Response to 'What has New Zealand gained and lost by being tough on COVID-19'

In his article entitled “What has New Zealand gained and lost by being tough on COVID-19?” Professor Roger Morris presents a timely response to the premise by many people that we could have done much better in our response to controlling COVID-19 in New Zealand. He points out that the SARS-CoV-2 virus evolved rapidly requiring rapid adjustment. He compares our deaths to those of the United States and the likely number of deaths globally in those with COVID-19. He shows that we have actually had fewer deaths than expected based on numbers of deaths per population before 2020. He also points out that the negative effects of our control measures on the economy and employment figures have been much less than countries which adopted less intensive measures. However, there are important lessons for New Zealand as we reflect on our COVID-19 response so far.

It is crucial, for example, to think about the early acute response to a pandemic. In the race against time to roll out an effective vaccine, keeping the virus at bay in the most efficient way possible should be the goal. When a virus has only recently crossed over from animals to humans, it has not yet fully adapted to its new host and may have significant weaknesses which can be exploited. For example, the SARS-CoV-1 virus was not very infectious until about day 7 into symptomatic illness. This meant that case isolation with reasonable contact tracing was highly effective at containing outbreaks, eliminating the virus from humans before it adapted to become infectious earlier. SARS-CoV-2, while having a similar ‘R’ value initially to SARS-CoV-1, was much more infectious early in illness. However, it was similarly slow at causing disease in the human host, with an initial incubation period of around 5 to 6 days. As such we witnessed remarkable turnarounds of large COVID-19 epidemics in, for example, China, South Korea, Vietnam, Singapore and Taiwan through smart and capable public health responses that centred on rapid case contact management.

In contrast, New Zealand’s early response to COVID-19 was not able to contain the virus, hence the decision for an early and hard lockdown. New Zealand did make an important contribution to the world’s understanding of the place of early versus late lockdown in countries where lockdown was inevitable. New Zealand showed that early lockdown with high quality messaging to the public and huge public buy-in produces better results across key COVID-19 and economic indicators than an approach which leads to ‘forced’ lockdown when cases numbers and hospitalisations are overwhelming. Professor Morris is right to make comparisons across countries that required lockdown. However, because lockdown has far-reaching effects beyond those reflected in the indicators he mentions, public health specialists are extremely cautious in labelling it as a preferred approach, whether done early or late.

Taiwan is an example of a country that contained COVID-19 until vaccination rollout, without hard lockdowns. In early 2020, Taiwan’s case numbers peaked at 300 per day across the country and then returned to zero. Taiwan’s government learned from its 2003 SARS-CoV-1 experience and established a public health response mechanism for rapid actions against the next threat. As soon as The World Health Organisation was notified of pneumonia of unknown cause in Wuhan on Dec 31, 2019, Taiwanese officials began to board planes and assess passengers on direct flights from Wuhan. Over January border surveillance and quarantine procedures were established, a Central Epidemic Command Centre was activated and all interagency relationships and systems needed for the clinical and public health response were put in place. Innovation was incorporated across the response, with integration of big data and state of the art technology from the start. QR code scanning and specialised text messaging linked to careful risk profiling were employed early. The government addressed the issue of disease stigma and by providing food, frequent health checks, and mental health support for those under quarantine. A huge public health capacity enabled rapid case contact management at the level of quality required to contain outbreaks.

Other issues will arise from further reflection on our pandemic response. For example, at present we are faced with a relatively high daily reported death toll from ‘living with the virus’. This raises a number of issues, not the least of which is the need to be part of the global initiative to find new improved vaccines and to take advantage of the fact that we have several scientists who have been trained in the labs that created the current ones. We also need to face the fact that our response has not been as equitable as it could have been. Māori and Pasifika people in particular have suffered more from COVID-19 illness and death than other populations. They have also been more adversely affected by the ‘downside’ of measures that have been taken to combat the virus, and had less effective access to vaccination in an otherwise successful rollout. Data systems created ‘on the fly’ performed reasonably well but often did not facilitate equity-based decision-making in real-time and there were ongoing problems with numerators and denominators. Genuine involvement that includes design and not just consultation is crucial and would enrich the response.

It is reasonable to respond to unfair criticism of the New Zealand COVID-19 pandemic response. However, the story of the COVID-19 pandemic is not yet fully told, and there are many ways in which we can prepare better for the next pandemic. 

Professor Philip Hill is a medically trained infectious diseases and public health specialist, the McAuley Professor of International Health at the University of Otago, and co-Director of the University’s Global Health Institute.