It is no longer reasonable to dispute that COVID-19 is a global pandemic. That term should not necessarily be linked to the notion of a global disaster. However, it does mean there is no safe haven from COVID-19.
Here in New Zealand there is still a chance that we can contain the disease but our current containment policy is not going to work. The only way it can work is if mandatory home-isolation is a requirement for all those returning from overseas. That means no international visitors who cannot demonstrate that they can self-isolate in either a home or equivalent environment, with all other people in that household also self-isolating.
There is only one place in the world where the disease is on the wane, at least in the meantime, and that is China. Daily new cases there are now down to around two percent of what they were a month ago. More than 97 percent of world-wide new cases each day are currently from outside China.
The example for New Zealand to watch closely is Singapore. They have done an outstanding job of controlling the disease, despite more than 30 separate importations of the virus by travellers. Most cases have been caught very quickly and total cases are still only 150, despite so many primary cases.
The Singapore authorities have been both rigorous and totally transparent as to the situation and that seems to have helped greatly. However, whether the disease or the authorities will eventually dominate within Singapore remains uncertain. This remarkable infographic summarises the disease pathways within Singapore.
The disease is currently running fastest in Europe, with over 2000 new cases there per day. It is now obvious that the disease in Northern Italy was not contained and it is now running rife across all of Northern Europe, and also spreading out rapidly from there. Italian authorities have now barricaded Milan and the North from the rest of Italy, but it is too late.
There are also puzzling questions as to why the death rates are so high in Italy, already at five percent of total cases with another 11 percent in intensive care. In rapid outbreaks, the death rate always lags the number of cases and so the Italian death rate, which has been increasing each day, is likely to further increase.
We know that coronaviruses rely on RNA replication, which means the replication is error prone and mutations are likely. It is possible that the Italian variant has higher inherent mortality risk.
At the level of individual returnees to New Zealand from overseas, the risk of being infected is still less than one chance in many thousand. But it is at the level of the total population of returnees that the risks have to be assessed. Currently, the biggest risk that New Zealand is not dealing with is from Europe
Restrictions on travel from Europe need to be immediate. It should have already occurred.
The evidence that cruise ships can become hotbeds of viral activity is now very clear. It only needs one person out of several thousand on a ship to be incubating the disease and from there it exponentiates. I find it remarkable that cruise ships are still coming to New Zealand and visitors coming ashore.
Disease progression in North America is only about one week behind Europe. Travel restrictions from there are also needed.
Australia also needs close scrutiny. Currently there are already 80 cases, and the incidence per person of population is three times that in New Zealand. Australia could well go out of control in coming days. Another week and it may well be too late.
To some people this may all sound extreme. Indeed, putting restriction on Australian travel to New Zealand may still be a step too far for the politicians, but community understanding is changing rapidly as the COVID-19 black swan bears down. In particular, awareness is now starting to develop that unless there is containment our health services are going to be overwhelmed.
Community understanding will increase rapidly in the coming days as both Europe and the USA tell a stark story. American freeways in places like Washington State, which is a minor hotbed of the disease, are now close to deserted. Further south, Stanford University is already only offering its courses online. The non-stop train services from New York to Washington DC have already stopped through lack of demand. These are just the first steps.
If we do things right, then New Zealand still has a chance of getting through the next few months without a major breakout of disease. To repeat a phrase I have used before, a stitch in time saves nine. The alternative is that normal life will grind to a halt, as we are seeing in Italy and about to see elsewhere in Europe and in North America.
*Keith Woodford was Professor of Farm Management and Agribusiness at Lincoln University for 15 years through to 2015. He is now Principal Consultant at AgriFood Systems Ltd, and has had a longstanding interest in epidemiology. He can be contacted at kbwoodford@gmail.com
154 Comments
Because otherwise the labs would be swamped with thousands of tests for the common cold because the hypocondriacs out there are losing their minds.
The test criteria will need to be loosened up once there is community transmission in NZ, but at the moment there is no need to test every random with the sniffles.
Yes, everybody with Covid-like symptoms should self-isolate at home for a couple of weeks, and income support be provided so people don't have to go into work to pay the bills. If there is a known link to someone/a location with known covid-19 infections then tests should be run, and more intensive monitoring for those that are well enough to self-isolate.
No, the first decent test kit wasn't designed until mid January, they've had a month and a bit to gear up, and the test kit doesn't detect covid-19 until there is a decent viral load, so testing too early is a waste of time, you just get a false negative.
