It is critical to ensure our houses are in order with skilled staff and strong procedures, but the valuable ‘lessons learned’ from true-life emergency events are never that cut and dried, writes former public health worker Richard Simpson.

There are different breeds of emergency manager. At one extreme there are the Abraham Lincoln types who, given six hours to chop down a tree, would “spend the first four sharpening the axe”. Then there are the Mike Tyson types, who counter that “everyone has a plan until they are punched in the mouth”.

I recall one of the large emergency management conferences in Wellington which focused on “lessons learned” from the 2010 Darfield earthquake. The room was filled with decision-makers and movers-and-shakers from the government and emergency services. The high profile presenters were well prepared, professional and expert. They had great information about the unusual, sudden earthquake affecting Christchurch and the fortunate fact there were minimal casualties and no deaths.

Then we broke for lunch and, one by one, people’s cellphones began to chirp. The highest profile attendees started to huddle before disappearing out the door. The room began to get strangely subdued. Eventually, the breaking news reached those of us at the lower echelons and at some stage, a bright spark put a live stream on the conference projector. Because this particular conference happened to take place on February 22, 2011.

And this is where items like the Coordinated Incident Management System (CIMS) really shine. Before our eyes, we saw the “responsive, flexible and unified” Lego bricks of CIMS fit into place as we transitioned from conference schmoozing to the pressing needs of activating a national emergency. This is the value of the “all-emergency” element of emergency management, where a strong foundation builds resilience in many areas

Many conspiracy theorists make hay over the fact these kinds of conferences and exercises “conveniently happen” to take place near major disasters. Of course, we can’t predict earthquakes, but many 9/11 truthers will cry foul over how emergency services were already on-hand in readiness for a bioterrorism drill that was scheduled for September 12, 2001. The loony fringe is already foaming at their keyboards over Covid-19, pointing at recent pandemic warnings by Bill Gates and Anthony Fauci as “proof that they knew” a novel coronavirus would emerge in Wuhan in 2019.

Anyone in the industry will tell you this only demonstrates how frequently these drills and exercises are happening because they’re so valuable. After all, the US is in the middle of a heated debate about whether – and how much – the Trump administration ignored the Obama-era “pandemic playbook”, a document that says at the beginning that exercises are critical “to improve interoperability and real-time decision making”.

So how do you establish an exercise regime that covers off more than the how-to of standard operating procedures and equipment drills, but where the policy and political environment is unpredictable? And how do you do it for something as complex as a pandemic? For some countries, their “worst-case pandemic scenario” doesn’t just involve the human health impacts, but also the survival of political structures and possible civil unrest, not to mention the world economy which is already in ICU.

Preparedness isn’t just about people knowing how to treat a patient or how to use the backup servers. Even before you get into pressure testing or “red teaming” ways to make an exercise more challenging, people need to get comfortable with the scope of their roles. This involves having ownership of their main tasks, and knowing how their responsibilities interact with those in their own organisation and other agencies across the full span of command and control. This is the value of emergency management exercises and conferences. To discuss and test plans on a moving carpet, and always with an understanding that things will change once you eventually get punched in the mouth.

Emergency scenarios are critical for this because exercises are a safe space where people can learn and make mistakes at the outer fringes of their capabilities, not just demonstrate what they already know. The last thing you want is someone to be defensive about participating and arguing that “it wouldn’t really happen this way in real life”.

One option is to use a historical scenario as an initial template. At the very least, it means the overall timeline – as well as the technical and scientific details – can’t be disputed, even if the decisions and the social and political context may differ. But while a historical scenario can be useful, it can be a hard sell for practical-minded participants who may already be uncomfortable with the “play-acting” element of exercises.

Another option is to get this social and political context straight from the horse’s mouth. One of the benefits of the National Exercise Programme is to practice the strategic and operational levels of a major emergency in alignment, so those at the regional and local level know the context they’ll be working in. To borrow a US analogy, the type of response that regional and frontline staff are directed to mount within a Trump-era or Obama-era context may be wildly different.  It makes the job of the emergency planning team a lot more comfortable if they left this debate to the actual decision-makers, rather than risk an educated guess about what the higher-ups are likely to do.

But people don’t like to make mistakes in public. People don’t like to appear that they don’t know what they’re doing. These issues are multiplied when people know their performance will be scrutinised by those at higher levels, or that their decisions will be filtered down to the lower rungs in a hierarchy, especially when more than one agency is in the room. This is when you risk the exercise going off-track by upper echelon decisions messing with the exercise with “key performance indicators”. How do you achieve your aim of testing policing methods during lockdown if the higher-ups agree they already did a spectacular job of stopping the pandemic in its tracks?

