Big Read: Grieving family's questions join chorus over Covid-19

The family of the person said to be our first Covid-19 fatality don't believe she had the virus at all.

And yet she did, says health authorities, who have the answers to this question and many others still troubling the family of Anne Guenole, 73.

Finding a format in which this question - and many others about our Covid-19 response - can be aired and answered is yet to be decided.

Prime Minister Jacinda Ardern's office says that time will come but nothing beyond a vague assurance has yet to be offered.

Right now, though, "no decisions have been made around inquiries into New Zealand's response as the focus remains on responding to the virus, recovering and rebuilding the economy".

There's the Guenole family's doubts. There's the likelihood the first "recorded" case on February 28 was not our first actual case. And there's the odd spike in deaths among elderly that month.

Alongside the uncomfortable questions is the extraordinary work being done by scientists that is crying out for a stage. New Zealand is precariously perched on the shoulder of history - we may yet maintain a ring-fenced virus ecosystem that is small enough to manage but with enough cases to create real knowledge that can make a difference.

A Royal Commission - or some similar wide-ranging inquiry - will answer nagging doubts, answer honest questions and put to bed conspiracy theories. We've been moving at such a rapid pace that the country - the world, even - has struggled to catch its breath.

Guenole's family is barely starting to do so. "We feel Anne never had it," says Brett Cummings, her son-in-law.

"No one else around her got it. My wife and her brother spent four-and-a-half days in the same room with her. They were in some PPE, no eye goggles, and they never got it.

"She was tested for pneumonia. They came back and said she had a positive coronavirus test but she didn't get the [Covid-19] test we got."

Anne Guenole, who is considered to be New Zealand's first Covid-19 fatality. Photo / Supplied

And they can't ask for her to be tested again. "They incinerated her straight away. They put her in a bag - didn't take any of the [lures] out of her at all and just incinerated her in the bag."

Up close, it all seemed too fast and there was too much they needed to know that they weren't being told.

Guenole, who lost her husband Peter in September, died on a Sunday. It was March 29, just four days after the lockdown began. At the time, New Zealand's public service was scrambling to cope. Organisation was chaotic. Health officials were trying to reconcile the pandemic plan - based around an influenza outbreak - with the reality of an exploding new virus. On that day, a total of 514 people had contracted the virus.

The unfolding madness of it had a real consequence at Grey Base Hospital in Greymouth. Cummings' wife Dianne and her brother Peter slept on the floor of their mother's hospital room with one blanket between them.

"They eventually relented and brought them a mattress on the last night."

Cummings is no crank. He's as West Coast as it gets - a gold miner and a battler for democracy through his role as a regional councillor. Voicing questions such as this have him self-mockingly refer to "conspiracies".

Cummings says his wife Dianne - Guenole's daughter - has since spoken to others who also lost their loved ones and they, too, are struggling to understand what happened. In those cases, people died with "respiratory issues" then were recorded as Covid-19 fatalities.

"We tried to make some sense out of it." In the immediate aftermath, the family was grieving and the questions that come easily now were hard to form at the time. And there was an awareness of what was unfolding. "We didn't want to rock the boat."

There was some contact from health authorities, although it seemed geared towards offering support if they weren't coping rather than providing the information that would help them cope.

Cummings had a call from someone else calling from Christchurch - the West Coast health board gets logistic support from its larger east coast sibling - but the conversation didn't go well. "I said 'your pandemic plan is s***. It cost you money but you never put it in place'."

Contact tracing wasn't great, either. Cummings says it took a week for health workers to contact Guenole's brother even though they had a phone number and he lived only 25 kilometres away.

Whatever questions there are around the testing that was done, the practical aspect of Guenole's life and her contact with others has left Cummings baffled as to why the West Coast has only two recorded cases. She had been to funerals, entertained visitors for long chats and cups of tea. For all that contact, though, no one can work out how she could have contracted the disease.

Brett Cummings, the son-in-law of Anne Guenole. Photo / Supplied

"If Anne had it, then the cluster on the West Coast would have been huge. It would have made the Marist one look like a pimple."