What appears to be the best test method was only certified a week or so ago.
https://med.stanford.edu/news/all-news/2020/03/stanford-medicine-COVID-…
As with all currently available tests, it’s not yet clear how long a person needs to be infected before testing positive, or whether someone who's infected could be identified by the test before displaying symptoms.
But no need to let reality get in the way of a good old panic eh?
once they have a fully developed infection they are.. but at that point its just confirming its covid-19 and not some other respiratory illness. Good for statistical purposes, but does it really change the treatment protocol compared to pneumonia from other causes?
Sorry Prags, they have been running test for sometime and yes they are not definitive and thats why they have to isolate and test multiple times.
This is not about panic its about looking at NZ's capacity in hospitals and trying to get in front of any breakouts (absolute failure here so far).
Govt should be doing more to support potential people in isolation but its all be left to people to sort.
Prag, sure comms have been poor compared to Sing &Sth K so people left to own devices.
Hypochondriacs are people too (remember 1 patent took down a roster of 43 HCWers in Auckland).
Better the labs are crashed, than the hospitals.
Blitz test will provide great data, quarantine all travellers will delay spread and protect health system for as long as we can.
As an aside what do you think of this "escape" story. Is this action community minded?
https://i.stuff.co.nz/travel/news/120111765/before-italys-virus-lockdow…
Oh go on TTP, it's got little to do with the govt. If people don't follow precautions and hygiene etc. there's nothing Soiman's party could have done better.
Also I think there's a "ship-load" of luck involved, both literally and figuratively
Look: https://www.nzherald.co.nz/business/news/article.cfm?c_id=3&objectid=12…
"Overregulation of diagnostic testing has played a major role in this delay. For weeks, the CDC operated the nation’s sole diagnostic laboratory for coronavirus, while testing in the rest of the world proceeded apace.
...In China, labs have tested thousands of patients each day. By Feb. 23, the Chinese government had approved 10 test kits, and production capacity reached 1.65 million tests per week. Meantime, South Korea has more than 500 testing sites and has screened over 100,000 people, reportedly testing 10,000 individuals per day and pioneering “drive-through” testing facilities.
This enhanced testing capability is a key reason why the country has reported over 5,100 cases — the second-largest, outside China — including larger numbers of patients with mild illness, as reflected in a case fatality rate less than 1 percent.
By contrast, the United States had performed a paltry 472 tests by March 2. Further, CDC testing criteria have precluded recognizing community spread because of requirements stipulating recent travel to China or exposure to an infected person."
https://nypost.com/2020/03/07/overregulation-is-making-the-coronavirus-…
You mark this as out, hit wicket
https://i.stuff.co.nz/national/health/coronavirus/120122652/coronavirus…
Got to keep labs open
Very sensible commentary. Time for govt dithering is long-past. Every day they fail to institute self-isolation and quarantining just increases the magnitude of the problem that they will inevitably face. Italy went from 3 cases to 3000 in 2 weeks! Europe is only trailing Italy by 1-2 weeks in progression, and we will be in a similar state a week or two later. Hospitals will be overwhelmed in a month if govt don't pull out the big guns now.
We have no big guns mate. Hospital staff here dont even have any PPE up to the standard required its like trying to get the honey out of a hive while wearing your speedos or a bikini. The Asians had a series of things like SARS that means that they had at least a plan and equipment available. We get 5 cases then reports the hospital cannot cope. Our only big gun was the fact we are an isolated island and thats it.
The govt has maybe a month before the excrement really hits the fan and hospitals are overwhelmed. A huge amount can be done in that time to increase treatment capacity if they apply competent project management, near-unlimited funding and start today (conscript uni students!). But that won't happen, they will dither as usual and do little to nothing other than talk about it. Give Coalition a deadline of two months and tell them that at that point all MPs will be deliberately infected - bet they would lift their game then.
The initial surge in infections in Korea was in a relatively youthful charismatic church - and young are far less likely to die. Deaths lag infections by several weeks as well so with rapid spread the deaths we see now are really linked to infected numbers 1-2 weeks back. Expect Korean CFR (death % of infected) to skyrocket in next week or two.
Highly likely. I would imagine SK has a lot better Healthcare system, as well as apopulace that inclined to take a bit more care, due to previous SARS experience.
