On Why We Shouldn’t Be Pushed Into Re-opening Our Borders
I believe in yesterday as much as Paul McCartney, but it was bemusing to see the amount of media attention lavished last week on the pandemic-related musings by former government science adviser Sir Peter Gluckman, former Prime Minister Helen Clark and former Air New Zealand CEO Rob Fyfe. Unfortunately, the Gluckman paper had no fresh insights to offer as to how and when New Zealand should re-open to visitors from places where the Covid-19 virus rages on, virtually unchecked. Instead, Gluckman and Co posed a string of rhetorical questions – I counted 23 of them in a three page document – presented as if no-one has ever considered such matters before. At this point, the decision-makers should reasonably expect more from those purporting to offer them expert advice.
Instead, much of the document traverses very familiar ground. Maybe, it suggests, we should invest in a low cost Bluetooth or Covid card tracing app. Maybe it will take longer than we think to develop a Covid-19 vaccine,. Maybe a transTasman bubble will happen, but maybe not as soon as we’d like. Maybe universities could quarantine foreign students themselves but only if they could afford it. Maybe devising a strategy for lockdowns is easy, but maybe re-opening to the world will be harder. Maybe we could fast track arrivals, but only assuming we can detect them safely. Maybe “much depends on what is happening in other countries.” And so on.
Am I being too negative? Wellll, Gluckman is no longer the government’s chief science adviser. Professor Juliet Gerrard is. In late May, Gerrard and her colleague Rachel Chiaroni-Clarke published a discussion paper called “”Bubbles, Borders and Risk : What Does Common Sense Look like in a Global Pandemic?” Frankly, it is difficult to find any point on which the Gluckman paper takes the debate on re-opening our borders beyond what Gerrard and her colleague said six weeks ago with far greater clarity, and with more relevant global comparisons. (Read in sequence, the Gluckman paper reads like a once-over-lightly reprisal of the Gerrard paper.) Can there be any reason why the work of these two female scientists has been all but ignored, while what Gluckman and Co had to say won prominent coverage on the nation’s news bulletins?
Given the prominence it has been afforded, it is necessary to look closely at what Gluckman, Clark and Fyfe are saying. Their paper begins by creating a straw man:
To many epidemiologists, elimination means the reduction to zero of an infection in a defined geographical area. But as epidemiologist Sir David Skegg noted in his advice to the Epidemic Response Committee before lockdown was imposed, many others in the epidemiological community pragmatically define elimination as the reduction of case-transmission to a predetermined very low level.
In reality, this alleged conflict between extremists and pragmatists has never existed here. Who were these “many” epidemiologists who have allegedly been advocating all along for a reduction to zero as an achievable policy goal? None come to mind. A controllable amount, not zero has been the aim. As long ago as late April, MoH director Dr Ashley Bloomfield was carefully defining “ elimination” in the same limited terms as Skegg:
"A small number of cases, a knowledge of where those cases are coming from and an ability to identify cases early, stamp them out and maintain strict border restrictions so we're not importing new cases. That's what underpins the elimination goal".
Similarly…in April, Otago university epidemiologist professor Nick Wilson was also defining “elimination” as a controllable number of cases, and with a managed re-opening of the borders and a possible transTasman bubble in mind. Yet having created the straw man, Gluckman proceeded to offer this account of recent history to RNZ :
Speaking to Morning Report on Friday, Gluckman said planning for the future has become bogged down in an unhelpful shift to New Zealand's goals after the country went into lockdown - from trying to 'flatten the curve' of the numbers infected with the virus at any one time, to complete elimination. “Nobody is saying open the borders today ... but at some time in the near future we have to have a strategy in place of gradually opening the border, because we cannot [keep it closed] indefinitely," he said.
In reality, New Zealand’s goals have not shifted between the two poles identified to RNZ by Gluckman because neither pole has ever been embraced here. The ‘flattening the curve’ approach ( adopted with variations by the UK and Sweden with deadly consequences) was explicitly rejected by PM Jacinda Ardern back in late February . So the claim that New Zealand has since got“ bogged down” in an “unhelpful shift” to an equally fantastical goal of “ complete elimination” is bizarrely beside the point.
