PM we need a coordinated defence

With a vaccine just around the corner (according to some politicians) is the mitigation of Covid-19 still worth the work to establish the “system” for mitigation?  Our own experience in New Zealand under the stewardship of Prime Minister Jacinda Ardern and her government illustrates the leverage of human factors has been world best practice but waning in effect.

The Government – its ministers and politicians, its bureaucrats and employees – have been thoughtful in pulling the required levers for containment and mitigation, and tireless in their application.  But the virus is outpacing their learning curve and the mood of the public is outpacing the impact of their ability to appeal “we’re all in this together”.  Part of this is erosion of impact is simply risk/reward trade-offs people are willing to make to save their business, find new employment or be close to their loved ones.  And part is the bias that sets in once “freedom” is experienced and then taken away in a recurrence of lock-down as a mitigating action.

Prime Minister Ardern and her famous empathy have helped New Zealand be very aware of the precariousness of human performance in this pandemic situation.  Sustaining the morale of front-line workers who protect us from incursions and mitigate the impact through testing, tracing and enforcement is balanced with “selling” compliance to the rest of us through a mix of community spirit and fear.  On top of this the PM and cabinet have been decisive in pulling levers that restrict movement and not just flatten but defeat the virus ... but only temporarily.  We still don’t know where the latest incursion has come from, and we are assured there is not a sleeping infection waiting for the right conditions to re-emerge in our communities.  It seems no one knows for certain yet whether “recovered” cases are points of dormant potential, let alone the impact of asymptomatic carriers.

Ardern and her Director of Health, the unflappable Dr Ashly Bloomfield, have rightfully emphasized that the virus is our enemy, not its infected victims.  Yet all of New Zealand, and indeed most of the world are now its victims, at least economically and in too many cases tragically via loss of physical and mental health and loved ones.  And we continue to forego potential benefits from those wishing to sequester in New Zealand during the pandemic as well as essential workers to support our essential, export and building industries due to limited inbound capacity under current settings.

Globally, mitigation strategies vary from laissez-faire “herd immunity” to dictatorial lock downs and invasive tracing.  Few have resulted in balanced personal welfare, and so we cheer from the sidelines as governments submit vaccine purchase orders to queue-up their citizens and hopefully their economic recoveries.

In the meantime, New Zealand is throwing additional resource at the defence of our borders, literally additional foot soldiers who are deemed better at following orders, and managerial resources deemed to have a fresh and expert perspective on shoring up our defensive strategies and tactics.  While this may illustrate another of the PM’s attributes, willingness to collaborate with her advisors and influencers, it is unlikely to provide the sort of insurance Kiwis are looking for – and that other countries might come to emulate if it were to work.  This bespoke “solution” is systemically weak and may rely too heavily on the fallback tactic of community appeal and selective lockdowns, with unfortunately diminishing effect.

In order to preserve the government’s social license to lead, the enemy can be met with a purpose-built response that is transparent, built on learnings from around the world, and a command-and-control structure that complements the government’s morale authority and ability to lead.

Five Horizons of Defence

In many endeavors “offense is the best defence”, but while a vaccine is in development a systemic defence likely needs to be constructed. 

There appear to be five “horizons” of defence for any given geographic area – In New Zealand we are lucky to have just a few islands to consider, but other countries are conveniently divided into provinces and states, municipalities and neighbourhoods with borders of their own that can be defined and protected as necessary.

1.  Pre-border:  For people and goods moving into New Zealand there is a complex network of entry points and boarding criteria and transit arrangements to consider.  So far it seems only China has declared risks from imported goods, and so consideration focuses on people movements.  Professor Sir Peter Gluckman has provided great examples of testing pre-boarding personnel as a way to mitigate entry of the virus (temperature checks, fast testing for virus antibodies), and airlines have assured us of pre-boarding virus-killing cleaning and in-flight protocols and air filtration that mitigates spreading in the aircraft cabin.  New Zealand can certainly impose these requirements on flights into New Zealand, but there are risks in ensuring compliance and complications for travellers if asked to pay with their pre-flight time and logistics as well as fees imposed for these heightened testing measures.  Cooperation amongst nations, airports and airlines would help, should the rest of the world adopt the same Covid-defending stance.

