Managing Well with Covid-19

  The news about New Zealand’s “massive Covid outbreak” needs context. After over 100 days of daily life with zero new cases other than those sequestered at the border quarantine facilities, during 14-21 August 2020, New Zealand had a "big surge" in Covid-19 number of total cases and those requiring hospitalisation of 500%. In real numbers, the number of cases rose from approximately 20 to 100 and the number of people requiring hospital care increased from 1 to 5. By comparison, South Carolina, a state in the US close to New Zealand in population, had 5,537 new cases and 255 deaths the same week. In the history of the pandemic, New Zealand has had approximately 1600 cases and 22 deaths, versus South Carolina's 110,000 cases and 2500 deaths.   (www.worldometers.info/coronavirus/country/us)

The origin of New Zealand's index case of community transmission – a worker at a cold storage facility, has not yet been determined, but rigorous scientific testing is being performed to rule out sources. It does not have the same genome as New Zealand’s earlier cases, nor does it match the genome of any of the recent overseas arrivals in the managed isolation quarantine facility.

I am living in Auckland, the country’s largest city that was put in lockdown last week with less than 24 hours’ notice, closing non-essential businesses, reducing cafes and restaurants to take-out only, and further restricting movements and gatherings. Schools are open for children of essential workers, but parents are encouraged to keep kids at home if possible. With this lockdown, the government also asked the public to wear masks in public places, such as public transportation or grocery stores.

How are we doing? Quite well, following the testing, tracing and communication advice from the experts:

TESTING - Our Covid testing quickly ramped up from an average of 5,000 per day prior to the four cases of community transmission identified on 11 August 2020 to an average of over 17,000 per day. The testing has focused on cluster areas with known contacts of positive cases, and results each day have yielded less than 0.1% positive, versus the average of 6.7% positive tests in the US.

Source: https://www.health.govt.nz/

A world map with percentages of positive test results is offered by https://ourworldindata.org/coronavirus-testing (see below). This metric is used by public health officials to determine opening of businesses and schools. From this site: "According to criteria published by WHO in May, a positive rate of less than 5% is one indicator that the epidemic is under control." 

The US 7-day average rate is reported on this date to be 6.7%, worse than Romania. Remarkably, the US infection rate on 15 July (prior to the data being reported through the White House) was 8.4%. Without any specific intervention, the US improved considerably in four weeks, just in time for schools to re-open.

 

 TRACING - The NZ tracing team followed up on thousands of contacts during the week after the virus re-appeared in the community. Most of the cases identified this week in New Zealand had been identified as contacts to the original case, so they were already isolating when they tested positive. 

THE TRACING APP   Photo source: https://www.health.govt.nz/

CLEAR, CONSISTENT COMMUNICATION…WITH DATA -  The daily live televised and streamed daily briefings are open and transparent. They report the daily numbers of new cases, number of tests and updates on the previous cases, then take questions from the press. Leaders compassionately express condolences to affected families and humbly admit mistakes and corrective actions. Details of affected schools and businesses are made public after their leadership has been contacted. Working inside a healthcare facility, I am honoured to witness some of the data analysts contributing to the trove of data reported here and on the government websites. It’s a very big job, being done by very competent and dedicated people.

COMMUNITY ENGAGEMENT - From the beginning the Prime Minister has led with the message, “our team of five million is fighting the virus”. The hashtag message #BeKind has been visible on the interactive motorway signs, supermarket entrances, and written in chalk on walkways by neighbourhood children. New Zealanders are reminded to be kind to one another and to check on their neighbours frequently during the daily Covid updates from the Ministry of Health.

The team of five million is engaged in this. For the second wave, in one week wearing masks in public places changed from less than 5% to about 90% (source: my poll at the supermarket).

