Coronavirus Government Global Briefing: May 1

By Chris Woods

May 1, 2020

Welcome to Coronavirus Government Global Briefing, Mandarin Premium’s morning update on everything in local and global government responses to the COVID-19 outbreak.

What we can learn about recovery from South Korea’s journey to zero community infections

Yesterday, South Korea’s Centres for Disease Control and Prevention’s (KCDC) announced that, with just four imported cases confirmed on 29 April, “for the first time since 18 February (the 31st confirmed case), no confirmed case was reported in the community level”.

Additionally, The Straits Times report that the country of 51.64 million people managed to hold a parliamentary election with no local transmission; while the country created new options for patients in hospital and those self-isolating, infections at in-person voting booths were apparently suppressed through disinfectant teams, social distancing of 1 metre, and requirements to wear masks and plastic gloves when casting ballots.

“Twenty-nine million voters participated in the April 15 parliamentary election… Not one case related to the election has been reported during the 14 days of incubation period,” Mr Yoon Tae-ho, director general for public health policy, told a briefing.

How South Korea nipped COVID-19 in the bud

From the start, South Korea drew early praise for extensive tracking and tracing programs — which included drive-through tests — a transparent and widespread communication campaign, all-level political cooperation, and social-distancing measures that have meant that, with the exception of a temporary closures of some schools and businesses, the country has not enforced complete lockdowns.

But that patient “31”, alluded to in the KCDC briefing, is significant; according to the World Economic Forum, they acted as a “super-spreader” throughout churches, malls, and hospitals in the days leading up to confirmation on 18 February — despite showing symptoms — and helped create a surge concurrent with the early outbreaks in Iran, Italy and Spain.

Graphic: Statista.

As Crikey explained last week, the country then followed a relatively similar trajectory to Australia — just four-to-six weeks ahead of us — using the same testing, tracing, and quarantine measure, the major differences being:

  • restaurants have remained open throughout, and citizens do not require the food/work/exercise/etc reasons to leave home;
  • testing cam;
  • citizens, following earlier SARS and MERS outbreak, willingly self-isolate, while failures in the latter outbreak led to an overhaul of the KCDC; and
  • there are regular tracing texts, a mandatory tracking app for new arrivals, and electronic bracelets for quarantine breachers.

Additionally, The Strategist explains how authorities relied on mobile-phone GPS data, credit card transaction records and CCTV footage to enact contact tracing, while local governments both quarantined potential carriers and publicly disclosed individual travel histories to inform nearby residents; this has led, understandably, to some backlash, as individuals may have faced public shaming. Project Syndicate explains how those civil groups, including non-governmental organisations and trade unions, have pushed for checks and balances on private data and further pressured the government to look after vulnerable groups, such as refugees.

Still, after slashing the outbreak from a maximum of rate of 909 new cases on 29 February to below 100 within a fortnight, President Moon Jae-in ruling party swept the 15 April election.

In an Asian News Network post-election wrap, commentator for the Philippine Daily Inquirer Richard Heydarian noted the win demonstrated a “second chance” reward for President Moon Jae-in, who faced impeachment demands from 1.3 million citizens on 28 February:

“Mr Moon, who came to power based on a promise of historic peace on the Korean peninsula and economic justice amid rising inequality, faced the greatest crisis of his career. Instead of blaming people for its failures, however, the government responded with decisive measures, including unprecedented drive-through mass testing facilities, specialised software and drones-based contact tracing and monitoring mechanisms, and an all-out public information campaign.”

Where to next?

Now, as cases dry up and the KCDC determines epidemiological links for 80.5% of the total cases 10,765 — 9.6% of whom are either under investigation or sporadic cases — the body plans to ramp up serological studies to check “herd immunity” and determine transmission trends. Additionally, “the use of blood samples collected through Korea National Health and Nutrition Examination Survey and antibody test in the Special Management Regions are under consideration”.

On the testing front, Inquirer reports that a clinical expert panel concluded earlier this week that the 292 people who tested positive again after having already recovered from the virus were not “reactivated” or reinfected, but were false positives due to technical limits in testing.

Finally, ahead of an upcoming long holiday weekend, the KCDC has issued the following guidelines:

  • People who have fever or respiratory symptoms should not go on vacation trips.
  • Any traveling, if at all, should be done in small family units in personal vehicle.
  • Crowded or popular destinations should be avoided.
  • During the trip, everyone should wash their hands frequently, cover up their nose and mouth with their sleeve when sneezing/coughing, maintain distance of at least 2 meters from other people, and wear face-masks if visiting indoor public venues.
  • People who develop fever or respiratory symptoms while traveling should stay in their room and get rest.
  • People with prolonging fever or aggravating symptoms should call KCDC call centre or contact a local public health centre or visit a screening clinic to get tested early.

