How New Zealand Has Eliminated COVID-19
By Michael Baker, Amanda Kvalsvig and Nick Wilson
On Sunday, New Zealand marked 100 days without community transmission of COVID-19.
From the first known case imported into New Zealand on February 26 to the last case of community transmission detected on May 1, elimination took 65 days.
New Zealand relied on three types of measures to get rid of the virus:
- ongoing border controls to stop COVID-19 from entering the country
- a lockdown and physical distancing to stop community transmission
- case-based controls using testing, contact tracing and quarantine.
Collectively, these measures have achieved low case numbers and deaths compared with high-income countries in Europe and North America that pursued a suppression strategy.
Deaths From COVID-19 Per Million Population
New Zealand is one of a small number of jurisdictions – including mainland China, Hong Kong, Taiwan, South Korea, Vietnam, Mongolia, Australia and Fiji – pursuing COVID-19 containment or elimination. Most have had new outbreaks. The exceptions are Taiwan, Mongolia, Fiji and New Zealand.
Australia adopted very similar responses to the pandemic and it is important to note that most states and territories are in the same position as New Zealand. But Victoria and, to a lesser extent, New South Wales are seeing a significant resurgence.
The key difference is that New Zealand committed relatively early to a clearly articulated elimination strategy and pursued it aggressively. An intense lockdown proved highly effective at rapidly extinguishing the virus.
This difference can be seen graphically in this stringency index published by Oxford University's Our World in Data.
There are key lessons from New Zealand's COVID-19 experience.
A vigorous, decisive response to the pandemic was highly effective at minimizing cases and deaths. New Zealand has the lowest COVID-19 death rate in the OECD.
Total all-cause deaths also dropped during the lockdown. This observation suggests it did not have severe negative effects on health, although it will almost certainly have some negative long-term effects.
Elimination of the virus appears to have allowed New Zealand to return to near-normal operation fairly rapidly, and minimized economic damage compared with Australia. But the economic impact is likely to keep playing out over the coming months.
COVID-19 Update There are no new cases of COVID-19 to report in New Zealand today. It has been 100 days since t… https://t.co/Cz55ixGZUz— Unite against COVID-19 (@Unite against COVID-19)1596936201.0
Getting Through the Pandemic
We have gained a much better understanding of COVID-19 over the past eight months. Without effective control measures, it is likely to continue to spread globally for many months to years, ultimately infecting billions and killing millions. The proportion of infected people who die appears to be slightly below 1%.
This infection also causes serious long-term consequences for some survivors. The largest uncertainties involve immunity to this virus, whether it can develop from exposure to infection or vaccines, and if it is long-lasting. The potential for treatment with antivirals and other therapeutics is also still uncertain.
This knowledge reinforces the huge benefits of sustaining elimination. We know that if New Zealand were to experience widespread COVID-19 transmission, the impact on Māori and Pasifika populations could be catastrophic.
We have previously described critical measures to get us through this period, including the use of fabric face masks, improving contact tracing with suitable digital tools, applying a science-based approach to border management, and the need for a dedicated national public health agency.
Maintaining elimination depends on adopting a highly strategic approach to risk management. This approach involves choosing an optimal mix of interventions and using resources in the most efficient way to keep the risk of COVID-19 outbreaks at a consistently low level. Several measures can contribute to this goal over the next few months, while also allowing incremental increases in international travel:
- resurgence planning for a border-control failure and outbreaks of various sizes, with state-of-the-art contact tracing and an upgraded alert level system
- ensuring all New Zealanders own a re-useable fabric face mask with their use built into the alert level system
- conducting exercises and simulations to test outbreak management procedures, possibly including "mass masking days" to engage the public in the response
- carefully exploring processes to allow quarantine-free travel between jurisdictions free of COVID-19, notably various Pacific Islands, Tasmania and Taiwan (which may require digital tracking of arriving travellers for the first few weeks)
- planning for carefully managed inbound travel by key long-term visitor groups such as tertiary students who would generally still need managed quarantine.
Building Back Better
New Zealand cannot change the reality of the global COVID-19 pandemic. But it can leverage possible benefits.
We should conduct an official inquiry into the COVID-19 response so we learn everything we possibly can to improve our response capacity for future events.
We also need to establish a specialized national public health agency to manage serious threats to public health and provide critical mass to advance public health generally. Such an agency appears to have been a key factor in the success of Taiwan, which avoided a costly lockdown entirely.
Business as usual should not be an option for the recovery phase. A recent Massey University survey suggests seven out of ten New Zealanders support a green recovery approach.
New Zealand's elimination of COVID-19 has drawn attention worldwide, with a description just published in the New England Journal of Medicine. We support a rejuvenated World Health Organization that can provide improved global leadership for pandemic prevention and control, including greater use of an elimination approach to combat COVID-19.
Michael Baker is a Professor of Public Health, University of Otago.
Amanda Kvalsvig is a Senior Research Fellow, Department of Public Health, University of Otago.
