Success against COVID-19 depends on driving down the transmission rate such that on average, each infected person infects less than one other person. Lots of testing, social distancing and avoiding super-spreading events lie at the heart of it

Success against COVID-19 depends on driving down the transmission rate such that on average, each infected person infects less than one other person. Lots of testing, social distancing and avoiding super-spreading events lie at the heart of it

The key issue with eliminating COVID-19 from New Zealand is whether or not the transmission rate, alternatively worded as the reproduction rate, R., can be reduced to well below ‘1’ and kept there. This value of R=1 is where each infected person on average infects one other person.

If this rate can be held below ‘1’ then the disease will eventually die out by itself from within the community. The further the R value is below ‘1’, then the faster the disease will fade away.

The current expectation is that daily rates of new cases will increase through to about 6 April. No-one knows what that peak rate will be. The fact that it has declined a little from 83 on 28 March to 63 on 29 March is certainly good news but it may also mean absolutely nothing.

Taking Spain as an example, since their lockdown on 14 March, which appears to have been strictly observed, new case rates have declined on four different days, but the overall trend of new daily cases has been strongly upwards, having risen from 1159 on 14 March at the start of lockdown to 7516 on 28 March. They may now have just turned the corner, but it will be another two to three days before we can be sure. Spain is worth watching, because their lockdown has been strict, somewhat like ours.

Regardless of where we peak, we should know well before the four-week lockdown period is over whether or not we are on track. If we reach our peak daily cases by around 6 April, as seems reasonable and as the Prime Minister is suggesting, and if our lockdown is strict enough to get an R value of 0.5, then daily cases should decline thereafter by between 60% and 75% over the following two weeks. And from there we should be able to quickly drive it down close to zero. 

However, if we can only get the R value down to around 0.75, then it is going to take much longer.  Modelling produced here [https://www.tepunahamatatini.ac.nz/2020/03/26/suppression-and-mitigation-strategies-for-control-of-covid-19-in-new-zealand/] and supplied to Government assumed R=0.75 as their lowest tested result, and they thought that it would take too long at this level for the program to be sustainable. So, we really do have to go hard over the next few weeks to get on top of things.

The likely reason we have seen daily case rates stabilising on 28 March at 83 (from 85 the previous day) and then declining on 29 March to 63 new cases is that we are seeing fewer primary cases from new arrivals into New Zealand. The big question relates to the unseen waves in the pipeline from existing cases, with these having been seeded already from existing cases.  The answer will become evident over the next one to two weeks.

One of the real problems that can negate achievement of a low R value is super-spreader events where one person directly or indirectly affects many others. Currently in New Zealand we have at seven clusters which have acted as super-efficient spreaders. These is the Marist College in Auckland, the World Hereford Conference in Queenstown, a private wedding in Wellington, a US travel group from Wellington, a Hamilton Rest Home, a publicly undefined group from Matamata, and a Christchurch workplace. Each cluster has between nine and 36 cases, adding to 113 cases across all clusters, with numbers still climbing. If we are to get the overall average transmission rate below ‘1’ hereafter, then any new clusters have to be balanced elsewhere by many cases that infect no-one. 

So, there is a simple message there: do everything possible to avoid cluster events. And let’s hope we have no big super-spreading events in the pipeline.

Big cluster events overseas have included church events in Korea and Singapore, large private dinners in Singapore and elsewhere, weddings in multiple countries, a football game in Northern Italy between Valencia and the local Atalanta team,  which in all likelihood was the super-spreader event  transferring the disease to Spain,  and beer-pong in a well-known Austrian pub in the resort of Ischgl. This last event apparently led to transfer cross much of Northern Europe.

For those who don’t know the game of beer-pong, it is a well-known drinking game played by a different generation to me, that has a number of variants. Most of those variants were identified a long time ago as a source of ‘pong-flu’ linked to poor drinking hygiene. It seems the Austrian version played in Ischgl had particularly poor hygiene, with participants using shared whistles to project the pong balls into cups of beer which other people then had to drink. Yuck!

Where things can really turn to custard is when one super-spreader seeds another super-spreader. That is the risk we face right now in New Zealand, particularly from the Hereford Conference.  That cluster only become apparent when an Australian left the conference early to return home in an attempt to beat the Australian isolation edict. Fortunately, she was quickly tested on showing symptoms back in Australia.

 In contrast, Hereford Conference attendees here in NZ who became sick were refused testing because they had not travelled overseas. Further, authorities downplayed the risk arising from the Australian attendee because that person left the conference before being likely to be infective. Alas, the question was not asked as to where that person might have got the virus!

