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

Business and the economy versus the ill, elderly and others

There’s no doubt that Covid-19 will have a very large impact on businesses and employment and livelihoods in New Zealand, and our economy will take a big hit. This will have happened regardless of the actions taken by the Government. It’s debatable what would be worse, doing more or doing less to limit the spread and infection rates.

It is also likely there will be deaths here. There are currently 368 confirmed and probably cases. Many of those will be mild to moderate and are being treated at home. Some are more serious and require hospitalisation.

Even with the relatively stringent lockdown cases are expected to rise for the next 7-10 days (or more if people flout the restrictions on movement away from home).

There is no doubt that without the level 4 lock down there would be a lot more spread, many more people catching the virus, and a real risk of quite a few deaths.  This shows how easily it can spread even with restrictions:

Marist College, Auckland – 18 confirmed cases, 1 probable
Private wedding, Wellington – 10 confirmed cases, 2 probable
Rest home, Hamilton – 11 confirmed cases

Older people and people with existing medical conditions (especially lung or heart) are particularly susceptible to Covid-19, but this is hardly surprising, they are also more susceptible to other viruses and illnesses. Younger people seem to generally have milder symptoms – but they can still spread the virus.

There have been suggestions that the virus should be left to take it’s course, to build ‘herd immunity’. This must accept an inevitable casualty rate – people would die, possible quite a few people.

It has been suggested elsewhere and also here that it isn’t a big deal that old people and people with illnesses might die of Covid-19. They die of other things anyway, Covid will just knock them off a bit sooner.

From Australia Victoria’s first two coronavirus deaths were cancer patients caught in Alfred hospital outbreak

Victoria’s first two coronavirus deaths were cancer patients at The Alfred hospital, and a further five cases of COVID-19 have been confirmed among patients and staff.

Duker commented on this:

Bingo! It seems like northern Italy all over again, the sick people get sicker and the elderly have less chance to recover.
It’s a fact of life and one day it will be my turn.

I’m quite disturbed by this attitude.

It’s a fundamental fact of life that we will all die, eventually.

But it is also a fundamental facet of a decent society that we don’t just do nothing to prevent old and ill people dying of any new virus or disease, treating them as expendable.

We put huge budgets and resources into health care to try to keep everyone alive as long as reasonably possible.

People who get old often live to get quite a bit older after having illnesses.

My father had most of his stomach removed in the 1980s, had a bowel cancer operation in the early 1990s, his lungs were fag fucked with emphysema, but he still had a fairly good life up until 2000.

In the mid-90s he was given a choice of having chemotherapy which would give him a 60% chance of not dying of cancer, or doing nothing and lowering his chances to 40%. He chose not to have chemo because he didn’t want to suffer through the treatment with a close to 50/50 chance it wouldn’t save him anyway. But this was his choice, and I think a sensible one.

If a Covid-like virus had hot the country then and I was given a choice of saving my business (I was a sole trader than) or saving his life I would have chosen his life. I had already changed jobs and moved so I could support him as his health problems increased (just after he had a mild stroke).

I’m sure there are many people who would put people before money in this way.

I think it would be terrible to let Covid-19 spread freely in New Zealand to try to reduce the impact on business and the economy.

I also think it would be misguided. If we didn’t have a lockdown and Covid-19 ran rampant here, as it almost certainly would, there would likely be hundreds if not thousands of deaths and many more hospitalisations. That in itself would be expensive.

If our hospitals were swamped with Covid cases – I presume no one things they should be left to suffer and die untreated – it would increase deaths by other causes because of lack of resources and treatment.

And if New Zealand was ravaged by Covid-19 there is no chance of tourism  recovering, no one would want to come here. New Zealanders would be banned from travelling to many countries. It’s likely exports would also be affected, air and sea transport would be badly compromised, and New Zealand would be an unpopular source of goods.

Internally if the virus was uncontrolled it would also have a major impact on travel and business. Many people would willingly keep away from places and businesses that were a risk to their health and life.

The main difference would not be economic impact, it would be whether the economic and employment was in a well controlled situation or chaotic and uncontrolled.

It’s debatable (and impossible to know) which would be economically worse, doing a lot to limit Covid-19 as we are, or doing much less or nothing.

Regardless of the economic factors and effects, we can’t just treat the elderly and the ill as expendable to try to save a few jobs and possibly (but probably not) keep the economy healthy.

“But the flu’ is trotted out by Trump and some here – but we have a choice of vaccinating against the flu and minimising our risks. We can’t do that with Covid. And because we could potentially die of something else, the flu (more often of complications), of cancer, of heart disease, is a very poor reason to not protect against a new threat.

If I was in a decision making position I certainly would put the health of citizens – especially the old and the ill – ahead of the economy. I back and applaud our Government and unanimous Parliament doing this.

