The Pacific Election 2023 debate kicked off today with one of the most pressing issues for Pacific communties — an amnesty for overstayers.

The Dawn Raids apology was two years ago, and weeks out from the election, the Labour Party has announced it would offer a lifeline for long-term overstayers in New Zealand.

It followed anger from Pacific community leaders, disappointed it had not happened in all the years following the apology.

On the panel were Labour’s Carmel Sepuloni, National’s Fonoti Agnes Loheni, ACT’s Karen Chhour and Teanau Tuiono from the Green Party.

Labour’s Sepuloni said the amnesty announcement was not an attempt at baiting voters.

“You have to think about everything that has been expected of Immigration New Zealand in the last couple of years and the immense pressure that they have been under,” Sepuloni said.

An amnesty would be granted “in the first 100 days if we are re-elected,” she said.

Green support for amnesty
The Green Party would also suppport an amnesty for overstayers.

“Amnesty for overstayers is more than timely. It is late,” said Green Party Pacific Peoples spokesperson Teanau Tuiano, criticising Labour for taking too long.

The Pacific Issues Debate. Video: RNZ Pacific and PMN

Meanwhile, both National and ACT would not back an amnesty.

National leader Christopher Luxon had previously said it would send the wrong message and encourage “rule breakers”.

National’s Pacific spokesperson Loheni said the the Dawn Raids was no doubt “discrimination and abhorrent”.

But, she took the side of people “working hard to go through the legal steps to become residents”.

Health
Around 40 percent of New Zealanders — and half of Pasifika people — cannot afford dental care.

The Green Party plans to make dental care free for everyone — paid through a wealth tax system, which the Labour Party had already ruled out.

However, the Labour government said it would provide free dental care for everyone under 30 years old.

Dental care in New Zealand is free until a person turns 18 years old. But this excludes orthodontic care, i.e. braces because it is classed as “specialist dental care”.

National’s plan to tackle the health crisis was to attract an overseas workforce and plug the nurses and doctor shortage within New Zealand. Loheni reiterated her party leader’s stance and refused to back “race-based” policies but did acknowledge the hardships Pacific people faced.

“The numbers are grim for the Pacific. We need to get more of a workforce here,” Loheni said.

“The health system is in absolute crisis. We are 4800 nurses short. We are about 1700, GP’s short and about 1000 midwives short,” she said.

ACT Party candidate Karen Chhour said, “I’m hearing all around the country and especially up north and just the lack of GPs up north.”

Chhour said it was about helping to “ease pressure off hospital services” and “investing in the front line services”.

Two thirds of students experience poverty.

“Why would you go into university to study medicine . . . we would pay this through a wealth tax,” Greens Tuiano said.

This policy is expected to provide a guaranteed income for students or a person who has fallen out of work to help them get through university.

Labour said it would address health inequities because Pacific and Māori people were more disadvantaged.

“It has been incredibly ugly on the campaign trail . . . the level of racism that is resulted because of the rhetoric around measures like this, when they are purely equity measures and they should be embraced by everyone,” Sepuloni said.

She said seen since 2019, around 1000 health scholarships had been given to Pacific people.

Housing
One in 10 Pacific (11 percent) children live in damp and mouldy homes, where they are 80 times more likely to develop acute rheumatic fever, which can lead to heart disease and death.

Sepuloni said: “We have increased that by 13,000 homes, stopped selling them off. We have got 2700 Pacific people signed up with our programme that provides them with support to pathway into home ownership . . .

“Some of our Pacific populated areas are getting investment that they never had before. Like the NZ$1.5 billion we put into put it for housing revitalisation.”

But ACT’s Chhour hit back and said the “government should be held to the same account as landlords”.

“Kāinga Ora is one of the worst landlords in some cases where they do not meet those standards and where they have got extra time to meet those standards,” she said.

Green’s Tuiono said prices for rentals needed to be capped to protect tenants.

“There are 1.4 million renters within New Zealand and many of those people are our people.”

National’s Loheni said she “grew up in a state house with a crowd 15 people. One of my sisters has lived with asthma her whole life and it put her behind in school”.

She said under the Labour government “rents have gone up $180 per week.

“Unfortunately, we still need social housing, emergency housing. We have got 500 people living in cars at the moment. So we got a priority category to move those people who have been living in cars further up that social housing list.”

Education
Pasifika students face significant achievement gaps and underfunding, while teachers struggle with complex job demands and mental health issues.

“The government has failed our students,” Loheni said.

Loheni got emotional during the debate when sharing the declining pass rates of some Pasifika students.

“Only 14.5 percent Pasifika students reach the minimum curriculum for maths compared to the rest of the population of 41.5 percent,” she said.

“Please don’t say it’s covid because why is it Pasifika students, the lowest of all groups, and nothing has been done.”

Sepuloni defended her party, and said it had invested $5 billion into the education system – mainly “towards pay for teachers”.

Chhour said there’s a lot of pressure on teachers.

“Not only are they teachers, social workers, kids have been through a lot. They have effectively had interrupted education for the last three years.

“A lot of them are feeling anxiety about whether they agree with your exams. A lot of them are suffering from mental health issues . . . so teachers are dealing with all of this on top of actually trying to educate our kids.”

She said under the ACT party, they wanted to “bring back” charter schools and partnership schools for young people “who didn’t quite fit into the education system”.

Greens’ Tuiono said the government’s payout to support teachers was “vital”.

“I talked to some teachers where their pay rise hasn’t kept up with inflation for 10 years.”

Crime
Almost half of our Pacific children are likely to live around family violence. Pacific children are twice as likely to be hospitalised due to assault, neglect and maltreatment.

Sepuloni said it was about addressing “intergenerational impacts”.

She said sending more young people to prison was “an opportunity for gangs to actually recruit once they’re in there”.

Instead, a programme they had put in place addressed this issue and had seen more than 80 percent of young offenders not go on to reoffend.

“It actually requires full wraparound support for not just them but for their siblings and their families.”

Loheni said the National Party would address the rise of RAM raids and through “social investment,” and planned to put young people through military and cadet training, which studies had previously shown to be ineffective.

“We do have policies around military academies where they are going to have wraparound support, note that they do work.”

Tuiono disagreed. “Locking them up into boot camps that just won’t work.”

“We also have to address those underlying drivers of poverty because if you have the stable home life, there’s food on the table, you know the family can afford to keep the lights on, that helps to stabilise our families.

“That’s what we should be doing,” he said.

Climate change
National plans to “double renewable energy, help farmers clean up in the areas and invest in public transport,” Loheni said.

Sepuloni said Labour was “action oriented” and their “track record” with the Greens “goes to show that we have been able to reduce carbon emissions”.

Tuiono said “a vote for the Greens is a vote for climate action”.

“We have got some money set aside to support our towns and our councils to make their towns and councils more more climate resilient.”

ACT’s Chhour said the party would be looking at how “we’re building our infrastructure and adapting to climate change”.

This article is republished under a community partnership agreement with RNZ.

Article by AsiaPacificReport.nz

Late last month, New Zealand Health Minister Andrew Little stated what most who work in health already know.

Healthcare is all about people – the people being cared for and the people doing the caring.

Population growth, ageing and a pandemic mean there is no shortage of those needing care, but in New Zealand and globally, there is a chronic shortage of healthcare workers.

Little stopped short of calling it a crisis, but researchers and international agencies alike agree with a survey of New Zealand doctors that the health workforce is in crisis.

In 2016, the World Health Organisation (WHO) projected a global shortage of 18 million healthcare workers by 2030. That was before the covid-19 pandemic. Between 80,000 and 180,000 healthcare workers have died globally during the pandemic’s first 16 months, according to the WHO’s conservative estimate.

“Public statements from political leaders that there is ‘no crisis’ in the health system have seemed increasingly out of step with doctors’ experience over the past year” https://t.co/dXMhA38XIO

— Emma Espiner (@emmawehipeihana) July 11, 2022

Add to this the impact the pandemic has had on the mental health of frontline health staff, including reports of post-traumatic stress disorder (PTSD), and a healthcare workforce seven times more likely to have severe covid and now carrying the burden of long covid.

It’s clear healthcare is no longer the attractive sector it once was.

A highly mobile workforce and a global shortage
Like the cost-of-living crisis, the health workforce shortage is not unique to Aotearoa New Zealand.

This year’s budget included NZ$76 million for medical training and primary care specialists, but doctors who started training this year will not be specialists until 2034.

Meanwhile, Labour’s solution is to undertake an international recruitment drive. It is hailing New Zealand as one of the easiest places in the world for healthcare workers to come to. But are our newly opened borders attractive enough?

Overseas recruitment drive for nurses gains ‘good response’ https://t.co/RZrM4fW67L

— RNZ News (@rnz_news) July 13, 2022

In my health economics lectures I often use an anecdote about the Indian doctor who gets a job in the UK (colonial ties and a multicultural society), the British doctor who moves to Canada (less administration and more family friendly hours), the Canadian doctor who moves to the United States (specialists have much higher earning potential), and the US doctor who undertakes missionary work in India.

This highlights two issues: the health workforce is highly mobile and employment isn’t always about money. Aotearoa New Zealand is competing in a global health workforce market, and minister Little recently acknowledged the health sector as “fiercely competitive”.

But this isn’t a new phenomenon for New Zealand.

The health workforce in New Zealand has one of the largest shares of migrant workers, with 42 percent of doctors and almost 30 percent of nurses foreign-born (second only to Israel and Ireland, respectively). This is much higher than the aggregate estimates showing one in six doctors practicing in OECD countries studied overseas.

The OECD estimates the number of foreign-born doctors and nurses in OECD countries has increased by 20 percent, twice the growth rate of the overall increase across the workforce. This is what is most concerning.

The health workforce is not equally distributed. Migration of workers from low- and middle-income countries to high-income countries like Aotearoa New Zealand is a real threat to achieving universal health coverage and sustainable development goals.

New Zealand needs to be mindful that promoting our open borders is not at the expense of under-performing health systems with much greater need.

Losing healthcare workers to Australia
Outflow is also a problem in New Zealand, with New Zealand-trained doctors and nurses crossing the Tasman every year. Add to this the international recruits leaving New Zealand for Australia and there most definitely is a health workforce crisis.

As our nearest neighbour, Australia is aggressively recruiting staff. And like pavlova and Phar Lap they are happy to claim what is ours as theirs. An easier route to citizenship and voting rights will make Australia even more desirable.

How can New Zealand compete in this market? Minister Little refers to encouraging New Zealanders to return home, including lifting their pay. Research shows it’s not all about income. Location and professional development opportunities are important factors when choosing career moves.

The healthcare reforms helped tempt me back to New Zealand after 22 years away. Perhaps working in a system which has equity as its focus may encourage those who are clinically trained to return as well.

There is considerable research to inform policies around retention and recruitment. The New Zealand Ministry of Health may wish to look to the UK, which was historically dependent on EU health and care workers and now has a health workforce depleted by both Brexit and the pandemic.

In the recent LSE-Lancet Commission on the future of the NHS, British scholars argued a sustainable workforce needed integrated approaches to be developed alongside reforms to education and training that reflect changes in roles and the skill mix, and more multidisciplinary working.

The LSE-Lancet Commission authors flagged the need for better workforce planning. New Zealand’s approach to workforce forecasting has also been criticised previously.

Planning aside, a possible solution worthy of discussion is the required skill mix of the workforce, particularly with technological advancements and changing health needs. For example, the introduction of non-medical prescribers has improved job satisfaction, released clinical time and increased patient access.

New Zealand’s once-in-a-generation health reforms offer a logical time to undertake workforce reforms. We need to learn from our own historical mistakes and avoid disconnecting the workforce from the policy reforms.

If minister Little and the ministry are to solve this, he will first need to admit there is a health workforce crisis.

Aotearoa New Zealand is unfortunately not alone in its quest to adequately staff healthcare, but the transformation of the health sector to create a more equitable, accessible, cohesive and people-centred system means New Zealand is uniquely placed to put those people who deliver care at the centre.