2.  Border entry:  Similar to pre-boarding, fast testing has been recommended for all New Zealand arrivals – passengers and operators.  This again presents complications for the arrangement of airports and ports; provisioning, protecting and testing front-line personnel and equipment on top of normal customs and immigration; and inevitable delays and irritations for passengers.  But airports and related agencies in potential bubbles are cooperating in making the required arrangements.  There may be some difficulty in executing a coordinated response at this critical point of entry when multiple agencies, resource levels, cultures and procedures are involved.  A “Border Force”, comprised of recently unemployed and others looking for structured training could be launched and trained under the supervision of Customers & Immigration, Police and the Military, to supplement staffing needs at entry points and subsequent horizons of defense.  The Honorable Winston Peters has recently nominated a similar initiative.  

3.  Border isolation:  Isolation will likely continue to be a required “insurance policy” against an active virus as we rely on the immune system of carriers and a two-week window of internal combat readiness.  With the advent of testing in isolation at days 3 and 12, isolation arrangements seem conceptually simple – designated hotels complete with in-house food and beverage services that keep the virus contained.  However, this mechanism has proved to be not just logistically complicated, but also porous based on experience in New Zealand and overseas.

As in many situations, human factors make things difficult: ”escapees”, visitors, approved exceptions as well as front-line workers all provide vectors of community transmission.  Systemic solutions like better fencing and monitoring, as well as improved execution of testing for front-line workers are all necessary.  Improved command-and-control via a Border Force with “military discipline” and police enforcement can also help, but the training and culture of a specialised agency will take some doing, and in the meantime a resource from mixed backgrounds and norms is likely difficult to manage.

System issues also need to be resolved.  Mixed use of facilities for isolation and residents/hotel guests seems an obvious failing, and likely reflects the scarcity of facilities with the right mix of self-reliance in food preparation willing to be part of the border program.  And this also reflects one of the limiting factors on expanding the border program to let in more returning Kiwis as well as aforementioned economic contributors.  NZ First have been promoting the use of military bases with less salubrious accommodation blocks – idled by the run down in New Zealand’s military numbers and supplemented with temporary accommodations.

The “simple” transport of entrants moving to isolation, as well as those with positive tests moving between isolation facilities, seems to have also been found wanting in terms of how to contain passengers in the “transport bubble”, and how to protect front-line workers.  This is all the more troubling with recent hypotheses of one Auckland case believed to be transmitted from a person leaving isolation to a maintenance worker via a button and/or atmosphere in an elevator.

If the virus is indeed transferrable via non-host contact, further issues are raised with goods and vehicles leaving isolation facilities – buses, cars and trucks; food and food wastes; linen for cleaning; wastewater and sewage; etc.

A comprehensive review of these systemic issues and risks needs to accompany the review of human factors mitigation.

Some have suggested broadening isolation facilities to private dwellings and for-hire facilities catering to segments such as wealthy tourists and returnees and essential workers with company benefits, predicated on enforced location tracking via a chaperone or more actively using an ankle bracelet or similar.  This seems inordinately risky until the above risk assessments are complete, and some assurances can be provided – but even then, the cost of compliance supervision and stretch on scarce border resources seems unworkable (even rich people misbehave apparently). 

4.  Incursion tracing:  Likely incursions will happen regardless of the tightness of elements 1-3 above.  There appear to be four key considerations: the carrier and therefore ability to test them subsequent to potential exposure, the time required to detect an incursion outside the border/isolation area, the accuracy and completeness of subsequent contact tracing and time lag to do so, and the compliance of identified close contacts to self-isolate and report any ensuing ill health.  To date this horizon has depended on goodwill and a small army of contact tracers, and hence the effort and leadership of Ardern and Bloomfield (and supporting cast) in reinforcing people as our key defence mechanism.

