Last Thursday (9 April), many Kiwis would have been feeling very proud of themselves with only 29 new cases of COVID-19, both confirmed and probable, announced that day. It looked like we were smashing COVID-19.
By Friday 10 April that did not seem quite so clear cut, with new cases up to 44. Suddenly, the chances of going to Level 3 on 22 April following the planned Cabinet Meeting on 20 April started to look more wobbly.
Two days later on Sunday 12 April, we are down 18 new cases. Things are looking much better again, albeit off lower testing numbers.
The big question right now is whether, given this combination of trend and volatility, we can be ready to go to Level 3 by 22 April. That could mean most people then getting back to work, but combined with social distancing and no mass events.
Stamping out becomes much harder at Level 3
If our New Zealand policy really is to stamp out COVID-19 and not just to suppress it, then the Achilles heel of the Level 3 policy will be any failure to hunt down every single case of community transmission. This community transmission was the key reason we had to go to Level 4 lockdown in the first place.
The statistic that stares us in the face right now is the that we currently have two percent of cases of confirmed community transmission (approximately 26 people) combined with the 11 percent of current cases (>140 cases) whose origin is unknown. Many if not most of these cases of ‘unknown’ origin are likely to be community transmission.
The fact this ‘unknown’ number is so high tells us very clearly that the current contact-tracing program is overwhelmed. It also means that the process of working through the contact-tracing for each unknown case is taking many days, and that is not good enough for Level 3.
Our health authorities have been consistently reluctant to acknowledge any weaknesses in their program, be that at overall Ministry level or at District Health Board level. Their denials fly in the face of reality. In the long run, it is always better to be transparent, but it is something that Ministries struggle with.
Part of our current problems may well be linked to the regional system of health delivery in New Zealand. Each district does things its own way, with the Ministry focusing on policy but not delivery. The current situation with clusters and associated tracing, with most of the clusters spread across the country, illustrates that point.
In the case of the Bluff cluster, it is apparent that not one person actually lives in Bluff and the cluster members are wedding attendees from all over the country. Consequently, there is a lot of information sharing between Health Boards that is needed. If each Health Board is only seeing its own data, then information integration and co-ordination become big issues. In normal times, there is much to be said for decentralised decision making, but in a time of war co-ordination is paramount.
As long as we remain in Level 4, then the currently inadequate tracing is not fatal to the program. This is because formation of new clusters is heavily constrained, given that people are in most cases remaining in their bubbles.
Under Level 3, that changes, with much greater possibility of community transmission that seeds new clusters which then fan out across the country and feed on each other. This is the disaster that we should all fear.
Without antibody testing combined with back-tracing the risks are much higher
The evidence from Iceland now seems clear that up to half the people infected with COVID-19 may have minimal symptoms. However, in a track and trace campaign we still have to find these people as they are part of the transmission pathways. Without a combination of antibody testing plus PCR (swab testing) working in combination, the program is unlikely to succeed. Our Government has yet to commit to an antibody-testing program.
The key reason that most other countries including Australia are focusing on suppression rather than elimination is that they doubt whether they can stop all community transmission. In large part, this is because they doubt that they can maintain an ongoing ‘social licence’ for a Level 4 type of lockdown. In this context, China and New Zealand are the only two countries that appear to have been explicit that their aim is total elimination.
Given this situation, then we have to put a lot more work into contact-tracing and getting those systems set-up with appropriately trained staff. It is no good just being as good as other countries. We have to be better, given that our policy, is to ‘stamp it out’ and not just suppress.
One of the good things that New Zealand can expect in coming days is that the number of people with ordinary flu who come in for testing should start to decline very quickly. This is because the Level 4 system that we currently have in place should be smashing any community transmission of ordinary flu. This will ease up some resources that can be allocated to testing all close contacts.
Some weeks ago, Kiwis could take comfort that New Zealand was doing better than Australia. Our overall levels of infection were much lower, even on a per capita basis. However, that is no longer evident. Per capita total infection rates are now similar in both countries. More importantly, Australia’s per capita rates of new cases are now less than half of ours, having previously been well above us. What are they suddenly doing better than us to achieve this?
There is no clear-cut answer to this, but it is apparent that Australia’s testing of people with symptoms got up to speed more quickly than in New Zealand, all within well-oiled state health systems. In contrast, New Zealand got off to a very slow start with very low testing capacity, with that reality never acknowledged by the authorities. Ironically, Australia may yet spoil its advantage by now taking the brakes off too soon.
Rigorous back-tracing is a daunting task
The way a top-quality contact-tracing and testing program needs to work is that results of testing must be available within hours of the testing taking place. It needs to be same day testing, with couriers travelling hourly between testing centres and the laboratories.
There must be results for every person who is tested within a matter of hours. If that means laboratories working at night, then so be it. This is a war.
At the same time that an infected person or suspected infected person goes into isolation, the contact tracers needs to swing into action. It can’t be the next day; it has to be the same day.
All close contacts must be identified going back some two weeks.
The most recent contacts are the easiest ones. These are the forward traces. These people all have to go into immediate self-isolation. Ideally, they should also then be tested every day. This is probably best with the existing PCR test, but possibly in conjunction with serology (antibody testing).
Identifying close contacts for the prior 14 days will be very challenging for most people, especially once we come out of our bubbles and are moving around more under Level 3. Accordingly, we should all be asked to keep a diary of our close contacts to allow this back-tracing to occur. No ifs or buts; this has to happen.
Whereas forward tracing is to identify people that might be in the incubation stage, back-tracing is to identify earlier contacts who may have been the source. There is little point in testing these back-traces with the PCR test because if these people have recovered then the result will be negative. But a serology test for antibodies will identify the possible source. Having narrowed down the suspects in this way, a PCR (swab) test can then be used to confirm if the person is still infected. As a matter of risk minimisation, and given the false negatives that occur with PCR testing, that person should still go into self-isolation for at least a week.
