Thursday, 13 August 2020

Better border defences

Ages back, Tyler Cowen posted about the contrast between America's world-leading higher education system, and, well:

The United States circa 2012 is one of the most productive economies of all time, arguably the most productive if you take into account size and diversification (rules out Norway, etc.). Internationally speaking, in the richest and most productive global economy of all time, which is our most competitive sector?

Hollywood? Maybe, but it could well be higher education. Students from all over the world want to go to U.S. higher education. If we had nicer immigration authorities, this advantage would be all the more pronounced.

In other words, I work in what is perhaps the most competitive and successful sector in the most competitive and successful economy of all time.

And yet what I see around me is a total, total mess. And I believe my school to be considerably above average in terms of how well it is run.

I've felt like this about New Zealand's success in keeping Covid out, and the daily stories about the latest bit of dysfunction at the border. 

And the inevitable obtained. We have an outbreak.

Not just an outbreak though. An outbreak where the government has no clue, as yet, where it came from.

That isn't good.

Under a "Gee, wouldn't you think they'd run this seriously?" assumption, it would be impossible, right? Everyone working in the Managed Isolation and Quarantine system, whether on the planes getting people here, in the airports, on the busses shuttling them through to facilities, or staffing those facilities, would be tested for Covid so often that it would be impossible for one of them to do more than pass it on to their own immediate contacts before it was noticed. 

Right? 

Testing everyone weekly would mean it would be really unlikely that anyone could go more than 7 days without being caught. In the worst case, your test day is the last possible second before your viral load is high enough to be caught, and you're infectious one or two days later, and you never develop noticeable symptoms. Even in that case, you maybe have had 6 days to pass it on. In that period, it is not terribly likely that anyone you've infected has become infectious. It could all be handled quickly and easily through contact tracing. 

But we could do even better than that, right? In a system that cared about it, and that wanted to avoid $1.5 billion-dollar-a-month lockdowns of Auckland, you'd think they'd also be running those cheap-as saliva tests. Sure, they're not as good as PCR. But they're real fast, and they're real cheap, and if they were being used daily, it's real likely that anyone who was contagious would be caught. 

But no.

They were doing none of that, were they. 

There's some small chance that the current outbreak was caused by the virus having come in in refrigerated transport. Maybe. But I do know that under a better system, the government could have said "We've double-checked our audit trail. Every single person working in the MIQ system has returned a negative COVID test in the past week, so it had to have come from somewhere else." Or, they would have caught it long before it took an unknown number of hops to reach the positive case that was found. 

BusinessDesk asked me yesterday for a short piece on the mess. I had a bit of a rant. It's paywalled; here are some snips. 

It has been obvious for a while that border practices have a Dad’s Army flavour to them.

Last week, the government received a report suggesting that testing frontline border and managed isolation staff only once every two weeks might not be enough. When pressed by journalists, the report’s author, Professor Shaun Hendy, conceded people “shouldn’t be forced to take weekly swabs but strongly encouraged to do so” – to use a journalist’s paraphrase.

This is astonishing. In any sane system, agreeing to be tested regularly would be a condition of employment in the managed isolation and quarantine system.
...

The government could require everyone who leaves managed isolation to show up for one further test a week after leaving managed isolation. The government could require everyone who leaves managed isolation to turn on Google Maps location tracking and to share their movement history with contact tracing teams if required.

Those together would vastly simplify the task facing contact tracing teams.

The post-isolation test would mean that anything that did get out would be caught earlier.

...

Every traveller leaving managed isolation presents a small risk. That risk can be reduced through post-isolation testing and by helping the contact tracing teams. But there is also a risk with every worker in the managed isolation and quarantine system. Every worker on the airplanes delivering visitors to Auckland. Every bus driver shuttling visitors from the airport to their isolation facility. Every worker within those facilities who may be in contact with the isolated visitors.

Even with the best of personal protective equipment and facilities, safety protocols can still fail. Workers are human. The protocols must be checked to make sure they’re being followed and tightened up where necessary. Is every incoming visitor masked when getting on the plane all the way through to arriving in their managed isolation room? If not, why not?

But those protocols must also be augmented with frequent compulsory testing of workers in the system. New Zealand’s PCR tests are highly accurate, yet they are costly and can take time to return results. Saliva-based strip tests are cheap and fast, but only accurate for those with lots of the virus in their bodies. Daily checks with cheap and fast strip tests coupled with less frequent PCR tests could be an effective combination for managed isolation workers. That frequent testing would not stop a worker from passing the virus to a close contact. But they would catch it quickly.

...

If a month in level 3 costs Auckland $1.5 billion in financial terms, plus added misery, but each strip test costs about $10, each Aucklander could be tested a hundred times before hitting the financial cost of that month in level 3. And only workers in the managed isolation system need regular testing.

A full-bore cost-benefit assessment isn’t needed to start doing this. It is almost incomprehensible that the system considers regular testing of staff an “aspirational” goal. The prime minister said in yesterday's press briefing that asking every worker to undergo a daily swab test is unreasonable. But inadequate testing that leads to a new level 3 lockdown is even more unreasonable. And there are options sitting between irregular and daily swab testing.

Finally, the government must create an incentive for the workers to be tested.

The government could compensate employers for providing extra days of sick leave for self-isolating workers awaiting test results. For the past month, officials have urged people to be tested if they develop symptoms and worried about the declining number of people presenting for testing. But they have not looked to the financial disincentives that bar many workers from being tested, even when the tests are free. This must be remedied.
I live in what is perhaps the most successful country in dealing with Covid - barring Taiwan.

And yet what I see around me is a total, total mess. 

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