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

Covid-19 testing criteria expanded to boost number of tests

The number of tests being done for Covid-19 has been an issue in many countries, including here in New Zealand.

This came up in the first day of operation of the Epidemic Response Committee in Parliament.

Newshub: Sir David Skegg urges Government to show clear plan to eliminate COVID-19

Professor Sir David Skegg, an epidemiologist from Otago University, appeared in front of Parliament’s Epidemic Response Committee on Tuesday.

He said the Government did well to put in place early border restrictions and raise the national alert level to 4 but that it appears to lack a concrete, long-term strategy to stem the spread of COVID-19.

With the Government assuming the majority of those infected would have links to overseas travel – and therefore focusing its testing on them – it was hard to gauge the true extent of community transmission, he said.

“The actual number of people who have been infected will be far higher than the 589 notified and we really have no idea of the extent of community spread,” said Sir David.

“I’m afraid that only complacency can have allowed our authorities to imply that the virus would behave differently here than everywhere else.”

The number of tests done here has increased substantially over the last week (currently averaging 1,777 per day over a week) with a total of 21,384 done to date. The criteria for tests is to be loosened so more tests are done.

Newsroom: 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.

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 more tests the better the data to with which to model and base decisions on, but so far with a very low death rate (still just 1) it appears there hasn’t been a critical shortage of tests done.

Wider testing will be needed to determine just how much community spread there is  and where in the country there are problems as we get towards the end of the 4 week lockdown period and decisions will presumably be made on whether the alert level is reduced and restrictions eased, either countrywide or regional.

Skegg:

Suppressing the virus was only the first step in eradicating it, he said, adding that it was “worrying” the Government wasn’t clearly talking about eliminating it completely.

“A lockdown on its own is not enough. It’s like pressing the pause button on your device.”

Tackling a virus of this kind took a willingness to be transparent and change tactics when necessary, he said.

“If elimination cannot be achieved, when and how will we know that? And what will be the next goal? Those are the kinds of things I would expect to see in a strategy document”.

The Government and their health advisers will have been very busy but there is obviously a lot more work to do still.

 

Sweden’s different Covid strategy looks shaky

Sweden has taken a far less restrictive approach to containing the Covid-19 virus. In Do the consequences of this lockdown really match the threat? University of Auckland senior lecturer and epidemiologist Simon Thornley writes:

We don’t want to squash a flea with a sledgehammer and bring the house down. I believe that other countries, such as Sweden, are steering a more sensible course through this turbulent time.

It will probably take months to see which approach to containing the virus, limiting deaths and not damaging the economy too much worked best, but the situation in Sweden doesn’t look that good at the moment compared to New Zealand, and not great compared to many countries.

From the link in Thornley’s commment:

Universities have been closed, and on Friday, the government tightened the ban on events to limit them to no more than 50 people. But if you develop symptoms, you can still go back to work or school just two days after you feel better. If a parent starts showing symptoms, they’re allowed to continue to send their children to school.

“I feel that the Swedish government is handling this very reasonably,” argues Erika Lindquist, who is drinking with her brother and Danish husband at another table at the Nyhavn. “They’re listening to the health department; they’re listening to the experts they have on hand.”

There is criticism, however. More than 2,000 Swedish university researchers published a joint letter on Wednesday questioning the Public Health Agency’s position, while the previous week saw leading epidemiologists attack the agency in emails leaked to Swedish television.

It has only been in the past couple of days that the death toll has started to increase significantly, rising by a third in a single day on Thursday and Friday, with 92 people now dead and 209 in intensive care. As he announced the tighter restrictions on Friday, the prime minister, Stefan Löfven, warned that the coming weeks and months would be tough.

This chart shows that number of cases in Sweden are 21st on the list but that’s in part because they are not testing as much as other countries, and their cases and deaths are climbing.

From https://www.worldometers.info/coronavirus/#countries – daily totals are from GMT+0 (that’s 1pm yesterday NZ time).