Similarly, no-one has been putting their head in the sand as if an indefinite closure is either possible, or desirable. Instead, they have been implementing a careful approach to re-opening – try this, wait and see before proceeding further - that has been consistent with saving lives, and with conserving the limited resources that New Zealand has in reserve to track and treat a major outbreak of community transmission. (“Oops” is not a strategy, however noble the intentions may have been.)
Our success so far has been the product of good management and a dose of good luck. But there is no room for assuming we will continue to be lucky. Nor is there any imperative to gamble with community health, simply because the added risk factors we entertain might hopefully benefit a particular sector of the economy. As the Melbourne based Otago University epidemiologist professor Tony Blakely warned only yesterday : “If you have eliminated the virus – look after that status. Do not lose it.” To its cost, Melbourne is now finding the stress and uncertainty caused by having to plunge back into lockdown is a markedly worse situation for residents, and for the economy.
No-one likes to be a killjoy. Yet surely….urging relaxation at our borders as if this is pragmatic, hard headed common sense flies in the face of the current global experience with this virus, from Florida to Flemington. For whatever reason, Gluckman has led himself into making further false contrasts :
Do we continue as we are now indefinitely, relying on strict quarantine and a giant moat? Even with current controls, the number of cases at the border will likely grow as more New Zealanders drift home. Do we need to start exploring alternative strategies that might at the appropriate time allow increased border flow, thus allowing more of New Zealand to flourish? And when would that be? What would be the criteria?
When and what, indeed. In reality, the entire premise is false. No-one has been projecting strict quarantine behind a giant moat in perpetuity, although – as an aside - there are marketing advantages in the interim from New Zealand being seen to be the safest place on the planet. All along, the coalition government has been open to exploring what Gluckman calls “alternative strategies that might at the appropriate time [love those qualifiers] allow increased border flow, thus allowing more of New Zealand to flourish.” Sigh. To repeat : this is exactly what the government has been doing. Yet the false polarities that permeate Gluckman’s argument keep on a-coming :
These distinctions may appear subtle, but they become critical in our collective thinking about the path ahead. The former creates an expectation of keeping the virus out absolutely and indefinitely and that even one case coming in could be seen as a failure. The latter accepts that cases will occur and that processes need to be in place to ensure community spread is not established.
Huh? No-one except the hysterics in the media and in the National Party happen to regard “one case coming in as a failure.” It seems necessary at this point to repeat that it is the virus – and not the lockdown – that is causing the biggest global recession in a century. That is why countries with different approaches to containment than New Zealand have been hit equally as hard, economically speaking. It is a tired observation – but unless we continue to contain the virus successfully, we won’t be able to respond successfully to the economic recession. The measures have to proceed in tandem, frustrating as that may be.
To that end….currently, New Zealand business is not imprisoned behind a giant moat or by the security measures at the borders. Domestically, many retail and hospitality outlets are currently profiting from the safe public spaces those cautionary measures have created, while exporters are benefitting from the fact our trade routes and supply lines have largely been kept open during the pandemic, despite the pressures placed on them. Lets not exaggerate, for effect.
The actual strategy – not the straw figure in Gluckman’s head – is to gradually rachet up the balance between the incoming risk and our existing treatment and tracing capacities, both of which – to repeat – remain at risk of being quickly over-run by a large community outbreak. Yes, it may take months, or even a year or more. That’s what it may take to protect life during a pandemic. In the meantime, having people stamping their feet about the pace at which business-as-normal is being restored is simply childish. Fortunately, the adults in the room are still in charge.
No doubt, Gluckman would like to be viewed as the pragmatic voice of reason and foresight, beset by the allegedly short term thinking of an imaginary band of public health extremists. I’m just not buying it. All along, the goals being pursued by government, by the MoH and by “many epidemiologists” have been relentlessly pragmatic. First, stamp out community transmission, then reduce imported cases to a manageable level such that neither route of infection can overwhelm our treatment and tracing capacity. Nothing about this effort has become “bogged down”. The policy is succeeding brilliantly : there has been no case of community transmission in this country since May 22. People have been able to resume their normal lives, and businesses have been enabled to start recouping their losses through being able to re-open in a climate where their customers feel secure enough to venture out. In New Zealand, firms are not lurching back and forth into lockdown as Victoria has just done, and as several US states are about to do.