Dr Paula Lorgelly is professor of health economics, University of Auckland. This article is republished from The Conversation under a Creative Commons licence. Read the original article.

Article by AsiaPacificReport.nz

An Auckland nurse says a lucrative incentive payment has not fixed the city’s dire hospital staffing shortage in Aotearoa New Zealand’s current covid-19 outbreak.

Nurses, midwives and others employed by the region’s district health boards (DHBs) have been entitled to an extra $500 on top of their normal pay for extra shifts overnight.

The scheme is being reviewed today and the clinical director in charge of co-ordinating the city’s health response, Dr Andrew Old, said it would continue if it was needed to address staffing shortages.

Dr Old said going into the pandemic Auckland’s hospitals had about 15 percent staff vacancies across the board which meant starting from a challenging position.

“So you then layer on top of that the challenge of Covid and it really has stretched the city.”

A nurses’ union delegate at Waitematā DHB, Di McCulloch, said while the $500 incentive scheme was popular, it had not been good for nursing overall because it led to exhausted workers and did not fix the staffing problems.

She said the nursing situation was dire.

Influx of unwell patients
“We continue to have an influx of unwell patients that normally enter the hospital and this has been compounded by omicron.”

She said once the subsidy ends the nursing shortages will continue and the DHBs will continue to redeploy non-clinical staff to fill the staffing gaps in wards.

Dr Old acknowledged how tired hospital staff in Auckland are.

“You know this has been going on for two years and the intensity has really stepped up in the last couple of weeks and I think certainly the city and the country are incredibly well served by the professionalism of the health workforce.”

Dr Old said the $500 payment was being reviewed today and there was the potential for it to be extended.

It aimed to ensure staff were available, particularly for hard to fill shifts such as overnights, he said.

“Look, we recognise people are tired, we’re asking them to go above and beyond and it’s just a recognition of the fact that actually everyone is really stretched.”

Hospitals just managing
Association of Salaried Medical Specialists executive director Sarah Dalton described the current situation as a crisis and said hospitals were only just managing.

“People are going above and beyond, they’re doing everything they can to keep it safe for patients, but that doesn’t mean it’s not a crisis, it doesn’t mean that the entrenched short staffing that we were trying to deal with before covid hasn’t made this almost impossible to deal with.”

It was not just Auckland and a lot of surgery and outpatient appointments were being cancelled around the country, she said.

McCulloch said the border closure had made the nursing shortages worse because in the past there had been a reliance on internationally qualified nurses (IQN).

“So it’s become an ongoing issue, this has been going on for years within nursing and the nursing voice are saying that we are tired, we are exhausted, we are short-staffed daily on the ground.”

But McCulloch said that had “not been heard by the powers that be”.

In terms of dealing with New Zealand’s ongoing nursing shortage, McCulloch said New Zealand needed to keep its new nursing graduates working here.

She said that could mean bonding newly qualified nurses to working in New Zealand for a minimum of two years.

Auckland hospitals put care on hold
Auckland hospitals have put all but the most urgent care on hold to allow them to focus on covid-19 patients.

At the same time they are managing with 25 percent fewer staff as covid-19 cases continue to rise.

There were 19,566 cases and 930 people in hospital with the virus yesterday, more than two thirds of them in Auckland. Ten new covid-related deaths were also reported, taking the total to 151.

Dr Old said the region was grappling with peak hospitalisations and staff shortages due to the omicron outbreak.

“We’re in the eye of the storm now, so with cases thankfully coming down a bit but peak hospitalisations coinciding with near peak staff needing to be off to support their own family or off with covid themselves.”

But Dr Old said the number of staff vacancies due to covid-19 was starting to come down as coronavirus numbers start to drop and he was hopeful that things would improve this week.

He said there had been some limited cases of covid-19 positive staff working at Auckland hospital’s as the region dealt with the peak.

Serious challenges
“Those have been people where without them coming back we would have had serious challenges keeping those services going and so yes, coming back into environments where they’re only dealing with covid positive patients.”

Dalton said it was appalling to be in a position where in limited circumstances employers are encouraging staff unwell with covid-19 to go back to work.

“What they’re saying is they’re only doing that in covid settings and where otherwise there would be risk to life and limb effectively, so it’s a life preserving service.

“But to think that we’re in such a fragile state in terms of staffing that that has to be part of cover at the moment is really distressing.”

Dr Old stressed that urgent care was still available at the region’s hospitals.

“But anything that can be deferred essentially over the last couple of weeks really has been, so that’s pretty much all out-patient activity … and almost all planned surgery as well.”

Challenging to get support to South Auckland families
Auckland Pacific health and social service provider The Fono said it was run off its feet keeping up with the demands of a community struck by covid-19.

Chief executive Tevita Funaki said the service was looking after more than 900 active cases at one time.

“It’s not just the health challenges but also the whole welfare support and food and also other needs of the families.”

The service also had a number of staff getting sick or isolating due to covid-19.

The Fono had been using the network of churches in the Pacific community to distribute what was needed for families, Tevita said.

This article is republished under a community partnership agreement with RNZ.

Article by AsiaPacificReport.nz

New Zealand is under siege from Covid19. We can learn some things from medieval city sieges.

A traditional siege takes place in a fortress, and the besieging agent waits outside the wall or the moat. The defenders also waited, in a battle of attrition; they won if the besieging attackers went away of their own accord (military besiegers were in a sense also under siege, when their own supply lines were weak), or the besiegers were attacked by a third party (eg the cavalry of an allied principality). Waiting was the ‘elimination strategy’.

If there is no prospect that the besieger will go away, and there is no likelihood of rescue from an allied cavalry force, then you – the besieged – are going to have to confront your enemy. The best way to do this successfully is to:

·         choose the date and place of the coming battle

·         prepare for the battle by being at maximum fitness

We note that high performance athletes prepare for (ie train for) their battles so that they peak on the chosen date or dates. In the military sense, to be a successful defender, you must be prepared to mount the best possible defence.

Choosing the Date and Time for Battle

Covid – the ‘enemy’ – is at maximum strength in winter, and also has a second maximum in hot summer. These are times when people spend much of their time indoors, in poorly ventilated or air-conditioned environments.

The burghers of Adelaide (South Australia) – which gets very hot in summer – should be choosing October and November of this year, for their battle; indeed they have a moatless border to defend. Cooler New Zealander should be choosing January and February 2022. This would indeed match the July and August 2021 dates of the battle fought in England and Europe. While the jury is still out on whether England’s battle has been won (or maybe drawn), Denmark has declared victory; likewise, Sweden seems to have won its battle. Victory means that the virus has become endemic. While Sweden continues to record 1,000 new ‘delta’ cases per day, its last day with more than one death was 25 August.

For New Zealand, including Auckland, to break out of its siege (and siege mentality) in time for these optimal months, New Zealand needs to open up to normal international travel (albeit with arriving travellers having vaccine passports, and rapid saliva tests) after the New Year holiday weekend. [I remember those days of having vaccination ‘passports’ for smallpox and yellow fever; indeed, when visiting Madagascar in 1978 (arriving from Tanzania in Africa) I had to report to a government health clinic in Antananarivo on day 3.]

It means that all domestic quarantines for Covid19 should end on or (preferably) before the beginning of December. (Other limited and local restrictions may still apply, but only as indicated by wastewater testing.) Further, it is essential that the relevant dates be announced this month, so that New Zealanders can make their own plans for a summer without siege. (Those of us with a fearful mindset may of course choose to take a summer ‘staycation’ as a way of using annual leave.)

Most of us know about ‘mission creep’; we just remind ourselves about the extended western military interventions in Iraq and Afghanistan. ‘Lockdown creep’ is a bit similar. Once in a siege mindset, we find it very hard to let go.

Preparing for Battle

As renowned British television doctor Michael Mosley suggested in The Listener (‘Defeating the Viral Enemy’, 24 July 2021), “tweak your health to reduce the risk of getting seriously ill from Covid”. We need to be ‘fighting fit’ when the necessary opening-up takes place.

The first and most important measure that we can take to boost our ‘host fitness’ is to get fully vaccinated. And there should be no government vacillation around vaccination. By the end of November, every New Zealander over 12 should have been offered a vaccination, and every person who has not had a vaccination in the preceding six months should be classed as ‘unvaccinated’. (I would regard myself as unvaccinated from influenza if, in any year, I miss out on my annual influenza immunisation.)

The second is to recognise that we get vaccinated in order to free ourselves from Covid’s siege. It’s a waste of vaccination resources to vaccinate people and then force them to stay at home for months on end. So it should not be ‘vaccinate and stay at home’; and, it should not be ‘vaccinate and wear a mask’. Rather, it should be ‘maintain vaccination status or wear a mask’. Most people reluctant to get vaccines are even more reluctant to wear facemasks; let them choose, and reward those who do the right thing. When we fight for freedom, we should be rewarded with freedom. Face covers are oppressive, especially but not only in a secular culture.

The second component of our preparation for battle is to open ourselves to the day-to-day acceptable risks of common colds and even (for young people) influenza. (After all, it was only people aged over 65 who were expected to get influenza immunisation; the rest were expected to maintain immunity through regular exposure to seasonal viruses.) The ideal timing for this ‘fitness-exposure’ is spring and early summer. It means that New Zealanders not subject to quarantines should be actively discouraged from wearing facemasks. (We can think of this process of living normal lives in the community as priming ourselves – in the pub, on the bus, on the beach, in the gym – for the coming unavoidable confrontation.) Facemasks, as well as being oppressive, impede rather than facilitate our preparation for the ‘battle’ ahead.

We need to recognise that, for most of us, natural immunity has always been a complement to immunity by vaccination. This principle still applies. Indeed, it would appear that the most-immune people in Europe (and elsewhere) are those who have been both vaccinated against the virus and exposed to the virus. In Aotearoa in January and February, we will need as many people as possible to have been immunised against Covid, by vaccination and with some help from nature, in the preceding months.

The third component of our preparation for battle in the New Year is to eat good healthy foods that support rather than inhibit immune system responses. Thus, it is time to promote, for example, fresh vegetables and fruit, through subsidies and delivery programs; and by allowing greengrocers to stay open during quarantines. Further, it is time to apply substantial disincentives to the consumption of ‘junk foods’ which promote obesity and other comorbidities.

Additionally, people should be encouraged to stock up on Vitamin C supplements, and to take extra Vitamin C from the beginning of 2022 until, at least, the end of winter. I know some public health professionals disapprove of Vitamin C supplementation. But this is a time that the anti-vitamin brigade should keep quiet, and allow the ‘abundance of caution’ principle to prevail; the potential for good from Vitamin C is substantial (albeit disputed), while the health risks of excess Vitamin C are very small. Vitamin C can indeed be part of our preparation for the siege-breaking ‘battle’ ahead.

When does a Pandemic End?

Last week I read the following article, in Practical Ethics: The end of the COVID-19 Pandemic, by Alberto Giubilini and Erica Charters, both from Oxford University. They start: “it is not clear what it means to be in the middle of a pandemic if we don’t know what it means for a pandemic to end”. They continue: “the end of an epidemic is not determined by epidemiological factors alone. Historically, epidemics end not with the end of the disease, but with the disease becoming endemic”.

Among other things the authors discuss the apparent disappearance of SARS (Covid03). And they note that, disappearance is no longer an option for Covid19. (I would argue that elimination could have been a global option back in February 2020, but that poor policymaking in the European Union in that month ensured that this particular Covid genie could never ever be put back into the bottle.)

