• Dr. Young Lee

Level 3.5 - Level 4 with KFC... LOL :)

Level 3.5 - Level 4 with KFC... LOL :)

Well - what a Monday! We now have confirmation of New Zealand's future with regards to our personal freedoms over the next 3 weeks. We will be in Level 4 lock down for another week until Monday 27 April 2020. Then we will go into Level 3 from Tuesday 28 April 2020 for 2 weeks. Then there will be a reassessment period after.  I thought it's best to address the above with an FAQ style format. Hope this helps.

How is alert Level 3 different from alert Level 4?

NZ has chosen  a very stringent Level 3. It's essentially equivalent to what Australia is doing now. In Level 4, we have to stay at home, exercise with family in safe activities only, essential services can work and supermarkets are open. In Level 3 - we mostly have to stay at home, exercise can include non motorized water activities (swimming, kayaking, fishing on the wharf), mild mountain biking, we are allowed to drive to exercise locally (no definitive distance rules - but assume 5-6 km as per previously), non contact retail is allowed (food - take outs, online retail) and we have to stay in our bubbles. Bubble rules are mildly fuzzy but assume it's still pretty tight - try not to visit your elderly relatives. 

How does this affect general practice visits?

No difference - we should still aim for video and telephone consults where possible. Essentially no change for us. We will continue to delay Well Checks, screening procedures etc. We will also continue to delay screening blood tests etc.

What do I think about going to alert Level 3?

It's a reasonable compromise. Here is the best way to illustrate it. After reaching 4 weeks of lock down, NZ essentially has 3 options: Option 1 - continue lock down level 4 until the number of new cases gets to Zero. Risk of the population cooperating less and less. Please note that in the first week of the lock down, it was estimated about 87% of people were compliant. By last week about 76% or so. Compliance to a stay at home order likely to drop due to weariness. Prioritize health at any cost. Option 2 - go to level 1 or 2 as case numbers are falling. Businesses go back to business as close as possible to usual. High risk of new clusters exploding like the second waves seen in Hong Kong or Singapore. Prioritize the economy over health. Option 3 - go to a very strict level 3 - essentially a level 3.5 to allow people to get their shopping and fast food fix. Allow 400,000 people back to work in a likely limited capacity (I don't think they'll be 100% productive or efficient - possibly due to the drop in customers). Make sure that all new cases are from existing cases - no unlinked cases. Make sure testing and contact tracing is scalable. Allow flexibility to g up or down levels as required. Use 2 week rotations so that we can see cause and effect of any policy changes. Prioritize health but NOT at any cost.  As you can see - they really are only 3 options. It depends on what you're aiming for. Option 1 allows us to go for elimination - which might benefit the economy in the long run. Remember - elimination means getting rid of COVID19 from our borders. Eradication means getting rid of COVID19 worldwide - so this is just a bit of terminology for everyone. Option 2 gives us more money in the short term - but is really a terrible choice - we will get more out breaks and then have problems cycling up and down the lock down levels. Option 2 can also include a weak Level 3 that will probably end up with the same cycling result - this will be devastating for the economy as it will be so hard to plan anything. Option 3 is probably the most reasonable. As a medical practitioner - I prefer option 1 for another 2 weeks. As a human being - I prefer option 3. Under no circumstances would I ever endorse option 2 - it's a terrible idea. It will essentially waste the last 3.5 weeks of lock down.

COVID-19 update: How is New Zealand doing?

Pretty well. Case numbers continue to drop. NZ also counts probable cases - again I'm not sure if many other countries do. We are also doing random testing on people to try to catch any asymptomatic COVID-19 carriers. All the results have so far been negative. However - we are really only doing 500-1000 random tests a day. The total number of tests yesterday was about 4000. Regarding surveillance - we should really be doing about 1000+ random tests a day. Medical and care staff that have or are caring for COVID-19 patients should ideally be tested on a regular basis - i.e. weekly to check for any asymptomatic infections. I have not heard our new sexiest man alive in New Zealand candidate - Dr. Ashley Bloomfield mentioning surveillance testing yet. This is a crazy world when an epidemiologist and public health expert is now considered a sex symbol - this is what a pandemic does to us. As one of my female medical classmates was swooning the other day - "He's got a nice head of hair". 

We should be able to achieve elimination with lots of testing, contact tracing and a little bit of luck. However - until a vaccine is available - the price of relative peace will be eternal vigilance. COVID-19 is like a wild dog that will tear through you the moment you let go of pressure on it's throat. 

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