Are we ready?

13/01/2021

How serious is the infection rate for Covid-19 in the UK?

This serious:

That tweet is from a doctor in the USA.

In New Zealand we are in the very fortunate situation of having no community transmission of the disease – at least none we’re aware of.

Is enough being done to ensure that continues and is enough being done to keep border workers safe?

As the COVID-19 crisis continues to deepen overseas, the National Party warns we’re exposing people to a “totally unacceptable” level of risk at the border. 

Four new cases were announced in managed isolation on Monday, and with the threat of two new strains of the virus looming, Judith Collins is telling the Government to start vaccinating now or consider closing the borders.

She’s accusing the Government of playing fast and loose with the new, more infectious strains of COVID-19, and agrees with epidemiologist Michael Baker, who told Newshub on Sunday it’s time to consider closing the borders to some countries.

“I think we are being a bit slow in response to these new, more infectious variants. I think now we have to be very proactive again and take decisive action,” he said.

“At one extreme, unfortunately, I think we may need to look at suspending travel from countries where this new variant is circulating very vigorously.” . . 

The government has already announced stricter conditions for returnees:

On Tuesday, the Government announced it will give the Director-General of Health the power to require a negative pre-departure COVID-19 test from all New Zealanders returning to the country – and he will soon do so.

Arrivals from Australia, Antarctica and some Pacific Island nations will be exempt.

Currently, just those returning to New Zealand from the UK or the US have to test negative prior to departure. . . 

Now all returnees will have to remain in their hotel rooms until they can be tested on their first day back in New Zealand. . . 

These measures will increase the likelihood of catching anyone who is infected and quarantining them sooner, but is it enough?

Citizens always have the right to come home.

Does that mean the government doesn’t have the right to require anyone coming from countries where the disease is rampant to be disease-free before they board a plane to return?

Even if they can, it would take time to to set up and in the meantime highly infectious people are coming home.

Is our border secure enough and are we ready if it’s not?


Is it fit for purpose now?

22/12/2020

Heather Simpson and Sir Brian Roche delivered their report on New Zealand’s Covid-19 response in September. It was finally released last week, after parliament had risen.

Given it’s content, it’s not surprising the government didn’t want parliament’s scrutiny and did want public attention elsewhere.

Thomas Coughlan says the report is damning – and particularly damning of the Ministry of Health, the heroes of the Covid-19 response.:

Of the 28 recommendations made across two reports, 25 were for the Ministry – the criticism is wide-ranging and accusations of what amounts to a power grab by the Ministry of Health, which didn’t properly share information with other ministries or even ministers and failed to cooperate properly with the rest of Government.

The report found that the there was “inappropriate accountability” for different parts of the strategy and that “numerous written reports” from the Ministry on progress it was making at the border “did not always reflect concrete action on the ground”.

The report said the Ministry’s approach to the implementation of policy “was often seen as being at odds with the overall collective interest”.

Testing rates – something we know is crucial to the keeping Covid out – were kept low because the Ministry was lax in actually paying the people doing the testing.

Unsurprisingly this led to “increased dissatisfaction with the system and at times made for reluctance to increase testing rates, consequently reducing access”.

This gives credence to the view that keeping the disease out has owed a lot to luck.

It’s little wonder that the official answer for not releasing the report earlier was to give the Ministry time to respond to allegations of serious failings on their part.

Other parts of the Government “without exception… expressed concern at their ability to be ‘heard’ by the Ministry of Health.

Other agencies and the private sector said the Health Ministry acted without full regard for the impact of its decisions, even as they “consistently sought more input into operationalising implementation plans”.

This can’t have been helped by the fact that the big cross-government group (All of Government group or AoG) set up to manage the pandemic didn’t actually include the Ministry of Health. The Ministry decided on its own not to participate.

Did the Ministers know that?

Once the country went back into level 1, that problem deepened. The AoG “effectively became a ‘Rest of Government Unit’ being everything other than Health”.

This was a problem because at the time, difficulties n communication in the Health Ministry meant future planning had to be put on hiatus.

Throughout the pandemic, public servants and ministers have struggled to strike the balance between public heath and other concerns. This report suggests that the Ministry of Health didn’t even try to strike that balance, sending off policy advice to ministers before consulting other parts of Government.

“The Ministry of Health is the principal advisor to the Government as it is essential that decisions taken as part of the response are firmly grounded in the best public health science,”

“At times, however, this seems to have been interpreted as meaning that advice should not be influenced by information or legitimate concerns expressed by other sectors.

“That should clearly not be the case,” the report said.

Is anyone being held accountable for that?

“Too often decision-making papers have gone to Cabinet with little or no real analysis of options and little evidence of input from outside health or even from different parts of the health Ministry or sector,” the report said.

The reviewers acknowledge that such chaos would be forgivable in the first weeks of the pandemic, but “it should not be continuing eight months into an issue as we are currently facing”. . . 

The MoH is a policy organisation not designed for implementing strategy, but if it was sending papers to Cabinet with insufficient analysis it wasn’t even doing policy well.

Michael Morrah lists the key themes in the report:

  • consistency and quality of communication, and consultation with relevant stakeholders was suboptimal
  • inappropriate accountability for various aspects of the strategies and their implementation
  • border control directives have been difficult to understand and implement
  • lack of clarity in the testing framework
  • lack of good forward planning from the perspective of an end-to-end system
  • underutilisation of health expertise outside the Ministry of Health leading to suboptimal analysis and planning documents
  • lack of confidence in data being reported to key decision makers.
  • The report says “exhausted” officials weren’t ready for the August outbreak, which sent Auckland back to alert level 3 after 102 days of no community transmission.

