Dr Rawiri Taonui | COVID Māori Weekly Update 2 June | Echoes of the Spanish Flu Second Wave
|02 Jun 2020 22:51 PM|
|Author: Dr Rawiri Taonui|
|Photo images supplied / Dr Rawiri Taonui|
COVID Māori Weekly Update 2 June | Echoes of the Spanish Flu Second Wave
LATEST DATA ETHNIC TESTING
The latest data to 27 May shows improved testing of Māori and Pacific communities. The National Average for testing by ethnic group is 50 tests per1000 people. An acceptable range is +/- 20% of that figure (between 40 to 60 people per1000 of the population).
The significant improvement of Māori and Pacific owes much to the strength of Māori and Pacific health providers. Māori have run magnificent testing campaigns in places like Northland, Counties-Manukau, Te Tai Rāwhiti, Waikato, Taranaki, and Capital Coast. Pacific, especially through their church communities, have been equally splendid in Waitematā, Auckland, Counties Manukau, Bay of Plenty, Hawkes Bay, Waikato, Te Tai Rāwhiti, Whanganui and South Canterbury.
The low rate of testing for our Asian community reflects an absence of health advocacy for this community. The last decade has seen a rise in advocacy for Māori and Pacific communities. The energy in this space drove a successful campaign bringing Māori and Pacific on par and above the rate of testing for Pākehā. The same has not happened for our Asian community. This week I was advised of an Asian church in the Mid-Central region that was declined opening its doors to testing. The absence of testing is a risk.
THE NEW ZEALAND SITUATION
Recovered, Active and New Cases
This is great news. New Zealand has the lowest number of Active Cases for any Western country. We appear to have beaten the First Wave.
There have been 27 consecutive ZERO days of new Māori cases for 27 days and 41 since 12 April.
There have been no new Pacific cases for 18 days and a total of 33 ZERO days of new cases since 3 April.
Our positive figures need to be tempered with the memory of the Spanish Flu of 1918, during which most deaths occurred in a second wave four to six weeks after the disease first struck New Zealand.
A Warning from Wuhan China
We must remain vigilant. 11 ZERO days in a row is not enough. Wuhan China had 36 days consecutive ZERO new cases since 3 April. On Sunday 10 May and Monday 11 May, six new cases were reported. One of the new cases was the wife of a man who was the ‘last’ case detected 36 days prior. Five of the new cases were also asymptomatic meaning that they could have continued infecting others. The first case in this group had no travel history outside of the city. It is likely the infection came from within the city.
China reacted by testing the whole city, a population of 11 million. As of 26 May, they had tested 6.5 million people discovering 198 mainly asymptomatic cases. Translating this to a New Zealand context with a population half that of Wuhan, if we tested half our population that would translate to around 45 cases. While it is likely we do not have 45 undetected cases, the caution is real, 11 consecutive days of ZERO new cases means we have beaten the First Wave but possibly not yet fully beaten Covid 19.
Other Warnings from Australia
Other cautions come from Australia. The Northern Territory went 25 days with no new cases then found two on 2 May. The state has been clear since but the mini-spike reminds to stay alert. South Australia twice found one case after two 14-day and 18-day runs of ZERO new cases, the last, one week ago. Western Australia has had 26 ZERO new case days since 20 April but in the last 8 days has reported 34 new cases.
LEVEL 1 POSSIBLE THE CALL TO GO EARLIER- SECOND WAVE RISK
Cabinet is due to meet on 8 June to revisit and if necessary ‘tweak’ the indices for Level 2. Cabinet is also due to meet on 22 June to decide about moving to Level 1. New Zealand First Leader, Winston Peters, has called for a move to Level 1 now. New National Party Leader Todd Muller has said the government should move to re-open the country more quickly. Both might influence the Labour government on 8 June.
Going to Level 1 has appeal because the economic damage has been significant. Many think this is the real battle. Very many of New Zealand’s 800,000 businesses have suffered. Many will not make it out of the Covid 19 crisis. More than 1000 New Zealanders a day went on a benefit last month as the impact of Covid 19 hit.
