Monday, 13 April 2020

COVID-19: WE STILL DON'T HAVE A PLAN. TELL POLITICIANS THAT TESTING IS THE BEST ONE AVAILABLE.

We should be concerned that the politicians - the one-string violins preaching social distancing - are far too caught up in the daily afternoon “War by Video Conference”. They are not making any real decisions to control COVID-19 spread or how to return the province’s economy to life as fast as possible, without precipitating another outbreak. They are awaiting instructions from Ottawa. 

Having emptied the public Treasury these past five years, why would we think that they possess the skills necessary to manage a pandemic, anyway?   

Let’s get serious. The afternoon “Video Conference” is nothing more than chatter; it is as predictable as the afternoon Soaps. When you have heard all the admonishments over “social distancing”, what have you learned except that they will return for more of the same the next day?  We hear it all from the PM anyway. 

We need a Plan, and we don’t yet have one. This article will suggest one.


But, first, let’s start here.

Dr. Rahman is a well respected specialist in this Province but he ought to have counselled the politicians patience, until his team was ready. The caveats that accompany the presentation are simply too many.

The NL model suggests that peak infections will occur in this province in November, if penetration of the virus is kept low (which assumes the same control of human movement as in the Canadian model). His projection also suggests new infections and deaths occurring in the province into 2021. But, as in the Canadian model, long term projections tend to be very inaccurate. It is the short term which warrants our attention.

In contrast to the NL model, the Canadian model suggests that a flattening of the curve will occur sometime during the summer, presumably July, with the “strong epidemic control” currently being applied. The inconsistency however, is likely due, as Dr. Rahman notes, to “frequently misleading” assumptions, the cluster effect (presumably he is referring to the funeral home case), and the small number of deaths recorded here. The model works better on large populations. Rahman has stated that his team plans to continue refining the model based on local data and look for “consistency with other models”, too.  He should be encouraged to do so.

Nothing stopped provincial politicians from embracing Dr. Rahman’s work prematurely, however.  It has already elicited a response from Health Minister, Dr. John Haggie, who the CBC recorded saying in reply to those critical of how many businesses have been allowed to stay open: “…you’re going to live like this until November”.  

The economy of an insolvent province might be able to cripple along for two months, possibly three. But until November?  A loss of jobs and incomes, the closure of businesses that may never reopen. That is a profound reality with disturbing social and psychological consequences. Less than a choice about fighting COVID-19, the economy is actually integral to the public’s health and welfare. For that reason, the urgency of the strategies selected must be based on science – but –a plan to achieve this outcome must not become confused with the rhetoric of Video Conferencing. It must be found in a Plan of specific action, something far more than just social distancing.

Such a Plan must be inspired by urgency, too.

We should remember that most of the health care system was operating at 100% before the appearance of COVID-19; consistently reported was an uncomfortably large backlog of work.  Months of delay dealing with non-COVID concerns, as COVID capacity is reserved, suggests that there will be no catching up on the massive backlog over the next two years, at minimum.

Taking all those issues into account, if Dr. Haggie believes that Dr. Rahman’s model is accurate enough, the public ought to have heard the urgent question: how can we “flatten the curve” more vigorously, prevent a second outbreak and not kill the economy, too? It is a tough question. It is one that he and Premier Ball ought to have said they will be reflecting on, and employng competent expertise to consider how that might be done. But no such luck!

Other provinces and countries are thinking of their economy.

The case of New Zealand (population 4.8 million and an island) may be very instructive. Though having only 102 cases of COVID-19 and no deaths at the time, the country “imposed some of the toughest restrictions in the world.” Two weeks later the government’s science advisor reports a "flattening off" of cases…adding, "We haven’t seen any further growth". The next phase, she says, is to "squash it". New Zealand, in taking such an aggressive approach to containing the virus, seems to have removed any prospect that their economy will be shuttered for long.  