Many of these back-trace people are themselves unlikely to be infectious, but their own forward-traces will probably still be infected. And so we need to go forward again from there, to find those new forward-traces to catch these people who may well by then be seeding their own clusters.
There is also a current weakness in that we are assuming people have stopped shedding the virus if testing is negative for two days following cessation of symptoms. That criterion is possibly OK for countries that are only trying to suppress, and it seems that it does align with WHO advice. But if we want to stamp out this disease then we have to be tougher. One week of negative test results after cessation of symptoms would be safer.
Now, some people are going to say that this all sounds very daunting. Well, rigorous contract-tracing and quarantine is daunting. But if we want to stamp out this disease then either we have to stay in Level 4 for many more weeks and possibly months, or we need to set up a comprehensive track and trace.
There are two parts to making it work. One is that the Ministry of Health and the Health Boards need to get themselves much better organised for the track and trace. The other part is that every one of us needs to start keeping those diaries. I say again, no ‘ifs and buts’, absolutely everyone. We are all in this together.
Our Government hopes to use an app from Singapore to help identify where infected people have travelled and who they have come in contact with. But the app won’t be ready until some time in May. It is therefore no substitute for diaries that we can be keeping as of now. My broader family, which includes multiple bubbles and a health worker, is already doing this.
As long as we are in Level 4 we can win the war, but we can’t stay there for ever.
The overall trend of the last few days tells us with reasonable clarity that we have dropped the transmission rate, R, well below the critical level of ‘1’. That means we can have an expectation that as long as we stay in Level 4, then numbers will further decrease, but with ongoing volatility. If only we could stay in Level 4, then eventually the disease would die out.
To reduce volatility when analysing the data, I use three-day rolling averages. Our latest three-day average of new cases is 30 (comprising 44, 29, and 18 cases). A week ago it was 81. If we can keep driving it down at about that same rate of 63% decline in a week, then we will be down to a three-day rolling average of about 11 cases by the time Cabinet meets on 20 April.
If we can get the daily new cases to somewhere around 10 to 12 people by that time, then in theory we should be able to pour lots of resources into identifying the forward and back traces for each of them.
In working out more precisely where we stand, we need information each day as to how many of the new cases involve transmission ‘within-bubble’, how many are from ‘outside-bubble’, and how many are from within Government-managed isolation. All of this information must surely be known for each case from the outset.
In contrast, it is no longer particularly relevant to current decision-making as to how many historical cases came from overseas travel, and how many are close contacts. We need to know what is the situation with the latest cases.
If there are still any cases coming through the system from ‘outside bubble’ then something is going wrong given that we have been in our bubbles for more than two weeks.
Is 22 April too soon for Level 3?
Given all of the current uncertainties, my own inclination is that April 22 may well be too soon to come out of Level 4. My preference would be to stay in Level 4 for another 2 weeks and then move very fast down through the levels from there. But it does all depend on getting the track and trace system operating at a much higher level than currently.
I believe New Zealanders would accept anther two weeks of Level 4, if that then allows us to move much more quickly down through the other levels.
Once we do move to Level 3, then we must place all close contacts of existing cases under very tight isolation, as if those individuals are still in full Level 4. Otherwise, Level 3 is doomed to be a failure. That failure is essentially what has happened in some of the East Asian countries like Japan and Singapore where they are now moving from soft isolation policies to harder policies.
As a person who comes from animal-based industries, I have been in many discussions with Ministry of Primary Industries (MPI) over the last three years about some remarkably similar issues that have had to be addressed with the Mycoplasma bovis campaign. That Mycoplasma bovis campaign is still ongoing. Failures to undertake track and trace with sufficient speed and rigour, together with an unwillingness of MPI during the first 21 months of that program to acknowledge problems that were evident to all of us in the field, lie at the heart of the problems that campaign has faced. Even now, we still don’t know whether it is the Mycoplasma bovis authorities or the disease that is running the fastest. That race is still ongoing.
Somewhat ironically, it is animal scientists around the world who have the most experience in running disease eradication campaigns, be that TB, bovine leucosis, brucellosis and now Mycoplasma bovis here in New Zealand, or internationally for foot and mouth and mad-cow disease. In contrast, the human epidemiologists have never had to wage an eradication campaign except in situations where they have had a vaccine to create immunity and thereby carry the burden of the campaign.
One of the lessons from the animal world, is that every disease has its unique characteristics that determine the specific strategy. But every time, one way or another, it requires a track and trace that is carried out with speed and rigour.
*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.
91 Comments
We need to be very careful about lifting restrictions too early, otherwise we'll be spinning out of control like the US is right now. If you haven't seen this info graphic form the BBC and Johns Hopkins University the data show the rapid spread of COVID-19 since January 2020. You really should take a look.
Times Standard article: https://www.times-standard.com/2020/04/10/bbc-johns-hopkins-university-…
More info from BBC: https://www.bbc.com/news/world-51235105
Cannot come this far only to let the cat out of the bag. Having gone into level 4 then all the reasons and criteria that made that action necessary will clearly need to have been eliminated, before we can reduce from level 4, otherwise may as well not have bothered.
ps. great graphic - tks.
Keith - I do hope the health people running CV management understand this. I have had the feeling they are adhering too closely to a standard (WHO?) pandemic playbook, which has proven to be poorly suited to this new virus. I really hope I’m wrong and we will end up being nimble and adapt our strategy along the lines you suggest.
The agri world I presume also shared information about diseases and their origins to aid the elimination of the disease.
China appears to be doing precisely the opposite, spreading falsehoods about the origins, silencing academics and vetting publication of research on the diseases origins.
"The Centre promotes knowledge and understanding of contemporary China in New Zealand through research, collaboration and knowledge sharing."
