By Grant Jacobs 23/10/2020


New Zealand has been called out as an outstanding player in managing COVID-19. We’ve done well,[1] but we’re far from perfect. We could do a lot better at backing our front row.

Epidemiologists advise nations not to play “wait and see”. If By the time they do see, it’s all over them. “She’ll be right”… until it isn’t.

We’re less likely to have restrictions imposed if we all play our part.

Like in team sports, it’s no good just watching someone attack. You’ve got to step up and defend. No good just watching your front line cover you either: everyone needs to be in the game.

On the game

It’s a crucial rugby test match. The All Blacks’ opposition are being held behind their goal line (the border). The opposition has the ball, and they’re not letting it go. It’s 5–3 to us. A ridiculously slow clock ticks down. Defending will win it.

The front line players (the staff maintaining the border) nail most efforts to escape. Great effort at the front!

There’s a fluff! The second line covers the breakout, narrows the attack down, snuffs it out, and hacks the ball back behind the line. Phew. Saved!

Off the sidelines, and very strangely, the team’s barista has set up cooking up a brew. It’s weird stuff, but this is fiction and my story has her with a cracker cuppa the players can’t get enough of.

It’s been a tough tour and they’d love a break.

The midfield defensive players get a whiff of caffeine in the swirling, bitter breeze. A few glance over, see the brew, and say to their mates, “Eh, there’s a brew on! We’re good, let’s leave it to the forwards” … and trundle off.

Now there’s just the front row and the last of the backs! Things are looking rather thin! A few in the second row gamely stick to the coach’s script, looking bewildered. Good coffee, but what the hell?

The forwards are good, but they’re not supermen. Sooner or later there’s going to another crazy move from a wily back, or an innocent fumble.

Playing short-handed

The last of the backs are the contact tracing team, the Ministry of Health, the police and more.

You and I, we’re the players meant to be front of them. We’re not being asked to face much contact; our job is to “guide” breakouts to thin lines of attack help them snuff the attack out, and put the ball back behind the line.

Unfortunately in the real-world version of this game, it’s always game on. With COVID-19 there’s no putting enough points in the bank so that the opposition can’t win. We win if we keep COVID-19 from scoring (or taking out our players) until the match is over.

My fellow scientists and science communicators and I are in this too. We’re some those second-line players still on the field looking a bit gob-smacked. What’s the up with the rest of the team?

We’re not being asked to do much. In fact, what we’re asked to do will help us avoid contact with some massive player coming at us. Great for us small players!

But we have to play. If we don’t narrow down the attack, the opposition will be all over us, and the ball straight to our line. Then we’ll be forced to play a whole other game. We’ll be back cranking up the Levels again. It may not happen today, but we’re helping it not happen.

Othering

We’ve got this terrible habit in New Zealand of doing as little as we can unless we really have to. We’re great when pushed into a team and made to play.

But ask us to do the thing anyway, and too often we deflect. It’s someone else’s job.

Reality is, you and I are also a layer in the defence, and things would go better if we played our part.

Layered defense

Playing against COVID-19 requires a layered defense.

The front line can’t do it all, and neither can the last of the backs. Players in the middle—us—have to chip in, too. If we don’t the backs have a hell of job covering breakouts.

In August I wrote that the border will leak a few cases (in the section Borders are not perfect),

[…] In practice, border measures are highly probable things.

Most people staying in isolation for 14 days are not going to bring an infection into the country, but border measures are not ‘100%’.

Our border measures are good, but they’ll always be imperfect: winning the COVID-19 game is about strong borders and efficiently squashing outbreaks.

Part of the game is using layered approaches. Epidemiologists talk of the ‘Swiss cheese model’. Each layer of measures has holes, but layered up appropriately the holes are covered. (Think of stacking slices of holey cheese.)

More on Swiss cheese—the Emmental or Gruyère kind, with holes—later.

Like the first defensive line in the match, some cases will come through.

The border measures are meant to filter out all but a few. Lets say, of a thousand infectious people at the border, 999 don’t get into the country while infectious. Good stuff. But one will.

Media pounce on these as “failures”. The real failure would be if the rate of these happening is much greater than the one-in-a-thousand infectious at the border: one in a thousand are expected to.

Our job is to make it easier to shut down those few breakouts.

It’s complicated by that with COVID-19 there are a few days (a few passes) where no-one defending can see the ball! We don’t know if someone is infectious until a few days after they are. The defense has to be good!

What can we do?

Siouxsie has covered a lot of what I had intended to write on the ‘Swiss cheese model’.[2] Layers of cheese slices with holes represent measures that help, but are not perfect.

There’s a long list of things scientists and science communicators think about. Siouxsie’s post reflects that, but the things we’re being asked to do are a few fairly simple things.

They vary with our different Levels. We’re currently at Level One. That level still asks us to do stuff! Things like,

  • Record where you’ve been
  • Get tested if you have symptoms
  • Physical distancing
  • Wear masks on public transport
  • Good hygiene (handwashing, careful sneezing & coughing, clean surfaces)
  • Stay at home if sick

They’re easy, and several are really things we ought to be doing better at anyway, COVID-19 or not.

Some may ‘only’ be recommendations, but they’re made as recommendations as they’re a good idea! Smart teams listen to the coach; they know they’ll play better.

Over 50 years without a major disease like polio has made us lazy. Asians and Africans do well partly because they’re used to responding to one disease or other.

There are more things we can do, but a bigger, deeper, issue is complacency.

It’s out there. It will come through the border (just hopefully not too often).

In particular, keeping a record of where you have been must be done at least a week before any cases occur. In reality this means we have to do always until the pandemic is over. Don’t stop scanning those QR codes, or whatever you do to record where you’ve visited!

This might help: make them a habit.

Things are easy if they become habitual. Keep making yourself do them, and after a bit you’ll just do it out of habit.

About me

I’m a scientist (a computational biologist) and writer. I’ve tracked this pandemic from early on by fortuitous accident. Most of 2019 I was researching zoonoses for writing projects. Part of that was looking out for examples of outbreaks. In early December 2019, a ‘pneumonia of unknown cause’ from China caught my attention, and I’ve followed the science and specialists’ discussions closely since. Consider this an opinion piece, but one founded on research science and specialists’ thoughts. You can follow me on Twitter.

Other articles in Code for life

COVID-19: sequence the viral genomes of all border cases

Political parties and GMOs: we all need to move on

Scientific paper has a face in a turd. Who could it be?

1000 of these now(Links to lots of reading here!)

Footnotes

All rights reserved, ©Grant Jacobs.

I’ve only ever played two games of rugby, both as a school kid. I’m sure it shows. Forgive me, but I wanted to play with this analogy anyway; writers do that sort of thing.

1. We’re not ‘the best’, whatever that really means.

2. I started over a week ago! It’s been a struggle to write this year; too much I could say. I will probably come back to the ‘Swiss cheese’ model as part of science communication issues I’d like to tackle.

Featured image

It’s out there. Cases will occasionally come through our border. This map is from Wikipedia’s COVID-19 pandemic page. Darker areas are regions with higher rates of cases per 100,000 people as of October 22, 2020. Authors: Raphaël Dunant, Gajmar (maintainer), CC 4.0 International.