Lockdown could be maintained ‘for a long while’

New Zealand has just started the second week of a four week lockdown, (which means isolation at home with exceptions for essential activities). But this always looked like an initial period, and there are more signs that it could extend for some time longer in some parts of the country at least as it has emerged that the plan here is to try to ‘stamp out’ the Covid-19 virus.

That could see lockdown maintained “for a long while”.

Stuff: Government says it has no plan B if lockdown fails to stamp out Covid-19

Health Director General Ashley Bloomfield told reporters on Thursday that the Government would keep the country or parts of it in lockdown for as long as possible to “stamp out” Covid-19.

“One of our key drivers on this has been to protect our healthcare system, protect our population – keep them well – and to not see the number of deaths modelling suggested would happen. We didn’t see that as tenable.”

Some  non-health people see the initial impact on the economy as untenable (with some justification), let alone the impact on businesses and jobs if there’s an extended lockdown.

Asked again if there was any backup plan, Bloomfield said the Government was “in the plan” and that could see lockdown maintained for a long while.

“Well we are in the plan. The plan is the plan, isn’t it. That’s why we’ve got alert level 4. If we need to we will keep the measures in place until we see that dropoff in cases. We will then maintain that long-term stamp-it-out phase.”

He referred back to the pandemic influenza plan which has acted as a blueprint for government action, but said the Government had essentially decided to stay away from the phase of that plan where the disease was “managed”.

“We decided we didn’t want to move to manage it. We wanted to stay in an extended keep it out, stamp it out phase. And the stamp it out we are trying to do at the moment is stamp it out altogether.”

But can we afford (economically and socially) to wait an extended time to see if our approach works?

University of Otago epidemiologist Nick Wilson, who has worked on the models for the Government, said on Tuesday that the Government needed clarity around a Plan A and a Plan B if it failed.

This might involve all older people staying in lockdown but other age groups restarting something closer to normal life.

Bloomfield said the Government was currently working out what exactly the conditions would need to be for either the whole country or parts of it to exit the level 4 lockdown.

He expected this work would be completed in the next few days.

So they don’t know yet. They have had to make big decisions based on limited information in a very short space of time, but we should be given a reasonable idea of what to expect over the next few months and for the rest of the year.

ODT: South may face Level 4 lockdown for longer

The Southern District Health Board amassed 10 new cases yesterday, and director-general of health Ashley Bloomfield advised the amount of cases due to community transmission was higher than previously stated.

They don’t even knoiw the amount of community transmission due to fairly narrow criteria for testing up until now.

Further, he said the Government was just now looking at how the spread of the coronavirus might indicate when lockdown restrictions could be eased.

“The goal is to get the number of cases right down again, and as soon as we can.

“We want to be able to release, or step down from, Alert Level 4 to Alert Level 3.

“It may well be that we are not able to do that in every part of the country at the same time, as one possible scenario,” Dr Bloomfield said.

The Southern district (Otago and Southland) has the highest number of cases in total and by far the highest number per population so we could be well down the de-lockdown list. Personally this doesn’t worry me, I can keep working from home if the rest of the country cranks up and there’s work to do. But the situation is a lot trickier for many people.

Australia has not taken as drastic action as here, but Prime Minister Scott Morrison has warned of ‘the long haul’: Scott Morrison scraps childcare fees while warning Australia to brace for six months of upheaval

Morrison declined to be specific when asked on Thursday when Australia’s international border might reopen or other strict restrictions on public gatherings might be lifted. But he took the opportunity to urge Australia to “stay together” and brace for the long haul, ahead of another meeting of the national cabinet on Friday.

“There is a new normal here in Australia and it’s one that we now need to get used to and settle into for that haul over the next six months,” Morrison said. “That is something that will go against the grain for so many, but we adapt. We can change the way we live, but it doesn’t change who we are.”

Morrison said he is the only leader in the world talking about a much longer timeframe.

I’ve just heard Morrison on RNZ in response to questions about opening borders to the US, UK and Europe: “It is likely to be at least six months, It could be longer.”

It’s time for Jacinda Ardern to be giving us in New Zealand a clear indication of her expectations of timeframes in lockdown and reduced to Level 3. If it’s doing to be ‘a long while’ we should know about it.

 

NZ academics argue over Covid-19

There are a number of contentious aspects of the Covid-19 pandemic, in particular how stringent restrictions should be on travel and on home isolation, and the economic management and effects. There is a lot to debate.

Some New Zealand academics have been doing their debating in public, which is generally a good thing, these are important issues that need to be openly discussed.

Newsroom: Navigating a public spat between scientists

A scientific spat over Covid-19 reached peak contrarian yesterday thanks to the country’s contrarian-in-chief, Mike Hosking.

Following a Stuff opinion piece that said “We don’t want to squash a flea with a sledgehammer and bring the house down”, University of Auckland senior lecturer and epidemiologist Simon Thornley explained his views on Newstalk ZB.

He told broadcaster Hosking overall mortality figures in heavily affected countries haven’t gone up, concluding: “These deaths are occurring in people who are running out of time.”

“Exactly,” one-man-reckon-machine Hosking responded. “They were going to die anyway and something was going to get them. It just happens, now, to have been this. Or maybe it wasn’t. Or maybe this exacerbated it. Or maybe this complicated it.”

(Or maybe the fact these people were going to die “anyway”, of something, sometime, is a statistical irrelevance in a society that cares about preserving life and protecting the public from preventable causes of death.)