I guess my point was more around trust. This event is showing just how untrustworthly all Govt and internation groups are. WHO yet to declare a pandemic. US barely testing, yet from all accounts Wuflu is widespread across most states. The lack of any real political pressure on China. Most official talk is that China are handling it very well. Again the spread would suggest otherwise.
I think that Italy and Iran are working backwards because of no boarder controls, so they have become aware when alot of peopkle are starting to get really sick and die, by which time the virus already had a major foothold.
In italy I expect the amount of infections to skyrocket and the death to case ratio will probably fall as it does. Iran is a lost cause, they are making no real efforts to contain.
The "real " number that is missing is the total actually infected, without symptoms, that number is much larger in fact due simply to the impracticality of testing everyone. Politicians in some countries influence the testing so that only those obviously with symptoms (or dead) are tested, that is ludicrously inadequate and shows up possibly only 20% of actual infections.
If you apply the very broad calculation of 2% mortality across the population and calculate back from the number dying then you get the real number infected.
Then extrapolate that "real" number exponentially over time in a highly populated and very mobile region, 2, 4, 8, 16, 32, 64, 128, 256, .... every day for every infected person. Billions come up very quickly
To late guys how many times do i have to repeat that all air travel should have been suspended weeks ago now. Now your reduced to taking the problem into your own hands due to government inaction. Self isolation and minimised contact with other people right now and then you have the job of deciding at what number of cases there are in your region before you totally self isolate.
We should be on total lockdown now. That would give our medics time to prep. The more we delay the better off we will be, if they prep. But I cant see that happening. Can you? This half way house of trying to please everybody will please nobody. 133 dead in Italy over night. Thats what we are headed for. Of course no test no know. We seem to be following the US in this manner. It looks like well over 20 dead in one rest home over there, with more falling ill and many in a bad way.
I understand it is a terrible call for the government to make, but if they dont ...
I have read a lot of what the virologists and mathmaticians have said. This aint no flu. Its headed for the stars. Our old people are in big trouble. Do we care about them, or not? Jacinda?
There is a balance between the deaths and economic disruption to be struck. Vast economic disruption is now baked in - coming ready or not. But we could still dramatically lower deaths and keep hospitals functional with a universal 2-4 week quarantine now (rather than a month's time as is inevitable and too late to be really effective), followed up with Singaporean type methods. My bet is govt will fail to act decisively (yet again) and doom tens of thousands more to die as a result.
The WHO have been a complete failure on this matter. Their initial advice was for countries not to ban Chinese travel and when a few did they were admonished by the head of WHO for being racist. Now the WHO is saying that countries aren't doing enough to stop the spread of this virus.
"The tenure of the World Health Organization's Director-General Tedros Adhanom Ghebreyesus has been marred by incompetence and deference to dictators. The coronavirus pandemic is far too serious to allow Dr. Ghebreyesus to continue in his post. The WHO should be led by someone else."
https://www.acsh.org/news/2020/03/02/coronavirus-who-director-general-t…
In NZ, it seems that the government thinks that COVID-19 also enjoy a break of a weekend last week.
Looking at events around country, AKL still held the around bay while Wgnt still had its event in New Town.
That is not a good sign.
And J Arden was absolutely wrong by saying COVID-19 is just like a flu!!!
I found this really confusing - the 'No new cases!' without the obvious thought that most medical centres would be closed Saturday/Sunday and few members of the general public would be being tested unless they went to an ED or already in a hospital setting. Taking this as an indication there is no increased community transmission is extremely, extremely questionable.
You only find it if you test for it, and NZ health system has been studiously avoiding testing unless could show a direct link to known or likely WuFlu infection. Without testing you don't start to see anything anomalous in an area until there are ~5-10 serious pneumonia cases - meaning 100 infected one or two weeks previous. This is most likely where NZ are right now.
What a load of BS!
If that was the case we would be seeing alot of old people all of a sudden becoming ill and dying like Italy.
More likely we are 2 weeks behind where Europe is right now.
You same argument could be had for the common flu and that has a death rate of 0.1% of cases Coronavirus has a 6% death rate of resolved cases
How do you think community spread can even happen, if people can't have it without getting sick and being diagnosed? The fact that people are even talking about community spread, implies that there are people who have never been tested but have had the virus. Otherwise contact tracing would work and there would be no issue.
点水之恩，涌泉相报。(the favor of a drop of water has been rewarded with the gratitude of a fountain of water).