The natural inclination is to reduce the exercise scope. Are you testing a response to a remote train crash from a collapsed bridge? Well, simply create some kind of fictional timeline that results in this being an issue, and practice specific tasks only within this context. But this reductionist approach often means that exercises stay within the scope of the tried-and-tested in a necessarily artificial setting. In other words, it simply becomes a complicated simulation drill of standard operating procedures. Important, yes, but not necessarily enlightening.

The “sharpening the axe” element of Covid-19 continues to reveal the fact that while it’s critical to ensure our houses are in order with skilled staff and strong procedures, the valuable “lessons learned” from true-life emergency events are never that cut and dried. The current debate over privacy, metadata and tracking apps are an example of upper echelons becoming more hands-on for the operational side of an emergency, but more importantly, it shows the kind of true innovation and change that usually comes from the fringes.

The unexpected connections and the “non-status-quo” rise and shine during a real event, whether it’s the Student Army during the Canterbury Earthquakes, Takahanga marae during the Kaikōura earthquakes, or the national IT groups offering their services to support Covid-19 contact tracing. These groups would arguably either have no seat at the table during a reductionist, status-quo simulation exercise, or their true value (and the consequences) of their involvement would likely not have been explored in-depth, even if they had been.

Despite some pushback from traditionalists, game-based exercises are slowly becoming mainstream, like the approach championed by the PAXsims group. And whether it’s a modified board game or a matrix-style discussion exercise, simple and open-format exercises give a good opportunity to practice decision-making on the fly. These are great for agencies or interagency groups without the budget or organisational backing for a functional or Exercise Tangaroa-scale scenario. Game-based discussions surf the middle ground between the practicality of a complicated, military-style “counters-whiteboard-and-stopwatch” simulation drill, and the ordered chaos of a facilitated “tabletop discussion”.

Simple, rapid, game-based discussions allow participants at all levels to fail early and fail often, in order to get over the stigma of making mistakes. A discussion-based approach also lets players suggest unexpected or off-the-wall solutions to tricky problems. In other words, it represents what will really happen, rather than what we expect or want to happen. These games, as opposed to simulations, do not allow participants to delve into the finer points of their specialist roles, but this can be a good thing. This type of detail is, after all, often an unwelcome interruption during exercises when there are a wide range of specialities and agency interests around the table.

In October 2019, the Johns Hopkins Center for Health Security and the Bill and Melinda Gates Foundation hosted a major pandemic exercise in New York, with a discussion-based format that “illustrated areas where public/private partnerships will be necessary during the response to a severe pandemic”. Reuters recently reported how a South Korean pandemic tabletop exercise helped that country prepare and mobilise quickly for the coronavirus response. One of the experts said the exercise “helped us save much time developing testing methodology and identifying cases.”

This is the true value of multi-level interagency planning and exercises. To create and test different methodologies, to suggest unusual partnerships and solutions, and to work through the huge range of possible actions. Actions that depend on the unexpected decisions filtering from those in the upper echelons who at any given moment may appear to be guiding the overall response either with the benefit of a broad, birds-eye perspective, or with their heads stuck in the clouds.

There is no magic, catch-all solution, but if everyone takes part with a curious and open-minded approach, that’s where real improvements are made.

The greatest of cities is rapidly becoming the most afflicted by the Covid-19 pandemic. Tess McClure, a New Zealand journalist based in New York, writes. 

March 12 – 95 cases in NYC

At the start of today – Thursday – we still thought we’d be going to work. The first emails had come through that week, discussing prep to possibly work from home: instructions to download Zoom, queries about transporting equipment. But it wouldn’t happen yet. I’d already thought through my rationale for coming into the office: I walk to work, I don’t spend an hour in the subway car breathing in other commuters’ fumes. I’m attentive to handwashing, to cleaning surfaces. There aren’t as many people in the office building now. Fewer than 100 cases have been detected in a city of 8.6 million. No-one has died. I haven’t had contact with any sick people.

But this evening, as I walk home, my flatmate texts to tell me he has a fever and a tickle in his throat.

I make the walk, trying to buy more supplies on the way, targeting small neighbourhood pharmacies because the big drugstore chains are already wiped out. I buy one store’s last roll of Clorox wipes, a bottle of bleach spray, and the last pack of disposable gloves at the back of a shelf. I walk home under the subway bridge of the 1 train, and the city that night is quieter than at any time I have ever seen it.

I walk into my apartment, place the supplies on the ground, wash my hands twice, walk to my room, sit on my bed, and don’t move for several hours. I consider the shared surfaces of my house: doorknob, tap, kitchen bench, chopping board, lightswitch, towels. My apartment building – an enormous Blade Runner-vibe tower block – has units for more than 1,100 families. Some are multigenerational, many are living more than five to a unit. All of us share the same corridors, the same washers and dryers, the same recycling bins, the same rubbish chutes, the same elevator buttons and door handles. I make plans to stay at a friend’s apartment. The next day, I do not go in to the office.

