• Dr. Young Lee

Level 1- What does it mean?

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Hi guys! It's been a while since my last email. I've been told by many people that they've enjoyed these emails and I'll keep it going every week. I've just moved house recently and that caused a bit of interruption, as well as not having internet for about a week. How's everyone doing? As requested - more pictures of Fonsi, our small, white dog. He's about to go to sleep and he's tired. :) As New Zealand enters Level 1, we all have a few questions about what this means for us. I would also like to address the recent events, such as the 2 cases of COVID19 that were not picked up at quarantine and what happened. I'll give some insights into this as this will probably be helpful in trying to understand what's going on. The paramount thing that we all want is to feel safe. I hope that these emails will at least make things clearer, and give a sense of comfort.  I thought I'd address these issues, as well as what's going on at the clinic in a FAQ format as below. 

Clinic hours

We have gone back to pre lock down opening times. Monday to Friday - opening from 8am to 5pm. 

Flu jabs

Most people have had their flu jabs. We still have some supplies, so please contact us if you're interested in getting a flu jab. This year - flu and other respiratory illnesses are predicted to be less common because of the lock down. However - I would still strongly encourage everyone to get the flu jab. 

Flu jabs are free for people over 65 and those who have certain chronic medical conditions (i.e. cancer, asthma, heart disease, autoimmune disorders etc). Otherwise it's $35. 

Screening questions for COVID symptoms

Because there are likely to be cases of COVID19 coming through the border, we will have to continue to ask screening questions when people make an appointment. Thank you for your cooperation as we all work together to keep everyone safe. We will have to ask broad questions - such as are you coming in for any coughs/cold/sore throat symptoms etc. We apologize for any perception of your privacy being breached. These are pandemic times and we have to ask these questions. 

Masks and gloves

You don't have to wear masks or gloves when you come in. If you have a cough etc, we would encourage you to wear a mask - and we can provide you one. If you have respiratory symptoms, we may ask you to wait in your car, and then call you to come in after. 

The doctor and nurse will not be wearing masks and gloves as a routine procedure. We will wear protective equipment on a case by case basis. 

Video and Telephone Consultations still encouraged where able

We suggest that where it's convenient - video and telephone consults should be used. We are of course happy to see people in the clinic - but it's good to keep good practice habit. 

Remember - the purpose of Level 1 rather than no levels at all, is to allow the country to be prepared to move to tighter restrictions if required. 

My thoughts on border control and COVID19 cases coming into New Zealand. Recently there has been 3 new cases of COVID19 that have come into the country through Auckland Airport. There were 2 women from UK that were allowed to leave quarantine early after 6 or 7 days under compassionate reasons who later tested positive and then there was another man who tested positive during quarantine. Like many of you - I felt a sense of uneasiness and anger that 2 people could have left quarantine and had the opportunity to infect people in the community. Especially after the whole country had to be in lock down for 7 weeks. It felt like a real slap in the face. I'd like to comment on the circumstances around the 2 women being allowed to leave quarantine. As I understand it, they did nothing wrong. They followed procedure - and they voluntary turned up for testing after a drive from Auckland to Wellington. We were fortunate that these 2 women were responsible.  The specific points that bother me are the following: 1. COVID19 takes about 3-14 days for symptoms to develop. Therefore allowing anyone to leave quarantine before 14 days makes no mathematical sense. You cannot negotiate with the virus to show symptoms within 7 days. Therefore the compassionate early leave makes no sense at all. This is not a decision that should be made by the court - it has no scientific standing. My understanding is that the compassionate clause was put in because of a court ruling stating that this had to be considered. With all due respect to the judge - this makes no scientific sense and he or she should really just butt out. This is a public safety issue. The good of a few hundred people cannot outweigh the good of 5 million. The emergency powers of the state of emergency should be sufficient to trump this court ruling. 2. Procedures for early release include the following - Testing at day 3 and day 12. Negative results required. A daily questionnaire for symptoms. None of these were followed. There are 2 possible conclusions - the minders for people under quarantine are either incompetent or under trained. Incompetent means that the person in charge is untrainable - and this is usually less likely. It's much more likely that the staff at the hotels were under trained. Training to follow these procedures would usually require a checklist, drills (sort of like training for CPR) and periodical audits by peers or seniors. Hopefully, the military getting involved will help as they are specialist in logistics. 3. Why are we even inventing our own procedures? Countries like Taiwan are absolutely the gold standard when it comes to logistics, quarantine procedures and tracking. They have about 300 cases only and have never gone into lock down. In Taiwan - when you fly in you have to wear masks on the airplane. Flight crew wear masks as well. When you arrive, you are greeted by staff in PPE gear who will swab you for COVID19. You are then given a set of instructions. An app is installed on your phone that you have to tap on 3 times a day to send you GPS location. You will be rung at your isolation place (either your home or quarantine location) 3 times a day and you have to answer the phone. Failure to do any of these will result in someone visiting you within 40-60 minutes. You will be given a packet of masks for the 14 days. You will have transport arrange for you to the facility.  We have absolute gold standards that we can copy. It is pointless to reinvent the wheel and to think we can make it better. 4. Flight crew in Air New Zealand do not have to wear masks, and go back to their homes after work. There is a risk of transmission here to the wider community. My personal thoughts are that unless the government tightens up their procedures, this slack implementation of distancing and quarantine will fail. We will inevitably end up with community transmission cases and we will have a reasonable chance of being forced to Yo-Yo into level 2,3 or 4. This will be even more devastating for the economy and of course will result in illness and more deaths.  However there is quite a bit of hope. The government has shown that even though there was a slip up - we've gotten a bit lucky with the 2 cases that were in Wellington. And it appears that there is a transitioning of attitude from being reactive to proactive by putting logistic experts in for implementation. Lastly the director general of health, Dr. Ashley Bloomfield is doing a great job and cannot be held responsible for the failures of quarantine. He's the strategy guy, not the implementation person. It looks like they've gotten and expert on implementation and logistics. Too many exemptions to quarantine makes a mockery of the lock down process and embarrasses science and simple maths. I think the government should suck up the social niceties and just tell people that these are the rules - and there are no exceptions. I'm pretty sure all of us can count and work out that you can't turn 14 days of symptom development into 7, even if someone's family member is dying. It sucks for them, but that is no excuse to put the other 5 million at risk. I'll be checking the news just like everyone else over the next few days to see if there is improvement in our quarantine procedures, and improved safety for the flight crews. In the meanwhile - remember that Level 1 means being prepared. Continue to practice social distancing where able. If you have a cough, wear a mask in public.  

Just something for fun! I made a TV mount over the weekend. Spray painted it a classy glossy black. Setup rollers are the bottoms so I can move the TV forward or back. I've setup a car driving simulator in a corner of my house with my old PS3. It's a lot of fun. And yes - I've heard the comments. Maybe I really do have too much time. 

I managed to negotiate with my wife to get 10% of the house to myself, to turn into a gym, aquarium and car driving simulator. She gets the other 90%. As per usual - showing my expert negotiation skills. 

Please share this with your friends if you find this helpful, and you think it might be helpful to them.

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