NZ’s COVID-19 death toll rises – Expert Reaction

Though new cases of COVID-19 in New Zealand remain low – with just 20 confirmed cases reported today – three people have died since Thursday.

Two elderly people have died in Christchurch linked to a cluster of COVID-19 cases from Rosewood Rest Home & Hospital, and a man in his 80s died in Wellington yesterday linked to another cluster.

The SMC asked experts to comment.

Dr Christopher Gale Senior Lecturer Department of Psychological Medicine University of Otago, comments:

“I extend my sympathy to the three families who are grieving for the death of their loved older relatives. What is happening at present is that people within clusters of infection are becoming unwell, and this is putting a burden on certain communities, the families of people in those communities, and the doctors and nurses who care for that cluster. They also have my sympathy.

“Until this time we had been relatively spared, compared with other countries. The worldwide best estimate from the centre of evidence-based medicine in Oxford is that 5 in 1,000 who have symptomatic COVID-19 will die, but the rates in each nation vary considerably, with New Zealand close to the lowest rate reported.

“What is very clear is that in some people – and not all have co-existing conditions worldwide, nor are all old – this is a very serious infection. We need to be considering how to manage these outbreaks, and we need to have sufficient resources around the country to support the physical care of people who are severely sick. Some areas, to this time, are spared: others are not.

“We have, to date, been able to provide appropriate care for every person with COVID-19, but this has taken considerable effort on the behalf of district health boards, doctors, and nurses. Our health care system has pivoted to provide emergency care for the more seriously unwell people. In this, there have been delays of usual care and decisions made that may impact the health of other people with chronic illnesses. This is a time for understanding. No doctor or nurse wants to be in a situation where they are unable to provide needed care and comfort – and at present the issues we have are around delaying non-urgent care, not denying it.

“If we can continue social distancing we can decrease the infection rate of this virus and will be able to avoid reaching that point.

“The current strategy of the government is more ambitious. It was outlined by Michael Baker. We have closed our borders, we are contact tracing every person who is infected, and we aim to start surveys of COVID-19 infection. The hope is to eliminate it from New Zealand.

“We need to support those who grieve, cooperate with this strategy, and remain hopeful. With our geography—we have a moat around our islands – this could work.”

No conflict of interest.

Dr Ian de Terte, senior lecturer, clinical psychologist, Massey University, comments:

“Today is a very sad time for the family or whānau of the people who have succumbed to this virus and my thoughts are with them at this time. Not only have people lost their lives to this terrible illness, it will be hard for the family and friends to celebrate the lives of people who have lost their lives to this virus because of the restrictions or rules of level four.

“Although today is an extremely sad day, it appears that we have got this right in that by staying home we reduce the impact of coronavirus. Most of New Zealanders are listening to or trusting the advice of the experts, our Prime Minister, Ms Jacinda Arden, and the Director-General of Health, Dr Ashley Bloomfield. There are a number of people who are flouting the rules and some people on social media are calling for these people to be penalised.

“However, I will repeat what I have said before, people can only control their own behaviour and model the correct thing to do. I am going to finish this piece with a sports analogy. People can use whatever sports they follow or if they do not follow sports whatever is their pastime. I have chosen to compare this period of time to the sport of cricket.

“To date, New Zealanders have done an exceptional job with the ‘lockdown’ process, but it is only halfway. It is like a change of innings in a cricket game. We have batted well but now we have to field and bowl well to win the game. We need more of the same, so I am urging people to stay at home. Furthermore, it may be that we need to extend this level four period and so I will use the example of the recent world cup cricket final where we needed a super over, which extended the final. It may well be that we need to extend the ‘lockdown’ period except this super over may go on until we beat this virus otherwise more New Zealanders may die.

“My final thought is this; what worked well for you in the past or the first two weeks of ‘lockdown’ please use again. Again, I want to again express my extreme sorrow to the family/whānau, friends, and the community of the people who have succumbed to COVID-19.”

No conflict of interest.

Associate Professor Arindam Basu, School of Health Sciences, University of Canterbury, comments:

“As much as New Zealand has shown improvements, the news of more deaths is a stark reminder that we will need to continue with level 4 (strict isolation and mitigation efforts) to not just flatten the curve but also shrink the total case load. In this context, let us also keep in mind the new rising numbers in Singapore that short of complete mitigation, the virus has a tendency to ‘come back’ or ’emerge’.