Thornley’s column angered arguably our country’s most prominent scientist, Siouxsie Wiles, who tweeted on Tuesday: “For anyone who comes across the opinion piece of an epidemiologist suggesting lockdown is like using a sledgehammer to hit a flea: he studies diet not infectious diseases. Don’t listen to his reckons.”

She later apologised for making it personal, albeit without naming Thornley. Not before Auckland University of Technology Professor of Public Health Grant Schofield jumped in to back Thornley. Schofield, too, made it personal.

Accusing someone of being out of their scientific “lane” without discussing data wasn’t acceptable, he said on Twitter, adding: “Some would criticise you a microbiologist in public health.”

Wiles tells Newsroom it’s fair to question her credentials. “But I am doing my best to stay on top of the literature, which it would appear others are not. And have also changed my position as the evidence has changed and explained why.”

She says her frustration was sparked by “a piece that used old data disingenuously to strongly push a message that has the potential to lead to people’s deaths by undermining the lockdown”.

Thornley, meanwhile, says science, at its heart, is about open and honest debate. “That is what I intended to bring to this discussion, which, I believe, has been very one-sided.”

Schofield maintains he’s all for the lockdown but he’s also for robust, and civil, scientific debate. He was disappointed that Wiles used her authority not for scientific argument but to dismiss science she didn’t agree with.

“There is considerable uncertainty,” Schofield says. “[Thornley] is the single smartest guy I know, and he does have some challenging and possibly inconvenient truths about the uncertainty.”

The article then goes on to ‘weigh the evidence’ in some detail.

One aspect of Thornley’s article was quite questionable due to being too soon to call about the far more relaxed approach that Sweden had taken – see Sweden’s different Covid strategy looks shaky.

After making his “squash a flea with a sledgehammer” comment, he wrote in his Stuff story that he believed other countries, such as Sweden, are steering a more “sensible course”. He linked to a Guardian article, which mentions schools, kindergartens, bars, restaurants, ski resorts, sports clubs, and hairdressers remain open, unlike in neighbouring Denmark and Norway.

The Swedish Prime Minister, Stefan Löfven, has said coping with Covid-19 is about commonsense behaviour. “We all, as individuals, have to take responsibility. We can’t legislate and ban everything,” That country’s Public Health Agency’s position has been criticised in a joint letter from 2000 Swedish university researchers.

On Monday, in another Guardian article, Professor Cecilia Söderberg-Nauclér, a virus immunology researcher at Sweden’s Karolinska Institute, said: “We’re not testing enough, we’re not tracking, we’re not isolating enough – we have let the virus loose.” She concluded: “They are leading us to catastrophe.”

Comparing Sweden, Denmark, and Norway on coronavirus counter worldometers.com shows a concerning trend. Norway (4651) has more confirmed cases than Sweden (4435), but fewer deaths – 39 versus 180. Seventy of those Swedish deaths were reported on March 30 and 31. Denmark, meanwhile, has 90 deaths but far fewer cases than Sweden, at 2860.

Current numbers on those countries:

  • Sweden 282 deaths, 28 per million (population)
  • Denmark 123 deaths, 21 per million
  • Norway 50 deaths, 9 per million

Note that these are just snapshots and can be misleading as different countries are at different stages on Covid spread and effect.

Sweden was recently looking relatively good but over the last few days has surged as the curves (cases and deaths) swing upwards – see https://www.worldometers.info/coronavirus/country/sweden/

It will actually be months before we can really compare countries and try to see what approaches were most successful at minimising health issues and deaths as well as minimising the economic effects.

More from Newsroom: Lockdowns spark bad faith backlash

No one was more surprised to see that Neil Ferguson, the author of a groundbreaking paper on how to stop Covid-19, had walked back his dire projections on the anticipated death toll of the virus than Ferguson himself.

The Imperial College London academic, whose paper changed government policy towards Covid-19 in nations worldwide – including New Zealand – told a British parliamentary committee that, with the advent of the United Kingdom’s lockdown, he expected the death toll to be in the range of 20,000.

Critics then leapt on this statement, arguing that because Ferguson had previously predicted a death toll of 250,000 for the UK, he had now substantially walked back his estimates. Former New York Times journalist Alex Berenson, recently famous for publishing a book on cannabis and violence that was widely-panned as inaccurate, took to Twitter to make this argument.

It then went viral on right-wing websites like the Daily Wire and the Washington Times, the first of which has substantially edited its article in the face of fact-checking from more authoritative sources.

As the Financial Times explains, Ferguson didn’t revise his prediction at all – in fact, the 20,000 deaths figure was directly taken from his original report. This was the estimated toll if the United Kingdom engaged in the strict suppression measures – closing schools and most workplaces – that it ultimately has, whereas 250,000 deaths were anticipated if the UK took no action whatsoever.

Misinformation circulated online is a major problem generally, especially when it influences presidents.

In the United States, an article by highly-cited libertarian legal scholar and climate change denier Richard Epstein has buoyed an anti-lockdown faction within the White House. The March 16 article, titled “Coronavirus Perspective”, sought to contextualise what Epstein saw as a massive overreaction to Covid-19, which he thought would only kill 500 Americans.