As a technical solution for tracing, Sam Morgan has been promoting the “Covid Card” as a better solution than the Government’s contact tracing app, being a mechanism with greater likelihood of take-up, use and therefore effectiveness due to the passive nature of use and recording.  Short of an embedded chip he seems correct.  But people still need to carry it and ensure it is actively pinging away, so we come back to people and their willingness to comply.  While the PM and cabinet have shied away from required compliance in tracing to date, if recent tests on the “card” prove fruitful we may see them leverage their social license to compel use as an offset to further gross restrictions on personal discretion via lockdowns.

This compliance is likely to focus initially on front-line workers (as a requirement of employment) and recent isolation residents (say for 2-4 weeks post departure).

Unfortunately, the stigma of being an infected person and source of community spread has the potential to delay self-identification or coming forward as part of a family/related unit.  Here again we see the PM, Ministers and DoH leveraging their goodwill with the community to nullify these effects.  I doubt incentives would be as effective as this would likely exacerbate the stigma attached.  

5.  Incursion mitigation:  In this final horizon of defence New Zealand has famously developed a four-tier structure, providing transparent behavior expectations for individuals and organizations.  The PM has skilfully explained these, and for the most part compliance has been achieved with desired effect – on the virus incursion. 

The effect on the economy, businesses and other organisations, owners and employees has been mixed, and when it’s been bad it can be very bad.  

To date the most systemic response from Government has been subsidies and grants aligned to individuals and organizations, studies of the impact and solutions, beefing up of social services, and nudging of independent institutions such as banks, the Reserve Bank and SOE’s.  Many other individuals and organizations of various sizes have embraced the “we’re in this together” theme and provided services and benefits to the community.  Some insurance companies have rebated premiums due to lower losses, agile collaborations such as Manaaki have sprung up to assist small business, individuals have reached out to offer assistance formally and informally.

However there appears to be a lack of systemic thinking in these responses to date, and this is a good example of the virus outrunning the pace of response.  While the Government has learned that some businesses can stay open and operate at Level 3 in Auckland, there are examples provided by Michael Barnett of businesses that should be open and by Katherine Rich of essential workers prohibited from crossing the Auckland boundaries.

Potential Solution

If New Zealand is going to cope with this intimidating enemy and maintain a social license/moral authority for the Government to act effectively, it seems a focused defense is required across each of these five horizons:

• Establish a temporary Department aligned to the Office of the PM or State Services, with a Director of Covid Defence (DoCD)

• Allocate a budget for Covid Defence, considering the five horizons of defense

• Assign line authority to the Director (DoCD) for defence horizons 2-4 (Border, Border Isolation, Incursion Detection), with the authority and budget to utilise the resources of other Ministries and Departments as required (for example border operations for Customs and Immigration dealing with inbound passengers and personnel would come under the DoCD)

• Assign coordination authority to the DoCD for defence horizons 1 (Pre-border and NZ’s policy settings as well as required resources) and 5 (incursion mitigation, involving DoH, MAF, Police, etc)

• DoCD to convene an expert panel to develop systemic risk assessment and action planning for each horizon (20 days)

• DoCD to establish a Border Force

  • Beginning with secondments from Customs & Immigration, Police, Military, Health, Department of Internal Affairs, plus NGO’s and other organizations as required (Airline, Airports, ports, etc) (20 days)

  • Establish a training curriculum, trainers and recruitment drive for Border Force resource (20 days)

  • DoCD to recommend isolation system and capacity aligned to demand forecast including implementation plan:  (30 days)

    • Returning Kiwis

    • Essential workers

    • Others

• DoCD to direct implementation of any systemic changes approved in defence horizons 1-5

New Zealand has done exceptionally well defending against the Covid virus.  However, the virus is outrunning the Government’s leverage of goodwill and the ability of chief spokesperson Jacinda Ardern to keep the team together.  A clear and transparent point of accountability with informed system-thinking is now required to marshal resources in this defence.

 Timing is not great – with less than eight weeks to the general election there seems insufficient lead time for the Government to take decisive steps in this direction, notwithstanding their intent on running a campaign based on their record of Covid response.  Cross benches support also seems problematic during an election campaign but achieving some agreement on the issues and momentum towards a coordinated response would be a true display of leadership.