The Editor takes full responsibility for the headline.

By stewartb:

‘ROLL UP, ROLL UP …. GET YOUR ‘PERSPECTIVE’ HERE!

Covid-19 testing, care homes and New Zealand

For anyone following media reports and the comments of some opposition politicians in Scotland, you could be persuaded that Scottish Government ministers aided by Scotland’s public health institutions, Scottish Government officials and independent advisors must have all got this ‘Covid-19 testing in care homes’ issue so wrong – exceptionally and uniquely, even wilfully, wrong – by implementing an approach that is completely at odds with international practice.

Is this justified? This is where ‘perspective’ is needed. Unfortunately, ‘perspective’, like that other thing contributors to the TuSC harp on about, ‘context’, is in short supply in Scotland.

Where to look?

‘New Zealand’s Prime Minister Jacinda Ardern has said her country has “done what few countries have been able to do” and contained the community spread of Covid-19 and can start easing its lockdown measures. As the BBC’s Shaimaa Khalil writes, the country’s success – and Ardern’s leadership – have won it global attention.”

Source: https://www.bbc.co.uk/news/world-asia-52344299

So is NZ exhibiting a ‘gold standard’? If the BBC’s praise is justified – and it is the BBC after all –  it must be worthwhile learning from that country’s experience including in particular its experience dealing with Covid-19 in care homes.

What can we learn?

The impact to date of Coronavirus on NZ – which has been much less severe than in many parts of the world, including Scotland – is the result of that country’s distinctive ‘system level’ response.  

However, for a perspective on the challenges in its care homes during the pandemic, the views of a group of New Zealand academic experts from the Te Ārai Palliative Care and End of Life Research Group, School of Nursing at the University of Auckland are informative. Their opinion piece entitled ‘Covid-19 and care homes: the myths and realities’ was amplified internationally by publication on msn.com  on 3 May, 2020.

Source: https://tearairesearchgroup.org/2020/05/04/covid-19-and-care-homes-the-myths-and-realities/  

The nub of these NZ’s researchers’ views are contained in three quotes (with my emphasis): 

(1) “To date all the people who have died of Covid-19 in New Zealand have been more than 60 years old, and more than half lived in aged residential care. Care homes account for almost a third of the disease clusters. We have seen that once the virus invades these homes, it spreads like wildfire, not only to other residents but also to caregivers and nurses.”

So in NZ, a country being praised for its successful management of this public health emergency, there has also been a severe negative and differential impact of the virus spreading in care homes relative to other settings.

(Note: on disease clusters: a significant Covid-19 cluster in NZ is when there are ten or more cases connected through transmission and who are not all part of the same household. The cluster includes both confirmed and probable cases.)

These NZ researchers acknowledge that the challenging issues around care homes faced in NZ are far, far from being unique.

(2) “Worldwide, Covid-19 death statistics for older people in care homes are staggering. In Europe, official counts indicate people living in care homes account for 54 percent of all Covid-19 deaths. However, many care home deaths have not been included in official tolls and it is estimated the real toll of Covid-19 deaths may be up to five times higher.”

(Do we think the NZ sources forget to highlight the ‘Scotland case’, that exceptionally, uniquely awful one …that international outlier?)

(3) “Covid-19 has laid bare the negative impact of undervaluing aged residential care and positioning these facilities outside normal healthcare services.”

Policy and politics

The two points in the last quote surely important ones. For many Western-style democracies, these points probably come closest to a general truth that needs to be addressed! Are ALL Scotland’s politicians capable of finding a way to come together to ensure step-change improvement in this situation and soon?  Hopefully!

However, right now narrow attempts at point scoring by partisan hacks and allied opposition politicians in Scotland, keen to demonstrate their exceptional hindsight, seems the priority. Do they lack awareness of the mounting international evidence on Covid-19 and its differential impact on care residents in many (most) countries – even the evidence from somewhere like New Zealand that has dealt very effectively with the pandemic? Or are they deliberately ignoring the mounting evidence for political ends?

New Zealand’s pro-active care home sector

It is useful to get further insight specifically on testing of care home residents in NZ for Covid-19. This is from the NZ Herald on 4 April, 2020:

Source: https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12322501

“Aged Care Association chief executive Simon Wallace said rest homes until now had been accepting new admissions without testing but placing them in isolation for 14 days. Now, every admission will need to be tested first. If they test negative, the resident will be admitted but will be put into isolation for 14 days.” The newspaper report adds: “The Ministry of Health had been advised (i.e. by the ACE) of the new policy.”

The Aged Care Association (ACE) is a not-for-profit national membership organisation representing the residential care sector in NZ. It was the ACE that decided to introduce a change to the admissions policy for its members’ homes. It was the ACE that informed the NZ government of this change, i.e. the ACE took responsibility for assessing the risk to its clients and it was proactive in implementing a tighter admissions regime than had been required by government guidance. This proactive decision is on top of the ACE’s confidence that: “Rest homes are used to managing illness and the staff know how to prevent the spread of infectious diseases.”

New Zealand government’s response

Following the decision taken by the ACE members to tighten their admission criteria, the NZ Department of Health wrote a letter to the ACE’s CEO on 8 April. I’ll leave you to read its contents (below): they provide valuable insight into the situation concerning Covid-19 and care homes in another country – a ‘gold standard’ country.

Source: https://nzaca.org.nz/assets/COVID-19/8-April-2020-letter-from-Dr-Ashley-Bloomfield.pdf   

New Zealand’s testing regime

For information, NZ began testing for Covid-19 on 22 January 2020. The graph below shows the official figures for the number of tests per day for Covid-19 in NZ.

Source: https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-current-situation/covid-19-current-cases#lab

So the experiences of NZ, including the occurrence of Covid-19 clusters and the relatively high proportion of Covid-19 deaths both associated with care homes, happened in a country with a substantial track record on testing.

Final thoughts on the value of  ‘perspective’

It is not a solution in itself; it is not promoted here as a way to distract or to minimise, or to limit proper accountability; it is not offered to bolster complacency or denial or justify inaction. But ‘perspective’ provides balance, deepens understanding; maintains realism; and can add justification either for adverse criticism or praise. And as we form personal judgements on important issues at this time, and as we have to decide who to trust to make big decisions on our behalf, ‘perspective’ helps by improving the standard of public debate.

Media that choose to bring ‘perspective’ will serve the ‘public interest’. And the BBC may even agree – at least on paper! This is from its editorial guidelines:

“There is no single definition of public interest, but it includes freedom of expression; providing information that assists people to better comprehend or make decisions on matters of public importance; preventing people being misled by the statements or actions of individuals or organisations.” 

Source: https://www.bbc.com/editorialguidelines/guidelines/editorial-standards

If only BBC Scotland at least lived up to this!