Epstein now says he made a minor error while calculating this figure and has offered 5,000 as the final death toll. As of Thursday morning in New Zealand, more than 4,700 Americans have been killed by the virus and there are no signs of this slowing. Even Donald Trump now admits a far higher toll is likely – his goal is to limit deaths to 100,000, although they could rise as high as 240,000.

“Coronavirus Perspective” emboldened the anti-lockdown faction in Trump’s inner circle and lead to musings from Trump of lifting mitigation and lockdown measures by Easter. “We’re opening up this incredible country, because we have to do that. I would love to have it open by Easter,” Trump said on March 24, as the US death toll hit 706.

Evidently, more rational heads within the administration have managed to steer Trump back towards a strategy that avoided opening up the President to accusations of leading a death cult, but Epstein still took the time to defend his work in a March 30 interview with The New Yorker‘s Isaac Chotiner.

In defending his sloppy math, Epstein turned to bunk science, saying there are multiple strains of the virus – a stronger one that kills more people and a weaker one that is less lethal. Epstein believes, astoundingly, that the virus will also evolve to become weaker over time and falsely claimed the same occurred with AIDS, SARS and Ebola. Chotiner ended up having to turn to experts to fact-check Epstein in the text of the interview, lest he accidentally distribute fake news to all his readers.

Trump seems to have swung in behind the conventional concerns and actions over Covid.


I’m still very dubious about even best case projections because they still mention some very big numbers – Trump has accepted ‘successful’ death limitation in the US to a 100,000-220,000 range.

Even the worst hit countries (based on published data , China numbers in particular have to be questioned) are well below projections, Italy currently 13,155 deaths (yesterday +727 but already 760 today) and Spain 9,312 (yesterday +923, 709 so far today).

The UK curve is starting to look bad. The currently have ‘just’ 2,921 deaths, but were up 563 yesterday and have already reached that today (GMT so six hours to go).

Currently there are ‘just’ 5,600 deaths in the US. But deaths have recently surged, currently to about 1,000 a day.

But, if there is a widespread staggered hit from Covid around the US, that death rate over 100 days comes to 100,000 so that number doesn’t look out of reasonable expectations. And the daily death rate could easily climb quite a bit higher before it peaks and comes back down.

And it should be remember if lockdowns are relaxed there’s a high chance (it’s expected) that there will be ongoing surges in infections and deaths for many months, until vaccines become available – if effective vaccines are developed.

There’s a lot for academics and the rest of us to discuss and debate for some time on this.

Covid-19 daily newsletter

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Daily COVID-19 update from the New Zealand Government

2 April 2020

Stay at home. Break the Chain. Save Lives.

Latest news

  1. The total number of cases is 797, with 89 new or probable cases confirmed within the last 24 hours. 92 people have recovered. For the latest numbers visit the Ministry of Health website.
  2. Foreign nationals in New Zealand can now drive, or take domestic flights, to connect with commercial or chartered international flights to return home. Strict measures are in place to mitigate the risk of COVID-19 transmission and to protect the public. For more information, including the criteria foreign nationals must meet in order to take a domestic flight within New Zealand, visit our website.
  3. Essential workers who take leave to comply with public health guidance are being supported with a leave scheme to ensure they continue to receive income. The scheme supports those who are unable to work from home and need to self-isolate, are at higher risk of becoming sick with COVID-19, or have a higher risk person in their household. More information on the essential workers leave scheme can be found on the Beehive website.
  4. A Government WhatsApp channel has been launched to help make information more easily accessible and shareable in the fight against COVID-19. Govt.NZ – which is free to use on any mobile device – will carry information and news for the public, businesses, healthcare providers, not for profits and local government. Click here to set up the channel.
  5. If you’re healthy and under 70, please visit the supermarket instead of shopping online. This will keep home delivery slots free for the people who need them most. When visiting the store, retain social distancing of 2 metres, and wash your hands before and after shopping. You can find out more about how to shop safely on our website.

Answers to common questions

Q. Do I need to wear a face mask when I leave the house?

A. You don’t need to wear a face mask when you leave the house. Face masks are essential for front line medical staff, but not the most effective way for the public to protect themselves against COVID-19.

The virus is spread by droplets so the best action you can take is to wash your hands regularly and make sure you don’t touch your face particularly your eyes, nose or mouth. For more information on how you can stay safe, visit our website.

Q. What is the criteria for getting tested for COVID-19?

A. If you are concerned about any symptoms you are experiencing, please call your GP, or Healthline (for free) on 0800 358 5453 (or +64 9 358 5453 for international SIMs).

The criteria for testing has been updated to include anyone with respiratory symptoms consistent with COVID-19. This is regardless of whether somebody has been overseas or not. This will result in more testing, which we’re prepared for. The criteria is a guide for health professionals, who will continue to use their clinical judgement to decide when people need to get tested.

Q. How can I get financial help? 

A. If you’ve lost your job or had your hours reduced you may be able to get a benefit or some other financial help from Work and Income.

There is help available for urgent costs like:

  • food
  • accommodation costs (rent, mortgage, board, emergency housing)
  • repairs or replacing appliances
  • emergency dental treatment
  • emergency medical treatment
  • water tank refill

You can find more information about financial support (including eligibility criteria) on the Work and Income website.

Work and Income call centres are experiencing very high demand at the moment, so we recommend you check the website first.  If you don’t have access to the internet you can call us on 0800 559 009.

