The case for lockdown now
Public health expert Michael Baker says the country should go into lockdown now while it scales up its testing capabilities, Marc Daalder reports
Jacinda Ardern has just announced a new set of alert levels to track the spread of Covid-19 and the appropriate responses to it. These levels formalise the recommendations of a report from the Imperial College London, which said strict controls would need to be phased in and out over the next 18 months in order to manage the spread of Covid-19 without overwhelming healthcare systems.
The country is now on alert level two, where the risk of community transmission of the virus is growing, vulnerable people are encouraged to stay indoors and domestic travel is recommended against.
Now, infectious diseases expert Michael Baker has called on the Government to immediately move the country to level three or four, in order to freeze social life while New Zealand rapidly scales up its ability to contain the virus.
Ardern said such drastic action wasn't necessary when questioned after her announcement on Saturday. "There are public health experts who have said we're doing exactly what we should be doing," she said.
But Baker isn't alone in calling for a lockdown. Wellington urgent care doctor Kelvin Ward started a petition for medical professionals calling for similar measures, which received more than 200 signatures in six hours.
Reasons for a lockdown
Baker, a professor at Otago University's Department of Public Health, wants "very intense social distancing for a period, maybe two to four weeks, while we're ramping up testing and then do a lot of testing and once the testing's done then we'll feel much more comfortable that we've got it under control".
"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."
This effective lockdown would benefit the country's efforts to contain the virus in a number of ways. First, Baker remains convinced that New Zealand is not testing enough people for Covid-19, even as we have rapidly increased both the number of tests carried out each day and the number we can do in a day.
"We're just ramping up our capacity now but the virus won't wait," Baker said.
Without a sufficient testing regime, instances of community transmission - where the virus spreads undetected in a community and the originator is unable to be located - could be ongoing but hidden. On Saturday, Director-General of Health Ashley Bloomfield told the nation that two new cases couldn't be traced to overseas travel, but that investigations were ongoing.
These could be the first cases of community transmission in the country. "We cannot rule out a risk of community transmission in these cases," Bloomfield said.
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.
"Because we're not doing enough testing obviously, or we just don't have enough infrastructure built up yet for the containment process, we really need to acquire a pulse of maximum social distancing for a period, until we've done a lot of testing," Baker told Newsroom.
"That'll tell us how much infection is out there."
Test labs overwhelmed
Already, experts say, our testing regime risks being overwhelmed. In comment provided through the Science Media Centre, University of Otago Associate Professor James Ussher, Labtests director Gary McAuliffe and Canterbury DHB Dr Joshua Freeman say "diagnostic labs are really struggling to maintain testing capacity due to supply chain issues, which will be ongoing, as they are worldwide".
Bloomfield said on Wednesday there were 30,000 swab tests in the country for Covid-19.
"In an ideal world we would test all people with influenza-like symptoms even if they had no known contact with a case or travel, in order to prove there is no undetected community transmission. However, this is impossible given current supply chain issues," Ussher, McAuliffe and Freeman wrote.
"The influx of test requests outside the current case definition is currently threatening to overwhelm our capacity to test at all. Labs are working extremely hard to increase testing capacity, but there are many pinch points and issues to be addressed and it is not a straight-forward exercise for testing labs to scale up their operations.
"Messaging to the public about testing is very important. The Ministry of Health is doing the best it can under the circumstances, but the testing labs are in crisis."
Ward says he is already on the front lines of the pandemic, as his clinic has been running tests for most of the week. "Until today there has been no community testing facility in Wellington, so all week we've been getting a constant flow of people coming in who've been referred by Healthline," he said.
"We are not set up as an isolation or an infectious diseases clinic. We've had to make do with coopting a consult room as an isolation room. We've had to make physical changes to our building to try and isolate people and protect our staff. We've been basically given the job, by default, of a testing facility, without notice."
Baker sees this as emblematic of the need for a "pulse" of lockdown, which would allow the country to build up a supply of tests, set up clinics and alleviate the workload on medical staff.
"It sounds melodramatic to say now or never, but I think it's the case," Baker said.
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