Week 7

(This Blog was requested by Graham Thornicroft)

 

The countries in this blog are united by a common language and a belief in democracy. We are comparing a minnow (NZ), with two much larger fish (Australia and UK), and with a whale (USA). Each has used a different approach to the problems posed by the pandemic. We will use population data – per million (or per thousand) at risk, in order to compare the 4 countries.

 

New Zealand: has favoured an elimination strategy, aimed at removing cases of the virus by closing the points of entry,  and focuses on delaying the arrival of the virus, as well as range of measures to ‘flatten the curve’ of the pandemic.  There were just over 800 identified cases, almost entirely in people who had recently returned from overseas. Elimination introduces strong measures at the start in an effort to prevent introduction and local transmission of a pathogen such as COVID-19.. It also emphasises case isolation and quarantine of contacts to ‘stamp out’ chains of transmission. If started early it will result in fewer cases of illness and death, and it offers a clear exit path with a return to regular activities with resulting social and economic benefits.  There was a fiercely imposed lock down united with treatment of known cases, contact tracing and quarantine for detected cases. By 21 March it had imposed a ‘level 2’ strategy of limiting mass gatherings and imposing social distance rules. By 25 March the ‘level 4’ strategy of strict border controls, and closing all schools, churches, restaurants and museums and workplace closures, combined with the usual hand washing and coughing etiquette.. There is a strong focus on border control, which is obviously easier to apply for island states.

 

The other 3 countries have favoured a mitigation strategy, which aims at reducing the numbers of people a new case of the virus is capable of infecting, combined with restrictions on overseas travel, closure of all pubs, clubs, restaurants and churches, and on large gatherings. This strategy can be combined with case finding and quarantine of secondary cases.

 

Australia: encountered an early problem when it became clear that many were ignoring the government’s wishes to reduce large public gatherings and closure of pubs and restaurants. The policy adopted had 4 components: (1) identifying every case rapidly with extensive testing, and isolating cases. (2) tracking and quarantine of contacts (3) travel restrictions and (4) social distancing (including lockdown) to reduce contact and transmission between people. Australia has a weakness because of test kit shortages through most of February and March, and restricted testing policy, which means a proportion of cases remain undiagnosed. The  first case of the virus occurred on 28th February.  There were 25 cases by March 1st, and  4000 cases by March 28. Because of test kit shortages between February and March, a proportion of cases remain undiagnosed.

 

United Kingdom: has introduced important differences, as there were barely enough test materials to go beyond those with positive tests in hospital, so all plans for contact tracing and treatment of secondary cases had to be abandoned. The government wasted time after it was clear that we were faced with a serious pandemic, and even at 30 April have still not made adequate preparations in terms of adequate supplies of testing kits and PPE supplies – so that many centres still report shortages which should have been made good several months ago. After a long delay they produced supplies ventilation equipment. The PM, having attended rugby football matches, and boasted about his having shaken hands with everyone during a visit to a hospital for pandemic cases, contracted the disorder himself and was treated in intensive care during a 3 day admission to hospital. The extreme shortage of testing equipment means that only those referred to hospital have received testing – only by end-April have supplies been made available to hospice staff and those operating permitted services. There have been no checks and no information, on those arriving at our major airports.

 

 

United States: the usual mitigation strategy has been imposed by State Governors. The President has made no secret of his own views, delivered in daily tweets and conferences, in which he emphasizes that the treatment must not be worse than the disease. He has seen the disorder as a minor problem that many people will get over, and has supported the use of absurd remedies such as internal antiseptics. In particular he has supported those in the country who share his views on the economic harm being done to the country, and the imposition of measures of control which are anathema to citizen’s rights. At the end of March he declared that Easter Sunday (12 April) would be a ‘beautiful day to free the USA’. In fact, on that day the US had 90.5 cases/M of covid cases, to be compared with 89.6 for the UK, 3.9 for Australia and 3.1 for NZ. Since then, the rates have increased still further.

 

Comments: One might have expected differences between the two different strategies – but NZ and Australia are fairly similar. The two outliers are the UK and the USA.  The aim of the mitigation strategy is to decrease the infectivity (R number) of the virus, and to buy time by prolonging the time it may take to overwhelm the medical services in each country. In the UK the R number has been reduced to 0.7, and similar reductions occurred the antipodes. Similar findings to the UK are seen in countries such as Spain and Italy (see previous blogs).

 

The real difference between them are achieved by contact tracing and quarantine of secondary cases detected.  The table shows alarming differences between the antipodes and the UK for New Covid cases /M, Cases of death /M, and case fatality rates.

 

                                                New          Australia           United               United

                                                Zealand                            Kingdom             States

 

Population                             4.92M             8.8M          67.9M         331 thousand M

 

Area                                     268K km2      7,692M km2   242K km2       9,834M km2

                                                                    (deserts+)

 

THE BIG DIFFERENCES

 

Covid tests/K March28       4.0                      8.1                1.8                     0.7

Covid tests/K April  26        25.6                19.9                3.1                    16.4

           

Confirmed Covid Cases/M at risk

March 27                   15.7               12.5               31.8                 49.8

April   26                       0.48               0.50             67.2                 98.2

 

Days to double prev.             29                      32                 18                  17

 

Confiirmed Covid Deaths/M at risk

            April    5                     0                      0.16               10.4                 4.0

            April 28                      0                      0-08              12.2                  6.6

 

Case Fatality Rates

            April 28                      1.62                1.25            11.42                  5.69               

 

In the UK the much worse rates are due to the UK first wasting time, and compounding this by being unpardonably slow in obtaining extra test materials causing inability to carry out any case finding studies, and the shortage of  PPE materials causing the outrageous omission of providing safe conditions both for doctors and nurses who work in hospices, and still worse for the retired NHS staff who volunteered to return to the NHS.  In both the UK and the USA the behavior of the PM or the President have been outstandingly unhelpful. The USA is still far from its maximum values and further deterioration is highly likely, but while the PM has been stupid, the President has taken mismanagement to new heights.

 

 

David Goldberg

3rd May 2020

49 days survived, God only knows when (or if) we will be released

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