Financial Support – Wage Subsidy Scheme

The wage subsidy is to help keep your businesses going if they face laying off staff or reducing their hours because of COVID-19. If you’re an employer, contractor, sole trader or are self-employed you may qualify. The subsidy is a lump sum payment for the employer to pass on to employees and covers 12 weeks per employee.

For more information including how to apply for the Wage Subsidy Scheme visit the Work and Income website.

For more FAQs, visit our website.

Resources
  • Call Healthline if you suspect you have COVID-19 symptoms: 0800 358 5453
  • For any other COVID-19 related queries, contact the government helpline: 0800 779 997
  • Need to talk? Call or text 1737
  • Essential business enquiries essential@mbie.govt.nz or 0800 22 66 57
  • Report breaches of self-isolation 105.police.govt.nz

Stay up to date on all the latest information on our websiteFacebook and Instagram.

Daily update Thursday +89, 797 total cases

89 new cases (76 new confirmed and 13 probable). Total now 797.

So this has jumped back up and may be the highest daily increase so far.

13 in hospital, 2 stable in ICU.

1 death total.

92 recovered.

51% now linked directly to overseas travel, that’s coming down, 31% linked to existing cases. 1% only categorised as community travel, but 17% still being investigated and many are likely to be community transmission.

Tests yesterday 2563, total 26,015. Daily capacity now 4,000.

Dr Ashley Bloomfield said NZ isn’t at the turn around point yet – with the biggest number of cases and tests done in one day.

He said that elimination doesn’t mean we will get rid of Covid-19 forever and we may not be able to all step down to level 3 at the same time. Some regions may change levels at different times.

Police Commissioner Mike Bush talks about breaches of ‘stay at home’ and mentions Kaitaia as a problem area with more police being sent there.

He also says there has been a spike in domestic violence. But there is presumably a big drop in public violence.

Summary

As at 9.00 am, 2 April 2020
Total to date New in last 24 hours
Number of confirmed cases in New Zealand 723 76
Number of probable cases 74 13
Number of confirmed and probable cases 797 89
Number of cases in hospital 13
Number of recovered cases 92 10
Number of deaths 1

* Note – a person is defined as recovered if they have been without symptoms for 48 hours.

Total cases of COVID-19 in NZ by age

Total cases by ethnicity

Ethnicity No. of cases
Asian 63
European or Other 569
Māori 56
Middle Eastern / Latin American / African 21
Pacific People 23
Unknown 65

Meanwhile the latest international stats show that the US constitutes about a third of the daily new cases, and a quarter of the daily death increase.

Trump warns of “a very painful two week period” but…

Donald Trump’s ‘beautiful Easter Sunday’ aspiration seems a long time ago (it was last week).

Yesterday White House predicts 100,000 to 240,000 will die in US from coronavirus

President Donald Trump prepared Americans for a coming surge in coronavirus cases, calling COVID-19 a plague and saying the U.S. is facing a “very, very painful two weeks.”

“This could be a hell of a bad two weeks. This is going to be a very bad two, and maybe three weeks. This is going to be three weeks like we’ve never seen before,” Trump said at a White House press conference Tuesday. White House officials are projecting between 100,000 and 240,000 deaths in the U.S. with coronavirus fatalities peaking over the next two weeks. “When you look at night, the kind of death that has been caused by this invisible enemy, it’s incredible.”

He has been more on message with his health experts, but he is still saying some strange things.

President Trump Warns Of Coronavirus Apex: “This Is Going To Be A Very Painful Two Week Period”

“As a nation, we face a difficult two weeks as we approach that really important day when we’re going to see things get better, all of a sudden,” he said. “And it is going to be like a burst of light, I think, or I hope.”

It seems unlikely things will suddenly get better in two weeks. Italy and Spain are still struggling with high daily death rates and deaths are surging round Europe.

The US has  a huge problem looming in some states, in particular New York, but the virus has spread around the country at different rates, so it is likely to peak at different times.

It’s more likely to be a very painful month or two in the US at least.

Total cases in the US are now over 200,000, jumping by 24,742 yesterday (GMT) – that’s a third of the recorded world wide rise (73,770).

Deaths jumped to 912 for a total of 4,053 yesterday afternoon (now 4,528). That’s an alarming rise rate.

Source of stats https://www.worldometers.info/coronavirus/#countries

 

 

Certain and uncertain consequences of Covid lockdown

The lockdown of New Zealand will have some obvious consequences, but other consequences are less certain.

The near isolation of most people in their homes with some exceptions and exemptions will reduce the spread of the virus in the short term at least, and should keep the death toll lower than it would otherwise have been. The longer term health outcomes are less certain, it is dependent on short term success, improvements in treatment and the time taken to develop an effective vaccine.

It is certain there will be a substantial impact on the economy and an increase in unemployment. It is unknown how bad, and for how long – we don’t know if the economy will bounce back or if we will be in for a protracted recession, or whether it will deteriorate into a depression.

Sport was a prominent early casualty of the virus, and the flow on effect will be substantial for a year or two at least. Many sports have shut down for the short term at least. The Olympic Games have been delayed by a year.

There are other certainties and uncertainties. One significant uncertainty is how long the lockdown will be in place, and if it is relaxed by how much and for how long. For example we may be allowed to go back to work but still need to limit travel around the country.

Road toll

The lockdown means far fewer vehicles on the streets and roads, and shorter trips, so the road toll will come down for a while at least. There are already signs of this – the number of deaths from 1 January to 1 April 2020 are already down slightly, being 84 (for the same period in the four previous years the toll was 90, 92, 105, 100).

