From time to time, until the crisis has passed, the HEPL blog series authors will be given the opportunity to provide short updates on their country/region’s continuing response to this worldwide catastrophe and their further reflections on those responses. Each update will be labelled accordingly with the original response at the bottom of each post.

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HEPL blog series: Country Responses to the Covid19 Pandemic

New Zealand’s response to the COVID-19 Pandemic: The August Update (2020)

Dr Jacqueline Cumming, Health Services Research and Policy Consultant

On 9 August 2020, New Zealand reached 100 days without a community case of Covid-19. All recent and current (23) cases have been people returning from overseas, who have been in managed isolation. New Zealand has recorded a total of 1,569 cases, with 22 deaths; there have been no deaths since 24 May 2020.

International Borders

Since 9 April 2020, all those arriving in New Zealand must be in managed isolation for 14 days; they are tested for Covid-19 on days 3 and 12 and must test negative before they can leave managed isolation. Those testing positive are shifted to quarantine. Most of those entering New Zealand are New Zealanders returning home, but there have been some exemptions (e.g. for humanitarian reasons, essential medical workers, film crews to support jobs in New Zealand). Since 26 March 2020, 35,695 people have been through the managed isolation process. Some returnees (e.g., those leaving New Zealand and returning within a short time) are now charged for isolation costs. There have been some issues, including a number of people who have tried to abscond.

New Zealand is close to reaching limits on how many people can be managed officially in safety (7,662) and is now working with airlines to limit the numbers of people returning home at any one point in time. Attention, however, is now turning to how to get skilled workers into the economy where they are needed.

Restrictions and Alert Levels

New Zealand entered Level 2 alert status (see https://covid19.govt.nz/assets/resources/tables/COVID-19-alert-levels-detailed.pdf) on 21 March 2020; Level 3 on 23 March 2020 and Level 4 (full lockdown) on 25 March 2020. It returned to Level 3 on 27 April 2020, and to Level 2 on 13 May 2020. It entered Level 1 on 8 June 2020. However, as the country came close to reaching 100 days with no community cases, and watched the recent rising numbers of cases and deaths in Melbourne, Australia, government officials and commentators began to suggest that it would only be a matter of time before cases appeared once more in the community. They advised New Zealanders to be ready to wear masks where physical distancing is less feasible, should the country re-enter Level 2; this advice is new for New Zealand.

Cases, Clusters and Deaths

By 9 August 2020, New Zealand had had a total of 1,569 cases, with 22 deaths, and 23 active cases. No people were in hospital with Covid-19.

Forty-one percent of cases came into New Zealand from overseas, and a further 29% of cases were linked to imported cases. Twenty-five percent of cases were locally acquired, with an epidemiological link to a locally acquired case with unknown source. Only 6% of cases were locally acquired with an unknown source (https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-current-situation/covid-19-current-cases).

Tracing and Testing

Testing criteria changed several times during the pandemic, particularly emphasising those with symptoms. In recent days, there has been some general community testing to determine if there are community cases or not. By 9 August 2020, 494,481 tests had been completed; around 84 tests per 1,000 people. A Covid-19 app is in place, requiring people to download the app and link to QR codes in community locations (e.g., cafes). However, the app is regarded as not being well used and tests are underway for a CovidCard that would automatically (via Bluetooth) enable contact tracing should someone in the community contract the virus.

Reflections on the New Zealand Response

As of 9 August 2020, the New Zealand ‘hard’ and ‘early’ response to Covid-19 has been a stunning success. New Zealand has succeeded in keeping the virus under control.

As noted in earlier briefs, daily updates, regular commentaries by a range of experts, a framework for the response and signalling of when key decisions on Alert levels would be made, have all assisted. Most New Zealanders have supported the approach, while mostly adhering to the rules. There is now greater clarity over the Alert levels and what they mean.

Some have argued that New Zealand has gone too hard, and that the economic cost to the nation – through lost tourism, international students, local business and jobs, and future mental health and other health concerns from putting off care – will be too high. However, the worsening situation in Melbourne, Australia, has bolstered the view that New Zealand has taken the right approach. It remains to be seen if this story is still the same in several months’ time.

New Zealand’s Response to the coronavirus pandemic – Original post (May 2020)

Dr Jacqueline Cumming, Independent Consultant

New Zealand’s response to Covid-19 has been described as ‘hard’ and ‘early’. The first case was reported on 28 February; a significant lockdown began on 25 March; the first death occurred on 29 March. By 8 May, there were only 1,490 confirmed or probable cases, and 21 deaths, for a population of 4.8 million, and New Zealand was cautiously coming out of lockdown.

International Borders

From 27 January, New Zealand officials began to introduce measures to combat the entry of the virus, including restricting flights and asking for 14-day self-isolation for those coming from certain countries. Travel restrictions ramped up from mid-March (at 6 cases), with cruise ships banned and the government asking all those returning to go into 14 days self-isolation. On 19 March, New Zealand closed its borders to non-New Zealanders. By 25 March, all those returning home were to be screened, and quarantined unless they could get home safely. Concerns over whether this was happening meant from 9 April all those arriving home were actively quarantined for 14 days.