Does Sweden’s “trust” gamble paint a warning for the new normal?

According to the World Economic Forum, Chief Executive Director of the WHO’s Emergencies Programme Michael J. Ryan has used the latest briefing to emphasise the role of public trust in Sweden’s relatively-lax approach to suppressing the virus.

The country has drawn headlines for bucking the lockdown trend — as The New York Times reports, while gatherings of more than 50 people are banned, restaurants and bars have remained open — Ryan says the country has ensured healthcare capacity by ramping up intensive care units, implementing physical distancing measures, and building key protections into long-term care facilities.

Over two months into their outbreak, Sweden’s curve is only just starting to falter. Source: Statista.

The focus on public trust, Ryan argues, could act as the “new normal” template for countries coming out of lockdown measures:

“What it has done differently is it is very much relying on its relationship with its citizenry. It really has trusted its own communities to implement that physical distance… If we are to reach a new normal, in many ways Sweden represents a future model.”

However, Ryan notes, it “remains to be seen whether” Sweden’s approach works, and the country’s curve shows no sign of slowing.

As a CNN comparison of neighbouring countries that opted for earlier and stronger measures — Denmark, Norway and Finland — demonstrates, Sweden’s recorded a far higher per capita infection and death rate.

While Sweden’s leaders have shown regret over the spike in deaths — specifically amongst nursing homes — and rejected aiming for a “herd immunity” strategy, state epidemiologist Anders Tegnell believes the country will still be better prepared for any second wave.

Additionally, in that much more comprehensive CNN report, a professor in the Department of Microbiology, Tumor and Cell Biology at the Karolinska Institutet, Jan Albert, argues that herd immunity is ultimately “the only thing that will eventually stop this, unless there is a vaccine in time, which is quite unlikely”:

Stricter lockdowns “only serve to flatten the curve, and flattening the curve doesn’t mean that cases disappear — they are just moved in time. And as long as the healthcare system reasonably can cope with and give good care to the ones who need care, it’s not clear that having the cases later in time is better.”

Still, while it may take months or even years to gauge the long-term effectiveness of early lockdowns, you only need to look at Tagesspiegel’s comparison of EU countries to see Sweden, on a per-capita basis, is closer to Italy’s death rate than its immediate neighbours’.

Data: Johns Hopkins CSSE, Risklayer, CEDIM (KIT) et al.; Graph: Tagesspiegel.

On the home front: The NT’s ‘Roadmap to the New Normal’, the North West Regional Hospital outbreak interim report, SA testing and vaccine blitz and more

Yesterday, the Northern Territory government launched the ‘Roadmap to the New Normal‘, a three-stage plan detailing the next month of restrictions adjustments. The government notes that milestone dates are “indicative only” and dependent upon both zero community transmission and people complying with physical distancing and hygiene practices.

Stage One — to commence noon today, Friday 1 May

Today’s adjustments will focus on “simple and safe outdoor activities where physical distancing can be maintained at all times’, and will allow the following:

  • Personal gatherings including outdoor weddings and funerals.
  • Playgrounds, parks and campgrounds outside biosecurity areas.
  • Public swimming pools, lagoons and water parks.
  • Outdoor sports where physical distancing can be maintained including golf and tennis as well as training outdoors.
  • Go fishing, boating, and sailing with other people.
  • Real estate open house inspections and auctions, and gatherings in homes.

Stage Two — noon, Friday 15 May

These measures will allow “safer indoor activities for less than two hours,” such as:

  • Shopping centre food courts.
  • Restaurants, cafes, and bars for the consumption of food – excluding gaming areas.
  • Organised outdoor training activities for sport teams without physical contact.
  • Beauty therapy salons for non-facial services such as nails, massage and tanning.
  • Gymnasium.
  • Public libraries.
  • Places used for religious worship – including indoor weddings and funerals

Venues will also be required to complete a COVID-19 safety plan checklist to ensure they operate within physically distancing and hygiene guidelines, to be made available from 5 May. The government notes this will not create a new approvals process, that businesses will be able to complete and submit the checklist prior to opening, and that health officers will make subsequent compliance checks.

Stage Three — noon, Friday 5 June,

By 5 June, all territory businesses, services, facilities and organisations should reportedly have their own COVID-19 safety plan.