Also, while Swedish deaths per 1 m population are lower than the worst countries in Europe and Iran, they are higher than most other countries.

And there are other opinions on how well Sweden is doing.

Forbes: Why Sweden’s Coronavirus Approach Is So Different From Others

Prime Minister Stefan Löfven asked all citizens to avoid non-essential travel and for those who feel ill or are over the age of 70 to stay home, but has so far stopped short of implementing many of the strict emergency measures seen in Denmark and Norway. “Us adults need to be exactly that: adults. Not spread panic or rumours. No one is alone in this crisis, but each person carries a heavy responsibility,” he said during a recent televised speech.

But

Despite the government choosing to issue guidance over the implementation of restrictions, many locals are taking things into their own hands. The public transport company of Stockholm reported a fall in passenger numbers of 50% last week.

There’s mounting criticism among doctors and academics on Sweden’s “wait and see” approach. While Denmark and Norway closed their borders and imposed strict regulations on their residents, Sweden has done relatively little.

Is the strategy working?

According to the Swedish Institute of Public Health’s daily briefing of March 30, the number of positive cases of COVID-19 in the country has passed 4,000. The number is very similar to the infection rate in Norway, yet twice as many people live in Sweden.

However, Akinmade Åkerström says there’s a simple reason for the relatively low infection numbers: “Very few people are being tested so it’s impossible to know the true spread of the illness.”

While the infection numbers are difficult to compare, the difference in death rate is more clear-cut. At the time of writing, 146 people with COVID-19 have died in Sweden. In Norway, that number stands at 32.

Those are the current totals. Norway’s deaths per 1m population are 6.

Finland currently has 13 deaths, 2 per 1m population.

Two days ago, the Swedish Public Health Agency’s Karin Tegmark Wisell said in a radio interview that it was “too soon to tell” if the Swedish approach is proving successful.

It’s too soon to tell about a lot of things about Covid. Sweden may prove to have taken a more balanced successful approach than other countries, but if deaths keep rising they may change tack and try to clamp down like many other countries.

The population of Sweden is about 10 million, about, a bit over double New Zealand. They have a lot higher case and death rates, but being close to the big problem areas in Europe they are probably ahead of us in spread, so a direct comparison isn’t possible.

Sweden has over seven times as many active cases, and 306 serious/critical cases compared to 2 in New Zealand.

New Zealand’s single death so far and a flattening of case growth suggests that our lockdown approach has been at least no worse than Sweden’s far more unrestricted strategy at this stage, but it will take time to compare them properly


UPDATE:

Daily update – more cases but not much change

75 more cases today and another 6 recovered, with a total of confirmed and probably cases now 589.

Summary

As at 9.00 am, 30 March 2020
Total to date New in last 24 hours
Number of confirmed cases in New Zealand 552 76
Number of probable cases 37 -1
Number of confirmed and probable cases 589 75
Number of cases in hospital 12
Number of recovered cases 63 6
Number of deaths 1

View full details of the confirmed cases.

View details of significant COVID-19 clusters.

Case numbers are still expected to keep rising over the next week or so but at this stage things seem to be reasonably under control.

Police Commissioner Mike Bush:

Says two staff have tested positive for Covid-19. They are at home and not been hospitalised.

Mike Bush says 4547 Kiwis have returned over the past three days; 94 of those people were symptomatic and are in quarantine.

1200 did not have a satisfactory self-isolation plan.

About 3200 did have a plan and are self isolating, and police will ensure they are complying with those restrictions.

Three people have been arrested for repeat offences of breaching the lockdown and one person is still in custody, Mike Bush says.

He says tourists should refrain from travelling around the country.
If they persistently breach rules, police will take action, Bush says.

The New Zealand Government is today launching a daily email newsletter to give people a new way to stay up-to-date with COVID-19 information.

