Controlling Covid

Last May, the Government announced $37 million would be spent on a strategy to ensure New Zealand would not be left behind when it came to securing the COVID-19 vaccine.

In the lead up to the election, the Prime Minister announced “hundreds of millions” of dollars was being set aside to secure a vaccine for New Zealand: “I’ve been talking to a range of world leaders about global vaccine development, including Angela Merkel, Justin Trudeau and Scott Morrison. We are working particularly closely with Australia… to secure a vaccine as soon as it’s available.”

Yet here we are, still waiting for a vaccine, while in many other countries public vaccination programmes are already well advanced.

The Ministry of Health website shows the Government intends purchasing enough vaccine doses for 15 million people, with the first expected to arrive in March.

Top of the vaccination priority list will be those border workers and other front-line staff – along with household members – who are at greatest risk of infection. These will be followed by ‘essential’ personnel and other health and emergency workers.

The public rollout is expected to begin mid-year by prioritising the elderly and those with underlying health conditions.

Astonishingly, according to media reports, the ‘priority’ list is expected to include preference by race – not just those who are elderly or have underlying health conditions, but “Maori 50 years or older”.

The rationale being used to justify this race-based approach is that ‘Maori’ vaccination rates are lower than for other cohorts. But that is a spurious argument since a key consideration for the Ministry of Health will be to design a rollout strategy that is not only prioritised by need, but also ensures everyone who needs a vaccine gets one.

The reality is that any plan to prioritise Maori is racism at its worst. It is age and health status that determines a person’s vulnerability to COVID-19 – not the colour of one’s skin.

COVID-19 is a highly infectious respiratory virus that is impossible to eradicate globally.  With a vaccine now available, the pathway to opening up our borders is to approach the management of Covid-19 like a seasonal flu.

In a speech to Labour MPs last Tuesday, the Prime Minister confirmed that this indeed will be her Government’s strategy: “Our goal has to be to get the management of COVID-19 to a similar place as we do seasonally with the flu. It won’t be a disease that we will see simply disappear after one round of vaccine across our population. Our goal has to be to put it in a place where – as we do every year with a flu vaccination programme – we roll out a vaccine programme and maintain a level of normality in between time.”

Until widespread immunity has been built within the country through the vaccination programme, strong border controls remain a priority if we are to avoid further lockdowns.

That’s why the latest border failure, whereby a Northland woman who had just completed managed isolation tested positive for COVID-19, is so worrying – especially in light of the emergence of more contagious virus variants.

As of last week, there were 76 people with COVID-19 in New Zealand’s quarantine facilities, and of those, around 19 are believed to be infected with the more contagious virus strains.

Genome testing shows that since late last year when the new forms emerged, 36 infected people have arrived in this country – 29 with the B.1.1.7 UK variant and seven with the B.1.3.5.1 South African variant. These variants are thought to be around fifty percent more transmissible than the original virus – and may increase the severity of the disease. 

In response, the Government has introduced pre-departure testing for anyone travelling to New Zealand (except from Australia, Antarctica and most Pacific Islands), arrival-day testing at quarantine facilities, and daily saliva testing – although the more accurate nasal swabbing regime will also remain in place.

Border failures remain the country’s greatest vulnerability in the battle to keep New Zealand virus free. A University of Otago-trained microbiologist who went through managed isolation in Auckland late last year was so alarmed by what he found that he wrote to the Covid-19 Response Minister Chris Hipkins. Having received no response, he contacted the media last week to outline his concerns.

Duncan McMillan, an assistant professor of enzymology at Delft University of Technology in the Netherlands – who runs a pathogen laboratory handling infectious agents – checked in for his two-week stay at the Novotel Auckland Airport isolation hotel on November 4. In his view New Zealand’s managed isolation and quarantine (MIQ) system is “as leaky as a sieve”.

He said the Defence staff at the hotel were not properly trained: “They have no idea on how to be careful to the extent that is necessary, and there is seemingly little oversight by trained microbiology professionals.”

He described how nurses administering Covid-19 tests were not even wearing the proper N95 masks – thereby increasing the potential for cross-infection – and how social distancing protocols were frequently ignored, with new arrivals to the hotel mixing with guests who had already undergone their day-12 test and were preparing to leave.

This is in sharp contrast to Australia’s requirements, where returnees are essentially confined to their rooms for the duration of the 14-day quarantine period.  

What is so worrying about Professor McMillan’s observations is that some of those concerns – including the overcrowding of passengers on airport buses and the mixing of guests at different stages of quarantine – were all identified back in June and yet, despite assurances by the Government that such protocol breaches had been fixed, little appears to have changed. 

