Covid 19 coronavirus: Dr Gary Payinda - Get used to this because we're in for the long haul

COMMENT:

Last week two women from Britain made it through a hole in our ring-fenced border and two boys on 'quarantine leave' for a tangi absconded into thin air.

This week we heard 55 people left quarantine on compassionate grounds, 51 of them untested. Others were not tested because they had medical conditions, were children, or refused.

When I look up the medical contraindications to nasal swabbing, I can't find any. Age limits to testing? Can't find those either.

Refusal? Well, every child at kindy learns that sometimes it's about "we", not "me".

The shocker isn't that these things happened, it's that they haven't happened more often, given that one in every 250 people in New Zealand has been in 'managed isolation' or quarantine over the last 10 weeks.

That's 19,000 people being managed at home in 'high-trust' isolation scenarios or in high-cost hotel rooms. That's more than twice the number of inmates managed by all of our prisons.

What would be the likelihood of an adverse event if we doubled the prison population of Rimutaka Prison, New Zealand's largest, in a single week? That's the scale we're talking about: 2,000 travelers weekly. Even Rimutaka couldn't handle such an influx without tightening up every loose end from the front door to the exits.

Yet we thought we could handle these extraordinary numbers (and this extraordinary cost) with compassionate exemptions, free hotel stays, and trust.

Since lockdown began 64,000 people have entered New Zealand. Exemptions were granted to 3,200 of them. Some for family members out of compassion, some for essential workers, some for airline crews.

In our hospitals, even at the height of lockdown, there was a push by some staff and members of the public to soften visitor policies deemed as overly harsh, based of course on reasons of compassion.

Compassion is a term that's hard to pin down, and hard to argue against. Who could be against compassion?

But compassion doesn't only work in one direction. If compassion is an argument for letting a pregnant mum in labour have two visitors rather than one, it should also apply to compassion for the community, who would have to deal with two potentially exposed visitors walking out of the hospital instead of just one.

It is through the good fortune of geography as much as good policy that we have forestalled community spread, but with almost half a million deaths and 8 million cases worldwide, our luck won't hold out forever. It may not even hold out 'til next week.

Can New Zealand run the long game--literally years of managed isolation and quarantine--while footing a bill for $4,000 per hotel-quarantined traveller? Can our largest peacetime surveillance and detention system operate alongside 'compassionate exemptions' and 'high-trust' home isolation? Is it possible to perform a national lockdown, while letting 64,000 people cross our borders, as the global burden of disease soars?

If anyone could have pulled it off, it was the PM and her team of 5 million. Skilful and humane, her team defeated the initial surge. But the steady burn is proving harder to handle. There are signs that things are changing though.

Compassionate exclusions have been put on hold, and Assistant Chief of Defence Air Commodore Digby Webb will now be in charge of isolation facilities for Kiwis returning from overseas. For a government that has steadfastly refused to 'militarise' the Covid response, this is a sea change.

The 'team of 5 million' is slowly turning into an 'army of 5 million'...as it must if Covid goes from temporary nuisance to chronic scourge. Bubbles worked against the initial surge, but bubbles can't win sieges.

Meanwhile Covid has kept up its steady burn worldwide. It has killed roughly 5,000 people every day for the last month. And this is despite some stricken countries changing their case definitions, testing less, under-reporting, or in the case of Brazil, failing to publish Covid cases altogether for a period of time.

Covid cases and deaths are bad for national morale, bad for business, and bad for political campaigns. Covid fatigue has set in across the globe. People want to move on, but the virus hasn't gotten the message.

Covid started out as a bushfire. It has turned into something more like global warming.

There won't be any quick or easy fix. The question is whether we will approach potentially years of this Covid plague with bubbles and high-trust and exemptions, or with an impenetrable fortress wall located just behind the world's biggest moat.

• Dr. Gary Payinda works as an emergency doctor in Northland.