Do you really think so ? Surely you cant be that naive.
Regarding Level 3 - I'm not certain the govt has published guidance yet on what level 3 will actually look like. We had 2 days of a beta version before we went into full lock down but what it really means in practice may not be as relaxed as we may think. Let's wait and see.
Bill Maher would certainly agree with you on that and he has some good points. Perhaps they don't want to close down the wet markets. New Your Post article: https://nypost.com/2020/04/11/bill-maher-defends-calling-coronavirus-ch…
Very salient points, Keith. I have been appalled at the quite evident failures in Health generally:
- The logistics failures in getting tests, PPE etc distributed - good inventory software has been around for three decades with most Web-enabled in the last decade, so there's just no excuse for failures in this critical area. The number of SKU's is certainly low - in the hundreds would be my SWAG, whereas FMCG deals with tens of thousands SKU's, often with on-shelf lives of days.
- The plethora of DHB's, each with their own systems, staff, C-suite, local issues, and variable levels of corporate intelligence, is surely part of the issue too. Time for a re-centralisation, if not to a national level, then surely less than the twenty-something edifices we are blessed/cursed with now.
- The lack of a national track-and-trace system is baffling. Courier parcel tracking can tell a customer where their parcel is in near-real-time. Contact tracing is more complex but, dear God, there must be something that could have been patched together out of the good commercial candidates, to build a good-enough T&T. And there's a single NHI to tie every body to every other body. Not like parcels, where there's a new tracking instance for every parcel. I rather suspect, given the predilections of bureaucrats, that the Perfect has gotten in the way of the Good. Again.
- The PR narrative spin being liberally sprayed over every utterance from the Powers that Be. Applying glitter to turds is of course the dominant SOP, but all it's doing, as with M.Bovis, is lowering the trust that's needed between citizens and authorities, to move forward together. This trust alone, as with M.Bovis, will take years to rebuild and for some affected, never. Poster child - the large cohort of citizens who have symptoms but who have been refused tests because Reasons.
Re: the logistics failures, their goal is not actually to simply distribute PPE everywhere and be done with it. They don't want to give out so much PPE that people waste it willy nilly because they feel like they have huge stocks of it - it should be treated as a precious resource. Nor do they want to give out all of their PPE so they don't have stock on hand, so if an emergency does happen they have nothing left to distribute. So it's not apparent that using inventory software designed for retail and wholesale where the goal is to get the goods to their final destination ASAP is applicable here.
Re: equating human movements to those of courier parcels is so far off the mark I don't know where to begin.
Inventory systems have this wonderful 'Minimum Stock Level' value.....
Human movements can be traced multiple ways: bank records, phone GPS, facial recognition, etc. Once a face/bank card/phone and an NHI are associated, that's the starting point. My point is simply that some starter-kit software already exists and should be being taken advantage of. Whereas I suspect that the clots are attempting to build something from scratch. Gubmint efforts in this sphere have an inglorious record of expense and time over-runs, and sub-optimal performance or outright abandonment. Poster children: INCIS, and the failed attempt at an all-of-Gubmint financial transaction hub.
Yes, perhaps if we lived in a country that didn't care about privacy, those things would be on the table to be rolled out as rapidly as you believe they should be. However we don't live in that reality.
Also while it's possible to "do something", whatever that "something" is actually has to work. It's no use trying to roll out a widespread system that fails and then takes 10 weeks to fix into some semblance of working, if you could instead have just spent 5 weeks doing it properly from the beginning. See also: Novopay, software that was never in any way, shape or form fit for the purpose it was trying to be put to here.
Governing a country requires consent of the governed. If everyone decided to break level 4 lockdown tomorrow there's nothing the government or police could do about it. If the government tried to be overly intrusive in people's lives in the name of tracking health symptoms, or rolled out a shitty app that broke people's phones and plainly didn't work, then it only harms the situation.
We don't need to build anything new - there are already tried and tested contract tracing and outbreak management software tools used across the World and available in New Zealand, which include people tracing and object tracing (e.g. a country, airport, bus, hospital ward, school classroom, supermarket, water source, restaurant etc.. can all be the cause of an infection outbreak).
Having an APP to remind you where you've been is only part of the story - a solid system to do the linking once you have an individual's movements is the key to making contact tracing work. To my mind ' Lets build an APP for that' - shows one thing and one thing only - the person espousing it hasn't through. through the issue sufficiently.
An APP may be a useful component of the system wide solution however it is NEVER the whole solution.
If your phone is on the network they know which cell site you are connected to, and if you have reasonable signal from 3 or more cellsites, they can locate you to within a couple of meters. Yes, they can probably tell if you are taking a piss or sitting at the dining table in your own home if your phone is in your pocket.
"More importantly, Australia’s per capita rates of new cases are now less than half of ours, having previously been well above us. What are they suddenly doing better than us to achieve this?"
At least part of it is that our headline reporting includes Probable cases, whereas (to my knowledge) no other country is doing this. Recently, probable cases have been very high compared to confirmed cases - in further shows that the early stages of this the authorities must have been looking the other way when someone came in with symptoms, whereas now they seem much happier to pronounce someone as a probable case even with a negative test result.
I suspect, without any evidence, that we may have swung too far, and are now counting probable cases as actual cases when they aren't (antibody testing would surely help here!). If that is true, the situation may be better than what you're reckoning.
3 day rolling average of confirmed only gives us 19 cases, against 30 when probable are included (57 confirmed vs 34 probable).
Lanthanide
I agree that including 'probables' may be unusual on a world basis. But I think including them is the right thing to do. Part of the reason our 'probables' are so high is that frail people in rest homes are often not subjected to the test. Instead they are classified as 'probable' based on symptoms and circumstances. I do not have information as to what Australia does.
