Luke Pilkinton-Ching, Prof Michael Baker, Prof Nick Wilson
In this photo-essay of the COVID-19 pandemic in Aotearoa/NZ, each photo is accompanied by a brief comment on the pandemic impact or response. In some instances these images reflect success factors such as the relatively early introduction of border controls and the stringent nature of the “lockdown”. But we also consider some weaknesses: the slow adoption of mandated mass mask use and the recent run of eight border control failures.
Figure 1: Decisive science-informed government action. The distinguishing feature of the NZ response to COVID-19 was that the Government listened to science input and changed direction from the mitigation approach of its pandemic influenza plan to an elimination strategy.1 The goal of eliminating COVID-19 transmission in the community has driven subsequent interventions to keep it out at the borders and stamp it out with a lockdown followed by high volume testing, tracing, quarantine of contacts and isolation of cases. NZ is the only OECD country with an explicit elimination strategy and has the lowest COVID-19 mortality amoung this group of 37 countries.2 (All photos by Luke Pilkinton-Ching, University of Otago Wellington; unless otherwise indicated.)
Figure 2: Border restrictions meant that incoming travellers have been largely restricted to returning NZ citizens and a few essential workers. Along with the stringent lockdown, tight border control has almost certainly been a critical success factor in NZ being able to successfully eliminate transmission of the SARS-CoV-2 pandemic virus in the community.
Figure 3: A new type of “rush hour”, with this photo of the main motorway into Wellington City during Alert Level 4, early May 2020. The very stringent nature of the lockdown (where travel was largely limited to just essential workers and supermarket shopping within local areas) was successfully used to achieve the elimination of community transmission. Indeed, the stringency of the control measures was the highest out of all high-income countries (peaking with a score of 96.3/100 but also dropping markedly in mid-May to 36.1/100; with the equivalent scores for Australia being 73.2/100 and 64.5/100).3 Nevertheless, better prepared jurisdictions, such as Taiwan were able to avoid a lockdown while still achieving elimination of community transmission.4
Figure 4: Physical distancing during Alert Level 3 (May 2020) also resulted in some unusual adaptive arrangements. The concept of confining social contacts to a “bubble” was an extremely successful one (it was pioneered by Dr Tristram Ingham of the University of Otago).5
Figure 5: Hygiene-related signage in Christchurch Airport (Level 1 August 2020; photo: Nick Wilson). This signage includes the themes of hand hygiene, cough etiquette, using the “NZ COVID Tracer App” and also “being kind”. But the lack of messaging around masks, given the likely importance of the inhalation route for this pandemic virus6 (and especially on aircraft), is a notable deficit with the Government’s messaging up to this time.
Figure 6: Sign for a COVID-19 testing station at a school in Wellington. New Zealanders have done very well with getting tested and this is a valuable approach for early outbreak detection.7 Nevertheless, the adoption of testing by NZ was still relatively slow compared to various countries in East Asia. For example, South Korean firms were already accredited to develop and sell test kits for COVID-19 with local production virtually ready when the first case arrived (and 140,000+ tests were done in South Korea before early March 2020).8
Figure 7: Swabbing for the pandemic virus (SARS-CoV-2), Wellington, May 2020. This process might be phased out when saliva-based tests become reliable enough and are adopted for use in NZ.
Figure 8: Mandated mask use began for the first time for the NZ public in response to the Auckland August outbreak (ie, for public transport at Alert Level 3 for Auckland, and Alert Level 2 for the rest of NZ). This was a very slow approach to requiring mass mask use by the NZ Government (ie, after many months of advocacy by NZ researchers since April 2020).9 10 11 12 This is one of the likely failings of the NZ response that an official inquiry into the country’s pandemic response could investigate (as called for since June13).
Figure 9: The Jet Park Hotel in Auckland is one of the managed isolation and quarantine (MIQ) facilities in NZ. The use of such hotels has the advantage of utilising an existing resource and supporting employment of hotel staff at a time when international tourism has ended. However, such hotels are not appropriately designed for being either quarantine or isolation facilities and as such they appear to have contributed to most of the eight border control failures seen in NZ since the start of August.14 A solution to such problems may be a “traffic light” system for border controls,15 and with facilities built at a place like Ōhakea air base for people coming from high risk countries.16 For example, Australia is making a use of an air force base in the Northern Territory17 (although Australia has also had multiple failures with hotel-based quarantine).
Figure 10: Community support is shown in this photo of a volunteer from Kōkiri Marae with an example of cold goods included in food packages (8 April). This Marae distributed the packages to individuals and families that were in need. At a national-level the NZ Government also worked to cushion the economic consequences of the pandemic response with wage subsidies, job creation programmes and other measures (eg, home heating subsidies).
- Baker M, Kvalsvig A, Verrall A, Telfar-Barnard L, Wilson N. New Zealand’s elimination strategy for the COVID-19 pandemic and what is required to make it work. N Z Med J 2020;133(1512):10-14.