“The immediate goal had been achieved and much focus rightly turned to supporting economic recovery. In hindsight, however, better use could have been made in the 102 days to prepare for the inevitable outbreak. 

“This is important, not as a criticism of the actions in the past, but because it is essential, we learn that lesson now.” 

Have the lessons been learned and the necessary changes been made?

The patchwork of agencies and ministries involved in the response had done well, the report said, but the arrangement wasn’t sustainable in the long-term fight against COVID-19.

“We don’t have a status quo model which is well understood and could serve effectively for the next 24 to 36 months,” Sir Brian and Simpson said. “While the model is improving it is not yet fit for purpose.” 

It wasn’t fit for purpose when the report was written, is it now?

New South Wales has had another outbreak of Covid-19 and the UK has a new and more virulent strain of the disease which will almost certainly come here:

New Zealand will see the new variant of Covid-19 from the UK here within the next few weeks, a top epidemiologist warns.

But, the new Covid-19 variant found in the UK is potentially only a problem for New Zealand if the virus is imported and it starts an outbreak here, Professor Michael Baker said. . . 

“Basically every time we get an infected person going into a MIQ facility in New Zealand, it increases the risk of outbreaks because mistakes happen and it’s a tough virus to control.”

He said a simple measure is to add an extra step, an additional period of MIQ stay in the UK and having a negative test result before travelling.

“We will be bringing this virus into New Zealand now, or in the next few weeks because it’s becoming the dominant virus there.”

National Party election policy was to require MIQ and a negative test before people boarded planes to come to New Zealand. That wouldn’t stop everyone with the disease but it would catch some of them.

The logistics wouldn’t be easy and it wouldn’t be cheap but if it kept at least some infectious people out of the country it would be worth it, especially if our model isn’t yet fit for purpose.

The Simpson Roche report is here.


Should be on higher alert

21/03/2020

The government has announced four alert levels for dealing with Covid-19.

Level 1: Where Covid-19 is here but contained. Level 2: Where the disease is contained but risks are growing. Level 3: Where the disease is increasingly difficult to contain. Level 4: Where we have sustained transmission.

We’re at level two but is that high enough?

. . . Michael Baker, professor of public health at Otago University believes we should be at a higher alert level than level 2.

Baker said while he congratulates the government on fantastic leadership, unfortunately we’re underestimating Covid-19.

“We’re against a threat here that we’re never encountered before, unless we’re ahead of it, we’ll lose the battle.”

Now’s the time to implement maximum measures and we’re being far too conservative, he said.

Baker believes we should already be at alert level three or four.

Workplaces and schools should be shut down as fast as practically possible, he said.

Public transport should also be shut down at this stage, he said.

“You want to think about the places that transmission is going to occur and it’s any place people go…it’s not enough just to walk around with your hand sanitiser.”

If you’re slight unwell, you should not be in social contact with anyone else, he said.

“My view is that we’ve constantly underestimated the intensity of this infection as every other country in the world has.”

We don’t want to face lockdown for months like other countries because we haven’t got ahead of the curve, he said. . . 

A celebrant posted on Facebook that she had been booked to officiate at a wedding today.

The bride told her some guests had arrived from the UK a couple of days ago. The celebrant said they would have to self isolate and wouldn’t be able to come to the wedding. The bride argued, hung up the phone and called back later to say she’d got another celebrant.

It would be very difficult for someone who had flown half way round the world for a wedding to sit it out in a hotel, but that’s now the rule and anyone who isn’t complying is putting us all at risk.

Two of the 13 new cases of the disease don’t appear to have links to overseas which would mean we’ve now got community transmission.

We were late closing our borders. We’ll soon know if we’ve been too late to increase the alert level.

 


33 avoidable deaths

28/11/2019

The death toll from measles in Samoa is now 33.

All but four of the deaths are children – under the age of four – including one who died in the past day.

About 200 people with the disease remain in hospital.

A mass vaccination campaign is underway and dozens of New Zealand nurses are in Samoa to assist. . . 

It’s likely the epidemic came from New Zealand :

. . . Ease of travel, particularly international, and immunity gaps within New Zealand meant the epidemic was not surprising, Immunisation Advisory Centre director Nikki Turner said.

In a report published in The New Zealand Medical Journal on Friday, Turner said more action was needed to ensure better protection for the community and the elimination of measles.

Some of those steps included resourcing a national campaign targeting adolescents and young adults; the adequacy of vaccine supply and accessibility including more use of pharmacies and pop-up clinics; and support for front-line workers. 

There was a risk to both New Zealand and Pacific populations and the epidemic indicated the country’s immunisation programme fell short. The health sector’s response needed to be strengthened, the report said. 

“With multiple imports and more than 12 recognised outbreaks in the first five months of this year affecting most regions, this should appropriately be called an epidemic,” Turner said. . . 

Otago University, Wellington Department of Public Health professor Michael Baker said the only way to contain an epidemic was to rapidly fill the immunity gap.

 It would be a “very responsible step” for the country to consider extreme measures that prevented the transmission of measles, particularly to the Pacific. . . 

The epidemics in New Zealand and Samoa and the deaths that have resulted were preventable.

It started when someone who was infected travelled to New Zealand and spread the disease here and a traveller probably took it to Samoa.

New Zealand’s immunisation rate wasn’t high enough for herd immunity and Samoa’s was far lower.

Europeans brought diseases to the Pacific Islands more than 200 years ago. They had the excuse that they didn’t know the dangers and they didn’t have vaccinations.

That excuse cannot be used in the 21st century, especially when a preventable disease has already cost 33 lives.


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