How NZ pulled off the unthinkable

 

As the coronavirus began its rapid spread around the world, public health authorities warned that eliminating it would be virtually impossible without a vaccine.

Modelling showed the highly contagious COVID-19 had the potential to infect 60 per cent of the world's population within one to two years if left unchecked.

With each person infected having the potential to pass the virus on to three others, it looked like any country dealing with the pandemic would have to live with it for the rest of 2020 - at least.

But a little more than three months on from recording its first case, New Zealand is now coronavirus-free after one of the world's most drastic battle plans.

"We are confident we have eliminated transmission of the virus in New Zealand," the country's Prime Minister Jacinda Ardern announced today, after revealing she "did a little dance" when she received the confirmation.

But she added an important caveat: "For now."

"Elimination is not a point in time," Ms Ardern said. "It is a sustained effort. We almost certainly will see cases here again. And I do want to say that again - we will almost certainly see cases here again.

"That is not a sign that we have failed. It is a reality of this virus. But if and when that occurs, we have to make sure, and we are, that we are prepared."

This is how New Zealand achieved the once-considered unachievable, and how the country hopes to stay COVID-free for the long haul.

FAST AND HARD STRATEGY

The first case of coronavirus in New Zealand was confirmed on February 28 and the government enacted its pandemic response plan.

Numbers quickly grew and although most infections were imported - people returning from overseas - there were a number of instances of community transmission.

Ms Ardern, her government and a team of medical experts faced a dilemma.

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New Zealand made a drastic decision to place the country in total lockdown for four weeks in a bid to stop coronavirus – and it worked. Picture: Getty Images
New Zealand made a drastic decision to place the country in total lockdown for four weeks in a bid to stop coronavirus – and it worked. Picture: Getty Images

 

New Zealand could follow a mitigation strategy that other nations had deployed or opt for something much more ambitious and extreme.

By mid-March, there was strong support for adopting an elimination strategy and a four-tier system was announced, with the country entering 'level two' on March 21.

This limited mass gatherings, promoted health and hygiene measures and encouraged people to practice social distancing.

But the infection modelling showed that New Zealand risked seeing a rapid increase in cases despite those precautions, with cases forecast to double every four to five days.

And so, on March 26, the country entered a total lockdown.

Schools were closed, all non-essential businesses were shuttered, people had to work from home, travel was restricted and social gatherings of any kind were banned.

The country also entirely shut its international border - an unprecedented step that Australia eventually mirrored.

Ms Ardern declared a national emergency, giving authorities new powers to enforce the strict control measures.

Kiwis essentially went inside their homes and didn't venture out again for four long weeks.

It was a bold strategy that represented the strongest response to the COVID-19 pandemic almost anywhere in the world.

And it was not without its controversy.

The drastic decision to place the entire country in total lockdown was not without controversy. Picture: Getty Images
The drastic decision to place the entire country in total lockdown was not without controversy. Picture: Getty Images

 

The economic hit was and continues to be significant and New Zealand, like Australia, has experienced a slump in growth, rising unemployment and myriad fiscal consequences that demanded swift and significant government spending.

But when restrictions began to ease - first on April 27 with the end of full lockdown and again on May 13 with the move to level two - there were signs that the sacrifice was paying off.

Today, two leading epidemiologists who consulted on New Zealand's plan, Dr Michael Baker and Dr Nick Wilson, professors of public health at the University of Otago, said the short-term pain had delivered enormous gain.

On Monday night, New Zealand will step down to level one, bringing an end to all restrictions related to the pandemic.

"This is an important milestone and a time to celebrate," Dr Baker and Dr Wilson write in an article for The Conversation.

"But as we continue to rebuild the economy, there are several challenges ahead if New Zealand wants to retain its COVID-19-free status while the pandemic continues elsewhere."

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A jubilant Jacinda Ardern today announcing New Zealand is free for coronavirus. Picture: Getty Images
A jubilant Jacinda Ardern today announcing New Zealand is free for coronavirus. Picture: Getty Images

 

BATTLE WON, WAR NOT OVER

As Ms Ardern alluded to today, the move to level one heralds a success that should be celebrated and a return to life that resembles what it did just a few months ago.

But New Zealand will need to embrace a new normal that will linger for quite some time yet - and a big one relates to travel.

"If we do get further outbreaks of COVID-19, the most likely source will be new infections being introduced into the country as we open up the borders," Dr Amanda Kvalsvig, senior research fellow at the University of Otago, said.