Restrictions and Alert Levels

On 21 March (with 52 confirmed and 4 probable cases), the government asked New Zealanders who could, to work at home, and to limit travel. It asked those aged over 70 and with poorer health to stay home. It also announced an Alert Level framework, with four levels, level 1 the least restrictive. New Zealand was put on Alert Level 2: with physical distancing (1m), staying at home if possible, avoiding non-essential travel, and limits on indoor (100 people) and outdoor (500 people) gatherings.

Two days later, on 23 March (with a near doubling to 102 cases), New Zealand went to Alert level 3 – with people to stay and work at home, and schools and non-essential services to close. There was 48 hours’ notice of a move to Alert level 4, to last four weeks.

On 25 March (with 205 confirmed and probable cases), at 11.59 pm, New Zealand went into Alert level 4 lockdown. This meant: greater physical distancing (2m); staying at home with a small household bubble; staying local (e.g., for shopping, only at supermarkets and petrol stations, or for GP and pharmacy care); no public gatherings; closed public venues; closed education facilities; and essential items only (e.g., heaters, ovens etc) able to be purchased online from retail stores.

By April 16, there had been 1,401 cases and 9 deaths, but the number of new cases was below 30 each day.

On 20 April, the Prime Minister announced a move to Alert level 3 at 11.59pm, Monday 27 April. More businesses could open (e.g., construction) but with social distancing and hygiene requirements. Retail stores (including food outlets) could sell online only, with online payments, contactless pick-up or delivery. Those who could work at home were asked to stay at home. Schools (years 1-10) and early childhood centres could open only for those students who needed to be there (e.g., whose caregivers were back at work). Alert level 3 would be in place for 2 weeks.

On 7 May, the Prime Minister announced details on Alert level 2 – with a continued international travel ban, and requests for those who can, to continue to work at home. Educational facilities will reopen. Travel around New Zealand is to be allowed. Good hygiene and social distancing, along with contact tracing, will be the key tools to fight what remains of the virus.

A decision on whether and when New Zealand will move to Alert level 2 is to be announced on Monday, 11 May.

Cases, Clusters and Deaths

Thirty-eight percent of cases came about when New Zealanders were overseas, and a further 32% were related to those cases. Twenty-four percent have a clear link to a case with an unknown source, and 4% are labelled as ‘community transmission’, with no overseas travel and no link to an identified case. Nearly 40% of cases are in 16 clusters with 10 or more cases.

Those who have sadly died are all aged over 60: three aged 60-69; the rest over 70. Twelve deaths came from a single South Island rest home cluster; four other rest homes are among the 16 clusters. The Ombudsman is inspecting rest homes as a result.

Tracing and Testing

Testing originally focused on those who had travelled overseas or had close contact with someone who had tested positive or was a probable case. Testing ramped up in mid-March (by 23 March, 6,000 had been tested), then late April, as the criteria for testing were widened. By 7 May, 175,835 tests had been completed. Some targeted testing (e.g., at supermarket carparks) has taken place.

Contact tracing relied on capacity at 12 Public Health Units, which soon became stretched. Those units were later supported by a national contact tracing centre, which ramped up quickly but still faced issues in tracing all contacts. There has been work on a mobile phone response, but none has been recommended.

Capacity of the Health System

New Zealand identified 153 ICU beds, with the potential to repurpose to over 560 beds, and with sufficient staffing with elective services postponed. There was access to 520 ventilators.

Of persistent concern has been whether there is sufficient high quality personal protective equipment (PPE); who should be using it and when; whether it could be reused; and how it was distributed. The Ministry of Health argued there was enough, and that any issues were related to distribution. Nurses in hospitals, those working in rest homes, and personal caregivers were amongst those pointing to problems accessing or being allowed to use PPE.

Reflections on the New Zealand Response

New Zealand went hard and early in its response to Covid-19. Its distance from main population centres, ease of closing borders as an island nation, and low population density have supported the response. As at 8 May, New Zealand has succeeded in keeping the virus under control.

Daily updates, regular commentaries by a range of experts, a framework for the response and signalling of when key decisions on Alert levels would be made, have all assisted. Most New Zealanders have supported the approach, while mostly adhering to the rules.

There will be questions to come, however – it is possible that New Zealand might have had fewer cases if we had quarantined those returning home earlier; there is concern over having so many cases and deaths in rest homes; there is a clear need to better support public health units locally and nationally; and the situation with PPE needs to be far clearer than it has been, with agreement on future policies and practices that can be consistently applied throughout New Zealand, and agreed with key professional unions and staff representatives. At each Alert level, there has been some uncertainty over the exact rules to be applied in different sectors (e.g., construction, retail) but these appear to be being clarified quite quickly.

Some argue that New Zealand has gone too hard, and that the economic cost to the nation – through lost tourism, international students, local business and jobs, and future mental health and other health concerns from putting off care – will be too high.

A thorough review of our response, and policies to be ready next time, will be key to a safe and healthy future.

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