Giubilini and Charters continue: “A disease is endemic when disease rates are reduced to ‘a locally acceptable level’ and the disease becomes manageable. However, what level is considered manageable and acceptable, particularly for a new disease, is not defined by epidemiology. … There might well be a day in which the WHO declares the pandemic is over. … But that type of announcement will likely not mark the actual end of the pandemic for most.  For some – those who have resumed normal life — the pandemic will have already ended.  For others, the pandemic will continue not only through the effects of Covid19 related illness, but also through economic hardship, political instability, social dislocation, and non-Covid related health problems that restrictions imply. … Discussions [considering the end of a pandemic] should include input from those who specialise in understanding society, culture, and politics. Such discussions will necessarily involve articulating social priorities and cultural values, and calculating risks and benefits, alongside epidemiological data. Such discussions must therefore involve experts beyond the fields of medicine – ethicists, philosophers, and historians, as well as anthropologists, sociologists, economists, and political scientists. … Even as the virus keeps circulating and recirculating.”

I would add that such discussions should also involve people other than academic ‘experts’. Democracy works in large part because discussions are not confined to politicians and tohunga.

Has the HIV/AIDs pandemic ended? The answer will vary, depending on who you talk to. Likewise, the 1918 influenza pandemic. Certainly, variants of the H1N1 influenza virus continue to circulate. And numbers of deaths (up to 500 per year) were attributed to influenza, and another similar number to road traffic crashes; all these deaths, while lamented, were acceptable in terms of our previously accepted balancing of risk.

Who stands to benefit most by arguing for the perpetuation of restrictions, such as indefinite facemask mandates and compulsory record-keeping? Certainly, I suspect, not the communities who have been most victimised by the Covid19 pandemic. ‘Rogernomics’ in the 1980s put economist technocrats – true believers – at centre-stage, and the more their policy recommendations fell short, the more politicians and journalists sought advice from them. They enjoyed the spotlight. Is there a parallel today, in public health?

Conclusion

Let’s choose to break the Siege of Covid19, in the New Year of 2022. We need to prepare. And we need to understand that success in this ‘battle’ will be something less than ‘total victory’; rather, it will be an assimilation of sorts.

————-

Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

Public Health measures are restrictive ‘health’ imposts by an authority over some or all of the people subject to that authority. In most cases they are both ‘merit goods’ (having benefits which people ought to be willing to pay for), and ‘public goods’ (goods whose benefits are shared).

Quarantine may be such a measure, whereby a sub-population is cordoned off from the rest of the population. Quarantines may be ‘domestic’, whereby the quarantining authority has jurisdiction both inside and outside the cordon. Or quarantine may be inter-territorial, restricting the entry of ‘foreign’ people (or certain foreign biota) not otherwise subject to the restricting authority. A quarantine is a cordon that demarks an area from which people may not leave unless given specific permission to leave. The principal beneficiaries of quarantines are people on the outside of the cordon.

Today, from the point of view of a resident of Hamilton, New Zealand, there are two protective quarantines. People may not arrive from ‘the rest of the world’ (meaning the cordon is New Zealand’s international border), and they may not arrive from ‘Auckland’. (For both cases, we note the ‘specific permission’ proviso.) While the authorities in Hamilton cannot influence other public health in the foreign quarantine zone, Hamilton forms part of a jurisdiction – New Zealand – that can impose additional measures (eg lockdowns) upon the people in the Auckland domestic quarantine zone.

In general, public health measures always have costs, and usually have benefits. Those costs and benefits may change over time. Public health measures can only be justified if the benefits exceed the costs; so, clearly, whenever the benefits of a measure are zero, then a public health measure cannot be justified.

Public health measures include such things as seatbelt and helmet mandates (for cars and motorcyclists). In New Zealand there are two seatbelt mandates: the requirement for cars to have compliant seatbelts installed, and the requirement for people in cars to wear seatbelts. In both cases, these can be regarded as permanent mandates, because it is generally accepted that the benefits of these mandates do exceed their costs, and it is accepted that neither the costs nor the benefits are likely to change much.

Quarantine Example One: Los Angeles 1924

In 1924, a residential district – populated mainly by migrants of Mexican origin – suffered an outbreak of plague. Although known as a migrant area, there was no evidence that this area was in any sense dirtier than other parts of Los Angeles; on the contrary it was arguably cleaner than a number of other suburbs.

On the basis that this was bubonic plague, an immediate domestic quarantine cordon was placed by the local authorities around the affected streets. In addition, a major rodent hunt was instigated. It turned out to be mainly the even more dangerous pneumonic plague (a human-to-human transmitted respiratory disease that is several orders of magnitude worse than delta covid), and that the rodent hunt was largely ineffective as a measure to deal with this particular public health emergency. The quarantine cordon, which was adjusted a few times as new cases emerged, proved to be extremely effective. In the end, there were about 45 cases and 40 deaths, a case fatality ratio of about 90 percent. The quarantine was lifted when there were no more cases.

Beverly Hills is a different part of Los Angeles. As a result of suburban plague, quarantine was appropriately placed in just part of Los Angeles. That was the whole point; the quarantine allowed the rest of the city, places such as Beverly Hills, to live as normal. (Though all Los Angelinos might have expected to be visited by rat-hunters).

Covid19: the View from Hobart, Tasmania

Tasmania is a state within Australia, a federal polity. Like Hamilton, Hobart is affected by two quarantines; but in this case these are both quarantines that the government in Hobart cannot influence what happens within either of those zones. Both are extra-territorial quarantines, one set by the federal government in Canberra; the other set by the state government in Hobart. All the Tasmanian government can do is determine which other parts of Australia are in their Tasmanian imposed quarantine cordon.

Further, the Tasmanian government is free to rule that – because Tasmania has imposed a quarantine, but no part of Tasmania is subject to a domestic quarantine – then there is not a problem in Tasmania which requires any local public health mandates with respect to the Covid19 pandemic. And, because Tasmania does not at present have a Covid19 problem (except for externally-sourced disruptions to its economy, and its ability to get extraterritorial Tasmanians into Tasmania), any public health measures imposed within Tasmania would be unjustified; because the benefit (zero) would be less than the cost.

New Zealand is of course free to impose a quarantine on Tasmania (ie as part of a wider extraterritorial quarantine); indeed New Zealand has indeed included Tasmania in its cordon around the rest of the world. And it may be true that the overall cost of exempting Tasmania from our cordon would be more costly than not exempting it; for New Zealand the main cost would be risk arising from a lack of trust in the independent decisions made in Hobart with respect to how Tasmania manages its ‘Bass Strait’ cordon. (We might note that if the costs of New Zealand’s policy incurred by people in Tasmania were included as policy costs, as well as the costs of an exemption to people in New Zealand, the answer about whether or not to exempt Tasmania might be different.)

Hamilton’s problem

Hamilton is similar to Hobart, in that it does not have community Covid19. Hamilton is different from Hobart, in that it does not have the authority to exempt itself from the kinds of public health mandates that are appropriate to quarantined places (such as Auckland). Hamilton is not allowed to be exempt, as Beverly Hills was at the time of the 1924 Los Angeles plague outbreak.

In New Zealand we are seeing uninfected places being mandated to emergency public health measures, even though they do not have a public health emergency. Hamilton benefits, of course, from both the ‘rest of the world’ quarantine, and from the Auckland quarantine.

Quarantines are emergency measures by definition. There is really only one level of quarantine; it’s a binary, it’s either on or off. Within a quarantine zone, it is appropriate for an authority with jurisdiction (eg the New Zealand government) to impose other measures, and that those measures should vary depending on the severity and nature of the problem. But it is not appropriate to impose emergency public health mandates on an unquarantined and unaffected territory.

(Nationwide ‘Level 4 lockdowns’ are a special case when an authority imposes an effective quarantine on its entire self; a situation that can only be justified if there is a non-trivial chance that the whole of a ‘motu’ is infected by a pathogen that is sufficiently infectious to justify a ‘quarantine’ solution.)

It is an oxymoron to have emergency public health measures in places that do not have an emergency; and, by definition, harmful in that the costs (non-zero) must exceed the benefits (zero).

Zero Road-Deaths

In 2018, Associate Transport Minister Julie Anne Genter initiated a road death elimination policy. Sensibly, and practically, the policy was never more than aspiration. If we were really concerned to save these lives – about 400 per year in New Zealand – the government could introduce a nationwide ‘car lockdown’ policy. They could prohibit cars from being driven on public roads. Certainly, there is an ‘abundance of caution’ argument that the benefits – mainly, but not only, lives saved – would exceed the costs. The government could introduce car lockdowns as an emergency measure (maybe triggered by an unusually bad year on the roads), and then leave them in place as a permanent measure.

Doing the cost-benefit calculus.

Good cost-benefit ‘calculus’ is complex. More importantly, accurate cost-benefit calculus can only be done democratically. The people need to be involved – and in two ways. The first way is that people need to be asked what they like and don’t like, with the understanding that benefits (utility) and costs (disutility) are subjective (meaning that they vary from person to person), and without asking leading questions which reflect the researchers’ own likes and dislikes. The second way is that ‘revealed preference’ (especially re appetite for risk) needs to be taken account of, whereby costs and benefits are assessed from what people do (and don’t do) rather than simply what they say. In terms of both ways, the information – and methodology – needs to be ‘open-source’, subject to ongoing public evaluation and re-evaluation. Even for rapid emergency public health measures, retrospective (and democratic) evaluation of costs and benefits is required.

Important forms of potential cost are ‘unintended’ and ‘unforeseen’ adverse consequences. In the democratic cost-benefit accounting process, such possible consequences need to be explored, and concerns properly documented; this approach deals with the policymaking problem of ‘wilful blindness’. (While it can be argued that certain events and implemented policies have had some unintended and unforeseen benefits – historians may include the late-medieval Black Death (‘plague’) and the fiscal policies implemented during the Great Depression – little weight in policy discussions should be given to such possibilities.)

All public health measures have costs, some of which may not be obvious. Most public health measures have benefits. All public health measures should be evaluated in a democratic way; albeit retrospectively for emergency measures, for which speed is the essence. Public health measures for which the costs exceed the benefits should be avoided. And, while technocrats and bureaucrats may participate (even oversee) such cost-benefit calculations, they should never be allowed to commandeer what is necessarily a democratic process.

Appropriate quarantines work.

In Los Angeles in 1924, with its plague outbreak, neither a quarantine nor any other public health measure imposed on Beverly Hills, or San Francisco, would have done anybody any good however. That’s because these places had no known cases, and almost certainly had no unknown cases. Even San Francisco, which had had its own plague outbreak a few years earlier. Hamilton, almost certainly has no Covid19 community cases today; it deserves to have at least the same level of public health freedom that Hobart has.

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Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

The first two charts show official case numbers and deaths, for all countries, including the little countries that tend to dominate in the peak of the northern summer holiday season.

Chart 1 shows the countries with the highest case numbers per person – from French Polynesia (Tahiti) to Greece, plus four other countries for reference. Chart 2 shows cases in order of deaths per person.

The three top ‘countries’ are all French overseas territories, as are Saint Martin, French Guiana, and St Barth. Also listed are Sint Maartin and Aruba (and Curaçao on Chart 2 only), overseas territories of the Netherlands. Also shown in these charts are six Caribbean destinations in the British Commonwealth (the ‘West Indies’ as we know them, plus the Bahamas). Then there’s Cuba, now a popular holiday destination for Europeans. And Suriname is a former Dutch colony – and a holiday destination – in the Caribbean.

What we are seeing is a ‘colonisation’ problem, rich vaccinated people from rich European countries (a number of which are shown in grey, and the United Kingdom and United States, which have substantial case numbers but few deaths by 2020 standards. Covid19 has always been a condition of the rich which they have then passed on to the poor, especially the relatively poor people who provide services to those rich people. What is happening now is that ‘healthy’ vaccinated Europeans are infecting (with Delta) and killing the local service sector employees (and their families) in these mainly Caribbean destinations. These territories and countries are open because they are understood to be dependent on tourism from Europe (and, except for Cuba, from USA), and because this class of rich tourists is uncaring – entitled – in their lack of care towards the people whom they are killing. We look the other way, because these death zones are very small territories and countries.

In French Polynesia, 450 deaths per million people is equivalent to 2,250 covid deaths in New Zealand in just one week.