I also acknowledge that once the disease gets out of control in a country the statistics become increasingly unrelible - both cases and deaths. Many countries only include hospital cases. Also people who die outside of a hospital environment or for other reasons have not been offically certified as to cause of death, are often excluded. Also people who were already 'near to death' from other causes are often not included in the totals. Also, right now there is an 'Easter effect' in many countries with delayed reporting.
But I don't think we went too hard overall. Countries like Spain are now planning to release restrictions and I expect we will see an even bigger wave there in about a months time. But they have limited and perhaps zero altrnatives, with eradication no longer feasible.
KeithW
The government has had weeks to organize an App that everyone could use on their phones to help with contact tracing but I suspect those worried about civil liberties and big brother would start jumping up and down so its just a no go. We need to go to Level 3 now and just monitor the situation. Cannot stay at 4 any more. If a couple more people die then so be it the economic and resulting social cost from any more level 4 is to high.
How about the first two months let 15 to 25 year olds back to normal, then 25 to 35 for next two months, then 35 to 45 and so on. It will flatten the curve and provide the much needed immunity because without a vaccine we have to open up or hide. As we know about spanish flu that "By the summer of 1919, the flu pandemic came to an end, as those that were infected either died or developed immunity."
Blimey Keith. I was hoping to be back at work by the end of next week & now you've burst that bubble. I suspect we will never be rid of the viruses of various sorts that come from time to time. Surely, surely, surely we have to learn how to manage them & get back to work?
Point 2: The last time we went hell for leather into debt it took us 20 years to get out of it. And most of us have never forgiven Piggy for it. Still.
I think I have cracked it. In another thread I wondered aloud about the relative rarity of the virus being caught on a plane yet gatherings like parties, weddings and cruise liners were often hotbeds of infection. The main difference is the amount of talking that goes on. If you overhear a party it is very loud with people practically shouting at one another while planes are very quiet. I suspect a lot more chitter chatter goes on aboard ships as well to pass the time.
When people talk to each other they can get very close and droplets are probably sprayed all over their faces. Think back to how it is when talking with people at loud parties, having to lean forward to be heard. Don't talk to people if it is avoidable is my advice.
In his column of Friday April 3 Matthew Hooten, right-wing regular columnist for the Herald, wrote that he didn't wish for Millenials not to have the same opportunities that babyboomers had, and that the Government should take this into account when deciding on the length of lockdowns.
The clear implication was that the government should take its foot off the brake and loosen restrictions on business lockdowns so business can get on with it and thus retain opportunities for the millennials. He also added the impliction that if the older generation were sacrificed (he specifically mentioned eighty-year-olds) to Covid then so be it if it would retain opportunities for this younger generation.
I thus have two questions for Keith:
1. do you agree that this idea of Hooten's would be a good idea?
2. would so releasing business restrictions earlier than under the present programme, endanger the whole
population (i.e. all generations) and not just the older generation?
streetwise
1) No, I don't agree with Hooten
2) I don't think we can build herd immunity for this disease until most of the population has been infected. On a global basis, I think we are still only in the very early stages of this pandemic. And I agree with the Prime Minister's statement that eradication and minmising economic disruption is not a dichotomy. If we can eradicate, then that will be the best outcome both for wellbeing and the economy.
KeithW
All this talk above levels...lol. The levels were a last minute creation and appear to be meaningless - even the govt don't follow them.
Level 4 - We are locked down, except we aren't. Over 1 million "essential" workers out and about (plus a questionable Health Minister) The remaining population have all decided to train for an ironman. Most people have done more exercise over the last 2 weeks, than they have probably done over the last 2 years.
Level 3 - Education facilities are back open. Except they are not. Going 3-4 Schools were shut. Coming out of 4 Dipkins has clearly stated not to expect the schools to be open for a while. So for many parents we will stick to three full time jobs (Work from home, Parent, and Teach). Pity all the parent's that will be expected back at work - with Kids still at home.
I already sense dropping from 4 to 3 will be a giant free-for-all travel as people party, shop, and generally release x weeks of pent up energy.
So if the Govt were smart they would just stick to L4 for a few weeks more. Ensure cases are at Zero. Give a few weeks notice when we will move out of lockdown (So everyone can prepare). Then just announce we are all good to resume normal business.
The borders can stay shut to all non-citizens - at least until we have a surefire instant test. A vaccine is just a pipedream, there are too many current viruses with no vaccine. So why do we think this one will be different.
I don't think that's the case, nor have the government said it, and I don't think they've even hinted at it, either.
On the contrary, in response to people saying we need to be able to do tracing of 1,000 people and their contacts per day, Ashley Bloomfield responded that we should't need that capacity because the infection rate should not be anywhere near 1,000 per day if the lockdown is successful.
He didn't say "we won't need to do any contact tracing because our new transmissions will be at 0".
No the government has not said that in so many words if you have to be pedantic about it. No government volunteers information about anything until it is either ready or forced to do so. There have been though plenty of signals that any decisions will favour caution, be conservative and safety of the people first. Is thereanything to the contrary out there?
Um, no?
You seem to think we need to get to 0 new daily cases before the government will take us out of level 4 lockdown and have said that there have been many signals about this from the government. Yet you haven't provided any.
We don't need to be at 0 cases, we just need to be at very few - few enough that all contacts can be traced. And more to the point, I think they'd want to see 0 community transmission events ideally, which is not the same thing as 0 new cases each day.
"Level 4 - We are locked down, except we aren't."
Well that's always been the definition of lockdown level 4 - essential workers can keep working. Level 4 lockdown has never literally been "everyone has to fend for themselves for 4 weeks with whatever food they happen to have in their houses because all supermarkets are going to be shut". Stupid comment from you really.
"Then just announce we are all good to resume normal business."
