‘Sluggish’ virus response puts NZ in danger
Leading scientists tell Eugene Bingham the Government is failing to act fast enough, and is too closed-minded.
If New Zealand was to knock up a CV, surely a contender for top of the list of achievements would be its response to coronavirus, right? Check out all the glowing international tributes. Listen to the praise from Prime Minister Jacinda Ardern for our ‘‘Team of Five Million’’. And look at all the events we can enjoy now. Nailing it, aren’t we?
It’s a source of national pride. But there’s a thing about pride – as the old proverb warns, it can come before a fall.
And some experts believe that’s what we’re at risk of right now: that a giddy sense of selfsatisfaction is blinding us to the fact we are in mortal danger; that we could be caught flat-footed, just as the promised land of a virus-vanquishing vaccine appears.
And this is not just about the slumped rates of QR code scanning. It goes to the top, and seeps throughout the whole system, warns one senior doctor.
‘‘There’s just been this reluctance to engage with anybody else with ideas,’’ says Professor Des Gorman. ‘‘What underpins this reticence? Political risk has driven a culture of ‘best in show’, ‘we’re the envy of the world’. It’s a very pervasive culture, and it’s the wrong culture. The culture we should have is: how do we do better tomorrow than we did yesterday?’’
Gorman, a former associate dean of the Auckland Medical School, has criticised the country’s response before, most notably when he said New Zealand had been caught ‘‘with its pants down’’, a critique which earned him a rebuke from Ardern.
So perhaps it’s not surprising he is scathing. But he carefully lays out his evidence, conscious his words are liable to be dismissed.
And he’s not alone.
Professor Michael Baker, the Otago University epidemiologist whose work throughout the pandemic earned him a New Year’s Honour, is worried too.
Look, he says, fundamentally, the response has been outstanding, starting with the decision to go down the path of elimination.
‘‘But since then, I would say in general, New Zealand has been quite slow to adapt to the virus.’’
While the country’s leaders have been praised for taking a science-based approach, Baker says they’ve waited until the evidence is ‘‘overwhelming’’, and they’ve been ‘‘quite unresponsive at many points’’.
‘‘I would say New Zealand’s been quite sluggish in the speed with which it’s adapted to using evidence and responding to changes in the level of risk.’’
For Baker, this isn’t just a matter of looking in the rearview mirror and noting where we could have done better – it’s happening now, he warns.
He and Otago colleague Professor Nick Wilson have been pushing for about six months for changes to tighten the borders and quarantine. And while he’s pleased some changes have recently been introduced (pre-departure testing, for instance), he asks why it took so long. And, also, why haven’t we gone further?
He and Wilson advocate moving quarantine facilities out of Auckland and stopping the use of shared spaces, as well as reducing the number of arrivals; without tighter measures, they say, we are vulnerable to another outbreak.
Decisions aren’t being made fast enough, Baker says, a critical factor in the face of the more virulent strain.
‘‘It does strike me as we seem very slow to act on this evidence.’’
The director of public health, Dr Caroline McElnay, rejects the criticisms and insists the decision-making system is working well.
The Sunday Star-Times initially put questions to the ministry on November 10, but there was no response until January 14.
This week, though, McElnay fronted for an interview, and spoke over the phone from a windowless room in Wellington. It’s hard to defend yourself against accusations of defensiveness without sounding, well, defensive. But McElnay was open to questions.
‘‘We are listening to what is being said in the community at large,’’ she says.
‘‘We’re constantly reviewing our controls, how we do things. We’ve seen examples in the last couple of weeks around the introduction of predeparture testing, initially for the United States and the United Kingdom. Based on very quick, speedy advice we extended that to other countries, with the exception of Australia and parts of the Pacific. So again, that reflects the continual review of our controls to make sure they are fit for purpose.’’
The making of a pandemic requires a few ingredients. Most importantly, of course, is the infection – thanks very much, SARS-CoV-2, the virus that causes Covid-19. Another part is the response – how us humans and our governments react to the threat will determine how catastrophic the disease will be.
And it’s that second part which is really worrying Gorman.
Before he goes on, though, he wants to clarify something: ‘‘Look, we’re not arguing that everything’s bad, and everything’s rotten, and they’re a bunch of a...holes – we’re simply saying we need to adopt a culture of every day, trying to do better.’’
And that’s the problem, he says. As soon as we started to think we’d done well, we were in a dangerous position.
‘‘The minute you think you’re best in show, you become complacent and you start bullsh ..... g. You start setting the facts to the narrative rather than narrative to the facts. Hence, the: ‘Everyone’s being tested’. No they’re not. ‘No-one is being let go early’. Oh, yes they are. It just goes on and on.’’
It’s a failure of governance and management, he says. And it leads to a resistance to outside ideas.
‘‘When Nick Wilson or Michael Baker suggest [something], then immediately there’s pushback: ‘It’s not our idea, it didn’t come from the Wellington bubble’.