Another small tourist country to mention here is Seychelles, still among the top infection/death sites, and has been since April. In this case, as I understand it, Seychelles has become a tourism bolt hole for rich Indians, especially in the summer monsoon season.

And another small country is Iceland. This fully vaccinated country has, at present, a delta outbreak far worse than New Zealand’s, and in the last week has had its first deaths in this outbreak. Per capita, it is the worst affected in Scandinavia, although Norway and Denmark also have very high case numbers at present. (We should note that, since the start of the pandemic, and according to ourworldindata.org/excess-mortality-covid, all three of these Scandinavian countries have fewer excess deaths per person than does Aotearoa New Zealand.) These countries affirm that Covid19 remains highly infectious, that immunisation substantially lowers deaths, and that international travel by people from highly immunised countries is more dangerous than ever to people with low levels of immunity to Covid19.

It is important to note that the immunity in western Europe to severe illness from Covid19 is due to both a mix of vaccination and viral circulation. Even when New Zealand is as immunised through vaccination as are Europeans, New Zealand will remain substantially vulnerable to an opening up to tourism from Europe, USA, India, South Africa, and South America.

The second two charts are restricted to countries with more than 900,000 people.

Looking at death rates at the end of August, regions that show up are the Caucasian countries (Georgia, Armenia, Azerbaijan) and neighbours Russia, Kazakhstan and Iran.

Reunion, another far flung French territory, with a population (like Fiji) of 900,000, also shows up. (I visited Reunion in 1978; it’s a truly spectacular piece of real estate.)

Other important regions showing up in these two charts are southern Africa, the Balkans (southeast Europe), Sri Lanka and Southeast Asia, and Central America. And we note Greece, the Eurozone country with the highest covid death rate, and a country for whom the vast majority of recent deaths precede Delta. And South America – also non-Delta – still shows up strongly in the fatality data.

In Chart 3 above, we note the presence of Israel and Palestine. Many anxious eyes are looking in that direction, and the news at present is not good. Almost certainly the inequity between Israelis and Palestinians is an important part of the problem there. And, while Israel will resolve its problem, this month, through booster vaccination, it is likely that Israeli tourists are among the most dangerous for other countries to host. Lebanon, though no longer present on this chart, almost certainly continues to be ravaged by Covid19. Its economy is in a state of collapse, including three-digit inflation. We should be hearing much more about Lebanon in our mainstream news media.

Of countries with high infection rates though low death rates, the places that show up most are the British Isles (UK, Ireland, Isle of Man), and Switzerland. We also note the Baltic States (Estonia, Lithuania) and Portugal (with better holiday weather this year than Greece) getting new delta outbreaks, though with indications – see Lithuania – that deaths will soon follow. Interestingly, Poland, Lithuania’s neighbour, is much less affect at present (see final section below).

Australia and New Zealand remain well below the international radar, at least in the data if not in the global news cycle. (On Al Jazeera we continue to get frequent Covid19 reports from Australasia that are mainly of novelty interest to global audiences.) Canada broadly falls in between the experiences of the United States and Australia.

India now has low rates of Covid19, with the exception of Kerala. While the statistics there understate the true picture, that understatement is almost certainly less now than it was in the peak of India’s epidemic, and is probably no more understated than many other countries. India today is like Northern Europe, highly immunised, yet dangerous to people in countries with low immunity to Covid19 and comparable viruses.

Japan is interesting, given the Olympic and Paralympic Games. Its profile is very much like that of a typical northwestern European country.

This final chart shows historical (for the pandemic) excess deaths of people aged 65-74, in a range of countries all severely affected by Covid19. (A similar chart showing England and Spain, was on this site last week.) None of what features in this chart has anything to do with Delta. France was surprisingly little impacted; eg much less than England. Portugal just had the one peak, of Alpha, which strongly coincided with England’s peak.

In the Americas, Chile and the United States feature prominently. As a region, the Americas have suffered most of all this pandemic; ironic perhaps given that Brazil is the antipodes of the source country, China (whereas China has suffered the least mortality of any large country). Chile suffered severely from the Gamma strain of Covid19, and it really shows; and despite Chile’s high and early vaccination rates, which focussed especially on people aged over 75.

Finally, we note the severity of the pandemic in northeastern Europe, shown here through Czechia and Poland. Their deaths resulted from the non-variant Wuhan strain of Covid19; and they almost certainly occurred in large part because of (rather than ‘despite’) earlier restrictive policies to keep Covid19 out of their countries. (See the timing of France’s peak mortality.)

Poland is particularly interesting here, because I included it in the third chart above, and because it borders Lithuania and Germany, both much more infected. Poland even ‘lent’ Australia much of its excess stock of Pfizer vaccine. Through herd immunity, a mix of vaccination and calamitous infection last northern autumn and winter, Poland is, for now at least, able to have normal domestic freedoms. The same basically applies to Czechia, Slovakia and Hungary. No country would want to go through Poland’s experience to get to their present position. It is important, nevertheless, that we in little Aotearoa New Zealand do understand Poland’s situation, in these ‘Delta Days’.

Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

The first chart shows the three largest western countries: United States, United Kingdom, and Germany. The solid line plots represent quarterly average rates of excess death. It is clear that the United Kingdom copped Covid19 very early and very hard. The mid-June peak represents the period from mid-March to mid-June. It is important, however, to acknowledge the rapid fall in British deaths, after that peak. The United States had a much lower peak, and, for that same period, Germany hardly registers. The main issue here was the different abilities to protect the population aged over 80 from the ravages of the pandemic.

For Europe’s second wave, which represented the United States’ third wave, Germany was nearly as badly affected as United Kingdom; and slightly earlier, reflecting the continental European event that was most likely caused by late-summer tourism from the United States. (The later second peak in the United Kingdom reflects the Christmas New Year holidays; likewise, the United States whose peak was slightly earlier due to thanksgiving.)

The impact of the Delta variant barely shows on this chart, though we should note that Delta became predominant in the United Kingdom by 1 June (75% of cases), and by 1 July (just over 50% of cases) for Germany and the United States. The United Kingdom has lower deaths than the others in the most recent mortality data, probably due to more vaccinations, and despite rather than because of Delta.

The filled dots represent overall excess deaths, commencing with 24 May 2020, based on an assumption that the pandemic (outside of China) started to register in the death statistics from around 24 February 2020. And the unfilled dots represent annual average excess deaths; the first unfilled blue dot represents average excess mortality in the United States from mid-January 2020 to mid-January 2021.

We see that annual pandemic excess mortality is easily highest in the United States, due to its prolonged period of high Covid19 infection and death.

While overall excess deaths remain higher in United Kingdom than Germany, we see that annual excess deaths are now lower in the United Kingdom than Germany. Indeed Germany’s 2021 Covid19 outbreak, which roughly coincides in time with India’s big outbreak, is considerably more fatal than Germany’s first wave a year earlier. Germany’s 2020 outbreak – as shown through available excess death data – is too soon to be indicative of Delta.

The second chart, of the same type, shows Sweden and New Zealand. It uses the same scale as the previous chart. The timing of Sweden’s first peak is the same as that for the United Kingdom, though deaths in Sweden were fewer, more confined to the oldest age group. Covid19 had no direct impact on excess deaths in New Zealand. Sweden’s second peak, while lower than Germany’s, was identically timed. It would appear to be derivative from the wave of covid cases that first appeared in Europe’s prime tourist destinations around August 2020.

While Sweden continues to have more excess deaths than New Zealand over the whole pandemic period, this has not been true for annual excess deaths for the year to the end of June 2021. Projecting these data forward, it is quite plausible that Sweden’s overall pandemic-period mortality impact may prove to be less than New Zealand’s by December 2022.

Some of New Zealand’s excess deaths may be indirectly related to Covid19. We might also note that New Zealand has some unusual demographics which may be showing an overstatement of excess deaths. Sweden, on the other hand, a neutral country in World War Two, almost certainly shows a more conventional population pyramid, at least for people aged over 60.

New Zealand and Sweden represent opposite ends of the policy spectrum, when it comes to addressing Covid19. The ideal policy is probably to take the best of both country’s approaches. There is no doubt that Sweden’s initial strongly non-interventionist approach was a failure; in particular in its initial refusal to test for Covid19 except for people already hospitalised, and in its unwillingness to at least have a ‘circuit-breaker lockdown’. However Sweden paid much more attention to the need to have a well-immunised population, with immunisation coming from a mix of natural and artificial (ie vaccination) means. Sweden, with much higher vaccination rates than New Zealand, falls considerably short of United Kingdom vaccination levels.

The final chart shows quarterly excess mortality for people aged 65-to-74 (my age group) for six countries, including New Zealand. In principle this age group catches a mix of those who are older and hence more vulnerable and those who mix and mingle in the community. This is the classic ‘boomer’ age group. For the countries given, New Zealand has the third highest boomer excess mortality, after Spain and Austria. We note that Austria was affected by the same early summer third wave of Covid19 that affected Germany. And we note that Spain, while never coming close to its original peak mortality, has been largely living with Covid19 ever since then.

Two of the other three countries – Sweden and Denmark – have had consistently negative excess mortality for the boomer age group in 2021. Further, for this age group, excess mortality has been higher in New Zealand than in Sweden for the last twelve months. While New Zealand may have a faster growing age 65-74 cohort than Sweden, Sweden has a considerably lower base mortality for this age cohort (ie Sweden has a higher life expectancy than New Zealand). So, the two sources of possible bias in the data somewhat cancel out. Denmark, which had a bigger per capita caseload than Sweden in their second covid waves, has consistently lower excess mortality for 65-74 year-olds than either New Zealand or Sweden. And Denmark was more adversely affected by World War Two than was Sweden. Denmark’s demographic idiosyncrasies for births in the years 1940 to 1955 are likely to be few; or at least something of an average between Sweden’s and New Zealand’s.

Finally, the United Kingdom, the only one of the six countries whose shown Covid19 death rates could have been influenced by Delta, had the lowest incidence of boomer deaths in the three months to mid-July 2021. This most likely reflects the prolonged (albeit easing) England lockdown, and will probably not be sustained. (I am guessing that we will see quarterly excess deaths in England hover at around plus five percent for the remainder of the year.)

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Keith Rankin, trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

contact: keith at rankin dot nz

It’s a known known that the late Donald Rumsfeld’s principal legacy to the world is the following quote:

“As we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns—the ones we don’t know we don’t know.”

I might say that there are also unknown knowns, nuggets of truth buried in archives and barely read books and articles.

When it comes to known unknowns, there are two basic types. The first are questions posed for which we do not yet have any plausible answers. This could be due to technical (eg measurement) difficulties, or economic difficulties (the expected cost of finding answers being too high). The other type is because at least some people don’t want the questions answered (and may even place embargos on finding answers), or because the possible answers simply do not fit the prevailing filter through which the questions are framed in public discourse.

Re unknown unknowns there are also multiple categories. First there are cases where questions have never had reason to be posed, cases beyond the prevailing human imagination. These are genuine unknown unknowns; things that are true but that none of us had the capacity to imagine. I can offer no present examples. A past example is the electric light bulb, which could not have been imagined even by Julius Caesar. (Although the light bulb could have been imagined well before it happened; for example, after the scientific work of Michael Faraday.)

Then there are questions of wilful blindness, questions which verge on the final category of known unknowns. Third are the black swans, events that happen ‘out of the blue’ or ‘out of left-field’; but which were predictable ‘with hindsight’! Black swans represent something akin to wilful blindness; they are events that were genuinely unexpected, and for which the precise form of their manifestation could never have been predicted. Covid19 is a black swan. (Note that ‘black swan’ is an unfortunately ironic term. It was either first coined – as a metaphor – by someone who did not know that black swan birds exist, and are the normal type of swan in some parts of the world, including ours. Or it was coined because the ‘coiner’ believed that, for almost everybody except themself, actual black swans were unknown. In reality, black swans are not black swans, and they have been known in Europe since the seventeenth century. Nor are the black-white swans I saw on the island of Chiloe; I was not expecting to see them, but one reason people travel is to discover things that other people already know.)

