Transparency saves lives this Easter
How different this Easter is from any other we’ve ever experienced. Instead of celebrating new life, we will be grieving the loss of tens of thousands of people globally.
With transparency evident around our community testing and quarantine at the borders, New Zealanders are likely to experience a happier Easter than many. The focus on testing and identifying contacts provides a basis for optimism that New Zealand’s efforts to stamp out the virus will enable a staged return to a more normal lifestyle earlier than elsewhere.
Easter in the US will be hard
My best memories of Easter are as young child living in upstate New York.
My father always bought gardenia corsages for my mother and me with button-hole carnations for him and my two brothers. I can even remember the lovely smell of the flowers which could be kept fresh for a week in the fridge.
Once our corsages and hats were pinned on, we would head to church in a GM Oldsmobile on a lovely spring day. Afterwards at home we would watch celebrities out walking in their Easter hats, on our General Electric TV.
During Easter 2020, New York State will be experiencing more positive cases of COVID-19 and deaths than almost all other countries.
If New Zealand’s success in containing the virus holds, New Yorkers and other Americans may see that it makes sense to be at home, not attending church. If they are out walking, they will be keeping their social distance. If florists are still an 'essential service' there, they will be happy if they can smell them since one of the symptoms of the virus is lack of smell.
Instead of pinning on flowers, New Yorkers are donning masks. Instead of making cars and televisions, General Motors and General Electric are producing hundreds of thousands of ventilators. This is because the virus continues to be spread through community transmission. Leaders in US states were slow to move to community isolation. They were driven by a focus on the economic impact and listening to fake news. This was instead of monitoring the scientific knowledge about the way pandemics spread that has been available for years and unfolding in real life since January.
Global data is there for all to see
Caught in the maelstrom of the virus crisis, governments of all ideologies have been forced to face up to the stark and painful reality that they are not gods. Leaders worldwide - even the most autocratic ones – have been humbled by first-hand experience of the tragedy growing to nightmare proportion in New York and other global hot spots. This virus is lethal. No one can be sure of being immune from it and there is no known cure.
It is the effectiveness of their public health policy that distinguishes the real leaders.
Our interconnected planet provides an opportunity for a comparison of transparent testing, reporting and monitoring unlike any previous crisis. The scientist’s petri dish has expanded to real time analysis of data by country. There are several great statistical sources such as Worldometer, updated at least daily. They have been tracking the pandemic from an early stage - back to when China publicly acknowledged its first case of COVID-19 in January.
As well as recording positive cases and deaths, Worldometer is now also providing daily updates by country, on the number of tests being done. This means that the impact of testing on community transmission can be compared with the other data of reported positive cases and deaths.
New Zealand’s daily tests-per-million are above average and its deaths-per-million amongst the lowest. New Zealand is ramping up its testing to catch up with countries like Norway and South Korea, which were also early adopters of public health plans to address COVID-19.
New Zealand’s government moves to stamp out the virus
The day before April Fool's Day, perhaps so everyone would realise it wasn’t a joke, government officials announced that New Zealand’s policy objective moved from “flattening the curve” to “elimination of the COVID-19 virus.”
At that stage testing here was under 2,000 tests a day. To effectively stamp out the virus, focus turned to increasing the capacity for testing of suspected infection, to over 6,000. To be effective, the testing needs to reach that capacity. It needs to be nationwide with assurance that it is taking place in vulnerable rural and urban communities.
Those taking the test need to be quarantined until the test result is known. If they test positive, any community contacts need to be contacted and tested within a maximum of 4 days. Transparency about the timing of tests and identification of contacts reported daily along with the number of tests provides assurance that steps are being taken designed to stamp out community transmission.
The Ministry of Health’s data indicates that our positive cases are largely related to people arriving in New Zealand by plane. The group most vulnerable to death, 70+, has far lower numbers of positive cases than those aged 20-29.
To stamp out the virus in communities, tighter controls at the borders are also required with every arrival quarantined.
Based on the advice of a group of 40 or so science commentators led by University of Otago Public Health Professor, Michael Baker, New Zealand moved to community isolation and then to Alert Level 4 quicker than just about anywhere else in the world. According to Baker, “It meant that all those chains of transmission that might have been occurring around New Zealand [from the virus if people had continued to be in physical contact with each other] were effectively quarantined and could extinguish themselves.”
Moving quickly into lockdown takes courage
With unemployment rising, NGOs struggling, many businesses and sporting bodies facing insolvency, the COVID-19 cure is a painful one.
In addition, there is tension in the community with people self-isolating exacerbating mental health problems. Despite the Prime Minister's exhortation that we be kind, family harm has exceeded previous levels.
In this tense environment, not all scientists and statisticians agree. Some think that different and less draconian measures would have worked to curb the virus without such severe economic and social impact. Transparency of these discussions is important however, to identify lessons learned so we can do better next time.
As clinicians in New York are finding this Easter, the COVID-19 virus is unpredictable. We need to continue testing to remain safe well after we leave the lockdown. Once we leave, the social and economic costs to people's health could be even greater if we must return to lockdown again.
So, the COVID-19 frontline in New Zealand has moved from hospitals to those doing the testing. As the Prime Minister says, “test, test, test.” With testing, quarantining of contacts and social isolation, our hospitals have yet to see the expected influx in serious COVID-19 cases. If this holds, they will be able to refocus their resources back to their pre-COVID activities.
By Easter Sunday 2020 in New Zealand, it will be clearer whether our hospitals can go back to saving the lives of patients with other medical conditions. If everyone has a "staycation" and with the lockdown at Alert 4 for at least another week after Easter, there are likely to be fewer patients from traffic accidents or sporting injuries. This will allow waiting lists for other medical treatments to be addressed.
Based on the time taken to contain the virus in places like New York and elsewhere, it may be a long-time before world-wide international travel resumes.
Meanwhile, border controls and following local ways of locking-down appears to be working for Pacific Island countries as well as here. Australia is not too far behind. By transparently recording the processes and results of community-wide testing here and sharing best practices with our neighbours we are optimistic about eliminating the virus from the South Pacific.
If so, we might be able to widen our bubbles to include our island neighbours and smell the gardenias sooner than next Easter.
Suzanne Snively, ONZM
Transparency International New Zealand Inc.