More Trump ignorance on Covid testing

Donald Trump has been again combined contradictory and ignorant claims about Covid testing with an attack on media.

The US has done more testing than any other country, but Israel, Russia, Singapore, UK, Denmark and a bunch of small countries have done more testing per head of population (US is 19th on the WorldInfo list).

Testing is a critical means of controlling Covid, but the raw number of tests doesn’t say much anyway. Here’s some percentages of other numbers

USA has:

  • 4.26% of the world population
  • 17.28% of Covid tests
  • 22.93% of Covid deaths
  • 26.45% of total cases
  • 28.48% of serious/critical cases
  • 37.63% of active cases

Those are numbers are only based on recorded statistics so won’t be 100%, but give an obvious indication that the US is struggling with Covid.

Testing matters, but the quality of testing, the timing of testing and the use of the results of the testing are more important than raw numbers.

Testing in the US showed that Covid was still widespread in the US when Trump and some states pushed for relaxing lockdowns. Covid got worse – deaths have been trending back upwards there through July, and this week were the highest since May.

Tests are important but it’s how you use the tests that matter.

Note that New Zealand is included and rates very well on these charts.

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New Zealand’s testing rate of 93,574 per million is much less than the US rate of 177,883 per million, but we have 4 deaths per million compared to the US rate of 475 so we don’t need to do as much testing.

Our testing peaked at over 10,000 per day in June – when we came out of lockdown and wanted to make sure Covid was under control – and is now peaking at 3,000 per day. We need to make sure we don’t have community transmission, but because fewer people have symptoms or concerns, fewer get tested.

Reuters: U.S. records over 25,000 coronavirus deaths in July

U.S. coronavirus deaths rose by over 25,000 in July and cases doubled in 19 states during the month, according to a Reuters tally, dealing a crushing blow to hopes of quickly reopening the economy.

The United States recorded 1.87 million new cases in July, bringing total infections to 4.5 million, for an increase of 69%. Deaths in July rose 20% to nearly 154,000 total.

The biggest increases in July were in Florida, with over 310,000 new cases, followed by California and Texas with about 260,000 each. All three states saw cases double in June.

Cases also more than doubled in Alabama, Alaska, Arizona, Arkansas, Georgia, Hawaii, Idaho, Mississippi, Missouri, Montana, Nevada, Oklahoma, Oregon, South Carolina, Tennessee and West Virginia, according to the tally.

The United States shattered single-day global records when it reported over 77,000 new cases on July 16. During July, 33 out of the 50 U.S. states had one-day record increases in cases and 19 set records for their rise in deaths in 24 hours, according to a Reuters tally.

We have virtually no restrictions because we have Covid under control here.

And Covid isn’t the only worrying statistic in the US.

The news that more states could be hard hit by the virus comes a day after the U.S. reported that gross domestic product collapsed at a 32.9% annualized rate in the second quarter, the nation’s worst economic performance since the Great Depression.

We may be able to keep Covid out of New Zealand, but it will be difficult to avoid the economic impact.

Odd tweets about testing doesn’t address the problems the US still face.

Vaccines are being fast tracked but at best it will be some time before they limit the Covid damage.

Reuters: U.S. makes deal for 100 million doses of coronavirus vaccine, deaths expected to rise

Two major drug companies will supply the U.S. government with 100 million doses of an experimental coronavirus vaccine, the Trump administration said on Friday, as the nation’s top health agency predicted that fatalities would rise in the coming weeks.

The U.S. Centers for Disease Control on Friday forecast between 168,000 and 182,000 total fatalities by August 22, predicting that deaths will rise fastest in Alabama, Kentucky, New Jersey, Puerto Rico, Tennessee and Washington state.

The CDC also released a study that said COVID-19 had spread to nearly half the staff and campers at a sleep-away camp in Georgia over a week and a half ago.

The investigation demonstrated “that children of all ages are susceptible to SARS-CoV-2 infection and, contrary to early reports, might play an important role in transmission.”