(That the Taliban would rule over the whole of Afghanistan as soon as July 2021 was a black swan as recently as June 2021. It was not conceived of as even a possibility, except – maybe – by the Taliban themselves.)

Related to these unknowns are the unseen – or ignored – red flags. It is missed red flags that create black swans, such as Covid19. And – I would argue – our failure to adopt joined-up-scientific thinking re the known facts about Covid19 and related viral diseases, means that there are more black swans lurking. The most important red flag that I would mention in this case, is the present apparent loss of natural immunity to respiratory viruses; loss of what I will call ‘community respiratory viral immunity’ (CRVI). CRVI is not a binary concept; it’s a level of community immunity that, like the economy, has for the most part grown over time. Natural variation of immunity rises (or diminishes) through the changes in the pathogenic environment, rather than through interventions such as vaccination. (The economic growth analogy of a temporary loss of community immunity is a recession.)

The problem in New Zealand at present is epitomised by the way we report about ‘Delta’, a highly transmissible variant of the SARS-COV2 virus that causes Covid19; this ‘comms’ problem is perpetrated in particular by our technocrats, our bureaucrats, our ‘policrats’ (narrative-framing politicians), and our mediacrats.

Before discussing this further, I need to emphasise that New Zealand’s present ‘Level 4 lockdown’ is absolutely the correct emergency policy measure for the present outbreak in New Zealand of Covid19.

The Delta-Bogey and the Missing Science and CW2 (Covid-War 2)

The dominant narrative in Aotearoa New Zealand is that Covid19 – which we (the New Zealand ‘team of five million’) defeated in battle in 2020 – has morphed, like some demon – into Delta. And that Delta is a seriously mean beast. In creating Demon Delta, we implicitly treat its predecessors as comparatively harmless. Yet by far the majority of Covid19 deaths in the world have been caused by non-Delta variants. (If this latest outbreak had been identified as non-Delta, we should have been more – not less – alarmed; it would probably have come from South America, where Covid19 has most affected, and where Delta has been least present.) In this narrative, populations have four weapons at their disposal: macro barrier methods (lockdowns and quarantines), micro barrier methods (hygiene practices, including facemask wearing), contact tracing, and ‘silver bullet’ vaccinations. (By ‘silver bullet’ vaccinations, we mean that – after a course of vaccinations – a person may be classified as ‘immunised’; this is how we understand, for example, measles vaccinations.)

In this narrative, the implicit counterfactual is that the adverse consequences of a Delta outbreak are much greater than of an outbreak of the South American versions of Covid19, or of the original Wuhan version. While we have heard much about the greater transmissibility of Delta, I have heard of no scientific studies that compare Delta and non-Delta strains in fully comparable populations. (All scientific pharmaceutical trials require that drugs be tested alongside ‘control’ treatments.)

This predominant narrative may be called Hypothesis One.

There is a second obvious hypothesis (Hypothesis Two): that (i) Delta is substantially the same as previous versions of Covid19, though just enough more transmissible to displace other variants in circulation in the same environments (like grey squirrels displacing red squirrels), and (ii) from late 2020 – and especially in 2021 – populations have reduced CRVI (community respiratory viral immunity). (There is another possibility, an in-between hypothesis, that Delta is significantly more harmful than other variants, and that its impact is exacerbated through many current host populations having reduced CRVI.)

An extension of Hypothesis Two is that immunisation by vaccination may not be permanent. (It is a known known that measles immunisation is permanent, but that immunisation against influenza is temporary.)

In summary, Hypothesis One is that the major problem leading to ongoing mortality and morbidity is the more aggressive behaviour of the enemy (of Delta). Hypothesis Two is that the major problem leading to ongoing mortality and morbidity is the reduced CRVI of the population.

The counterfactual to the first hypothesis is that the Covid19 pandemic would be in its endgame, were it not for Delta. The counterfactual to the second hypothesis is that the outcome of New Zealand’s August 2021 outbreak of Covid19 (and recent Asian outbreaks) would be much the same – serious – whether or not this was the Delta strain. Both hypotheses predict that – without appropriate policy responses – there will be problematic levels of mortality and illness.

Policy Implications

Both hypotheses require policies of ’emergency lockdown’ and, if available, ‘vaccination’. (Fortunately, we do have available effective vaccinations which target the SARS-COV2 virus; had these vaccinations proven to be ineffective, then we would further emphasise ’emergency immunity management’ policies such as lockdowns.

There are two important policy differences, however, depending on which hypothesis is more true. The first policy difference relates to how populations should behave outside of periods of emergency lockdown. The second is about the ongoing vaccination programme.

In Hypothesis One, Delta is the problem, and success is the ‘elimination’ of SARS-COV2 (whereby SARS-COV2 goes to the same place that SARS-COV1 – in 2003 – went to), aided by the immunisation by vaccination of the population.

In Hypothesis Two, reduced CRVI is the problem, and success is a level of community immunity that would tolerate SARS-COV2 circulating in future as another seasonal ‘common cold’ coronavirus. And success means adopting practices – including regular vaccinations – that extend CRVI levels in the population. (The good news here is that regular Covid19 vaccinations should reduce illness from other endemic viruses by facilitating high CRVI levels. Good for labour productivity as well as for general wellness.)

CRVI

What exactly is community respiratory viral immunity? It’s probably not quantifiable as a precise metric, but is a real-world parameter that rises or falls under different conditions; and it’s a community attribute that, ideally, should be optimised but not necessarily maximised.

The key idea is that it is a measure of general immunity to an important class of pathogenic diseases, and not immunity to a specific respiratory virus. And it should be understood as a population measure, rather than a measure of an individual person’s immunity.

CRVI increases with exposure to respiratory viruses in aggressive or attenuated form. It relates to what might be called the ‘common’ classes of community viruses: influenzas, coronaviruses, rhinoviruses, and other similar viruses such as respiratory syncytial virus (RSV).

Novel viruses (such as coronavirus SARS-COV2) can be classed as ‘aggressive’ (mainly because they are unknown to our immune systems), though some may be more aggressive than others (eg SARS-COV1 was more lethal than SARS-COV2). Attenuated viruses can be classed as those which have evolved to be less aggressive, forming equilibriums with populations with given levels of community immunity. And the label ‘attenuated’ can be used to describe the deactivated viral sequences that constitute the active ingredients of our vaccines. Vaccination against community viruses is a relatively recent episode in the wider history of vaccination; until 2020, only influenza vaccinations were in place for this viral class, and even they are comparatively recent (ie, in practice, influenza vaccinations are twentyfirst century interventions).

Over the history of humanity, CRVI has increased, and necessarily so. As more community viruses circulate within human populations (ie become endemic to humans) – typically viruses passed to humans from other species for which they were already endemic – then CRVI levels increase due to accumulated exposure to ever-greater-numbers of these virus species. Thus, in 2019, CRVI levels in human populations throughout the world were probably at the highest level that they had ever been in human history. Indeed, the main driver of rising CRVI levels in recent decades has been the decreasing cost and increasing convenience of international air travel. Another important driver has been the introduction of annual influenza vaccinations.

CRVI levels are generally higher in urban populations, and highest of all in the world’s metropolitan cities; cities which are both densely populated and within close reach to international airports. One of the most important unknown knowns (or at least ‘little known’ knowns) in this regard is the difference in community immunity levels between different homeplaces of young men called into the United States’ military in 1917, the year that a new H1N1 influenza virus started to circulate in the United States. The weaker – indeed ‘weedier’ – city boys proved to be significantly more resistant to the virus than the muscular young men from the farms and the provincial towns. (Refer to The Pandemic Century (2019), by Mark Honigsbaum.)

An important feature of CRVI is that it wanes when not fortified by ongoing exposure to community viruses. CRVI is nuanced, in that if fortified mainly by rhinoviruses in one year, then populations become a little more susceptible to serious illnesses from influenza viruses in the following year. Nevertheless, exposure to one class of community viruses probably gives some degree of resistance to other classes of community viruses.

So, under Hypothesis Two, in early 2020, global population CRVI levels were very high. The result was that Covid19 illness – caused by the then novel coronavirus SARS-COV2 – was resisted by the younger infected population, including the middle-aged-populations which represented the majority of airline passengers. Thus the major health consequences were faced by the older and comorbid populations who were less able to mount the requisite immunity responses.

However – and under Hypothesis Two – the important but not understood story of 2020 was the unusually rapid waning of CRVI levels in (now largely physically disconnected) human populations. This waning was a result of restrictive behaviours, mandated and unmandated. Restrictive behaviours include both mandated isolations, and personal barrier restrictions (such as physical distancing and the widespread use of facemasks).

Under emergency conditions, a loss of CRVI is the necessary price we must pay in order to minimise – if not eliminate – a dangerous pathogen. This elimination was achieved with SARS-COV1. The under-recognised challenge is to – as best as possible – start to restore CRVI levels as soon as emergency conditions are lifted (and, as part of this, to fully lift domestic emergency mandates as soon as a novel virus has been suppressed).

Part of the CRVI restoration process is of course vaccination, and it is probable that booster influenza vaccinations did to some extent increase our abilities to resist new outbreaks of Covid19. Of course vaccines that specifically target coronaviruses – and SARS-COV2 in particular – would have much more impact during a coronavirus pandemic; and the beneficial side-effect of coronavirus vaccines is that they most likely reduce populations’ susceptibility to the other community viruses that give us colds and influenzas.

It is now possible to talk of the ‘benefits of complacency’. ‘Complacent’ barrier behaviour – though not so much complacency towards contact tracing – helps to restore CRVI, and prepares populations for the next (or next wave of) community viral infection.

Hypothesis Two states that the major single factor in the severity of outbreaks of Covid19 since the middle of 2020 has been the loss of CRVI, and not the increased virulence of the evolving viral agents.

1917-19 Influenza Pandemic

It is worth digressing here to note the epidemiology of the H1N1 influenza pandemic of 1917-19; the pandemic best called the ‘black flu’, though more commonly (and inappropriately) called the ‘Spanish flu’.

This pandemic essentially hit the world in three waves, with the second wave being the most severe. In New Zealand the probable fatality rate was about 0.8% of the population, though ‘officially’ it was more like 0.4%. (We note that the present official fatality rate of Covid19 in the United States state of New Jersey has, just this month, surpassed 0.3%.)

The first wave of this pandemic appears to have begun in the United States, and its spread was almost certainly facilitated by the mobilisation of conscipted troops, as the United States entered World War One (WW1). However, another variant of H1N1 influenza had been emerging in China, and it seems that, on the Western Front, the two versions fused into a new super H1N1 variant, the ‘second-wave’ variant that was brought to New Zealand by returning soldiers. (The best source for New Zealand epidemiological information is the second edition of Geoffrey Rice’s book Black November. And we should note that evolution – of viruses as well as larger creatures – is about hybridisation [fusion] as well as through descendant mutation [fission].)

The earlier variant had however circulated in New Zealand in the late winter of 1918, with some severe health outcomes, but also raising the effective CRVI in those parts of New Zealand that were affected. When the big second wave hit in November 1918, two groups suffered least. First were those – such as Ngāti Porou – who implemented local quarantines. Second, were those in the places most affected by the first wave. After the short emergency period (essentially the month of November 1918) people reverted to normal life – or as near to normal life as possible in the month that WW1 ended. CRVI levels were clearly very high by New Year 1919, so when the slightly attenuated third wave hit in 1919, New Zealand was barely affected. Australia – which had imposed a full quarantine in November 1918 – suffered much worse in 1919 than New Zealand, though not as badly as New Zealand had done in 1918. Clearly, New Zealand had – for that time in history – very high levels of CRVI in 1919; ‘herd immunity’ to influenza, and most likely a higher than normal immunity to other community respiratory infections.

The ‘black flu’ pandemic was an event that featured both a more virulent muted version of the H1N1 influenza virus, and significantly varying levels of community immunity to respiratory viruses.