 The Hereford Conference saga, as told to me by participants, is in fact somewhat longer than this but I will leave it there. Each of the super-spreader events will have its own story as to how it happened and how it could have been minimised.

There are some interesting demographics relating to the people who have currently been infected. I have drawn this information directly from the Ministry of Health spreadsheets available at their website.

Females comprise 54% and males 46%. We cannot read much into that at all, except that it does seem to contradict earlier suggestions that case rates were higher in males.

More intriguing is the age groups of the cases, with the 20-29 age group being easily the largest and comprising 24% of the total. In contrast, the over-70 cohort comprises only seven percent of total cases. It is also notable that in the big 20-29 age group, 62% are women. That raises interesting questions as to the social behaviours of this group.

Maori infection rates are only four percent of the total and Pacific Island rates a little over two percent. This probably says nothing more than that these groups travel less to Europe and the Americas than other demographic groups. It says nothing about their susceptibility to infection if the virus really takes hold within New Zealand.

People of Asian ethnicity are also under-represented in the COVID-19 statistics at seven percent, with European ethnicities being the ones that are over-represented. All of this probably says more about who has been travelling to overseas hotspots rather than any underlying susceptibilities.

Each day I search for evidence from overseas as to which countries have clearly reached peak daily cases and are now in major decline. Basically, there are none except for China, which now has very few new cases and with most of those few cases coming from people returning to China. China is not yet back to normal but it is close, with factories and restaurants largely open, and schools now starting to open in some provinces.

A likely explanation why we are not seeing a decline in other countries is that most of the lockdowns, where they are in place at all, have been in place for less than 14 days. The next few days should start to tell a story.


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If we and other countries fail to get a quick turnaround then we will have to ask ourselves what are the weak links in our approach. 

Almost certainly, the biggest weakness in our existing program is insufficient testing. Until we can test everybody who has symptoms, regardless of other factors, then we have no way of knowing the extent of community transmission.

The Ministry of Health, driven most likely by the need to maintain community support, which in Government jargon is known as ‘maintaining social licence’, has largely been in denial on that matter.  Beneath the waters, they will be paddling furiously to further increase our testing capacity, but they do need to ‘fess-up’ that it is an issue.

It is the absence of sufficient testing that reinforces the reality that we all have to act with social distancing and lockdowns as if we have already been infected. It also means that as a nation we have one hand tied behind our backs.

On a global basis, it is obvious that we are in the middle of Wave 2. Wave 1 was China and it peaked in mid-February. Wave 2 is centred in Europe and the Americas and has yet to peak.  It will take a lot longer to fade away than Wave 1. Wave 3 will be across the rest of the world. As of yet, Wave 3 is only just starting, but the trajectory is already there and it looks sure to happen. It is likely to be the biggest wave.

Once we can get on top of our own New Zealand epidemic, we will have to work out where we go from there in a world that is still full of COVID-19. The first step will be to work out how to relax the pressure internally, so that social licence is maintained but the disease does not run away from us again.  I think a lot of people will have ideas as to how that could and should happen. Anything that might create a super-spreading event cannot be allowed. That means ongoing restrictions on social events of any scale. Also, border restrictions will have to be very tight and with entry totally controlled.


*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. . He can be contacted at kbwoodford@gmail.com. Keith’s previous COVID-19 articles are available here.

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74 Comments

13
up

Another lesson observed, but will it be learned, time will tell

""In contrast, Hereford Conference attendees here in NZ who became sick were refused testing because they had not travelled overseas. Further, authorities downplayed the risk arising from the Australian attendee because that person left the conference before being likely to be ineffective. Alas, the question was not asked as to where that person might have got the virus!""

...the Australian attendee because that person left the conference before being likely to be ineffective.

Quite likely the Australian attendee was pretty ineffective the whole time.

13
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NZ stat on COVID 19 means nothing. It does not provide any reliable insight whatsoever. As up this morning, the protocol for testing was restricted to people coming in from overseas showing symptoms and those who has been in touch with confirmed cases. The outcome of this testing regime does not tell you anything.
It is incredibly unbelievable that the MOH, who designs and operates the testing regime, then says "the majority of cases are from overseas travel" without any form of community testing. Unless you accept that our top officials are so utterly incompetent, this can only be contributed to intentional misinformation without appearing to lie (after all, their statement about identified cases is true).
The whole NZ health system acts like a giant insurance company with its modus operandi being "do not admit people unless they are dying". People are used to toughing it out until it is too late (as was the case of the poor old woman who died from COVID).

Wrong. Drive up testing is underway. Has been since at least last week. Obviously not everywhere, but it's there.