New Zealand and Australia are in the process of negotiating a so-called 'travel bubble', allowing the movement of tourists between the two countries.

The timing is yet to be finalised and Ms Ardern has signalled she wants to see a further reduction in the number of new cases before the plan is enacted.

"We'll need strict border controls for a long time to come, but no control measure is 100% effective and we can't rely entirely on border measures to keep safe," Dr Kvalsvig warned.

While level one marks the end of restrictions across the ditch, Dr Kvalsvig said it would be critical for people to remain committed to basic infection control measures.

"Our new normal at level one will still include meticulous handwashing and cough etiquette, staying home if feeling unwell, testing and contact tracing."

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That might also include new measures not seen to date, Dr Kvalsvig said, with growing discussion about the use of non-medical face coverings.

"An obvious use for face coverings is on international flights to give additional border protection. Masks also have potential value on trains and buses and in other closed settings where physical distancing is difficult to achieve.

"GP waiting rooms are another example of that type of setting, perhaps especially there because people are unwell and there's a higher risk of someone in the room being infectious. How best to use face coverings in these situations is a conversation we should be having urgently as part of our preparation for a safe level one."

Dr Baker and Dr Wilson are two leading experts calling for the government to encourage the use of face masks by the general population.

"The evidence base for the effectiveness of even simple fabric face masks is now strong, according to a recent systematic review published in the Lancet.

"The World Health Organisation has also updated its guidelines to recommend that everyone wear fabric face masks in public areas where there is a risk of transmission.

"Establishing a culture of using face masks in specific settings in New Zealand will make it easier to expand their use if required in future outbreaks."

Life is slowly beginning to return to normal in New Zealand – but authorities warn it’ll be a ‘new normal’ that sticks around for a long time. Picture: Getty Images
Life is slowly beginning to return to normal in New Zealand – but authorities warn it’ll be a ‘new normal’ that sticks around for a long time. Picture: Getty Images

 

Other important steps New Zealand needs to take to maintain its COVID-free status include ramping up contact tracing capabilities and to establish a dedicated national public health agency.

"New Zealand has spent months expanding its capacities to eliminate COVID-19. But maintaining elimination will be challenging," Dr Baker and Dr Wilson wrote.

"Airports, seaports and quarantine facilities remain potential sites of transmission from overseas, particularly given the pressure to increase numbers of arrivals."

The arrival of colder months, when respiratory illness risk soars, and the return of indoor gatherings also pose challenges.

They added: "It is important to remind ourselves that active cases are not the ones we need to worry about. By definition, they have all been identified and placed in isolation and are very unlikely to infect others.

"The real target of elimination is to stop the unseen cases silently spreading in the community."

The big stumbling block to New Zealand’s continued elimination success is international travel. Picture: Getty Images
The big stumbling block to New Zealand’s continued elimination success is international travel. Picture: Getty Images

 

CAN AUSTRALIA FOLLOW SUIT?

Prime Minister Scott Morrison took the advice of the expert medical panel and consulted with National Cabinet to formulate Australia's COVID-19 response.

In short, Mr Morrison opted for containment rather than elimination.

Attempting to 'flatten the curve' became the strategy, with Australia working to test as many people as possible, isolate the infected immediately and quickly trace any of their contacts.

It was hoped that when the number of new cases was brought to a low enough level, it would be possible to begin easing the tough restrictions that were implemented.

It worked, and well ahead of schedule. But the approaches taken by Australia and New Zealand were different.

While a number of bans were placed on social gatherings and non-essential travel, large parts of Australia continued to function - including, often controversially, schooling.

Kiwis defined 'essential works' as those in healthcare, while Mr Morrison described the category as including "anyone with a job".

The outcomes for the two countries are different two, with Australia unlikely to totally eliminate coronavirus.

"We probably won't reach that stage where there are no cases in Australia, but we may get to a point where we have a really good handle on knowing where the virus is in the community and being able to manage it," Mr Morrison told SBS in May.

It's hoped that widespread testing and rapid contact tracing can help health authorities stay on top of any outbreaks that occur.

Originally published as NZ just pulled off the unthinkable

Schools across New Zealand closed for four weeks, seeing kids learn remotely from home. Picture: Getty Images
Schools across New Zealand closed for four weeks, seeing kids learn remotely from home. Picture: Getty Images


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