Thursday, 18 June 2020

Risk assessments and quarantine exemptions

The past few days have not brought a lot of confidence in New Zealand's quarantine system. It's been a mix of operational failures and poor decisions that have, so far, culminated in an ending of allowing early release from quarantine on compassionate grounds where accompanied by a safety plan around that release. 

Some of the safety plans around those compassionate releases have sounded really rather reasonable. Leaving quarantine early, staying in isolation in a private vehicle, then staying in a new private isolation bubble with the family member you have good compassionate grounds for needing to go to see doesn't sound all that high risk. Even where the travelers wind up COVID-positive, it should only affect those travelers and the one additional person. That case wound up falling apart in practice, especially where they hadn't bothered with testing before release, but even with failures it seems the kind of thing that can easily be contained through contact tracing - or at least in principle. It doesn't sound like the kind of thing that gets us back into lockdown. 

In the best case, officials would have ensured that the private vehicle used for travel either had sufficient range to make the trip from Auckland to Wellington or a few jerry-cans of fuel in the back, or that any fuel stops would be at unmanned stations and only when no one else was there and only with masks on and only with cleaning of any surfaces touched... ok, it quickly starts sounding pretty implausible in practice and it all should have raised a few queries about whether it seemed likely that safe practice would have been maintained. But it all seemed relatively low risk in the grand scheme of things. Even if those travelers turned up positive, the consequences would be relatively limited. 

But I just don't get what anybody was thinking in allowing early release from quarantine to attend a gang funeral. 

In any early release where there's risk that the person is infected, there will be risk if people don't follow the plan. And the plan in this case required staying in the car during the funeral. 

But in any of these, there will be different risks that obtain if the plan isn't followed. Even if the probability of failing to adhere to the safety plan's requirements is identical across people released, the risk imposed by failure at a gang funeral is just far higher than the risk imposed at other kinds of events involving even the same number of people. 

This seems pretty obvious. 

A gang funeral, whether it's a Mongrel Mob funeral, or a white power one, or any other gang funeral, will have a lot of people in attendance who will make contact tracing close to impossible. No everyone, obviously. Plenty of non-gang family members or acquaintances might also attend. But enough

Just think through the logistics for a minute of trying to run contact tracing if anything went wrong in the safety plan and folks got out of the car, mingled with guests at the funeral, and then turned up COVID-positive. 

If that happened at any funeral, the contact tracing team would need a guest list, would need to get in contact with each person who attended, would need to ask each of them who'd been in close contact with the case to get tested and stay in isolation until they'd gotten their results, and potentially also to provide contact details for each person they'd been in close contact with since the funeral. 

Thinking though actually doing that for a gang funeral immediately leads to a few complications. 

First, you need a guest list. 

Some in attendance at a gang funeral may well be there in contravention of a parole condition not to associate with other gang members. If those orders are broken at a funeral, would anyone in attendance be willing to name everyone else who was there who the contact tracing team might need to find? Even if there had been no breach of any such order, getting any complete list of guests in attendance, along with reliable phone numbers for fast contact tracing would very likely prove impossible. 

Tracking down each of the people whose names you did get would be very hard.

You might also expect a rather more difficult time than usual in getting any of those you found to name any of the people they'd been in close contact with since the funeral. 

The contact tracing team would need to encourage all close contacts to be tested, and to maintain self-isolation until test results had been released. Compliance could easily be a bigger issue in this case than would be the case for other funerals.  

Obviously these problems wouldn't obtain for each and every guest in attendance. There would be many in attendance happy to comply. But surely the proportion of likely difficult cases would be enough to make the whole thing seem just a bit of a bad idea. If someone did authorise it, you'd almost have to wonder if they just hated the contact tracing team. Because if anything went wrong, getting a large regional cluster seems rather easy, and getting that cluster of cases under control would seem rather hard. It is really easy to imagine it leading to at least a regional-level lockdown, or worse. 

Here's what happened. None of it seems sufficiently low probability that the folks setting the plan should have discounted it as a potential outcome, and the cost of all of it if one of those on leave from quarantine had been COVID-positive and contagious would have been rather high.
Two people who fled from authorities, breaching their Covid-19 quarantine restrictions, had been granted special exemption to attend the funeral of a Mongrel Mob relative in Hamilton.

