April 26, 2020
Dr Rawiri Taonui | Why Checkpoints remain ‘essential’ – The Ministry of Health obscures Community Transmission
Why Checkpoints remain ‘essential’ – The Ministry of Health obscures Community Transmission
Dr Rawiri Taonui
During early April, the Ministry of Health has said that the rate of community transmission was firstly 2%. More recently this increased to 4%. Today the Ministry has changed its classifications for Transmission (the origins of positive cases) to:
- Imported cases
Cases with a reported history of international travel within 14 days of onset.
- Imported related cases
Cases that have a reported link (close contact or epidemiological link) to an imported/overseas acquired case.
- Locally acquired cases, epidemiologically linked
Cases that have a reported link (close contact or other epidemiological link) to a locally acquired case with an unknown source.
- Locally acquired cases, unknown source
Cases that have no reported history of international travel within 14 days of onset and no recorded epidemiological link to a source case.
- Source Under Investigation
Source of infection remains under investigation whereby the source of infection could not be classified due to incomplete case report forms.
Essentially, what this means is that the Imported Cases are related directly to international travel. However, decoding the language the Imported related cases are subsequent ‘Community Transmission’ albeit from contact with travel cases. Locally Acquired Cases Known Source and Locally Acquired Cases Unknown Source are possibly also Community Transmission.
Charted as below, this means the actual potential rate of Community Transmission is as high as 63%. The key to this is the idea that infection from a traveller means transmission occurred in the community (41%). It is also difficult to see how ‘locally known source’ (3%) and ‘locally acquired unknown source’ (15%) are not or should be considered, at the very least to mitigate risk, as community transmission if the cases originated within the borders of our New Zealand community. The aim is not to be alarmist but rather highlight that the Ministry’s definitions seem designed to avoid calling anything ‘community transmission’.
Reordering the way the Ministry categorises the 16 clusters adds the same concern. 10 of the clusters totalling 321 cases are associated directly with overseas travel. These will have originated from one or more overseas traveller/s. The balance however will be the result of subsequent community transmission. The origins of the 6 other clusters totalling 267 cases are unknown. It is quite possible they too originate with unknown contact with an original overseas traveller or their contact and therefore equally that the majority also constitute community transmission.
What this means for Māori and Pacific Communities
Northland Māori and Māori in the Taranaki and the East Coast have said that they intend to continue mounting checkpoints. Reports that the checkpoints are no longer necessary focus on the reducing numbers of new and active cases. They overlook that the checkpoints will remain a priority for these communities as long as under-testing of Māori in the regions remain as an issue, and, until testing of Māori is addressed for as long as new cases continue to be discovered, all be they single digit. In that context, community transmission remains a risk no matter how the Ministry chooses to obfuscate its definition.
Noho haumaru, stay safe and self-sovereign, Dr Rawiri Taonui.
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