Demand for food grants has risen by more than 200 per cent. The number of special needs grants issued by MSD rose from 114,898 in February to 291,818 in April.
There were 184,404 people on a Jobseeker benefit at the end of April - a jump of 32,600 in just a month. In all, there were 346,121 people receiving a main benefit, a 13 per cent increase since the outbreak was confirmed in late February. Young people are among the worst affected. The growth in 18-24-year-olds getting a Jobseeker benefit has risen 42% since February, compared to 21% for the rest of the population.
The government needs to balance current economic damage against the risk of a second wave causing further carnage, deaths, and additional economic damage. There is already talk in several European countries that if a second wave strikes, countries may not be able to afford another lockdown. The scenario that emerges in that instance is too dreadful to comprehend.
One Treasury expert expects unemployment to hit 9.6% in June and possibly 20% by the end of the year. If this is the case, then Māori and Pacific unemployment could be at least 50% higher well above the extremely high 23% Māori unemployment peak of the early 1990s. Local communities will hit hardest.
The wisest course is to keep to the current timetable until we achieve as close as possible 28 consecutive days of ZERO new cases, the equivalent of two cycles of asymptomatic transmission.
Border Control & Repatriation
Hong Kong had a second wave triggered by returning citizens. Our border controls are tighter and working well. In the absence of a vaccine, our border controls should remain as they are for many more months.
The large urban DHBS of Waitematā, Auckland, Counties-Manukau, Waikato, and Canterbury are the most likely location of a second wave. This is a risk to our large Māori and Pacific communities in places like South Auckland. There is a further secondary risk in transmission via inter-regional travel. New Zealand might have considered opening inter-regional travel later.
The Ministry of Health has announced that many Community Based Assessment Centres (CBACs) have begun closing down. In the main, testing will return to approval by General Practitioners. DHBs will make their own decisions about what ability they keep re: CBACs and mobile testing units:
Leaving the decision to DHBs on what capacity they maintain is a mistake. There needs to be a national strategy. At the very least, each DHB should maintain a mobile testing capacity and regularly circulate that into small towns and communities.
Transferring the testing protocol back to doctors and mainstream clinics repeats the mistake of March and April testing that disproportionately under-tested Māori and Pacific and continues to under-test the Asian Community. The cost of seeing doctors will mean testing in our communities declines.
Already New Zealand is declining in testing both in number and when compared to testing per million of the population with other countries. In mid-May, our massive testing effort was the 27th highest in the world per million of population. Yesterday, we had fallen to 34th. Many other countries with steadily declining active cases are continuing to test at much higher levels. There is a risk that if we miss early second wave cases that go on to infect several others before they are discovered.
Another 6,000 people have signed up to New Zealand’s Covid Tracer app in the past day, with a total of 482,000 registrations. Businesses have created a total of 21,215 posters with unique QR codes to help with contact tracing. The latter is only 34% of businesses considered as ‘active’, predominantly hospitality venues and retail outlets. The app is regularly described as clunky and confusing, does not work on older phones and not helpful for those families with one phone and poor signal strength in remote areas.
Social Distancing - Mask Wearing
It seems clear that social distancing rules are beginning to break down more often as many become complacent that we have beaten Covid19. Many will have seen the Black Lives Matters march in Auckland. Morally just and an important stand on the rights of oppressed African Americans. Few masks. Little social distancing.
As of early May 2020, 88% of the world's population lives in countries that recommend or mandate the use of masks in public; more than 75 countries have mandated the use of masks in public spaces. New Zealand has not. As social distancing breaks down and inter-regional travel increases mask-wearing in crowded public places and on public transport should be a priority. Social distancing, handwashing, keeping a wash station at home and mask-wearing are the key personal strategies.
Noho haumaru, stay safe and self-sovereign, Dr Rawiri Taonui.
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