Coronavirus deaths in the United States are rising at their fastest rate since early June. Roughly one American died about every minute from COVID-19 on Wednesday.

Wisconsin joined 21 other states that have seen a surge in new cases.

The COVID-19 outbreak “is not in good control” in Wisconsin said Allison Arwady, commissioner of the Chicago Department of Public Health.

This isn’t fake news. Many US states are having very real problems with Covid.

While the president keeps fiddling with twitter his country burns.

As Covid testing surges Ministry limits criteria

One of the biggest concerns over the handling of Covid had been the limited criteria that the Ministry of Health used to allow testing for the virus. This became a bigger issue over the last two weeks regarding testing of people before releasing them from isolation or quarantine.

Criteria were relaxed, and this week there has been a surge in testing numbers, with a record 9,174 tests done on Tuesday (23 June).

There have been reports of long queues at testing stations – this will have been made worse because the number of testing stations have been significantly reduced.

Apparently as a result the Ministry has tightened up on testing criteria again.

RNZ:  Ministry of Health reintroduces high risk criteria for Covid-19 testing

Covid-19 testing for every person with a cough or cold symptom has been dropped by the Ministry of Health.

Under new Ministry of Health testing guidelines, doctors and testing clinics, are urged to instead focus on those at highest risk.

For the past several weeks, anyone with even a sniffle had been told they can be tested for Covid-19.

But that will no longer be the case unless they fall into a high risk group or their doctor advises it.

The high risk group includes anyone who have recently:

  • Had contact with an infected person
  • Been overseas
  • Had direct contact with someone who had been overseas
  • Worked on an international aircraft of ship
  • Worked at an airport or isolation facility

Other people with a cold or flu symptom could still be tested but it will not be a requirement.

The move is expected to put an end to the huge demand for tests in some areas over the past week as cold and flu season hit.

Northland GP Geoff Cunningham was so busy he ran out of swabs.

He was relieved to see the change.

“It would be unsustainable if we were to continue swabbing every minor respiratory tract infection,” he said.

Leading public health doctor Nick Wilson, said the change was the right thing to do because there was no evidence the virus was transmitting in the community.

These are risky decisions basing tests on symptoms, especially because it is well known now that people with no symptoms can carry the virus.

This may be fine for now. But if the virus does get out into the community again it may not be picked up soon enough to contain it.

At least the seem to have comprehensive testing in place for people coming into the country and going into mandatory isolation.

Covid-19 – Ireland acted sooner than UK, double the testing, less than half the deaths per 1m

A comparison between Ireland and England in dealing with the Covid-19 virus and their casualty rate seems to reinforce the importance of timing in locking down countries, and in testing rates.

Irish Central (March 17): Britain and Ireland’s differing approaches to Covid-19

The United Kingdom may be Ireland’s closest neighbor, but the two nations could hardly be further apart in how they are approaching COVID-19. 

They are virtually polar opposites and Britain’s approach could deeply impact the Republic of Ireland, especially since the countries share a significant border in Northern Ireland.

The UK has lagged behind Ireland (and indeed the rest of Europe) in implementing stringent measures to curb the spread of Coronavirus.

From a Twitter thread by historian and writer Elaine Doyle @laineydoyle (edited):

I don’t understand the British media. I really, really don’t. Basic things: Ireland and the UK started this pandemic with roughly the same number of ICU beds (6.5 per 100,000 for Ireland, 6.6 per 100,000 in the UK). If anything, the UK was slightly better off.

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(ICU beds is just one indicator of country preparedness. Germany and Austria have relatively low death sates compared to Italy, France and Belgium, but so do Portugal and Finland).

As of today, there have been 320 deaths from the coronavirus in Ireland, and 9,875 deaths in the UK.

So we adjust per capita – how many deaths per 100,000 people?

As of Saturday 11 April, there have been 6.5 deaths per 100,000 people in Ireland (now 6.8).

