Australian Reports of the Virus Spread

[HappyFlyerFamily]

A few observations on this if we were going to hit the wall:

• you'd see more interventions and lockdown controls implemented (despite the rhetoric they have more cards they can play around critical work)
  
  
• there's probably more higher-urgency elective surgery that can be deferred as people end up in ICU
  
  
• more sources of ICU can be choked off e.g. banning construction to reduce accidents and extending the curfew to more areas to reduce other types of crime or motor vehicle accidents
  
  
• the commonwealth would offer help such as ADF and AusMAT
  
  
• some of the incoming caseload will resolve one way or the other (recovered or death)

I highly doubt the NSW Government will do anything further lockdown/restrictions this side of 70% fully vaccinated. Its a case of lump it or leave it now.

I do see the possibility of ADF and AusMAT help staffing as a possibility, and the more you get over time, then there is a demonstrated case of needing a tightening of lockdown (in the post-80% fully vaccinated Australia).

 

[justinbrett]

I highly doubt the NSW Government will do anything further lockdown/restrictions this side of 70% fully vaccinated. Its a case of lump it or leave it now.

I do see the possibility of ADF and AusMAT help staffing as a possibility, and the more you get over time, then there is a demonstrated case of needing a tightening of lockdown (in the post-80% fully vaccinated Australia).

Except haircuts. That's being announced this week.

 

[antycbr]

I highly doubt the NSW Government will do anything further lockdown/restrictions this side of 70% fully vaccinated. Its a case of lump it or leave it now.

I do see the possibility of ADF and AusMAT help staffing as a possibility, and the more you get over time, then there is a demonstrated case of needing a tightening of lockdown (in the post-80% fully vaccinated Australia).

Yeah there's not much left in the tank in the LGAs of concern without pushing compliance down, it's a balancing act.

 

[HappyFlyerFamily]

Regardless what figure you want to use, the takeaway message is we still have plenty of capacity and it's not yet time to be concerned, regardless of what the headlines are on news.com.au. We just need to keep the vaccinate rate up and then we've got this in the bag.

I made no reference to news.com.au for this matter. I actually don't recall any news.com.au on this issue actually. Thanks.

You might not be concerned - but if you regard 420 as a problem, the lagging increase in ICU bed use for covid now would be a concern - you can't just stand up ICU beds in an instant.

 

[justinbrett]

Yeah there's not much left in the tank in the LGAs of concern without pushing compliance down, it's a balancing act.

Yes, no haircuts for them.

 

[SydneySwan]

Given what the ICU doctor at the recent NSW authorities press conference said - patients are staying longer in ICU as well.

I think this is the critical point. I can't remember where I read or heard it but Covid ICU patients average 9-10 days in ICU whereas regular ICU patients tend to average 3 days. So Covid ICU patients have an enormous impact on ICU bed utilisation and turnaround times.

 

[Seat0B]

We had no illness while daycare was restricted to permitted workers. Within a week of it being open to all, Miss TomCat got sick. The last two months she has rolled from one illness to another via daycare, and our five month old ended up with bronchiolitis. I’ve now got whatever she had

Oh I remember those days when the Seat children were in daycare. It's a tough time for everyone. The only light at the end of the tunnel with it is that at least their immune systems are gaining from the exposures. Family and friends who are teachers say that they can tell the Kindy/Prep/first year of real school whatever it's called in your country (formerly known as a state or territory of Australia) kids who did not go to daycare as they are the ones always sick in that first year.

Sending you hugs and wishes for a speedy recovery @blackcat20. It sucks to be a sick parent in charge of sick kids.

 

[justinbrett]

I made no reference to news.com.au for this matter. I actually don't recall any news.com.au on this issue actually. Thanks.

You might not be concerned - but if you regard 420 as a problem, the lagging increase in ICU bed use for covid now would be a concern - you can't just stand up ICU beds in an instant.

I didn't say you did refer to news.com.au but this line of fearmongering is what they do. Not saying you are fearmongering (I think you are genuinely concerned), but I think it is misplaced.

You completely missed the facts that ICU and ventilation are growing at a slower rate than hospitalisation and active cases, so the lag is not a factor. Even if they grew at the same rate we still have many, many weeks to reach the 420 number.

It is already getting better.

 

[lovetravellingoz]

beyond that?

The "beyond that" in terms of living with Covid post 80% vaccination rate is likely to become a resourcing issue with retaining healthcare workers to work in what will be ongoing facilities, or at least in first 6 months or so while vaccination rates keep edging up. Though until we are actually there the actual patient load is unknown.

