Week 13: Four countries with interesting pandemic policies – Norway, Denmark & the Antipodes.

First topic: How the 4 governments set about their task, and the extent they succeeded in it.

 

In an earlier Blog (7) New Zealand was described as an elimination strategy, while Australia was described as a containment strategy. In fact, the differences between them are minor, as both rely on border security with only returning citizens allowed in, and all quarantined for 2 weeks. New Zealand introduced their lockdown strategies in a phased manner, with the last phase not until 25th March,  closing all schools, churches, restaurants and museums and workplace closures, combined with the usual hand washing and coughing etiquette. On 8 June the recovery of the last Covid19 patient meant that there were no similar patients anywhere in NZ. All restrictions were lifted, special travel for Australians, only when they were in the same position.

Australia had broadly similar policies, but these were complicated by shortage of test equipment between February and March so many cases remain undiagnosed. They also encountered an early problem when it became clear that many were ignoring the government’s wishes to reduce large public gatherings on beaches,  and were not closing pubs and restaurants. Despite these important differences, the outcome has been broadly similar, with total elimination expected in Australia in the next 4 to 8 weeks.

 

Total               Total               Total        Total              Total                   Total              Deaths

                        Tests/K          Cases       per M           Deaths     Deaths/M                  June 12

 

New Zeal.          63                 1154           239                 22                         4.6                 0

 

Australia           66                 7276           284               102                         4.0                 0

 

Norway             49                 8576        1579                242                         44                 3

 

Denmark        126                12016      2071                593                       102                 0

 

UK (for           54                290143     4259           41279                        605             151

comparison)

 

 

Norway and Denmark were both dealt with in Blog 9, and both used imaginative responses to the pandemic and earlier lockdowns. Once more, they both used detection and isolation of infected people with contact tracing followed by quarantine of these contacts, and closing down businesses and events. Norway reserved large sums of money early on for vaccine development, digital solutions for contact tracing,  a mobile app for contact tracing, an app for remote medical consultation, for money training medical personelle in intensive care medicine, and for updating and distributing a digital tool. Unusual features are social distancing at only one metre, meetings of <50 people allowed, and detailed exit plans.  Denmark many cases came from holidays in Italy, and all were quarantined. Before lockdown hospitals were postponing non-urgent operations, but meetings of up to 1000 people were allowed. By March 11 this was reduced to 100 people, concerts cancelled or postponed. People were advised to walk or cycle to work of possible. After lockdown on march 13 all non-essential workers to stay home. Home schooling started ‘in some degree’. Schools universities advised museums and libraries closed. March 15 hairdressers, night clubs also closed. Restaurants open only for take aways. Grandparents told not to see their grandchildren. Groups of >10 people were not allowed.

 

Our own disastrous health policies (which we shared with France, Spain and Italy) did not allow us to test when it would have helped, and were also accompanied by shortages of PPE and ventilators, and were introduced at the very latest point. Australia was also late in obtaining equipment for testing and had a population that was reluctant to follow government advice (like the USA). It is reassuring that they have almost done as well as NZ, who are blessed with a more obedient population. The heroes of this blog are Norway and Denmark, both of whom had to deal with much higher rates of cases per million. The forward planning by Norwegians was very good indeed, their social distance was a mere 1 metre, and the lockdown was not as strict as ours, and the lockdown was introduced gradually. Despite high rates for cases and deaths per million, they have succeeded in bringing their daily death rates down to zero, an achievement we would be happy to have.

 

 

2nd topic: How do we pick up the virus?

Droplet transmission occurs when a person is at risk of having his/her mucosae (mouth and nose) or conjunctiva (eyes) exposed to potentially infective respiratory droplets; and is in in close contact (within 1 m) with someone who has respiratory symptoms (e.g., coughing or sneezing). Respiratory infections can be transmitted through droplets of different sizes: when the droplet particles are >5-10 μm in diameter they are referred to as respiratory droplets, and when then are <5μm in diameter, they are referred to as droplet nuclei. According to current evidence, COVID-19 virus is primarily transmitted between people through respiratory droplets and indirect contact routes.

Transmission of the COVID-19 virus can occur by direct contact with infected people and indirect contact with surfaces in the immediate environment (‘fomites’)  or with objects used on the infected person (e.g., stethoscope or thermometer). 

Airborne transmission may be possible in specific circumstances and settings in which procedures or support treatments that generate aerosols are performed; i.e., endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, manual ventilation before intubation, turning the patient to the prone position, disconnecting the patient from the ventilator, non-invasive positive-pressure ventilation, tracheostomy, and cardiopulmonary resuscitation. Airborne transmission refers to the presence of microbes within droplet nuclei, which are generally considered to be particles <5μm in diameter, can remain in the air for long periods of time and be transmitted to others over distances greater than 1 m. 

 

WHO continues to recommend droplet and contact precautions for those people caring for COVID-19 patients. It also recommends airborne precautions for circumstances and settings in which aerosol generating procedures and support treatment are performed. In a study of 800 asymptomatic Covid19 patients, it was not possible to culture the virus. Onward transmission by patients without symptoms is rare, based on large track and trace schemes. WHO stated last week that “between 6 and 41% of covid19 patients” are asymptomatic, but some are able to pass the virus on, but this is “very rare”. The % of asymptomatic patients is higher in the populations that wear masks (Statements by Dr van Kerkhove on behalf of WHO).

                       

 

Stop press: The only country with rising prevalence of Covid19 infection among US,  UK and Brazil this week is Brazil – but that was bound to happen anyway given the policy of Mr Bolsonaro towards the pandemic. However, watch this space.

 

David Goldberg

14th June

93 days served, no real prospect of release unless  dramatic breakthrough produces an effective vaccine fairly soon.

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