14
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You still need to meet the criteria for testing, the method for delivery of the testing (drive up, at home, in a space shuttle) is not what I have been talking about. And as was the case for the old woman, they were not even testing people who were very very sick if they were not coming from overseas, have been in touch with overseas people or been in contact with confirmed cases until late last week. This will not give you any insight into the spread of the COVID 19.

I share your interpretation.

They need to be testing everyone coming in from overseas, all current tourists in the country that have not been tested, any NZ that had been overseas since Jan, anyone showing symptoms, and then continuous random testing right through the population.

Especially not to take random samples in the general population means they are flying blind.

What it really means is our testing ability is as behind as our ICU ability.

Looking at the daily deaths in Italy it doesn't yet appear that social isolation is working. At the end if this month we may have to face the same fact and move to the South Korean model (testing, testing and more testing!) What we cannot afford to do is get to the end of the month without being ready to vastly expand our testing capacity.

Problem is neither NZ nor the rest of the world has enough testing kits and chemicals

We will need to synthesise and manufacture what we need along with building labs. Our prime minister is correct that the human cost of failure is incalculable.

Well, you can calculate it yeah, something like 30,000 to 60,000 dead Kiwi's.

That not true. That is patently not true. Where do you get that number from?
There will not be 30 000 death in New Zealand it is ludicrous.

From the spinoff website:
New modelling from the University of Otago predicts at least 14,000 New Zealanders could die if current efforts to stop Covid-19’s spread in New Zealand fail. Professor Nick Wilson from the University of Otago told Susie Ferguson on RNZ’s Morning Report today that if the lockdown strategy fails, over half of the population could be infected. “The worst-case scenario is when elimination fails, the virus spread is uncontrolled and we’re looking at up to 64% of New Zealanders getting sick, up to 32,000 people needing hospitalisation and up to 14,000 people potentially dying.”

You are just making stuff up mate and spreading fear. Which is how we are in this giant mess. This is feaar and panic NOT A DANGEROUS DISEASE.

Spreading numbers like that is every bit as irresponsible as Jacinda saying tens of thousands would die or Keith here with his 80 000 figure. Your figures are based on what? The imperial college study that has as many holes as a sieve and isn't even any science its just a flu epidemic model with some covid data thrown in.

You are as irresponsible as all the rest of the fear mongerers sleep walking us into a depression.

Don't forget the "South Korean model" also involves everyone wearing a mask in public, all the time. Moving forward we need an antibody test so that we can send recovered people back to work.

Indeed. They are looking for their car keys under the nearest streetlight.

The lesson from offshore successes is widespread testing of large samples, irrespective of symptoms or the lack of them. Only then can data on the following be anywhere near accurate:

  • Actual infection rate
  • Immune/asymptomatic but have had the lurgi (antigen testing shows this up)
  • Recovery (definitely had it but through it)
  • Death rate

Until this is done, as Keith points out, all is surmise except for the numbers revealed by the extremely limited (in total sample size) testing that has actually been done to date.

And the continued MSM stories about referred/symptomatic bodies getting rejected for testing because they did not meet some ill-defined criterion is simply tragic. It points to a cover-up of the actual capacity for testing (kits, safe locations, swabbers, lab slots, money, equipment) to which Answers should be Demanded. And remedial action taken.

No use saying 'clinicians can use their own judgement' and then turning away referrals from them - effectively over-ruling that professional judgement.... This makes a complete mockery of the original narrative.

Yes, the WHO issued the advice that testing was the key to success. Western governments appear to be ignoring the experts:
https://www.bbc.com/news/av/world-51916707/who-head-our-key-message-is-t...

While I don't disagree on the point of testing, the WHO have been pretty useless so far. They withheld the declaration of "global pandemic" for about three weeks after it was painfully obvious that nCoV was a serious global pandemic. Now they're engaged in semantics around the definition of "airborne" when it's painfully obvious that for all intents and purposes nCoV is airborne. The WHO are so useless that I cant bring myself to call this COVID19 so I'll stick to the old nomenclature of nCoV.

Devils advocate argument: If the PCR test is expensive, and we're only capturing around 1/5th of the actual infections, then what's the point in testing at all? Would it not be better to behave as if everyone's infected? Everyone wears masks in public. Washes hands, and cleans surfaces relentlessly. An all encompassing hygiene approach is probably more effective and far less expensive than attempting widespread testing. We're beyond the containment stage now!

It is also notable that in the big 20-29 age group, 62% are women. That raises interesting questions as to the social behaviours of this group.

Indeed, indeed....interesting questions.

Yes, testing, it's a black box, everything about it. For example, what's the accuracy, false - or +.

As for MoH is it a question of structure or pyschology that has it performing this way.