The daily updates will include:

  • The latest COVID-19 news
  • Answers to frequently asked questions, eg advice for essential workers
  • The latest resources, including translations, posters, and social media images

Sign up to get the latest updates from Unite Against Covid-19(external link)


How easily it can spread.

The Waikato District Health Board has confirmed a cluster of Covid-19 cases in Matamata can be linked to a St Patrick’s Day celebration at a local bar. There are now 23 confirmed cases in the area and most have been identified as attending the event on 17 March at the Redoubt bar, or are directly linked to those who attended.

There was at least one bar open for St Patricks day and also student parties.

Bars were closed and parades cancelled in Ireland for St Patricks Day

More New Zealanders in their 20s have Covid-19 than any other age group, Ministry of Health figures show, and it’s likely because most cases are connected to overseas travel. Ministry of Health data about the first 500 cases of Covid-19 shows people of European ethnicity in their 20s are the most likely to test positive for the virus.

OE exposure.

The Auckland girl’s school Marist College has 47 confirmed and probable cases of Covid-19. It is the biggest cluster of infection being tracked by health authorities. The board chairperson Stephen Dallow says the confirmed cases include teachers, students and adults within the community.

That’s why protecting schools was important (managed very well at Logan Park in Dunedin).

Source of virus unknown with first NZ Covid death

A Greymouth woman in her seventies is the first to die from Covid-19 in New Zealand, and it is not known how she contracted the virus.

Ministry of Health: Sadly, first death from COVID-19 in New Zealand

The death was in a woman in her seventies who had initially been admitted four days ago with what was thought to be influenza complicated by a underlying chronic health condition.

As a result of the initial diagnosis of influenza and then the subsequent confirmation of COVID-19 there was a period when staff treating the woman were using protective equipment suitable for influenza, but not COVID-19.

Once the diagnosis was confirmed staff took a range of measures to protect themselves and other patients, however as a precautionary approach, the DHB has placed 21 staff in self-isolation for the balance of 14 days from their last involvement in the patient’s care.

Family members visiting the woman in hospital, who do not have symptoms, will also be in monitored self-isolation for the next 14 days.

Stuff: Family of first person to die from Covid-19 in NZ don’t know how she contracted virus

The family of the first person to die of coronavirus in New Zealand say she was just going about her weekly routine and have no idea how she became infected.

Anne Guenole died in Grey Base Hospital, Greymouth on Sunday morning. The Ministry of Health said Guenole, in her 70s, had initially been diagnosed with influenza that was complicated by an underlying health condition, but returned a positive test for Covid-19 on Saturday morning. The 21 staff who treated her are self-isolating.

The woman had been admitted to hospital on Wednesday.

Just before the lockdown took effect. Obviously she contracted the virus well in advance of the lockdown, and possibly before people over seventy were told to self-isolate the Saturday before that.

Staff who first assessed her were in full personal protective equipment (PPE), however because she did not initially meet the case definition for Covid-19 they removed their eye protection.

By Thursday night, Meates said the woman met the case definition and staff started wearing eye protection again while waiting for test results which came through on Saturday morning. The 21 staff who came into contact with her had been placed in self-isolation.

Family members who visited the woman in hospital would also be monitored in self-isolation for the next 14 days.

…another relative of Guenole, who also declined to be named, told Stuff on Sunday evening the family had no idea how she contracted Covid-19.

“There’s so much emphasis on tourists and travel and all this sort of stuff but this is just a lovely lady just doing what she does week after week – going shopping, paying bills, nothing out of the ordinary for her.

“There’s a lot of blanks that we’re trying to fill in right now to see what’s where, what’s why, where she has been, things like that.”

The family was unaware of any significant health conditions.

Despite MOH saying she had an”underlying chronic health condition”.

“She was a very private person, she didn’t give a lot away. A lot of old-school people, they don’t let you know when they’re unwell, she just didn’t put much out there, kept her aches and pains to herself.”

