Category: Our Posts

29 April 2020

Gerhard Sundborn, Senior Lecturer Population and Pacific Health, The University of Auckland.

With Covid-19 bearing down on New Zealand, and fears of an overloaded health system and a death toll numbering many tens of thousands, the Government moved swiftly to implement a national lockdown. The magnitude of this threat is now being questioned by many epidemiologists and statisticians, here and internationally.

Although the lockdown was administered with the best intentions at heart, we at Plan B propose that the stringent five-week lockdown went further than necessary. Consequently, there are real questions to be asked about whether the benefits of the lockdown justify the negative social and health impacts. There is also doubt as to whether draconian measures such as lockdowns are any more effective than less severe measures such as social distancing.

Impact on Health Care Services

A clinician at a local hospital explained that they have been temporarily closed during level 4 and have been working out of a sister hospital nearby for acute patients only. When their hospital re-opens, to clear the accumulated backlog of surgical procedures and investigations it may take at least one to two years’ work including weekends to get back on track.

There are many reports of similar occurrences where hospitals around the country have reduced their provision of standard care and have been eerily quiet only operating at 50% of their usual capacity. The level to which life-saving and prolonging treatment and surgery has been either cancelled and delayed for many conditions including cancers, heart disease, diabetes, fertility, joint surgery and more need to be considered when weighing up whether the lockdown has been justified or has caused more pain, suffering and death than it has prevented and how much longer this can last.

In a recent communication the medical director for the Cancer Society feared that up to 400 cancer related deaths could be seen due to significant delays in diagnostic and treatment procedures resulting from the lockdown. Overseas evidence has shown that only half as many cancer diagnoses have been made during lockdown than normally expected.

Adding to this dilemma is the bizarre situation that many general practice clinics find themselves in where they may be forced out of business due to spiralling costs and falling revenue. One clinic explained that there are significant costs placed on GP practices in acquiring the right supplies in preparation for Covid-19 as well as a significant reduction in business from the lockdown. People have delayed seeking medical advice for less urgent ailments which has meant reduced income. People have also not sought treatment for more serious conditions for fear of becoming infected if they leave the safety of their ‘home-bubble’.

Short-term health and social harms

Domestic Violence – A surge in domestic violence as a result of lockdown procedures has occurred. In the UK, calls to helplines for domestic abuse increased by 25%, visits to their associated websites increased by 150% and cases of actual abuse soared. In China’s Hubei province during February domestic violence reports to police tripled. Regrettably, we (New Zealand) hold the title of having the highest rate of domestic violence in the developed world, meaning that we are not immune to this second ‘silent casualty’. Police statistics showed that just three days into lockdown (Sunday 29^th March) a 20% increase in reported cases of domestic violence. I am fearful to know what levels of domestic violence exist in our communities now – 5 weeks on. What do the victims – adults and children – go through and what impact will this have on their future? Added to this, some DHBs have reported rises in the number of drug and alcohol presentations to their Emergency Department and in cases of suicide.

Poverty – In the most recent Salvation Army Covid-19 Social Impact Report and Dashboard a number of measures are cause for concern, including the number of people and families that have become impoverished. The greatest increase was in the food security measure. In the third week of the lockdown, close to 6,000 food parcels were distributed. This is equivalent to what is usually distributed in one month.

Long-term health and social harms

Due to the impending economic downturn as a result of Covid-19, there are several negative health and social harms that are expected to continue over a number of years as a result of loss of jobs and higher poverty. The NZ treasury have predicted that unemployment rates could climb to twenty six percent.

At the individual level we expect increased:

• Use of primary and secondary care health services
• alcohol-related hospitalisation and death
• levels of chronic ill-health
• excess mortality from: circulatory disease; poor mental health; increased health harming behaviours; self-harm; and suicide

For families – studies have shown that following mass unemployment events there is likely to be increased:

• levels of divorce,
• conflict and domestic violence,
• unwanted pregnancy,
• levels of poorer spouse and child health,
• levels of financial hardship affecting parenting,
• strain of child mental health
• levels in lower educational attainment¹

For communities the experience of mass unemployment is likely to result in less social support networks and community participation, which add to a sense of grief, social isolation and a loss of community identity.

Level 2 Now

The negative implications from the lockdown on our lives as well as on the economy are causing damage that won’t be fully appreciated for years to come. This carnage is the result of business closures, job losses, rising unemployment and the stresses that go with it.