There have been 14.81 deaths per 100,000 people in the UK (now 15.6).

Guys, people have been dying at more than *twice the rate* in the UK.

That the UK’s closest neighbour, with almost the *exact* same starting line in terms of its health system, is having a wildly different outcome? Not saying Ireland’s a paragon of virtue! Loads to discuss & critique & make better!

But wait, it’s worse! Because if you compare the per capita death rate between Ireland and *England*, rather than the UK as a whole, England has almost *2.5* times the number of deaths as Ireland (14.81 deaths per 100,000 vs 6.5 deaths per 100,000).

So you have two English-speaking countries, with close cultural and historical associations, both with underfunded health systems, & comparable levels of ICU beds (almost half the EU average) going into the pandemic.

But England has more than 2.5 times the deaths? Why?

If you’re arguing over whether Boris & Co’s ‘herd immunity’ policy (& the resulting delay in lockdown) had any effect on death rates – here’s your angle, lads. You have a real-time A/B test happening *right in front of you*.

Because Ireland closed down earlier. Much earlier.

While Boris was telling the British people to wash their hands, our Taoiseach was closing the schools.

While Cheltenham was going ahead, and over 250,000 people were gathering in what would have been a massive super-spreader event, Ireland had *cancelled St Patrick’s Day*.

The four-day Cheltenham Festival is a meeting in the National Hunt racing calendar in the United Kingdom. It place annually in March at Cheltenham Racecourse in Cheltenham, Gloucestershire – Wikipedia

Daily Mail: Cheltenham Festival organisers say Boris Johnson’s trip to England-Wales Twickenham rugby match was one reason they didn’t cancel race meeting blamed for coronavirus spread  – since the festival took place hundreds of people have complained of getting symptoms of the deadly virus.

In Ireland, we watch a lot of British media and news, and let me tell you, it was like living in bizarro-world.

Because our Irish TV news was filled with very direct, serious pronouncements about what was coming. But when we switched to the British TV channels… *crickets*.

Particularly vivid for the weekend before Paddy’s Day. Rolling restrictions in Ireland, so no groups > 100, but pubs not yet closed. Video emerged of people singing in a pub in Temple Bar => public outcry, #shutthepubs trended, Health Minister comments, voluntary closure ensued.

 

I remember watching that video being posted on Twitter that Saturday night, and feeling sick to my stomach. How many people were being infected, at that very moment, singing along to the Stereophonics? It was such a huge crowd.

I assume there were people in Cardiff who felt the same way I did. But the difference was: I was supported by my government. You weren’t.

And that cost lives.

The Stereophonics gig was on the 14 March. Median 5-7 days to get sick, and let’s allow another 14 days to get seriously ill. The people infected at the Stereophonics gig were in hospital last week.

The people *they* infected will start dying next week.

Pandemics roll along exponential curves. The NYT (using @brittajewell’s calculations) showed it beautifully here:

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@brittajewell used US figures, & showed that if you started to stay home *this week* (March 13, at the time of publication), you could prevent 2400 infections. But if you started to home *next week* instead, you prevented 600 infections. (Those figures were based on US infection numbers at that point, with 30% growth rate per day. It’s not the UK.)

It’s weird, right? Exponential curves are really counter-intuitive. When they go up, they go up FAST. Timing matters, a lot. By staying home *this week* rather than *next week*, one person could prevent an extra 1800 infections. One person!

And as @jkottke pointed out, assuming a 1% death rate, that’s 18 lives saved. 18 lives saved, by the choices of one person to stay home for the week starting 13 March, rather than the following week. That Stereophonics gig? Was on 14 March.

Ireland cancelled Paddy’s Day on 9 March, initiating a series of rolling, controlled restrictions, from school closures & large group bans (12 March), to closure of non-essential businesses & social distancing, to full lockdown. It was precise, clearly communicated, controlled.