Very sad for the family, and a shock to the country. Covid deaths seemed inevitable, but when it happens it makes the dangers more stark.

Grey District Mayor Tania Gibson earlier said Guenole’s death came as a “big shock” to the small community.

Gibson said news of the death drove home the message that people needed to stick to their bubble and stay home to break the chain of transmission. She had heard of people not abiding by the rules, but said that needed to stop.

If you take risks, you are increasing risks for others. But it can be difficult convincing everyone.

RNZ Live:

The Director-General of Health has no doubt the cases of community transmission of Covid-19 are on the rise.

Ashley Bloomfield was asked how many of the 514 cases to date have been community transmission.

“I don’t have the exact figure and of the new cases in the last day or two, many of those are still being followed up and investigated.

“The number associated with community transmission will be increasing, I have no doubt about that, and particularly because we are seeing those small number of clusters around the place,” Dr Bloomfield said.

RNZ: PM backs families battling to keep seniors in their bubble

People over 70 and those with underlying health conditions were the first to feel the brunt of the lockdown, being told to stay home four days before the rest of the country but some aren’t taking notice.

Brooke Magill is trying to deal with her grandparents who are failing miserably at obeying the lockdown rules.

Despite being told family would drop off the groceries, her nana got to the local New World and began messaging about what a wonderful experience it was going to the supermarket and being given priority access.

“All her neighbours knew she’d also been out so what happened is one of the nurses across the road came across to her and quite robustly told her if she was to take her vehicle out again she’d slash her tyres.”

Magill isn’t alone and has plenty of friends and colleagues fighting the same battles, and for the most part it’s because their parents and grandparents are social people who can’t handle being stuck indoors.

Nelson’s Grey Power president Christine Tuffnell said it’s not so much about the elderly not listening to their children and more about how they get hold of information.

She said it’s the elderly living on their own, like her, that are the most isolated.

“I don’t think there’s an issue of the elderly not listening at all, I think it’s how we get the current information to them.

“It’s very much an online society but a lot of them aren’t online so we have to look at how we get that information out.”

Covid-19 is dominating all media, TV, radio and newspapers, so there should be few people who are unaware of what is happening and what they should or shouldn’t be doing.

Tuffnell said the number of over 70 year olds who have been infected by Covid-19 in New Zealand to date is quite low, which possibly reflects the fact they’re staying home.

At the time over 70s were told to stay home – when the country was still at level 2 – some thought it was a little early.

Tuffnell said looking back now it was a very wise move by the government.

And one message that has stuck with the elderly is staying in their own bubble.

“People have caught on to the bubble idea, I think that’s probably one of the best things – people are actually understanding the bubble,” she said.

It would be wise for everyone to ‘stay in their bubble’ as much as possible. As much as possible we should identify people living alone (or isolated couples), especially older people and those without the Internet, and provide safe means of communication.

Covid-19 update – first NZ death reported

The Prime Minister and Director-General of Health are holding a joint press conference at Parliament today (PM Ardern has been having a separate one later in the afternoon).

 

Director-General of Health Ashley Bloomfield (who had his first day off for a while yesterday) case update:

First death from Covid-19 on the West Coast, a woman in her seventies. She was admitted to hospital with what was thought to be influenza they were well known to the hospital due to other health conditions. When she was initially treated staff were not fully Covid protected, so 21 staff have been put in 14 day isolation (that makes it tough on health staffing).

Dr Bloomfield says that in preparation for Covid all hospitals have stopped elective surgery and other non-urgent work so are running at about 50% capacity, so staffing levels aren’t a concern.

63 new cases in the last 24 hours (up to 9 am Sunday) – so this is a lower increase than for the lastt few days, but this doesn’t mean a general downturn. It could still rise again.

56 now recovered.

9 in hospital, 1 in ICU on a ventilator.

The combined total of cases is now 514.

