As yet unidentified masked hoodlum proudly posing with a freshly-defaced Dr Shane Reti election hoarding.

Product Review! 

 

doctor reti's patented border incontinence miracle cure!

Not a real product. Or a real review.

This is in response to this article/interview on Newshub; reproduced in part without permission... But... Something about fair comment or public interest or something... Also for the image to the left? Parody. Justifying blatantly stealing that as a joke. But otherwise this is serious. Aside from a naughty double entendre, and a joke about your mother.

1) Genomics re-testing

Re-test people for genomics within 24 hours of every positive case.

"Increasing the number tested would help us identify linkages and the heritage of the virus," Dr Reti says.

 

 

 

I agree. This is an excellent idea. 

Though I hope that, in most instances of individual positive tests, sampling and sample handling will have been of a standard that yields enough virons for genomic study anyway.

I am also uncertain about whether it is beneficial for every positive case. For example, cases where there is a clear link to a known case - such as cohabiting family members, testing positive days apart, with no links to the border. It seems unlikely that genomic data on samples from both will be of benefit; because these infections will almost certainly be from the same source, and thus identical.

 

2) COVID-19 test times

Require a negative COVID-19 test turn-around time of 48 hours.

"People have been using up all of their sick leave waiting days for negative results," Dr Reti states.

"It is important positive tests continue to be the priority and reported in 24 hours. But negative tests should be tightened up with a measurable target of 80 percent of negative tests reported in 48 hours."

I somewhat agree. Obviously, everybody wants to receive such test results as quickly as possible.

Though there may be a very good reason why some negative tests take a long time to be returned; the test procedure in use is ‘Real Time Polymerase Chain Reaction’; [long explanation about the history of PCR and how magic it is, and how RT testing is different to traditional PCR].

 

Meaning its results are interpreted as the test runs. 

The ‘Chain Reaction’ part of the name should hopefully edify the reader as to the exponentially expanding proclivities of the test itself. But anyway, such a test requires, theoretically, only one strand of viral RNA within a sample; to be amplified to the point of detection; to yield a positive test result… But one strand takes longer than if there were several thousand strands of viral RNA to begin with, because... Mathematics.

Additionally, RT-PCR is a testing methodology with extremely high specificity (there’s essentially zero false positives), but lower specificity (there are false negatives). 

The risk of rushing testing here is substantial - if rushed, it is possible that stressed/pressured lab workers will prematurely ejaculate* a false negative, telling a person who has C19 that they do not; when if the test were to run to completion, it may have detected the infection; this could be very bad… Due to the lower specificity of the test to begin with (there will always be some false negatives), minimising the number of false negatives we’re dealing with is important!

That said, I obviously agree that tests need to be processed as quickly as possible, without ever sacrificing the standards of testing.

*Legitimate use of this phrase.

3) Record decline tests

Require people who have been declined tests to be recorded in the National Contact Tracing Solution.

"It is important we have this information because we may have people who turn up for testing who've failed the case definition, but subsequently test positive. And if we know who they are then we can improve the case definition."

I agree… This *should* already be in any competent Doctor or Nurses’ notes anyway… If they’re declining any test, then the reason for doing so should be written down, if only to cover their own backsides...

But I also know that a lot of clinicians are abysmal at keeping notes.

That said, by now, there should be almost no legitimate reason for any person who wishes to be tested to have their request declined by a healthcare provider.

For the presumably very few legitimate exceptions to this, the reasons why a requested test could not be performed should be recorded centrally.

4) Compulsory managed isolation testing

Make day-three managed isolation testing compulsory.

"The sooner we identify positive cases who have crossed our border, the more effective and safe our response is," Dr Reti says.

I disagree. This is forcing a medical procedure onto someone. That violates the Bill of Rights. For NZ citizens, I disagree. However, any person who declines to be tested should be moved to a dedicated, separate facility. They should be required to stay there for a duration sufficient to ensure there is no possibility that they are a risk to others.

Any non-NZ citizen should be required to undergo the testing as mandated.

 

5) Improve app

Improve the COVID-19 app so that it can display information as well.

"Currently the app can pull location information from what is being scanned, but it would be more effective if it could also share user information," Dr Reti states.

"This would make the contact tracing system much more efficient and effective as people could be identified quickly."

There’s a lot of ways the Covid tracer app could be improved... Throwing that garbage into the sea and making a system that’s good would be a great place to start. 

 

Note on requiring returning citizens to be tested and disease-free before returning.

 


NO! DANGER! EXTREMELY DANGER! DO NOT WANT.

That’s just a really bad idea. Also, probably a really illegal idea... Just don’t even go there… Encouraging people to get tested, if they can, prior to travel is a good idea. Requiring it is a terrible idea.

For non-citizens, it’s a different matter - if/when we’re ready to readmit foreigners (aside from Winston Peter’s mates to build horse racing tracks), requiring these people to provide evidence of disease free status before returning is a no-brainer.

The big fat elephant in the room.

 

  1. Is your Mum.

 

  1. All of this is totally pointless if there isn’t a good quarantine system; like the one I proposed in early July...
     

  2. All of this is kind of pointless if there isn’t a practicable surveillance system within New Zealand… For example, one based around the testing methodology I proposed in ~late Feburary...

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Cerberus - New zealand - Est 2019

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