We note that in the present pandemic, both Hypothesis One (a very lethal variant of the virus) and Hypothesis Two (waning CRVI levels) may contribute to the story. In 2021, however, the Hypothesis One story (the ‘delta’ story) seems less convincing; I suspect, because the newer more aggressive variant is a descendant (fission) variant, not a fusion of two already aggressive variants (as was the case in 1918).

Hypotheses One and Two: the Evidence

To start with, we need to look at the big European second wave of Covid19, in the northern autumn of 2020. By then, there was increased knowledge of Covid19, improved testing and contact tracing, and renewed use of barrier interventions to viral circulation; all of these should have reduced the impact of the second wave if the virulence of the virus was the main determinant of the level of deaths and serious illnesses. But none of the new ‘more transmissible’ variants were present at that time; Covid19 was not more virulent then. (‘Alpha’ was the ‘Kent variant’ that surfaced in England in about December 2020.)

Instead, what happened was that, in late 2020 in most West European countries, the death rates were similar to those of the preceding spring wave. Spain was different; its fatality rates were significantly lower. Of most importance for this analysis was East Europe, within the European Union. There, where, in the spring, barrier methods had largely kept Covid19 out, fatality rates soared in the autumn to levels much higher than in West Europe. It was the same virus in both parts of the European Union. This picture negates Hypothesis One, and strongly supports Hypothesis Two. The major determinants of Covid19 death in Europe in late 2020 would have been varying CRVI levels, lowest in the east due to its successful earlier precautions, highest in Spain. Whereas summer complacency in the Czech Republic (where CRVI had become dangerously low) undoubtedly contributed to the problem, summer complacency in Spain most likely contributed to the solution, by boosting CRVI there. We also note that, for the most part, younger people were more likely to die from Covid19 in East Europe. This is consistent with lower CRVI levels there and then, rather than greater levels of complacency (unlikely) being the problem in East Europe. By September 2020, Covid19 was a known known, no longer a ‘black swan’.

In the Americas, throughout the pandemic, piecemeal barrier protection almost certainly reduced the peaks of the outbreaks, but also brought about depressed CRVI levels. We see that, in the United States, the timing of outbreaks in the ‘blue’ (Democratic) states (where barrier controls were most followed) and the ‘red’ (Republican) states (where barrier controls were most resisted). In general, the new outbreaks started in ‘blue’ states (with less CRVI), and eventually moved on to red states (with higher CRVI than blue states, but less CRVI than in 2019). In the very latest outbreak, though, the blue states were saved through higher CRVI arising from much higher vaccination rates; the present outbreak is accentuated in the red states.

Hypothesis Two predicted that, in 2021, Asia (which had imposed the most effective barriers in 2020) would be very vulnerable. That has come to pass. And – as in Indonesia today – the age profile of fatalities has been coming down, suggesting that levels of CRVI in Asia in 2021 are even lower than in Eastern Europe in late 2020 and early 2021. The tragedy of Indonesia is that even very young children are dying.

Further, in Asia in 2021, those countries unable to implement sufficient barrier protections (such as India), have seen short (but severe) outbreaks of Covid19, this time with the Delta variant of SARS-COV2 featuring as a circulating virus. An extreme case of this is Afghanistan, already in political turmoil when Covid19 hit in June this year. Briefly, Afghanistan in June – as Nepal in May – was amongst the worst affected countries in the world. But now, in August and with even greater political turmoil, Covid19 seems to have largely disappeared. It looks like Afghanistan has experienced a dramatic boost to its CRVI status.

The present outbreaks in Australia are proceeding differently from those of 2020. The popular narrative is that of Hypothesis One – that the people are now up against a more vicious foe, a devil called Delta. But the manner of the more lethal spread of Covid19 in the young population is more suggestive of low CRVI levels, as in East Europe late in 2020. The (counterfactual) control here is the United Kingdom, and West Europe. In these places CRVI has largely been restored (though, as in Israel, may be waning due to the earliness of its jabs). There, Delta has behaved more like a pussy cat than a devil, infectious but not lethal. In the United Kingdom, CRVI was largely restored by vaccination, but the removal of mandated barrier protections will be ensuring that vaccination-induced CRVI is being enhanced by renewed community circulation of seasonal (non-novel) respiratory viruses. Australia – especially young Australians – have substantially less CRVI protection from serious illness.

Eastern Europe is an interesting test case; it seems to have been immune from Delta so far. However, waning community immunity may see it vulnerable this coming northern winter.

Here in Aotearoa New Zealand, the rapidly imposed emergency measures should – after a few weeks – repel the current outbreak. The challenge will be for us to substantially restore CRVI levels, in time for the southern winter of 2022. While vaccinations this year – and 2022 booster vaccinations for the more vulnerable – will represent the main part of meeting this challenge, a high dose of Level 1 barrier-complacency this summer (but not QI-code complacency, for contact tracing) should help to keep the unvaccinated somewhat safe, the rest of us safe from them, and should help the vaccinated to hold on to raised CRVI levels through next autumn. It means that, once back to Level 1 (no community presence of Covid19), we should be encouraged to remove our masks – and to enjoy mixing and mingling – at least until another border-infringement outbreak occurs. And, when international travel is once again opened up, our priority should be to maintain – and extend – high levels of CRVI (community respiratory viral immunity). Low CRVI means lots of infections, many serious, and not all Delta Covid19.

Conclusion

The evidence, at least as I have presented it, comes closer to disproving Hypothesis One (the aggressive Delta hypothesis) than to disproving Hypothesis Two (the deficient CRVI hypothesis). I would like to see, in the media, a proper scrutiny of both hypotheses. Until this happens, the attention that community respiratory viral immunity requires will be negligently missed. The likely truth that is Hypothesis Two will remain a known unknown.

Barrier methods – macro and micro – work in emergency contexts, much as cortisol reduces stress and anxiety in these contexts. But, out of these acute situations, excess cortisol becomes a source of ill health. Barrier infection blocks all of the community viruses that support CRVI levels, making us over time more vulnerable to community infections, and making those infections more dangerous. On the other hand, annual vaccinations for influenza and coronavirus will substantially extend CRVI levels, making us generally more healthy with respect to both influenza and common cold viruses. In the United Kingdom and West Europe, Delta Covid19 shows all the signs of becoming – in a few years – another common cold coronavirus.

————-

Keith Rankin, trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

contact: keith at rankin dot nz

We now have excess death data for most of western Europe, until the end of June 2021. The peaks are all due to Covid19.

We can see clearly that the pandemic in Europe began simultaneously in Italy and Spain, and almost certainly in January 2020. While we are yet to even try to tell the story about how Covid19 got to these two countries, it is most likely to have been due to multiple incursions by air from China, possibly in some cases via Chinese territories such as Macau and Hong Kong.

In the case of Italy, it seems like to have been due to economic ties; in particular the area around Milan in Italy is that country’s technological and entrepreneurial hub. Travel to the World Economic Forum in the Swiss Alps city of Davos, may have been part of the story. Certainly, Covid19 soon got from the Milan area to the ski resorts in the Alps. And from these resorts – in the February school holidays – Covid19 got into northwest Europe.

In the case of Spain, it seems likely – in mid-late-January – to have been a preferred European destination for wealthy Chinese tourists and covid-evacuees. Indeed I understand that a Wuhan football team evacuated to the south of Spain. Portugal was not nearly as affected as Spain, initially. Covid19 travelled mainly by air.

I am guessing that England got the covid-bug both from the Alps, and from English people who live in the south of Spain; such British people travel frequently by air between Spain and England. In Belgium covid seems to have been brought in mainly by holidaying Eurocrats, and then unwittingly transmitted into the rest homes for the elderly.

The subsequent dynamic, for these countries, was mainly summer travel within Europe. We see that, from the three months ended October 2020, Portugal’s excess deaths closely match England’s. (In the period before that, Portugal’s inability to shake-off Covid19 was most likely linked to its relationship with Brazil.)

We also note that the early second wave in Spain is likely to have originated in England, which is a large country whose people enjoy flying to places like Spain and Greece; England still had more active covid than did other northwestern European countries when intra-European tourism restarted. Greece seems to have got Covid19 this way, although it’s 2021 experience seems to be more linked to its East Europe neighbours than to West Europe.

The later timing of West Europe’s second wave in Italy and Belgium looks to be linked to returning tourists. The second chart, below, shows France, Netherlands and Luxembourg peaking at the same time as Italy and Belgium.

The other important dynamic in West Europe’s second wave is the youth tourist wave from the United States. Young Americans have certain particularly favoured destinations: Barcelona, Paris, Amsterdam, Prague (in Czechia), and Switzerland. We see early beginnings of the West Europe’s second wave in France, Netherlands and especially Czechia. Czechia’s wave was the important link to the rest of East Europe. Czechia aside, it is Switzerland that easily suffered the most in West Europe’s second wave of Covid19. (Note that smaller tourist-oriented countries will generally show greater amplitudes of variation; the tourist impact in Switzerland is greater per capita than is the tourist impact in France.)

West Europe’s Third Wave

The third wave has begun, with England leading the way. The countries most affected by West Europe’s third wave so far are ranked (in the world, per capita), for the seven days ending 11 July :

• United Kingdom (9th for cases, 79th for deaths)
• Ireland (55th, 111st)
• Channel Islands (6th, 159th=)
• Gibraltar (19th, 159th=)
• Portugal (21st, 68th)
• Spain (15th, 95th)
• Andorra (18th, 159th=)
• Netherlands (14th, 133rd)
• Denmark (60th, 139th)
• Luxembourg (28th, 103rd)
• Greece (39th, 65th)
• Cyprus (3rd, 120th) [ may be connected to Russia]

Time will tell whether the death rates will rise dramatically in response to recent high case numbers.

The hope will be that the case-fatality ratios will be much less this time, thanks to the vaccination of older and more vulnerable people, and thanks to it being summer. Indeed, this phase should be the beginning of the end of the pandemic, because the seasonal intermingling of people – young people in particular – will give widespread immunity to the young unvaccinated population; including, crucially, the many vaccine resistant people in Europe.

The proof will be the coming northern autumn and winter. If this works out, Covid19 will become a variant of the common cold, as the ‘Russian flu’ of 1889-90 (most likely a coronavirus) became. I am sure that this summer intermingling of young people is the critical final step to the resolution of this pandemic.

The most probable reason why this optimal scenario may not happen will be if winter booster vaccinations are not provided to the already vaccinated population.

—————

Note: New Zealand and MIQ

New Zealand will need to have higher regular Covid19 vaccinations, given the likely substantially lower level of ongoing immunity in the younger population. Further, all is generally far from well in this southern Garden of Eden.

The big scandal at present is the paucity of places in MIQ (managed isolation and quarantine). On the surface the government has taken a rather cruel approach to people who need to travel to New Zealand, and to people in New Zealand who are not deemed to be permanent residents.

While the word ‘cruel’ is probably apt, in an important sense the government may have been ‘hoisted by its own petard’. The present single-party government of New Zealand practices the ideology of economic nationalism – a closely related dogma to that of mercantilism – which means that it is philosophically opposed to immigration. The problem is that the government’s MIQ program is hamstrung by a labour shortage; a shortage that can only be resolved, in the short and medium term, by immigration. We need to expand MIQ before we can expand MIQ; Catch22.

Covid-19: Excess Deaths, the picture in Europe and the Americas – Last Friday I posted this chart showing ‘excess deaths’ in 2020 and early 2021, as quarterly averages. The chart showed New Zealand and Australia alongside three Scandinavian countries and South Korea. These are all countries with low Covid19 death tolls, and are countries which have been assiduous in collecting accurate statistics. In the process, the chart analysis revealed that New Zealand has been performing poorly on the non-covid front, with many excess deaths not attributable to Covid19.

The charts I am posting today look at:

• North Atlantic countries with much higher levels of Covid19 mortality
• Eastern Europe
• Latin America

The charts are generally self-explanatory, though I will make a few points.

