Coronavirus border policies need a deeper rethink

New Zealand’s current coronavirus border policies fail to reflect the current Northern Hemisphere surge in cases and the consequent enhanced risks to COVID-19 management in New Zealand

There are big contradictions within New Zealand’s coronavirus border policies. There is potential for these contradictions to become more serious with Northern Hemisphere COVID-19 levels now exponentiating upwards again.

Prime Minister Ardern has been saying in recent weeks that there is a high likelihood of further outbreaks in New Zealand and that New Zealanders must be ready for it. What we are not hearing is official acknowledgement that as the Northern Hemisphere approaches its winter, the risks are highly likely to increase further.

Given that new outbreaks are already to be expected, then the situation is not under control. Without further actions, the prospects are going to further deteriorate.

A quick analysis of worldometer data shows that the seven-day case rate in the United Kingdom is now five times what it was in July, and clearly on an exponential trail. Gatherings are now restricted to six people.

In France, the seven-day rolling average is now 20 times what it dropped to in June. Spain’s daily rate, with new restrictions now in place, is still more than ten times what it was back in June.

Germany, Switzerland, the Netherlands, Belgium and almost everywhere else in Europe are now also on strong upward curves although not always as dramatically as the aforementioned countries. Almost everywhere it is coming again.  There are no readily acceptable solutions for Europe.

The American situation is more complex, with the overall pattern being influenced by the recent declines in the Sunbelt States. However, at least half of American States are back on an upward curve.

As for Asia and much of South America, it is clear that case rates are currently at record levels.  In India, the daily recorded new case rate now exceeds 100,000 on most days, with the real rate undoubtedly much higher. In Indonesia, the capital Jakarta is back in lockdown with the heath system buckling.

Quite simply the proportion of travellers arriving in New Zealand who can be expected to test positive is on the rise. And therein lies the problem. The more travellers who are carrying the disease, then the greater the risk of an outbreak.

When things go wrong, the tendency is to blame operational mistakes. The reality is that such mistakes always occur in large scale operations. The New Zealand border operation, with between 400 and 500 people entering on most days, is very large scale.  Yes, mistakes will happen.

We have learned many things over the last six months both from our own New Zealand experience and also by looking overseas. First, we learned that Level Four restrictions, combined with most Kiwis playing their part in the Team of Five Million, really do work. Second, we are learning right now that it is much harder to shut down an outbreak under Levels Three and Two.  Also, there is considerable evidence of fatigue and frustration developing in relation to acceptance of COVID-19 restrictions.

The current Auckland outbreak is now closing in on 180 cases, all coming from a single escape episode of the COVID-19 organism. It has created a cluster approximately twice the size of any of the prior clusters, and it is still propagating. The national cost of that one escape of the organism will clearly be in the billions of dollars, plus great human cost.

Going forward, and now knowing what we do, combined with increasing difficulties getting everyone to play their part in the Team of Five Million as grumpiness and frustration increase, then surely we need to take renewed assessment of the situation.

Most of the people currently arriving in New Zealand come from Australia. Clearly these people need to go into managed isolation, but there is also a need to recognise that the risk from each of these persons is much lower than from almost everywhere else in the world.

So, this is not to argue for any relaxation in relation to Australia. But it is to argue that each person people coming from most other parts of the world needs to be assumed as being individually infectious and managed accordingly, and hence go into the highest level of quarantine until proven otherwise.

Currently there are two operational levels of isolation in New Zealand. There is the standard level which people go into when they arrive in New Zealand on the assumption that they are most likely negative for the disease. Then there is the higher level of isolation for people who are demonstrated to be infected. The argument here is that if the risks from people arriving from Europe, Asia and the Americas are to be minimised, then each person arriving from these regions has to be assumed as infected, and hence go into full quarantine, until proven otherwise.  That may well reduce the numbers that can be accepted each day.