Summary

As at 9.00 am, 29 March 2020
Total to date New in last 24 hours
Number of confirmed cases in New Zealand 476 60
Number of probable cases 38 3
Number of confirmed and probable cases 514 63
Number of cases in hospital 9 (28 total to date)
Number of recovered cases 56 6
Number of deaths 1

View full details of the confirmed cases.

Prime Minister Jacinda Ardern:

The first death brings home why the measures have been taken to stop the spread.

“It is critical we all stay at home to stop the spread.”

Ardern is critical of online bullying of people who have contracted Covid-19.

Some people have been flouting restrictions. This puts others at risk, and risks extending the lockdown period.

Police have launched an online form  to report breaches of home isolation at 105 Police Non-Emergency Supporting Information

(More details when they post them online)

In an emergency, always call 111.

You can now report to Police online

  • Suspected COVID-19 L4 isolation breaches
  • Businesses you suspect are breaching the essential services rule.

Before making your report, please refer to information from the Ministry of Health about self-isolation(link is external) the Government guidelines about Essential businesses(link is external).

To complete this report you will need to provide your name and email address so we can contact you if required.

Start your COVID-19 L4 breach report

Police non-emergencies

For all other Police non-emergencies that don’t need urgent Police assistance, please refer below.

Please read the information in the ‘Assistance required’ options listed below for the best way to report a non-emergency, get advice or request something – before making an online report. This will help us work though the high volume of online reports resulting from the COVID-19 Pandemic.

When making an online report please note:

  • You will need to provide a date of birth, email address and phone number to complete this report.
  • Please allow up to 10 minutes to complete this report.
  • The report cannot be saved to complete later.

 

Daily update – 83 new cases, total 451

From today’s Ministry of Health update:

83 new cases of Covid-19 (78 confirmed, 5 probable), total now 451

Summary

As at 9.00 am, 28 March 2020
Total to date New in last 24 hours
Number of confirmed cases in New Zealand 416 78
Number of probable cases 35 5
Number of confirmed and probable cases 451 13
Number of cases in hospital 12 (22 total to date)
Number of recovered cases 50 13

View full details of the confirmed cases.

View details of significant COVID-19 clusters.

Health officials expect to see an increase in covid-19 cases in the coming days, despite today’s number of cases being lower than yesterday’s.

50 individuals have recovered

12 people are in hospital:

  • 3 in Wellington Regional Hospital
  • 2 in Nelson Hospital
  • 2 in Whangarei Hospital
  • 1 each in Auckland, Waikato, Taranaki, Dunedin and Greymouth hospitals.

Average daily test number over a 7 day period is 1613

8 Air NZ staff are infected with Covid-19. Al worked on long haul from London or New York.

Government Controller John Ombler:

No one needs to worry about supermarkets running out of food, choose one person to do the shopping and respect the need for physical distancing

Can only leave house for physical exercise or essential reasons – stick to your bubble

Avoid undertaking activities that are a distance from home

Don’t travel out of your neighbourhood and go to baches or second homes – stay in one place

Police report most people are following the new rules, isolated incidents of people congregating – in these cases people were spoken to

If people believe others are not complying with new restrictions first port of call is to discuss it with them, otherwise you might like to call police on 105

Maritime New Zealand says the strong message during the lockdown, is that all recreational boating and other non-essential on-water activity must stop.

Where is all the money coming from?

Businesses and economies around the world will take a severe hit from the costs and effects of the Covid-19 coronavirus.

New Zealand has already announced $12.1 in spending to prop things up. It equates to about 4% of our GDP.

That amount is likely to grow substantially, and will add to borrowings. But that’s only small change in the international finance pond.

Across the Tasman: What Australia’s $189bn coronavirus economic rescue package means for you

The government has announced a second major economic rescue package worth $66bn, on top of an initial $17.6bn package and more than $100bn in emergency banking measures to prevent against a credit freeze.

