April 24, 2020
Dr Rawiri Taonui | COVID Update for Māori 24 April 2020 | Tensions in testing and at checkpoints
COVID Update for Māori 24 April 2020 | Tensions in testing and at checkpoints
Dr Rawiri Taonui
New and Total Cases
There are 5 new cases today. Total cases are 1456. New cases are single digit for 6 consecutive days 9-9-5-6-3-5. There is a single new death today and 17 in total.
Recovered and Active Cases
There are 1095 recovered cases and a new low of 344. This massive 63% decline since the peak of 930 active cases on April 6, is a real achievement of the lockdown. We need active cases to drop below 50 by the end of Level 3. On the current trend, active cases could reduce to around 100 cases within 7 days.
A record 6,961 tests were processed yesterday. Total testing is 108,238 at 21,650 tests per million. This is heading toward the right territory by international standards. The next goal should be 25,000 tests per million then 30,000 tests per million. Subject to any as yet undiscovered pockets of community transmission in the regions, we are on top of COVID-19. However, we must stay on guard. A recent analysis of ‘Patient One’ in China, Italy, Spain, Australia and South Korea demonstrates that COVID-19 is spread lethally and fast and that a single case either symptomatic or asymptomatic can create havoc through social contact and events.
For the first time, there are no new Māori cases for two days running. The total is 124. We remain 8.5% of all cases. In the last 8 days, new cases have run 2-1-0-2-1-0-0-0. This is positive. The emerging picture for Māori is one of thorough testing in the 4 DHBs of Auckland and the Waikato, but under-testing in several regions (see below).
Pacific Peoples Cases
There is 1 new Pacific case. The total is 69. Pacific remain steady at 4.7% of all cases but still below demographic. Over the last 10 days, new cases have run 1-1-1-1-1-0-0-1-1-1. This is great. The picture emerging for Pacific is one of thorough testing in the 4 DHBs of Auckland and the Waikato, but possible under-testing in the regions (see below).
Testing for Māori and Pacific
The national and regional figures for testing of Māori to 18 April are challenging to decipher because the Ministry of Health withholds testing data by ethnicity and DHB. I have however been able to develop a metric that can investigate a good proportion of the data.
There is emerging confidence of good testing of Māori and Pacific in the Auckland, Waitematā, CountiesManukau and Waikato DHBs. As four of our largest DHBs, they comprise 40% of all tests covering 2.174 million of the population at a rate of 16.8 tests per 1000 of population. The scale on which these DHBs are testing masks the situation in other regions. This has several implications. The main one is a significant challenge in reading the data. Despite that, the following clear summations can be made:
- The current emphasis on Māori and Pacific in Auckland likely means there is significant under-testing of the Asian community.
- The national rate of testing in regions beyond these DHBs is in most instances significantly lower.
- There is emerging confidence that testing of Māori in Auckland and the Waikato. Beyond that, there is serious concern about testing in the regions. Efforts are being made to address this. However, going on recent reports these are fraught. In the Taranaki, for instance, there is a report of the DHB insisting that one of their nurses conduct the swab tests although the Māori testing group they are working with have qualified nurses of their own.
- This is one of the main themes in Māori-Pacific testing. DHBs with higher numbers of Māori and Pacific managers have confidence in licensed Māori and Pacific health groups, those administrations with mainly Pākehā managers, less so. It reminds us of the 1913 Smallpox epidemic, when it was illegal for any Māori person, qualified or not, to deliver a vaccine injection.
- The concentration of the Pacific population in Auckland and the Waikato, the contribution of Pacific led testing sites, the strength of communities especially around the Churches and awareness of the recent measles epidemic means there is better two-way accessibility to testing and higher testing activity. One outcome is that the higher numbers of Pacific being tested in these areas possibly obscures pockets of under-testing in other regions.
- The Pacific population is much smaller outside of the Auckland, Waikato, Capital and Coast, Canterbury and Southern DHBs; less than 4% in 13 other DHBs. One of the possible inverse-adverse scenarios is that a systemic bias in testing will render these communities invisible. At least 2 or 3 snapshots or informal releases of testing data suggest this possibility. The metric my analysis applies is not able to interrogate this further. We will not know the true situation until the Ministry releases the ethnic testing data by DHB. That they have not done so only reinforces concern.
I received a note from the Northern Region DHB today. They report that in 40,000 tests, 16% were Māori and 16% Pacific. That is great. However, the region has 4 DHBs, 3 in Auckland and Northland. These sorts of figures look good (and I see positive things in Auckland). However, Northland is more remote, communities spread out and has a demographically much larger percentage Māori population. The problem with generalised rather than specific figures is that a positive figure in one DHB can obfuscate a quite different result in another area. Based on the analysis and the befuddling nature of this press release, there is a sense that the situation for Māori in Northland is under-testing. I have asked for clarity. Depending on the reply, we will know if this is right or wrong. I would like to be wrong. No response would tell its own story.
PPE Gear and Swabs
There are repeated reports of a lack of or inconsistent provision of PPE gear for the community, aged and disability health care workers and testing swabs. This is not an issue of stock. The Ministry has ample stocks of PPE and testing swabs. The problem lies with the distribution. PPE and swabs are distributed to DHBs. The incipient sense is an element of over-control exists at this point and supplies to the frontline community, aged and disability health care workers becomes problematic.
Noho haumaru stay safe and self-sovereign, Dr Rawiri Taonui
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