MANAGED ISOLATION QUARANTINE (MIQ) - Kiwis returning to New Zealand are required to stay 14 days in a managed quarantine facility. This has been an evolving story. Originally those arriving in New Zealand from overseas were told to go home and self-isolate. That didn’t work very well as many did not adhere to staying at home, so the government set up the managed facilities and required all overseas arrivals to stay 14 days before heading on their journey. Those in the quarantine facility are tested for Covid at about Day 3 and Day 12 of their stay. This had more success in containing the virus, but in the early days the administration at these sites was porous in their enforcement of the rules, mostly granting exceptions for compassionate reasons. In one case, two sisters were granted early leave of the facility to see their dying relative, but soon discovered they had tested positive. As a result, the independent contracting agency was replaced with the army who has a bit more reverence for following rules. Had the facility management started with the army, the tactic would have been perceived as too authoritarian and heavy-handed, but after the breaches it had the public’s support.

ICELAND

New Zealand is not the only country to be living without the ubiquitous threat of Covid within the community. Iceland has done well, with the same formula of testing, tracing, and communication. Interestingly, their leadership trio reporting daily consists of a doctor, an epidemiologist, and a police detective for the tracing part. Politicians have deferred the country’s Covid management to these three experts.

Photo source: https://www.icelandreview.com/ask-ir/whats-the-status-of-covid-19-in-iceland/

Iceland is back to enjoying life in spa pools, restaurants and bars. Like New Zealand, the only thing missing are the tourists. Though also like New Zealand, Icelanders are known to spend time and money overseas and they are spending it domestically this year.

Iceland’s border policy differs from New Zealand’s. As of 19 August 2020, all travelers to Iceland may choose to submit to two screening tests, separated by five days’ quarantine until the results of the second test are known, or not undergo screening test at the border and spend 14 days in quarantine after arrival. The quarantine location is up to the individual, with Iceland Immigration’s website providing specific rules. This is riskier than New Zealand’s mandatory 14-day quarantine, but Iceland feels confident they are able to reasonably contain and manage with their testing and tracing activities which also features a public tracing app, and their healthcare system.

UNIVERSAL HEALTHCARE - In both Iceland and New Zealand, costs of tests and treatment are not barriers, so those who need tests get them and those who need treatment do not have to ask how much it will cost. If the universal healthcare was thought to be too expensive, the alternative is obviously worse and urgently summons change. 

TAIWAN 

Covid-19 has revealed deficits in every country's healthcare system. Lessons are being learned from countries with the best outcomes, like Taiwan. With its close proximity to the epicentre in Wuhan, Taiwan's population of 23.8 million remarkably has only seen 487 cases and 7 deaths. Taiwan had a strong plan for pandemic management since the SARS emergence in 2003. Their early action included restricting international travel with mandatory 14-day stays in managed quarantine for incoming travelers, closing schools, and providing access to free and rapid testing centres. Masks were a key part of their strategy, and the government provided maps with real-time updates of locations with mask inventory. Wearing masks became a social norm, a stark contrast to America's individualistic approach. Those who not wearing masks in crowded public places such as subways might see their faces shamed on social media. Taiwan also has a universal healthcare record, and public health officials informed healthcare providers of patients' travel history. Doctors were alerted to check symptoms for patients who had been to China.

Taiwan is still determined to do better, and they are looking at improvement opportunities in their communication with the public. Though they provided frequent updates, they feel they could have done better at preparing the public for this pandemic by providing more information on prevention and how people should stay safe. Unfortunately, Taiwan has been excluded from the World Health Organisation because China claims Taiwan as its province with no right to their own diplomatic representation on the global stage and in international organisations. As a result, Taiwanese health officials say they were left out of receiving early firsthand information on the Coronavirus outbreak, and very unfortunately for the rest of the world, Taiwan's success story was unable to be shared.

As of 27 August 2020, Iceland has had 29 deaths, New Zealand has had 22 deaths, and the US has had over 184,000 deaths. IMAGINE, if they had managed Covid-19 as successfully as Taiwan, those numbers would be 1 for Iceland, 2 for New Zealand, and 100 for the US.