting two online events in October where you’ll get to hear from some of the editors and journalists you might be working with—their journey, the challenges and their advice—and to ask any questions you might have. Register here for the first event on October 20.
Wellington to allow more density as part of housing plan. The Dominion Post reports that the capital city has unveiled a massive overhaul of its planning rules after a vote on its spatial plan earlier in the year. New builds in the central city will need to be at least six storeys high, capped at 12 storeys in Te Aro. The plan should allow for the creation of thousands of new housing units in a city that desperately needs them.
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Right now on The Spinoff: Toby Morris returns with the latest instalment of the Side Eye looking at the Pacific pay gap. Reweti Kohere covers all your fashion needs for when you get the jab. Emily Writes explores programmes teaching mindfulness in primary and intermediate schools across the country. Bernard Hickey reports on the quarter of a million, mostly young, New Zealanders dabbling in cryptocurrencies. Tara Ward looks at the new season of the Great Kiwi Bake Off, the moistest show on TV.
For a longer read today, the country’s legal aid system is failing. RNZ has run a series looking at the legal aid system, something that isn’t often front of mind, but makes a massive difference to those who need it. The series finds that as government support has stagnated, the system has fallen deeper into disrepair. The chief justice warns that legal aid is on the edge of failure. In the final instalment, RNZ looks at a decision that means people eligible for legal aid a decade ago, like those on minimum wage and pensioners, no longer are. Here’s a sample:
So, what happens to those that don't qualify for legal aid? Lawyers fees are beyond the reach of many. The most recent survey conducted by the New Zealand Law Society took place in 2016. It found the average hourly rate for a lawyer working at a law firm was $292.70, add GST and it's more than $330.
In an Official Information Act request RNZ asked how Legal Aid Services figured that a person earning $23,821 per year had sufficient means to engage a lawyer.
An All Blacks legend for Ngāti Porou East Coast. Ma’a Nonu, the 103-test All Blacks great, will join the team in Ruatoria on Saturday in a bid to break an eight-year, 54 game losing streak, Stuff reports. Nonu left the All Blacks in 2015, the Blues in 2019 and has appeared with American and French teams since. Nonu signed up on one condition, that coach Hosea Gear would come out of retirement and join him.
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