NZ and many other was among the first ones that donated to China at the very early stage of COVID-19 breakout.
I am sure that if needed China will not only donate medicines to NZ but a suite of resources including testing strips, medical equipment, and doctors/experts/nurses.
After all, as President Xi said "We all live in a community with a shared future for mankind".
Correct....Stitch in time saves nine and NZ politicans/experts though aware are not takingit very seriously and will only wake up when it is too late.
"There are also puzzling questions as to why the death rates are so high in Italy, already at five percent of total cases with another 11 percent in intensive care"...may be China was not disclosing the actual number.
In next few weeks will know the extend of damage that virus can can do as numbers/data comming out of USA and Europe will help.
There is no puzzle! I've posted before that Italy is a huge international hub for sex trafficking and drugs. The mafia run most of it. They bring in females from Asia and Eastern Europe on the promise of a well-paid job waitressing or the like, and when in Italy they are distributed to the likes of the UK and Germany where they end up as sex slaves. Also drugs and drug ingredients are imported from Asia and distributed around Europe, although sex-trafficking is the most likely cause in this case.
And don't forget Italian Politics is the ultimate basket case......they have never had a stable, long-term government since the dictator Mussolini back in pre-WW2. Then there's the mafia!
This was on Uk channel 4, serious indeed.
https://www.zerohedge.com/health/most-frightening-disease-ive-ever-enco…
Yes, but I still don't think the world's virology experts are telling quite the whole story about why they are so concerned.
In simple terms I think of viruses as nature's AI. They have a circular characteristic: find a host, replicate, transmit and mutate - then rinse and repeat. That guy spoke of his concerns about the remarkable transmissibility of this novel virus but failed to go on to discuss its mutant properties. And it is this property that allows for rinse and repeat. So re-infection rates ought also to be reported on by all administrations.
I think that is why we had some reports of re-infection in China - something that happens when a virus mutates rapidly in a deleterious way.
And beyond that there is recombination - where two similar viruses in the same host exchange genetic material - and we end up with a whole new ball game.
I'm guessing the mutant strain in Italy and Iran is different than that in SK and Singapore if in the long run we end up seeing different mortality rates in different geographic areas.
The other thing that has occurred to me, is that it appears that COVID-19 (like SARS) finds its initial host in cilia cells in the upper respiratory tract - then replicates until the cilia cells slough off and fill the airways (lungs) with fluid and debris. Smoking, as I understand it, burns off cilia cells - and so I'm wondering whether the incidence of lethal complications from the virus is lower for smokers. I know it sounds ridiculous, but I reckon there is so much knowledge, or hunches, that virologists might have that just isn't being discussed.... yet.
yeah wake up time i think Jacinda..
Thousands of Chinese New Zealanders have asked the government to toughen restrictions aimed at controlling the Covid-19 outbreak.
More than 20 community groups signed a letter to the Prime Minister and the Health Minister.
They want travel bans expanded to include Italy and South Korea, all mass gatherings cancelled, and much stricter quarantines.
Barry Hung, president of the Pakuranga Chinese Association, which started the appeal, said the government was not paying enough attention to the virus.
The groups want all public events and mass gatherings to be stopped and are suggesting self-isolation needs to be broadened from diagnosed patients and their close contacts to anyone who may have had contact with them.
They are also asking for designated outpatient department facilities for all suspected coronavirus-related patients to prevent infection spreading to other patients and paramedics.
Among the groups supporting the letter are the Chinese Veterans Association of NZ, the New Zealand Overseas Chinese Association, the NZ Liaoning Provincial Association (and Chamber of Commerce) and the Blockhouse Bay Chinese Association.
https://www.rnz.co.nz/news/national/411260/covid-19-nz-must-ramp-up-con…
This narrative that China has successfully controlled COVID-19 is incredibly dangerous. If you look beyond the official reported case statistics there is limited and conflicting evidence for this.
It creates the idea that we can get rid if it if we try hard enough. Thus, we can more risks letting people into the country because if we get an outbreak we can shutdown for just 6 weeks and then return to BAU. As far as I'm concerned its too early to tell that if it becomes endemic in NZ we won't be on indefinite restrictions and lock-downs until we get a vaccine.
