An expert epidemiologist is calling on the Government to quarantine all people arriving in New Zealand from overseas and for a much wider testing and contact-tracing regime to prevent needless deaths from Covid-19.
Otago University Professor Sir David Skegg told Parliament's Epidemic Response Committee this morning that it was make or break time for the Government to eliminate Covid-19.
"We've got the opportunity now. Every day counts," Skegg told the committee.
"If we don't eliminate it in the next few weeks, the shutdown will continue for many months, or we will have a series of shutdowns that will paralyse our society for a year or 18 months, and it will never be the same again.
"If we now eliminate the virus, we can return to normal within a few weeks, or certainly in a month or so."
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He said if the virus wasn't stamped out, an outbreak would hit the country in a similar way to what has happened in the UK or the USA, which is considered the new epicentre of the global pandemic.
Eliminating the virus meant getting down to a defined minimum number of cases so that it can be handled at a local level.
"We can't get rid of all virus particles in New Zealand. We can effectively eliminate so there is no need for a lockdown. People could travel around New Zealand and have holidays.
"In the coming months, we could let tourists in with new antibody tests that can tell us who has had it and who is immune. We could open the country to an extent, so long as people can prove they are not carrying the disease."
The committee grilled Director General of Health Ashley Bloomfield and Health Minister David Clark this morning about the Government's response to the Covid-19 outbreak.
Under persistent questioning, they said testing criteria would be loosened, services deemed non-essential could be reconsidered - including weekly newspapers - and that personal protective equipment would be made available to frontline workers who wanted it, even if official guidelines said PPE was unnecessary.
Skegg said a lockdown was "bold" and had bought the Government time, but more than a lockdown was now urgently needed.
He called for more extensive and wider testing, comprehensive contact tracing, quarantining all people coming to New Zealand from overseas, and a clear Government strategy to eliminate the virus.
"A lockdown on its own is not enough. It's like pressing the pause button.
"We all know how costly this lockdown will be in human and economic terms. It's a terrible waste if we don't pull out all the stops now to maximise our chance to eliminate Covid-19."
Skegg said that the testing had been skewed to symptomatic people who have been overseas or were in close contact with a confirmed case, and was therefore a poor indication of community transmission.
Bloomfield has said that about 10 people, or 2 per cent of all cases, were due to community transmission, but Skegg said that was "very misleading".
"Every time the public are told only 2 per cent of the cases appear to involve community spread - it's meaningless.
"You only get tested if you come from overseas or if there are epidemiological reasons to suspect the person might be infected."
That strict criteria meant that there was probably a "far higher" number of actual cases than the 647 confirmed and probable cases to date, he said.
Far more testing was needed, Skegg said, and while the Ministry of Health had loosened the testing criteria, that message had failed to get through to clinicians in the field.
"I keep hearing of patients that should have been tested but they weren't because they had not been overseas recently."
Wider community surveillance testing needed to be done, he said.
"Have we got 500 undiagnosed cases out there or do we have several thousand? We don't know."
He cited the danger of false negatives, which could give a false reassurance to a person.
"But there are very few false positives, and a positive test is extremely useful."
Bloomfield told the committee that surveillance testing was about to get underway, but it now needed revision because many patients were being seen remotely rather than face-to-face, making it impossible to get a swab sample.
National leader Simon Bridges, who chairs the committee, said he had spoken to a symptomatic person who was told by her doctor to be tested, but clinicians at the testing station said they wouldn't test.
Bloomfield said the testing criteria had been loosened - and would likely be further loosened to include people with low respiratory tract infections - but clinicians ultimately had discretion to test.
But while David Clark said he expected a test to be done if a GP recommended it, Bloomfield said those at the testing station had the final say because they were experts who dealt with suspected Covid-19 cases all the time.
"I wouldn't want to second-guess their judgement."
There had been more than 21,000 tests to date, including many tests of people who didn't closely fit the criteria, he said.
Quarantine all arrivals from overseas
Skegg said people coming to New Zealand from overseas posed a greater risk by the day as the global pandemic continued to expand.
"Every effort must be made to prevent spread from New Zealanders returning from overseas. As each day goes by, the probability of those people carrying the virus increases."
He noted that Australia was putting all people arriving from overseas into quarantine, and he thought New Zealand should do the same.