It is now increasingly evident that the next six months are going to be critical. By March 2021, or maybe earlier, it will be evident as to whether a successful vaccine has been or is going to be developed. Timelines for the rollout should be known. In the interim, New Zealand cannot afford an ongoing series of outbreaks like the present Auckland outbreak that has shut down much of the economy and normal life across the country.

If there is no success in developing a vaccine within the next six months – and personally I am putting considerable hope in the Moderna vaccine based on messenger RNA (mRNA), but it could be another vaccine – then that will be the time when alternative strategies will be needed. One way or another, it is reasonable to expect increasing clarity well before that.

Our Prime Minister has been adamant that all New Zealand citizens have a right to come back to New Zealand. As a general principle, that cannot be argued against. It is a legal fact. However, there are many basic rights that have to be constrained for the greater good. For example, all New Zealanders have the fundamental right to travel freely within New Zealand, but most have accepted restrictions on internal travel for much of the last six months in the interests of that greater good.

Something else we have also learned over the last six months is that the New Zealand export economy, apart from the service industries of tourism and education, is remarkably resilient. New Zealand has shown that it can survive and indeed prosper without people criss-crossing the world all of the time, as long as cargo continues to flow, in the same way that it has been doing.

If New Zealand could get back to Level One, and stay there with extra tight borders from all high-risk regions of the world, then Government could focus on the specific groups who are disadvantaged, with the rest of the economy humming along.

The one country that I have purposefully not mentioned until now is China. Although some people are reluctant to acknowledge it, the evidence is clear that China has an exceptionally low level of COVID-19 relative to its population.

If matters were a simple case of logic, then people arriving from China would be treated like those coming from Australia, and placed in the current level of managed isolation. However, sometimes it can be too much to ask that decisions are made only on logic.

Seasonal workers from the Pacific Islands are also low risk. The existing isolation rules would seem appropriate for them, with similar isolation perhaps being appropriate before they return to their Pacific Island homes, depending on New Zealand’s COVID situation at that time. I have long been an advocate for seasonal work schemes for Pacific Islanders, ever since undertaking investigations on behalf of the Australian Government more than 20 years ago. These schemes are not just for the benefit of New Zealand (or Australia), but as the best way to stimulate bottom-up development in the Island communities. It is win-win.

At the risk of repetition, there is a need to emphasise that the suggestion here is not to exclude New Zealand citizens. Nor is it to argue against the compassionate needs of people caught outside the country who, for various reasons, do not currently have citizenship or permanent citizenship, but were on that pathway when caught outside the country.

Rather, what is being suggested is that restrictions on people entering New Zealand have to be proportional to the specific risk. Also, it is very clear that the risks associated with people from some parts of the world are many times greater than those coming from some other regions such as Australia and most of the Pacific Islands.

So, the argument is not to loosen the requirements for those coming from Australia or any other similarly low risk regions, but to increase the level of management for those coming from higher risk parts of the world. That might include daily monitoring of those from high-risk regions in the initial period following release from quarantine so as to minimise the risks from false negatives.  However, the biggest risk may will be from quarantine-management staff who are in contact with returnees while the returnees are in quarantine. Unfortunately, all of these factors emphasise the reality that the number of high-risk returnees does need to be constrained.

If New Zealand continues with its current systems, then there are two scenarios. New Zealand may succeed in keeping out COVID-19 through a combination of luck and good management. Alternatively, New Zealand may go the way of Victoria with one or more further outbreaks and never succeed getting back to Level One. That would be a real disaster.

Of course, there are some who say that we have to learn to live with this virus. That may indeed be what does finally happen. But in making such judgments it is important to acknowledge the mayhem and death associated with that policy.

One of the bigger flaws is to use Sweden as an example of living with the virus.  The reality is that life in Sweden is far from normal. It is just that to a considerable extent they rely on voluntary actions rather than compulsion. However, Sweden does still have restrictions on social gatherings and sporting events, and Sweden does have one of the higher COVID death rates, more than 100 times higher per capita than New Zealand.