A number of my friends and family have worked in the covid wards when covid patients were being treated.

All are ok with their normal working environments, which in one cases includes infectious diseases, and all quite happily did what they needed to do when the various covid surges were on. They are very giving and community minded people.

However working in a covid ward is most unpleasant and draining and none would wish to keeping working in such an environment as a permanent state of affairs. And the reasons are not just that the work is more physically draining and taxing, it is also aspects such as that the heightened infection protocols interfere with the normal staff interactions including the social interactions that we all like to enjoy at work. The work is less satisfying and life is a lot less enjoyable and fun. They are also very mindful of their own friends and family.

Now I am not saying that staff will not be found, just that permanent covid wards duties are not likely to be a sought after placement.

 

[teammongo]

ICU for covid is currently only using around 8% of NSW ICU beds - so let's not get carried away here.

That was 5 days ago. As per NSW health, there are

• 39 public general/combined ICUs with a proportion of units also accommodating quaternary service beds for severe burns, acute spinal injury, organ transplantation and ECMO (provided by 9 adult and 3 paediatric ICUs)*
• 22 private ICUs with 8 providing specialist cardiothoracic intensive care beds and 1 providing specialist neurosurgery intensive care beds
• 2 private high dependency units (HDUs).

* Total number of commissioned adult ICU beds as of July 2021 – 592 (level 4/5/6).
There are currently (25Aug) 113 ICU cases. IE 113/592 = 19%.

ICU and ventilator rates are growing slower than the hospitalisation rates, and certainly slower than the case rates (yes yes, I know there's a lag, but cases have been very consistent at 1.3 for a long time).

So The rate is NOT certainly slower - it is approximaterly 20% of all hospitalisations, but increases by the same rate as Reff of about 1.3.

The shedable load (ie load that can be decreased by stopping elective surgery) is about 30-40%. The other beds are taken by other sick patients such as trauma, heart attacks, sepsis etc.
So when ICU cases hit about 200 there will be no capacity at current resourcing, and surge capacity will be required. Australia has 191 ICUs with 2378 available intensive care beds during baseline activity, (9.4 ICU beds per 100,000 population). Usual staffing is about 1.1 Nurse per bed for 8 or 12 hour shifts. When sick and recreation leave is factored in you need about 8-10 nurses per staffed ICU bed.

Surge capacity is 4258 intensive care beds (191% increase) and 2631 invasive ventilators (120% increase). This could require up to an additional 4092 senior doctors (325% increase over baseline), and 42,720 registered ICU nurses (365% increase over baseline). There are approximately only about 100,000 nurses in NSW, the largest state. This includes medical, surgical, rehab, aged care. They are the nurses who will be looking after you, not a specialist ICU nurse.

The next few weeks will be very hard for NSW, and our thoughts are with you.

Please don't underestimate COVID.

TM

 

[HappyFlyerFamily]

I didn't say you did refer to news.com.au but this line of fearmongering is what they do. Not saying you are fearmongering (I think you are genuinely concerned), but I think it is misplaced.

You completely missed the facts that ICU and ventilation are growing at a slower rate than hospitalisation and active cases, so the lag is not a factor. Even if they grew at the same rate we still have many, many weeks to reach the 420 number.

It is already getting better.

Well your previous post referring to news.com.au could be much better written.

Here is the current NSW numbers - ICU and ventilators for the past 10 days - so everyone can make their own mind up.

16-Aug​	66​	28​
17-Aug​	69​	24​
18-Aug​	77​	25​
19-Aug​	82​	25​
20-Aug​	80​	27​
21-Aug​	85​	29​
22-Aug​	92​	31​
23-Aug​	100​	32​
24-Aug​	107​	34​
25-Aug​	113​	40​

 

[lovetravellingoz]

I think this is the critical point. I can't remember where I read or heard it but Covid ICU patients average 9-10 days in ICU whereas regular ICU patients tend to average 3 days. So Covid ICU patients have an enormous impact on ICU bed utilisation and turnaround times.

And it is not just the time Covid patients are in the ICU, it is also the total time they are in to hospital pre and post ICU.

Some Covid patients can remain in hospital for a long period of time whether they go into ICU or not.

 

[oznflfan]

The "beyond that" in terms of living with Covid post 80% vaccination rate is likely to become a resourcing issue with retaining healthcare workers to work in what will be ongoing facilities, or at least in first 6 months or so while vaccination rates keep edging up. Though until we are actually there the actual patient load is unknown.