Drownings

There is likely to be reduction in the number of deaths by drowning at least for the duration of the lockdown. Over the last three years total deaths have been 92, 78, 82.

Accidental and workplace deaths

Deaths in the workplace will reduce significantly while the lockdown is in place.In the year to January 2020 there were an average of 9.4 deaths per month, with 10 bin both last March and April.

Accidental deaths will probably also reduce, but they could still occur at home as people do more work on houses and rooves without being able to get scaffolding.

Suicides

It’s uncertain what the overall effect of the lockdown will have on our suicide rate.Some people will be more stressed, some will be less stressed. Being confined to home won’t stop some going out and at least trying, but the lockdown will reduce opportunities and increase contact and surveilance of at risk people.

There were a record 685 recorded suicides in the year to June 2019.

Relationships

The lockdown effect on relationships will be uneven and uncertain. Some relationships will be more stressed, some may benefit from more time together. Being confined to home during the lockdown their may be a lag in relationship breakups.

There will be less temptation and opportunity for infidelity and jealousy.

Family Time

Some parents and children will benefit from having enforced time together

Infectious and Communicable Diseases

Following on from the effect on relationships, there is likely to be less promiscuity and fewer sexually transmitted diseases.

It won’t just be the spread of Covid-19  that is limited, the lockdown will also reduce the cold, flu, hepatitis, measles and all other communicable diseases.

Schools being closed will improve the health of kids, and nits should be contained more than usual.

Other Health Issues

Along with the lockdown hospitals have geared up for treating Covid-19 patients by reducing operations and treatments. There could be a negative impact on health, which could result in more deaths from delayed or unavailable treatment and delayed diagnosis and detection of diseases.

Media

Traditional commercial media – newspapers, magazines, radio and television – were already struggling and in decline. They will be severely impacted by the hit to business activity, which has taken most of their revenue away (ironically while getting a big boost in readership and audience).


This is just some of the things that will be impacted by the Covid lockdown. It will take a year or two to quantify some of the impacts, and some impacts may never be quantified.

There are some certainties but many uncertainties, and there will be both positive and negative outcomes.

We are stuck with what we have got for now, we should be doing what we can to make something out of the change in opportunities – including not grumping and grizzling too much about things we can’t change..

Strategic shift from mitigation to suppression of Covid-19

New Zealand appears to be shifting from mitigation (“flatten the curve”) of the Covid-19 to “one of stamping it out and elimination” of the coronavirus until a vaccine is developed – “which is at least January 2021″.

From WRITTEN BRIEFING TO THE EPIDEMIC RESPONSE COMMITTEE (from John Ombler, All of Government Controller)

Standing up the national response to COVID-19

1. In the two months since the National Security System was first established in response to COVID-19 (January 27), there have been several significant and fast paced actions taken to ensure the leadership and organisation of the national response to COVID-19 is appropriately configured for the magnitude of the event. These actions have been taken to:

  • respond to the growing magnitude of the challenge that COVID-19 presents to New Zealand and New Zealanders
  • respond to a strategic shift from mitigation or “flatten the curve” approach to the current stamp it out and elimination strategy
  • broaden and deepen the national effort to increase the pace of delivery for a series of critical interventions and measures.

9. We have made a key strategic shift from a strategy of mitigation to one of stamping it out and elimination. We do not want to end up in a scenario of widespread outbreaks which would significantly overwhelm the health system, as we have seen in Italy, Spain and other countries that have experienced extensive outbreaks. Our current strategy centres around breaking the chain of community transmission through tougher public health measures, in particular intense physical distancing and travel restrictions, which are set out in Alert Level 4.

10. The strategy does incur significant economic and social disruption, but if we are successful at eliminating COVID-19 from New Zealand we will have better economic and social outcomes. Widespread outbreaks would lead to major health, economic and social impacts for New Zealand.

COVID-19 Mitigation versus suppression

  • Our strategy is focusing on keeping COVID-19 out, stamping it out and slowing it down.
  • Our aim is to prevent widespread outbreaks. Allowing widespread outbreaks (ie trajectories along the orange and blue curves (‘flattening the curve’)) will significantly overwhelm the health system.
  • The strategy centres on border restrictions, intense testing, aggressive contact tracing, and stringent self-isolation and quarantine.
  • Physical distancing will also be required to varying degrees as we continue along this path.
  • We can call this a suppression strategy.
  • Should outbreaks occur, a suppression strategy aims to reverse epidemic growth through tougher public health measures – eg by more intense physical distancing and travel restrictions.
  • The aim is to ensure that health system capacity is not exceeded through strengthening public health measures.
  • When cases fall, public health measures can be eased slightly.
  • This cycle repeats itself (refer squiggly green line).
  • However, we must still prepare for times when capacity of the health system is exceeded by having ‘surge’ options.
  • A suppression strategy does incur significant economic and social disruption. Longer periods of physical distancing, including school closures, will be required.
  • However, many lives will be saved and more people remain well so are able to operate the economy and the health care system.
  • We would need to maintain this approach until a vaccine is developed, which is at least January 2021, and/or the global pandemic has passed.
  • This approach is distinct from a mitigation strategy, which focuses on reducing the size of the peak (ie moving from the orange curve to the blue curve).