But that quarantine had to be enforced and checked, as it is in Singapore by requiring those in quarantine to send text messages multiple times a day.
"I just don't think we have that level of checking going on."
Currently a symptomatic person is quarantined at the border, while asymptomatic people with suitable self-isolation plans are allowed to go home. They are checked on by police within three days.
Those without a self-isolation plan are taken to supervised accommodation, but concerns have been raised after some overseas arrivals managed to leave Novotel in Ellerslie to go to the supermarket.
Bridges asked why every arrival from overseas wasn't being tested, but Bloomfield said they were being treated with extra vigilance.
"It's a high trust environment. The vast majority of people understand their role and comply.
"I have a lot of confidence in that. We rely on them to do that because we can't police every person."
Failing that, he said people could dob in non-compliance by using the police website.
"We rely on other New Zealanders to support our efforts. If people are not complying, the police have shown they are willing to take them to task."
Contact Tracing and the use of apps
Skegg said that rapid contact-tracing was needed as a "matter of urgency".
"Contacts need to be located, isolated and tested before they start infecting other people. This is a huge logistical exercise and a challenge which I don't underestimate."
He noted that apps had been used in South Korea and Taiwan for contact tracing, which required special legislation to be passed.
Clark said the Government was "very actively" looking at those options while also weighing up human rights and privacy considerations.
Skegg also challenged the definition of an essential service, and Clark said that community newspapers, deemed non-essential, were being reconsidered.
Act leader David Seymour said food outlets should be allowed to stay open where people are currently being forced to drive great distances to get to the nearest supermarket.
Bloomfield suggested there might be a case to reconsider those outlets, and the Government wanted to start with tighter restrictions that could be loosened in the right circumstances.
Personal Protective Gear
Home and community support workers looking after the fragile, elderly or disabled have been pleading with the Government for PPE, with some health workers threatening to resign.
Clark and Bloomfield have repeatedly said there is enough PPE for all relevant workers, and the Ministry of Health has just released guidelines on when to use it.
But Bloomfield conceded that some workers will want to use PPE in circumstances where the guidelines said it wasn't needed.
It was hard for such a worker to be told that they didn't need a mask after seeing supermarket checkout staff wearing them, he said.
Clark said all frontline staff should be able to use PPE if they wanted.
"We want to keep them safe because they are keeping us safe."
He added that the health workforce had been boosted by more than 6500 people returning to the profession, and more training would ensure enough staff could operate the country's ICU equipment.
There was capacity for 533 ICU beds in the public health sector, with 247 more in the private sector - but the equipment needed to be staffed around the clock.
No clear strategy
Even though alert level 4 is the "eliminate" level, Skegg criticised Clark for failing to use that language during his appearance before the committee.
"He didn't say that once. He talked about containing the spread, suppressing it, reducing the transmission. We need to stamp it out.
"I don't think people should be talking about smaller waves or flattening the curve. We want to flatline the curve."
There didn't seem to be a clearly communicated Government strategy, he said, which would include for example an alternative plan if elimination failed.
Earlier the head of the all of Government response to the Covid-19 outbreak, John Ombler, told the committee he wanted people dobbing in breaches of the lockdown rules to be a last resort.
The Government is enlisting Kiwis to be its spies and pass on any proof of supermarkets price-gouging, or to report their neighbours for breaking the lockdown rules.
A direct email address has been set up for people to send through pictures of receipts or items with questionably high price tags.
Ombler told the committee that the Government's strategy depended on stopping person-to-person and location-to-location spread of the disease.
He said his first preference was for people to do the right thing first, to have a conversation about the importance of compliance second, and to dob people in if necessary, but only as a last resort.
"If there are people who simply don't want to play the game, they are putting all other New Zealanders' lives at risk by their actions."
Asked about whether there should be guidelines issued about the use of the extraordinary powers allowed under the national state of emergency, Ombler said the situation was "a moving feast".
He said "by and large" the public were responding well, and the Covid-19 response team had not had much discussion about exercising "extreme powers".
Bridges said this week the committee would focus on the health response on Tuesday, the economic response on Wednesday with Finance Minister Grant Robertson and Treasury Secretary Caralee McLiesh appearing, and enforcement on Thursday with Police Commissioner Mike Bush appearing, as well as ministers and chief executives of Civil Defence and Customs.