The UK closed their schools on 20 March, a full week after we closed ours. Full lockdown came to the UK on 23 March.

And while there was some muddied, confused advice in the UK between times (avoid non-essential travel from 16 March? don’t go to the pub, but then again, they’re still open, so maybe do?) – there was an abrupt about-turn, after the Imperial College report came out.

The comparisons aren’t neat between the two countries, because the processes (and nomenclature) were different. Technically, the UK went into lockdown *before* Ireland; but that’s not a fair comparison, as we were already operating our ‘Delay Phase’ from 12-27 March.

But I would argue the crucial difference lies in that two-week period: from 9 March, when we cancelled Paddy’s Day, to 23 March, when the UK govt finally (and abruptly) wheeled about, and went into lockdown.

And because the UK government delayed, distorted and distracted for those two weeks, the UK people ended up on the wrong part of an exponential curve, when lockdown started. And now, the UK has over twice the number of deaths per capita than Ireland.

But wait, it’s worse! HOW how HOW can it be worse.

Because: testing.

Because the UK figures only include deaths, in hospitals, from people who had already been tested positive for COVID-19. That sentence has a whole pile of clauses and commas, doesn’t it? Let’s break it down.

It means that a person could die *in a UK hospital* of the coronavirus; and all their doctors could agree that yes, they definitely died of coronavirus; and their *death cert* says that yes, they did, in fact, die of coronavirus –

… and they wouldn’t be included in UK figures.

Because they weren’t tested.

And you have to have a positive test, before death, to be counted in the UK deaths.

The UK isn’t testing nearly as much as it needs to.

And Ireland is testing a *lot* more. We have a drive-through testing centre in the sacred sporting grounds of Croke Park – think turning Wembley Station into a testing centre, and you get somewhere close.

Ireland is still building its testing capacity, but we’ve been explicitly following the South Korean model of test, test, test (and contact trace). And we’re using our time in lockdown to build our testing network.

The aim is to have 15,000 tests per day, or 105,000 tests per week – that is, testing 2% of the population a week. 15,000 tests is about 7 months of flu testing for Ireland – and we’re planning this, every day, for months and months.

We’re not there! We had to grab Germany for a dig-out, we fell so far behind! There’s loads of teething problems! Like I said at the top of the thread: I’m not saying that Ireland is a paragon of virtue here.

Of course no country has dealt with Covid-19 perfectly, it was a rapidly evolving with big decisions needing to be made quickly that had huge health, economic and social ramifications. Not easy for any country to get things right.

And to date, Ireland has performed 8.69 tests per 1,000 people. ourworldindata.org/covid-testing# The UK has performed 4 tests per 1,000 people.

Currently Worldometer shows Ireland with 10.73 and the UK with 5.2 (New Zealand 12.68).

So: to my UK friends, let’s lay it out there. You’re testing at half the rate that Ireland is, and your loved ones, your family, your friends are dying over twice as fast.

So timing and testing have been very important.

And that’s still a wild underestimate of how bad things are, because your low testing rates are artificially depressing your death figures; whereas Ireland’s high testing rate is (comparatively) inflating ours (or, more fairly, accurately recording them in our figures).

Failed by your government, and failed by your media.

Failed, by news reports that (correctly!) talk about how horrific the death toll is in NYC, while eliding the horrors of nearly 1000 people dying in a single day at home.

Failed, because it didn’t have to be like this.

Failed, because there are lessons and exchanges to be found here, but in those 2 weeks when so much could have been done, your media didn’t pay any heed to what was happening beside it.

Because your media didn’t report on the contrast between Boris’ choices and ours.

Failed, because your media STILL isn’t reporting on the contrasts in death rates between us, and why that might be the case.

It’s too late to get the timing of even cancellations and lockdowns right, but not too late to ramp up testing.

Failed, because in this long-standing, complicated, skewed relationship between us, we can see you clearly, and you seem to barely see us at all.

And it breaks my heart.

