Eliminating Covid-19: a perspective from a career in biosecurity

– OPINION –

Prof Stephen Goldson FRSNZ ONZM

Affiliate member, Koi Tū: The Centre for Informed Futures
Bio-Protection Research Centre, Lincoln University and AgResearch

 

Like every New Zealander (and visitor), because of the Covid-19 pandemic, I now am in lockdown and aware of a continuing and complete silence. In truth, I am finding the silence quite unnerving.  I think that it is day six.  I am definitely lucky because as a biologist, I can work on papers.  Also, I have done lengthy Zoom conference calls which are obviously immensely important. Conversely, for me I had difficulty in dealing with last Friday evening’s online drinks.  Skype just doesn’t do it. However, the internet jokes have been great and some are very funny.  These move across borders at about the same speed as the pandemic.  Initially, I wondered how the hell would anyone find anything funny about an awful and protracted event.

Four hundred thousand people and I went through the Christchurch earthquakes. During this time, while watching our infrastructure disintegrate, the sense of community was immediate and essential. This helped us get through the inevitable apprehension and uncertainty.  Paradoxically, the required social isolation response to Covid-19 is in complete contrast to what went on before. The apprehension and uncertainly are back, but we can no longer do what our species does best when there is trouble – that is, to congregate.  The only thing these two events have in common is that, again, we don’t know how long it is going to last.  During the tectonic disturbances there was the emergence of models and predictions.  The same is happening again.  There are varying estimates of how long the lockdown and threat of infection is going to last, but that is where the similarities end.  Extraordinarily, we now rely utterly on other people’s behaviour although we cannot see them.  The obvious level of compliance by Kiwis is fantastic.  There should be national pride in our war against the viral enemy.

Notwithstanding the hoped-for arrival of anti-viral drugs and vaccines, the length of the lockdown is a source of abiding concern.  Certainly, models and Wuhan point to the probable efficacy of lockdown as a way of reducing the incidence of the disease, but it will only work in the absence of the recruitment of Covid-19 at the border.  The value of the lockdown will be greatly debased with the arrival of new infections.  As the renowned epidemiologist Sir David Skegg said, such a situation is rather like trying to empty the bath with a jug while the tap is on.  This is matter of great concern.  The border simply has to be sealed. He emphasised that in his impressive presentation to the Parliamentary Select Committee yesterday. Sir Peter Gluckman made similar comments in the media a few days ago when arguing for rapid lockdown.

My own background is in agricultural biosecurity and pest management, but the parallels are obvious. The question in any incursion is whether elimination is possible and is worth trying. To this effect Dr Ashley Bloomfield and the Government have said that is the goal. That has major policy implications quite different from the ‘flattening the curve’ and other such arguments.

It seems essential, if the elimination strategy is to succeed, that risk is minimised and that all arrivals with the disease are properly quarantined, as many other countries are now doing. To rely on self-isolation and quarantining only those who are symptomatic is risky when the evidence is clear that spread can occur from asymptomatic carriers and in the period before symptoms appear. Anecdote suggests self-isolation is only complied with by perhaps 80% of people, and our compliance checking does not start until three days after arrival.  New clusters are appearing, suggesting that levels of community transmission may be occurring as it is by no means clear that all in the cluster were primary contacts with the virus carrier. Yet the daily tally of infections continues to rise – in no small part because of the arrival of travellers with the disease.

It would definitely seem that there is no way other than to test 100% of all arrivals.  Indeed, in the absence of incoming cases of the disease, there are indications that the lock down could work as planned.  It did in Wuhan, and the Government is now considering what may be the next steps in New Zealand.  Singapore and South Korea took somewhat different approaches but key to success was their border control. A number of experts have now noted that any changes to the lockdown must be preceded by massive national testing for the disease.

Considering the need for extensive testing at the border and within New Zealand, it is obvious that this country simply must obtain more testing equipment and methodologies. This is likely to be challenging.

As has often been said, this is indeed war.  In wars and in states of emergency, governments can direct and requisition capability as well implement tactics and strategy for the common good.  Since the late 1990s, as part of the national science strategy, successive New Zealand governments have generously funded biotechnology start-ups and mature biotechnology companies.  It is now essential that these biotechnology companies are brought to the fore and specifically directed (and funded) to work on the feasibility of production of New Zealand-made kits both for RNA and antibody testing.  Should this be possible and suitable supplies of reagents procured, then production should be scaled up to very high levels immediately. This is exactly same model as Dyson in Britain making 20,000 ventilators for the National Health Service, what Ford is doing with 3M and the big German car companies’ diversion of effort into the 3D printing of ventilators.

This is indeed war.  Testing is our best weapon.