This is Part 2 of a two-part article to help New Zealand put in place timely preventative procedures to limit the death
toll and spread of Covid-19.
The epidemiology of any pandemic is determined by three simple interlocutory parameters.
The virulence of the Pathogen (covit-19),the susceptibility of the host (patient) and the time and concentration of the
exposure to the pathogen.(who you come into contact with and for how long)
To date, we have no clear idea of the virulence of the coronavirus because we don’t have any accurate figures as to the
total number of people that have “acquired” the virus worldwide.
I have used the word acquired rather than “infected” because clinical data indicates that for the majority of the general population, coronavirus
will not be a life threatening infection and present little or no symptoms.
Right now, there are probably millions of people walking amongst us on the planet infected with the virus but have no
symptoms (asymptomatic). However, for the first seven days of their infection they can transmit the disease to others
who may be more susceptible to the virus.
So it is critically important that we track and trace ALL people who are infected irrespective of their symptoms;
isolate them and monitor their quarantine compliance until they are no longer infectious.
This is what Singapore did.
They did not go into lockdown or stop mass gatherings; instead, they worked fast to quarantine infected people and keep
them separate from the general population.
For the host (patient), susceptibility is a critical determinant in any pandemic.
What we know so far is the majority of deaths have occurred in people over the age of 70 who have underlying health
issues and may be immune-compromised.
This is particularly important with respect to understanding the alarmingly high death rate in Italy.
According to Prof Walter Ricciardi, Scientific Adviser to Italy’s Minister of Health, the country’s mortality rate is
far higher due to demographics; the nation has the second oldest population worldwide.
“The age of our patients in hospitals is substantially older, the median is 67, while in China it was 46,” Prof
Ricciardi says. “So essentially the age distribution of our patients is substantially squeezed to an older age and this
is substantial in increasing the lethality.”
However, this is only half the story and what follows is critically vital for New Zealand.
In Italy, an estimated 450,000-700,000 cases of hospital introduced infections occur annually, representing an incidence
of 5-8%. The number of annual deaths due to hospital infections are estimated at 4,500-7,000 per year.
Concerning host susceptibility, Italy is a “perfect storm”, an aged population and a pre-existing hospital environment
with one of the highest Hospital Acquired Infection rates in the world.
Person to person exposure to a pathogen is another critical determinant in the containment of a viral pandemic, which is
where the New Zealand Government have focused their efforts to date.
The Government’s thesis is that if we shut our borders, self-isolate and keep our distance, we will prevent or at least
slowdown mass infections.
The problem with this approach is that it only focuses on one of the three pandemic precursors and will not curtail the
spread of the virus and the associated death rates. Viruses have no respect for any country borders.
Countries like Singapore and South Korea have stemmed the spread of the disease and limited the death toll by focusing
on testing and quarantining for ALL infected people even those with only mild symptoms and isolating them from the
general population rather than making the rest of the population play “hide and seek” to avoid contact with them.
Three weeks ago, WHO emergency Chief Michael Ryan stated that person to person transmission has been confirmed in
several countries and called this “a great concern”.
We have also seen the first cases of human to animal transmission of Covid-19. It is naive of the New Zealand Government
to state that “for the first time since the virus arrived in this country, authorities cannot rule out “community
spread” because two of the new cases don’t appear to have been contracted overseas.”
New Zealand’s “hide and seek strategy” virus prevention program is doomed to failure because infected people are out
there, in our society, circulating freely. Eventually, we will all need to go out and mingle with them to get bread,
butter and toilet paper.
Judging by the panic buying at the supermarkets and long queues, supermarkets are looking like an ideal place to
contract the virus. The receipt handed to you at the supermarket checkout may be all that is needed to acquire the
virus.
So we need to focus on locating, testing and isolating ALL infected people. So far, only 0.1% of our population has
tested for Covid-19.
For managing mass host infections, New Zealand is at serious risk of an Italian scale high mortality rate pandemic.
While we have a lower percentage of people over the age of seventy compared with Italy, our hospital system is arguably
more fragile than Italy’s.
Several years ago, as Chair of the New Zealand Health Innovation hub, formed to improve the quality of patient care
across New Zealand, I encouraged all major DHB’s in New Zealand to work on a collaborative strategy. It was an attempt
to reduce New Zealand’s hospital-acquired patient infection rates by determining the causes of these preventable
infections. Were these preventable infections due to hospital designs; materials of construction; air conditioning
filtration systems or clinical practices?