No matter what the financial impact of Covid-19 measures, businesses will survive, new businesses will fill gaps, the economy will recover.

No one recovers from death.

 

Day 2 of isolation – time to ponder our way of living

So far for me isolation at home is easy. I have very good company, and I have spent all days this week working from home anyway, so yesterday was much the same.

I’m enjoying working from home, but after a busy start to the week as clients were busy setting themselves up to work from home and rushing to get payrolls done before closing offices, it was noticeably quieter yesterday. I have other work I can do, but I don’t know if it will last four weeks.

Some messages from NZ First MPs.

A reversal:

Guardian environment editor – Coronavirus: ‘Nature is sending us a message’, says UN environment chief

Nature is sending us a message with the coronavirus pandemic and the ongoing climate crisis, according to the UN’s environment chief, Inger Andersen.

Andersen said humanity was placing too many pressures on the natural world with damaging consequences, and warned that failing to take care of the planet meant not taking care of ourselves.

Leading scientists also said the Covid-19 outbreak was a “clear warning shot”, given that far more deadly diseases existed in wildlife, and that today’s civilisation was “playing with fire”. They said it was almost always human behaviour that caused diseases to spill over into humans.

To prevent further outbreaks, the experts said, both global heating and the destruction of the natural world for farming, mining and housing have to end, as both drive wildlife into contact with people.

I’ve heard others make links between the virus and climate change and the environment and I think it is dubious at best.

Sure if the human population was a tenth what it is and no one travelled apart from walking then viruses and other contagious diseases would spread less quickly and less far, but I don’t think modern humans are any more responsible for naural mutations than past civilisations.

Aaron Bernstein, at the Harvard School of Public Health in the US, said the destruction of natural places drives wildlife to live close to people and that climate change was also forcing animals to move: “That creates an opportunity for pathogens to get into new hosts.”

“We’ve had Sars, Mers, Covid-19, HIV. We need to see what nature is trying to tell us here. We need to recognise that we’re playing with fire,” he said.

“The separation of health and environmental policy is a ​dangerous delusion. Our health entirely depends on the climate and the other organisms we share the planet with.”

Maybe, but 7.8 billion people need somewhere to live and need food to survive.

The Covid-19 crisis may provide an opportunity for change, but Cunningham is not convinced it will be taken: “I thought things would have changed after Sars, which was a massive wake up call – the biggest economic impact of any emerging disease to that date,” he said.

What sort of change? Reversing population growth?

Here from Newsroom: Covid-19 may be just what climate change needs

Big jolts wake us up and force us to act today. Gina Williams looks at how the Covid-19 pandemic might give us the chance to redesign our society to combat climate change.

Things like no cars, no meat, no international travel, no business or commercialism?

Right now use of cars is limited of course, but they help us keep in our bubbles going to supermarkets to get food. If everyone had to walk to a local dairy for provisions it would be much harder to lock down the virus.

Nature has always had ways of checking and limiting and reducing species of plants and animals that grow too prolifically.

Should we just let Covid-19 to knock the population  back? That would be getting back to nature, letting nature take it’s course.

There’s been a bit of idealist opportunism alongside the rapid sweep of Covid-19. Now is not a good time to make maajor knee jerk changes. We are in survival mode. lets get through the next year and then see what we should be doing differently.


But maybe with most of us confined to our homes with a lot less to do this could be a good time to contemplate the situation we and our society become, and to consider better ways of living.

There already seems to have been renewed interest in growing more food at home and cooking and baking from raw ingredients rather than relying on fast food and packets.

We will also have to work harder on relationships. Many of us will be spending a lot more time with a few people close to us for longer than usual.

There could be an opportunity for online nutrition advice and relationship counselling – but perhaps we should be working things out for ourselves more rather than relying on paid for quick fixes that often don’t work for long or at all.

 

Covid-19 up, markets down, down, down

The Covid-19 virus is getting worse in some places, especially Italy but it is also getting a hold in Spain.

And following a bad week on sharemarkets in the last two weeks there are even bigger drops this week, with the Dow Jones slumping.

At the same time oil prices have crashed by more than 20%.

The spread of the virus seems under control in New Zealand for now, but the economic effects are significant with Air New Zealand scaling back operations and many businesses under stress.

We may benefit from plunging oil prices, but our stock market (and Kiwisaver investments) is suffering, and it is likely to follow \world markets down and get worse today.

And problems around the world are much worse, especially currently in Italy where they are shutting down a lot of the country to try and stop the virus spreading.

Reuters: EU seeks to tackle coronavirus as Italy locks down north, prisoners riot

EU leaders will seek a coordinated response to the coronavirus after global markets plunged on Monday and Italy sealed off much of its industrial north, where six prisoners were killed in a riot over curbs on visits.