Framed as a “safety” package, the second wave of stimulus ramps up support for small business and also includes a major boost to welfare recipients and for people who lose work as a result of the Covid-19 pandemic.

In total, the government has now committed economic support worth $189bn – almost 10% of GDP – and has also flagged more packages as the crisis unfolds.

UK Government: Support for those affected by COVID-19

On 17 March, the Chancellor announced an unprecedented package of government-backed and guaranteed loans to support businesses, making available an initial £330 billion of guarantees – equivalent to 15% of GDP.

This was on top of a series of measures announced at Budget 2020, the government announced £30 billion of additional support for public services, individuals and businesses experiencing financial difficulties because of COVID-19, including a new £5 billion COVID-19 Response Fund, to provide any extra resources needed by the NHS and other public services to tackle the virus.

Just announced in the US: Senate, White House reach $2 trillion stimulus deal to blunt coronavirus fallout

Senate leaders and the Trump administration reached agreement early Wednesday on a $2 trillion stimulus package to rescue the economy from the coronavirus assault, setting the stage for swift passage of the massive legislation through both chambers of Congress.

National Post: Trump and his children banned from applying to US$2 trillion stimulus plan

Together with Fed intervention, the proposed legislation amounted to a $6 trillion stimulus, according to White House economic adviser Larry Kudlow, or about 30 per cent of annual GDP.

The package will likely more than double a U.S budget deficit that was already set to hit $1 trillion this year before the outbreak. It also may not be the last infusion of government spending in response to the spread of the virus.

The US has had growing deficits and growing debt since the GDP in 2008:

As of February 2020, federal debt held by the public is 17.23 trillion and intragovernmental holdings were $6.02 trillion, for a total national debt of $25.3 trillion

 

At the end of 2018, debt held by the public was approximately 76.4% of GDP and approximately 29% of the debt held by the public was owned by foreigners. The United States has the largest external debt in the world.

https://en.wikipedia.org/wiki/National_debt_of_the_United_States

When the US package was announced the country was heralded as ‘the greatest country in then world’, as they tend to do. That may refer to the greatest debt in the world. That’s one thing trump has been biggest and best at, growing debt.

There’s some big numbers here, and this is just four countries.

Where will all this support package money come from? Are loans already secured?

 

We’re now in Covid-19 Level 4 household isolation

This is New Zealand’s first day in Covid-19 Level 4 ‘lockdown’.

Lockdown is a commonly used term but it is a bit misleading – we are in household isolation but able to go to the supermarket, pharmacy or doctor, and able to go for walks in the vicinity of our homes (people are expected to ‘stay local’ when leaving the home) as long as we keep at least a 2 metre distance from anyone not in our household.

For the household I’m in we will keep supermarket visits to a minimum, probably about once a week. We don’t need to go shopping for a week from now. And only one person from the household will do the shopping. Our aim is to do what we can to keep a virus free household, for our own sakes, but we have also taken in a person at higher risk that we have undertaken to protect from the virus as much as possible.

I expect that the number of cases in New Zealand will continue to climb over the next couple of weeks, due to people who have been travelling still returning home, and the congregations of people who have felt compelled to binge and panic shop prior to the lockdown, and for some reason have seen it necessary over the last few days to have their last fixes of fast food and commercial coffee.

The household isolation will be tough for some people (especially those who live alone), and some household groups. Access to essentials will be difficult for some – if you have your own transport check that neighbours are managing. Relationships may get strained, family violence may increase.

Some who are at risk through their work are taking precautions: Frontline doctors prepare for ‘what’s coming’ by sending kids away (a kid has been ‘sent away’ to us to give them better protection).

But there will be positives. Some households and families will come together and benefit from spending more time together. Many people seem to be looking at getting back to basics, making and baking food rather than relying on time saving but less healthy highly processed packets.

Many will catch up on odd jobs around the home that have suffered from a lack of time.

It is also an opportunity to discover and rediscover different ways of entertaining ourselves.