Henry,
The test they are using is called a PCR test. These tests rely on finding the specific genetic code in a piece of virus collected in a swab, and then amplified in the lab prior to testing.
As such there should be no false positives - if the test comes out positive then the person carries the virus, is shedding it, and is therefore infectious. The only false positive would be if there was contamination in the lab.
However, false negatives are very common with PCR tests. For example, if the virus is mainly replicating in the lungs then it is often not picked up by a swab taken from the throat or nose.
The other type of test is an ELISA. This measures antibodies and not the virus itself. The problem with ELISA tests is that they do often give false positives. Although I have never been a lab technician, I do have considerable experience in interpretation of ELISA results both for animals and humans. And the interpretations can be tricky.
With an ELISA test, it does have the advantage that it can be used to investigate whether a person has previously had the disease and hence likely to now have immunity. It may also give guidance in the early stages of a disease when PCR is still negative. But it can give false answers so at the individual level it is dangerous to rely on it. At the population level it can give useful guidance as to what is happening in the population but once again inexperienced people can come to false conclusions, and we may be seeing some of that starting to happen in Europe. To the best of my knowledge we are not yet doing any ELISA tests for COVID-19 in NZ, and it is very doubtful as to whether any testing kits have yet been brought into the country. That simply reflects that testing kits are still being developed and validated to estimate their false positive and negative attributes. I doubt whether we would have development and validation capabilities within NZ, but the animal health labs would have good capacity to apply such tests once the kits become available.
KeithW

Keoth could we utilising our mbovis testing technicians and giving up on mbovis to concentrate on covid19?

Belle, found this from Thursday, sounds like there are just not enough swabs.

https://i.stuff.co.nz/national/health/120582903/coronavirus-doctors-told...

Question. Do social licences expire?
Seems like there is a set of MoH types who refuse to change their behaviour cling to BAU practises irrespective of the war footing we have against the pandemic.

Who would have thought we would see Gallipoli style decision making in the here and now.

The article says nothing about the rate of false negatives.
Nor masks.

Belle
I have just seen your question. As far as I can tell none of the Animal Health or Asure Quality Labs have been roped in. I heard today from one human health laboratory technical officer who tells me that they are actually not very busy at all. This was in effect confirmed by Jacina Ardern when she higlighted the difference between our current capacity and the number of tests actually being done. So the swab collecting teams have been acting as gatekeepers and not letting enough sick people through the drafting system. I thought Jacinda made it very clear in polite but firm terms that she wants to see a lot more testing occurring. As soon as they increase the testing, we can expect the number of confirmed cases to rise. Fingers crossed on those numbers.
KeithW
KeithW

I can't help but wonder how we can get back to anything near normal until we get herd immunity, either from waiting for a vaccine or from the majority of the population catching then recovering from the virus. Maybe that is Trumps unspoken plan, let the carnage happen then get the economy open for business?

11
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Although he is a bumbler, the US globally is incredibly vulnerable at present to global conflict. So I get what he's saying...do you let the economy collapse trying to save the (mostly) old and sick with multiple chronic health issues and weaken yourself to the extent the Russia/China mobsters will have a crack?

Or do you say no, the trade off is too high.

The MSM and flowerly types are ignoring the massive risk of war if the US becomes too weak.

Europe is looking awfully vulnerable at this point. Perhaps why Putin has lent a helping hand to Italy

Rastus, I think if society were to go there and throw the vulnerable under the bus because its expedient on some level, this takes us to a very dark place that maybe hard to return from. Mostly its unthinkable except to the criminally insane or those with borderline personality disorder, guess who .
I think we can do this without sacrificing grandma for the Dow.

If resources were limited we could do it on a voluntary basis. What if grandma wants to be thrown under the bus? We could fill in a "No ICU" form of some sort much like a no resuscitation declaration.

There could come a point where managing this would save more lives. Actually decisions like this are made all the time in hospitals. Now's not the time to be wearing your rose tinted glasses.

I hadn't considered the possibility of war. My worst case scenario is that nCoV displays antibody dependent enhancement (ADE). There's good reason to believe that's the case too, see here. It's possible that a second wave of infection will strike people down who'd previously recovered from the disease. If the R0 is the same, but the CFR is much higher then the disease could pose an existential threat to human civilization. On the plus side there's a recent paper claiming monkeys exposed to the virus were immune (see here) however they reinfected the monkeys almost immediately after they recovered and so that doesn't disqualify ADE which requires antibody titres to fall below a certain threshold.

Are you really saying that China and Russia are the 'baddies' and the USA is the 'goody' in all of this?

