Saturday 21 March is the day when community transmission of COVID-19 first became evident. It is apparent that there is now at least one COVID-19 case from unknown community transmission, with this being in the Wairarapa. There also appears to be a case in Auckland involving a two-step infection back to a traveller.
Assuming the Wairarapa infection occurred three to seven days ago, then the likelihood is that there are now multiple more cases ‘out there’ waiting to be found.
Until now, the cases predominantly link to air arrivals up to about 15 March and most are from several days prior to that. But in this last week, the risk profile of new returnees has increased considerably.
Given that identified infections have risen approximately six-fold in the last week, currently standing at 53 and up from 28 just two days ago, it is reasonable to expect a similar rate of increase in the next week. An increase of anything less than three-times over the coming week would be a good outcome, but that would still take us to over 150 cases.
For arrivals from most countries, the apparent risk factor associated with each person has increased by a factor of about four in this last week, but for those from the United States it appears to have increased at a considerably faster rate. The flow of returnees in this last week has been remarkable.
In designing the appropriate policy for this coming week, the key issues relate to the people who arrived last week, together with all of the people who are still to come in this week.
There are two key weak points with the current control system. The first relates to the lax quarantining of people, including but not only New Zealanders, arriving from overseas. The second relates to internal transmission within the country through the contacts of these people. I have previously described these as fatal flaws.
The time has now come for all new returnees to be placed upon arrival in Government quarantine for fourteen days at army facilities. Returnees could be transported to facilities such as at Whangaparoa, Linton and Burnham, including using chartered planes from Auckland.
There must be thousands of camper vans that rental companies would love to rent to the authorities to house the returnees at the army bases. The army could feed them. If necessary, hotels could be contracted to provide additional meals. The system has essentially already been trialled for the 150 Wuhan returnees back in early February.
As for internal transmission, it is remarkable that pubs, restaurants, libraries, museums and gyms still remain open. Where they have closed, then it is based on decisions by local authorities and individual businesses, not by central government.
I have been hearing our Prime Minister referring multiple times to the examples of Taiwan, Singapore and even South Korea as the models we are following. This is make-believe from her health advisers who clearly do not understand how those societies work. I have discussed that previously.
In any case, numbers are now ramping up again in all three of these countries, largely driven by their own citizens returning home but also from internal transmission.
The following quote is taken from a comment in the New York Times, dated there as 20 March. It was written for an American audience, and of course with American spelling, but it is just as relevant for us. The key point is that we may think that we are patterning ourselves on these countries, but we aren’t.
“I was in Taiwan for several months when the Wuhan outbreak first happened. People on the street were concerned, fearful, but staunch - went about their daily routines. The government was really fast - boarding airplanes from China, taking temperatures of passengers and also arriving passengers from different places. If you went to a restaurant or museum, your temperature was first taken, your hands sanitized, and you had to wear a face mask if you wanted in. The custom in Taiwan is opposite Italy’s, people keep a polite distance. Public touching, not much. Public and mass transportation - wear face masks. Healthcare is universal and data of sick people went right to the epidemiology command center in real time. People were quarantined and tracked by their cell-phone to ensure compliance. Violators were fined substantially.”
I have yet to see any evidence of thermometers being used as a screening tool in New Zealand.
I also note our Prime Minister says in defence of our testing rate that the New Zealand rate is similar to South Korea on a per capita basis. There are two issues there.
First, I think her advisers have got their maths wrong. But even more important, they have not factored in that the South Korean outbreak was focused in the city of Daegu, and also that most of the infected people belonged to a particular religious sect, with these people largely socialising among themselves. Every member of that sect who could be identified, some 200,000, was tested. Despite all of those advantages, infections are increasing rather rapidly again in South Korea, with over 380 new cases in the last three days.
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Here in New Zealand, a key voice that authorities do not seem to be listening to is Professor Michael Baker from the Wellington Campus of Otago Medical School. His speciality is public health. He has spoken publicly on multiple occasions in recent weeks about COVID-19 and these statements are easily found by googling his name.
In recent days, Professor Baker has talked about schools being great places for viruses to spread within and hence the need to now close schools until we get things under control. Today, he has also described the current situation and lack of testing in New Zealand as “emblematic of the need for a pulse of lockdown”. He says that “it sounds melodramatic to say now or never, but I think it's the case."
As for asking over-70s to stay at home, I am cautious about that. As a measure of self-protection, it will become increasingly necessary as the infection rates rise. But right now, the key issue is getting ahead of the curve, and it won’t help very much at all in that regard.
Given that the Government’s policy is increasingly looking like flattening the curve, and hence consistent with a long-term goal of herd immunity rather than focusing on stamping it out, the over-70s are at risk of being shut up for a very long time. The issue of social isolation of this group becomes of great importance.
The longer that our leaders and their advisers focus on the rear vision mirror and use incorrect analogies from overseas, then the more we will stay behind the curve.
Let’s get pro-active and stamp it out. The harder we stamp then the shorter time it will take. And that means that we all have to do our part in the next month to six weeks.
If we stamp hard enough then we still have an excellent chance of eliminating the disease from our shores, although we will now have to stamp considerably harder than if we had moved more proactively a week ago. It is in that context that I said several days ago that the Government had lost the plot.
Government quarantine of all new returnees, plus closing of pubs, restaurants, nightclubs and gyms, and also unfortunately the closing of schools until the end of Easter, is what we now need. The alternative is a long and brutal winter.
*Keith Woodford was Professor of Farm Management and Agribusiness at Lincoln University for 15 years through to 2015. He is now Principal Consultant at AgriFood Systems Ltd, and has had a longstanding interest in epidemiology. He can be contacted at firstname.lastname@example.org