Part 2 – In quarantine, coming out, new community transmission, and way forward.
This post is a follow up on my earlier post – Part 1
On Tuesday, August 11th, New Zealand’s dream run of being COVID 19 free came to an end. As one commentator puts it, "our luck ran out that day." Understandably, the public reaction was a mixture of surprise, anger, frustration, and disbelief.
The government called on the “team of 5 million” to rise to the challenge and reminds them that they have done it before and can do it again.
This news of community transmission should not be a surprise for three main reasons. First, we live in a connected world, and no country's government can completely seal off its border, pull up its draw bridge, and disconnect with the rest of the world until a vaccine arrives. Second, this virus is still novel, and infectious even when the host is asymptomatic. Finally, this virus can spread exponentially. All this virus needs in the current pre-vaccine environment is a lapse in discipline to maintain social distancing, wearing a face mask and personal hygiene.
The war to get this pandemic under control is fought on several fronts, multiple campaigns, and countless battles. Winning a few battles is a long way from winning the war!
Winning the war against this virus will require exceptional leadership, cohesive partnerships between public services, private sector, academia, unions, advocacy groups, and civil society, a high performing and resilient health system, and finally, strong social cohesion.
After New Zealand won the battle against the first wave of this virus, the country went to Level 1 on June 8th. Stadiums were full, bars and restaurant packed, schools re-open, and domestic tourism promoted aggressively. Safeguards such as social distancing, hand hygiene quickly forgotten, and face mask was not even part of the government Level 1 program of "non-pharmaceutical interventions."
The message was, “we have eliminated this virus, and the only real threat is from our borders." If border control was tight and quarantine facilities were secure, life can pretty much be like pre-COVID 19. Much to the dismay of over a million Kiwis living overseas, there were calls to shut the borders even to New Zealanders living abroad who wanted to return.
Our misplaced sense of confidence saw testing levels started to drop, and subscription of the government contact tracing application slowed down to a trickle. The new Minister of Health was rightly concerned.
In reality, New Zealand, like all countries, cannot close its border completely. Cargo planes, returning citizens, residents, repatriation flights for stranded visitors, essential workers, and those with exemptions continue to cross our borders.
In countries like Hong Kong, Singapore, and South Korea, where there is a greater compliance culture, their strict border and quarantine measures did not prevent subsequent waves.
Did we waste the last two months between June 8th and August 11th, having a pre-COVID 19 rest and recreation, and taking the foot off the pedal?
In late July and early August Victoria, Australia saw a rising number of deaths and infections. Could this have jolted our political and senior health officials to ramp up messaging about a possible second wave?
Coming home
I return to New Zealand after four months away and spent fourteen days in quarantine in late July. In my earlier LinkedIn post entitled "COMING BACK TO NEW ZEALAND – Departure from KL and arrival at Auckland," I shared my observations of my flight back and experienced at both airports.
On arrival at Auckland airport, most of what I saw was good practice. However, there were enough breaches of protocol for this virus to exploit at Auckland airport, especially at the baggage inspection hall managed by the Ministry of Primary Industries.
In quarantine I started my fourteen days quarantine on July 18th. During my stay, I interacted with staff from seven different organizations (Defence Force, Police, Aviation Security, private security, primary care nurses, Ministry of Health, and the hotel. On days three and twelve, I had my RT-PCR test. Both came back with negative results, and on August 1st, I left quarantine.
During my quarantine stay, much of what I saw and experienced was people doing their best to adhere to proper protocols. But like at Auckland airport, there were enough lapses in discipline and breaches of protocols for this virus to exploit. Some of the most glaring infection control breaches included:
Nurses not changing gloves after testing each returnee,
Security staff from Aviation Security who were taking bookings for daily exercise, not wearing a face mask and not consistent with keeping physical distancing when interacting with returnees,
On one occasion, three staff entered the lift with me in it; this is a clear breach of protocol. Fortunately, on that occasion, a
During my stay, I did speak and provide feedback to the Defence Force officers in charge. They were excellent to deal with, always polite, discipline, courteous, and responsive to feedback.