From a public health standpoint, we need to limit the social and health harms to our society, we need to move to ‘Level 2’ immediately. We will need to wrap stronger protection around hospitals as well as elderly care facilities and develop ways in which we can better support the elderly and people with underling health conditions who are living in homes with younger family members. These initiatives will need to be carefully thought out, developed and resourced appropriately. The vast majority of our population, including most working people, students and infants, face minimal risk from the virus and can safely resume normal life.

We need to get our society up and running again and open for business. Students need to be back at school and in tertiary education and all types of workplaces opened immediately.

The sooner the ‘lockdown’ can be lifted the more businesses and jobs that can be saved, the better us all. Unfortunately, the long-term impacts of the situation we find ourselves in will need to be worked off over many years and possibly decades by ourselves and our children and will shape our lives and society in ways that we are yet to fully appreciate.

25 April

Simon Thornley

The government is now cautiously opening schools, but many parents are reticent, fearing that their child will be exposed to the virus. Let’s take a look at we have learned about childrens’ risk of exposure to Covid-19 at school?

When thinking about the risk of death from Covid-19, it is important to appreciate that the risk is not the same for everyone. As our experience has made clear in the recent weeks, older people, living in resthomes are much higher risk of dying from the virus compared to all other groups. One’s risk of dying from the virus is about the same as our risk of dying that year given our age. This means that children of school age are extremely low risk for having severe complications from the virus.

In a systematic review of scientific studies relating to Covid-19 in children, the authors concluded that children had a much milder response to the virus than for adults. Of three children that required intensive care, all had severe underlying conditions. In one case-series in China, 90% of test-positive cases had no symptoms attributable to the virus. Of all children, infants are more likely to have severe complications.

One possible objection to returning to school is that adults could catch the infection from children. While this is possible, an analysis of cases from Shenzhen, China, shows that attack rates are higher in older adults and the majority of transmission occurs among household contacts. Modellers have concluded that school closures are unlikely to be an effective strategy for halting Covid-19. New Zealand has had a cluster of about 92 students at Marist College in Mount Albert, Auckland. The first identified case was a teacher and 12 students have subsequently tested positive. The majority of cases have been adults and at the time of writing, 79 cases had recovered.

In New Zealand, there is little evidence of risk from spread of infection in children. According to the Ministry of Health, at the time of writing, there were 18/344 or 5% of New Zealand’s active cases in people    under the age of 20 years. Overseas data shows that immunity to the virus is building in populations that have been tested. It is very sensible for the government to open schools. I believe that this will help build higher levels of immunity in children to act as barriers for the spread to elderly and those with pre-existing medical conditions. These people are the ones we really want to protect from the virus.

As a scientist I am trained to think critically, to evaluate evidence, and ask questions – lots and lots of questions. That’s my job. In March 2020 the World Health Organization predicted that 3.6% of those infected with COVID-19 would die. New Zealand’s own modelling predicted 80,000 Kiwis would die. These numbers seemed extraordinary to me. If they were accurate the impact of COVID-19 would be enormous. But, as I delved deeper, I began to question the accuracy of the predictions. At the time, the infection fatality rate was calculated as the number of COVID-19 deaths divided by the number of confirmed infections. As a scientist, that seemed overly simplistic. Surely many more people would have caught COVID-19 than had been officially tested? If correct, that would lower the predicted fatality rate dramatically. So I began to do what I’m trained to do: think critically, evaluate evidence and ask questions.

What I found was analysis and perspectives I had not been exposed to in New Zealand. John Ioannidis, Professor at Stanford University, and one of the world’s leading physician-scientists, was particularly vocal. The data collected on how many people had been infected (and used to model the fatality rate) were “utterly unreliable”. Not only was there no reliable evidence for “draconian countermeasures” like lockdowns, but if enacted, the measures would themselves lead to significant long-term social and health harm. His concerns were echoed by Sucharit Bhakdi (Professor Emeritus, Johannes Gutenberg-Universität Mainz, Germany) as well as many other eminent epidemiologists around the world. Why had I not heard these different arguments and perspectives in New Zealand? Where was the balanced debate?

On 31 March Dr Simon Thornley, an epidemiologist at the University of Auckland, published an article entitled “Do the consequences of this lockdown really match the threat?” His questions and concerns about the data resonated with me. It turned out I wasn’t alone. Simon received emails from across New Zealand with similar and related concerns. What impact would the lockdown have on mental health, rates of suicide, long-term unemployment, and poverty? What were the legal and ethical ramifications? The list of questions went on.