“One particular angle to keep in mind is about the biological property of the virus that determines its invasive properties. The pathology is such that those with hypertension, diabetes, increased age, reduced immunity, predisposing lung disease, smoking-related illnesses are at risk of adverse outcomes. In turn, we need to be mindful of three contexts of care:

  1. Aged care
  2. Primary care as these conditions (high blood pressure, diabetes, heart disease, asthma, chronic obstructive lung disease) constitute what is referred to as ambulatory care sensitive conditions and therefore access to primary care (diseases cared for in the outpatients department would not incur care in inpatient department) and we make sure that such people at risk are accounted for
  3. Care for our Māori and Pacific peoples (among whom health disparity and prevalence of diabetes and hypertension are high).

For all these reasons, we need to be extra careful about:

  1. Care of our aged persons and their needs
  2. People with high primary healthcare utilisation (and those whom we have missed in the primary care) — those with high blood pressure, diabetes, or both conditions, and
  3. The Māori and Pacific peoples or community (increased surveillance and messages about how to stay safe), perhaps add a Te Reo language version to the televised messages we receive every evening.

“With no efficacious medicines and vaccines in sight, we will have to step up and strive to stay on course — stay indoors, use protective gear when we have to be out and about, be extra careful about our elderly and those with predisposing conditions. In particular, we need to be particularly careful about situations and households where children and elderly people (65+ years) live together and have chances of mixing, so before re-opening schools and day-care centres, these factors will possibly need to be kept in the perspective. Plus, we need to trust that despite case numbers and deaths, there is evidence that the shut down is working; we have to be extra careful.”

No conflict of interest.

Jacqui Maguire, Registered Clinical Psychologist, comments:

“It could be assumed that the declining daily COVID-19 case numbers will act as a collective motivation boost across our island nation. ‘We are staying home, we are saving lives, we can do this’. For some, this positive reinforcement will help them stay the course.

“However, these projected wins also coincide with the ‘mid zone’ of our four-week lockdown and Easter weekend. A period where many now agitated, frustrated and bored Kiwis are experiencing real loss: no family get-togethers at the bach, religious gatherings or community egg hunts. There is risk these falling case numbers provide a false sense of security that the war on COVID-19 is already won, enabling people to justify rule-breaking behaviours. Moreover, with all four deaths occurring in the 70+ age bracket, unhelpful beliefs that COVID-19 is only a risk for ‘them’ (the elderly) not ‘us’ may be strengthened.

“It is paramount we continue to conscientiously forge forward throughout level-4’s entirety, whilst validating how tough this might be feeling. Validation from our public leaders is just as important in scaffolding compliance as positive reinforcement.

“If you are requiring a boost in motivation, try the following:

  1. Create an altruistic mindset: Staying home will protect those who are vulnerable. Picturing someone you love that is vulnerable can help.
  2. Focus on one day at a time rather than the end date.
  3. List and savour the benefits of lockdown. E.g., pause from the hustle culture, time to read books, no traffic, money-saving because you can’t shop…
  4. Schedule things to look forward to each day
  5. Plan how your bubble will celebrate when we come out of level-4. My bubble will be the first patrons outside the local café to enjoy our flat whites.”

No conflict of interest.

Dr Dougal Sutherland, Clinical Psychologist, Victoria University of Wellington and Umbrella Health, comments:

“How quickly things can change in 48 hours. Before Easter the police were warning people not to consider travelling to holiday homes and baches. There appeared to be a growing sense of optimism and even pride about how well we were doing containing Covid-19. But the incredibly sad news of three deaths in two days may be a sobering reminder of the job we still have ahead of us.

“It’s natural that people might respond to these new deaths with a heightened sense of anxiety. In this situation our anxiety is useful. Anxiety tells us that there could be danger present and that we should take steps to reduce our risk. And right now our anxiety is real and we should listen to it.
“Our job isn’t done yet. The lives of the vulnerable and the elderly depend on us continuing to stay home in our bubble. We should listen to our anxiety and then choose to respond, not with fear or suspicion, but with kindness and compassion. We have the opportunity to create a lasting legacy in our country, a legacy that says we stayed home because we cared.”

No conflict of interest.