From Florida to Footscray
As I’ve mentioned in previous columns, you would think the plight of Victoria ( population 6.3 million) would feature prominently in any meaningful debate on how New Zealand should – and shouldn’t - proceed. Nope. Victoria’s re-infections and community transmission kicked back into life a fortnight ago, yet Gluckman devotes only half a sentence to it, and then not by name : “Even opening the Trans-Tasman bubble looks further away than it did a month ago with resurgent community spread in at least one Australian state.” End of story. Australia’s softer lockdown has been sung to the skies by National politicians here over recent months. That model is currently getting some extremely bad press, yet Gluckman can barely bring himself to mention it. Presumably because Victoria contradicts his thesis that our public health extremists are holding the country to ransom, unnecessarily.
Sure, one can understand the bashful reticence about mentioning Victoria. There could hardly be a worse time to be blustering that “at some time in the near future we have to have a strategy in place of gradually opening the border, because we cannot be [closed] indefinitely.” Obviously. Yet Melbourne is demonstrating in spades just how dangerous it is to relax the rules sooner rather than later. What is needed now is not grandstanding…. but the hard intellectual work of devising what the pre-conditions for re-opening should be, along with a practical timetable for phasing them in. Stamping your feet and demanding a strategy is not a strategy.
Footnote One : Interesting to see Gluckman embracing without question the media narrative that there is significant public “anger” at the government for the occasional lapses that have occurred in the quarantine system. Hopefully, the patronising tone here is accidental:
The public has shown remarkable forbearance and support for the sacrifices of lockdown. But people’s anger at process breakdowns was to be anticipated, given the early phase of the pandemic, during which most of us enjoined in a collective and cohesive blitz mentality, had passed. This is entirely as we would expect our emotions to evolve as we transition through a prolonged crisis.
In fact, the opinion polls do not indicate that significant levels of public anger do exist about the limited number of quarantine security lapses that – so far - have not resulted in a single case of illness, let alone a single death. Instead, the polls indicate widespread support for the government’s handling of the crisis. Gluckman’s assumptions to the contrary remind me of the US situation where - for partisan political reasons, amplified by the media – it became received wisdom that the US public was chafing at the lockdowns and itching to get the economy back open again. This was despite US opinion polls indicating massive levels of public support for the lockdowns, with 80% of respondents saying that they felt protecting health and safety was a higher priority than re-starting the economy.
Much the same applies here. With reason. After all, who would be willing to offer their own family members as the canaries in a Covid-19 experimental coalmine, merely for the greater good of the economy? The coalition government still has a solid mandate for moving with extreme caution on the re-opening of our borders.
Footnote Two: If I can ask another rhetorical question : what is Helen Clark doing lending her name to this geezerish attack upon the coalition’s handling of Covid-19 ? At one point, Gluckman mutters darkly about the political motivations of those who disagree : “To what extent is the political cycle affecting necessary discussion and decisions?” Does Clark agree with this premise - that for political advantage, the people making the decisions about Covid-19 are dragging their feet on relaxing border security, thereby inhibiting“ necessary” discussion and debate ? Or has this been an own-goal, in that the paper was expected to make a positive contribution to the debate on border re-openings ? If so, such hopes were misplaced.
Footnote Three: The Gluckman paper shows a touching faith in the efficacy of automated contact tracing :
The costs of failing to develop an effective automatic tracking system may come to haunt us. Any simpler border system will meet public expectations and public-health needs only if track, trace and isolation are rapid and effective. The costs of the COVID-card-type methodology are small compared with the costs of continued complete lockdown. If we required such a tracing system for all incoming passengers and provided a large number of New Zealanders had adopted it, then we would have more alternatives, at least for low-risk entrants.
Can the co-authors really be so unaware of the backlash against the over-hyped expectations formerly held about Covid card/smartphone apps, given their limited uptake, and limited utility? Reportedly, six million Australians have downloaded the tracing app over there, yet not a single case of infection has been detected via the app that was not detected by other means. As for uptake, Singapore’s much touted TraceTogether app never achieved more than 20-25 % uptake even in that tech savvy location, such that Gluckman’s phrase “provided a large number of New Zealanders had adopted it” rather begs the question. Besides the affordability/access issues to do with uptake – including users needing to be able to afford to keep Bluetooth operational at all times on their smartphones - proximity does not mean infection, and the apps and Covid cards being mooted have (so far) routinely delivered troubling levels of false positives and false negatives.
