Should we quarantine all with Covid-19?
Experts are uncertain about whether a strategy that proved effective in China could or should be applied in New Zealand, Marc Daalder reports
Quarantining every person with Covid-19 - even the 80 percent who display mild or no symptoms - was key to the fight against the virus in Wuhan. Now, experts are uncertain whether the same tactic could or should be applied in New Zealand.
The strategy, called centralised quarantine, was highlighted in an academic paper from researchers in Wuhan who attempted to model the impact of various policy interventions on the spread of the virus. As the below chart from the paper shows, the implementation of a lockdown on January 23 slowed the spread of the virus, but the advent of centralised quarantine on February 1 led to a decline in new case numbers almost immediately.
There are two reasons for this. First, people with the virus who might have defied the lockdown rules and subsequently infected others would be unable to do so. Second, even those who followed the rules and stayed at home still risked infecting family members and housemates. A person with mild symptoms who didn't require extensive resources could accidentally infect an older person or someone who was immunocompromised, leading to further stress on the health system.
Instead of allowing this to happen, China hastily assembled makeshift field hospitals with thousands of beds in sports stadiums and other unused venues. People with mild symptoms were held there until they were no longer symptomatic and infectious.
Michael Baker, a professor in the University of Otago's Department of Public Health, told Newsroom this was something New Zealand should look at over the next few weeks.
"I think this period of shutdown is the time for us to be working out all of these policies and what to do when the shutdown's eased. We should be learning from countries that have been through this as much as we can," he said.
"The reason China seemed to have lots of people hospitalised in much higher proportion than anywhere else is that's where they sent people; often they sent all their cases to those sorts of facilities.
"The number one thing - once you move away from this mass population [lockdown] approach, which obviously you want to move out of that as soon as you can in a graded way - but after that the mainstay is really managing all your cases so that they don't infect others. The confirmed cases absolutely are a key focus because they really can infect other people."
David Murdoch, an infectious diseases expert and Dean of the University of Otago, Christchurch, said making comparisons between what worked overseas was difficult because there were too many factors to weigh up.
"The comparisons are difficult, aren't they, because there are multiple differences between them and you don't know whether that thing made a difference or not or whether in China this made a difference or not," he said.
While the core thesis of centralised quarantines made sense, Murdoch wasn't sure it could be applied to New Zealand. "The idea in general principle is the more secure you can make an isolation, obviously, the more effective it can potentially be. And then there's all the civil liberties arguments and I'm sure a lot of what was done in China would not be acceptable in New Zealand."
When questioned about centralised quarantining on Monday, Director-General of Health Ashley Bloomfield said the Government was keeping all of its options open. However, he said, it was mostly looking at quarantines in the cases of people returning from overseas.
"One of the things we are able to do here of course is check on people who are cases or close contacts. They do get daily check-ins and they have to report in on their health and so on. We're also looking at options for quarantine and whether that would be for people coming into the country and/or others in the country where we weren’t confident about their compliance with self-isolation expectations," he said.
"We've got the experience at Whangapāraoa as a good starting point, so we know how to set it up quickly, how to make it work and how to look after people."
There are also alternative options for a quarantine system, Baker said.
"Given that the tourist industry [is collapsing] - I mean this is just speculation - but I imagine there's more hotel rooms and so on that can potentially be made available."
Dean Humphries, the national director of hotels at Collier International, also said that hotels could be used as quarantine sites.
"Hotels are well placed to provide self-quarantine accommodation if hospitals simply can’t cope with capacity. This will require government support and careful management. Hotels near hospitals could be ideally located to assist. Floors or wings could be isolated, and nurses or caregivers could be employed and provided with in-house accommodation," he said.
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