There are no answers, only trade-offs

Dr Eric Crampton
Insights Newsletter
3 September, 2021

Politics is hard when every available option is terrible. Get ready for a year of awful choices.

If borders remain closed after the vaccination rollout, split families will face insurmountable costs. Many skilled migrants stuck on temporary visas in immigration queues, including some 3000 doctors and nurses, will leave. Business connections will atrophy. Trading nations cannot isolate themselves from the world forever.

If borders ease, Covid outbreaks become inevitable unless vaccination is close to universal, according to work in The Lancet modelling effects of ten daily Covid-positive arrivals. MIQ has sometimes reported ten daily cases.

If 90% of us, and almost everyone in high-risk groups, were vaccinated, peak daily hospital admissions might be held to only 36. But more than 10% of the population is younger than 12.

Thirty-six daily hospitalisations might mean about five new ICU cases per day. ICU beds are scarce – New Zealand has far less ICU capacity than other OECD countries. Covid patients spend a long time in ICU. Inevitably, non-Covid patients would be unable to access critical treatment. Auckland’s outbreak is already sending non-Covid ICU patients elsewhere while Auckland seeks ICU staff from other regions.

More vigorous measures could encourage or compel vaccination so the vaccine-averse take up fewer ICU spaces in any outbreak. Absent those measures, is it worse to deny treatment to accident victims and heart attack patients when ICU is full, or simply to close hospital doors to the wilfully-unvaccinated needing Covid treatment? Vaccination mandates are bad. Realistic alternatives seem worse.

The government can take steps, now, to make each option less bad.

Effective therapeutics are being ordered, used, and stockpiled overseas. Ordering them now would avoid our being at the back of yet another queue and help keep people out of ICU.

The Government could end the blanket ban on point-of-care antigen tests, enabling appropriate use at essential workplaces.

Public health orders could ensure vaccination of workers in health, schools, and early childhood education who deal with vulnerable and unvaccinated people.

And the Government could decide to treat migrants less horribly, so we might attract ICU staff rather than driving skilled medical professionals away.

On Tuesday, Waikato University’s Professor of Laws Alexander Gillespie started the conversation by noting some of these terrible trade-offs in the Stuff newspapers. Every option is bad, and every one of them will only get worse if the government delays weighing them.

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