In the revealing second piece from a two-part interview, Ashley Bloomfield and Newsroom’s Marc Daalder discuss the decision to enter lockdown, and whether this could be the last pandemic.
It isn’t until around 6pm that the seriousness of the coronavirus pandemic strikes me.
It’s March 18, 2020 and I’m sitting on the No. 3 bus, balancing my laptop on my knees and transcribing an interview I’d carried out with epidemiologist Michael Baker just a half hour earlier.
The bus is crowded – it’s rush hour – and so I’m surrounded by people chatting, listening to music, quieting their kids. They’re all blissfully unaware of what Baker is telling me, the realisation that is slowly dawning on me: This virus is about to change the way we live our lives for months, if not years, to come.
If New Zealand can’t exclude the virus and we can’t control it, Baker is saying, then we might have to live in lockdown for the next two months, before easing off, and then plunge back into lockdown again. Flicking the switch on our economic and social lives on and off, again and again, for 12 to 18 months. It’s a bleak prediction of a “suppression” strategy that might be needed to avert tens of thousands of deaths.
Read part one: Bloomfield sees some restrictions for three to five years
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“It’s one thing to hear about it and see it happening at a distance. It’s like watching a Netflix series from overseas, but actually, that will be us if we don’t contain it,” Baker tells me. Of course, this is the second time I’m hearing it, but it’s a concept that takes time and repetition to process.
“It’s a new way of living that’s pretty foreign. It’s pretty obvious that no one alive today has seen a pandemic like this.”
‘It’s a sort of now or never moment’
Baker’s conviction that an immediate lockdown is needed is backed up by modelling – not just his own, but a new report out of the Imperial College London. Experts working there to advise the British government on its own Covid-19 response have found that the “flatten the curve” or “mitigation” approach would kill a quarter of a million Brits and more than 1.1 million Americans.
Boris Johnson and Donald Trump had both been presented with a draft copy of the findings in recent days and immediately shifted their strategies in response to it.
New Zealand, too, was about to do so. At the March 18 press conference in the Ministry of Health building, Director-General Ashley Bloomfield said he’d just seen new evidence that changed our plan for fighting the virus.
“We’ve got a paper that just came through overnight to the Prime Minister’s Chief Science Advisor that looks not so much at the modelling but at what you can do to prevent that big peak. What we have to date been talking about is flattening the peak, but even if you do that, you still likely exceed your health system capacity,” he said.
“Our approach – and this is what successful countries have been doing – is you want to have a series of small peaks over a longer period of time and you amplify up quite stringent controls to ensure that you don’t exceed your health system capacity. Then as it goes down again, you can ease those and be prepared to ramp them up again.”
Now, sitting in that same room at the Ministry of Health more than a year later, Bloomfield tells me the Imperial College London paper was just as important for underscoring the severity of the coronavirus to him as it was to me.
“The Imperial College London paper was, I think for many people, really important in terms of the understanding that we needed to move very quickly if we were going to head off a very significant outbreak,” he says.
“But I think that that paper from Imperial College was, in many people’s minds, including mine, the one that really sort of realised, it’s a sort of now or never moment.”
There were two earlier hints that this was going to be not only worse than the SARS outbreak of 2003 but something on the verge of a once-in-a-century occurrence.
“My first moment of, sort of, I guess, anxiety as I could call it – just in a general sense – was just as information started to emerge and the WHO you could see was taking this very seriously. Really a sense that there was every chance this was going to become the pandemic,” Bloomfield says. This is in February, after the World Health Organisation had declared the coronavirus a Public Health Emergency of International Concern – the loudest alarm bell in its arsenal.
Come March, just prior to the publication of the Imperial College London report, Bloomfield found himself pacing the room at a backpackers in Invercargill, fretting about exponential growth. He had just read a paper from an American expert, showing that cases in the United States and United Kingdom were about to spike exponentially. Would the same happen in New Zealand?
“I can remember being, and I’ve talked about this publicly before, being down at the New Zealand pipe band national championship in Invercargill and having read that on a Saturday evening as I paced around my room at the local backpackers. Actually, it really gave me a sense, ‘Goodness me, we’ve got to move, we’ve got to move quite quickly here,’ because you see what was happening,” he says.
