COMMENT
The Government says it is "going hard and going early" to deal with the Coronavirus pandemic. But how true is this? Some public health experts and commentators do not believe the Government is being radical enough, and that the consequences, in terms of life and death, could be huge.
Leading the charge for a more radical approach is University of Otago Professor of Public Health, Michael Baker, who has been advocating for months that an aggressive approach is required to stave off disaster. Baker, who is an expert in the spread of pandemics and how to control them argues that New Zealand is wrong to take what he sees as a "conservative" approach in which it is accepted that coronavirus will become widespread here with the emphasis on managing it.
He argues New Zealand has a small window of opportunity to stop the spread of coronavirus, and needs to take extreme measures, such as an immediate lockdown of the country: "It sounds melodramatic to say now or never, but I think it's the case". He advocates the Government immediately lift the official alert level to three or four.
Baker's strategy also involves much more testing than is currently being done. His method is more in-line with the important paper released by the Imperial College of London, which debunked the "flatten the curve" approach New Zealand has been following and called for a drastic suppression approach to the epidemic.
Baker's views are clearly laid out by Marc Daalder in his article yesterday: The case for lockdown now. According to this, Baker believes the Government's current strategy seeks to avoid disruption but will actually be worse in the longterm: "It's extremely inconvenient to do this but the alternative is we follow everywhere else in the world, excluding parts of Asia, towards a certain future of widespread transmission."
Here's his main argument for an immediate lockdown: "In order to scale up the testing regime and catch further potential cases of community transmission, time is sorely needed. As long as the virus has time to circulate in communities through everyday social interaction, it becomes that much harder to find, contain and suppress, Baker says. A lockdown would freeze the virus where it is, allowing the Government to identify extant cases, halt the spread and dedicate time and resources to increasing our testing capacity and hiring more workers to contact trace."
His views are also reported by Pattrick Smellie in the article: Shut everything now: Govt still behind the curve – health expert. In this, Baker says the New Zealand Government still has the ability to avoid the fate of other countries, but this "means acting very decisively and things that risk looking like an over-reaction. Nothing is an over-reaction at the moment. They are not doing enough. They have to shut the country down now."
Here's Baker's view: "Everyone's being too conservative. They're tip-toeing around because a shutdown would be very inconvenient. Well, it will be bloody inconvenient if we delay acting now and get a sustained epidemic because then we might still be in shutdown in 18 months' time".
Journalist Michael Wright says: "we have been told, over and over again, that there are certain countries in the world whose actions we must now emulate if we are to keep the effects of a pandemic on our society and economy to a minimum. Those countries, in no particular order, are Singapore, Taiwan, and Hong Kong" – see: Coronavirus: Can New Zealand follow Taiwan, Singapore and Hong Kong in containing the spread?.
This article also reports the views of Baker, saying "contact tracing" is key to fighting the virus: "Every resource possible should be thrown at it. 'Not the kitchen sink,' Baker said, 'The whole house.' Once contact tracing gets away on you, it can't be reined in. The number of people you need to identify, find and isolate grows exponentially, like a virus'."
Such strategies are best done under a lockdown, according to Baker, who believes this is less drastic than the alternative: "If we don't do that we move into this next stage where we're no longer containing it, we're just suppressing it. And that means potentially 18 months of lockdown to the whole country until a vaccine or antivirals appear."
Baker also wrote an article on Friday with colleague Nick Wilson which reportedly annoyed Ministry of Health officials, because it disagrees with the official line that a more cautious strategy can still work – see: Why New Zealand needs to continue decisive action to contain coronavirus.
In this, Baker and Wilson argue for an extension of the containment strategy: "New Zealand is vulnerable until our testing rates and contact tracing capacity increases, potentially to the levels used successfully in South Korea. To guard against this risk New Zealand should consider a short 'pulse' [a few weeks] of intense social distancing, including bringing forward the school holidays and temporary closures of most businesses, social meeting places and public transport. Doing this now has the potential to slow undetected chains of transmission while containment measures are being ramped up."