Which country(s) goes around invading other countries in pointless regime change wars? Which country has more arms than the next 4 combined? And also spends more on arms each year than the rest of the world: https://www.nationalpriorities.org/campaigns/us-military-spending-vs-world/

I think you might be brainwashed mate.

It is also a highly armed population with a history of not having much respect for government. I would say the chance of internal insurrection is as a big a worry as anything.

Especially when you get 3.3 million unemployed at the drop of a hat.....nothing to eat but lots of guns

10
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The great equation. Deaths from Covid v deaths from depression, poverty, crime and despair caused by mass unemployment and bankruptcies. Lots of side issues...the road toll should drop significantly, possibly 30-50 lives will be saved. Air pollution in cities, too. And other diseases such as flu won’t spread so easily. I do think the ‘ level’ status should be under constant review. As many businesses as possible need to keep going. Teddy bears in windows are all well and good but you can’t eat them.

Each day I search for evidence from overseas as to which countries have clearly reached peak daily cases and are now in major decline. Basically, there are none except for China, which now has very few new cases and with most of those few cases coming from people returning to China.

Exactly this. We have a long way to go to get on top of this. I found the way the data was displayed here very informative:
https://aatishb.com/covidtrends/

It basically shows daily confirmed rates (averaged over a week) vs total confirmed cases, with time being displayed as the animation. It clearly shows only 2 countries have managed to actually materially impact and hold down infection rates once the spread takes hold ... China and South Korea. Even countries like singapore who got on top of the initial spread have found rates trending back up.

Once a country has over 200 confirmed cases it feels almost inevitable numbers will start rising exponentially until drastic measures are taken. It may also be the measures taken in a lot of countries are simply not drastic enough.

Gotta take the official numbers from China with an urn of salt

Italy has taken drastic measures and it has done nothing the virus is simply going through a natural boom and but pattern anyway.

The problem with this is it's not a very harmful disease. Plenty of people will have had very few symptoms and thought they just had a cold. Under reporting of cases whether due to lack of testing, or people not realizing they have it, or confusing it with cold or flu, or even hay fever (which can also have respiratory implications), will be massive.

The Italians estimate under by a factor of 10. That means 200 is at least 2000, and 1800 of them we have no idea where they are going or what they are doing.

They currently have over 100k in confirmed cases. That's at least a million then. Why bother with a lock down all they are doing is stopping their chance at long term herd immunity. They have been in lockdown for three weeks....it did nothing the virus was already widespread.

A million cases puts the mortality rate at roughly......0.1%. No worse than flu. And targeting a demographic cohort (old and already sick), quite specifically.

Some people are starting to ask the right questions instead of blindly panicking like Keith is on this site.....

https://www.stuff.co.nz/national/health/coronavirus/120666809/do-the-con...

11
up

I do not believe the data being captured by the government (and many other governments) through testing is a representative sample or offers insight into the broader population. We should be basing all projections and commentary on non-travel related spreading, the bias in testing people who have used air travel is skewing the reported figures. Also we will need far more testing going forwards or we'll be flying blind over the next month.

Yes, seems to be test if sick only. Don't test those who are directly connected with the sick person. I think the lockdown period will highlight who then gets sick but not as we come out of it.....Need to test. What is measured can be managed!

China is not yet back to normal....angry crowds rioted near the Chinese city of Wuhan

https://www.dailymail.co.uk/news/article-8162773/Chinas-coronavirus-epic...

Thank you Keith, a great piece that explains the spreading of the virus simply and clearly and finally looks at "what happens after lockdown". I hope more will read it, I will share it

"the 20-29 age group being easily the largest and comprising 24% of the total. In contrast, the over-70 cohort comprises only seven percent of total cases"

I think there is a common misconception that younger people don't get CV, that is clearly not true but the really important fact is that very few young, healthy people die from it. It's somewhat good news that the group most at risk, the over 70 represent only 7% of all infected cases

'Can we stamp out COVID-19' ?
Yes and NZ is showing the way to the world. We shall win and prevail, no doubt.

the problems is our border control.
people were left to wander in for weeks and handed a pamphlet.
unless they go the whole way , every body in tested and held for 48 hours, if negative they can carry on to lockdown (and this to be followed up) and these people retested after 14 days to confirm they were ok
the rest that bring back a positive result immediately separated until they recover
also all those at the border and on the airlines tested every ten days /
in short test test test isolate
if we don't then no we will not beat this,

Heather du Plessis-Allan wrote today:

To do that, it must stop the arrival of coronavirus into this country from overseas. As many as 50 infected people are arriving here each day. That's according to Dr David Skegg, who reckons we're trying to empty a bath with a jug while the tap's still running. The tap is the flow of infected arrivals from overseas.
And this