To those who say it is only old people who die, it is worth noting that there are now more than 7000 individually identified cases of health workers across the globe  who have paid the extreme sacrifice. This is nothing like the seasonal flu. Britain alone has lost over 600 healthcare workers and the USA more than 1000. And all of this was despite lockdowns. If countries are forced to live with the virus then it is not going to be pretty.

I have a reasonable international network, including regular internet chats with my own university and high school cohorts from many years ago, who laid down their roots widely across the world.  They and other international folk that I have met on the journey of life keep telling tell me how lucky we are here in New Zealand.

I sometimes wonder whether my international friends will still be saying the same thing in another six months.   I think many of us Kiwis have had our confidence dented by the last six weeks. The evidential need is for amended policies that are proactive, not just reactive, and which reflect New Zealand’s unique situation.

About Keith Woodford

Keith Woodford is an independent consultant, based in New Zealand, who works internationally on agri-food systems and rural development projects. He holds honorary positions as Professor of Agri-Food Systems at Lincoln University, New Zealand, and as Senior Research Fellow at the Contemporary China Research Centre at Victoria University, Wellington.
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16 Responses to Coronavirus border policies need a deeper rethink

  1. sallyco says:

    “Methinks thou dost protest too much!” IMHO you need to broaden your research. How about starting with Ivor Cummins. https://thefatemperor.com/
    There are ways to fight this needless travesty that are humane – not this politically led tyranny.

  2. Tania says:

    I am wondering whether you have looked into the claims of Professor Thomas Barody regarding his discovery of a Covid treatment/prevention triple therapy of Ivermectin, Zinc & Doxycycline? As I understand it, the Ivermectin opens the pathway for the zinc to do its thing to beat Covid at a cellular level. Prof Barody is extremely well respected and world renowned for his work in developing the triple therapy antibiotic cure for Peptic ulcers, and as a nurse I am aware of how much this has revolutionised medicine in this field. He was interviewed by Leighton Smith on his podcast a few weeks ago, the link is https://www.newstalkzb.co.nz/podcasts/the-leighton-smith-podcast/leighton-smith-podcast-episode-78-august-26th-2020/
    Prof Barody is putting his reputation on the line with his claims, and I for one would take his treatment in a heartbeat but would almost certainly not accept a Covid vaccine due to the inability of any rigorous testing, given the tight time frame necessary for it to be rolled out. Prof Barody states in the interview that the worst case scenario for his triple therapy treatment is that you still have Covid but are worm free! Assuming that his treatment does work to both treat (he actually uses the word ‘cure’) and prevent Covid, there are huge implications for almost a full opening of our borders and an end to these economically and personally devastating lockdowns and restrictions. Despite his reputation and previous success in his field, the professor is gaining very little traction with what i believe is very likely a Covid breakthough. I would be really interested in your thoughts

    • Keith Woodford says:

      Tania,
      My earlier reply seems to have gone astray. My own judgement is that Barody is likely to be correct. And yes, I have been aware of what he is sayiing. But I have not been sufficiently sure that I am on top of all the evidence to burst forth into print about this. The American data that Barody referred to looked strong.
      KeithW

    • David Porter says:

      Hi Tania. It does indeed look like Prof. Barody may be on to something and is obviously a highly respected academic. Can I just draw to your attention something you said in your posting though:

      “…and I for one would take his treatment in a heartbeat but would almost certainly not accept a Covid vaccine due to the inability of any rigorous testing…”

      Given that the Ivermectin therapy has only been around since April, has it had enough time to prove itself to the standard that you are requiring of vaccines? The vaccines are certainly being fast tracked through the approval process but they aren’t skipping any of the usual steps, they are overlapping them. For instance, the efficacy trials and manufacturing scale-up would normally be run consecutively but are running concurrently in this instance which saves months in the overall development time. It a big financial risk for the developer should the Phase 3 trials prove the vaccine to be not up to the required standard but the rewards will be big if their product is successful and makes it to market first so they take that financial risk.