Some MIQ workers – on condition of anonymity – have also shared concerns about border management with the media. They are worried that the measures currently in place are not adequate to contain the more infectious strains of the virus.

They outlined how smoking and social distancing rules inside facilities were being flaunted through guests mixing and mingling far more than they should. And they expressed real concerns about the possible spread of the virus through hotel ventilation systems. 

Otago University’s Professor Nick Wilson has analysed the cases: “Six of these failures were associated with MIQ facilities, one with work at a port, and one remains of unknown origin (although this Auckland August outbreak was probably also MIQ related). Of the six MIQ failures, five involved workers (three health workers, a defence worker and a maintenance worker) and one was a returnee infected in a facility. The three health workers and the defence worker were all infected in MIQ facilities used for managing infected cases (as opposed to facilities used for quarantining people not known to be infected). One failure resulted in a large outbreak (179 cases, 3 deaths), but the others were successfully contained at under six cases each. This total of eight failures is probably an under-estimate given the likelihood that some community cases arising from border control failures were never detected.”

He says, “This high failure rate is unacceptable from a border control perspective (with the goal of protecting NZ from outbreaks of Covid-19), as well as from an occupational health perspective (for protecting workers from a potentially fatal infection). Therefore, there is a need for an urgent review of the country’s border control arrangements.”  

As a result of that Auckland outbreak – which resulted in a three-month lockdown affecting the whole country to varying degrees – the Government appointed Heather Simpson, Helen Clark’s former chief of staff, and Sir Brian Roche, the chairman of the New Zealand Transport Agency, to review border controls.

While the provisional report was received by the Government before the election, with the final version delivered at the end of November, it wasn’t released publicly until just before Christmas – no doubt to minimise adverse publicity.

It raises a multitude of criticisms, including of the virus testing regime, the fact that the 102-day hiatus between the nation-wide lockdown and the emergence of the Auckland cluster had not been used to better plan for new outbreaks, and a lack of cooperation between the Ministry of Health and other Government agencies that meant the social and economic consequences of public health decisions were not adequately taken into account.

The report provided some bizarre revelations. It turns out that the Government was not paying Covid-testing staff in a timely manner, leaving many workers disillusioned. It explains that the Government’s ‘Surveillance Plan’ was developed by a “veterinary epidemiologist, as no human disease epidemiologist was available”. And it outlines how the Ministry of Health’s refusal to join the ‘All of Government Group’ set up to manage the pandemic is resulting in poor policy advice.

It was this failure of Government agencies to properly consult on the impact of public policy decision-making that undoubtedly led to the economic and social cost of the March lockdown being far greater than it needed to be.

The report stresses the importance of ensuring in the future that “economic and social concerns are properly incorporated into policy advice”.

It also reveals that large gaps in border security still exist – at the time of writing, only two of the country’s 14 major ports had Covid-testing regimes in place for workers.

This week’s NZCPR Guest Commentator Dr Eric Crampton, Chief Economist at the New Zealand Initiative, has examined the damning Simpson-Roche report and believes that some of the suggestions to reduce the risk of future COVID-19 outbreaks detailed in the New Zealand Medical Journal are worthy of consideration:

“The University of Otago’s epidemiologists listed a series of measures that would obviously help to reduce the risk of future outbreaks. Many are simple; some would take more work. But when outbreaks cost billions of dollars, in addition to obvious health costs and distress, even a percentage point reduction in the risk of an outbreak can be worth millions.

“They suggest adjusting the intensity of border control measures to the risk involved in travel from different places. It makes little sense that travellers from places where Covid is widespread and transmission is uncontrolled are treated the same way as travellers from places without Covid, like Covid-free islands, Taiwan, and parts of Australia…

“There are many opportunities for the MIQ system to expand to handle more arrivals, safely. People arriving from low-risk places could stay in facilities that had been ruled out because they were too far from hospitals, leaving more room in other facilities for travellers from riskier places.”

It is likely to be many months before New Zealand will be able to safely open our borders. Until then, we depend on the Government’s border management to keep the country safe. The fact that the new community Covid case was infected while in managed isolation, seems to confirm the assertion that New Zealand’s MIQ system is indeed “as leaky as a sieve”.

The Prime Minister now needs to step up and not only accept responsibility for this MIQ failure, but demonstrate that her administration is indeed up to the job of properly protecting our borders and keeping New Zealand safe.

THIS WEEK’S POLL ASKS:

Should the Covid-19 vaccine rollout be prioritised on the basis of race? 

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