Still a lot of flights

https://www.flightradar24.com/

Some have criticised New Zealand for being slow in closing our borders, but we seem to have been far better at isolating ourselves than other countries.

If you zoom in there’s actually about half a dozen flights currently in New Zealand.

The amount of US air activity is remarkable.

This could be changing – Americans face nearly unprecedented travel restrictions inside US as states rush to stem coronavirus tide

As more and more Americans fall ill with the coronavirus and President Trump warns it will peak sometime in April, states nationwide are moving quickly to implement travel restrictions on people coming in from other parts of the country, regulating the interstate travel of Americans to an extent not seen in modern American history.

Rhode Island was one of the first states to implement restrictions on Americans coming from a coronavirus hot spot by mandating that any New Yorkers traveling to the state self-quarantine for 14 days.

That restriction led New York Democratic Gov. Andrew Cuomo to threaten to sue as the Rhode Island National Guard went door-to-door in the state to tell New Yorkers about their mandatory 14-day quarantine.

“I understand the goal … but there’s a point of absurdity, and I think what Rhode Island did is at that point of absurdity,” Cuomo said. “We have to keep the ideas and the policies we implement positive rather than reactionary and emotional.”

Or not.

Texas Gov. Greg Abbott, a Republican, announced Sunday that he would require visitors to his state from anywhere in Louisiana to self-quarantine for 14 days after previously mandating such a quarantine for travelers from New York, New Jersey, Connecticut and New Orleans. He also included air travelers from California, Washington state, Atlanta, Chicago, Detroit and Miami in the new mandatory self-quarantine.

Florida has required anyone entering the state from New York, New Jersey or Connecticut to self-quarantine for 14 days while also setting up roadside checkpoints to screen travelers entering the state from Louisiana. Oklahoma ordered all travelers from six different states to quarantine for 14 days. Alaska has required “all people” entering the state to self-quarantine. Montana issued an almost identical directive Monday. So did Massachusetts on Friday.

Some stable doors being closed, but well after the virus has bolted.

This charts flight activity for the year, with an obvious recent drop:

Total and Commercial traffic in 2020

Why were we slow to increase Covid-19 testing?

A number of Governments around the world have been criticised for their lack of testing for the Covid-19 virus. This may have helped the virus spread undetected in communities.

Some countries like Italy and Spain had so many serious cases to deal with they didn’t have sufficient resources to test.

The US and UK were both slow to ramp up testing.

It is apparent in some places that the horse had bolted before comprehensive testing at the stable was started.

The spread of the virus and the actions taken by countries including here has been a rapidly changing situation, perhaps governments have struggled to keep up with demand, or perhaps governments are just too slow to act in emergencies like this (although the modern world has not experienced a virus like Covid-19).

New Zealand was also slow off the mark, limiting testing to people with Covid symptoms AND some link to international travel. Last week testing rates were increased, but only yesterday it was announced that the criteria for testing would be widened.  But even the highest risk group, travellers coming into the country, were not all tested (I suspect that there were too many too handle at the time).

This is despite medical experts and academics calling for far more testing.

The prime minister Jacinda Ardern has been criticised for possibly misleading the country over testing. Her first official release on Covid-19 was Saturday 14 March (just two and a half weeks go).  From Major steps taken to protect New Zealanders from COVID-19

  • Every person entering New Zealand from anywhere in the world will be required to self-isolate for 14 days, excluding the Pacific [i]. ‘
  • These restrictions will all be reviewed in 16 days’ time.
  • Existing travel ban retained for China and Iran
  • Cruise ships banned from coming to New Zealand, until at least 30 June 2020
  • Strict new health measures at the border for people departing to the Pacific
  • A range of measures to assist those in self-isolation to be announced next week
  • Government will work closely with the aviation sector to encourage airlines to remain active in New Zealand, limit impacts on the tourism sector and exporters
  • Directive on mass gatherings to be announced early next week

There was no mention of testing in her statement.

Tuesday 17 March she did mention testing in Economic package to fight COVID-19

“We will be investing in more health staff, more virus testing, more medicines, facemasks, extra intensive care capacity and equipment at hospitals, and more money for GPs. If we can manage the virus we can mitigate the damage to the economy.

The same day in Parliament from 2. Question No. 2—Prime Minister

Hon Simon Bridges: Why are people being denied coronavirus tests when they are displaying symptoms?

Rt Hon JACINDA ARDERN: I reject the assertion they are. I want to read—

Hon Simon Bridges: Well, they are.

Rt Hon JACINDA ARDERN: I would like to read from the case notes provided to doctors. Under the case definition, it says, “Note”—this is for clinicians—”that due to the ongoing changing global and domestic situation, clinical judgement should apply as to whether someone who doesn’t quite meet the current case definition should be tested or not.” Any person who a clinician thinks needs a test should get a test.

Hon Simon Bridges: So does she deny the email to me from a Wellingtonian and his partner who had all the symptoms and were denied the tests yesterday?

Rt Hon JACINDA ARDERN: Again, as I’ve just said, that decision sits with doctors. I will read, again: “due to the ongoing changing [environment], clinical judgement should apply as to whether someone who doesn’t … meet the … case definition should be tested or not.” I cannot be clearer. Any person a doctor believes should be tested can and should be tested. We have the capacity to do up to 1,500 tests a day. My understanding is that we have hundreds of tests currently being processed for which we will have the results tomorrow.