Last week our cross-disciplinary group of academics published COVID Plan B. Our aim is to get those different arguments and perspectives heard, expand debate and provide a pathway out of lockdown. We want to help New Zealand navigate its way through this pandemic in a way that mitigates its impact on all kiwis. But, while we have received considerable positive support from concerned members of the public, we have also received criticism because of our desire to widen the debate. We have been criticised, for example, for not focusing enough on the elderly or vulnerable. You may wish to read point’s 2 and 4 of Plan B to learn otherwise. To offer a different perspective is apparently now to be ‘contrarians’: people to be dismissed as outside the scientific consensus. I assume, by association, that Professor Ioannidis and those many eminent epidemiologist are also ‘contrarians’? As Michael Crichton (MD Harvard and author) says…“the work of science has nothing to do with consensus. Consensus is the business of politics… invoked only in situations where the science is not solid enough”. Some commentators and scientists have even suggested that we should remain silent and toe the line. This attempt to stifle debate and marginalise those who offer a different perspective on one of the most important issues of our time is deeply worrying and has more in common with political activism than science.

We must never stop interrogating and adapting our COVID-19 strategy. We should, at all times, be open to new analysis, different perspectives and vigorous debate, however uncomfortable that makes us. Different perspectives should be welcomed, not castigated. There can be few decisions in history that would not have benefitted from different perspectives and wider input. No one is well-served by groupthink. As Galileo said “In questions of science, the authority of a thousand is not worth the humble reasoning of a single individual.”

Dr Michael Jackson is a postdoctoral research at Victoria University of Wellington.

Gerhard Sundborn, Senior Lecturer Population and Pacific Health, the University of Auckland, urges us to consider that while staying home may be saving some lives, it is causing death and devastation to many more.

On Thursday 26^th March in response to Covid-19, in an unprecedented action, our government enacted a state of emergency to lock our country down to prevent a purported

The modelling that generated these frightening statistics is questionable. When we look at the actual number of infections of covid-19 in New Zealand in proportion to those deaths ‘possibly’ related to covid-19 it is apparent that this modelling was incredibly misleading. Renowned Stanford University epidemiologist Professor John Ioannidis raised the notion that much of the debate and statistics around covid-19 is a “once-in-a-century evidence fiasco.”

After 28 days, 12 elderly people have sadly died in their 70s, 80s and 90s. It has not been established if they died with Covid-19 or from the virus.  Although these deaths are undoubtedly sad, when viewed from the perspective of ‘years of life lost’, this is nothing like a wartime tragedy as modellers have made it out to be.

On average our country has had one Covid-19 related death every two and a half days.

Meanwhile, by comparison, across the country, two hundred and forty New Zealanders die every two and a half days from less publicised but equally tragic health conditions such as: heart disease, cancers, suicide, diabetes, pneumonia, respiratory infections, the flu and old age. Over the four week ‘lockdown’ period to date approximately 2,688 New Zealanders have died from other causes.

Like the twelve Covid-19 related deaths, these 2,688 non-Covid related deaths are not merely statistics. They are individuals – our mothers, fathers, grandparents, children, brothers, sisters and friends. Each loss of life is heartbreaking for those left behind.

Regrettably, the strict conditions imposed during this ‘lockdown’ has meant that for those 2,688 + 12 individuals who have departed – children have not been able to farewell dying parents in hospitals, dying people have not been surrounded by their loved ones during their final days, and funerals have taken place in empty funeral halls with no more than a lonesome widow by the departed one’s casket. These unconscionable conditions are outlined on a pandemic response funeral management plan prescribed by our Ministry of Health and based on a scenario that 32,000 deaths had occurred, which was last updated in 2012.

Within our Tongan community, a friend explained that already his family has endured these restrictions in the passing of four family members on separate occasions since the lockdown began. No doubt, for the close family and friends of each of the 2,688 and 12 deaths during this period – additional stress, depression, and grief is likely to be experienced long into the future as a consequence of not being able to celebrate their loved one’s life with the dignity and respect deserved. Where is the dignity and humanity afforded to anyone or family in such circumstances?

Dr Elana Curtis, Associate Professor in Māori Health has described similar experiences in her Māori community and speaks to the “terror being unleashed on my people”, specifically relating to tangi.

A workmate explained to me her frustrations with this ‘lockdown’ as her first grandchild was expected and she was primed to support her daughter during such a special time. These plans had been derailed. The emotional anguish was clear and understandably so.