As the Government shifted to a suppression approach, it devised an alert level system (influenced by the successful framework launched in Singapore) to signal to New Zealanders whether we were in a period of relaxing restrictions or ratcheting them up. On March 20, officials still envisioned remaining at Level 2 for weeks to come. By the next day, when the Prime Minister announced the alert level system in a televised address to the nation, that was already starting to change.
“I think that all came together that weekend, you know, on the 21st of March when the Prime Minister presented the alert level framework on the Saturday. I have quite vivid memories of that weekend, realising that actually we couldn’t afford to be in Alert Level 2 for two weeks. The Sunday, there were a number of conversations about the need to move more quickly and that’s hence the announcement on Monday the 23rd, that we were going to Alert Level 3 and then in two days’ time to Alert Level 4,” he says.
“That would be where, in a sense, my mind was made up. I think, though, that the mind was made up of quite a lot of people. Having spent quite a bit of that Sunday with the Prime Minister and senior ministers and senior public servants, there was a convergence of views. Including from senior people in the private sector. A number of our well-known epidemiological voices had reached that conclusion.”
Now it’s late April 2020, and I’m speaking to Michael Baker again, and he’s telling me we could have avoided lockdown in the first place. By the time we shifted to suppression, it was too late, but the issue here is how long it took us to move to suppression.
“We had a mitigation approach when in fact the Chinese had shown us really very convincingly I think by the end of February that you could take a containment approach with a view towards elimination,” he says. The root of the problem is our playbook – we were using an influenza pandemic plan that didn’t entertain elimination, or suppression. Once the virus took hold in the country, the plan said we should move straight to mitigation, because influenza has such a short incubation period that it can’t be effectively contact traced and ring-fenced.
“We had a good plan for the wrong virus,” Baker says.
“I think quite a bit’s been made of the fact we weren’t ready. Well, actually, it wasn’t about readiness.”
Bloomfield now readily concedes the same thing.
“I guess one of the immediate challenges was that we and other countries had planned for an influenza pandemic and here we had a different virus. So, there was a sense already even early on, that our playbook might not be quite the right playbook,” he tells me.
However, he defends the Government’s overall response, saying the approach was remarkably flexible in response to new information. After all, it took just 72 hours from receiving the Imperial College London report to implementing the alert level system which, in effect, created the framework for operationalising that report.
“Our biggest strategic asset over the last year and a bit has been our agility. I talked earlier on about, in a sense, having to put our playbook to the side very early on. From that period on, we were doing, as we say in public sector parlance, ‘learning it forward’,” he says.
“I think the New Zealand public service has shown its ability to be very agile in the past, and that’s been a great asset for us. And it’s not just the public service. I think our decision-making, because of a unicameral government system, the closeness of decision-makers to communities, and the ability for us to get information out and for people to understand what was going on.”
The lesson, then, for a future global health threat?
“Again our biggest strategic asset will be our ability to be agile and respond, and learn continuously. And I think what that means, reflecting on our preparedness – and I’ve talked with colleagues across government about this – is probably less focus on detailed planning around a specific organism. So we don’t need inch-thick plans on pandemic influenza or pandemic coronavirus,” he says.
“We need to think about, ‘What are the really core pillars of a response to a global health or other security threat?’ and build those up. Our ability to get information, our data and analytics. Our leadership structures and decision-making processes. And then exercise those through on a whole range of different scenarios.”
While Bloomfield acknowledges that New Zealand lags behind other OECD countries in per capita ICU capacity – and broader health system capacity – he says better resources wouldn’t have necessarily helped us in this pandemic.
“There was a lot of talk about the fact that our system didn’t have the capacity to deal with it – both the public health aspect of it and then the healthcare system. But what was already obvious was that even the two systems that were apparently the best prepared – according to the Global Health Security [Index] assessment the previous year – which were the UK and the US, weren’t going to cope with it either,” he says.
“We saw that no system could cope without some sort of significant restrictions on movement, no matter how well-resourced the system was from both a public health, contact tracing, testing capacity perspective and a health system perspective. I think quite a bit’s been made of the fact we weren’t ready. Well, actually, it wasn’t about readiness.”
