Making Mistakes

Oh damn, got to get it wrong sometime, sorry! I got called out in regard to our coronavirus tea party – it was not in the spirit of the government’s intentions around lockdown. In our defence, we chose not to include Kerrin and Kirsty in our bubble definition at the outset, although they have remained on our property throughout lockdown and not interacted with anyone else. However, I see that people could take my description of a tea party the wrong way, and invite random neighbours over, thus increasing contacts and potential rate of COVID-19 transmission. Also, along with all the other clarifications over what Level 4 means, the government has asked people to stop sitting at their gates and communing. Thank goodness I am just a blogger, rather than a Health Minister (the New Zealand Health Minister just got demoted for going for a drive with his family to the beach and to a local mountain bike park, all against the behaviours required of New Zealanders in Level 4 lockdown); all that can happen is people stop reading my posts, there will be no requirements from the general populace for me to resign. These are timely reminders that we all make mistakes, of various magnitudes, and the best course of action is to acknowledge them in the process of improvement.

Trading Lives

Another point I would like to follow up on today, are the continual trade-offs inherent in our national, COVID-19-related actions. This came to the top of my mind when I was corresponding with a friend who has a heart condition. As a result of our lockdown, some people who might have got COVID-19 will not. As a result they won’t get ill or die, although they still have to avoid getting COVID-19 prior to the, still uncertain, development of a vaccine. As a result of our lockdown, people who might have died from COVID-19 complications in a time of hospital overload, will be treated and survive. However, my friend Graham, who urgently needs a mitral valve replacement, will have to wait for an operation until we finish Level 4. He could suffer a fatal heart attack in the interim, I really hope he doesn’t. Graham has been feeling quite unwell for some months and will continue to do so until he gets an operation. When the hospitals open up for broader business again, I wonder how far up Graham will be on the treatment list given that there will be a whole new cadre of urgent patients who haven’t had the interventions they need?

I also wonder what will happen for all those people with e.g. melanoma or breast cancer, whose diagnosis or investigations will be delayed, and who therefore may die where they could have survived as a result of very early intervention. Such deaths will never be classified as casualties of the lockdown, but they will be. It is important to hold in mind that all courses of action are a trade-off , the paths we are currently treading are about managing, and hopefully minimising, the scale of loss. We have no tested map to follow.

Tracking People

The next big ‘must’, in the Government’s list of what we need to do, is tracing of people who have been in contact with those infected by COVID-19. International and local scientists are all saying we must scale up and speed up tracing of contacts.

There is growing evidence from other countries that contact tracing is a critical part of current best practice for COVID-19 suppression – going back through the chain of people who have been in contact with someone diagnosed with COVID-19, contacting those people, getting them to self-isolate and get tested for COVID-19, and to continue isolating if they are ill. Contact tracing has been employed in China (along with lockdown/isolation), South Korea, Singapore and Taiwan, all countries that have got their COVID-19 case numbers under current control. COVID-19 takes an average of 5 days, and up to 14 days , to manifest once someone is infected, so there is time to trace them. Potential limitations to the utility of contact tracing include that COVID-19 may be infectious prior to symptoms being manifested, and completely asymptomatic people may be infectious (like ‘ Typhoid Mary ‘, a completely asymptomatic cook who spread typhoid through multiple east coast USA families in the early 1900s).

Currently in New Zealand, contact tracing is done by people interviewing those with COVID-19, calling all the people who they might have been in contact with, then repeating the process for the first set of contacts to get a second set. This is time consuming and flawed, given that people’s memories are hardly perfect in regard to who they have been in contact with, where they have been and when. Automated tracking of people’s movements would speed up the process and make it more accurate. An obvious method is use of phone apps to use GPS to track location, and to ping nearby phones, which has been done in the Asian countries listed above.

I was discussing contact tracing with a friend yesterday morning. We both agreed that freedom is a primary value for us and having the government knowing where you are at all times through tracking your phone is somewhat disturbing. Even if you opt into tracking, there is the risk you could be giving the government the right to track you on an ongoing basis, unless you can also switch the app off at any time, at which point its utility starts to diminish. One of the greatest concerns around giving governments powers in emergencies is that they can forget to give back your freedom once the emergency is past; how can you be sure that the government won’t take control of an tracking app and all the useful data it provides?

By evening I was critiquing a grant (this is what I do for a living) proposing the very product concept we had discussed in the morning – an open source software app for contact tracing, where the data resides on your phone and can be queried, but the phone does not report your whereabouts. A COVID-19 world certainly means things are moving quickly in government! But are they moving quickly enough?

An interview on National Radio this morning suggested we need automated contact tracing before we can exit lockdown. The grant proposal figured that an app could be developed ready for use in around 11 weeks; I don’t think the NZ population is going to put up with lockdown for that long! While the ‘easy’ solution might seem to be use of apps already developed in Asia, the down side is that those countries have very different concepts regarding data privacy compared to New Zealand. Here we won’t publish the names of people with confirmed illness or organisations where COVID-19 is present; in China if you want to travel you have to accept being tracked at all times. We can all wait with baited breath (while remembering that one should actually do meditative breathing rather than holding one’s breath ) to see what the government accesses, develops and proposes in the way of tracing technologies.