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On Buying Ventilators, And Expanding The Testing For Covid-19

Before getting into recent developments….. who knew that Covid-19 was so powerful it could make NZ parliamentarians act like adults, and make them pose intelligent questions to officials and Cabinet Ministers about issues of public interest? Wowzah. Yet that’s what happened yesterday during the first session of the Epidemic Response Committee (ERC) which allows the Opposition (and a few backbench MPs) to critically scrutinise the government’s response to Covid-19. If normality ever returns, could we make Parliament be more like this, and less like the usual Question Time circus in the House ?

1.Ventilators. Scarily, we have one of the lowest ratios of ventilators per capita of any country in the developed world. Our public hospitals have only 533 ventilators and there is another 247 in private hospitals and other organisations. Obviously, it is good news that New Zealand has managed to order – successfully, one assumes – some more ventilators on the global market.

On RNZ this morning, Health Minister David Clark indicated that via two separate contracts, a total of 200 extra ventilators have been purchased – believed to be from a factory in China These machines are expected to arrive in about a month. This is welcome news but really, it is still only a drop in the bucket. Arguably, it would take a quadrupling of our current stores of ventilators before anyone could begin to relax.

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So….we have not licked the ventilator problem by getting only 200 more of them. If we still have fewer than 1,000 of these machines, doctors will still shortly be forced to decide who lives, and who dies. As mentioned before in this column, the last resort would be the splitting of the ventilator air flows between multiple patients, and trying (as much as possible) to mitigate the risks to patients at different levels of need, that this desperate procedure would pose.

Yes and ideally ventilators also require ICU beds and staff fully trained in their use and able to devote 24/7 of their time to monitoring them - but this is a far more manageable shortage than getting hold of the machines themselves, given how essential ventilators are to the saving of lives. Covid-19 is a respiratory disease that attacks the lungs, and ventilators either augment or take over entirely the role of the lungs until the body can rally its own forces. There are invasive and non-invasive types of ventilators, and it is currently unclear how our stock – and the new orders – break down between those two categories.

What has been. missing from the equation so far is any sign of the government launching a crash programme to build ventilators here. Thanks to years of effort by the free trade zealots, we’ve gutted our local manufacturing capacity – but even so, Fisher & Paykel Healthcare has R & D based in NZ, hundreds of graduate engineers, relevant technology and production capability including 3D printers. Rocket Labs also have the composite carbon fibre technology, materials & skilled workforce. So….is the government putting them to work to build ventilators? And if not, why not ? Tait Electronics is another possible contributor that comes to mind. Does the veterinary sector have any animal ventilators that might be adaptable for human use?

This stuff is urgent. There is even an argument for openly integrating our private/public hospital systems, at least for the duration of this crisis.

Here with regard to ventilators is what Australia has done :

Australia’s strategy on ventilators has had four main elements. They were:

  • Activate the reserves. This includes drawing on existing equipment, including ventilators currently in veterinary clinics. A separate study in the Medical Journal of Australia found 188 invasive ventilators existed in 120 veterinary facilities, of which 179 were human model ventilators.
  • Purchase from overseas via existing suppliers, including from German company Draeger, which specialises in breathing and protective equipment.
  • Purchase from existing domestic manufacturers, most notably Melbourne-based company Resmed. An order has been placed for 1,000 new Resmed ventilators, and the company says it expects to double or triple its production.
  • Activate additional domestic manufacturers. The AMGC is supporting a consortium of local manufacturers to adopt an existing ventilator design, owned by companies abroad, for onshore production.

Note the activation of the Aussie manufacturer Resmed to build 1,000 extra ventilators locally. According to Channel 9. Holden Special Vehicles in Australia is also retooling its 3D manufacturing to produce ventilators. Where is the leadership and the evidence of a similar effort underway here ? In almost every other realm, we seem to be so dead keen on launching PPPs. 

2. The Backstory. The world shortage of ventilators is a classic example of the folly of allowing the profit motive to dictate the provision for social needs. In 2006, the US began the process of acquiring the 70,000 extra ventilators assessed to be the minimum US need in a pandemic, and a small US firm called Newport won the contract to build – for $3,000 apiece! - a cheap ventilator that would be vastly more affordable than the going price of circa $10,000. The plan was to recoup the production costs by marketing and selling hundreds of thousands of these cheap new machines out on the global market. Every other country after all, had been skimping on their pandemic preparations.

Contracts were signed – but then in 2012, Newport was bought by a huge firm called Covidien which shut down the programme, largely because it was eroding the profits it was making on its existing ventilators. Link below, but :

Government officials and executives at rival ventilator companies said they suspected that Covidien had acquired Newport to prevent it from building a cheaper product that would undermine Covidien’s profits from its existing ventilator business.

The Obama administration tried to find a new supplier, but the process was nowhere near completion when the Covid 19 pandemic arrived. Even now the Trump administration is trying (and failing) to get General Motors and then the Ford Motor Company to build 16,000 ventilators – which is far, far short of the 70,000 ventilators the US had been assessed to be needing back in 2006. The whole story of the Newport/Covidien fiasco is available here.

