Wednesday , April 1 2020

Ready-up

Summary:
My column in the last Insights newsletter covered some of the coming Coronavirus mess. The government this week extended the COVID-19 (coronavirus) travel ban barring foreign nationals from arriving in New Zealand from mainland China and suggesting self-quarantine for Kiwis returning.The continued ban feels like the right decision for a highly contagious disease with mortality rates that appear to be around twenty times higher than the seasonal flu. But feels are a poor basis for policy.The disease has some very worrying features.Oral swab testing can miss cases detected by a blood test. And while the virus can be detected in most people within three to seven days, it takes up to 24 days for others. Quarantine for those who have been in contact with anyone who has been infected will be

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The government this week extended the COVID-19 (coronavirus) travel ban barring foreign nationals from arriving in New Zealand from mainland China and suggesting self-quarantine for Kiwis returning.

The continued ban feels like the right decision for a highly contagious disease with mortality rates that appear to be around twenty times higher than the seasonal flu. But feels are a poor basis for policy.

The disease has some very worrying features.

Oral swab testing can miss cases detected by a blood test. And while the virus can be detected in most people within three to seven days, it takes up to 24 days for others. Quarantine for those who have been in contact with anyone who has been infected will be long.

Where about 5% of similar patients in Singapore wind up in intensive care, Wellington’s 29 ICU beds are starting to look just a bit inadequate. The health system will very likely quickly be overwhelmed if there is any serious outbreak.

So, preventing an outbreak seems important, if it is possible.

As more cases emerge internationally, any travel-ban strategy would have to expand rapidly but would become far less effective. And, as NZIER pointed out this week, delaying COVID-19’s arrival to coincide with the local flu season could make things worse rather than better.

We need to be thinking beyond the ban.

The government is contemplating support for exporters. But that seems only the start of the problem. How many businesses depend on timely deliveries of critical parts, tools and materials from China? Inventories will be running low and China’s shutdown will not end soon. Will everyone get a bailout?

There may be a case for compensating workers and firms affected by quarantine requirements for workers who have been exposed. Not providing that compensation makes it far too tempting for firms to tell workers to come into the office regardless of quarantine requirements, as a SkyCity manager reportedly did with an employee under quarantine after returning from Wuhan.

Singapore compensates firms for quarantined workers while applying sharp penalties to firms and workers who break quarantine. It is managing to keep something of a handle on its outbreak. The government should be considering that kind of model.

Businesses should be preparing to deal with short-notice work-from-home arrangements in addition to supply chain disruption.

The travel ban has bought us a bit of time, nothing more. Use it wisely.

Italy went from 3 cases to 130 in 48 hours, including 26 in intensive care and three deaths. And Bocconi University is now closed, along with schools in Milan. There's also a ban on public events.

It looks to be not under control in South Korea, and not even close to being under control in Iran.

The government today announced another extension of the travel ban with China. It seems almost pointless. There are still far more cases in China than elsewhere, but folks could fly in from Milan, or Iran, or bring it back from a trip to Bali where nobody seems to believe the official stats that there aren't any cases.

I would be surprised if the virus were not already here.

It has a long incubation period and exhibits similarly to a cold for a lot of people after that. I am surprised that we have not yet had a confirmed case.

It doesn't seem implausible that the first case that presents here will quickly open up a pile of additional diagnoses among close contacts, and their close contacts. Numbers rising quickly consequent to knowing where to be testing will require the government to move quickly. It would be best if they had already mapped out what they plan on doing in that event.

The government does have a pandemic plan.

It isn't communicating anything from it.

Under what conditions will schools be closed?

What provisions will be in place to support those placed under quarantine, and their employers?

What penalties will apply to workers and employers who allow breaching of quarantine?

What facilities is the government putting in place for quarantine for those who are ill?

How much isolation-ward capacity do the hospitals have, and what happens if that becomes overwhelmed? Do we know whether the spread to almost all patients in the psychiatric ward in one South Korean hospital was a function of the perhaps greater difficulty of hygiene control in a psychiatric ward, or something more endemic to hospitals in places that are not Singapore?

Has the government sought assurances from providers of critical infrastructure that they are prepared for potential loss of critical workers and for breaks in supply chains?

A lot of GPs require people to show up in person for a re-up on a regular scrip, probably because that's how they get the fees. Might the government consider requiring that regular scrips be issued on request in the lead up to and during a pandemic so as to reduce the number of people showing up at the GP? Like, maybe there's some sense in having the GP check that my daughter still has asthma and that the meds are appropriate, but making people show up at the doctor's right now seems silly to dangerous.

There seems to be a lot of stuff that could be being sorted out during this brief respite in which it feels like we're just waiting for the Mask of the Red Death to make his appearance. If the government is onto it, I haven't heard about it.

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