My grandmother is 93 and lives in a retirement village close by. Her memory is vague these days and she is thought to have a mild case of Alzheimer’s dementia. She has been accustomed to seeing her family every day or two, does not like to socialise with others and is becoming increasingly agitated, lonely, and confused. She often asks why we have not visited and has spoken of ‘what is the use of being around if I can’t see my family’ even going as far as saying she should end it all. Along with this, our team has received reports of increased rates of suicides from District Health Board members. It was distressing to hear of the 93-year-old man from the Kapiti Coast who developed panic attacks and eventually died as a result of social isolation measures, rather than from the virus. My fear is that my grandmother is giving up and may well die of loneliness and despair before we can see her again, hold her hand, comfort her with idle chat over a cup of tea, a smile or a hug.

The question must be asked how many more of these ‘silent casualties’ is the lockdown responsible for?

While these are anecdotes, our team has received e-mails from District Health Board members who state that suicides have increased during the lockdown. As Treasury forecasts increasing unemployment of up to 26%, this is not unexpected, since evidence shows that suicide risk triples in frequency during similar circumstances.

These silent deaths and silent tragedies combine with growing evidence that the health risk of the pandemic has been exaggerated, to suggest that staying home is saving some lives but taking others.

New Zealand has changed dramatically in response to Covid-19.  Fundamental rights and liberties have been curtailed to assist in suppressing the virus.  From a legal history perspective, this is similar to what New Zealand experienced in World Wars One and Two and during the 1951 Waterfront Dispute.  It is unclear how long these measures will be necessary.  At the present time we just don’t have enough data to confirm the true case fatality rate of this virus in New Zealand, or overseas.  In the absence of comprehensive information, the government is now taking the cautious approach with a nationwide lockdown.

Under section 162(4) of the Education Act 1989, universities “accept a role as critic and conscience of society.”  As a New Zealand citizen, I understand and acknowledge the reasons for this lockdown.  As a legal academic and historian, what has concerned me most is some of the language being used by those currently leading the Covid-19 response.

My argument is that our leaders can achieve the necessary public cooperation without recourse to language which engenders panic and fear.  We can acknowledge the tremendous pressure on our leaders while also providing criticism and analysis.

The Prime Minister made the following statements in her lockdown speech on Monday 23 March.  “We currently have 102 cases.  But so did Italy once.”  “If community transmission takes off in New Zealand the number of cases will double every five days.  If that happens unchecked, our health system will be inundated, and tens of thousands of New Zealanders will die.”

We need to carefully analyse the situation in various jurisdictions around the world.  This includes Italy, Spain and New York City.  But it also includes Taiwan, Australia, and perhaps most importantly, Iceland.  Iceland has a population of 364,000.  It has embarked on a massive testing experiment and has currently tested over 36,000 people, both with and without symptoms.  That is 10% of its population.  As at Tues 14 April, there have been 1720 positive cases, many of which have exhibited no clear symptoms.  Thirty-nine people are hospitalised, with 8 in intensive care.  Eight people have died, giving a case fatality rate of 0.46%, compared with approximately 0.1% for the seasonal flu.  Iceland has implemented social distancing measures, but not as strict as New Zealand.  This information is available at the Icelandic government’s excellent website: https://www.covid.is/data.

So which case study is correct: Italy or Iceland?  Or does it all depend on how the pandemic is handled?  I don’t have the answer to this but by continually emphasising Italy and ignoring Iceland we lose balance in the debate and go straight to the most frightening case study.  Our leaders should be encouraging New Zealanders to discuss all the possible outcomes.  Informed discussion can reduce anxiety and panic.  As at Tues 14 April, we have 1366 cases in New Zealand.  Fifteen people are in hospital, with three in intensive care.  Nine people have died.  This is a case fatality rate of 0.65%.  So far our statistics seem to reflect those of Iceland, but we have carried out much less testing on a per capita basis and it will become increasingly difficult to know whether a low death rate reflects the nature of the virus or the success of the lockdown, or both.  The situation is so fluid and fast-moving that the statistics in this article will soon be out of date.

There is currently a big debate occurring in some jurisdictions about the accuracy of coronavirus modelling.  In particular, the work of Professor Neil Ferguson from the Imperial College London, has been challenged.  Professor Ferguson’s predictions of chaos from unchecked Covid-19 spread influenced Prime Minster Boris Johnson’s decision to lockdown Britain.  Professor Ferguson has since heavily revised down his predicted mortality rate, albeit in response to the lockdown decision and its possible effect.  My point is not to agree or disagree with Professor Ferguson’s modelling but rather to point out that there is huge uncertainty about how this pandemic will progress.  Our Prime Minister’s recent statements do not reflect the extent of this uncertainty.