Every day that arrivals keep bringing it in is potentially another delay in lifting the lockdown. It's heartening that the Government is now quarantining arrivals who are sick or who have no satisfactory plans to self-isolate. But that's simply not enough.

exactly if you look at korea, they don't even get in
South Korea has installed "walk-through" testing stations at Incheon airport to meet the need for checks.
The tent-like facilities, set up just outside the airport, are capable of running more than 10 tests an hour, whereas regular hospitals conduct up to three and drive-through stations handle six to eight, the health ministry said.
The government said on Friday it would require all inbound flights to check passengers' temperatures starting from Monday and anyone with a temperature over 37.5C would be denied entry.

Heather du Plessis-Allan? Riiight.

a monkey at a keyboard will eventually type a word
same with a ZB host eventually they say something sensible

Numbers starting to emerge that there are high numbers of Asymptomatic carriers of this out there that dont even know they have it. Only widespread testing can determine if you have it or have had it and recovered. Chances are this cannot be contained but only slowed at this point in time. There will come a point that the government will have to make a very difficult decision do we keep lockdown or do we get back to work. Any vaccine is going to be to slow to arrive so no way anyone is going to stay in lockdown for over 12months.

some regions notably not high tourism zones have low numbers , will they open them back up and how do you stop people crossing over to that zone from zones that are still on lockdown, I am thinking of Whanganui (3 cases) west coast ( 3 cases) wairarapa (5 cases) tairawhiti (1 case)
the main centres seem to be the big cities auckland wellington christchurch and dunedin

870,000 tourists a year visit the West Coast....

What’s our end game?

Say we do eradicate COVID-19 from NZ. Then what? The rest of the world still has it. Would we then just keep our boarders closed until when (if) a vaccine is developed?

There is no end game. We are stalling for time and hoping we get a vaccine before we go broke or society breaks under the pressure of lockdown.

If you think that's a crap plan then you are right. Keith loves it though.

A friend in the Netherlands said their province was where it started there. They have 70+yr old family who rang the helpline saying they felt unwell etc. Were told that from the symptoms, yes they had COVID, but as they only had a 'mild' version of it they wouldn't be tested.
How many kiwis, have mild symptoms and just think they have a cold or flu so are not seeking medical help which would trigger a test?

Crap loads.

There is massive under reporting, the Italians estimate by a fact or of 10 at least.

So the mortality rate will be much lower than we think.

This is not a big deal if you get it unless you are old and already sick.

The problem will be the hit to the health system....but we will likely get that whatever we do so lockdown is pointless.

I know of someone who was refused testing and now is in hospital with covid - 19.
He hadn't traveled overseas so didn't fit criteria - it was community spread in Auckland

Did you actually read the Imperial college paper?

It states quite clearly that you cannot leave the most restrictive levels without a vaccine. Or the outbreak arises as if nothing happened. Lockdown buys time nothing else.

It also states in that paper that large scale events don't represent a big risk for spread as people are generally not in contact long enough. Bars and restaurants sure. Festivals apparently not.

I actually think the paper is pretty poor really it's just some basic modelling borrowed form flu models with early covid data that is out of date and with many, many assumptions. But seeing as it seems to be the basis for our response.....

Lockdown is a terrible mistake. We have given ourselves a recession, probably a depression. We can't fund a health system, overwhelmed or not, if we are bankrupt.

But if we had a more competent govt then it would give us time to massively increase our emergency treatment capacity - field hospitals and medics with limited training - to allow us to save everyone we can if/when the epidemic sweeps through the majority of the population. Countries like Germany have expanded their ICU capacity (per head of population) to nearly 10x NZ, but I've seen nothing to suggest that NZ govt is doing anything significant to help the situation in that critical metric.

I like the German system. Everyone pays a National Health contribution (tax). This money doesn't go in to the govt coffers but in to a fund that is ring fenced solely for health. If you look at what ACC has accumulated over the years by everyone paying, if we had the same for health ie instead of current tax rates, these were dropped by what ever proportion was put toward a separate NHS and it didn't go near govt coffers, how much better off our health system would be.

Germany has for a long time had a high number of ICU beds per capita. What you're seeing here is the result of deferred maintenance and investment from the "tax cuts!" crowd.

Where will we get the stuff from?

Lets think about this, all the stuff you need to treat people seriously ill from covid is stuff that everyone else in the world wants. And will continue to want for the next few months.

Where will the doctors, nurses and ventilators come from? All those things are busy elsewhere.