Auckland University physics professor Shaun Hendy is also an advocate of the Government taking a more aggressive suppression strategy, which involves healthy people being quarantined. And he has been modelling what mortality rates might be under the different approaches – see today's article by Nikki Macdonald: Coronavirus: Controls could cut Kiwi deaths from 60,000 to 10,000.
Here's the main information: "Modelling has shown aggressive controls such as quarantine, contact tracing and school closures could reduce Covid-19 deaths in NZ from 60,000 to 10,000", and that "with no controls – cases would grow exponentially, 80-90 per cent of the population would catch it, and up to 60,000 Kiwis could die".
Of course, to achieve the lower death rates, huge sacrifice would be required: "The tradeoff is that suppression measures, such as school closures, might need to stay in place for 12-18 months, until a vaccine is developed."
See also Jamie Morton's Coronavirus: ICU overload risks 'thousands' more NZ deaths – model.
Hendy warned on Friday that "quarantining people who are sick, staying away from public gatherings and hand-washing all help, but to turn the level of infections from a 'tsunami into a number of small waves' needs more aggressive action" – see RNZ's Coronavirus: Control measures for Covid-19 needed 'until we've got a vaccine'.
Hendy says the key is to start quarantining even healthy people: "You can describe our strategy at the moment as trying to find all the people who are sick or might be sick and quarantine them… To get to the situation where we can actually bring numbers down, we'd actually need to quarantine ourselves even if we haven't got symptoms, and that's going to mean things like closing schools, closing universities, working from home and limiting our mobility particularly around the country".
Business journalist Pattrick Smellie has also argued that, although the Government has stepped up from their "scarily somnolent" approach of previous weeks, "it's still not enough" – see: The govt must go far harder and far faster.
He puts forward three pieces of evidence about why the Government isn't being radical enough, and may miss the window of opportunity: "Most worrying for us is that Australia has missed the boat on that opportunity. Within two or three weeks, so will New Zealand unless the Government becomes far more radical in its thinking about what New Zealanders will accept to minimise the huge and inevitable impact of this global pandemic."
Smellie also suggests the Government may be out of sync with the public: "As the rumour of a national lockdown spread like wildfire around the country yesterday, the striking thing was how many people reacted by welcoming it. The Government may still be thinking there is too much political risk in such a massive curtailment of daily life as we all know it. That may be a miscalculation, just as it miscalculated the public mood up until the middle of last week".
Similarly, entrepreneur Sam Morgan is exasperated by the Government's "slow and indecisive" approach, which he says will ultimately lead to many more deaths – see: Why urgency, not gradualism, is needed for Covid-19.
Morgan calls for greater control measures, including more testing, saying "the scale of this health disaster could be 10 times bigger than it should be because of this lack of urgency on social isolation and testing. We need to take some bold, economy-hurting and unpopular steps to prevent unnecessary deaths. Every day is precious".
He concludes: "Why wait for the proof of community transmission before closing our schools and universities and moving to much stricter social isolation? Go there now. It will save lives."
Of course, not all experts and commentators disagree with the Government's current approach. Microbiologist Siouxsie Wiles has been at the forefront of communicating the Government's "flatten the curve" strategy. You can see her latest piece, with cartoonist Toby Morris, explaining the Government's recent decisions: What does 'level two' mean – and why does it matter?.
Elsewhere, Wiles has explained why the Government isn't moving into more aggressive strategies such as lockdowns: "There's a line to draw between doing stuff that's not necessary that puts strain on our resources that we don't need to put on versus moving too fast. We're taking a cautious approach but we're not doing what's not necessary."
Prime Minister Jacinda Ardern has pointed out "There are public health experts who have said we're doing exactly what we should be doing".
Of course, the Government and Health Ministry are adopting new strategies as the evidence changes. For example, Marc Daalder reported late last week that "Director-General of Health Ashley Bloomfield confirmed he had read the [Imperial College London] paper and that New Zealand had altered its policy in response to its conclusions Minister of Health David Clark said he had received advice on the paper" – see: NZ's new Covid-19 strategy explained.
Finally, although Australia is further down the path of infection, they are facing the same challenges about whether to adopt a more aggressive control strategy before it's too late – see John Daley's The case for shutting down almost everything, and restarting when coronavirus is gone.
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