AYESHA VERRALL
A voice for progress
The fretting started on February 29. The World Health Organisation mission to China had just published its report, which found Covid-19 was very serious and spreading with astonishing speed.
Whilemany questioned China’s data, Wellington epidemiologist and infectious diseases doctor Ayesha Verrall did not. Having worked in Singapore under one of the report’s authors – Professor Dale Fisher – she knew he would never be cavalier about something so big. Instead, she began toworry, a state that continued for almost two months.
‘‘I was upset about the thought of our hospital being over-run . . . How destructive that would be for our workforce to have this horrible experience of not being able to look after people . . . Having to make these awful decisions about who does and doesn’t get a ventilator, for example – a decision that’s morally unacceptable to you.’’
Thewhoreport emphasised that China’s success in fighting back the disease rested on public health measures, such as isolating cases and tracing everyone they’d had contactwith. But as thewhoscientists pointed out, ‘‘concerningly, global and national preparedness planning is often ambivalent about such interventions’’.
Verrall, 40, knew New Zealand was no exception. A tuberculosis specialist, she’d used the country’s contact tracing system to track TB infections. She knew our regionalised health system meant different public health units used completely different data systems. And she’d tried – unsuccessfully – to fix it.
‘‘I knew the gap between whatwould be required to turn around an outbreak, and wherewewere, was huge.’’
So she started making noise. On March 6, when New Zealand had just four cases, she warned we needed more public health staff to trace contacts. The March 17 economic package included $40 million for public health units and contact tracing.
But then case numbers escalated. No-one disagreed with her, or told her to shut up, but officials were too busy figuring out complex border control rules. So she started emailing Dr Ashley Bloomfield. Anyone who would listen, she laughs. And she began to lose sleep.
‘‘The thing with the outbreak is that you have to keep going. Because you can’t do something and say ‘Oh, it’s done’. Because the outbreak progresses, and whatwas an achievement two days ago is now no longer enough.’’
Verrall is sleeping better now she has been heard. On April 10, she had a day to audit New Zealand’s contact tracing system and recommend improvements. She channelled the course Fisher sent her on in Cambodia, where they had a week to report on a simulated disease outbreak.
On Easter Saturday, she emailed her report, which found problems with timeliness, incorrect contact details and staff numbers. The system could trace just 185 cases a day.
As Verrall put it succinctly on Twitter: ‘‘Our contact tracing capacity is a fire extinguisher, we need a fire engine.’’ Then she went back to parenting her 6-year-old daughter Laila, whose care she had guiltily abandoned to her partner Alice for four days.
This week, the Health Ministry accepted her recommendations and promised another $55 million and 300 staff, and her face and voice beamed around the nation as she did 10 media interviews in two days.
It’s been hard, but important, she says. She drew on her past experience as president of the Otago University Students Association, and her current role as deputy chair of Wellington’s health board.
She’s her best selfwhen she has something to get stuck into, a concreteway to make a difference.
It was that chance to make an impact beyond your own patients that drew Verrall to epidemiology. She studied under Sir David Skegg – who has been prominent in the Covid19 response – and influential Aids epidemiologists Charlotte Paul and Nigel Dickson.
Her friend Chris Jackson – now the Cancer Society’s medical director – told her she’d be perfect as an infectious diseases doctor. In the end, she did both.
Given she’s not afraid of pus or germs or putting herself in harm’s way (with the right protections), it was a good fit.
The decision to study tuberculosis was more personal. Verrall is named after her grandmother, who died of fever when Verrall’s mother Lathee was just two. They lived in the Maldives, in a house with a dirt floor and a corrugated iron roof that could not withstand the monsoon.
They never found out what her grandmother died of – possibly typhoid. Verrall’s mother was cared for by an aunt, who encouraged her education. She came to New Zealand to study, and married Verrall’s dad Bill.
The family lived in the Maldives when Verrall was aged 3 to 5, and Lathee talked often of her experiences. So Verrall understood how a health tragedy could impact a family.
She wanted to do something with global impact. While HIV treatment, diagnosis and prevention had advanced massively, tuberculosis – the world’s most deadly infection – was neglected, with no new drugs, a vaccine that only half worked, and treatment that took six months.
So Verrall went to Indonesia to undertake a PHD, studying the immunity of people living with those with TB. She, Alice and baby Laila spent 18 months there – a gay couple in the conservative city of Bandung, living their own lockdown of sorts, learning to be parents and mostly staying at home.
Verrall is not a fan of lockdown. While it was the right decision under the circumstances, she’d ratherwe had the ability to instead manage outbreakswith testing, case isolation and rapid contact tracing.
That’s because she sees the lockdown’s toll on her infectious disease patients.
‘‘How ami meant to look aftermy patients who have got HIV who can’t speak English, on the telephone? It’s really hard . . . I put people in isolation all the time, and I know that there’s a massive difference in how that impacts wealthy people with good social support versus people with precarious or no employment . . . I think about how important it is for my patients to stay in their jobs, for their connection to the community and for their good health and financial situation. Their health and the economy is tied up so tightly.’’
All the more reason to bump up New Zealand’s contact-tracing surge capacity to 1000 cases a day, Verrall says. That way, if several large clusters develop after restrictions are relaxed, decision-makers can back themselves to limit the spread, rather than putting the country back in lockdown.
Verrall supports the goal of eliminating the virus, but says it will be hard. And we need better science – if people without symptoms can spread the disease, finding and isolating every case will be incredibly difficult. But she’s sceptical. If asymptomatic people were spreaders, you’d expect them to give it to others in their household, who would then get symptoms and appear in the mystery transmission cases.
‘‘There’s only six people we can’t link to a case since the lockdown began. So at some point, we have to stop believing in fairies . . . If we look at the strongest data we have – our case numbers – New Zealanders should start to feel confident that Covid is extremely uncommon in our community now.’’
Coming out of lockdown, Verrall is most looking forward to having a party to share beer, curry and stories with friends. But she’ll also be looking for something good to come out of the crisis. One positive surprise in her audit was how well – and how quickly – the Health Ministry had been able to set up a nationalised IT system for tricky data.
That means ‘‘every DHB is different’’ should not be an acceptable answer to why problems can’t be looked at nationally.
‘‘I don’t think everything should be centralised, but I’d much rather we had a pragmatic approach and thought ‘What do we need to solve this problem?’ – whether it’s cancer, Covid, tuberculosis, diabetes – rather than putting the health system structure first and using that as a justification for why it can’t improve.’’
‘‘You have to keep going ... Because the outbreak progresses, and whatwas an achievement two days ago is now no longer enough.’’