May 17, 2020
Dr Rawiri Taonui | COVID Māori Update 17 May 2020| Level 2 Positive Numbers and the Second Wave Risk
COVID Māori Update 17 May 2020 | Level 2 Positive Numbers and the Second Wave Risk
Dr Rawiri Taonui
New Zealand Situation
This update assesses the numbers and risk of a second wave as we move further into Level 2. Cafes, bars, gyms, restaurants, and cinemas were opened on 14 May. Schools open tomorrow. Bars will re-open starting 21 May. The main risk of a second wave lies in the five large urban DHBs (Waitematā, Auckland, Counties Manukau, Waikato, and Canterbury). There is a risk to Māori and Pacific communities in those centres. There is also a risk of transfer into Māori and Pacific communities in the regions because inter-regional travel restrictions have been lifted.
We have had six ZERO days since 4 May. The 14-day trend is: 2-0-0-2-1-2-2-2-3-0-0-1-0-1. This is positive; but not enough to assume we have defeated COVID-19.
Queensland, for example, reported 12 ZERO days between 20 April but has now reported new cases four times in the last five days. We need a different profile with a longer run of ZEROs before having confidence we have beaten COVID-19. South Australia has reported ZERO news cases 23 times in the last 24 days but is still not fully confident they have overcome COVID-19.
The key here is that thorough testing, which we have, picks up most mild and full infections. However, many other countries are now experiencing second waves because of undetected passive asymptomatic infections which continue to spread among the population. Confidence that we have control over this dynamic only comes from exceptionally long sequences of ZERO new case days. Six is not enough.
Active Cases and Days Since DHBs Report Active Cases
For the last two days, we have finally reported less than 50 Active Case. Several DHBs have not reported any new cases for over three weeks. 10 DHBs have no active cases.
Most remaining cases are in large urban DHBs. They remain a risk because each has reported new cases within the last week. They are the likely source of a second wave.
Testing has turned a corner. At the macro level, we have conducted 228,148 tests at the rate of 45,630 tests per million of the population. This ranks us 26th in the world for testing by country and territories.
We need to keep going. Countries like Ireland, Spain, Belgium, Israel, Portugal, and Denmark are now testing at well over 50,000 and 60,000 per million of the population. And, while we can be proud of our efforts, we need note that countries like South Korea achieved greater control over COVID-19 because they started vigorous and more widespread testing well before we went up a gear in mid-April.
Improved Ethnic Testing Figures
The latest testing figures are for 173,670 individual tests conducted to 9 May. I previously wrote that there was concern that Māori and Pacific were below the national average of 35 tests per1000 people in 11 DHBs each and the Asian community below that figure in 19 of 20 DHBs.
After re-assessing the numbers, it is clear that some extraordinarily high testing of Māori and Pacific populations, for example, 74 test per million for Pacific in the Bay of Plenty, over 60 for Māori and Pacific in Te Tai Rāwhiti, has pushed up the national average. This makes it reasonable to accept that any testing at 85%, or 30 tests per 1000 people acceptable.
The pattern of reported cases and testing support this picture. There have been fewer cases in the regions outside the major urban DHBs. Many regions have not reported new cases for several weeks. The Ministry and the DHBs have conducted a further 50,000 or more tests since 9 May.
On this scale, Māori are below 85% of average in just two DHBs, Pacific in four. This is credit to Māori and Pacific in Auckland who initiated the involvement of Māori and Pacific health providers, and the community in regions like Northland, Taranaki, the Bay of Plenty, East Coast and Whanganui who in the space of two weeks turned around some abysmal testing figures. Real heroes.
Pākehā marginally below in three. The concerns are that the MidCentral and Nelson-Marlborough DHDs have significantly under-testing Māori, Pacific and the Asian community. Under-testing in the Asian community is still unacceptable. They are below the revised 85% of the national average in 19 DHBs. This heightens the risk for undetected transmission and racism again our Asian community. The Ministry and the DHBs have had months to get this right but are obviously cross-culturally befuddled for much of the time.