This pragmatic commentary from the Brookings Institute also seems relevant:
We have serious doubts that voluntary, anonymous contact tracing through smartphone apps—as Apple, Google, and faculty at a number of academic institutions all propose—can free [users] of the terrible choice between staying home or risking exposure. We worry that contact-tracing apps will serve as vehicles for abuse and disinformation, while providing a false sense of security to justify reopening local and national economies well before it is safe to do so.
True, the Brookings Institute does also say that automated contract tracing can be helpful if and when infection levels have previously been kept low. Unfortunately, that window is prone to being quickly overwhelmed by a major outbreak. The low infection situation in New Zealand is precisely what would be jeopardised.by the kind of border openings being mooted by Gluckman. Currently, our quarantine capacity is struggling with the thousands of Kiwis returning home, let alone with the influx of new tourists, new business arrivals and international students he is proposing.
To enable this, Gluckman and Co suggest it would be possible ( somehow, sometime) to detect and safely fast track “low risk arrivals” such as “long term tourists business travellers and tertiary students” coming from countries that would allegedly require only limited screening – and managed self isolation - with the help of quick and reliable pre-departure blood tests and antigen /RNA detection procedures that currently do not exist. Oh, and the relaxation of the rules being urged would paradoxically, also entail “mandatory tests every day or second day, and a shorter quarantine for people from low-risk countries who want to enter. ” Hate to ask rhetorical questions again - but is he seriously suggesting shorter quarantine periods than the incubation phase of the virus? And is he also seriously suggesting mandatory 24 hour or 48 hour Covid testing for tourists and busy business executives during their time spent here? Hard to imagine many would be willing to comply.
Footnote Four : To its detriment, socio-economic factors are entirely missing from the Gluckman/Clark/Fyfe analysis. Apropos of which Professor Tony Blakeley gives this useful background
Two hotels have had outbreaks among the staff undertaking the quarantine. These staff, in large part, appear to have been private company security guards contracted to undertake the quarantine duties. This under-trained workforce (not their fault) are also, unsurprisingly, living in lower socioeconomic suburbs with larger families, more crowding, and so on. Boom – the perfect recipe for things to go wrong. One hotel we could put down to bad luck. But two hotels? This really does look like a systems failure. And a judicial inquiry has been launched. To be clear, mistakes will happen in a fast moving pandemic situation”
Indeed. Not every mistake is a fiasco or a calamity, even if the New Zealand media tends to to treat them as such. (Mindful of the Melbourne lessons, the Ardern government has been beefing up the hygiene procedures among security staff and contractors at our own quarantine sites.) The nine housing estate in Flemington and North Melbourne now in total lockdown house an estimated 3,000 people in 1,345 units.
There have long been concerns about overcrowding in the blocks, which often have shared laundry facilities and small units. To be eligible for housing assistance, people are usually on low incomes or live with disabilities. "Some public housing tenants have fled war or family violence," Victorian Council of Social Service chief executive Emma King said."Some are dealing with mental health challenges. Many don't speak English as their first language,,,”
That’s a key point. Many of the Melbourne tower block residents work in casual or insecure jobs likely to be jeopardised by the 14 day lockdown now imposed. Many of the people affected cannot afford food deliveries, and many lack the language skills and the translated documents necessary to know what is going on. Especially since – as I’ve been told - the loudhailer messages to the tower blocs along Racecourse Rd in Flemington seem to be being made only in English.
While this is horrendous in itself, the Melbourne crisis is also a vision of what could have happened – and may still happen – here, in the overcrowded, low income areas of Auckland and other NZ metropolitan centres, if border security was thrown open to greater experimentation. That, finally, is what so irritating about the tone and content of the Gluckman, Clark and Fyfe analysis. It embodies the impatience of the privileged, and the advocacy of risks whose outcomes would be borne by others, many of them on benefits or precariously employed within the service economy.
Meaning : continued caution is entirely appropriate, as part of a duty of protection. The vulnerable shouldn’t be exposed to Covid-19 security experiments, and especially not by thought experiments that enable experts to present themselves as innovative thinkers about our post-Covid future. Play with your own lives, if you must.