A number of my friends and family have worked in the covid wards when covid patients were being treated.

All are ok with their normal working environments, which in one cases includes infectious diseases, and all quite happily did what they needed to do when the various covid surges were on. They are very giving and community minded people.

However working in a covid ward is most unpleasant and draining and none would wish to keeping working in such an environment as a permanent state of affairs. And the reasons are not just that the work is more physically draining and taxing, it is also aspects such as that the heightened infection protocols interfere with the normal staff interactions including the social interactions that we all like to enjoy at work. The work is less satisfying and life is a lot less enjoyable and fun. They are also very mindful of their own friends and family.

Now I am not saying that staff will not be found, just that permanent covid wards duties are not likely to be a sought after placement.

Everyone on a COVID ward gets $200 per day COVID resilience payment, tax free. Over and above normal salary/wages. Government can afford that, very small bikkies compared to the millions they spend now.

 

[justinbrett]

Well your previous post referring to news.com.au could be much better written.

Here is the current NSW numbers - ICU and ventilators for the past 10 days - so everyone can make their own mind up.

16-Aug​	66​	28​
17-Aug​	69​	24​
18-Aug​	77​	25​
19-Aug​	82​	25​
20-Aug​	80​	27​
21-Aug​	85​	29​
22-Aug​	92​	31​
23-Aug​	100​	32​
24-Aug​	107​	34​
25-Aug​	113​	40​

Might be better to look at the complete picture, considering that at the end of July, ICU was in the high 50s and ventilators in the high 20s.

I think there's some selective interpretation of the numbers, so I won't comment any further. Those looking for doom and gloom are welcome to do so, but it doesn't make it so, and it certainly doesn't help.

 

[moa999]

So other than haircuts what are views on what else might be relaxed for fully vaccinated?

My other thought, relating more to the mental health aspect, is possibly outdoor swimming pools.
Think indoor pools and gyms still to much of a risk.

 

[jrfsp]

So other than haircuts what are views on what else might be relaxed for fully vaccinated?

My other thought, relating more to the mental health aspect, is possibly outdoor swimming pools.
Think indoor pools and gyms still to much of a risk.

Surely outdoor hospitality, seated only.

 

[justinbrett]

So other than haircuts what are views on what else might be relaxed for fully vaccinated?

My other thought, relating more to the mental health aspect, is possibly outdoor swimming pools.
Think indoor pools and gyms still to much of a risk.

Gladys is saying it's just one thing.

But I think they are also talking about return to school plan, but that won't be starting in September.

 

[HappyFlyerFamily]

So other than haircuts what are views on what else might be relaxed for fully vaccinated?

My other thought, relating more to the mental health aspect, is possibly outdoor swimming pools.
Think indoor pools and gyms still to much of a risk.

Its likely the NSW Government would be ridiculed if it was just hairdressers/barbers and nail salons.

I think whatever is suggested needs to consider the complexities to police enforcement. For example, household limits could be easily increased where everyone (except children) are fully vaccinated.

Outdoor exercise in groups of say up to 5 will create a lot of complexity - and potentially more will just mistakenly (or "intended confusion") choose to join in even though some might be half-vaccinated.

More than 1 shopping when fully vaccinated. Personal/health services like dentist, physio, chiro re-open,

The other examples are quite difficult to administer (do you need all customer-facing staff to be fully vaccinated to allow outdoor dining?)

Given the NSW CHO indicated the full effect of the 6m jabs might not be seen in case numbers until mid-September, I actually think the simple easings won't commence until 15 September at the earliest.

Further afield, I think vaccinated (may be one dose) HSC students will be allowed to attend required school classes (like practicals) in term 3 - then all HSC students (both vaccinated and unvaccinated) for the 4 weeks of exams in Term 4. Then after HSC finishes the rest of high school. Primary to recommence in Term 4.

 

[pagingjoan]

Just as well the AFF community is not responsible for drawing up the Public Health orders.
Can you imagine that exercise?

 

[SydneySwan]

I can't help but think that the NSW Govt have created expectations about the 'óne' additional freedom for the vaccinated that they simply won't be able to deliver on. I am preparing to be completely underwhelmed and expect that internally they wish Gladys had never floated the idea.

You can rule out opening places like nail salons as they are used by primarily one gender and are predominantly staffed by young ladies who won't in the main be fully vaccinated. I imagine it will be something token like allowing 2 people to go shopping.