Saturday, 27 November 2021

On Public Health

 The NZ public hospital system is in crisis. The predicted massive surge of Covid infections, with vulnerable people and the unvaccinated forming the bulk of those needing hospitalisation, could easily tip it into chaos.

If you need any sort of diagnostic procedure or are in need of some sort of elective surgery that is deemed to be non-urgent – and if you don't have insurance or the cash to pay the huge fees of the private sector – you may just have to continue to suffer.

If you are unlucky enough to have a heart attack, a serious accident etc you will be entering a system which has inadequate ICU provision even without a mass of critically ill people with Covid.

THIS is the primary reason for the controls. 

Ardern's government inherited an inadequate public health system and we cannot reasonably blame it for not reversing all the trends of the past forty years – especially not given it has been dealing with a global pandemic for most of its current term – and was hamstrung by a rightwing coalition partner in its first term. 

It's not possible to build, equip, and staff primary health centres and new hospitals in the middle of a global pandemic.

But imagine if all the money that has been poured into wage subsidies, vaccines, tracking systems, PPE etc had been invested in the creation of a proper NHS. One in which there are primary health hubs with a full range of diagnostic equipment and trained staff, a range of auxiliary services, and GPs employed by the NHS, not a privately owned practice with an eye on profit margins. Primary health centres which engage with community health issues, health promotion and disease/injury prevention. 

Well, an old advocate of a socialised, holistic health system can dream.

So this government gets a bit of a pass – but only a bit and none of those which preceded it do. And let's not forget, National has governed for most of the past forty years of neoliberal asset-stripping and diversion of state funds into private pockets.

That Covid-sceptic, Christian doctor up north who claims to care so much about his community – owns the practice, ie it's a business first, health provider second. He cares so much about his Māori community, his practice doesn't even employ a te reo speaker.

So he, and all like him, can sod off with his posturing in the robes of a defender of democratic freedoms, as can all the other medical people who are choosing, not just to be unvaccinated, but who are trying to persuade others to do the same.

Vaccination is one part of the wider approach to managing this virus. The vaccine gives degrees of protection against the Delta variant but it won't necessarily stop you getting it or passing it on. Nor will it stop other vaccine-resistant variants from emerging.

The biggest danger to the public health strategy is that among the vaccine-resisters, there will be a higher proportion of people who are sceptical about the dangers of the virus, and with that about the need for other infection-prevention and control measures, such as masking, hand washing, social distancing, scanning, etc.

Unvaccinated people are statistically more likely to catch the virus and pass it on, including to people who are highly vulnerable because of known or unknown vulnerabilities.. All the evidence points to the fact that an unvaccinated person is more likely to catch and to transmit the virus, to become extremely ill, to need ICU treatment, and to die. It might be their choice, but their choice may well adversely affect other people.

The greatest irony in all this is that the main reason for mass vaccination and control measures like mandates, is the parlous state of the NZ health service. This is not a phenomenon that can be blamed on the Ardern government alone - the erosion of the already compromised principle of free health care (I'm looking at all those self-interested doctors who refused to participate and have leapt on every opportunity since to make money out of the contract culture) – can be laid at the door of successive governments which have enabled the encroachments of the private sector and under-funded the public sector.

Treatment of people with Covid in hospital is massively resource intensive – not just in the ICU – and puts already over stretched and stressed hospital workers at far greater risk of harm. 

Covid-sceptics in Canterbury should be aware that when there is the predicted mass wave of infections as Auckland borders open for the summer exodus – we will see an upsurge down here, not just of mildly sick people, but people ill enough to need to be hospitalised and to be rated in ICU – in a DHB which has now formally closed its waiting lists for any and all non-urgent procedures.

The Canterbury DHB has been upping its triage game over the past year - refusing all diagnostics to anyone not considered by them to be an urgent / acute case. Pretty much the only way into Christchurch public hospital now will be via an ambulance or for life-saving treatment.

And, if you have a heart attack or a serious accident, be prepared to enter a system that will be diverting massive amounts of resources into treating critically ill people with Covid - a high proportion of whom will be vaccine-resisters. A large number of people with Covid will be left to isolate at home and we will see yet more deaths in that scenario. 

So for all those who will now try to blame this government for what is about to happen – if you have never bothered to engage with any of these issues in the past; if you stood by and watched a two-tier health system develop; if you pocketed profits from the sale of publicly owned assets or excused that happening; if you have refused vaccination and/or not taken other infection control measures seriously–-I very politely request that you sod off with your cynical, sceptical, or stupid claims about defending democracy.

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