The Herald understands the pair, aged 8 and 19, flew with four other family members, including their mother, from Melbourne, before being granted an exemption to attend the tangi of slain gang member Deiderick John Grant, known as DJ Rogue.

The 57-year-old was killed at a Slim St, Bader, property on June 5.

The family are believed to have flown to New Zealand to be with their whānau the following day.

The pair were given strict instructions to follow as part of their compassionate exemption, including to remain in their vehicle on the journey to Hamilton - and to wear personal protective equipment (PPE) if they got out. They are also understood to have been told to stay in the vehicle during the tangi.

They were then required, with their other family members, to return to the quarantine hotel, the Pullman, in Auckland afterwards.

Instead, the pair fled.

And last night former police commissioner Mike Bush claimed six members of the Australian family had absconded, though five were now back in isolation at the hotel.

When questioned by the Herald last night, the Ministry of Health revealed the two youngsters had now tested negative.

"The six members were staying at the Pullman Auckland in managed isolation and were granted exemption on compassionate grounds to attend the tangi and return to the facility on the same day.

"Four members of the family returned. A teenager and a child did not. The child was returned to the hotel managed isolation and quarantine facility in Auckland.

"The teenager remains in self-isolation at a family property. The teenager in self-isolation in Hamilton has had a Covid-19 test and tested negative.

"The five family members' request to join the teenager has been declined and they will complete their isolation at the managed isolation and quarantine facility in Auckland."

...

The person [an unnamed source who contacted the Herald] said the family came over from Melbourne to attend Grant's funeral.

"As soon as these kids have left the isolation centre, with their mother who was also part of the set up, they've just gapped it.

"They've breached all of the conditions of their agreement that was set up and just disappeared."

The condition for the mourners to stay in their vehicle at the tangi was "never going to happen", the person said.

"It was just ridiculous."

Hundreds of mourners from all around the North Island were believed to have attended Grant's tangi last week.

The source said the boys, and the rest of their family, mingled with them all.

"The ridiculous thing about the Mongrel Mob funeral in Hamilton ... you could see how many hundreds of people there were there ... these boys who essentially just came in the country from Melbourne were mingling all in amongst those people."

Another condition of being granted an exemption is to provide two addresses of where they would be staying. One would be a back-up.

The source claimed the first address provided to authorities was fake, while their back-up address was Slim St, the property where Grant was killed.

It led him to believe that the addresses provided by visitors were not being verified before their exemptions were granted.

"If that's the security we're providing ... it's just an absolute joke. They should be asking, 'what is the risk here?'"

He said asking families to wear PPE at all times was also "completely impossible" and said the ministry needed to up its game to protect New Zealanders.

"This is the thing, there's how many billions of dollars that's going to be spent, how long it is it going to take for the country to get back on track? How many people have lost their jobs? There's people who have committed suicide.

"It's crazy, and yet I'm guessing it's the Ministry of Health, as they're the lead agency, are prepared to throw it all away for these guys to come over for a Mongrel Mob tangi?

"It actually frightens me about how incompetent these people are."
Read through the account a couple of times. It's always possible that the account is exaggerated or wrong, but none of it is implausible, and I'd expect the Herald to have done some checking. And the very bad consequences of any breach of conditions, if those travelers had been positive, should have been obvious too. 

If the folks on early release from quarantine had been COVID-positive and infectious while mingling with hundreds of attendees at a gang funeral - attendees who had come in from across the North Island, would it be possible to get the consequences under control without another lockdown? 

If officials had any kind of discretion in granting compassionate exemptions like this, why did the very obvious red flags not prompt a refusal of permission to leave quarantine early? The risks if the plan were not followed were far far greater than the risks involved in allowing two people to travel from Auckland to Wellington to share a self-isolating bubble with a single family-member. And there just might be reason to think that those attending a gang funeral might be less likely than average to follow an unmonitored safety plan. Twitter reaction to my incredulity over this case suggests the officials might have feared being called racist for even thinking that a gang funeral might be of a different category of risk than a non-gang funeral. 

I often say we don't know how lucky we are in New Zealand. In this case, we are incredibly lucky about which case turned up unlucky. If the travelers from Melbourne had wound up Covid-positive rather than the travelers from London, things could be very very very worse. 

We need better processes if we don't want to keep testing our luck. 

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