- Wilson N, Chambers T, Kvalsvig A, Mizdrak A, Nghiem N, Summers J, Baker M. NZ’s “Team of 5 million” has achieved the lowest COVID-19 death rate in the OECD – but there are still gaps in our pandemic response. Public Health Expert [Blog] 2020;(22 July). https://blogs.otago.ac.nz/pubhealthexpert/2020/07/22/nzs-team-of-5-million-has-achieved-the-lowest-covid-19-death-rate-in-the-oecd-but-there-are-still-gaps-in-our-pandemic-response/.
- Hale T, Webster S, Petherick A, Phillips T, Kira B. Oxford COVID-19 Government Response Tracker. Blavatnik School of Government. 2020;https://covidtracker.bsg.ox.ac.uk/.
- Summers J, Lin H-H, Cheng H-Y, Telfar Barnard L, Kvalsvig A, Wilson N, Baker M. Potential lessons from the Taiwan and New Zealand health responses to the COVID-19 pandemic. Lancet Regional Health Western Paciﬁc 2020;https://doi.org/10.1016/j.lanwpc.2020.100044.
- Franks J. Dr Tristram Ingham, the brains behind the Covid-19 ‘bubble’. Stuff 2020;(18 July). https://www.stuff.co.nz/national/health/coronavirus/122163720/dr-tristram-ingham-the-brains-behind-the-covid19-bubble
- Prather KA, Marr LC, Schooley RT, McDiarmid MA, Wilson ME, Milton DK. Airborne transmission of SARS-CoV-2. Science 2020;370:303-04.
- Wilson N, Schwehm M, Verrall AJ, Parry M, Baker MG, Eichner M. Detecting the re-emergent COVID-19 pandemic after elimination: modelling study of combined primary care and hospital surveillance. N Z Med J 2020;133:28-39.
- Kim H, Kim S, Che C. Virus Testing Blitz Appears to Keep Korea Death Rate Low. Bloomberg Business Week. 2020;(5 March). https://www.bloomberg.com/news/articles/2020-03-04/south-korea-tests-hundreds-of-thousands-to-fight-virus-outbreak.
- Chan L, Febery S. Why NZ should consider adopting “mass masking” as an additional step to speed elimination of the Covid-19 pandemic. Public Health Expert (Blog). 2020;(22 April). https://blogs.otago.ac.nz/pubhealthexpert/2020/04/22/why-nz-should-consider-adopting-mass-masking-as-an-additional-step-to-speed-elimination-of-the-covid-19-pandemic/
- Wilson N, Febery S, Chan L, Kvalsvig A, Baker M. The Strong Case for Mask Requirements in Public Transportation and Border Control Settings in NZ’s Current COVID-19 Pandemic Context. Public Health Expert (Blog). 2020;(11 May). https://blogs.otago.ac.nz/pubhealthexpert/2020/05/11/the-strong-case-for-mask-requirements-in-public-transportation-and-border-control-settings-in-nzs-current-covid-19-pandemic-context/
- Wilson N, Febery S, Chan L, Summers J, Baker M. Why a “mouth and nose” lockdown with masks might help avoid a “full body” lockdown at home. Public Health Expert (Blog). (20 May). 2020; https://blogs.otago.ac.nz/pubhealthexpert/2020/05/20/why-a-mouth-and-nose-lockdown-with-masks-might-help-avoid-a-full-body-lockdown-at-home/.
- Kvalsvig A, Wilson N, Chan L, Febery S, Roberts S, Betty B, Baker M. Mass masking: an alternative to a second lockdown in Aotearoa. N Z Med J 2020;133(1517):8-13.
- Wilson N, Summers J, Thomson G, Kvalsvig A, Boyd M, Baker M. Five Key Reasons why NZ Should have an Official Inquiry into the Response to the COVID-19 Pandemic. Public Health Expert (Blog) 2020;(11 June). https://blogs.otago.ac.nz/pubhealthexpert/2020/06/11/five-key-reasons-why-nz-should-have-an-official-inquiry-into-the-response-to-the-covid-19-pandemic/
- Wilson N, Grout L, Kvalsvig A, Baker M. Time to Stop Dodging Bullets? NZ’s Eight Recent Border Control Failures. Public Health Expert (Blog) 2020;(16 November). https://blogs.otago.ac.nz/pubhealthexpert/2020/11/16/time-to-stop-dodging-bullets-nzs-eight-recent-border-control-failures/.
- Wilson N, Baker M. New Zealand needs a ‘traffic light’ system to stop COVID-19 creeping in at the border. The Conversation 2020;(4 November). https://theconversation.com/new-zealand-needs-a-traffic-light-system-to-stop-covid-19-creeping-in-at-the-border-149262.
- Wilson N, Baker M. Shifting all Isolation/Quarantine Facilities to a Single Air Force Base: The Need for a Critical Analysis. Public Health Expert 2020;(14 September). https://blogs.otago.ac.nz/pubhealthexpert/2020/09/14/shifting-all-isolation-quarantine-facilities-to-a-single-air-force-base-the-need-for-a-critical-analysis/.
- Probyn A, Borys S, Hitch G. Coronavirus quarantine capacity for arrivals in Australia to be expanded with new Darwin processing centre. ABC News 2020;(15 October). https://www.abc.net.au/news/2020-10-15/howard-springs-coronavirus-quarantine-expanded-australians-home/12769796.