March 14 – 296 cases, one death

On Saturday, people start dying. The first death in the city is an 82-year-old woman.

A week earlier, I had taken the subway downtown to a gathering held in the stark-lit basement of a city building. It gives support to people seeking asylum in the US or attempting to find relief and moral support with the brutal mechanics of deportation and detention. It calls people who come through the door “friends”, not clients or customers. That night, a friend sat for three hours at the table I was assigned to, painstakingly filling out an asylum form. They had little time left before the court date. Slowly, they answered brief questions, blunted by the language barrier: “Gunshots? How many? Women or children, or women and children? How many? Estimate?” The night had ended with the asylum form half completed.

On Saturday, an email announced the clinic was cancelled and would attempt to move online. I wondered what would happen to this friend. I googled ICE court appearances and saw they were going ahead. I tried to think about every person in New York without a computer and without a buffer of time, financial resource, insurance, citizenship, or government sympathy to carry them through this. How many in this city alone – 500,000? Maybe a million, maybe two.

March 15 (700 cases, 3 deaths) to March 23 (10,764 cases, 99 deaths)

This week, they announce all restaurants and bars will close. The city’s streets start emptying out. But spring break begins, and the party rolls on into Miami, through Florida. “If I get corona, I get corona! At the end of the day, I’m not gonna let it stop me from partying,” a ruddy-cheeked teenager scoffs to camera. The Florida partiers set off a wave of condemnation for the risk they pose to their communities, their parents, and their grandparents – we still thought at the start of the week that young people weren’t at risk.

But on Wednesday, the New York Times releases a report that young people are getting sick, making up 40% of those hospitalised. In news feeds, there are more and more accounts of young people dying: a Brooklyn school principal. A teenager from California. Two young doctors. I try to break the habit of scrolling down looking for sentences about pre-existing conditions. Often enough, they don’t seem to have any.

My flatmate’s fever continues, and I look for empty apartments from friends who have left the city to house-sit. On Sunday night, New York Governor Andrew Cuomo tells us all to stay home. The next day, the city’s death toll ticks over to 99.

March 24 – 12,000 cases, 192 deaths

Over chat and Zoom, we talk incessantly about testing. Why aren’t they testing? How do you get a test if you’re sick? Everyone knows someone who knows someone with the symptoms – the fever, the cough, the tight chest – who can’t get a test. The state is still only testing people who require hospitalisation. I have a recurring anxiety dream about walking up a lushly grassed hill that becomes steeper and steeper until I suddenly realise it’s too steep – unclimbable. My sneakers start to slide over the flattened grass, scrabbling for purchase. Occasionally, I tip backwards and start to fall.

Governor Cuomo holds one of his daily press conferences. “We haven’t flattened the curve and the curve is actually increasing,” he says. I look up a graph of the US trajectory of cases. The line arcs up, almost vertical now, cases doubling every few days. No sign of a slowdown, of suddenly returning to a gentler, surmountable incline.

March 31 – 41,771 cases, 1,096 deaths

I get an email that two people from the immigration clinic have died. Most of the city has paused, but the more brutal institutions plough on. There is no cessation of many immigration courts. Asylum seekers in camps remain there. Prisoners stay in their blocks. They start digging graves and manufacturing hand sanitiser for the outside, while the virus moves quickly from cell to cell. Tomorrow, with millions of people already out of work, rent will be due.

April 2 – 52,000 cases, 1,562 deaths

A video circulates on social media and I watch it three times. A man is filming on his phone, out the car window, outside Brooklyn hospital. “This is for real y’all,” he repeats over and over again, “This is for real.” The phone shakes in his hands, as he watches staff using a pallet-stacker to load bodies into a refrigerated truck. “This is for real. please stay home, y’all, please. This is for real,” his voice starts to crack. “Please take this seriously. Please stay home.”

The day before yesterday, President Trump held a press conference. He stood in front of a large slide, titled “goals of community mitigation”. The slide showed the two, now-ubiquitous curves of intervention and non-intervention. In smaller script, by the flattened curve, it read “100-240,000”. Up to 200,000 may die if America followed containment measures “almost perfectly”, said Dr Deborah Birx, the White House coronavirus coordinator. She said many states had yet to put strict stay-at-home measures in place; 240,000 is death on an unimaginable scale – it’s the city of Wellington. It’s every student at a state secondary school in Aotearoa. It’s more than the population of Samoa.

April 2-6 – 57,159 cases, 1,867 deaths

In a quarantined apartment, most of the work is getting through the boredom, loneliness and anxiety – I know I’m insufferably lucky that those are my primary challenges.

