any more information on yesterday's case in the community? they didn't even say where it was - you'd think it it was in AKL they would have said a case in AKL but they didn't ...

Seems it is really Auckland as its 'Auckland Public Health Service' , the press release is very terse.
They have apparently immediately got and tested all contacts, but they don't state how many where in Auckland or any places they may have visited.

All people who don't get out much.

https://www.health.govt.nz/news-media/media-releases/2-new-cases-covid-19-19

""
The source of the community case is still being investigated.
 
In the meantime, Auckland Regional Public Health Service has identified all close contacts, who have been isolated and tested.
""

With no press conference I suppose press ability to press the point is limited.

More hurry up and wait for more news.

Edit , Additional info.

Oh a clue here , in the list we see the top 2 cases are related to air travel.
So to be in community its either a returnee tested positive after release from isolation
or
Aircrew, or grooms that don't have to isolate.

Guess we shall see ...

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

ezbee:

 

...

 

Edit , Additional info.

 

Oh a clue here , in the list we see the top 2 cases are related to air travel.
So to be in community its either a returnee tested positive after release from isolation
or
Aircrew, or grooms that don't have to isolate.

 

Guess we shall see ...

 

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

 

Yes, not only that but it states "Male    40 to 49    Auckland    Yes" (overseas travel).  So overseas travel but not in "Managed isolation & quarantine" as per other overseas travel cases.

Also, a delay in reporting todays figures .. ?

New cases, two in community

19/09/2020     Female     30 to 39     Counties Manukau     No
19/09/2020     Male     10 to 14     Counties Manukau     No
19/09/2020     Male     20 to 29     Managed isolation & quarantine     Yes

Edit: my last post was accidentally deleted (by me) instead of being updated. But I think the question has now been answered regarding the community case linked to overseas travel. Someone went through managed isolation, tested negative and then tested positive a few days later.

alexx:

 

New cases, two in community

 

19/09/2020     Female     30 to 39     Counties Manukau     No
19/09/2020     Male     10 to 14     Counties Manukau     No
19/09/2020     Male     20 to 29     Managed isolation & quarantine     Yes

 

More today -quote

"

Reanalyse:

 

More today -quote

 

"

 

The two community cases are household contacts of the case reported yesterday, which is not connected to the Auckland cluster, the Ministry of Health says.   The case reported yesterday is a recent returnee who arrived in New Zealand from India on August 27 and completed managed isolation, returning two negative tests at the facility in Christchurch before returning home to Auckland on September 11, it says."     Real worry - overseas, in isolation for 14 days , two negative tests - leaves isolation and then goes positive and passes it on to family members So where now - longer isolation ? Home isolation for additional 14 days for returnees ?  

What about the possibility of a false negative prior to leaving isolation? I thought the 14 day isolation period was a well established time frame.

It appears that he had been back in Auckland for 5 days before developing symptoms.

https://www.rnz.co.nz/news/national/426509/covid-19-update-four-new-cases-two-community-and-two-imported

Otherwise they would need to tracing everyone that this person might have been in contact with since leaving MIQ in Christchurch and testing positive in Auckland.

I'm not sure if it's practical to keep everyone for another week, but I hope they are all briefed with instructions to self-isolate as much as possible and act as if they were in level 3/4 for as much as possible for the next week.

14 days with or without test has been adopted elsewhere, we are probably at top end of measures with 2 tests.
Certain people wanted to shorten this to 10 days or less, etc to get more open border.

Biological systems and variability, not nice and deterministic like simple mechanical systems. 

Seems this thing is really out to get us.

Review of tester training and techniques, how this was handled through the lab would be good to be sure.
Taiwan seem to have not had this type of breach with similar 14 Days, 
and probably greater numbers crossing their border, so very rare indeed ?

Statistics can be unkind 1/1000 year tsunami does not mean one may not arrive a few years into life of your nuclear power plant.

No details on locations in Auckland, other warnings, so they went home and stayed there for 5 days, interacted with no-one ? 
Reported symptoms Wednesday, so would have been out of circulation since then.
Good on them for reporting this not assuming , two tests must be clear.
Very lucky, it was not a family of social butterflies.

Good news, its not common, indeed very very rare given the large numbers who have gone through system.

they should be given a medal for being responsible and reporting even having had 2 negative tests. wow. i was wondering how many had left isolation after 2 neg tests .... and .... ok i'm going to stop wondering it's not healthy.

Full Media release from Ministry of health here:

https://www.health.govt.nz/news-media/media-releases/4-new-cases-covid-19-2

Key bit is as follows:

The source of the case’s infection is still under investigation, but genome sequencing is consistent with two confirmed cases from the same flight from India to New Zealand that landed on August 27.  

It is possible that this case was infected during that flight and has had an extremely long incubation period – there is evidence that in rare instances the incubation period can be up to 24 days. This person developed symptoms 21 days after he arrived in New Zealand.  If this is the case, it sits well outside the standard incubation period of the virus. 

The vast majority of people who are infected with COVID-19 will become unwell within 14 days. Having returnees stay in managed isolation for 14 days remains the gold standard, and this is also the approach adopted by other countries. Our own modelling confirms that 14 days spent in managed isolation with two tests leaves a very low risk that someone will leave managed isolation with COVID-19.

Another possible scenario is that the case may have been infected during the flight from Christchurch to Auckland – other passengers from that flight are currently being contacted and assessed as a precautionary measure in order to exclude them as the source of infection.

Emphasis mine.

What seems to be another obvious possibility is that it was passed within the managed isolation facility from one of the two people with the same strain from the same flight. I guess the odds of people from the same flight being at the same isolation facility is fairly high (especially given the limited number of facilities in Christchurch).

