Dr Rawiri Taonui | Covid Maori | Maori & Pacific may pay the price of low testing - 18 August 2020
|18 Aug 2020 21:21 PM|
|Author: Dr Rawiri Taonui|
|Photo images supplied / Dr Rawiri Taonui|
Dr Rawiri Taonui | Covid Maori | Maori & Pacific pay the price of low testing -18 August 2020
The Second Wave
The Covid-19 outbreak in Auckland is disproportionally impacting Māori and Pacific communities. During the first wave, Māori (8.6%) and Pacific (5.9%) were 14% of all cases. In the current second wave Auckland centred outbreak, Māori (12.7%) and Pacific (74.6%) are 87.3% of all cases.
During the first wave, Māori and Pacific communities had the lowest ratio of cases to demographic percentage of the population. The differential impact of the Auckland outbreak now means Pacific cases (8.4%) are today, for the first time, over their demographic share of the population (8.0%).
This means Pacific cases are now 5% higher than their share of the population. Māori remain the lowest on this index with cases just over half of 50.6% their demographic.
Second Wave or Mini-Wave
A second wave is a sudden increase with multiple cases across several clusters after a distinct decline in cases. A mini-wave will have a smaller number of cases in one or two clusters. Auckland is a mini-wave and looking ahead, the first of several.
71 cases of Covid-19 have been detected in New Zealand since 11 Aug. Today, the Director-General of Health Dr Ashley Bloomfield said he believed this might become the largest cluster thus found in New Zealand. The largest first wave cluster, the Bluff wedding, totalled 98 cases. This means something over 100 cases.
That aside, we know that 69 of the 71 cases so far are from one case who became sick on July 31. These are all part of a line of infection carrying the Covid-19 B.1.1.1 strain (BTriple1). The 69 and one other case under investigation form one cluster.
There is one other case, a transmission of a maintenance worker at the Rydges Hotel in Auckland. This person’s infection is indirectly from a returnee from the United States who was at the hotel between 28 and 31 July. This appears as a solitary case rather than a cluster.
ANALYSING THE OUTBREAK
The key parts to analysing the second wave in Auckland, include asking if we are being effective in ring-fencing this outbreak through testing and isolation; and if possible, identifying the source.
Testing and Containment
We can have confidence that current elevated levels of testing will at some point contain the current outbreak. There have been 107,666 tests in the last five days. This includes contact tracing family and friends and casual contacts of all cases; all co-workers; all staff working in Auckland Managed Isolation and Quarantine Facilities (MIQ), and several thousand workers at maritime ports in Auckland, Tauranga and further afield.
Having identified the outbreak is one cluster, there is confidence that it will be contained. There are no other clusters. There are just two cases outside of Auckland. These are contained. What the timeframe for containment will be is uncertain. On current information, it is sooner, say within three weeks, rather than later.
Identifying the source
The first case in the Auckland outbreak works at AmeriCold in Mt Wellington, Auckland. Three other members of this family have also tested positive. The person fell sick on 31 July. They could have picked up the infection as early as 20 July give or take a few days.
The Covid-19 genome or strain they carry is B.188.8.131.52 or B-Triple1. The sequence has not previously shown up in New Zealand. It has mostly been found in Australia or Britain. All testing results to date, reinforce that this case is the first in the current sequence of transmission.
A recent positive case in MIQ
Genome sequencing of cases in quarantine has not established a link to BTriple1. However, we also know from a column today that not all first wave cases in MIQ were sequenced.
Those who left Isolation without being tested
Before 16 June, over 1200 people left isolation without being tested. As of late June, 300 had not been found and 120 who were found, refused a test. While this is some time ago and the possibility is remote, the virus could have been transmitted through one or two asymptomatic intermediaries before infecting the family at the centre of the outbreak. This remote possibility is not being actively explored.
Transmission from MIQ staff
As we saw in the Australian state of Victoria, security staff became infected and passed Covid-19 into the community. We have seen today that a maintenance worker at Rydges in Auckland picked up an infection from a returnee who stayed in the hotel between 28 to 31 July before being transferred to quarantine. Mandatory testing of all Auckland MIQ staff is currently underway. 2,600 tests have been completed. This is 97% of all staff. No positive cases have been notified. There is no link with the BTriple1 strain.
Transmission from Auckland border airport staff member
As with MIQ, there have been problems establishing a testing regime for border staff. Currently, all border staff are undergoing mandatory testing. Results to date have not shown any positive cases. If a border staff member picked up the virus from an incoming returnee the BTriple1 strain would show. Thus far there have been no positive tests or any link to BTriple1. The possibility that a border staff picked up the virus from an incoming passenger who also was not tested is remote.
AmeriCold receives shipments of chilled foodstuffs through Auckland Airport, Auckland Ports, and the Port of Tauranga. The Mt Wellington facility has 10 positive cases, seven are employees and three are contractors. None predates the first case above. Other staff have come back negative
It was thought that the virus could have travelled to Americold's facility from its Melbourne operation where two staff had tested positive. Surface contamination as a source was also explored. Managing director Richard Winnall said environment testing in Australia showed no traces of the virus at the plant. Winnall also stressed there were no shipments from the Melbourne plant directly to the company's Auckland factories and the positive Australian cases worked on a completely different supply chain. Officials have now ruled out both human and surface transmission.