Does that mean bolstering our health system shouldn’t be a focus of future preparedness efforts? Bloomfield equivocates. The centralisation of functions in the Ministry of Health has been beneficial, for example.
“There’s been no, in the past, neither a sense of a need to nor the capacity to have a single distribution system around PPE. So there’s a lot we have put in place now that are sort of legacy systems that will support preparation for and any response in a future pandemic, but they will also help the system to function better, I think, even in peacetime,” he says.
“This should be the last pandemic. If we do the right things from here, individually and collectively, then it could be.”
“Again though, let’s say we doubled our ICU capacity and our hospital bed capacity. We’ve recognised we’ve got good laboratory capacity and we can surge that up if we need to. It’s the willingness to act early on information and intelligence from a public health perspective that is the critical thing here. I mean Australia implemented a similar series of lockdowns, effectively, to what we did, even though we’re often compared with Australia around ICU capacity and health system capacity.
“So I think that’s part of it, and having those national systems in place now will help for the future. But the core will still be our ability to understand what is happening from a public health perspective and then respond accordingly, including making, what were in this instance very courageous decisions quite early on and ones that have served us well.”
Can we do better next time?
This doesn’t mean there’s no room for improvement. Bloomfield views the Government’s new health reforms as a crucial step for better preparing the country. These involve centralising the 12 public health units into a single Public Health Service. In the event of a measles outbreak in Auckland, for example, resources could much more easily be redistributed around the country.
Already in responding to Covid-19, this centralisation has begun. Much of the country’s contact tracing is run out of a call centre in Wellington, the National Investigation and Tracing Centre.
Public health policy, too, will be pulled from disparate parts of the health system and Ministry of Health and consolidated into a Public Health Agency. The two public health entities would ideally, in the event of another pandemic or other global health emergency, take over the show.
“I’m really pleased that the health reforms have confirmed intent to establish a Public Health Agency here in the Ministry of Health. And to really build the capability and capacity that is needed, not just to prepare for and respond to these sorts of events but actually to look hard at, ‘What are the other public health issues across the country – including and this is of course my area of interest – but non-communicable diseases?’”
Bloomfield also says global response and coordination in future events needs work. One of his major takeaways from the recent independent review of the global response to the pandemic – co-chaired by Helen Clark – is that the world needs to cooperate far better in future emergencies.
“I think the key theme in the report for me was this need for countries, member states of the WHO and indeed the UN, to really think again about the need to act collectively in both response and then of course around vaccine distribution,” he says.
“The report argues, you know, I mean in a sense it’s saying: ‘If not now, when?’ There cannot be a better reason for us to fund the WHO to the level it needs to be funded to enable and empower it to play the global leadership role it needs to in these sorts of situations and arguably beyond and govern it better.”
The report challenges the global community to make Covid-19 the last pandemic. Is that possible?
“I think the challenge is a good one. This should be the last pandemic. If we do the right things from here, individually and collectively, then it could be. But we’ve certainly got to do things differently and do different things in the future. I think that’s what the report argues pretty convincingly in my mind.”
Is that likely? Does Bloomfield really think New Zealand – let alone the world – will remember the lessons of Covid-19 and make the necessary changes to head off future threats? Ever the optimist, he says with earnestness that he does.
I hope he’s right. I’m glad that the worst case scenario I envisioned on that bus ride in March of last year never eventuated – at least in New Zealand.
Other countries haven’t been so lucky. There are nearly 3.5 million confirmed deaths from the virus and 165 million more have been sickened by it. Around the world, more than 180 countries are living with more stringent restrictions than we are – including 70 operating above the equivalent of our Level 3.
“There’s always a risk that our memories of the reality will wane over time and therefore the imperative to just maintain that really strong public health infrastructure in particular – and the supporting infrastructure across government – that is needed to respond to these global health security threats, there’s a risk that that could wane over time and become less of a priority,” Bloomfield says.
“But let’s think about it: This is the biggest global health security event in 100 years and arguably one of the most significant global challenges in 100 years. I think that it’s a long way off before people will forget the importance of it.”