Plainly, profit motives cannot be allowed any longer to become the over-riding factor on how (and whether) society’s needs get met.

The stalled efforts to create a new class of cheap, easy-to-use ventilators highlight the perils of outsourcing projects with critical public-health implications to private companies; their focus on maximizing profits is not always consistent with the government’s goal of preparing for a future crisis.

Not the nice qualifier : “Not always” … Hey, not ever.

3. Testing. It has taken a while, but Health Minister David Clark has confirmed that testing can be ramped up from the current 7-day rolling average of 1,777, to around 3.700 daily. If that’s truly the case, why not do it now? Clark’s rationale for a gradual ramping up of capacity has never sounded convincing. Part of the testing expansion that’s ( belatedly) being pursued from now onwards will be possible only because the symptoms that qualify for a Covid-19 test have been relaxed.

Thankfully, this means it will no longer be necessary to demonstrate a link to overseas travel or to an infection route directly traceable back to a foreign source. As community transmission ramps up, asking the virus for its passport no longer seems sensible.. So from now on …if your GP assesses your symptoms as justifying a referral for testing, that clinical judgement will (hopefully) not be at risk anymore of getting over-ruled by someone down at the testing station.

Why have our testing criteria been so restrictive for so long ? Well….open-ended testing from the outset would have quickly overwhelmed our supply of the re-agent swabs required to do the tests. Not anymore, allegedly. As Health Minister David Clark told the Epidemic Response Committee yesterday, we have 35,000 test kits in hand, with 30,000 more of them due next week., and more on order. In reply to a question, Clark said that the test kits/swabs are not a “constraint” on testing. Not anymore, at least.

Globally, there are two basic kinds of Covid-19 tests. The standard PCR-RT test that we use takes a nasal or lung mucus swab to detect the presence of the virus, but it can still take days to process/convey the results. The Holy Grail is to develop a reliable, simple test (akin to a pregnancy test) that can use say, a blood sample to detect the presence of the antibodies that the body is rallying to combat the invading virus.

As you would expect, this blood serum test is less accurate if it is done early – before the antibodies have assembled in force – than it is later on. The evidence from Spain and the Czech Republic suggests that these blood-based kits can deliver false negatives at rates of between 20-30 percent. Reportedly, there is hope on the horizon on Covid-19 rapid testing though, via Abbott Pharmaceuticals, which yesterday got a production greenlight from the FDA for its Covid-19 instant testing apparatus : 

Abbott is launching a rapid coronavirus test able to deliver positive results in as little as five minutes from a tabletop box the size of a small toaster oven. Weighing less than seven pounds, the company’s ID NOW diagnostic can be run just about anywhere, inside or outside of a hospital…The FDA granted the molecular system an emergency authorization for use against COVID-19, and Abbott said it is currently ramping up production with plans to deliver 50,000 tests per day starting next week.

Currently if the number of test kits we have available are not a constraint…we should go all out. Given that community transmission is ramping up, we need to be actively and pre-emptively carrying out regular testing sample surveys to detect the extent and location of community infection nests.

4. Aussie Rules. As you may have heard, Australia has finally recognised that if Kiwis live and work in Australia and pay taxes and contribute to the economy and their community, they deserve help when a crisis hits. Finally, Aussie PM Scott Morrison has responded to NZ entreaties and included Kiwi workers in the JobKeeper wage subsidy relief package. 

At first blush, it looked as though only fulltime workers employed as of March 1st would be eligible, but the ABC has since confirmed that the subsidy net will be cast wider :

Full-time workers, part-time employees, sole traders and casuals (who've been at the company or not-for-profit for at least one year) can have their wages subsidised if they were with the organisation on March 1.

Interestingly, New Zealand put its wage subsidy scheme in place almost overnight – and despite a few glitches, the vast bulk of the money began flowing very, very quickly. By contrast, Australia’s more generous wage subsidy scheme will not be able to start payments until early May, though these will be back-dated until Match 30.

Anything is better than nothing, and the wage subsidy will certainly help many of the circa 300,000 Kiwis potentially in need of some form of employment support. Yet it is still just crumbs from the table. As non-citizens, tax-paying New Zealanders in Australia will still be shut out from welfare support, and will still be denied any meaningful path to citizenship. (Since 2016, being able to prove that you’ve earned $A53,900 or more in each of the preceding four years is necessary for even filing a citizenship application.)

Contrast this with the welfare support, the right to vote and the path to citizenship that we generously extend to Australians living over here. They can file for unemployment benefits after being here for two years, can vote after a year, and can file for citizenship after five years. To repeat: yes, it is very nice that Kiwis who have been living and working and paying taxes in Australia for years will be given access to the JobKeeper wage subsidy scheme, even if they’re only casuals and part-timers in the gig economy over there.

Yet the grim prospect is that once the JobKeeper subsidy scheme expires and more firms continue to fold, there are many, many Kiwis in Australia who are likely to be back on the unemployment scrap heap, and still without access to any income support from the Australian welfare system. Basically, we need to ensure that the JobKeeper concession isn’t the beginning and the end of the Australian response to our people.

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