Except we won't be. Level 1 still bans gatherings of 500 people or more. We'll likely to stay at least in that level until a vaccine is widely deployed.
"A vaccine is just a pipedream, there are too many current viruses with no vaccine. So why do we think this one will be different."
1. Because the nature of this virus is such that a vaccine can be developed for it. For example HIV mutates so quickly and directly attacks and hides from the immune system itself so that a vaccine is not effective, this virus is not like that at all.
2. Vaccines were developed for SARS, although never to full commercialisation because the disease was contained and so no further investment was warranted.
3. No one in the scientific / medical community has been suggesting that a vaccine may prove difficult, aside from the length of time required to validate one as safe and produce it en masse. In the absence of such cautions, there's no reason to suspect that one can't be developed.
4. More of the world's resources are being put into this virus in such a short period of time that it would eclipse the effort put into any other disease in such a similar period of time ever.
One of the good things that New Zealand can expect in coming days is that the number of people with ordinary flu who come in for testing should start to decline very quickly. This is because the Level 4 system that we currently have in place should be smashing any community transmission of ordinary flu. This will ease up some resources that can be allocated to testing all close contacts.
Still very early in the season but it looks like this is already happening:
I think we are not prepared for this. Not lockdown. Not losing jobs. Not the loss of freedoms we never thought we would lose. Push the lockdown too far for some and the result will be loss of cooperation. Contact tracing requires firstly honesty. Let's face it, lockdown is house arrest for some and not all are coping. This virus has the jump on us....invisible, spreads while asymptomatic, carrier cases [probably kids and young adults]. And it kills the economy by strangulation.
Yeah time to pull the pin on level 4 on the 22nd April and closely monitor the situation. New case numbers by then should be single digits and almost "expected or foreseeable" anyway as they should all be now contained within your bubble and somebody and only somebody within you bubble already has it right ? No point keeping everyone in lockdown, it will be pointless as the usual few idiots are already running around ignoring it. Maintain wearing masks and eye protection in public, this is going to be mandatory for months to come.
We are going to end up in a situation in the coming weeks and months where the rest of the world is through the worst of it and opening back up while New Zealand is closed off from the world indefinitely.
This German study is showing that simply managing the outbreak is probably the best approach.
It seems to me that Jacinda's eradication strategy risks curb stomping the economy to achieve its aims but then leaves us in limbo with no viable exit strategy other than waiting indefinitely for a possible vaccine or eventually just giving up and working through the infection like the rest of the world will have already done.
Jacinda is making some very high stakes gambles on what the future holds. I hope she isnt just doing this to feed her nauseating worship cult.
Brock
For the rest of the world, they are not going to be through the worst of it. There is still only a very small proportion that will have immunity and then the next wave will hit with a lag of three to six weeks from when they take off the lockdown shackles. The situation is actually very grim for all of those countries, with no alternative for those countries beyond suppressing but not eliminating the disease over a long tmeframe. This is why it is so important that our lockdown is successful.
KeithW
I'm more optimistic on the situation overseas.
Effective treatments will become available and each successive wave will be of a smaller and more manageable size while restrictions are gradually lifted.
The spreadability of the disease will decrease naturally as the percentage of immune hosts increases. You don't need full herd immunity to slow it down.
Time will tell let's see the situation a few months from now. My guess is that the outlook won't be dire at all.
The loss of life has to be minmised, but in balance with the damage being done to the rest of society.
Brock,
A key issue is the R value under different strategies. If, for example, the R-zero is 3, then we need to have two thirds of the population to have been infected before herd immunity kicks in. If R-zero is only 2, then immuity will kick in when half the population is infected. Actually, the required levels for each R value are somewhat hiigher than this because the transmission cycles are so short and there are some lags as immunity kicks in, but these figures are roughly right and anything more accurate requires a fancy model.
Currently, we don't know the correct value for R-zero but the speed at which the disease exponentiates in the absence of lockdowns tells us that it is certainly more than 2. Some estimates are that it is as high as 6, and that may well be true in concentrated living situations - both in big Third World cities, and even in places like Kiribati and Tuvalu, both countries where I have worked, and where population densities are extreme. Even at R-zero of 4, herd immunity does not really kick in and the disease start to die away until 75% of the population is infected.
You are correct in saying that you don't need full herd immunity to slow it down, but the percentages relating to each R figuresI have quoted are where each infected person is still on average infecting one other person. So when I say 'kicks in', this is the point at which the disease starts to die away, and the total cases curve changes from exponential to flattening, and becomes what is called a Gompertz curve. It is not the point when it finally dies out. That comes later! With ordinary flu, herd immunity works ebcause the R-zero is of the order of only about 1.3. That means that only 25% of the population has to beinfected before herd immunity is kicking in.
KeithW
Here is something to chromecast in the background.
https://youtu.be/U_XsRZXL2Ic
CNA out if Sungapore have their reporters across Asia.
Indonesia, Philippines India.
My assumption has always been that the level 4 lockdown was done early simply because there was a recognition (even if not publicly stated) that we lacked the infrastructure and resources to ramp up testing and contact tracing. South Korea showed the virus could be managed in this way, IF the necessary systems were already in place.
I would hope that if the government has been unable to ramp up our testing and contact tracing capabilities during the lock down period we will extend level 4 until we have the spread sufficiently under control.
It will be incredibly silly to take the hit of an early level 4 lockdown, but still end up with the virus running rampant, just with a few weeks delay.
My assumption was level 4 lockdown (a good policy given the circumstances) was brought in because the spokesmen for nurses and doctors were rightly or wrongly demanding it. A decision forced on our govt because if things in NZ had descended to what was being shown on the news from Italy then every politician involved would have been pariahs.
A secondary issue would have been a serious outbreak may have proved we hadn't prepared - the Ministry of Health's twitter account for March 11th said "The risk of an ongoing outbreak of #COVID19 in New Zealand remains low".
