Comment

NZ’s Covid response: We need to be more open

The New Zealand Government should be congratulated on many aspects of its response to the COVID-19 pandemic. But there is an urgent need for more openness about the current situation and the options for controlling further spread of this disease.

Community transmission

For some weeks I have been concerned by repeated statements that the probability of community transmission of the coronavirus in this country is low. Not nearly enough testing has been carried out so far. Since testing has been heavily skewed towards people who have been overseas recently, it is hardly surprising that most of the cases detected had links to overseas travel.

All the epidemiologists I talk with expect that community transmission is already occurring, at least in some places. Why should the virus behave differently in New Zealand than elsewhere?

Authorities have argued that decisions about testing are left to the expert judgement of clinicians. Yet some clinicians have complained about difficulty in arranging tests.

A more crucial point is that testing for this virus is not just an aid to the management of particular patients. It is an essential tool for public health surveillance, and that function cannot be planned by individual doctors and nurses.

Complacency about numbers

New Zealand has a small population, so it is easy to be fooled by the modest numbers of cases detected, compared with much larger countries. There has been an unfortunate tendency to pat ourselves on the back, while a dangerous situation develops.

People are surprised when I tell them that, allowing for population size, the epidemic of COVID-19 in New Zealand appears to be running only about 8 days behind that in the United Kingdom – a country that had no border controls.

Scientific advice

All nations are struggling with decisions about options for minimising the spread of this virus. We fear that our health services (especially intensive care facilities) may be utterly overwhelmed, as has already occurred in some places.

There are no simple answers, although we can learn from the experience of various countries – both successes and failures.

Professor Michael Baker, an infectious disease epidemiologist, has been calling for more radical measures than those so far adopted by our Government. He believes that, with a concerted effort, this coronavirus could be eradicated from New Zealand within a couple of months. Life could then return to normal, except that border restrictions would need to continue. I think his ideas deserve careful consideration by people who are experts in disease control.

A big difference between the UK and New Zealand is that the scientific advice underpinning decisions in Britain has been open to public scrutiny and debate. As new information has come to hand, the public health scientists assisting the UK Government have revised their opinions. New strategies have been developed.

Only yesterday, the UK Government published a large dossier of evidence from its expert committees.

When the Director-General of Health was asked why New Zealand was not adopting the approach advocated by Professor Baker, he responded that he was talking with a range of health advisers, his chief science adviser and the Prime Minister’s chief science adviser. I am sure the latter two individuals, for whom I have much respect, would make no claim to be experts on epidemiology and public health.

We need to know what rigorous scientific analysis and modelling underpin the strategy being followed here. It seems strange that we know more about the rationale for decisions in the United Kingdom than in our own country.

Conclusion

New Zealand is facing an unprecedented challenge. The Director-General of Health, Dr Ashley Bloomfield, should be congratulated for his outstanding leadership during this crisis. I am conscious of the huge burden he is carrying, because I have argued previously that the running down of public health capacity in New Zealand has seriously weakened our ability to respond to pandemic threats.

Urgent decisions are required now. Do we need to close schools? Can testing and rapid case contact tracing be expanded quickly enough? Could contact tracing be enhanced using smartphone technology? How strict does physical (“social”) distancing in the community need to be?

Whatever the answers to these questions, new information will emerge that requires policies to be modified.

And new questions will keep arising over the next 12 or 18 months, before there is any hope of an effective vaccine becoming available.

Our response to this challenge will be successful only if the Government accepts that it cannot have all the answers yet. It needs to commit to transparency and openness about scientific advice, just as in other areas of decision-making.

Sir David Skegg is an epidemiologist at the University of Otago Medical School. He is a former Chairman of the Public Health Commission, the Health Research Council, and New Zealand’s Science Board.

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