But there’s still time. Time to flatten your curve. Time to build testing. Time to develop a robust contact tracing system. Time to *use* your lockdown as it should be used, while we do the same. Time to be our partners in this, as we all must be, in a globalised pandemic.

The best time to plant an oak tree was 20 years ago; the second-best time is now.

The best time to stop this pandemic was last January. The second-best time is now.

And while we’re working this ground together, remember that over the fence, in your neighbouring allotment, we’re tackling the same tasks as you. It might be worth taking a peek over the fence sometime, to see what we can share.

The UK seems to be similar to how France was, not counting deaths in rest homes.

Business Insider: Hundreds of coronavirus deaths are taking place in UK care homes but not being included in the official death toll

BBC: Warning over daily death figures

Over the weekend, NHS England released new figures broken down by the actual date of death.

And these reveal that between 11 March and 1 April there were about 300 more deaths than previously thought during that period.

Separate figures, published by the Office for National Statistics (ONS) also suggest the number of people dying with coronavirus is higher than the daily totals indicate.

The ONS examined registrations and found deaths in the community not included in the daily hospital deaths figures.

In the week to 27 March, for the 501 deaths recorded in hospitals the ONS also found 38 deaths linked to coronavirus in the community.

Also from BBC:

Larissa Nolan (Irish Mirror:  7 April): UK and Ireland’s responses to Covid-19 crisis are worlds apart

For far too long, the Brits’ approach to this crisis was to stick their fingers in the ears, close their eyes and go: “Lalalalalala”.

Like many others in Ireland, I watched on; worried for relations and friends in England. What were they at over there?

British political leaders have subsequently made some attempts to address it, but it’s too late now. The “denialism” – as a senior British scientist called it – is too strong.

Reports from the weekend show Britons still gathering, regardless. Attitudes are ingrained. Behaviours have been set. Outcomes are following accordingly.

Here in New Zealand we don’t have such a stark contrast in approaches with our larger neighbour, Australia, except for timing. Covid-19 seemed to become established in Australia a few days sooner than here, particularly in New South Wales, but we lockdown harder and about the same time as Australia.

Current deaths in New Zealand 4, in Australia 59.

 

Constructive Simon Bridges interview on NZ Q+A

Leader of the Opposition Simon Bridges cam across surprisingly well in an interview on NZ Q+A this morning. He was supportive of many Government actions in dealing with Covid-19, and his criticisms were reasonable and constructive on quarantining people arriving in New Zealand and Covid testing.

He also pushed for more businesses to be able to open.

1 News: Bridges calls for more businesses to safely operate during lockdown

A “constructive conversation” is needed on whether contactless businesses should be able to run safely during lockdown, National leader Simon Bridges says.

“When you think about our economy, the longer we see the devastation, the job losses, the businesses going under, it’s heart attacks, it’s mental health issues, it’s fatalities in its own way,” Mr Bridges told TVNZ1’s Q+A with Jack Tame.

“Let’s try and deal with some of the randomness where one is an essential service and one isn’t, let’s be agile and potentially we can move to a more risk-based system.”

Mr Bridges said the country needed to be “quite agile about those questions now and certainly if lockdown goes longer”.

“The Government needs to do everything it can to have the most effective lockdown so we can get out of this as soon as we can.

“We’re devastating our economy, we’re curtailing freedoms, so the sooner we can get out the better.”

Mr Bridges also called for an increase to testing, pushing the daily tests into the “tens of thousands”.

As of yesterday, a total of 33,116 Covid-19 tests had been done, with the country at a capacity to do over 6000 tests per day.

“If you dealt with everyone who had symptoms, close contact, overseas, you would be testing more,” Mr Bridges said.