‘‘When Michael started advocating mandatory mask-wearing, what was the response from the ministry? Not proven, not necessary, push back, push back.’’
Baker admits he was ‘‘disappointed’’ by the reaction.
‘‘I couldn’t understand why there was so much reluctance. It did seem to be a litmus-test issue about New Zealand’s ability to use evidence and be adaptable, because it seemed to be a pretty poor response.’’
Eventually, masks were made mandatory on flights, and public transport in Auckland – but only months after Baker started pushing.
In the end, masks have not played a critical role in New Zealand – so far.
But one vital measure is testing at the border. And it’s something that Baker says he was holding his breath over. ‘‘I did breathe a sigh of relief when we did introduce testing in the managed isolation facilities.’’
It’s hard to remember a time before the ubiquitous Managed Isolation and Quarantine (MIQ) facilities existed. But back in March, even after lockdown, New Zealand was relying on most arrivals to self-isolate.
On March 31, at the Epidemic Response Committee (which filled Parliament’s oversight role), MPs including National’s then-leader Simon Bridges repeatedly asked the Director-General of Health, Dr Ashley Bloomfield, why we weren’t testing all arrivals.
‘‘Surely, given the extreme measures we’re taking as a country, we should simply test everyone at the border, given it’s a small number of hundreds each day?’’ Bridges asked.
Bloomfield told the committee the current policy was to test anyone who was symptomatic. ‘‘It’s just getting this balance right between using testing where we know that, if someone is symptomatic, we want to rule out or rule in Covid19.’’
The important part was the quarantine, he told Bridges.
The question came up at the committee again, on April 7.
From April 9, all arrivals were required to go into MIQ, rather than self-isolating, but it was another two months, after more questions, before the day 3 and day 12 testing regime was introduced.
In a written response to a question about why it wasn’t introduced earlier, the ministry said: ‘‘We have always consistently said that our most important protection at the border is the 14 days in isolation and/or quarantine, together with the
‘‘I couldn’t understand why there was so much reluctance. It did seem to be a litmus test issue about New Zealand’s ability to use evidence and be adaptable, because it seemed to be a pretty poor response.’’ Michael Baker
daily symptom checks (and testing if symptomatic).’’
Which is an answer that doesn’t deal with the question.
On the phone, though, McElnay is upfront: ‘‘We now know, yes, asymptomatic people can be infectious. But we didn’t know that in the early days.’’
In fact, she says, the introduction of testing at the border is an example of how the ministry does listen to advice and adapt.
‘‘Someone at some point would have said: ‘Well, should we test all people?’ And I don’t recall who said that, but it clearly emerged as a real question.’’
The idea bounced around inside the ministry, and, eventually, there were discussions with Australia. ‘‘They weren’t testing at the time, but they were asking the same questions. We had a useful exchange of what would be the benefits, are there any downsides, how would we operationally do it?’’
Testing at the border was first floated in a paper to Cabinet on May 25, and signed off on June 8.
McElnay says the ministry has sought advice from experts throughout, including the Technical Advisory Group set up last January.
‘‘It’s not a one-way exchange of information. Being health professionals, they’re very willing to provide advice to us that we haven’t actually asked for, but we welcome that. We certainly, hopefully, have made it clear we’re very willing to be contacted. That certainly has happened personally myself.’’
Baker has sat on the group since the beginning, one of a number he’s been on. ‘‘They work best when you’re dealing with things that aren’t timecritical, and are often about refining strategies that were refined over years, sometimes decades. They don’t work so well in a crisis.’’
Nonetheless, he agrees there have been opportunities for personal contact – the health and science community is a village – and he says the ministry’s chief science adviser, Professor Ian Town, and the prime minister’s chief science
adviser, Professor Dame Juliet Gerrard, have been ‘‘pressure release valves’’.
Dr Nikki Freed, a senior lecturer at Massey University’s school of natural and computational sciences, thinks the response, generally, has been outstanding, from the initial moves to the modifications.
‘‘I worry, however, that we are placing almost all of our faith in MIQ facilities.
‘‘I think with the emergence of new viral variants that show increased transmission, we will need to really be on our game.’’ And for that, the whole community has a part to play, such as scanning – we can’t just rely on the Government.
If there is anything the Government can do, she says ‘‘having the MIQ facilities in the heart of the country’s largest city is not ideal’’, though she understands the desire to use hotels with low occupancy use.
But with Covid-19 raging, and more people returning who are infected, ‘‘the risk grows that we will have another outbreak’’.
To avoid that happening, Gorman, too, would like to see Baker and Wilson’s ideas picked up (‘‘quarantining people from the UK and US in Auckland is just nuts’’).
He’s just not confident the people who need to act are listening.
‘‘On the one hand, you have to say that if you choose a country to live in it would be New Zealand,’’ says Gorman.
‘‘But on the other, you say we should have dealt with this a whole lot better. And when you consider that the pandemic still has some time to run . . . we just can’t afford to continue to muddle our way through.’’