The fog of war

Dr Eric Crampton
Insights Newsletter
17 March, 2020

In wartime, it’s often hard to know exactly what is going on. Good communication is critical but it’s hard for governments – or anyone else – to make good decisions in the absence of information.

I have watched this Covid-19 pandemic for some time. One of the first things I did after my summer holiday in mid-January was to attempt to purchase N95 masks – but they were already sold out. A month ago, I warned in our Insights newsletter that our ICUs were likely to be overwhelmed if things got serious. This week, that same warning showed up in Newsroom.

But there are lots of things I do not know, either because they are known and not disclosed, or because I missed them because of the fog of war. I would very much like to know the answers to a few questions.

1. What is the current actual total testing capability and what are the plans for scaling it up?

The Government keeps announcing it has capacity to perform a high number of tests per day. But total testing remains well below this stated daily capacity, and the proper conditions for testing has precluded a lot of potential cases. We could easily have community transmission and not know until someone shows up at the emergency department with unexplained pneumonia. Today’s budget announcement included $5 million to boost lab testing capabilities. If testing is that cheap, why wasn’t there greater provision for it earlier? Are there other scaling constraints, and how are we easing them?

2. How much can be done to increase intensive care unit (ICU) capacity?

It has been obvious for at least a month that our ICUs will be utterly overwhelmed if the virus breaks out. We do not have enough negative-pressure rooms, respirators, ventilators or ECMO (ExtraCorporeal Membrane Oxygenation – artificial lung) systems. And we do not have enough staff trained in how to use any of those systems either.

The Government has announced $32 million to purchase additional ICU capacity. How much of an increase can this provide and will it be enough? Has the Government identified the likely constraints in expanding this capacity and how to ease them? If ventilators and respirators are hard to source or sold out internationally, has the Government investigated encouraging manufacturing from domestic suppliers? Respirators and ventilators from 20 years ago are certainly better than nothing, are out of patent and could be built here if manufacturers could be certain about demand. It is not beyond the wit of Kiwi engineers and entrepreneurs to reinvent and build machines that were common decades ago, or protective gear. But they must be asked. Has the Government asked likely suppliers about potential options or considered announcing a price it is willing to pay for standard designs?

3. What provisions has the Government made for expanding medical staff capabilities and reducing the burden on critical workers?

When the Registered Nurses of Ontario asked retired staff and other health professionals to assist with healthline phone lines, over 2,300 volunteered. Has the Government asked medical professionals which tasks can be done by retired health workers, or workers whose registration has lapsed, or by workers provided a minimal amount of training? Are we considering retraining schemes for furloughed workers? China quickly redeployed idle workers in Wuhan for tasks like recording temperatures. Will we really wind up with a situation with tens of thousands of idle workers because of the collapse of tourism while hospitals are crushed by the lack of trained staff?

4.What sorts of measures is the Government using to monitor and enforce self-isolation?

Most people will behave themselves and observe self-isolation periods. The Government must have measures in place for spot-checking. Providing every detail of the scheme would make it too easy for some to evade detection. But simple measures like regular cellphone calls for incoming arrivals, combined with phone tracking to ensure the self-isolated remain near their home, would go a long way.

5. When and under what conditions will different parts of the pandemic plan be activated?

New Zealand’s pandemic planning framework offers many options for reducing the spread of illness. Sensible approaches include strict localised controls when warranted to avoid the need for broader restrictions. But the relatively limited testing so far makes it harder to detect community spread. Community preparedness requires more discussion about the kinds of measures likely to be undertaken.

6. What provisions are being made for securing aged care facilities?

We know elderly folk are at the highest risk. What provisions are being made to ensure staff and visitors do not put residents of aged care facilities at risk.

7. Will the Government trust us with more information?

So far, Government communications have focused on reassurance and avoiding panic. We may worry that the absence of information about critical aspects can lead people to infer the worst, even when the Government is making sensible preparations behind the scenes. We really need to dispel the fog of war about current preparations. Being forthright about gaps might even encourage those able to help to offer assistance.

I hope the government starts providing a bit more detail on the planning going on behind the scenes. While I have lodged an OIA request for detail on the number of tests actually available, it should not take OIA requests to bring us out of the fog of war. We are, after all, on the same team here. And the virus is not monitoring our communications.

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