Thread by @PartTimePM

By request - a quick overview of some of the managerial problems with the govt response to C19. A long one sorry, and obviously very incomplete - I'm one person, and this is what I can recall off the top of my head in half an hour. Long thread sorry.

#nzpol

1/ So, from the start. Back in January, it was clear that this might merit some attention, or might be nothing much. Spending a couple of grand to put a few people in a room brainstorming possible scenarios for if it reached NZ, or became a major global threat, would have been a

2/ good idea. Also implement distance sitting options for Parliament, because we need that regardless of C19, and incapacitating the executive in the middle of a crisis is an extraordinarily bad idea.

3/ In early February, it was clear this was a big deal. Detailed scenario planning and risk modelling should have taken place at this point. This was also the time to start ramping up capacity in critical pinch points - training temporary healthline staff to have on standby,

4/ organising cheap temporary overflow hospital capacity (likely in community spaces), ensuring supply lines for PPE, medication, other medical supplies etc was robust and had a decent buffer. Ensure existing stockpiles were in good condition, and that there was a good plan to

5/ distribute them. Massive ramp-up in test capacity in case we needed it. Detailed planning for border defence under various pandemic scenarios. Create detailed comms strategy for public consumption, and put together a comprehensive advertising campaign on it. Ensure contact

6/ tracing was robust, timely, and investigate technological solutions that may help. Ensure that reporting lines on key metrics were clear, in the right places, and that there was sufficient managerial skill and resource to monitor and understand them. Set up large temporary

7/ quarantine facilities, ideally near a major runway (I have advocated for Ohakea in the past), and *not* near a major city. Ensure that systems which would be needed on a national level (e.g. C19 testing) were integrated on a national level. Attempt to procure additional flu

8/ vaccine to help lower the incidence of ambiguous symptoms - too late for the normal order to be produced (it's a six-month manufactoring lead), but try to get more elsewhere. Plan for what to do with the economic fallout from a closed border, social restrictions, and

9/ potentially lockdown. Create, put through due expedited process, and pass, legislation to deal with as much of the above as possible - not all of it necessarily active, but certainly with a mechanism to activate it quickly. Increase IRD & MSD resources to deal with extra load

10/ from stimulus packages & unemployment load. Create a few speculative budget options to address potential scenarios, including some interim ones. Hire or purchase one or more cruise ships as additional fast quarantine capacity, because the temp facilities under construction

11/ won't be done yet. Define regional borders & procedure for enforcing them and managing crossings. Train and empower additional non-police staff for arrest & physical detainment of people trying to cross borders or violate quarantine. Investigate wastewater testing.

12/ Ramp up sequencing resources - uni bio labs can help.

Late Feb / early March, C19 reached NZ, and we could see the way Italy was going. This was the time to pull the trigger on the advertising campaign, tell the public about levels 1-4 and what they would mean. Advise L1

13/ currently, with likely move to L2 soon. Move to L2 if community cases spike beyond a very small number. Advise economic stimulus details (wage subsidy etc). Encourage public to socially distance where possible. Activate legislation. Call up standby staff. Start aggressive

14/ rollout of additional temporary hospital capacity. Close border to all non-citizen / PR arrivals. For all arrivals, and for any positive or suspect positive cases: mandatory quarantine, partition cohorts by arrival date. Do not allow self isolation of positive or suspected

15/ cases. Mandatory regular health checks, symptom declaration, and pooled PCR testing of all quarantined and all border / quarantine support staff / hospital staff / airline crew / public transport crew. Begin aggressive auditing of all areas to catch implementation bugs,

16/ missing process, and mistakes - there will be many. Test all KPI reporting lines, and ensure they are delivered in a form that is quick to digest & assess even when management is overloaded. Roll out any technological measure that is available to assist contact tracing - if

17/ none is available, write something quick & dirty and worry about doing it properly later (even someting as simple as a centralised web form is better than nothing). Compel businesses to use it if uptake is not widespread and rapid. Ban any competing solution. Begin flu

18/ vaccination campaign early. Test wastewater if available. Continue ramp-up of bottleneck capacity as per Feb, and any new problem points discovered in the meantime. Aggressive monitoring of all KPIs, and release most of them publicly on a daily basis - the public & media are

19/ quick to spot problems, so let them - it increases trust in govt transparency at a time when authoritarian measures are necessary, and helps catch things management might miss.

20/ Mid March, if new C19 case numbers are still climbing, move whole country to L3. L4 if they

20/ are climbing fast, but with above measures they should not be, and may actually be falling. Pass interim budget bill. Roll out of stimulus as needed. Continue ramp-up of all pinch points. Daily press releases or conferences. Continue auditing. If new community case numbers

21/ are still climbing, increase audit of process around new cases unless their origin is known, and patch the holes.