Being confined to the hotel room for 24 hours, except for 45 minutes of exercise per day, was a new challenging experience. I struggled with jet lag at the best of times, but the rooms' confinement made the fourteen days feel much longer. The knock on the door four times a day (3 meals and the nurses’ daily temperature and symptom check) provided a brief break in the monotony of watching TV or surfing the internet. My daily routine involves reading, writing, chats with my wife, and at least one phone call to my children, friends, and colleagues. Fortunately, my room looked down on the main street, and people watching provided some light relief.
I followed all the rules during the fourteen days to give myself the best chance to get two negative COVID test results. Staying another day longer in quarantine was not an option for me.
Leaving quarantine
I checked out my quarantine hotel on August 1st. Friends and family had warned me that leaving quarantine would be a shock for me. There was no social distancing; hardly anyone is wearing a face mask, and life was pretty much like it was pre-COVID 19.
They were right. It was a shock to me. I felt quite unsafe when I walked into a restaurant (to collect a takeaway) packed with people, sitting shoulder to shoulder, talking loudly at each other, and not a single person wearing a face mask. I quickly found a corner of the restaurant as far away from the crowd as possible and put on my face mask!
It was the same flying back to Wellington from Auckland on August 3rd. The flight was full, and my wife and I were the only ones wearing a face mask (we kept it on for the whole trip).
I wondered about the risk of an asymptomatic super spreader in the restaurant or on the plane. Friends I talked to about my fears dismissed them by reminding me that there is no community transmission. Well, that bubble burst on August 11th.
Second wave
On August 4th, two articles warned New Zealanders to prepare for a second wave. The first article was from a group of experts, and the second was from Dr. Ashley Bloomfield, the New Zealand Director-General of Health.
I agree with this warning, and from my recent border and quarantine experience, I was surprised it had not already happened. It is possible that the reported drop in testing meant that there could be transmission but not being picked up until someone became unwell, saw a doctor, and got tested.
Reading about the drop in testing, lack of public support for the government official contact tracing application, and the lack of traction for the public to wear face masks were all red flags.
For four months while I was in Malaysia, I wore a reusable cloth mask, every day when I was in public. I also scan the QR code everywhere I went and maintained physical distancing in public places. Between August 1st and August 11th, I felt out of place back in New Zealand. But all that changed on August 11th!
At 9.15 pm on Tuesday, August 11th, the Prime Minister announced that there was now community transmission in Auckland. Auckland went into a Level 3 lockdown and the rest of the country on a Level 2 lockdown from noon Wednesday, August 12th, for three days. Massive testing took place in Auckland and two other towns in the North Island. These tests have uncovered more confirmed cases linked to the index case and family.
On Friday, August 14th, the government decided to extend to August 26th, level three, for Auckland and level two for the rest of the country.
As has happened in Victoria, Australia, there was a run on supermarkets and pharmacy (for face masks and toilet papers!), long queues at testing stations, and some made a run to leave Auckland before police roadblocks put in place.
As expected, there is now a big focus on tests, contact tracing, and the wearing of face mask (finally).
Messaging and social cohesion
Is it time for political and health leaders to review how their messaging and actions impact social cohesion? For example, is it time to change the government slogan from a team of five million to six million? Or do the government not value the one million Kiwis living overseas. It is not surprising there is a growing sense amongst the diaspore New Zealanders of being abandon by their government. The slogan team of five million has created a “them and us” divide and not helped by some commentators in New Zealand fuelling such sentiments. There is genuine concern about how in a few short months, fear of new community infections, and anxiety over economic uncertainty is changing who we are as New Zealanders. This sentiment is reflected strongly in a recent moving article written by a bereaved brother of his sister’s death in Australia from cancer. He makes this powerful observation “Where New Zealanders were once pragmatic, adventurous and resilient, we are now reactive and anxious – governed by a few weak slogans we expect others to live up to.”