AT least Jacinda makes me feel good. Its just like the Flu. I am shocked at how clueless they are. Our politicians won't wake up until they start getting it. There is one good thing this about though and that is it should get rid of feel good politics and ideology for a while afterwards
Cindy's PR people have reduced her pandemic media exposure, with a colourless technocrat (read fall guy) now mainly fronting. They will have seen the poor public perception polls on her covid19 management, have worked out the coalition have already allowed the horse to bolt and that our health system will be quickly overwhelmed so have moved into brand Cindy damage control mode.
Population density plays a key role in an epidemic.
Italy: 216/km2; S.Korea: 503/km2; Mainland China: 145 /km2; New Zealand: 18/km2; Australia: 3.3/km2.
Obviously the population density itself doesn't draw a completed picture. Though Auckland's population density is close to that of Wuhan, Auckland feels much less crowded because of the primary residence and commute style is also different.
On that though, that's an average which is highly variable and doesn't reflect an entire day. A student going to university and using public transport to get there during Mad March is going encounter far higher population densities than the average.
I'm also not sure we have the discipline - if someone has symptoms, everyone in the household would in theory have to isolate, be they school kids, breadwinners, etc. China welded buildings shut. I know I'm guilty of showing up to work when I was too sick because I felt I had no choice, even when I got sent home for it. We aren't primed for this.
https://www.youtube.com/watch?v=hZm73FOl14U fast forward to 2.05. No need to panic!!
On its own? Very little. We've established people here are catching it off close contacts and so are people who haven't traveled. It is likely there is a degree of community spread. We are sort of locked into whatever happens from now on happening. The question is how soon will we get an idea of the extent of our domestic problem, and by the time we do, will we have any time to actively limit the consequences of it vs. just managing the consequences of it.
I mean what do we think the financial and geopolitical reactions might be? Would our dollar soar (I think so)? Would world leaders condemn NZ for such an action? I think not, given much larger populations are being quarantined the world over. I agree we have many, many more folks carrying the virus here that as yet we don't know about, but actions around the globe suggest isolation (prevention of spread) is the only sensible measure. Hence, I think we should isolate. It's so easy (and almost a no brainer) for an island nation.
Kate, yours is the best approach of all. Unfortunately it would have worked better two weeks ago than it might now. What the international response might be is an interesting conjecture to which we will probably never know the answer. Still, I am sure most Kiwis would rather be healthy and vilified than dead and well thought of.
The national GP shortage crisis (Aug 2019): https://www.noted.co.nz/health/health-health/gp-crisis-shortage-family-…
For whatever reason, Germany has more ICU beds (29.2 per 100,000 population) than any other country in Europe:
https://link.springer.com/article/10.1007%2Fs00134-012-2627-8
so that might help. On the same list, Italy scores 12.5. Best guess for NZ is 5:
http://www.stuff.co.nz/national/health/2837046/New-Zealand-poor-in-ICU-…
New Zealand also has lower healthcare expenditure per capita than quite a few other similar countries (and dissimilar ones).
The mantra is often that they "need to do more with less by increasing efficiency", but it seems like given the funding things are actually being done not too badly.
Sadly, here there are some so mesmerized by the beauty of the black swan they fail realize imminent reality of personal financial loss. Alas, the news is not all bad. There will soon be genuine bargains to be had. Real estate will be the last domino to fall. Nearly 0.5 million are here on temporary work permits. As the work runs out they will leave for home. As vacancy rates rise, competition amongst Landlords will ensue. Just think of all those adult kids who have no choice but to move in with their parents!
Yvil, as you previously commented, (do you still think) this Black Swan is beautiful?
As a country, we won't be able to out run this. 3 months ago, by sealing the borders maybe.Hindsight for you. There will be too many carriers with little or no symptoms. This in now pandemic all but in name. I also the believe the contracted mortality rate is too high and will drop down in time as the world takes stock of who has actually contracted it. Take influenza for example. By the time you rock up to the hospital with breathing complications, you're in a power of sh!t already, and have a much higher chance of not coming back out. Covid-19 will be similar. This has to be skewing the numbers. The age extremes will bear the brunt of this. Until a vaccine becomes available, I wonder if the consequential fallout from this will be the biggest killer - e.g. suicide, stress and misadventure from self isolation.
It can be stopped at any time by isolating everyone at home for a month and distributing essentials via deliveries. Anyone infected gets over it before they can pass it on to anyone else. Essential services get managed carefully to minimize contact and go through testing/isolation in shifts
Doubt everyone in world will self isolate. After a month and we reopen the boarders - boom! Off we go again.