LOCKDOWN is a complete over response. It was not even recommended in the half baked imperial college paper. We make ourselves weaker as a society (people not trusting each other, mental health problems, and widespread bankruptcy and unemployment) and then we will get the outbreak anyway. We can't afford to have most of the population doing very little for months on end while we hope someone comes up with a vaccine. That is not a plan.

Keith, It is also notable that in the big 20-29 age group, 62% are women. That raises interesting questions as to the social behaviours of this group.
Your last statement is offensive. I know young women in this age with COVID and every one has come back home from overseas travel. This age group is ripe for taking OE's. The ones I know showed no symptoms when they left their host country. So did they get it on the plane or in their host countries? To imply its their 'social behavours' is a slur on these young women. I expected you to be better than that.

Casual Observer,
We all have social behaviours and those behaviours do differ by age group and gender. That is a simple fact. In trying to understand the drivers of disease transmission, these are the factors that we have to understand. For example, the Govt is currently trying to modify the social behaviours of over-70s by telling them not to go out at all, even to the supermarket. We know that the 20-29 age group is over represented in the current stats, and that within that group, for some reason, females are over represented relative to males, despite no evidence that I am aware of that females travel more. It would be helpful if we could understand why the rate of infection is so high relative to all other groups.
KeithW

Keith, Australian highest rates as at yesterday was 20-29y rold females also. Last week it was the 30-39yr old females followed by 40-49yr old females. Yesterdays data show that this week there are now more 30-39yr old males than females, and considerably more 40-49yr old males. So data is fluid.

Like Australia, travel and returning Kiwis living and working oversea are the biggest group of people with it. Before you look to social behaviour in a particular group how about analysing the travel data first. Who knows it might be as in Australia where the males will start to overtake females. The Aussie data finishes with "The proportion of COVID-19 cases in males and females is roughly equal."

It is early days yet, the govt made recommendations to 70+yr olds because that appears to be the group with the highest death rate.

Perhaps you would be better to ponder why the SouthernDHB has considerably more cases per head of population than any other DHB, and given it was the same in 1918, and the 1918 death rate in Southland was the NZ highest per head of population, are there any similarities in other regions this time round.

Casual Observer,
The Australian and NZ trends are similar, although overall Australia may now pull away from us for a while in terms of per-capita case-rates.
In NZ and Australia, it seems there has been a tendency for early cases to be European females, mainly young. The genders then blance out as the new returnees infect their close contacts. The spread to other ethnicities takes longer. The final distributions will depend on social behaviours which in turn are influenced by socio economics and also cultural practices. As for Southern case rates, the Southern Health Board also includes Otago. Places like Queenstown have their own socio demographics and associated social behaviours.
KeithW

Who cares. It's not interesting.

What is interesting is how many people get seriously ill from it and put pressure on the health system. That is all that matters right now.

And even that fear is potentially way over done. Time series of mortalities in Europe show suprisingly few mortalities overall at the moment:

https://www.euromomo.eu/outputs/zscore_country65.html

All the mortality stats are over done because cases will be massively under reported.

This has far more in common with a study of a panic than it does of a dangerous pandemic.

I am still waiting for my government supplied face masks to turn up in my letter box. Has anybody else received them yet?
This is the only way to contain the spread.
The government response is very lacking.
We need to fly each one of those hospital ized patient's to one dedicated covid hospital,not risk 10 separate hospitals and all their staff.We need to test,test,test.
What do we do? We send the infected home to infect the rest of the family.!!!
What a mess, get your shit together Jacinda and Bloomfield.

It is scary to consider that this virus is invisible and spreads without symptoms, but that is the norm for 'flu viruses. A USA doctor emailed today that she checked an ASYMPTOMATIC patient with a chest X-ray because the oxygen saturation was a little low. The patient had severe pneumonia. Clovid testing [temperatures at the border, swabbing guidelines, etc] will not catch the invisible wolf.And the plans will be in error.

Do you think that a pulse oximeter could be used to qualitatively diagnose pneumonia in asymptomatic patients? Pulse oximeters can be purchased cheaply on ebay, and claim to have an accuracy of +-2%.

Hi Keith,

Just wondering if there is any evidence that Covid-19 is causing more deaths that previous severe flu outbreaks? I'm sure you've seen data such as https://www.euromomo.eu/outputs/zscore_country_total.html which shows big spikes in deaths in previous flu seasons. Is it just too early to see Covid-19 in this data?