The final stage will see the two-hour time limit removed and restrictions eased on further indoor activities, including:

  • Officiating, participating and supporting the playing of team sports such as football, basketball, soccer and netball.
  • TABs, and all licensed gaming venues.
  • Any cinema or theatre, concert hall, music hall, dance hall, nightclub or any other similar entertainment venue in approved configuration.
  • Previously restricted services at a place that provides beauty therapy, and/or cosmetic services including facial care.
  • All businesses, facilities and services previously restricted can now resume ensuring adherence to key principles.

The government notes the changes will also apply to communities within designated biosecurity areas.

Looking ahead, the territory’s internal border controls under the Commonwealth Biosecurity Act are due to expire on 18 June, and the territory government notes that — while existing border security and quarantine arrangements will not change — the decision on whether to lift internal controls will be made in partnership with the federal government, land councils and communities – and based on the health advice.

Tasmania’s North West Regional Hospital Outbreak Interim Report

Yesterday, the Tasmanian government released Public Health Services’ 28-page North West Regional Hospital Outbreak Interim Report, which found hospital staff worked while sick and suggests the original source of infection for the hospital was most likely to have been one (or both) of “two inpatients who were admitted to the NWRH with COVID-19 acquired on a cruise ship, the Ruby Princess.”

Further, it was likely that by the time those cases were diagnosed, there was already community transmission within the hospital.

As health minister Sarah Courtney announced on the document’s launch, the government has accepted all recommendations and tasked the Secretary with developing an implementation plan.

These include:

  1. Develop strategies to reduce the unnecessary movement of staff between facilities, particularly during outbreaks.
  2. Resource infection prevention and control and infectious diseases services in the north west.
  3. Clearly describe the structure, roles and resources required for the outbreak management team.
  4. Implement consistent staff and visitor screening processes to ensure that any person with respiratory illness does not enter the facility.
  5. Establish processes governing patient transfers between facilities.
  6. Develop a formal outbreak management plan.
  7. Develop clear, consistent and documented processes and responsibilities for the tracing and management of contacts for patients, staff and community.
  8. Clarify statewide return to work (RTW) processes for COVID-positive and quarantined contacts.
  9. Identify improvements necessary to facilitate a move away from paper systems.
  10. Evaluate and promote social distancing and proactive rostering.
  11. Identify drivers for presenteeism [also known as why staff present for work while symptomatic].
  12. Undertaken regular audits on infection preventions and control (IPC) practices in Tasmania’s hospitals.
  13. Strengthen local and statewide IPC networks and culture.
  14. Improve processes for the timely and transparent sharing of information on transmission events with the health workforce.
  15. Develop and implement new mandatory training and education package that emphasises infection control and PPE use, and enhance communication with staff.
  16. Maintain a strong communications strategy to keep staff informed.
  17. Staff wellbeing programs.

For more in-depth explanations, read the report itself.

Courtney notes that some recommendations already being actioned include enhanced staff screening, improving PPE training and communication for staff, and clarifying return to work processes on a statewide basis, while others will take progressively longer to implement — presumably, this include Recommendation 11, understanding and working to alleviate the reasons some health staff present to work while sick.

South Australia’s testing and vaccine blitz

Yesterday, South Australia hit 57,389 virus samples taken, reportedly the highest per capita tests in the country, at more than 3.2%, and even triple Western Australia’s testing rate of 1.4%. The government announced the “blitz” will now be expanded “ongoing for anyone with cold or flu-like symptoms, no matter how mild, and expanded to include anyone with unexplained loss of taste or smell.”

Separately, the government passed legislation expanding the ‘No Jab, No Play’ policy, which now excludes children up to the age of six from early learning services who have not been fully vaccinated from early August, with health minister Stephen Wade announcing:

“The lack of a vaccine to protect against COVID-19 event has highlighted just how important it is to vaccinate against dangerous diseases we can prevent.”

Wade also announced that residents who test positive for COVID-19 will receive comprehensive daily support throughout self-isolation from two new dedicated teams, the the COVID-19 GP Assessment Team and the nurse-led SA Health Remote Monitoring Service.

State wrap

In other state news:

Finally, the NSW government has also today launched ‘COVID-19 in NSW by postcode’, a heat map that tracks active cases, recovery rates and testing numbers by suburb.

Source: NSW government.

For health department updates: Federal, NSW, Victoria, QueenslandACTSouth AustraliaTasmaniaNorthern Territory and Western Australia.

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