How New Zealand Eliminated Covid-19
A return of the virus is inevitable but it takes nothing away from the efforts of this tiny island nation
New Zealand reported its first case of Covid-19 on 28th February. Its last locally transmitted case was reported on Ist May. Prime Minister Jacinda Ardern announced, on June 9, that they are confident that they have eliminated the transmission of the virus in New Zealand for now. Yesterday (August 9) marked 100 days without local transmission of the novel coronavirus. How New Zealand succeeded in controlling the coronavirus where others could not? Short answer: By adopting a timely and determined, science-based approach. For details, let's dig in.
Elimination vs Mitigation
The strategy adopted by most countries of Europe and the Americas to counter the pandemic has been what can be called the ‘mitigation model’, where efforts are made, first to delay the arrival of the virus and then — once the virus starts spreading locally — to slow down its spread by imposing social restrictions of varying degrees. The aim is to expose as little people to the virus as possible at a time, otherwise known as ‘flattening the curve’. The severity of social restrictions correlates with the extent and speed of disease spread. They start, typically, from border control and travel restrictions and, as the infection spreads, closure of non-essential & entertainment services, and ultimately schools and workplaces follow. I will spare you the details since everyone, by now, is familiar with the mantra.
New Zealand chose a different approach. On 23rd March, a month after the first case was reported, New Zealand government decided to opt for an ‘elimination strategy’ rather than the mitigation one. The aim was not to suppress the local transmission of the virus but to completely abolish it. The strategy of mitigation is based on experience with the influenza pandemic of 1918. Due to their ease of transmission and a substantial proportion of difficult to identify asymptomatic carriers, respiratory viruses are considered improbable if not impossible to eliminate. New Zealand, however, had done their math. Based on early data from China and some other countries, model scenarios were plotted. One of these scenarios predicted approximately 14,400 deaths in New Zealand if they couldn’t contain the disease. Learning from experience in smaller south Asian countries including Hong Kong and South Korea, New Zealand authorities reasoned that Covid-19 was different than pandemic influenza and an elimination strategy was feasible. A strict lockdown was imposed in which all schools and non-essential services were closed, social gatherings banned and severe travel restrictions imposed. The timing was important too. New Zealand reacted early and imposed the lockdown when there were only 102 cases and zero deaths across the country. As opposed to the mitigation model where social restrictions are gradually ramped up in response to increasing infection rates, elimination hits hard from the get-go. New Zealand went into a ‘level 2 response’ on March 21 where social gatherings were restricted. The response level was escalated 2 days later to level 4 — a complete lockdown as it is commonly called.
Led by Science
New Zealand's response to the pandemic has been led by science rather than being influenced by business motives, religious authorities, or other pressure groups. Michael Baker, professor at the University of Otago’s department of public health, has been advising the New Zealand government on its response. While some doubted the plausibility of his elimination strategy, according to him, he thought there was overwhelming evidence that elimination could be achieved. Instead of banking on the premise of yet to be proven strategies like herd immunity and the unrealistic expectations of a soon-to-be-available vaccine, New Zealand authorities focused on the task at hand and invested in extensive contact tracing and testing. Both close and casual contacts of cases were traced and tested. In a country with a population of just about 5 million, 300,000 tests have been done between Jan 22 and June 13.
Building trust
Microbiologist and associate professor at the University of Auckland, Siouxsie Wiles believes one of the keys to New Zealand’s success is the way Covid-19 was framed to the public. Where on the other side of the equator, the message swung from one of false hope and personal whims to panic and finger-pointing, New Zealand government’s stance was more careful, science-based, and realistic which made it appear trustworthy to the public. As Siouxsie Wiles puts it:
“In other countries, people have been talking about war and battle, which puts people in a negative and fearful frame of mind. The official response here has been guided by the principle that you do not stigmatize and that we unite against Covid-19.”
New Zealand’s virus tally reached 1504 with 22 deaths at the start of May, and when no new cases were reported for nearly a month, restrictions were eased on June 9. The post-elimination course isn’t going to be smooth sailing though. International flights resumed after mid-June. The challenge in front of New Zealand now is to maintain this state of elimination and they are aware of this. While easing social restrictions on June 9, PM Jacinda Ardern had a message for her countrymen:
“This freedom from restrictions relies though heavily on the ongoing role that our border controls will play in keeping the virus out. The virus will be in our world for some time to come.”
Entry into New Zealand requires 14 days in quarantine or managed isolation and a negative Covid-19 test. Since the lifting of travel restrictions, 95 cases have been identified at the borders. Currently (10th August) 21 are in managed isolation. No community transmitted case has been reported in the last 100 days — a remarkable achievement, considering the global tally has increased from 3 million to 20 million in the same time period. Some would argue the relative geographic isolation of this tiny island nation helped it achieve this feat. Geopolitics might have played a role but there is no question that a determined, authentic and honest approach, one based on science and ground realities, helped New Zealand achieve what now seems impossible for the majority of the world.
With the virus still rampant across the world, its return to New Zealand seems only a matter of time. The fact, however, remains that in their success lies a lesson for the whole world and a glimpse of what could have been if the rest of us had responded differently!