And with the Internet available to many keeping in touch with family that are isolated in other households will be easy. I’m used doing this with family living overseas anyway.

Level 4 isolation is an unprecedented imposition on us, having experienced nothing like it before in our lifetimes. But it is also an opportunity to take a pause from modern hectic lifestyles, to re-evaluate our way of living and looking at getting a better balance into our lives.

Household isolation is both a challenge and an opportunity.

This is what level 4 officially means for us:


We are at Level 4 of New Zealand’s four-level COVID-19 alert system. It is likely Level 4 measures will stay in place for a number of weeks.

Staying at home – what it means

We need your support to protect New Zealand and eradicate COVID-19. Enforcement measures may be used to ensure everyone acts together, now.

  • Everyone must now stay home, except those providing essential services.
  • Only make physical contact with those that you live with.

Food and shopping

  • Supermarkets, dairies and pharmacies will remain open.
  • When shopping, as much as possible send in only one family member at a time, practice physical distancing and hygiene rules while shopping.
  • Dairies will operate a strict ‘one-in, one-out’ policy and they won’t be allowed to sell food prepared on the premises.
  • Primary industries, including food and beverage production and processing, will still operate.
  • Freight and courier drivers will continue to transport and deliver food.
  • Grocery food deliveries – such as My Food Bag and Hello Fresh – are considered as essential and will continue as long as the food is not pre-cooked.
  • Takeaway services will be closed.
  • Liquor stores will close, unless within a licensing trust area and will operate with a strict ‘one-in, one-out’ policy. Wine and beer will continue to be sold at supermarkets.

Public spaces

  • Places where the public congregate must close.
  • All bars, restaurants, cafes, gyms, cinemas, pools, museums, libraries, playgrounds and any other place where the public congregate must close their face-to-face function.
  • Playgrounds are classed as an area where people congregate and so are off-limits.
  • People can exercise outdoors but must maintain a two metre distance from others.
  • People are expected to stay local when leaving the home.

Services

  • Rubbish collection will continue. Check your local authority website for recycling.
  • NZ Post will deliver mail and courier drivers will continue to make deliveries.
  • Self-service laundries can stay open, as long as 2 metre physical distancing is enforced.
  • Service stations will remain open and will be supplied.
  • Public transport, regional air travel and ferries are mostly restricted to those involved in essential services and freight.
  • Some public transport will be available for essential trips, such as to the supermarket or doctor, but options will be limited.
  • Building and construction workers will carry on in cases where they’re needed to maintain human health or safety.

Recreation or exercise

  • You can go for a walk, run, or bike ride. Exercise is good for people’s mental health.
  • If you do, it must be solitary, or with those you live with.
  • Keep a 2 metre distance.
  • However, if you are unwell, do NOT go outside.
  • DOC has closed all its campsites and huts.
  • Do not go hunting or hiking, and especially not on overnight trips.

Interaction with others

  • Staying at home is meant to reduce the transmission of the virus.
  • For this to work, you are asked to only have contact with the people you live with.
  • If you want to talk to a friend, call or video chat with them.
  • If you want to talk to a neighbour, do it over the fence.
  • Please note that children CAN travel between the homes of separated parents so as long as they live in the same town/city.
  • Feel free to drop off groceries to others e.g. a grandma, but keep a 2 metre distance for her safety.

If you are unable to find what you need, and are not sure who to contact for help, call the free government helpline on 0800 779 997 or on 0800 22 66 57 (8am–1am, 7 days a week).

Essential businesses

Only businesses that are essential may remain open during the Level 4 Alert period. If a business isn’t sure if it provides services or products which qualify as essential, it should close.

Find out more about essential businesses

Where can I get financial support?

The Government is acting to support New Zealanders through these changes. This includes:

  • a wage subsidy scheme
  • leave and self-isolation support
  • business cash flow and tax measures.