The numbers? Believe them? Seems like most do. Read this article, then have a think about national policy etc.
https://www.rt.com/op-ed/485425-west-china-covid-19-figures/
The govt. Any govt for that matter, are free to choose their own approach, and stage manage as required. Dept of stats deaths 2019. All figures available.
2020, jan, feb and march still not available. Possibly, if the numbers aren't being fudged as I write, looking for large spikes in the death rate is the only way the public will get any idea of the impact of this virus. No doubt lots of influenza deaths.
I'm surprised Bridges and his lot aren't on to this, they're experts at tampering with dept of stats, ie inflation etc. We need to take notice, stop patting ourselves on the back for job well done.
It is all about speed. In level 4 we are assuming everyone has the virus - essentially everyone is in quarantine.
In level 3 we are assuming no-one has the virus - except for those who have tested positive, and those who have arrived from overseas.
So level 4 is the ultimate in speedy response - as everyone is already in quarantine, so the contact tracing and testing of those contacts isn't really doing a hell of a lot more.
For level 3 we need those people who have symptoms, and therefore think they need a test to immediately go into quarantine instead of waiting to see the doctor, get referred, get the test, waiting for the results. Their contacts should also go into quarantine immediately. Waiting for the test results is stupid in level 3. Maybe at level 2 it is appropriate.
Time is the thing you don't waste with the log growth of this. The medical system is not built for speed. In this case we don't need precision we just need to be fast. Don't let perfect be the enemy of good.
The swab has three problems: it's extremely unpleasant: you need to scrape off cells at the back of your nose. It's easy to do it wrong, so you get not enough material, therefore test won't be conclusive. Finally, the test itself is not sensitive enough, so we have large cases of false negatives.
Berend,
I agree with all of those points.
That is why I say that PCR (swab) tests can only be one part of the trace and test policy.
In the case of Mycoplasma bovis, MPI have to a large extent moved away from PCR. Even when the swabs come from the tonsils of slaughtered animals it is common to get false negatives. With Mycoplasma, the main testing now is using ELISA antibody tests, in blood and milk.
But with COVID-19, PCR still remains on of the important tools, and rightly so.
KeithW
Given a large proportion of C-19 appears to be asymptomatic, I’m surprised Keith doesn’t include a role for a well-constructed surveillance programme. Critical, I would’ve thought. Re the lack of transparency, we need a few journos with technical knowledge or access to it. There are too many ‘soft ball questions’ about PPE and individual instances, with too few about systems like contact tracing. In terms of how NZ inc has performed in this crisis, our preparedness and initial response were woeful, while the rest of the response has been great. But as we move to the later stage of response and into recovery, I feel we’re kidding ourselves that we’re somehow exceptional - we need to up our game significantly along the lines of this article.
I think all New Zealanders have to admit the obvious. Our Government made a massive error. The situation is now farcical.
We were told by our PM, that there may be "thousands of deaths". There has been four. The infection fatality rate is four out of probably 6,000 cases (given that 80% never develop serious symptoms). This mortality rate is lower than the flu - which kills 500 kiwis every year. The total annual fatality rate has not risen for any country in the world.
The evidence that this bug was not dangerous was clear from the outset, namely the "Pacific Princess", Vo and Icelandic data analysis from world leading epidemiologists such as Professor Wittkowski and John Ioannidis. We need to re-open schools and businesses immediately to generate herd immunity and maybe maintain infection control in rest homes.
Contact tracing might have worked in the first few weeks, but it's too late for that. We cannot "eliminate" the virus - it has gone global. Are we to close New Zealand permanently?
In my opinion, we have blown $12 billion plus for no good reason. We need a "No Panic Act" to stop it happening again.
I base this on the fact that a recent study found that in Wuhan the actual number of infected as of February 11, 2020 was probably 100 times the number that had been laboratory tested positive. The number of infected must, therefore in NZ be higher than 1349 cases as now confirmed.
Recent German study (some of the best data so far) suggests the mortality rate is around 0.4, or four times that of the flu:
https://reason.com/2020/04/09/preliminary-german-study-shows-a-covid-19…
We were told by our PM, that there may be "thousands of deaths". There has been four.
Man rails against umbrellas as unnecessary expense after standing under one in the rain and not getting wet.
Ten NZ academics and epidemiologists ie Simon Thornley, Paul Schofield ( AUT Prof) and nine others, today agreed with my (maths major) statistics - this is the same as the flu.
When large, random samples are done as in Vo, in Italy, the fatality rate is 0.1%. Research also indicates the epidemic in China and elsewhere, actually peaked before lock down.
The average age of death of all Covid-19 sufferers, as Paul Schofield notes, is the same as life expectancy. This has been a normal respiratory virus season.
Again with academics only looking at the raw fatality rate and failing to consider the problem that COVID-19 overwhelms hospitals, driving the fatality rate higher and preventing those hospitals from being able to treat other emergencies such as heart attacks.
1. Compared to flu, COVID-19 spreads much much faster (R0 of 2.5-4 compared to ~1.3 for flu), so it infects a lot of people at the same time very quickly
2. The rate of people who need to be hospitalised with COVID-19 compared to flu is higher
3. People stay in hospital for 11-12 days with COVID-19 vs 5-6 with flu
4. There is no vaccine for COVID-19 like there is for flu. Flu vaccines are given to all front line medical staff. This isn't possible for COVID-19, so those medical staff themselves become ill (and can help spread it to people visiting the hospital for other reasons), thus lessening the resources available to help care for those that have COVID-19, further exascerbating the fatality of the disease
Fishout of water
I do see a role for surveillance but it is difficult to make that work using PCR tests given the amount of testing that is required. That is where we need to bring antibody testing into the picture. I have previoulsy written about that. But I believe that rigorous contact testing together with testing of anyone who has any symptoms at all is more important than random testing in terms of priorities. I read today that loss of smell is still not sufficient by itself to trigger testing under the current guidelines. This is absoutely crazy! And that is putting it politely.