Firstly, the first data point on each chart covers the three months ending 31 March 2020; so, with a few early exceptions, this data point represents a pre-covid benchmark, providing context for the subsequent datapoints.

Secondly, a chart value of 100% means that – for that three-month period – total deaths were double the normal level of deaths; ie that ‘at least’ half the deaths were due to Covid19, and the remainder to other causes. I say ‘at least’, because the lockdowns and other restrictions clearly reduced other-cause mortality in all countries/

Thirdly, some countries keep very poor death records, so adequate data on excess deaths is not available. India is a country that falls into this category. Other countries are slow to report their death data; Australia, Canada, and Uruguay fall into this ‘late reporting’ category.

On individual countries, we may note that Hungary – worst in the world for official Covid19 death statistics in the first quarter of 2021 – was not as bad as some of its neighbours. (This is also true for Ireland.) It means that Hungary was more assiduous in counting Covid19 deaths than were many other countries. Another country to note is Uruguay, which on the statistics presented (2020 only) performed better than New Zealand. However, in the second quarter of 2021, Uruguay surpassed Hungary as the worst country in the world for Covid19 deaths; for Uruguay from April 2021, look at Paraguay and then add some.

Finally, we need to note that – of countries for which good death statistics are available – by far the worst affected country in the world has been Peru, a country I enjoyed the hospitality of over Christmas and New Year in 2016/17. I really feel for Peru, and believe that no other country (eg India) will come close to having suffered so much.

New Zealand has, for the rest of this month, banned all people who have been in India this month from entry into New Zealand. The decision is based not on the incidence of Covid19 in India; rather it is based on the numbers of New Zealanders arriving from India.

This would be like saying that, among convicted felons, ‘most felons convicted for fraud are men, therefore we will only gaol male fraudsters’.

The chart includes five other countries which became Magnitude 5 (ie about 100,000 daily cases per 100 million people) in March. A random person living in Brazil, Uruguay, Turkey, France or Hungary is about five times more likely to have been tested positive for Covid19 than a random person in India. Thus people departing from these countries are not safer to let into New Zealand than are people departing from India.

There are in fact 73 countries with more reported positive Covid19 cases per capita in the last week. At present, a random person in Turkey is 5.3 times more likely to have tested positive for Covid19 than a random person in India. Yes, there is almost certainly an undercount in India; but also there is almost certainly an undercount in Turkey, and Germany for that matter.

New Zealand is shown in this chart for comparison. We note that, up to August 2020, Hungary and Uruguay had case numbers per capita comparable with New Zealand. Yet, of countries with more than 300,000 people, these two were worst in the world for reported incidence of Covid19 at the end of March 2021.

Recorded deaths is a better historical measure of the impact of a disease such as Covid19. Thus Hungary has been a covid disaster since November, and especially since March. Uruguay, which barely registered until December, now has a daily Covid19 death rate of 20 per million, equivalent to 100 deaths a day in New Zealand.

India comes in at 84th in the post-Easter death league; much lower than all the others on the chart. Indeed Germany, not shown, is 46th. Eastern Europe continues to be the part of the world that has suffered vastly more than any other part of the world. Not that we would know it, given the way that Covid19 is reported.

While it will be true that India’s true death toll is greater than recorded, this will also be true of many of the other countries.

One important country whose Covid19 status is not at all well revealed by the statistics is Mexico. In Mexico’s case, the undercount for cases is much greater than the undercount for deaths. I have shown my estimate for covid deaths in Mexico on this chart, based on reports that the true death toll is at least 60 percent higher than the recorded toll. (While there has been some recent adjustment to Mexican official figures, I have simply multiplied all the official figures by 1.6.) Mexico probably has a true daily death rate about five times higher than India, at present.

All countries shown in this chart flatlined in the northern Hemisphere summer, except for many of those in the Americas. While the March to May outbreak of Covid19 in the Americas came from Europe, almost certainly the larger wave of the northern autumn came back to Europe from the Americas. The present wave is affecting many countries that were barely affected ten months ago. Of particular concern now is Asia; indeed, Thailand has also had a very recent splurge of cases. India will almost certainly get Covid19 worse than at present.

Before noting the role of Czechia – the Czech Republic – in the most lethal wave of the Covid19 pandemic in Europe, we should note the tragic recent circumstance of Portugal. In the first chart above, we see that Portugal, a country that in April performed very well compared to its neighbours, should have now suffered so much. One of the problems was that Portugal was never able to throw‑off Covid19 to the extent that its neighbours did. This has the look of a country that took very strong domestic measures, but kept its international borders open – especially its air border. This is especially pertinent in light of Portugal’s relationship with Brazil.

The other part of the Portugal story is the close correlation that Portugal’s death statistics show with the United Kingdom, a country that has had long economic and tourist ties with Portugal.

I have previously attributed Spain’s early resurgence of Covid19 to its strong population links with the United Kingdom, especially in the context that both the United Kingdom and Portugal were much slower to shake‑off Covid19 in May and June than were other West European countries.

Nevertheless, the overall picture in Europe was that Covid19 was beaten, especially if looking at death statistics using charts with a simple arithmetic axis. Czechia had had a successful lockdown for about four weeks in March and April. Complacency then set in, alongside the concern in Europe about the economy and the summer tourist season. A clue may have been in this 1 July 2020 BBC story: Czechs hold ‘farewell party’ for pandemic.

Then, in the autumn, whoa!!

In these charts, clearly Czechia leads the way in the second European wave, with deaths peaking in early November. Only Belgium has a similar mortality peak in November, about a week after Czechia’s.

In December, this article about New Zealand was published internationally: Genomic epidemiology reveals transmission patterns and dynamics of SARS-CoV-2 in Aotearoa New Zealand. It shows that, out of 649 March/April cases sequenced, there were 277 separate introductions of the virus into the country. 57% of those 277 introductions were not transmitted within New Zealand.

The Covid19 discussion in the international media – and in places such as Wikipedia – focussed on the domestic experience and emphasised the very first introductions. It seems that, while countries were taking very strong domestic measures to constrain Covid19, too many countries did too little too late on their international borders. There was too much focus on the mythical ‘R’‑number (giving the impression that every infected person was a spreader), and on ‘flattening the curve’ (ie tolerating this coronavirus much as we once tolerated measles). Authorities were trying to curb domestic cases of the virus while leaving the tap on. Indeed, in New Zealand, in the first week of the March lockdown, the edict to self-isolate was not enforced while domestic lockdown breaches were treated sombrely. Subsequent enforceable quarantine processes were introduced. Yet it took many months before these measures were managed properly. Other countries clearly did not pay due attention to the many separate introductions of Covid19 into their countries.

Previously, I have noted the huge rise in Covid19 in Caribbean holiday destination over the northern summer. Probably the main incursions here came from the United States – which had much higher levels of domestic covid in June than did European countries. But in these Caribbean countries, Americans and Europeans mingled, and Europeans brought it back.

Perhaps even more significantly, Europe is the major target tourist destinations for United States tourists. Americans have shorter holidays than Europeans, so they tend to focus the key cities in their Lonely Planet (and other) guidebooks. One of those cities in Europe is Prague, the historic capital of Czechia. Prague is particularly known – like Barcelona – as a youth ‘must visit’ destination. Many young Americans and Europeans like to visit Prague before they return home to their studies. Another part of the story is that such young Americans booked cheap airfares in advance, and were unable to get refunds. So they went ahead with their trips, sometimes with misgivings, but also with the bravado of youth.

It looks as though there were other similar trans‑Atlantic introductions of coronavirus into the other main tourist cities of Europe, especially from July to September. And European Union bureaucracy countries like Belgium have very large numbers of border entries and exits in all months, and exits and entries in the holiday months of July and August.

From Prague, there seems to have been a spread into the other more westernised Eastern European countries. Another part of the story is that Russia had quite a lot of cases over the summer, and countries along the Black Sea – including Bulgaria – may have got much of its Covid from Russia.

If I am correct, then young infected visitors to Prague (many asymptomatic) will have first infected young locals, who in turn will have infected their parents and grandparents. Hence the death peak in late October and November, two to three months after the peak tourist inflows. Czechia then suffered again, with a huge Christmas outbreak. Good King Wenceslas might have been crying in his Bohemian grave.

In line with my comments above, I note the following very recent story: Covid-19: International travel ‘biggest impact’ on deaths. (The story is about deaths per capita, not deaths per case.)

I have just included one chart that shows reported cases of Covid19, and is charted using the logarithmic scale to show trends in their early stages. This shows that, from low levels, cases in Czechia started rising in June. Then, from July to early January, cases in Czechia were being reported at a higher rate than in the United Kingdom. The steep rise in reported cases dates from early September, suggesting at the rise in infections happened in August, peak visitor season. United States’ students return to their studies at various dates in September.

This chart also shows how Portugal was unable to ‘shat the door’ on the covid virus in June and July. After that, Portugal followed the European norm – including a period of slow exponential growth in September and October. It’s only in January 2021 that the outbreak erupted in Portugal, making that country pretty much the worst affected in the world in January.

Television New Zealand’s journalists have come out on top at the annual Voyager Media Awards last night, scooping a number of awards in key categories, reports TVNZ 1 News.

1 News Pacific correspondent Barbara Dreaver was recognised for both the Best TV/Video News Item and Best Coverage of a Major News Event for her leading coverage of the Samoan measles crisis last year.

Sunday’s Jehan Casinader was awarded Broadcast Reporter of the Year and Best TV/Video Current Affairs, Short, for his feature Black Friday.

READ MORE: Voyager Media Awards 2020

Grief in Samoa ‘next level’ as measles epidemic claims at least 68 lives – TVNZ 1 News

TVNZ’s online news and current affairs platform Re: rounded out the Best TV/Video Current Affairs Category, winning the Long section for the feature Rediscovering Aotearoa: aroha/love.

The runner-ups for those categories were TVNZ’s Seven Sharp for Harri Brown’s story and Sunday’s feature on The Numbers Game.

In other categories, Re: reporter Cass Marrett won Best Video Journalist – Junior, while Mava Enoka received the Peter M Acland Fellowship, which will see her undertake a placement at Al Jazeera international television network Southeast Asia headquarters in Kuala Lumpur.

The 1 News design team won Best Artwork/Graphics, with their high-end augmented reality work featuring highly on 1 News’ news bulletins.

The major media awards were conducted remotely this year due to the covid-19 corovavirus pandemic gathering restrictions.

Other major categories include Newspaper of the Year and Website of the Year, both of which went to The New Zealand Herald.