Calaverite
Yes, the data there is very interesting.
The particular graph I am watching is https://www.euromomo.eu/outputs/number.html
By my calculations the deaths should have been showing up in week 12 (ending about 23 March) with an overall up tick of about 10 percent at that stage, but rising considerably hereafter. That assumes that Spain and Italy are both Euromonitor countries, and it would be surprising if they are not. However, it is also possible with these countries in lockdown and there health bureaucrats highly stressed that the numbers are not getting through.
What is also interesting is that death rates seem to have declined considerably from all causes in week 12 even for very young people, which suggests that changed behaviours are leading to a less deaths of all types. This is consistent with what I know in NZ where, for example, there are a lot less people coming in to hospitals with broken bones.
A big problem at the moment is knowing which data we can rely on.
KeithW

Calaverite,
What I missed in my earlier reply is that the lockdowns around the world have grastically reduced the transmission of ordinary flu, and this too is contrbuting to the overall decline.
That was remiss of me.
KeithW

Saw a graph that showed the most successful countries at combating the virus are also the countries where it is compulsory to wear a mask or where everyone is wearing one.

Maybe the masks don't work as we as told by some professionals, but what they probably represent is that if you can get people to wear masks either by regulation or education, then the general public and the Govt. are probably doing everything else properly as well, like social distancing, self-isolation, other hygiene, and testing.

Fascinating news regarding Ischgl. My partner just told me that was where her colleague was skiing before he tested positive a couple of weeks ago.

fat pat
The Kitzloch Bar with its beer-pong was the super hotspot within the Ischgl hotspot
From there it travelled all across Northern Europe including the UK and as far north as Iceland. An amazing super-seeding event.
KeithW

I believe all the data now indicates that the mortality rate and rate of spread of Covid-19, is about the same as that of the flu, which kills about one person in a thousand or more precisely has an "infection fatality ratio" of about 0.1% :https://swprs.org/a-swiss-doctor-on-covid-19/#latest. Two Stanford professors actually think that the mortality rate is lower than the flu : https://web.archive.org/web/20200325103650/https://www.wsj.com/articles/...

The evidence is also in on, "excess mortality". This bug has NOT raised total death rates in all of Europe, the UK or the USA. Less people are actually dying this year than last year in most of Europe:https://www.euromomo.eu/index.html

The scare has partly been driven by bad data. For example, research now indicates that the Italian death figures are about ten times too high, as they count all people dying "with" Covid-19, as dying because of Covid-19. The lockdown in Lombardy, Italy also increased the fatality rate as 30% of the elderly there still live at home and many sick young Italians were forced to move back home from large cities, when the lockdown commenced.

A recent study also shows that the mortality rates were also vastly over stated in Wuhan, as the amount of people actually infected was a lot larger than those that had tested positive: https://www.medrxiv.org/content/10.1101/2020.02.12.20022434v2. This research found that as at February 11, 2020 (before the diagnosis definition changed) 1.9 million people in Wuhan probably had the virus, out of 10 million residents. This was about 100 times more than had been diagnosed as positive at the time. As a result the infection fatality ratio (time delay adjusted) was therefore only 0.12%. WHO claimed on March 3, 2020 that the death rate was 3.8% - probably forty times too high.

The Wuhan study also confirmed that about 80% of people with Covid-19 in Wuhan were asymptomatic or had very slight symptoms which was why the reporting rate was so low. The transmission potential was also similar to the flu ie a reproduction rate or R of 0.58 by February 11, 2020. The lockdown had little effect on the decline in infections.

Based on the above Wuhan research, the total number of infected here must be at least five times the reported level of about 1,300 ie 6,500. The testers here will refuse to test you if you have no symptoms.

All this evidence shows why only four people have died in NZ from Covid-19 out of the 6,500 that probably have it, an infection fatality lower than the flu. This new corona virus is not dangerous. The epidemic has now peaked and it will probably end up killing less than 10 people. The flu kills 500 every year in New Zealand.

In my humble opinion, we have to end the lock down very soon, as the amount of suicides and deaths caused by it will exceed lives saved. A lockdown only makes sense if it reduces total mortality or if there is a possibility the hospitals are going to become overloaded as it merely "flattens the curve" and delays herd immunity. The chance of overloading in New Zealand is nil. There has only been four deaths and the peak has passed.

In Sweden, which had no lockdown, they had the same length of infection and rate of deaths as their neighbours. As stated by world leading epidemiologist, Professor Wittkowski (who invented the concept of reproduction rate when studying HIV) in a 4 April, 2020 paper; " Of particular interest is Sweden, where no “social distancing” policy was implemented. Still, there
was no difference in the shape of the epidemic or the height of its peak to the other Scandinavian
countries" :https://www.medrxiv.org/content/10.1101/2020.03.28.20036715v2.full.pdf+html.

We could possibly retain infection control in rest homes but that is enough. It is time for a return to freedom.