KeithW
Why does Stanford professor John Ioannidis disagree with everything you say? Why has total mortality not risen anywhere in Europe, the UK and the USA?
Do you accept the IFR in NZ is 0.1% - the same as the flu? This is a respiratory virus and your policies of prolonging the crisis will cause more domestic violence and suicide deaths than those that are saved. Less people are dying In Europe this year than last year and the average age of death from Covid-19 is the same as life expectancy...
Why have the Swedes not had a higher death rate than their Scandinavian neighbours (with no lockdown)?
You ignore mathematical analysis and facts. Think.
by sunchap. You could well be right, but it's funny that in past years we haven't seen TV reports of excavators digging mass graves on wasteland in New York with literally hundreds of coffins stacked in rows as far as the eye can see. What you're saying is that this does happen every year in New York from common seasonal flu but it just so happens that this year the media decided for no particular reason that they should cover it.
We have problem his name is Winstone Peters , yes he's worried about economy but making mumblings about the long period of time , but stamp the beast out go another 2 weeks to make sure or we have wasted everyone's time.
As for level 3 social distancing I have seen young people at my local New World under level 4 chatting side by side, so level 3 is going to be more venerable.
As for schools under level 3 , kids will not obey social distancing even with small classes , we have winter coming on and who usually brings the flu home first and then spreads it around the family .
Minister Hipkins must be taking some magic lolly that gives him hallucinations no matter how much they have small or special classes and so many free laptops and internet connections
I would argue there is also a need for supporting mass surveillance using both PCR and ELISA. For at risk professions like nurses and doctors we may want to test weekly, we will want to test every runny nose and cough of course.
You can already see that there are missing links in clusters such as the Christchurch rest home. Somewhere in that organisation is likely an asymptomatic carrier we have yet to locate.
Involve the community in the surveillance program. I am happy to dob my neighbours, friends and family in. Especially if I get some sort of benefit from it. The suspect across the road went for 2 walks today. He also smiled at me as he walked past. A totally socially bad egg.
Like sexually transmitted disease testing, it's not always straightforward getting the facts on an individual person level. National current M Bovis eradication attempt is for domesticated/ captivated animals, but some people are more likely to behave like feral goats in a national park and be more difficult to contact trace, ie not all will be as able nor as motivated to backward trace for 2 weeks with diaries,etc
Unfortunately I feel based on the contact tracing so far, which does appear overwhelmed due to the manual resources it needs, and they are struggling to trace cases back to the point of origin, that if we move out of level 4, we don't have much hope in contact tracing and containment if numbers start ramping up. Staying in level 4 allows us more time to reset the virus and starve it of hosts. But I fear the media telling the public that we are now over halfway through the lockdown, that the public and businesses won't accept remaining in level 4 lockdown for longer than 4 weeks. Until we get zero new case for a few weeks, I don't think we can afford to leave level 4 lockdown, as we don't have the automated systems in place to deal with tracing and testing. They re looking into apps, but only a small percentage of people will install such an app, unless they make it requirement for anyone moving out of level 4, to always have their mobile device on them, to allow them to be tracked. But who is going to pay for mobile data etc, for people to use such an app? The whole problem with this illness is that it spreads silently, and it has a 2 week incubation period.
We have to look at other countries like the UK who will be in and out of lockdown for over a year or more to contain new waves, and new outbreaks.
Those that want the lockdown relaxed sooner rather than later are now supported by some local experts:
Zachary,
I never use the word 'expert' because essentially it is a 'call to authority'. There is this idea that 'experts' must be right. I prefer the notion that we should all consider ourseleves as learners, and in our arguments we should go wherever the evidence leads us.
But I do agree with you that a group of specialists in a range of disciplines is arguing that we should get out of lockdown very quickly. Personally, I find their arguments very questionable.
KeithW
The vast majority of deaths occur in sick and frail people. Protect them and manage the crisis from there. Otherwise, it’s a permanent level 4 until a few billion doses of some yet-to-be-found vaccine is available. The social and economic damage we risk doing in a vain attempt to eradicate Covid will blight our children’s future. Has anyone ever managed to eradicate a virus, anywhere? Essentially, we are being incredibly selfish. And how churlish of people to criticise Winston Peters for fishing from his front lawn, or who want to dob in neighbours for walking their dog to far or too frequently. The same ‘they are hiding Jews’ mentality existed in prewar Germany. Now that was herd mentality and something to be really feared.
I agree totally.
"Eradication" is impossible, as there is no world wide herd immunity and can only happen with a long lockdown which would destroy our tourism industry. That is why Grant Schofield (AUT Prof) and about 10 other NZ academics today said lift the lockdown immediately as this bug is the same as the flu
When you read of people with "pre-existing conditions", this does not mean they are sick and frail. The two most common pre-existing conditions are high blood pressure and diabetes, both extremely common and not generally a death sentence. Even in healthy young and middle-aged people, the fatality rate is estimated at 0.2% - higher if hospitals became overwhelmed. Most people consider this too high a price to pay. That's why countries are trying to flatten the curve and NZ is trying to eliminate it. SARS and MERS were eradicated world-wide. A vaccine is entirely possible - with the 2009 influenza epidemic, 3 billion doses of vaccine were administered (although that was easier as it was related to a known flu virus).
Hi Keith
This is written by Jonathan Tepper.
https://medium.com/@tepper_jonathan/ground-zero-when-the-cure-is-worse-…
It's a shame that Tepper mentions "koalas" as being sold in the Wuhan market as that is extremely unlikely. Apparently they were a large rodent of some sort that the Chinese there call tree bears. There possibly weren't any bats there either.