All winners at the Voyager Media Awards 2020

Best headline, caption or hook  – Barnaby Sharp, Nelson Mail/Stuff

Best artwork / graphics – 1 NEWS Design Team, TVNZ

Best interview or profile – Michelle Langstone, NZ Herald/NZME

Cartoonist of the Year – Toby Morris, The Spinoff

Opinion Writer of the Year – Emma Espiner, Newsroom

Reviewer of the Year – Paul Little, North & South/Bauer Media

Travel Journalist of the Year – Mike White, North & South/Bauer Media

Editorial Executive of the Year – Annabelle Lee-Mather, The Hui GSTV for MediaWorks

Best feature or current affairs video – single video journalist – Luke McPake with “Death Bed: The Story of Kelly Savage”, RNZ

Best video journalist – junior – Cass Marrett, Re: / TVNZ

Video Journalist of the Year – Lawrence Smith, Stuff

Best TV/video documentary – Stuff Circuit/Stuff and Māori Television, “Infinite Evil”

Best TV/video news item – 1 NEWS/TVNZ with Barbara Dreaver, “Measles lockdown”

Best TV/video current affairs, short (up to 10 mins) – Sunday/TVNZ with Jehan Casinader, “Black Friday”

Best TV/video current affairs, long (between 10 mins and 20 mins) – Re:/TVNZ, “Rediscovering Aotearoa: aroha/love”

Reporting – crime and justice – Blair Ensor, The Press/Stuff

Reporting – social issues, including health and education – Emma Russell, NZ Herald/NZME

Reporting – general – Patrick Gower, Newshub/MediaWorks

Best reporting – Māori Affairs – Te Aniwa Hurihanganui, RNZ

Environmental/Sustainability Award – Kate Evans, New Zealand Geographic/Kōwhai Media

Science Journalism Award – Eloise Gibson, newsroom.co.nz

Best individual investigation – Patrick Gower for “Exposing white supremacy in New Zealand”, Newshub/MediaWorks

Best team investigation – Stuff, “Product of Australia”

Best (single) news story / scoop – Melanie Reid, newsroom.co.nz

Best coverage of a major news event – 1 News/TVNZ with Barbara Dreaver, “Samoan measles crisis”

Best editorial campaign or project – newsroom.co.nz, “Oranga Tamariki uplifts”

Best Reporter – junior – Logan Church, RNZ

Student Journalist of the Year – Ashley Stanley, newsroom.co.nz

Community Journalist of the Year – Virginia Fallon, Kāpiti Observer/Stuff

Regional Journalist of the Year – Hamish McNeilly, The Press/Stuff

Sports Journalist of the Year – Dana Johannsen, Stuff

Business Journalist of the Year – Tim Hunter, NBR

Political Journalist of the Year – Audrey Young, NZ Herald/NZME

Broadcast Reporter of the Year – Jehan Casinader, Sunday/TVNZ

Reporter of the Year – Guyon Espiner, RNZ

nib Health Journalism Scholarship – junior – Emma Russell, NZ Herald/NZME

nib Health Journalism Scholarship – senior – Nicholas Jones, NZ Herald/NZME

Regional Journalism Scholarship – Natalie Akoorie, NZ Herald/NZME; Aaron Leaman, Waikato Times/Stuff

Peter M Acland Foundation Fellowship – Mava Enoka, TVNZ; Charles Anderson, Vanishing Point Studio

Feature writing – crime and justice – Mike White, North & South/Bauer Media

Feature writing – social issues, including health and education – Florence Kerr, Stuff

Feature writing – general – Steve Braunias, NZ Herald/NZME and newsroom.co.nz; Duncan Greive, The Spinoff

Best first-person essay or feature (no word limit) – Tayi Tibble, newsroom.co.nz

Best feature writer – junior (no word limit) – Joel MacManus, Stuff

Feature Writer of the Year – short form (up to 3500 words) – Nicholas Jones, NZ Herald/NZME

Feature Writer of the Year – long form (3500+ words) – Aaron Smale, RNZ

Best magazine cover – HOME New Zealand/Bauer Media

Best magazine design – HOME New Zealand/Bauer Media

Best newspaper-inserted magazine – Sunday Magazine, Sunday Star-Times/Stuff

Best trade/specialist publication, free magazine and/or website – Air Force News/Defence Public Affairs

Magazine of the Year – Metro magazine/Bauer Media; New Zealand Geographic/Kōwhai Media

Best photography – features (including portraits, fashion, food and architecture) – Braden Fastier, Nelson Mail/Stuff

Best photography – news – George Heard, The Press/Stuff

Judges’ prize for the single best news photo – Stacy Squires, The Press, Dominion Post, Sunday Star-Times/Stuff

Best photography – sport – Mark Baker, Associated Press

Best photo-story/essay – Cameron McLaren, New Zealand Geographic/Kōwhai Publishing

Photographer of the Year – Alan Gibson, NZ Herald/NZME

Best newspaper front page – The Press/Stuff

Community Newspaper of the Year – The Beacon/Beacon Media Group

Newspaper of the Year (up to 30,000 circulation) – Waikato Times/Stuff

Newspaper of the Year (more than 30,000 circulation) – NZ Herald/NZME

Weekly Newspaper of the Year – Sunday Star-Times/Stuff

Voyager Newspaper of the Year – NZ Herald/NZME

Podcast – Best narrative/serial – “White Silence”, RNZ and Stuff

Podcast – Best episodic/recurrent – “He Kakano Ahau”, RNZ and Ursula Grace Films; “Out of My Mind”, Stuff

Best innovation in digital storytelling – “Fighting the Demon”, NZ Herald/NZME and Greenstone

Best news website or app – nzherald.co.nz/NZME

Website of the Year – nzherald.co.nz/NZME

Article by AsiaPacificReport.nz

The Samoa Observer media freedom video, Journalism Without Fear or Favour.

By Sri Krishnamurthi, contributing editor of Pacific Media Watch

Papua New Guinea’s two daily newspapers – the PNG Post-Courier and The National – which dominate the market, demonstrated “overwhelming deference” to the office of former  Prime Minister Peter O’Neill, says a new report about the country’s media freedom.

Transparency International Papua New Guinea (TIPNG) released a preliminary statement from a research report on World Press Freedom Day last Sunday, saying it found “much wrong” with the PNG media. 

The full report, which says public trust in the media is eroding, will be available later in the year.

READ MORE: Pacific governments accused of using coronavirus crisis as cover for media crackdown

The global WPFD20 theme this year was “Journalism Without Fear or Favour” and the Transparency International statement featured media trends in Papua New Guinea and the issue of bias in reporting on governance issues among print media. 

Analysing a period from June 2017 to August 2018, the report examines the balance of coverage on governance issues in particular. 

“The threats to PNG’s media freedom are most obvious when it comes to major national events that require objective reporting in the public interest,” the statement said.

Hampered by other interests
“Recent instances where the ability of the media to report have been hampered by other interests (often political) include:

• the 2017 national election;
• the 2018 APEC Leaders Summit;
• the 2019 Political Transition [after the ousting of O’Neill and the formation of a new government led by current Prime Minister James Marape]; and
  
• the 2020 Covid-19 coronavirus pandemic public spending.

“Journalists in PNG are further disadvantaged by the lack of Right to Information (RTI) legislation to enable them to obtain public documents from the state.” the statement added.

“In the absence of a RTI law in PNG the media outlets are further beholden to political interests as sources of information – which further erodes public trust in news outlets.”

Transparency International also said: “While PNG has enjoyed a relatively free media, this has been under threat in recent years. For instance, the 2020 Reporters Without Borders (RSF)  World Press Freedom Index  assessed PNG to have a press whose independence is ‘endangered’, with a corresponding drop of eight places in rank since last year,” the report said. 

“Interestingly one of the reasons cited by RSF for the diminished ranking is that journalists nonetheless continue to be dependent on the concerns of those who own their media.” 

‘Crisis on multiple fronts’
Commenting on the report, Scott Waide, the Lae bureau chief of EMTV News,  told Pacific Media Watch “what we have here is a crisis on multiple fronts“.

“Debate is stifled, journalists are threatened, abused and ridiculed, editors, CEOs and board members are put under pressure – you are excluded from events  or deliberately not informed,” he said. 

“Politicians feel invincible because of the image we reinforce in the media. They want us to  report the facts  but  not  report the  why and how. They avoid live debates, or live interviews, unless  they feel they have some control over them.

“They avoid interviews unless you push them into a corner, if they cannot fully control them, they will influence them.” 

Waide said he had given lectures on the misgiving of the PNG media which become beset with many problems. 

“Politicians are put on a pedestal and adored, corruption is normalised and legalised. Politicians feel that government policy should not be questioned, and critical thinking  is largely absent in public debate.” 

The problems stemmed from the overall decline in the quality of training at universities where students took journalism as second or third choice. 

‘A constant void’
“As well as the steady exit of senior  journalists, taking with them years of accumulated institutional knowledge, younger journalists leave after an average of five years, there is always a constant void that needs filling in newsrooms and the absence of critical debate driven by the media,” he said. 

He pointed out there was a general absence of proactive action to question, analyse and explain bad government decisions, and fact checking of political statements was non-existent. 

The Transparency International report said: “To reach its potential, however, professional and ethical journalism standards need to be raised in the face of increasing political pressures.”

However, Waide was forthright in his assessment: “The solution is cross-sectoral and  can’t be done only by media organisations.” 

Meanwhile, in Samoa similar problems were expressed by Samoa Observer editors and reporters of not being informed of press conferences by the government. 

The newspaper, one of the region’s leading advocates of media freedom, produced a video on social media speaking about the virtues of media on World Press Freedom Day. 

“You are talking about giving the media the ability to go out there and reach out to the masses, give them a voice, give them the ability to reach out to the leaders of this country, give them an opportunity to tell them this what you should do,” said co-editor Alexander Rheeney, who is also a former editor of the Post-Courier in Port Moresby. 

Samoa media ‘encroachments’
His co-editor, James Robertson, said: “There regular updates on this coronavirus situation in Samoa to which we are not invited, there are regular press conferences by the prime minister to which we are not allowed to send reporters to ask questions.” 

“And these are significant encroachments of press freedom in Samoa,” he said. 

 Rheeney was more philosophical, asking the reporters not to take their jobs for granted. 

 “I asked them not to clock-in in the morning and clock-out in the evening Monday to Friday without thinking about their work as reporters, and the power they have in their hands to change the lives of ordinary Samoans for the better and to influence government policy decisions for the benefit of the people,” he told Pacific Media Watch. 

“There is a big difference between working for a daily newspaper that publishes ordinary news stories Monday to Friday without thinking about the ‘big picture issues’, unlike at the Samoa Observer where we urge our reporters to think outside the box. 

“We strive to get our reporters to tell the bigger story and not just focus on news that gets fed from the Prime Minister’s Facebook livestream or at a press conference where the questions that matter don’t normally get asked,” he said. 

Article by AsiaPacificReport.nz

These two charts show the total number of cases and deaths, by country, over the seven days ended 2 May 2020. In these charts a number of countries with populations below 50,000 have been omitted; countries which have shown in earlier charts.

The first chart is sequenced by death rates (orange). Generally it shows the countries that have featured in the past, suggesting that the pandemic continues to be concentrated in the same places – the economically developed countries that were too slow to act. We note that, when we extend the United Kingdom to the British Isles, that Ireland and the Isle of Man make strong appearances reflecting their interconnectedness. Further, the Channel Islands and Bermuda – functionally part of the United Kingdom – match these British territories.

We also see the appearance of Latin American countries: Ecuador, Peru and Brazil.

The second chart shows the reappearance of Qatar, Bahrain, Kuwait, UAE; also, Singapore. And the inclusion of Saudi Arabia with them. These six countries continue to have low death rates. It seems likely that the Arabian countries will generally share the experience of Singapore; in many ways they are similar societies with similar economies. Also of note is the far-flung French enclave off the coast of Africa, Mayotte; the high-end tourist resort country, Maldives; a shipping, financial and tax avoidance centre in Latin America, Panama; and an ex-Soviet country which had previously pretended the problem did not exist; Belarus. And Russia. And another large Latin American country, Chile.

Here we see the incidence of Covid19 victims in hospital, classified as serious or critical. This is a good ‘flow’ measure of recent cases; contrast total cases and total deaths for which in many countries the data are now dominated by earlier cases. For this chart, I have excluded countries with less than 200,000 people.

Again we see the dominance of the usual suspects. Moldova, however, makes an unexpected appearance, suggesting an outbreak previously disguised by low testing. Indeed there are some other Eastern European countries that will probably appear on these charts if I repeat them next week.

Iran – an established Covid19 country – shows up here, suggesting that both its case count and death count are underreported. Brazil also shows up strongly, reflecting its status as a country that has underplayed Covid19. And Guadeloupe is a French outpost in the Caribbean, a region with a high Covid19 caseload, especially among the smallest Dutch, French and British outposts there. A number of the countries excluded because they are too small are in the Caribbean.

Finally, Canada is a country that features in all three charts. I am concerned for Canada. I was travelling through Canada at this time last year, and am somewhat distressed by Canada’s similar to the USA inability to manage the pandemic in time. Quebec and Ontario in particular reflect the high incidence of Covid19 in the northeast of the United States.