The Ministry of Health and DHBs have a contradictory position on face mask-wearing. It claims that the evidence for mask-wearing is inconclusive. We can note the oddity of drive-through testing. A medic leans into a car, wearing a face mask to protect themselves from being infected, the possibly asymptomatic person in the car has no face mask to protect from infecting the medic or for that matter any others in the community.
Western health institutions stockpile masks for medical personnel to protect them from infection. Asian countries issue face masks to medical personnel to protect them from infection but also to the public to prevent passive cases from infecting others until testing discovers them.
This is consistent with the science. COVID-19 can linger in the air for up to 4 hours on tiny droplets called aerosols. And, the real danger comes from passive carriers. Without mask-wearing, in public places, they are a potential main source of second wave transmission.
New Zealand’s approach that anything less than a full medical mask is no protection is clearly wrong. In eastern countries, the policy is that any barrier being a medical mask, scarf and homemade cloth face mask is some protection.
New Zealand approach that wearing a mask causes people to touch their faces is also wrong. We touch our faces 15 to 20 times per hour. A mask of any kind is a barrier to contacting the face. Simple.
There are more than 50 countries now that require face wearing in public. Within one week of their first case, Taiwan nationalised all PPE manufacturing an issued 10 masks per person each week at no charge. They have one of the lowest rates of infection in the world as do all other countries that introduced face wearing at the first sign of the outbreak.
The best approach in New Zealand would be to wear face masks in all large urban DHBs, while travelling on public transport, and when travelling from a region to a large urban area or vice versa.
Pubs will open this Thursday. They present a major risk. South Korea has found more than 100 new cases spread by one person through several nightclubs. Health officials are trying to test more than 5,500 people who visited the clubs since late April.
In an irony of racism, pubs and restaurants will allow 100 customers. Māori will only have 50 at a tangihanga. Māori have the lowest number of cases per proportion of the population. Pākehā have been most offenders crossing checkpoints, the majority charged by Police. Go figure.
Trend for Māori and Pacific
The 14-day trend of new Māori cases is: 0-0-0-1-0-0-0-0-0-0-0-0-0-0, with 24 ZERO days since 12 April. The Pacific 14-day trend is 2-0-0-0-0-0-1-0-0-0-0-0-1-0, with 16 ZERO days since 3 April. We are awesome.
The most likely scenarios for a second wave outbreak are new cases spread from an undetected passive asymptomatic person in one of the large urban DHBs. The risks to Māori and Pacific are twofold. One is that our larger populations in a centre like Auckland. The second more concerning scenario is transfer into the regions from one of the main urban DHBs.
Wu Zunyou, the chief epidemiologist of the Chinese Center for Disease Control and Prevention, or CDC, said ‘It’s now proven that the epidemic has a very long tail’. There is a growing consensus that the virus will not just go away, unlike its close cousin that caused the Severe Acute Respiratory Syndrome outbreak in 2003 that infected some 8,000 people in Asia. People who contracted SARS were immediately and visibly ill, and once they were quarantined for treatment, transmission was halted. But the new coronavirus manifests in many people with few, no, or uncommon symptoms, thus ensuring that hidden chains of transmission endure and cases will reoccur, perhaps seasonally like with the flu, until there is a vaccine.
There has been hope that COVID-19, like the flu, will decline over warmer months because hotter temperatures dry them out and the ultraviolet light from sunnier weather affects them. However, a recent study published in the Canadian Medical Association Journal, suggests that COVID-19 seems impervious to temperature differences and only slightly affected by humidity. The recent outbreak in Mumbai and Indonesia's ongoing struggle to contain the virus highlight how the pandemic is affecting countries across climate zones, including many regions at or near the equator.
Noho haumaru, stay safe and self-sovereign, Dr Rawiri Taonui.
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