We should be able to trust in New Zealanders to debate our situation without worrying that it will undermine our efforts to contain Covid-19.  The debates can actually act as a safety valve as the days of lockdown go by and provide a space for our right to freedom of expression (section 14, NZ Bill of Rights Act 1990).  The debates should include a rational discussion about how Covid-19 is developing in New Zealand in comparison to previous pandemics, such as the H1N1 Swine Flu of 2009, and comparing the different measures taken.

At the beginning of the lockdown, Police Commissioner Mike Bush was another leader in a position of huge, largely unchecked, power.  In response to the question of whether a citizen was allowed to go for a drive to a local beach or park, Commissioner Bush replied: “There’s a short answer to that – no they’re not.” (Interview, NewstalkZB, Wed 25 March).  This appeared to be in contradiction to the Prime Minister’s earlier advice and the instructions on the government’s official Covid-19 website.  The Prime Minister’s advice suggested more faith in the ability of New Zealand citizens to both help contain Covid-19 and keep an element of normality in their lives, not to mention have some freedom of movement (section 18, NZ Bill of Rights Act 1990).  The Police Commissioner’s language reflects an unnecessarily rigid and draconian approach.

This approach was further evidenced the next day when Commissioner Bush stated that citizens should only drive when absolutely essential and that “We may even have a little drive with you to see where you’re going.” (Interview, NewstalkZB, Thurs 26 March).  For those who don’t follow the rules, the Commissioner warned they would be “having a little trip to our place.” (Interview, RNZ, Thurs 26 March).  While police supervision of the lockdown is necessary, I believe the language used here is unnecessarily intimidating and provocative.  While acknowledging that the police needed to set boundaries early on, the instructions can be phrased in a way that reflects trust in the citizenry and reduces fear and anxiety.

This article is not focused on the specific laws involved in this lockdown.  However, on one hand we have the Health Act 1956, Civil Defence Emergency Management Act 2002 and the Epidemic Preparedness Act 2006 providing authorities with their current powers.  On the other hand, we have Magna Carta 1297 (original Charter signed in 1215), Bill of Rights 1688, NZ Bill of Rights Act 1990 and centuries of common law precedents protecting our freedoms as citizens.  Look carefully at the dates of those statutes.  Our fundamental rights go back over 800 years.  Our legal and constitutional traditions emphasise freedom and liberty.  That is the default option.  Only in times of extreme emergency should those rights be limited.  Even in this crisis, it is imperative that we remember our constitutional heritage.

In 1951, Prime Minister Sidney Holland invoked emergency law powers in an attempt to crush the Waterfront Strike.  This clampdown restricted freedom of association and freedom of expression, amongst other rights.  Holland’s actions could be viewed as a cynical power-play to destroy ideological opponents.  During both World Wars, the state took extreme measures to control the population, including conscription.  This could be viewed as a necessary corollary to fighting a war.  A Stuff poll on the eve of lockdown (Wed 25 March) suggested strong support for the government’s initial decision.[1]  This showed a nation concerned for its public health and its most vulnerable citizens.  Our leaders, including the Prime Minister and Police Commissioners, can do more to maintain this goodwill and reduce fear by the language they use and the information they provide.

The nervousness in our society is understandable.  However, the official talk of carrying papers, reporting on neighbours, mobilising the military, and providing police with massive discretionary powers increases this anxiety.  I trust the New Zealand public to form their views on the current lockdown based on its merits without requiring the additional overt and implied threats from authorities.  That trust comes from our shared democratic heritage and commitment to acting in New Zealand’s best interests.

New Zealand’s streets are currently deserted.  Some have made analogies to the New Zealand movie, The Quiet Earth (1985), in which three survivors wander around an empty New Zealand after an apocalypse.  It is now more important than ever to critically analyse the information available and debate the best way forward in an open and robust way.  We need to make sure that we never get to a situation where the analogies are instead being made to another New Zealand movie from long ago.

Sleeping Dogs (1977).

Dr Grant Morris is Associate Professor in Law, Victoria University of Wellington

[1] https://www.stuff.co.nz/national/health/coronavirus/120534052/coronavirus-poll-shows-kiwis-back-harsh-measures-but-are-extremely-worried-about-virus