      I would be right with you regarding some of the vaccines being released now, for example the Russian vaccine of which seems to be using general release as their Phase 3 trial!

      • Tania says:

        Hi David, given that Ivermectin has been around since the 70’s and used in humans since the 80’s, I would be happy to take it over a vaccine! If it was a choice between suffering through Covid 19 (although I don’t feel at all personally at risk of serious illness or death from Covid) and trying Prof Barody’s triple therapy treatment, I have no doubt that I would take the treatment. If it was my 75 year old mother who had Covid I would be scouring NZ to find a doctor who would prescribe the triple therapy for her. If Ivermectin, along with zinc & doyxcycline are even half as effective as they are claimed to be, I honestly don’t see what NZ and the world has to lose in using them as a tool to combat the virus. Going even further, I have a friend who is a natural nutritionist and she told me about 6 weeks ago that every week natural therapists are having herbal and other natural remedies pulled from supply. These treatments are used on cancer and other people who are in desperate need of them. The reason the suppliers are giving for not selling these remedies are that the NZ government has dictated that they may be used to treat Covid in NZ and are therefore unable to be sold. What the heck is all that about???!! That was a side note, sorry, but I do wonder about the real reasons that Prof Barody’s treatment is not gaining any traction. I truly don’t know what those reasons are but it’s hard not to draw conclusions after the conversation I had with my lovely nutritionist friend.

      • David Porter says:

        Hi Tania. I take on board what you are saying and indeed the work should be done to prove safety/efficacy. There are too many examples throughout recent history of medicines rushed to market causing significant problems. This leads to scepticism and the preponderance of conspiracy theories that we see now regarding medicines and especially vaccines.
        Saying that, my point remains that you are holding vaccines to a higher burden of proof than you are the ivermectin combination therapy even though both are novel products for this purpose. Ivermectin has been around for a long time but so have vaccines, indeed considerably longer. There are contra-indicators for ivermectin which must be assessed by trials before general release. Drugs such as statins, HIV protease inhibitors, Ca channel blockers and other medicines typically taken by the type of people most vulnerable to Covid complications all inhibit the enzyme which degrades ivermectin in the liver. Considering that the intracellular concentration of ivermectin required to suppress Covid in-vitro was 10000 times that what is licensed (to kill parasites), I think some safety trials must carried out to assess the therapy.

      • Tania says:

        Hi David, we don’t have a vaccine for Covid but we do have Ivermectin, so your point is hypothetical. We may never have a viable vaccine but we can’t keep going as we are with rolling lockdowns and our borders closed without bankrupting our country even more than we already have. I believe that the Ivermectin triple therapy (and others) which are claimed by the doctors who are able to prescribe them to be highly effective in both preventing and treating the virus, should be looked at as a matter of urgency. It truly perplexes me as to why medical and natural therapies are sidelined or even maligned, in favour of panic and closures

      • David Porter says:

        Hi Tania. Can I dispute your assertion about the inherent safety of the Ivermectin therapy. Yes, Ivermectin has been around for some time now but what you are proposing has two important differences to the existing uses, namely the dose rate and interactions with the other components of the treatment and other treatments.
        You have also not addressed my point about the contra-indicators likely with the very people most likely to need this treatment. Remember that you are proposing to give it to people who are gravely ill and severely immunocompromised and likely to be on one or more medicines already.
        Regarding a vaccine, you may well be right about the timeline and we cannot put all of our eggs in that basket. AIDS and hepatitis C vaccines have eluded us for a long time despite the efforts and money put in to them. Saying that, vaccines tend to be the cheapest form treating a disease of any kind. If you can’t catch it, you can’t get sick from it, although I acknowledge that there is no vaccine yet that is perfect, just like no medicinal treatment is perfect.
        In summary, I agree that the Ivermectin therapy should be investigated as there is a theoretical explanation for efficacy and some very limited trial work that showed it had a positive effect. That to me says that it deserves investigation.

