On February 28, the news emerged of New Zealand’s first case of Covid-19. For Michael Baker, a government advisor and epidemiologist at the University of Otago in Wellington, the following weeks would be a time of extreme anxiety.
While New Zealand is now regarded as a global success story in containing the coronavirus – as of May 7 it has reported just 1,489 cases and 21 deaths amongst a population of five million – this did not always appear such a likely outcome. Indeed, scientists believe that without the right strategies being swiftly implemented at crucial times, the country could have experienced more than 1,000 cases a day, overwhelming its fragile healthcare network.
When the news arrived that Covid-19 had reached New Zealand’s shores, Baker had already been monitoring the seemingly inexorable global progression of the pandemic since early January. He was well aware of the devastation wreaked by the virus in Wuhan, and grim reports were already filtering through of the worsening outbreak in Italy. While New Zealand’s relative geographical isolation had provided some protection thus far, he knew how swiftly the tide could turn.
“It was the most intense period of my working life,” he says. “The distant drumbeat was getting louder and I felt we were on a knife edge in terms of what would happen.”
A member of the Ministry of Health’s technical advisory group, Baker had read the report of the World Health Organisation’s joint mission to China at the end of February. “It showed that the Chinese had done the almost impossible, they’d stopped a pandemic in full flight which was remarkable,” he says. “This showed that it was containable.”
Inspired by this, and reports from fellow island nations such as Taiwan who had also managed to contain the outbreak, he realised that if New Zealand acted swiftly and strongly, it could prevent a disaster before it had even begun. He started calling for an approach to eliminate, rather than merely suppress the virus.
At that point – like most other countries – New Zealand was applying the same action plans for Covid-19 as with a bout of pandemic influenza, steadily ramping up their response as the pandemic progressed to try and mitigate it and flatten the curve. But while the rate at which influenza is transmitted means it is nigh impossible to stop, the data showed that Covid-19 was different.
“The fundamental difference is that the virus incubation period is longer for Covid-19,” said Baker. “For influenza, it’s one to three days depending on what strain, and with Covid-19 it’s about five days on average. This means that contact tracing and quarantining contacts really does work if you do it quickly enough.”
Epidemiologists began advising the government to change strategy and implement a preventative full lockdown. This involved completely shutting the borders, and enforcing a maximum containment policy where the entire population bar essential workers were required to stay at home unless for medical reasons or food supplies.
“We recommended going early and hard,” Baker says. “There are two advantages to that. First you prevent a lot of cases and deaths, and also if you control it early, there’s fewer chains of transmission that have to be stamped out and so your lockdown is likely to be for a shorter period of time.”
But not all policy makers in New Zealand agreed. Baker said that he initially felt like quite a lonely voice calling for these measures. However as March went on and the situation in Europe worsened, his argument gained increasing weight. “One of our main advantages was we had a little more time early in the pandemic to see what was happening internationally and respond accordingly,” says Ayesha Verrall, an infectious diseases researcher at the University of Otago. “We saw this toll of overwhelmed hospitals, and we knew we had fewer intensive care beds per capita than countries like the UK.”
By the final week of March, the country had 100 cases, but with increasing numbers of New Zealanders returning home from other parts of the world, the figure was starting to increase at a rate of 60-80 per day. On March 23, Prime Minister Jacinda Ardern took the decision to aim for elimination and announce a lockdown.
Verrall believes that one of the reasons why the government’s lockdown has proved successful is because of the transparency of the messages from late March onwards. A four-level Covid-19 alert system was designed – New Zealand moved to Level 4, the highest level – on March 26 with an emergency text messages sent to all citizens providing clear explanations of what this would entail. Ardern herself conducted Facebook Live sessions in which she explained why the government was taking these preventative steps and how long it would likely take to yield benefits.
One of the points Ardern repeatedly made was that the early lockdown would buy the government time to ramp up capabilities such as efficient testing and contact tracing systems which could be used to bring the outbreak under control and allow normal life to resume.
Doing this meant overcoming considerable challenges, including generating non-existent infrastructure in a matter of weeks. New Zealand’s healthcare system has traditionally been highly devolved with little national coordination, while over the past two decades its capacity has been increasingly scaled back through repeated cuts.
Yet over a period of just six weeks, the Ministry of Health created a centralised network which by the start of May was processing 8,000 tests per day, the highest per capita in the world. And while many countries simply gave up on trying to trace contacts as cases of Covid-19 spiralled, New Zealand implemented a sophisticated digital system called the National Contact Tracing Solution which integrated with existing health records to send automatic text messages to people suspected of coming in contact with the virus. This prevented call centre staff from becoming overwhelmed and enabled public health officials to track in real-time how swiftly contacts were being traced.
“In six weeks, they’ve set up this amazing system which will be available for infectious diseases outbreaks in the future,” said Verrall. “We’re still in the Covid-19 response phase, but they might use it in future for rolling out vaccination when it becomes available.”
On May 4, New Zealand recorded zero new cases of the coronavirus, its first day without any new infections since the country went into lockdown in March. The Covid-19 alert system is set to drop to Level 2, enabling social distancing precautions to begin to be relaxed, with increasing numbers of people allowed to return to work.
It is an impressive milestone although scientists caution that the virus has still not technically been eliminated, so it is important to avoid complacency. “One of the elements of elimination is having no new cases for two maximum incubation periods which is 28 days,” said Baker. “The big worry is that at the moment we’re just seeing the effects of several weeks of lockdown, and that there are still cases out there which will emerge. I think it’s very early to be fully comfortable about this and we would rather see the current precautions continue for another two weeks to be more certain that we have wiped it out.”
Baker is also advocating for a mass masking policy to be enforced for enclosed public spaces such as public transport and retail areas, to reduce the likelihood of further outbreaks. Like all countries who have come close to eliminating the virus, the biggest challenge for New Zealand will be maintaining this as they gradually open up to the rest of the globe, especially as a nation which depends heavily on tourism revenue. But with Australia having also made impressive progress towards elimination, plans are in place for a ‘trans-Tasman bubble’ which would allow travel between the two neighbours in the months to come.
For now, most New Zealanders are simply relieved they have avoided the kind of pandemic which so many other nations have experienced. “Of the cases we’ve had, our largest number per capita is actually in the most remote part of the south island, which just shows how easily the virus spreads,” said Verrall. “We could have had a really big outbreak if we hadn’t acted.”
Updated 12.05.2020: A previous version of the article stated that New Zealand hadn't recorded any coronavirus cases since May 4. This has been amended
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This article was originally published by WIRED UK