I do agree that hospital admissions in Italy likely caused a lot more deaths as apparently even mild cases in vulnerable people were rushed to the hospital. Intubation as well could be causing unnecessary deaths.
When we move to level two we should keep talking outside the bubble down to an absolute minimum. No talking on public transport or in shops. No social gatherings at all. I have managed to avoid social gatherings for years now. Stick to digital communications.
Not enough is being done by the government to prep people for moving to level two. They should start the preparation work now. Avoid talking, wear masks and eye protection. Why do doctors wear the face shields? To avoid the saliva splattering that results from talking. This alone would suppress the virus I believe.
Andrewj
Eventually, after getting to cut and paste about 10 times, I got the Jonathan Tepper link to work.
And I am glad I persisted.
The most important messaage in my opinion is that hospitals are a great place to spread infectious diseases of all types.
In relation to COVID-19, it was actually the Chinese who warned us of that very early on.
One of the consequences of this, which many people have not appreciated, is that with a herd immunity approach the only non-COVID patients going to hospital should be those needing urgent surgery.
Even with the eradication program, the NZ hospitals recognise the enhanced risk in hospital, and that is one reason for avoiding elective surgery currently. Also, for all patients needing urgent surgery, the first step that hospitals are taking is to test for COVID-19.
What Tepper may not have recognised, is that with a herd immunity approach it is impossible to keep COVID-19 out of rest-homes. They get it from their carers.
KeithW
Really puzzled now Keith.
In previous articles you stated that the complete failure of farmers to use NAIT and its ability to assist track and trace was not relevant to the Microplasma Bovis issue.
Now you say that Contact Tracing is the golden bullet re the Wuhan Virus.
Not disagreeing but confused about the double standards?
Smalltown,
I don't believe I have ever used the words 'complete failure' in regard to NAIT. However, NAIT has always had serious limitations, some of which have been progressively solved, but others still remain.
For example, one of those multiple weaknesses is that the NAIT system cannot deal with situations where MPI places part of a farm under NOD but not the whole farm. I mention that as an example because I work with a farmer who has recently got caught in just such a tangle when MPI used NAIT to conclude that there had been a trail of illegal animal transfers from another farm to his farm, but those transfers were in fact legal. But that is just one example of many.
One of the flaws of the Mycoplasma bovis campaign has been to rely on NAIT as if it were accurate and the key tool. And for a long time MPI were very averse to recognising alternative evidence when the NAIT records were incorrect, often through no fault of farmers. I have dozens of examples of this.
Over time, MPI has recognised the value of doing farm censuses looking for specific NAIT codes. That has been helpful, but that too can lead to incorrect conclusions if one does not keep an open mind.
Perhaps the error in your thinking is to assume that NAIT records and contact-tracing are the same thing. Contact-tracing lies at the heart of all successful eradication campaigns, but using the various tools that are appropriate to the specific situation. For example, many farmers learn that they have trace animals from other farrmers contacting them about their own forward traces, months before MPI gets there. But MPI has had access tothis information all along. I have been currently involved (over Easter) in a Mycoplasma bovis case where the forward-trace farmers have known for months that they should be under NOD, based on information from farmers who sold animals to them, but MPI still has not go there. The difference now is that MPI, at senior levels, when told of these situations, is much more inclined to acknowledge weaknesses in their systems. That give us a much greater chance of making progress.
Can I also suggest to you, that rather than using terms such as 'double standards' with its associated implications, it would be better to simply ask whether there is a contradiction between the things that I have said about Mycoplasma bovis and what I say about COVID-19. That would allow for the possibilty that it is your own incomplete understanding of the situation that has led to your perspective.
KeithW
Living in NZ I am happy that the govt. is doing its best to keep CoronaV at bay, but at the same time, it appears that its spread is inevitable. NZ cannot lock itself down for more than a few weeks without ending up with hyperinflation. A vaccine, by all accounts, is more than 12 months away. The moment it goes down to Level 3, or when international flights start, the spread will slowly begin again, rendering all previous efforts wasted. I am now of the mind that this game will not be over until most people around the world have developed natural immunity though actually contracting it. It is the new flu. The best we can do is delay it such that hospitals can cope with the more severe cases. That being said, if NZ hunkers down and becomes self-sufficient (cows, milk, fish, fresh water, veg - it's all here) then who knows, maybe that vaccine is not so far away ... Politicians only want to be seen to be doing the right thing. Doctors can only say things that preserve life. Economists speak for the well-being economy, while 'other things' are 'taken into calculation'. Personally, I think the economists will win.
Yes, I agree. The trouble with the Government's approach is that by keeping all children out of schools the time to achieve herd immunity has been extended and it has thus has become harder to protect the elderly. More will therefore die - in the long term, as infection control measures probably won't stay on in rest homes, for the 18 months it takes to find a vaccine. Schools and businesses should therefore open next week.
The top public health experts at Auckland Uni and AUT are now proposing this, ie the medical consensus now opposes Taxcinda. Her cunning plan is unnecessarily destroying our tourism sector which earns 16% of GDP.
As you say if Jacinda waits for a vaccine we will all be bankrupt. The UK was going for herd immunity until their replacement expert Neil Ferguson made incorrect assessments of the infection fatality rate.
Keith, what evidence do you have around how many more contacts people will be having at Level 3 than Level 4? Currently, Germany has seen new cases fall 50% in 3 weeks, and they estimate R0=0.7, which is enough to eventually eliminate the virus. NZ has much tighter restrictions, extremely well observed, and has had new cases fall 75% in 3 weeks. So likely our R0 is smaller, perhaps 0.5, and has scope to safely increase a little. Even Sweden has a flat case load. Countries markedly less strict than us (Norway, Denmark) are preparing to relax restrictions a little.
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