Inside, life is mundane, uneventful, and utterly domestic. Outside, just out of sight, the catastrophe rolls on. The dissonance deepens the longer I remain indoors – the enormity of events outside, the smallness of events inside.

It is like trying to make your brain exist in two places at once. The Times reports that some hospital morgues are filling. They start to park refrigerated trucks outside to hold the bodies. When I hear this, I walk a circle around the apartment and stop to press my thumb into the soil of a potted plant to check if it’s overwatered. Some hospitals are reaching capacity now and you see on TV sick people lining up outside for hours. At home, I make another cup of tea. While I adjust my laptop angle for another Zoom meeting, a colleague says a temporary morgue has been constructed on his block. In Texas, an official argues to reopen the shops, to embrace the spread, and allow over-70s to fend for themselves. Last week, Trump announced he wanted the country’s restrictions lifted for Easter so the economy can recover. Podcast hosts start to debate how many lives – hundreds of thousands? Millions? – are worth sacrificing to keep the US economy rolling. I open Youtube to Yoga with Adriene and spread a mat in the space beside the coffee table.

It is difficult to continue to take in what is happening when so little of it is immediately visible and so little meaningful action is available in response. I listen to an interview on the New Yorker Radio Hour where behavioural economist and psychologist Daniel Kahnemann – author of Thinking: Fast and Slow – describes his own hemming and hawing about whether to take a trip to Paris, even as the death toll mounted and the trajectory of the virus became predictable. Even with the facts in mind, he couldn’t quite grasp what was approaching. An epidemic, with its exponential growth, is “beyond intuitive human comprehension”. He says the challenge is getting people “to behave in a way that is appropriate to a state of fear when they’re not experiencing fear”. Maybe this best describes life inside: behaviour appropriate to fear made strange by the appearance of normalcy, the lack of visible terrors.

For now, I tell myself that much of the task has to do with the small things: endless hand washing, wiping doorknobs, overtipping food workers, resisting the temptation to take an extra pack of toilet paper, stepping into the gutter to keep a six-foot (approximately two-metre) radius from the person on the footpath. I start to think that even to militantly maintain these small things may be hard. It’s hard to resist carelessness, especially as time rolls on, and the crisis isn’t visible inside the small, tightening radius of my current life.

Perhaps it will be harder still in New Zealand, where competent government and strictly-enforced lockdown have hope of keeping the cases and the death toll low. When I read the New Zealand news, I start to see op-eds speculating that it might all be an overreaction. Columnists have begun to worry: don’t use a hammer to crush a flea, they write. My persistent, internal feeling, as I tend pot plants and watch the death toll rise, is of underreaction: feeling like a flea, skittering in place, wishing for some force and weight to wield. Like Kahneman, I think it’s hard to comprehend that the worst might come to you, even as you watch it topple other countries.

A few weeks ago, I read an op-ed by an Italian journalist who had a warning the US. “We thought a few local lockdowns, cancelling public gatherings, and warmly encouraging working from home would be enough to stop the spread of the virus,” he wrote. “We now know that wasn’t nearly enough.” I thought: that sounds like what we’re doing.

Sometime between April 6-7

Things show little sign of slowing. Governor Cuomo has announced that the peak in cases will not come until the end of April. Hospitals are inching closer to full capacity. Health workers have begun to die. Supermarket workers have begun to die. Train workers have begun to die.

New York quickly became the epicentre of the virus in the United States, which now has the worst outbreak in the world. As is often the case with American suffering, black and native communities across the country are meted out the worst of it.

April 7 – 76,876 cases, 5,489 deaths

The streets aren’t dead quiet, but they’re quieter than ever. When I first moved to this neighbourhood, it took time to learn to sleep and work through the constant noise of the city: 2am fights, taxi drivers leaning on the horn, jackhammers a block away, bottles smashing, prayers at the mosque next door, the man who used to set up his speaker-on-wheels and deckchair and play The Miseducation of Lauryn Hill outside my window. I remember actively listening to it some nights and thinking: it’s not just the crashing and yelling of this street, it’s the next block, and the next block, and beyond that whole city’s cumulative rumble.

Now, there’s not much of that. You hear more birds, which is nice. And you still hear sirens, maybe more than ever, wailing up and down Manhattan.

Last night I took a walk through Morningside Park, near dusk. At 7pm, I start to hear the noise growing, rumbling in from the distance, and then a woman starts slamming a pot till it rings like a bell on her balcony. A man whistles and yells “HELL YES” from an apartment roof, and it grows, the city collectively leaning out its apartment windows to holler and clap for frontline workers. It’s good to hear it again, not just the shouts nearby, but the blending of thousands of other people’s noise. After so much quiet, the clapping seems to fill up the hollow of the park and rebound off the schist, cresting the hill, maybe, and echoing all the way to Mt Sinai Hospital, up on the rise.