Perhaps the above was obvious to the ministry of health, but has been ruled out because they were in a different facility. 

Reanalyse:

 

So where now - longer isolation ? Home isolation for additional 14 days for returnees ? 

Hard to say. Extending managed isolation to say 28 days is going to have big issues:

• Halve our capacity to accept returning residents etc.
• Double the cost per person (from say $7k to say 14k)
• You would start to run into issues with people going crazy etc. A 28 day stay enforced in hotel would be brutal. 14 days is harsh enough.

With regards to home isolation for a subsequent 14 days, this could be viable, but would require an entire system for monitoring & enforcing those in home isolation to be set up. We would need to decide if it is acceptable to isolate in a home with flatmates etc.

We could also consider sticking with the 14 days, but requiring agreement to submit to a test at 21 & 28 days as a condition of release from managed isolation (at 14 days rather than 28 days). This is a similar approach to what we use for border workers. We don't require them isolate, but regular testing combined with contact tracing gives us a fighting chance to surround close contacts quickly of a positive test, potentially avoiding an outbreak.

Technofreak:

 

 

 

What about the possibility of a false negative prior to leaving isolation? I thought the 14 day isolation period was a well established time frame.

 

Old article, but it is fair to say that a false test is a reasonable possibility. https://www.biotechniques.com/covid-19/false-negatives-how-accurate-are-pcr-tests-for-covid-19/

That said, The point of the managed isolation time period is to allow symptoms to show. The person developing symptoms at day 21 is indicative of either a latter infection date, or a very long incubation period regardless of day 12 test result.

The 14 days isolation is often used overseas, and is backed by the WHO. That said, it is not hard to find examples where the incubation period has been longer.

https://www.businessinsider.com.au/wuhan-coronavirus-symptoms-24-days-after-infection-2020-2?r=US&IR=T

In many overseas locations, and in the absence of genomic sequencing, it is easy question examples of long incubation period, as there is a possibility the person was exposed more recently to the virus.

agree genomic sequencing would hopefully be able to shed some light if picked locally or in India or where-ever ...

wellygary: The “infected on the flight from Chc-Akl “ theory just throws up even more questions , such where that original infection came from... meaning that they got through isolation in CHc without returning a positive test ... so there are two (or more) potential clusters from the initial case

Also didn’t all those on the flights from India Require a negative test before departure ...

Yes they do have neg-to-fly

And it's still related to the news from Spet 8 and not clear, is the how did they get to chch (details on airline and stopovers etc). Aug 23 and Aug27 were some of the hottest figures arriving from india, seemingly via Multiple stopovers. As above often references to 'to new zealand'. But sometimes referred to 'to christchurch'

https://www.rnz.co.nz/news/national/425496/surge-in-positive-covid-19-cases-returning-to-nz-from-india 

But unless I'm going insane. We get about 4 internationals a week to chc. The rest are domestic. Fiji stopped flying around Mar 17. ANZ don't seem to?. Singapore didn't come in on those days. 23rd was a Sunday - even less movements. Emirates come in on 27th (a thur). And the only thing I can find online is tickets via AKL.

The mind ponders. Can't seem to download any daily historic stats easily

/edit I went all plane nerd. And only one I can find, was this. But it was direct, not via Fiji like was released. https://flightaware.com/live/flight/AIC1320/history/20200822/1410Z/VIDP/NZAA 

Scott3:

 

 

 

That said, The point of the managed isolation time period is to allow symptoms to show. The person developing symptoms at day 21 is indicative of either a latter infection date, or a very long incubation period regardless of day 12 test result.

The 14 days isolation is often used overseas, and is backed by the WHO. That said, it is not hard to find examples where the incubation period has been longer.

 

 

 

I would have thought that if that was the case, then there would be a belts and braces process to prevent these outlier cases getting into the community.  We don't know if the virus isn't changing and the incubation period could be extending on some strains for example. They claim that 14 days is 'Gold Standard', but I am not sure what standard they are referring to.  But I presume that 'Gold Standard'  is set by the WHO?.  We know that masks also help control the virus, well before the WHO started to recommended them, and the MOH didn't require them because the WHO didn't recommend them, until they did recommend them.

But we don't know that they didn't catch it while in MIQ. Apparently people in isolation can socialize while exercising while in MIQ (guessing physically distanced from one another), but they  would be sharing the same lifts as they move around the hotel, so I would have thought that it is possible that people could get infected while in a MIQ from others, prior to being detected as a positive case. Infact a hotel worker apparently did become infected from using a lift, after an infected person used it.  So imagine they breathed in the stale air from the lift containing the virus, or got it from a lift button? We also don't know that the second test this person took, was a false negative. These tests apparently are not extremely accurate, so they could have stated to develop the virus while in the hotel, but the test was wrong, and then it worsened. NZs first case shame up as negative for the first 2 tests, and it wasn't until the third, did it show up.

Glad they did the right thing and got tested, and also isolated while waiting for the test result..

Batman:

 

they should be given a medal for being responsible and reporting even having had 2 negative tests. wow. i was wondering how many had left isolation after 2 neg tests .... and .... ok i'm going to stop wondering it's not healthy.

 

The problem is that tests IMO are giving people  a false sense of security. It is the 14 day isolation that is supposed to be the key factor. The question is whether they caught it in MIQ, which means that the 14 days needed to be restarted. Or whether they are an outlier case, which IMO is more of a worry, as it may need us to change our processes. 

Patient number zero in the Auckland outbreak couldn't be found, and it is always  possible it could have been a similar type of case where someone developed the virus after leaving MIQ.