Are we at the right alert level
It’s good that the Government has now published a guide to what we can expect in the future in terms of restrictions on work and movement. Of course it should have been out weeks ago, not two months into the crisis.
One of the most difficult things for the public has been the radical shifts in stance from the Government, often within 24 hours. We went from no need to take action against travellers from Italy to needing to take action against every country on Earth. We went literally within 24 hours from no need to cancel March 15 commemorations to cancelling then. We had the half hearted self quarantine policy which a few days later became the much needed travel ban.
So the four alert levels should help in terms of the public knowing what the likely next steps are. However there are still two big questions.
The first is it is not clear what the criteria will be to step down an alert level, once there. Is it expected Level 4 would last for weeks or for months? What is the criteria to decide Level 4 can be wound back to Level 3?
The bigger question though, and a crucial one, is whether the Government is right to have New Zealand at only Level 2, rather than Level 3 or even 4.
The difference may be massive.
An excellent analysis is on Medium by Tomas Pueyo. His previous analysis has been viewed over 40 million times, It has been endorsed by numerous public health experts.
He is scathing of the mitigation strategy which is around flattening the curve.
This is based on the UK. It shows flattening the curve still has the need for ICU beds well in excess of capacity by more than a factor of 10. And also it means the health system remains at over capacity for longer.
The current UK policy is the blue line. Better than the black line, but still terrible.
So the author recommends a suppression strategy:
Go hard right now. Order heavy social distancing. Get this thing under control.
Suppression does mean that people will eventually get infected, so what is the benefit of delaying it. He explains:
The US (and presumably the UK) are about to go to war without armor.
We have masks for just two weeks, few personal protective equipments (“PPE”), not enough ventilators, not enough ICU beds, not enough ECMOs (blood oxygenation machines)… This is why the fatality rate would be so high in a mitigation strategy.
But if we buy ourselves some time, we can turn this around:
- We have more time to buy equipment we will need for a future wave
- We can quickly build up our production of masks, PPEs, ventilators, ECMOs, and any other critical device to reduce fatality rate.
Put in another way: we don’t need years to get our armor, we need weeks. Let’s do everything we can to get our production humming now. Countries are mobilized. People are being inventive, such as using 3D printing for ventilator parts. We can do it. We just need more time. Would you wait a few weeks to get yourself some armor before facing a mortal enemy?
This is not the only capacity we need. We will need health workers as soon as possible. Where will we get them? We need to train people to assist nurses, and we need to get medical workers out of retirement. Many countries have already started, but this takes time. We can do this in a few weeks, but not if everything collapses.
He looks at how Governments need to do everything to get the rate of infection (r) below 1. And how all decisions should be data driven based on cost and likely effectiveness.
I really recommend people read the whole article, then decide for yourselves if you think being at Alert Level 2 is a sensible level or not. Should we going for a mitigation strategy or a suppression strategy? If the latter, then shouldn’t we be at Alert Level 4?