Your usual financial support, such as benefits, will continue.

Find out more about COVID-19 support , including how to apply, on the (external link)Work and Income website.

Gatherings are cancelled

All indoor and outdoor events cannot proceed.

This does not include workplaces of people undertaking essential businesses .

These requirements apply to family and social gatherings such as birthdays and weddings. These gatherings cannot go ahead.

We are asking you only spend time with those who you are in self-isolation with, and keep your distance from all others at all times.

Funerals and tangi

Funeral directors provide essential services and will continue working during Level 4. However, gathering together for funerals and tangi is not permitted while New Zealand is at Alert Level 4.

This may be a challenging time for you and your family. If you ever feel you are not coping, it is important to talk with a health professional. For support, you can call or text 1737 – free, anytime, 24 hours a day, 7 days a week – to talk with a trained counsellor.

Find out more about funerals and tangi.

Education

All schools and early childhood education centres will be closed.

Schools will be providing information directly to all parents about what this means for them.

The upcoming school term break will be brought forward to start on Monday, 30 March. For the remainder of this week and through the term break, schools will establish ways to deliver teaching online and remotely.

Where possible, essential workers with children aged 0-14 need to make their own arrangements for childcare. We know this will not be possible for everyone.

Alternative arrangements are in place to allow essential workers to access childcare and continue to work.

Your employer will tell you if you qualify as an essential worker for these purposes.

How to access healthcare

Health and medical facilities are essential services and will remain open while we are at Alert Level 4.

Just because you have to stay home doesn’t mean you can’t get medical help if you need it.  This includes healthcare services, such as Healthline, GPs, cancer services, disability and aged support services.

The way these services operate might change  for example your GP might be talking to you over the phone rather than seeing you in person.

The health system will continue to provide the necessities of life for New Zealanders.

If you need to see a Doctor or other medical professional you MUST phone first.

Most consultations will happen over the phone (or by videoconference) to stop any risk of Covid-19 spreading by person to person contact.

If a face-to-face meeting is required, your doctor or other medical professional will organise this with you.

Please only call Healthline if you or someone you know feels unwell or you need medical advice, rather than general questions about COVID-19. It’s important Healthline is able to answer calls from those who need medical advice. The more people who call asking for general information, the fewer people who need medical advice can get through.

If you cannot get through and are severely unwell, for example having trouble breathing, contact emergency services (dial 111).

Further advice on how to access healthcare

Public transport and travel

You may not fly within New Zealand.

You may use a private vehicle to get food or medicine.

Private Vehicles and active travel

Using private vehicles for transport is allowed. Where possible, practice physical distancing.

Personal walks and other active travel like biking, is fine, provided you follow the two metre physical distancing requirement at all times.

International air travel

Visitors and tourists can still use international air services to travel home but commercial flights have been impacted.

Do not go to the airport unless you have a ticket. If you do not have ticket contact a travel agent or airline directly. If you are unable to secure a ticket please contact your country embassy.

For information about the Government Epidemic Notice issued and information about visa extensions, go to the Immigration New Zealand website.(external link)

Domestic air travel

While in Alert Level 4, air travel will be used only for the transport of people undertaking essential services and the transport of freight.

At risk people

Vulnerable people in particular should stay at home, and ask others to pick up supplies for them. You just need to ask them to leave these at the door, rather than come in. Drop offs at the door (rather than coming in) will protect vulnerable people from exposure to COVID-19.

You are at high-risk if you are over 70, have a compromised immune system or have underlying health conditions.

People with underlying medical conditions include a compromised immune system, liver disease, cancer, kidney disease, heart disease and diabetes mellitus, pregnant people or those on immunosuppressant medications.

You need to take more precautions to protect yourself against all infections, including COVID-19.

Source: https://covid19.govt.nz/government-actions/covid-19-alert-level/

More information for vulnerable and at risk groups

Download a poster asking people not to enter your building

Find out more about COVID-19