Transmission from a maritime port
The ports of Auckland and Tauranga have come under focus, because AmeriCold, the company where the first case works, uses the ports for incoming freight. While AmeriCold has been ruled out, there is the possibility of transmission from other ships and crew to border workers and then into Auckland. One of today’s positive cases was from the ports of Auckland. Other ports are now being included. 12,000 workers are being tested. Comprehensive results are not in.
NZ Airline Crew
Air New Zealand staff who spend more than two nights overlaying in other countries must isolate for 48 hours in New Zealand and not come out of isolation until they test negative.
Staff on shorter stay overs do not isolate. Although flights have strict protocols, there is a risk that this is a source of transmission. There is also concern that Air NZ flying inside New Zealand have been on flights transporting cases to quarantine and have then carried on working on other flights. Testing needs to be conducted and a new protocol established to close this loophole.
Aircrew from Other Countries
Airline crew from other countries go directly through customs and are housed in our MIQ separate from others and without testing. This is a site of transmission, for example, from aircrew to border staff to the family in South Auckland. There is no protocol that they are tested and if they are staying one night, they simply leave the following day. This loophole also needs to be closed.
AN UNANSWERED QUESTION
Why did it take three weeks, from an infection start date of 15 to 20 July to 11 Aug to discover the first case in the cluster? The answer is that the government and the Ministry of Health halted the surveillance or random testing that would have picked up this new wave of Covid-19.
On Monday, Director-General of Health Dr Ashley Bloomfield made note to congratulate the Māori and Pacific response to Covid-19. In particular, he noted that they were the highest tested communities in New Zealand. What he overlooked was that Māori and Pacific achieved this by replacing the Ministry’s symptomatic over asymptomatic priority with one saying we are vulnerable so test as many of our people as possible. Indeed, the Ministry also conducted random testing toward the end of the first wave
Between April and the end of June, testing averaged 134,000 per month with a high of 165,000 in May. In July, testing fell by 100,000 to low of 66,000. Testing sometimes averaged just 1,000 a day across the whole country and at times was as low as 500 or 600 per day. New Zealand plummeted from the 25th highest testing country in the world to 45th.
The decline in testing coincides with the beginning of the Auckland cluster. If a higher rate of testing had been maintained, the Auckland outbreak would have been detected earlier. Simply put more testing, 120,000 tests per month, means more likely to find cases.
Testing fell after the first wave because the Ministry passed testing back to DHBs. The DHBs closed many Community Based Assessment Centres (CBACs) because the main emergency had passed, to cut costs and more fatally because random testing ceased in favour of a return to an emphasis on testing symptomatic patients only.
Testing was also passed back to Medical Centres many of which were struggling as businesses. As such, some Medical Centres began placing a surcharge on asymptomatic patients seeking a test, reportedly as high as $100. The combined effect was that surveillance or random testing as a protective measure against a second wave fell away.
Managed Isolation and Quarantine
The government also dropped the ball because it was distracted by tensions at the border and in MIQ facilities.
After several people left MIQ without being tested in the first half of June, the government said it would tighten MIQ security, regularly test all border and MIQ staff, and consider either slowing the rate of New Zealanders returning home or increasing capacity to bring more home sooner because of the worsening global situation.
Housing Minister Megan Woods and Air Commodore Darryn Webb commissioned a review which found significant stress in MIQ in managing increased flows of arrivals. The report described staff as demoralised and the broader system faltering. Changes and training followed.
Unfortunately, over the next five weeks, the MIQ dealt with seven escapes and two attempted break-ins which led to more security upgrades and more pressure to perform.
In addition, the government had through kindness increased MIQ facilities by 10 hotels over three weeks to 18 July. This placed further pressure on MIQ. Over 72 days between 26 March to 16 June, 19,416 returnees passed through MIQ at an average of 270 people per day including 30 positive cases. Over the next 56 days to 11 August, 17,342 returnees crossed our borders at a 40% higher 377 per day. Positive cases increased by 120% to 66.
Testing Border Staff
Clearly, the government’s attempt to both fix MIQ and raise its capacity explains why, the Ministry of Health was unable to fulfil the 23 June promise from the then Minister of Health David Clark that it would be a requirement to regularly test all frontline border staff in customs, biosecurity, immigration and other airport workers - as well as people employed in managed isolation and quarantine facilities and international air and maritime crew.
By the first week of August, it was clear that 63% of the 7,000 MIQ staff had never been tested. Dr Bloomfield has attempted to explain that the testing was ramping up. He has also admitted that it was voluntary rather than required.
Testing is now mandatory. This is important because there are six facilities in 36% Māori and Pacific South Auckland, others in 20% Māori Hamilton and 30% Māori Rotorua.
By focussing on processing a higher rate of returnees, overlooking testing of border staff and more importantly dropping surveillance testing by 100,000 tests in July, the government and Ministry placed Pacific and Māori communities and indeed all New Zealanders at risk. Pacific are paying the highest price.
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