Late March / early April, new community cases should be falling, and R should be usefully below 1. Hold current level / restrictions until new community cases

22/ reach zero plus at least one more transmission cycle, then drop one level. Drop a further level after at least two cycles if still no new cases. Continue until we are at L1. If at any point new community cases show up, hold current level and use contact tracing to catch the

23/ outbreak fast. Aggressively increase restrictions around the outbreak. If unrelated new cases show up, aggressively increase level. Continue border / quarantine restrictions. Continue aggressive community surveillance testing.

24/ Once back at L1, hold that. Do not allow any non-distanced large event, or any large event that is not ticketed. Continue border / quarantine restrictions. Continue aggressive community surveillance testing.

25/ Once back at L1, hold that. Do not allow any non-distanced large event, or any large event that is not ticketed. Continue border / quarantine restrictions. Continue aggressive community surveillance testing.

26/ After several months of no new community cases, allow large events as usual without restriction. Reverse this immediately if any new community cases show up.

27/ Obviously I will have missed a bunch of stuff off that - I'm only one person, and I don't have insight into the whole picture. And there's probably a bunch more than I have thought of over the last few months and forgotten about. However, that's a big part of why I'm unhappy

28/ with the managerial performance of the govt response on this. It's not hard to come up with high-level stuff like this, and if you put a few more qualified people in a room, they will come up with a much more comprehensive plan than I ever could.

29/ So... on to the evidence of failure.

1. The January brainstorming session didn't happen, or was ignored.

2. Most of the early-feb prep didn't happen, leading to the following when we started seeing C19 cases here:
a) healthline overload;
b) public uncertainty;

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c) insufficient hospital capacity to cope with projected load;
d) no full border plan ready to go;
e) no quarantine capacity;
f) no extra trained staff in most pinch points;
g) near-nil test capacity, mostly flown to Australia for processing;

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h) severe shortage of PPE in many areas;
i) no clear public picture of response strategy (e.g. levels).
j) no public advertising campaign until a couple of days before L4.

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3. Once border restrictions implemented, it was not audited, leading to many cases of execution not matching govt direction or advise to public.
4. Once MIQ was implemented, it was not audited, leading to many cases of execution not matching govt direction / advice to public.

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5. Many trivial risk surfaces at borders & MIQ were left unmanaged (e.g. mingling of guests & airport arrivals, no onsite staff with detainment powers, domestic transfers, unrestricted airline crew).
6. Many obvious defense layers were missing (e.g. health checks AND symptom

34/ declaration AND testing AND distancing AND PPE AND partitioning AND mandatory quarantine).
7. Quarantine was entirely urban, and mostly in Auckland - which means our biggest economic surfaces are threatened by any breach.

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8. Processes were ignored without proper risk management (e.g. compassionate exemptions from quarantine)

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9. Many KPIs were either not present, not watched, not understood, or ignored, and auditing was insufficient. This lead to things like:
a) no database that holds a list of NHI numbers for all border & MIQ staff.
b) many unmanaged risks that were not caught (see point 5).

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c) many cases where execution didn't match govt messaging or direction (e.g. regular testing, mandatory quarantine).
d) issues that were caught, but much later than they otherwise would have been.
e) issues that were caught, but only as result of public or media attention.

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10. When we reached L4, public only had a few days to get used to the alert levels, and only a couple of days notice before full L4. More panic than necessary ensued (some was inevitable though).
11. Following L4, the details of alert levels were constantly revised. Levels

39/ as published in March were substantially different, and changes were not advised until the actual level change.
12. No govt advise was provided to the public regarding what scenarios would cause NZ to move between levels, keeping businesses guessing.

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13. Small business cashflow issues, especially regarding L4, weren't properly comprehended until after a lot of pressure, and only addressed a few weeks later.
14. Mistakes indicative of lack of (9) were not learned from, as proper KPI monitoring and auditing continued to be

41/ absent. This lead to more preventable mistakes later.
15. Lack of layers in border defense, esp. testing, lead to the latest case not being picked up until mandatory testing was finally enforced. We got very lucky - had it occurred a couple of weeks earlier, it may well have

42/ resulted in a much larger cluster or clusters.
16. Not following up on tests lead to Americold cluster going undetected for about a week longer than it should have, and resulted in additional transmission.
17. Lack of mandatory quarantine lead to repeated household

43/ transmission and much longer isolation periods for some households earlier on.
18. Urban quarantine has likely resulted in a second, L3, lockdown of Auckland (Americold cluster is most likely to be border-origin, although not yet traced there).

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19. Airline crew continue to be trusted with loose restrictions after arriving from overseas, or operating transfer flights, even with known positive cases on board.
20. Govt continues to deny that many of the risks exist, and still needs to be dragged into reacting to

45/ problems as they are reported in the media.
21. KPIs are still not being properly monitored, auditing still isn't being done properly.

Obviously I'm just one person, and this is what I could recall in half an hour - there will be a LOT missing from both prep & problems. I talked about much of this at the time, but not all.

@threadreaderapp Please unroll this humongous thing so that readers may peruse it more easily.