      • Keith Woodford says:

        David,
        Ivermectin is currently being used in many hospitals overseas, particularly in Asia and South America, for treatment of COVID-19. The typical dose rate is the same as approved for treating river fever. Barody advocates a triple treatment that includes zinc and doxycycline. All three of those drugs are off patent so ‘Big Pharma’ has no interest. Hence, properly set up clinical randomised trials, which are expeneive, and very difficult in a crisis environment, are not available. But the results of the Florida intevention trial are impressive.
        KeithW

      • Tania says:

        Hi David, I’m not qualified to address your concerns re contraindications, you would have to approach Prof Borody for that! I understood the dosing to be low, though.

        I’m not sure if you have listened to the interview Leighton Smith did with the professor, but the triple therapy is given either as a preventative or very early in infection, as opposed to those on death’s door. I venture to say that Hyroxychloroquine, combined with zinc and possibly an antibiotic and inhaled steroid, is very likely to be a very effective prevention & treatment for Covid too, when given early and in the correct combination. Yet trials have used it alone and often in gravely ill Covid patients, and therefore conclude it to be ineffective. However doctors using it in practice and in combination have very different results.

        I wonder how much it will cost to develop a vaccine, I suspect many, many millions (billions?) of dollars, vs existing treatments such as HCQ & Ivermetin. Which are, as Keith says, off patent and therefore not a big money maker for anyone….

      • David Porter says:

        Hi Tania. Can I again repeat that I am not disputing the efficacy of Ivermectin (combination therapy) as a treatment. Nobody can just as nobody can truly attest to the efficacy because the trials have not been done. My single point in this discussion is that proper safety/efficacy trials must be done with any new therapy for anything including novel uses.
        It would be the best results possible if Ivermectin was to be found to be the best treatment. Believe me, I’m no fan of big pharma. Saying that I don’t accept your assertion that there is some kind of conspiracy to prevent Ivermectin being used to treat Covid. There are multiple pharma companies who specialise in the manufacture of off-patent products who would benefit from a massive upsurge in demand for Ivermectin as well as packaging, excipient and adjuvant manufacturers who would jump at this opportunity.

  3. Tania says:

    Sorry, I should have said that if you do listen to the podcast, listen to the introduction and then skip to 9 & 1/2 minutes in, as that is when the interview actually starts

  4. Greg van Paassen says:

    A bit disappointing that the quack remedies are even turning up in your comments, Keith. But what can one do?

    Philosophically I don’t hold with the existence of rights, only duties. The government’s primary duty is to protect the welfare of its citizens. Individuals have a duty to avoid harming others, a duty to obey the law, and so on. What we call “rights” are customary freedoms of action that are available to all in ordinary circumstances.

    Through that lens your advice seems very sound, except that New Zealanders overseas have a duty not to endanger those living here.

    • Keith Woodford says:

      Hi Greg
      There are ocassions when I delete comments when I think they detract from the debate. I think Tania’s comment is important and I very much welcome it. However, there is another comment there from another person that arguably does not belong.
      KeithW

      • Tania says:

        I look forward so much to the time you do burst forth into print on Professor Barody’s treatment, Keith! 🙂

  5. David Porter says:

    Thanks for your article Keith. Being ever the optimist, I’m sure that one of the vaccines will pass the test and do the job of allowing us back to normal life, albeit with some lessons learned about a lot of things hopefully. However, if I’m wrong, and it does, like AIDS, resist our ability to be able to create immunity to it, we must face up to it becoming another virus that we have to live with as quarantine, as you say, isn’t perfect and won’t keep Covid out forever. Will that mean a (hopefully) controlled herd immunity programme of some kind? I don’t know how it could be done and would be unpleasant in the extreme but is there any other way of living with the virus long term?

    By the way, I’m asking this as a genuine question rather than wishing for it I assure you!

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