Strategising the peaks

It's easy to get rub ourselves into a soapy lather over the rise in Covid-19 cases in New Zealand but if I wanted to cool myself down, I assure myself that there must be a tactician, probably a chess player, behind the scenes planning moves, feints and stratagems that fit into a grand plan. Go back just one week to that "Self Isolation policy for all arrivals". At that time there were only 5 cases - and that 16 day strategy lasted all of 5 days before the announcement of a complete closing of the borders. In some ways it might seem that the self-isolation policy was a misstep, but you don't need to be too generous to think that it was actually a telegraphed phase in a bigger strategy.

The day she announced the self-isolation policy, the Prime Minister, with just five cases, said that the plan was to "flatten the curve", the curve being the surge of cases. Without any prevention measures, the outbreak would have a large peak that would overwhelm the health system. So to flatten the curve it implies that there would be measures deployed in the face of the virus to dampen that surge. For there to be a surge, there needs to be the spreading of the virus. For there to be a spreading of the virus there needs to be cases and community spread. The plan of flattening the curve was clearly informed by the need to have a long term plan of herd immunity through gradual spread, rather than containment. This article in the New Zealand Herald it elaborates clearly a strategy of "managed peaks" as New Zealand's best bet.

It was actually possible at the five case mark to shut the door. It was already pretty clear that wherever the disease landed it burst through any line of defence. We could have contained the disease outside our shores and extinguished whatever signs of it there were within. That would be an easy strategy - but also it's a very temporary strategy, unless you want New Zealand to become an autarky a la North Korea.

The key is to have a few cases, not too many cases at one time. Like a captain on a ship planning to tack, they waited to a particular time and then slammed the door to the entry of imported cases on Thursday night. Today it was announced that there were two cases not from travel. For some this is a moment to fret, not realising that the strategy is clear: the majority is going to get exposed, slowly, with the contagion slowed with social distancing, and tracing easier with movements restricted. Local transmission is how you get the virus to the non-travelling population.

It is not a politically easy statement to make: we want you to be sick, at some time, in an orderly way. Britain, of course, made a similar statement but with negligible testing, existing wide community spread and fatalities already emerging. It will be interesting to see how our Prime Minister would answer if asked directly if they were intending people to get infected, even though she has coded it. 

Which brings me to China. Their official numbers seem to indicate that the community spread is negligible, the outbreak extinguished and that the only source of cases was from the outside. But they still haven't started the school year; there are anecdotal stories that there are still lock downs and the sealing of towns. My theory is that China is also maintaining a low level controlled infection of the populace. But also that is not a palatable fact, hence the suppression of accurate numbers of true local transmission.

It could be possible that New Zealand has too many cases - we just don't know how many cases are actually out there. With the speed of this outbreak, a week is a long time. Every week from here to Christmas will be a long time. With a bit of luck, we'll have vaguely normal lives and a slow inevitable infection, while treatments and vaccines are eventually developed. Fingers crossed.