Joining the global rout, triggered by a 22% slump in oil prices, Wall Street’s main share indexes dropped 7% and the Dow Jones Industrials crashed 2,000 points – which would be its biggest ever one-day ever if there is no recovery by the close.

More than 110,000 people have been infected in 105 countries and territories, and 3,800 have died, the vast majority in mainland China, according to a Reuters tally.

With Italy’s economy already on the brink of recession, bars and restaurants in Lombardy were ordered to close or to restrict entry and maintain a distance of at least a meter between people on their premises.

Major sporting events in Italy, including top-flight Serie A football, will be played without spectators for a month.

This must have a major impact in the Italian economy. And the virus is spreading in Spain.

In Spain, schools were closed in the town of Labastida near Vitoria in the Basque country after nearly 150 cases of coronavirus were identified in the region.

Spain has reported 999 cases in all, most of them in two areas around Madrid and around Vitoria in the north. Prime Minister Pedro Sanchez said it had prepared an emergency plan to deal with the economic consequences of the virus.

It is improving in regions that were first hit.

China and South Korea, Asia’s second-worst-hit country, both reported a slowdown in new infections.

Mainland China, outside Hubei province, center of the outbreak, reported no new locally transmitted coronavirus cases for the second day on Monday, but a top Communist Party official warned people against dropping their guard.

South Korea reported 165 new coronavirus cases, bringing the national tally to 7,478, while the death toll rose by one to 51.

The New Zealand Government is rolling out economic measures.

Beehive: Cabinet approves Business Continuity Package in response to COVID-19

Cabinet today approved the development of a Business Continuity Package to help support the economy through the disruption caused by COVID-19.

The Business Continuity Package includes:

  • a targeted wage subsidy scheme for workers in the most adversely affected sectors.
  • training and re-deployment options for affected employees; and
  • working with banks on the potential for future working capital support for companies that face temporary credit constraints;

As part of the package:

  • The Treasury and IRD have been directed to develop tax policy options in line with the goal of reducing the impact for affected businesses, to support businesses to maintain operational continuity.
  • The Treasury and MSD have been directed to develop policy options to support households to maintain incomes and labour market attachment.

The detail of this package is now being worked through. It will be discussed again at the Cabinet COVID-19 committee on Wednesday, and the Government expects to be in a position to make further detailed announcements next week.

So a bit of dabbling so far.

“New Zealand is well-placed to respond to COVID-19. We have been running surpluses and our net debt position at 19.5% of GDP is well below what we inherited, and well below other countries,” Finance Minister Grant Robertson says.

But if world markets crash they will drag us down, and that could have a major impact.

Newshub: BNZ becomes first major New Zealand bank to predict a recession

BNZ is now using the much-dreaded R-word, saying it’s more than likely there’ll be a recession this year.

“Everyone sort of panics when they hear the word recession,” BNZ head of research Stephen Toplis said. “It’s like the whole world’s going to fall in.

That may be happening now.

CNBC: Oil nosedives as Saudi Arabia and Russia set off ‘scorched earth’ price war

Oil prices fell through the floor in early trading Monday, tanking as much as 30% after Saudi Arabia slashed its crude prices for buyers. The kingdom is reportedly preparing to open the taps in an apparent retaliation for Russia’s unwillingness to cut its own output.

  • Oil prices are down nearly 50% for the year after OPEC+ talks collapsed and Saudi Arabia announced slashed prices in an apparent price war with Russia.
  • With previously agreed OPEC+ production cuts expiring at the end of March, Saudi Arabia and Russia can theoretically pump as much crude as they want.
  • An oil price war will have massive geopolitical consequences, pummeling markets already shaken by the new coronavirus, COVID-19.

Reuters: Wall Street pounded by oil crash, virus fears

Wall Street’s main stock indexes plummeted about 5% on Monday, as a slump in oil prices and the rapid spread of the coronavirus amplified fears of a global recession on the anniversary of the U.S. stock market’s longest bull run.

The energy .SPNY index plunged 18.2% to its lowest level since August 2004 and crude prices were on track for their worst day in three decades as Saudi Arabia and Russia moved to significantly ramp up production after the collapse of a supply cut agreement. [O/R]

Companies listed on the S&P 500 have now lost more than $5 trillion in value in a sell-off sparked by fears that the coronavirus epidemic could tip the global economy into recession.

That report is out of date, Wall Street has got progressively worse through the day, with several trading haalts to try to pause the slide.

At 2:15 pm Monday in New York the Dow Jones is down 7.3% for the day.

The NZX already dropped 2.94% in Monday trading and will be affected by international markets today. All we can do is wait and see what happens.

And all the New Zealand Government can do is try to limit the damage here, but the may be chasing a bear.