Hon Simon Bridges: Why doesn’t she just guarantee that those who show the clear symptoms will get the testing, as Prime Minister of our country?

Rt Hon JACINDA ARDERN: I’ve just given you the exact advice that is for doctors. Doctors make those decisions, not politicians, but what they have been told is that anyone who they believe should be tested should be tested. I cannot be clearer than that. I cannot make those judgments, but they can, and they should.

Hon Simon Bridges: Why is she only suggesting ramping up tests now after the World Health Organization has called for countries to test, test, test?

Rt Hon JACINDA ARDERN: The member is utterly incorrect. We’ve had the capacity to test up to a thousand a day for a very long time.

Hon Simon Bridges: Is she concerned that a comparable country like Norway has tested 8,000 people and we’ve tested less than 600?

Rt Hon JACINDA ARDERN: Again, the member seems to be upset about where our global standing currently is in terms of case profile. We have, currently, a small number of cases, that have been confirmed through testing. But I expect that we will have many hundreds more tests conducted. In fact, I understand we have hundreds currently being processed this very day.

Hon Simon Bridges: Isn’t the reason we only have a dozen confirmed cases and not dozens and dozens and dozens because under her Government, since the start of the year, we just haven’t done many tests?

Rt Hon JACINDA ARDERN: That is an appalling, appalling statement to make. The implication that tests are being determined by politics is appalling. Doctors are making the call, and they are being told that if they believe they should test, they should. I cannot be clearer about the advice that has been provided by the Ministry of Health; it is in black in white—in fact, it is in bold.

Hon Dr David Clark: Is the Prime Minister aware that Norway currently has 1,200 confirmed cases of the virus, and is in Europe, which has been described as the epicentre of the outbreak?

Rt Hon JACINDA ARDERN: Yes. In those cases, you would expect, therefore, that the contact tracing and symptoms would therefore lead to the other testing outcomes that they have. It seems extraordinary to me that the suggestion seems to be that there is disappointment about where we are. Hundreds of tests are being processed today. Very unfortunately, we will see—[Interruption] We will see more—

SPEAKER: Order! Order! Can I just ask members on both sides—this is a very serious issue, and petty calling back and forth from both sides ill behoves the House.

Hon Simon Bridges: Does she accept that the reason, say, Norway has many more confirmed cases is because they have done many, many thousands more tests, and that’s where we needed to be weeks ago.

Rt Hon JACINDA ARDERN: No, I reject that, and I again confirm I have just been advised there are 500 tests currently being processed. That capacity has always existed, but we have allowed doctors to make that decision, not politicians.

Hon Simon Bridges: Will she apologise to New Zealanders who have been previously denied a test under her Government last month, the month before, and as little ago as yesterday?

Rt Hon JACINDA ARDERN: No one who a doctor believes should be tested should have been denied a test.

Ardern said “there are 500 tests currently being processed”. The average tests over the past week is 1,777 daily as of yesterday when more testing was called for by Ardern.

That same day from Question No. 10—Health

Dr Shane Reti: Does New Zealand coronavirus testing align with Centers for Disease Control and Prevention recommendations to test all older people with symptoms who also have heart conditions; if not, why not?

Hon Dr DAVID CLARK: The member will have heard from the Prime Minister earlier in today’s House session that all primary-care workers who are so qualified are being encouraged to test if they have any clinical suspicion.

Dr Shane Reti: What is the weakest point in the health system for coronavirus management, and how can we help?

Hon Dr DAVID CLARK: It’s misinformation, and members of the Opposition can help by making sure that they are pointing people toward the Ministry of Health website, where the most up-to-date and correct information is on hand. They can share that widely, and I would appreciate it. Thank you.

Two days after that a nurse I know who works in an age care hospital had flu-like symptoms and south a test but ws told she didn’t need one, and could return to work the following Saturday.

Also on 17 March – Jacinda Ardern urges clinicians to do more COVID-19 testing: ‘We have the capacity’

The Prime Minister is urging clinicians to conduct more testing for the coronavirus COVID-19 insisting New Zealand has the capacity to do 1500 tests per day.

“Our capacity is significant. We’re ramping up the ability to have up to 1500 tests per day,” Jacinda Ardern said on Tuesday. “That test number you’ve been seeing per day happening in the community is growing day on day.”

It comes after the World Health Organization (WHO) pleaded for countries to ramp up testing of every suspected coronavirus COVID-19 case as it warns children are dying of the illness.

Several more media releases by Ardern didn’t mention testing, including the big announcement on Saturday 21 March – Nation steps up to COVID-19 Alert Level 2

Two days later on Monday 23 March from Prime Minister: COVID-19 Alert Level increased:

We will continue to vigorously contact trace every single case. Testing will continue at pace to help us understand the current number of cases in New Zealand and where they are based. If we flush out the cases we already have and see transmission slow, we will potentially be able to move areas out of Level 4 over time.

Ardern made several more media statements since then with no mention of testing.

Wednesday 25 March from Returning New Zealanders will be tested for Covid-19

New Zealand borders will be open for returning New Zealanders but all of them will be screened at their port of arrival, Prime Minister Jacinda Ardern has said.

“All incoming passengers will be tested and anyone found systematic will be quarantined in a facility. All others will be asked to go into self-isolation. The Police will monitor them and anyone found violating the order will be fined and quarantined,” she said.