Did she or didn't she? As it stands, Anne Guenole will become a significant bookmark in New Zealand's history as the first fatality in the Covid-19 pandemic. And if she did have it, was she the first to die from the virus?

Cummings: "Anne hated any limelight. She would have been absolutely horrified she was on the front page of the paper."

Shifting ground in virus knowledge

So much uncertainty. Doctors in France discovered Covid-19 in a pneumonia sample taken from Amirouche Hammar, 47, on December 27. Until then, the understood transmission timeline saw the virus arriving in Europe a month later.

Hammar, who lived in northeast Paris, had not travelled abroad although his wife worked in a supermarket near Charles de Gaul airport. It takes Covid-19 symptoms five-14 days to emerge, meaning Hammar was most likely to have been infected between December 14 and December 22.

The World Health Organisation has asked countries to undertake similar testing to identify earlier cases. The Ministry of Health has told the Herald it has not done so.

In France, intrigued doctors at a hospital in the northeast went back through chest x-rays and discovered evidence of Covid-19 in patients from November 16 and 18.

In the United States, there was a similar shift in solid ground when an autopsy in California discovered the first known death came weeks earlier than previously believed. The new autopsy revealed a Covid-19 death

An autopsy in California has revealed that the first US coronavirus-related death came weeks earlier than previously thought. It found the virus in people who had died on February 6 and February 17 - the previously accepted "first death" in the US had been in Seattle on February 26 and not in California until March 4.

It is highly likely our experience is the same. Here, our first case was a traveller from Iran who arrived on February 26 and returned a positive test result two days later. That was 19 days after a briefing to government warned "the likelihood of one or more imported cases of Covid-19 infection in New Zealand is high".

February was also a month during which New Zealand experienced a higher than usual number of deaths in those aged 80 or older. As highlighted in the Act Party's weekly newsletter, an Official Information Act response show 1270 people aged 80 or older died in February. For the five Februaries prior, the average was 1114. "Did we miss a stealthy Covid-19 wave In February," it asked. "These are the sorts of questions an eventual Royal Commission must ask."

Infectious diseases specialist Dr Ayesha Verrall - who reviewed our contact tracing system and found it wanting - agrees it likely the virus had already found a path into New Zealand although rates it as a low possibility it was transmitted.

She talks of the border as akin to flicking matches at a bundle of dry sticks. Each person that crosses the border with the virus is a match tossed at the kindling. Most will flare and then die out.

"It might be the 27th match that will get going and you have five or six sticks that catch fire. It goes up exponentially or it burns out."

Verrall is understandably wary of suggestions such as the February death data being linked to Covid-19. She says February was a month that saw a strain of flu pass through our communities.

"One thing I would caution about is that there is a lot of fear out there that Covid is being transmitted in a way we're not detecting. I think that's a pretty low probability."

And yet, transmission also occurs - or doesn't - in ways that would surprise people. Verrall finds it "unbelievable" that household transmission of the virus appears to occur in only 5 per cent to 15 per cent of cases.

If Verrall is still building a bedrock of knowledge, where does that leave the rest of us?

Too much in the dark, says Seymour, and we need answers now.

The Act Party leader - who has been hearing evidence at the Epidemic Response select committee - says New Zealand should know now what sort of inquiry will be held and when it should report.

The urgency lies in the future, he says. "We may well find it has a seasonal effect. The Royal Commission - and we don't know if that's what it will be - needs to be done and dusted to inform next year's response."

The inquiry needs to draw a commissioner or commissioners from outside New Zealand, he says. Our country is too small, and too many people with expertise have been involved in or invested in our response, to leave it to locals.

There's precedence for this, whether it be the Australian commissioner who was one of three to hear evidence during the Royal Commission into twice-murder convicted Arthur Thomas in 1980, or the retired judge from Canada who inquired in David Bain's conviction.

When? In Seymour's view, an inquiry which studies not only the epidemiology of the virus but our government's response is urgent.

"Six months from now we should have an informed response."

Time for science to shine

"It's an unprecedented event during our lifetime," says associate professor James Ussher, clinical microbiologist at the University of Otago. "The response of our scientific and medical community has been outstanding."