The case of Iceland is even more relevant. The population of 365,000 recorded one of the highest confirmed cases, per capita, of COVID-19 in the world at 1300. The British paper, The Telegraph, reports that in the Island country you will find “cafes, pubs and shops are doing a gentle trade, while schools remain open”, as is the tourist trade – if a flight can be had.  What is Iceland doing that’s different? The answer: testing, testing, and more testing. In proportion to the population, Iceland has tested five times as many people as has South Korea (the best prepared and one of the most successful countries in the fight against COVID-19) and 30 times the testing conducted in the UK.

Did Newfoundland pick up the phone to Iceland or New Zealand for advice? 

In Quebec, a Province still hard hit by the Coronavirus, Premier Legault expects the infection rate to peak “in the next few days”. While rightly acknowledging that controlling the spread of COVID-19 is their “No. 1 priority”, according to the Globe and Mail, he and his director of public health, Horacio Arruda, say “they have begun talking about a need to balance economic growth with an acceptable rate of infection”.

A number of provinces have trended to near zero daily cases of COVID-19 and some others seem to be well past peak; they will be thinking – and talking - about an economic restart much as Quebec is – and should be. The worry is this: in restarting the economy, will the COVID-19 spread be re-initiated? Has any thought been given to reducing the prospect of a second flare up?

The stated goal of governments has been to both minimize COVID-19 spread and to “flatten the curve” so that the health care system does not collapse due to lack of capacity. The government has taking for granted that people will comply with social distancing protocols and, otherwise, believe that they need do nothing else. But even this limited goal has no sense of urgency. People arriving at Torbay Airport, for example, are allowed to bypass the officials who are dispensing information on quarantine requirements. The declaration form does not require that contact information to be supplied. There appears to be no follow-up, no tracing, no policing of quarantine regulations. 

How can this not be considered gross negligence on the part of the government? Are we really prepared to kill our economy having no measures in place, to make the economic shutdown effective or follow-up when business starts up again? How could the funeral home incident, responible for around two thirds of all cases in this province, not be a clarion call to put in place and enforce a regime of quarantine?  

There are other dimensions to the issue. The Canadian Press reports that Harvard researchers have released a March 27 analysis, ahead of peer review, suggesting “that multiple “intermittent” periods of physical distancing might be a more effective strategy for saving lives than continuing with “strict” distancing measures.” If that outcome is confirmed, New Zealand may not have seen the last of its firm lockdowns. Unlike New Zealand, however, a place like NL, where indecisive leadership is our worst fear, uncertainty about the research can only add to dither. At least New Zealand has a Plan even if the jury is out whether it is the best plan.

Iceland, however, may be able to teach us a lot.  

The Basis of a Real Plan
There are sound reasons for following the course Iceland has taken - testing. It is also the basis of a plan proposed by the Tony Blair Institute for Global Change to the British Government entitled: Covid-19 Testing in the UK: Unpicking the Lockdown. The Institute proposes mass testing of the British population for COVID-19. States Blair: “I do not see a way out of this crisis without mass testing and the development of a clear exit strategy involving testing and tracing, together with innovations in treatment and the use of technology.”

Pressing the point, Blair adds: "testing is not simply of importance. It is fundamental to success. It is not one dimension that ranks alongside all the others. It is paramount. Without it, the lockdown is longer and the exit less predictable and more hazardous."

The Blair Institute’s Plan for testing makes enormous sense; it is eminently suited to both large and small populations. It is a “Plan” that will give each one of us confidence, while we still employ “social distancing” and other practices, that the workplace is as safe as it can be until a vaccine, the ultimate solution, is available.  It is a Plan that provides some insurance that having shut down our economy - with all the costs that measure implies - it will have been worth it.

Finally, the Prime Minister of Canada is never going to say when we should all don our boots and get back to work. That is the job of local elected officials; it is their job to have a strategy – and a Plan – that works for this province. 

It should be added that the media play a critical role here. They can choose to fill their news slots with the easy rhetoric of flat-footed politicians or they can ask their own tough questions about whether there exists any desire - or sense of urgency - to fight a war against COVID-19 that reflects the magnitude of the economic and financial loss being endured by so many. If they have learned anything from the Muskrat Falls debacle, the best talkers are some of the most dangerous and empty-headed, too.

Frankly, all us – the public, too – have let the politicians off far too easily.