As the data started to come in, it was clear that some hospitals had 100% more infections than others. However, when we
began to survey clinical staff to determine the critical determinants for the high infection rates, some DHB’s decided
not to participate further because they thought they were under “investigation” and ultimately, the New Zealand Health
Innovation Hub disbanded.
According to Government reports, “Hospital Acquired Infection (HAI) rates can be as high as 10% and are therefore of
serious concern”.
So in July 2019, a partnership between DHBs and the Health Quality & Safety Commission was put in place to provide sustainable funding to support initiatives to reduce HAI’s. Sadly, to
date, little progress has been made to reduce HAI in New Zealand Hospitals.
So we know, just like Italy, on an ordinary day we have serious rates of Hospital Acquired Infections in our Hospitals.
Unless we take urgent action NOW we could end up, like Italy, with significantly higher mortality Covid -19 rates than
other countries.
Over the past thirty years, I have designed and commissioned numerous Class 10,000 and Class 1,000 cleanrooms and
hospital HEPA air filtration systems throughout Europe, Africa and Asia and some in Singapore following on from the SARS
epidemic.
Singapore Hospitals were prepared for the Covid-19 pandemic because they had constructed purpose built Hospital negative
pressure biocontainment suites within existing hospitals following on from the SARS pandemic.
New Zealand’s Hospital system is totally unprepared with respect to how to look after an large influx of patients
infected with Covid-19.
Clinical staff and nursing staff are already overworked and our hospitals are not fit for purpose with respect to the
biocontainment of an infectious disease.
In contrast, China built purpose-built biocontainment facilities in a matter of weeks to isolate and treat all Covid -19
patients, even those with only minor symptoms.
The New Zealand Government needs to create purpose-built biocontainment facilities to isolate and treat at the very
least critically ill Covid-19 patients.
This does not need to involve constructing costly new facilities or massive expenditure but using simple proven
biological containment facility designs and validated biological containment practices.
For example, in Nepal and Tibet, in a matter of days, we could turn derelict school houses into high tech sterile
operating theatres to conduct cataract surgery on thousands of patients.
The rate of post-operative infections was less than that observed in “first world” operating theatres.
To beat the virus, we need to learn from what has been successful in other countries.
In Singapore, they used technology to bring Covid-19 under control by using mobile phone apps to track and trace
people’s movements; trace infection patterns and monitor quarantine compliance.
In contrast, the New Zealand Government wants the hospitality industry to track people’s movements by having them write
down their name and address when they arrive at the pub or restaurant.
Apart from the fact, the same pen is likely to be used by all the patrons to fill in the “visitor’ form and may act as a
“hotbed” infection route for transferring the virus from person to person. And, by the time Nigel, the waiter, sends the
visitor book to the Government, and the data evaluated by the government, then potentially, thousands of people may have
been infected.
The Government needs to get smarter and use remote cloud-based, “real-time” people tracking and geofencing technology to
combat Covid-19 infections, as did Singapore.
The New Zealand Tech company Jupl Ltd has an “off the shelf” mobile phone app that can track and trace people and their
cloud-based system can alert anyone who may have been in contact with an infected person so they can get tested.
Message to the Government.
Test everyone who is arriving in NZ and anyone even with only mild disease symptoms then Isolate infected people and monitor their
quarantine compliance using remote phone app technology .
Track ,trace and isolate all infected people until they have developed natural immunity.
Set up negative pressure Hospital biocontainment areas to quarantine and treat at all Covid-19 patients who exhibit
fevers and train staff in biological control Standard Operating Procedures.
It is tragic to see images of medical intervention containment staff in Italy and the personnel in New Zealand
conducting drive through testing wearing disposable Class 1 Tyvek coveralls which allow 10% of any contagion through the
fabric. It is why there is such a high rate of deaths among people treating and testing infected patients.
By using Class 3 Tychem suites which stop all but 0.001% of viruses could save lives and prevent person to person
infections.
If we focus on implementing preventative measure to address all three of the clinical parameters which underpin the
spread of infectious disease, then we have a chance of beating this virus.
Our size, our relative isolation from the rest of the world, our low population density and cleverness means we have a
real chance of being a beacon for the rest of the world on how to manage and contain an unprecedented pandemic.
The lives of thousands of New Zealanders are literally at risk if we just send everyone home and hope for the best.Sir Ray Avery
Sir Ray is the CEO and Founder of the Kaizen Group which provides expert consultancy services for the design and
commissioning of class 10,000 and class 1,000 Pharmaceutical and Medical Device cleanrooms and Hospital biocontainment
systems.