Full interview via https://www.tvnz.co.nz/one-news/new-zealand/bridges-calls-more-businesses-safely-operate-during-lockdown

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

Symptoms of Covid-19 and what to do if you might have it

Symptoms of the Covid-19 coronavirus have some things in common with a cold or flu, but this shows differences (it has been posted in comments but it’s worth repeating):

The article it is from is interesting too – Siouxsie Wiles: How testing for Covid-19 works

How the process runs, why we’re not testing everyone who feels ill, and something you can do online immediately and easily to help the fight against the virus.

What you can do to help

While the Ministry of Health look at other strategies for early detection of Covid-19, there is one we can all help with right now. We need every household in New Zealand to sign up to the FluTracking project. Each week you’ll be sent an email asking if anyone in your house has had a fever or cough. This information is being used as an early warning system for Covid-19.

So, in summary. If all you know about testing for infectious diseases is stuff you’ve been reading on the internet, then stop tweeting your reckons and firing off your hot takes. Sign up to FluTracking. Wash your hands. Stay at home if you start to develop any symptoms. If you’re unsure what those symptoms are, we’ve got you covered.

Check Spinoff cartoonist Toby Morris’s handy guide above or  click here for a printable, high-res PDF version.

Ministry of Health latest report:

New Zealand has twenty confirmed cases of COVID-19. For a summary of the current status see our latest media release (18 March).

More information is now available on our current cases page.

With continued vigilance the chance of widespread community outbreak is expected to remain low.

New border measures are in place as of Monday 16 March. Most travellers arriving in New Zealand are now required to self isolate for 14 days – check our information for travellers arriving to New Zealand to find out more.

If you have been overseas within the last 14 days and develop a fever, cough or shortness of breath, phone Healthline’s dedicated COVID-19 number 0800 358 5453 or contact your GP, including phoning ahead of your visit.

For COVID-19 health advice and information, contact the Healthline team (for free) on 0800 358 5453 or +64 9 358 5453 for international SIMS.

Other information and advice:

 

 

Trump declares US ‘national emergency’, ramps up Covid-19 tests

President Donald Trump has just had a media conference in which he declared a ‘national emergency’ due to the Covid-19 coronavirus pandemic. there are rep[oets he is also invoking the Stafford Act.

  • The national emergency gives access to expanded authorities for the executive branch.
  • The Stafford Act is what frees up the extra federal funding and allows access to the funds.

Trump said this would “open up access to up to $50 billion,” which was “a large amount of money for states and territories and localities in our shared fight against this disease.”

Trump also urged states to set up emergency operation centres immediately.

Many states have already declared emergencies and taken significant steps to try to contain the spread of the virus.

After recently claiming virus tests in the US were ‘the best’ (and was contradicted by a top health official) Trump also announced a major increase in screening tests around the US – up to 5 million tests a month.

This is a major shift for Trump – but the media conference seemed heavy on PR in reaction to strong and widespread criticism of Trump and the US response.

Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases:

“We still have a long way to go. There will be many more cases. But we’ll take care of that and ultimately, as the President said, this will end.

But what’s going on here today is going to help it to end sooner than it would have.”

Trump: “We don’t want everybody taking this test. It’s totally unnecessary”.

CNN: President Trump continues to shake hands with corporate chiefs in the Rose Garden, even as health experts warn against the practice in a bid to prevent community spread.

“I’ve waived interest on all student loans held by federal government agencies, and that will be until further notice”.

He said he also directed the Secretary of Energy “to purchase large quantities of crude oil for the US strategic reserves.”

Vice-President Pence is talking a load of PR bull, praising Trump for everything he has done.

Meanwhile the US sharemarket has partially bounced back, recovering (currently 4.8% on the Dow Jones) from yesterdays 10% slump (it hasn’t reacted noticeably to the announcement yet). I expect the timing of the announcement had the close of the US markets in mind. Update – a late jump almost regained all of yesterday’s loss, closing up 9.36% (yesterday was down 9.99%), although it is still down nearly 3000 points over the week.

In response to media questions he criticises the Democrats, and slams the Obama for what he claims were failures over an epidemic, but when called on his claims by a reporter he shut them down.