Yesterday (31 March) – Covid-19: More testing needed, Ardern says

The number of tests for coronavirus is set to ramp up, with health officials relaxing the testing criteria as Prime Minister Jacinda Ardern called for more testing to be done.

New Zealand’s testing regime has been under scrutiny for some time, with people complaining of being turned away despite medical recommendations they get tested.

The matter was at the fore during the inaugural meeting of the epidemic response committee earlier on Tuesday, where Director-General of Health Ashley Bloomfield indicated a change was coming.

Now, Ardern has confirmed the technical advisory group overseeing the case definition of Covid-19 had agreed to expand it to include people who had symptoms potentially indicative of the virus, but without a link to overseas travel or a close contact who had tested positive.

The new advice would be circulated to Healthline, GPs and community clinics, with the Prime Minister expressing a desire to see testing levels ramp up further.

“I want more tests, we’ve built the capacity for more tests, more tests will only allow us to get a better picture of the spread of Covid-19.”

However, she pushed back when asked why the Government had not made such a change earlier, saying New Zealand had already been conducting a high level of tests relative to other countries.

The rapidly spreading and dangerous Covid-19 pandemic is an unprecedented health emergency and has been very difficult for governments to deal with. One thing we should get is open and honest information. Questions remain about the slow lift in testing for the virus.

3,500 tests are now being done per day with plans to lift it to 5,000 a day but we may need more. This is being discussed now on RNZ:

Michael Baker, an epidemiologist from the University of Otago, tells Morning Report that although the shutdown has been very tough on people, it’s the right move from the government and they acted in a nick of time to get Covid-19 under control.

Prof Baker says that as we start to test more, we could see the number of cases rise dramatically.

He said more about testing, may have to wait for the audio.

Minister of Health David Clark is just being asked about this on RNZ,

The Minister of Health David Clark tells Morning Report the government asked the Ministry of Health to revisit their criteria for testing.

“We need to continue to ramp our testing, absolutely, and we are,” David Clark says.

He acknowledges there are valid questions that need answers about testing but that should be directed at clinicians who decide on who should be tested. He is waffling around the question.

He said current testing capacity is 3,700 per day.

Clark is already being questioned about the number of ventilators, he doesn’t sound assured or confident answering but says we have the capacity for about 500 ventilators with about another 200 ordered.

Public and private hospitals have about 750 ventilators between them.

It is a relatively low number per capita – with only 4.7 intensive care beds per 100,000 people compared to 35 per 100,000 in the United States and 29 in Germany.

Doctors have warned if Covid-19 pushes up demand so that 3000-4000 patients need ICU treatment at any one time, current capacity would be overwhelmed.

https://www.rnz.co.nz/news/national/413111/covid-19-nz-sources-more-ventilators-amid-rampant-global-demand

Covid-19 deaths per 1m

Going by the scramble here in New Zealand and worldwide to secure more ventilators that are essential for treating serious cases of Covid-19 it is expected that things will get worse, quite a bit worse.

Changes in statistics in just one day show how quickly things are getting worse. This was yesterday morning:

Now:

I posted about Sweden yesterday – Sweden’s different Covid strategy looks shaky – when they had 14 deaths per million, today it is up to 18.

The US has increased from 9 to 10 and is expected to get much worse (they are saying 100,000 deaths would be a good achievement).

Where is New Zealand headed? We currently have just one death. If we rise to 10 per million that’s about 50 deaths.

If we reach the death rate of France, Belgium, Netherlands, Switzerland that would bring us up to hundreds of deaths.

I hope we get nowhere near as bad as Italy and Spain which would equate to about 1,000 deaths.

But the above figures are current, and all countries will get worse, including New Zealand. It’s hard to predict how bad it will get.

The current world total deaths stands at just over 40,000.

Another projection: 14,000 could die in NZ if control efforts fail

The Otago University projections paint a bleak picture, but are more optimistic than other modelling by the University of Auckland’s Te Pūnaha Matatini.

That report concluded that, left unchecked, the virus would infect 89 percent of the population and kill up to 80,000 people.

“If New Zealand fails with its current eradication strategy toward Covid-19, then health outcomes for New Zealand could be very severe.

“If interventions were intense enough however, in some scenarios the epidemic peak could still be

The University of Otago research paper – which was provided to the Ministry of Health last week – estimates that up to 64 percent of the population could fall ill with up to 14,400 people dying.

The report noted that 14,400 is 0.29 percent of the population and would not be as severe as the 0.8 percent that died from the 1918 flu pandemic in New Zealand (9000 deaths out of a population of 1.149 million people).

“Another unfortunate comparison with the 1918 pandemic is the potential increased risk of death for Māori and Pacific populations (albeit based on the H1N1 influenza pandemic experience in 2009),” the report said.

Co-author of the report, Associate Professor Nick Wilson, told Morning Report that going off his research, New Zealand is currently on track for the best case scenario given the government’s measures.

“If we are successful (in eliminating the virus), we will start to see that in the coming weeks.

“That will definitely be the best outcome because it may mean relatively few hospitalisations and deaths and it might mean we are able to open up the economy, though maintaining very good border control until we get a vaccine.

“New Zealand has been in a good position and as an island nation it can have very good border control with quarantine, so we’re in a situation where we really have adopted the best strategy which is the elimination one and very few other countries have been able to do that.”

So we are in a good position to come out of this with a lower death rate than other countries, especially to worst of them.