Likewise, is it time for messaging with the public to replace the word “eliminate.” Elimination amongst the public health aficionados has a precise meaning and is not confused with "eradicate." The challenge is for some laypeople; the nuance of the two words is lost in translation. When New Zealand declared it had eliminated the virus in early June, the government did warn that future infections could not be ruled out. However, this warning was quickly forgotten when the Prime Minister announced that "We can hold public events without limitations. Private events such as weddings, functions, and funerals without limitations. Retail is back without limitations. Hospitality is back without limitations. Public transport and travel across the country are fully opened."
Subsequent waves are a reality faced by many countries such as Iceland, Taiwan, South Korea, and Singapore. This recent new community transmission is a reminder that New Zealand is no exception. The word "eliminate" will wear thin with an increasing number of the public as their lives and livelihood gets "paused and disrupted” whenever there is a new community transmission.
Locking out families
Governments need to do better than allow providers to "lockout" family support for mothers giving birth and the elderly in care. Giving birth and caring for the elderly, especially those who are dying, are the two bookends of all our lives. Do more tests, provide PPEs, and create a safe space or travel corridor so that families can support the beginning and end of life. Denying new mothers and the dying of family support undermines social cohesion.
The reality is until a vaccine is widely available, this virus is here to stay. So, every time there is a new outbreak, the health,economic and social responses need to strengthen social cohesion and public trust, not cause more fragmentation.
Final word - fronts, campaigns, battles, and different types of leaders needed
To ultimately succeed in coming out on the right side of this pandemic, countries need to fight on many fronts, campaigns, and battles.
Fronts that all governments faced are social, economic, and health. Success in all three fronts is necessary to win the war against COVID 19. Governments need strategic leaders that can tackle all three fronts concurrently.
The slogan of "getting on top of the health challenge gives us the best platform for an economic recovery is a linear solution approach. When faced with the novel, complex, and exponential speed of destruction of COVID 19, such a linear approach to advance each of these three fronts is flawed.
Currently, victory on the health front is hinged on the arrival of an effective, affordable, and accessible vaccine. There are optimistic speculations of an effective vaccine by the end of 2020. But a more realistic timeframe of mass vaccinations globally is towards the later part of 2021 or even early 2022. It does not take a rocket scientist to work out that social and economic fallout will be horrendous and beyond devastating by then.
Campaigns that must be won on these three fronts include:
vaccines, treatments, testing, contact tracing, face masks, personal hygiene, PPEs, border, and quarantine controls, protecting high-risk groups, taking care of health and other frontline workers),
supporting jobs, businesses, places of learning and worship, basic human events of births and deaths
strengthening social cohesion.
Every one of these campaigns is complex programs with many moving and interdependent parts. For example, rolling out a national vaccination campaign requires timely procurement and delivery, proper warehousing, rapid distribution, training a small army of vaccinators, and a fit for purpose digital national immunization register platform.
Governments need competent campaign level operational leaders that can make progress on all campaigns concurrently.
Battles of fresh community transmission need to be led by disciplined and competent frontline operational leaders. Executing fast track, trace, and test is key to getting each community transmission under control.
Having the right talent, capacity, and capability of leaders at the strategic, operational, and frontline levels is a fundamental factor in coming out on the right side of this pandemic. Each of these three levels of leadership has different roles and responsibilities. There cannot be any dissonance in purpose and mission between them.
When battling an outbreak, leaders cannot afford to be only fighting down in the trenches. They must look up and keep an eye on the many campaigns of this pandemic and its impact on ordinary people’s lives. Finally, they have to look around and ahead to drive pace and momentum on all fronts.
CHAI CHUAH August 21 st , 2020 Wellington, New Zealand