Drug driver testing consultation by Government

Last week National MP Nick Smith tried to get a members’ bill trying to address drug driving fast tracked in Parliament.

Hon Dr NICK SMITH (National—Nelson): I seek leave of the House for the Land Transport (Roadside Drug Testing) Amendment Bill to be set down as the first members’ order of the day on the next members’ day on 22 May.

The Speaker Trevor Mallard intervened himself (an unusual move from the Speaker who is supposed to be neutral), and when Smith reacted in response sent Smith from Parliament. This escalated when Smith over-reacted and was then officially ‘named’ by the Speaker and copped a 1 day ban from Parliament.

See Nick Smith named and suspended from Parliament for “grossly disorderly conduct”

This week the Government decided to do something about drug driver testing themselves.


Safety focus in improved drug driver testing

Improving the safety of all road users is the focus of a new public consultation document on the issue of drug driver testing.

Plans for public consultation on options to improve the drug driver testing process have been announced by Associate Transport Minister Julie Anne Genter and Minister of Police Stuart Nash.

Julie Anne Genter said: “While drug drivers already face serious criminal penalties if caught, the current law makes it hard for Police to carry out higher numbers of tests that could deter drug driving.

“And unlike with alcohol testing, drug testing comes with some unique challenges, which is why we want expert and public input into the design process.   For example, unlike alcohol breath tests, drug tests can only detect the presence of drugs or medication. They cannot test if a driver is impaired.

“We know the public wants to be involved in the development of legislation that will impact them. Consultation will ensure changes to the current system incorporate the needs and wishes of New Zealanders.

“A considered approach to developing enhanced drug driver testing will mean we can develop a robust testing system that’s grounded in evidence and best practice. We need to do this thoughtfully,” says Julie Anne Genter.

“Irrespective of whether someone is impaired by alcohol, medication or recreational drugs, they shouldn’t be behind the wheel,” says Stuart Nash.

“Last year, 71 people were killed in crashes where a driver was found to have drugs or medication in their system which may have impaired their driving.  That compares to 109 deaths where a driver was found to have alcohol in their system.

“We need to do more to stop dangerous drivers getting behind the wheel and enforcement on our roads is a key part of this.  However Police cannot do this on their own. Every one of us must challenge dangerous driving behaviours when we see them,” Mr Nash said.

Consultation will take place over the next six weeks, concluding on Friday 28 June. The Government will be looking to confirm its options at the end of this year.

The Government is looking for feedback on:

  • the methods that could be used to screen and test for drugs
  • the circumstances in which a driver should be tested
  • what drugs should be tested for
  • how an offence for drug driving should be dealt with by Police.

Ministry of Transport:  Drug Driving

Changes to the drug driver testing and enforcement system in New Zealand

The Government is considering making changes to New Zealand’s drug driver testing and enforcement regime. Research shows that many illicit and prescription drugs have the potential to impair driving, and studies show that New Zealanders are using those drugs and driving.

Addressing drug impaired driving is an important objective if we are to make our roads safer – since 2013, the number of road deaths in New Zealand has increased by nearly 50 percent. Drug driving is making an increasing contribution to this statistic.

The Government has decided that it is time to reconsider our approach to drug driving and the public should be involved in that conversation.

A Discussion Document has been developed to facilitate a conversation about possible approaches to improving our drug driving system. The consultation seeks feedback about:

  • How we can be better at detecting drug drivers and deterring drug driving?
  • The circumstances in which drivers should be tested for drugs?
  • How to decide which drugs to test for?
  • What evidence is required to establish a drug driving offence?
  • How we should deal with people caught drug driving?

Download the Discussion Document [PDF, 1.4 MB]

Consultation process

The Ministry requests written submissions and they must arrive by 5.00 pm Friday 28 June 2019 to be considered. Submissions can be forwarded to the Ministry at:

drugdrivingconsultation@transport.govt.nz

Also: