179 CMAAO CORONA FACTS and MYTH New Zealand Eliminates
Dr K Aggarwal
With inputs from Dr Monica Vasudev
1045: Successful Elimination of Covid-19 Transmission in New Zealand
NEJM Excerpts: Despite New Zealand’s geographic isolation, introduction of SARS-CoV-2 was imminent because of the large numbers of tourists and students who arrive in the country each summer, predominantly from Europe and mainland China.
New Zealand began implementing its pandemic influenza plan in earnest in February, which included preparing hospitals for an influx of patients. It also began instituting border-control policies to delay the pandemic’s arrival.
SARS-CoV-2 was behaving more like severe acute respiratory syndrome (SARS) than like influenza, which suggested that containment was possible.
By mid-March, it was clear that community transmission was occurring in New Zealand and that the country didn’t have sufficient testing and contact-tracing capacity to contain the virus.
Informed by strong, science-based advocacy, national leaders decisively switched from a mitigation strategy to an elimination strategy.
The government implemented a stringent countrywide lockdown (designated Alert Level 4) on March 26. After 5 weeks, and with the number of new cases declining rapidly, New Zealand moved to Alert Level 3 for an additional 2 weeks, resulting in a total of 7 weeks of what was essentially a national stay-at-home order.
In early May, the last known Covid-19 case was identified in the community and the person was placed in isolation, which marked the end of identified community spread. On June 8, the government announced a move to Alert Level 1, thereby effectively declaring the pandemic over in New Zealand, 103 days after the first identified case.
New Zealand is now in the post-elimination stage. The only cases identified in the country are among international travellers, all of whom are kept in government-managed quarantine or isolation for 14 days after arrival so they don’t compromise the country’s elimination status.
New Zealand remains vulnerable to future outbreaks arising from failures of border-control and quarantine or isolation policies. Most jurisdictions pursuing containment (including mainland China, Hong Kong, Singapore, South Korea, and Australia) have experienced such setbacks and have responded with rapid reescalation of control measures.
New Zealand needs to plan to respond to resurgences with a range of control measures, including mass masking, which hasn’t been part of the response to date.
New Zealand’s total case count (1569) and deaths (22) have remained low, and its Covid-related mortality (4 per 1 million) is the lowest among the 37 Organization for Economic Cooperation and Development countries.
Public life has returned to near normal. Many parts of the domestic economy are now operating at pre-Covid levels. Planning is under way for cautious relaxing of some border-control policies that may permit quarantine-free travel from jurisdictions that have eliminated Covid-19 or that never had cases (e.g., some Pacific Islands).
The lockdown and consequent deferral of routine health care have undoubtedly had negative health effects, although total national weekly deaths declined during the lockdown.
To mitigate adverse economic effects, the government instituted a spending program to support businesses and supplement the incomes of employees who lost their jobs or whose jobs were threatened.
There are several lessons from New Zealand’s pandemic response.
1. Rapid, science-based risk assessment linked to early, decisive government action
2. Implementing interventions at various levels (border-control measures, community-transmission control measures, and case-based control measures)
3. Prime Minister Jacinda Ardern empathic leadership and effectively communicated key messages to the public
4. Framing combating the pandemic as the work of a unified “team of 5 million” — which resulted in high public confidence and adherence to a suite of relatively burdensome pandemic-control measures.