Not everyone will cure themselves after a month either, as we're all not built equal. I'd also suspect this virus will mutate, as that's what they can do.
We're going to have to ride it out, with dramatic increases in medical resources, and hope for the best.
This is a parody account, not up for humour, look away.
https://mobile.twitter.com/TitaniaMcGrath/status/1232675707924439046
Have people forgotten that a virus is a living entity?
As a vegan and humanitarian, I welcome all refugees of any species.
And yes, that includes the coronavirus.
https://www.amazon.com/Woke-Social-Justice-Titania-McGrath/dp/1472130847
Keith, which individual NZder, past or present, would you pick to lead NZ in an extreme crisis?
I would pick Sir Keith Park who more or less led the Royal Air force to victory in WW2's Battle of Britain and of whom Winston Churchill said of him and his pilots: "Never in the field of human conflict has so much been owed by so many to so few".
"https://www.google.com/search?q=sir+keith+Park+wiki&rlz=1C1CHBD_enNZ867…
I would also pick Sir Michael Cullen as his right -hand man.
The response to COVID 19 seems to reflect an unrealistic expectation of immortality. The cats out of the bag, we won’t contain COVID. On the plus side, there are more cases out there than have been recorded, but all the deaths are so the death rate is less than 1-2% across all ages, and it’s great it’s about 0% for under age s. It’s 5-10 in my age group and I’m travelling next month. But my immune system won’t be compromised by stress. Keep calm and carry on.
Disagree. All down to human error:
The cats are out of the bag because Chinese local Wuhan health officials were basically too scared to notify their autocratic upper echelons because they feared for their jobs. And they didn't listen to the young doctors who saw it coming early on.
And New Zealand has got cases because our Government dithered for a couple of weeks and didn't act decisively soon enough.
After we have come to grips with the health aspects of Covid 19 the next thing will be the economic impacts. It is becoming increasingly obvious that the only industry still firing is farming. For the foreseeable future it will provide our only reliable source of export income. Business continuity grants and the like are only funny money - the nation needs a continuing supply of real money, especially as the putative darlings of the loopy left, trees and tourism are both tanking bigtime. Timber may make a comeback, but tourism, if not already dead is probably mortally wounded. The question is, what value can farming extract from this situation? I would suggest that a good start would be to tell the government that we need the National Policy Statements on Fresh Water and Indigenous Biodiversity off the table for at least the duration of the crisis, and that the timeline for methane reduction be pushed back so as not to start until the crisis is considered over.
1918 influenza lasted approx 2months and estimated deaths were 9000. ODT back then published: The influenza which is prevalent here is, however, not of the severe type that is epidemic in Auckland and to a less extent in Wellington and other cities, and it is probable that the climatic conditions in Otago will furnish the community with a measure of protection against the disease," the ODT reported on November 9 — five days after the first influenza death in Dunedin.
Any lessons to learn from history here?
https://www.odt.co.nz/news/dunedin/health/pandemic%E2%80%99s-terrible-t…
Keith, during my younger years.. I often travel to Singapore with the whole family.
Do you know the size of that little nation? - well google it, understand how many tropical Covid19 outbreak, then join the two and two together, NZ be very well prepare please.. we're going into cold seasons.
I believe the border needed to be closed as soon as reports of the coronavirus was growing. Isn't it better to sacrifice a few to save many. Yet people are being allowed to enter. As a small country we have the means to survive. Panic and stressed people are selfish towards the vulnerable. Panic buying toilet paper of all things. Vanity?? Humans have survived for centuries without toilet paper. Super Bug? Mutation of the flu? Bred in a petrie dish in a Lab? Somebody out in the world knows exactly where this came from. Another form of Terrorism seems to me to be highly likely.
If it's going to go parabolic in Australia then it will happen here. We will just be a week or two behind them. Australia like NZ, weren't testing, even in hospital, unless you met the strict criteria that were in place last month of having visited Wuhan etc, on top of the symptoms. Now they and the UK are testing anyone presenting with respiratory issues and temperatures. I would suggest most early cases weren't diagnosed. It is too late to close the borders as the virus is often asymptomatic, and the incubation time can be weeks. I think the elderly and other immuno-compromised people should self isolate now. Looking at the statistics from Italy, elderly men in particular are very vulnerable to the virus, and our health system will be completely overwhelmed if the virus spreads suddenly like it did there.
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