Seeking answers to emerging questions is "in some ways academic". "In other ways, it's important to understand how this pandemic has emerged and evolved."

It is striking that Ussher, when talking about the virus, conveys an impression of rapidly unfolding knowledge. It's almost as if every day is a new frontier, with a playbook being constantly updated.

Ussher's academic life is dedicated to the development of diagnostics, vaccines, and infection control and yet Covid-19 is providing a constant learning curve. He points to the enormous amount of research underway, and the flood of academic papers being published prior to peer review, such is the urgency for knowledge.

Social distancing at the Auckland Night Markets. Photo / Dean Purcell

"We understand a lot about this virus but we're yet to find a golden bullet to control it."

Ussher's deep understanding lets him keep balance while surfing this new knowledge wave. A structured environment or format - like a Royal Commission - would similarly provide the public stable ground.

Along with the uncomfortable questions, it allows the explanation and understanding of work such as that currently being done by gene scientists, coordinated through ESR.

They are studying at a genetic level every positive sample of Covid-19 taken in New Zealand. So far, slightly more than 300 samples have been analysed.

The initial focus was on cases labelled "infection source unknown", says Dr Joep de Ligt, ESR's bioinformatics lead. That was to assist with contact tracing through looking for genetic markers that identify the lineage of different virus infections.

It is through this work that we are able to say with absolute genetic certainty that our Covid-19 cases came from all countries across the world.

With the slowing down of case numbers, the urgency has faded and the team working on sequencing the virus is building a detailed picture of how the virus made its way into New Zealand and what it did once it arrived.

University of Otago senior lecturer Dr Jemma Geoghegan is working with de Ligt on the project and considers New Zealand to have "a unique opportunity to sequence the genome of every positive case we have".

With our new cases effectively static, it's a chance other countries do not have while trying to grapple with exponential or even flat-line growth. Once complete, New Zealand will have a complete picture of its encounter with Covid-19.

In a war against an unknown enemy, it is intelligence such as this which will be invaluable to helping plan for the next wave - if or when it comes - and to preserve the national advantage we currently enjoy.

"It would be interesting to have what's happening at a genomics level as publicly available information," says Geoghegan. The process is also invaluable for establishing a system through which New Zealand can carry out real-time genomic study "when the next pandemic comes".

The truth is out there

There are answers to the endless questions about New Zealand's brush with Covid-19, whether they are simple questions such as those from Guenole's family or the more outlandish questions sprouting on social media.

At this stage, they rest with individuals and institutions, tucked away in files and memories and - as yet - not collected in a single place.

The answers to many of the questions posed by Cummings about Guenole's death and the family's experience rest with the West Coast health board that runs Grey Hospital where she died.

The board's general manager Philip Wheble told the Herald Guenole was confirmed as having Covid-19 after a swab test for respiratory illness was examined at Canterbury Health Laboratories. "Only one test for Covid-19 was done and the result was strongly positive.

"Her clinical condition and the strong positive swab result leave no doubt that this was a true positive result."

Yes, said Wheble, Guenole's children "were permitted to stay in the room with their mother" after "compassionate consideration". It was, he said, a departure from Ministry of Health guidelines that would have otherwise limited visiting to individuals or 15 minutes.

"Unfortunately the temporary isolation ward facilities did not have space to fit in sleeping equipment for family members due to the spaces being set up for infection prevention and control purposes."

They were provided with food, regular changes of PPE and showering facilities, he said.

Wheble offered an alternate explanation to Cummings' doubts over the presence of Covid-19 because of the absence of transmission.

"We believe this PPE was effective as no family members contracted Covid-19 despite being in close proximity to their mother during her stay in hospital."

He confirmed 22 staff members caring for Guenole were required to self-isolate because they had not worn goggles with their PPE gear. The reason for the lack of goggles was the delay in onset of Guenole's Covid-19 symptoms. None contracted the disease.

As for the source of the infection, Wheble said: "There have been no further cases of Covid-19 associated with this case before or after they were infected.

"After extensive investigation the source of infection for this case remains unknown."

• Covid19.govt.nz: The Government's official Covid-19 advisory website