Nick Wilson is a Professor of Public Health, University of Otago.
Disclosure statement: Michael Baker receives funding for COVID-19 research from the Health Research Council of New Zealand (HRC: 20/1066). Amanda Kvalsvig receives funding for COVID-19 research from the New Zealand Health Research Council (HRC; 20/1066). Nick Wilson does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Reposted with permission from The Conversation.
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A Game of Jenga<p>Think of it as a game of Jenga and the planet's climate system as the tower. For generations, we have been slowly removing blocks. But at some point, we will remove a pivotal block, such as the collapse of one of the major global ocean circulation systems, for example the Atlantic Meridional Overturning Circulation (AMOC), that will cause all or part of the global climate system to fall into a planetary emergency.</p><p>But worse still, it could cause runaway damage: Where the tipping points form a domino-like cascade, where breaching one triggers breaches of others, creating an unstoppable shift to a radically and swiftly changing climate.</p><p>One of the most concerning tipping points is mass methane release. Methane can be found in deep freeze storage within permafrost and at the bottom of the deepest oceans in the form of methane hydrates. But rising sea and air temperatures are beginning to thaw these stores of methane.</p><p>This would release a powerful greenhouse gas into the atmosphere, 30-times more potent than carbon dioxide as a global warming agent. This would drastically increase temperatures and rush us towards the breach of other tipping points.</p><p>This could include the acceleration of ice thaw on all three of the globe's large, land-based ice sheets – Greenland, West Antarctica and the Wilkes Basin in East Antarctica. The potential collapse of the West Antarctic ice sheet is seen as a key tipping point, as its loss could eventually <a href="https://science.sciencemag.org/content/324/5929/901" target="_blank">raise global sea levels by 3.3 meters</a> with important regional variations.</p><p>More than that, we would be on the irreversible path to full land-ice melt, causing sea levels to rise by up to 30 meters, roughly at the rate of two meters per century, or maybe faster. Just look at the raised beaches around the world, at the last high stand of global sea level, at the end of the Pleistocene period around 120,0000 years ago, to see the evidence of such a warm world, which was just 2°C warmer than the present day.</p>
Cutting Off Circulation<p>As well as devastating low-lying and coastal areas around the world, melting polar ice could set off another tipping point: a disablement to the AMOC.</p><p>This circulation system drives a northward flow of warm, salty water on the upper layers of the ocean from the tropics to the northeast Atlantic region, and a southward flow of cold water deep in the ocean.</p><p>The ocean conveyor belt has a major effect on the climate, seasonal cycles and temperature in western and northern Europe. It means the region is warmer than other areas of similar latitude.</p><p>But melting ice from the Greenland ice sheet could threaten the AMOC system. It would dilute the salty sea water in the north Atlantic, making the water lighter and less able or unable to sink. This would slow the engine that drives this ocean circulation.</p><p><a href="https://www.carbonbrief.org/atlantic-conveyor-belt-has-slowed-15-per-cent-since-mid-twentieth-century" target="_blank">Recent research</a> suggests the AMOC has already weakened by around 15% since the middle of the 20th century. If this continues, it could have a major impact on the climate of the northern hemisphere, but particularly Europe. It may even lead to the <a href="https://ore.exeter.ac.uk/repository/handle/10871/39731?show=full" target="_blank" rel="noopener noreferrer">cessation of arable farming</a> in the UK, for instance.</p><p>It may also reduce rainfall over the Amazon basin, impact the monsoon systems in Asia and, by bringing warm waters into the Southern Ocean, further destabilize ice in Antarctica and accelerate global sea level rise.</p>
The Atlantic Meridional Overturning Circulation has a major effect on the climate. Praetorius (2018)
Is it Time to Declare a Climate Emergency?<p>At what stage, and at what rise in global temperatures, will these tipping points be reached? No one is entirely sure. It may take centuries, millennia or it could be imminent.</p><p>But as COVID-19 taught us, we need to prepare for the expected. We were aware of the risk of a pandemic. We also knew that we were not sufficiently prepared. But we didn't act in a meaningful manner. Thankfully, we have been able to fast-track the production of vaccines to combat COVID-19. But there is no vaccine for climate change once we have passed these tipping points.</p><p><a href="https://www.weforum.org/reports/the-global-risks-report-2021" target="_blank">We need to act now on our climate</a>. Act like these tipping points are imminent. And stop thinking of climate change as a slow-moving, long-term threat that enables us to kick the problem down the road and let future generations deal with it. We must take immediate action to reduce global warming and fulfill our commitments to the <a href="https://www.ipcc.ch/sr15/" target="_blank" rel="noopener noreferrer">Paris Agreement</a>, and build resilience with these tipping points in mind.</p><p>We need to plan now to mitigate greenhouse gas emissions, but we also need to plan for the impacts, such as the ability to feed everyone on the planet, develop plans to manage flood risk, as well as manage the social and geopolitical impacts of human migrations that will be a consequence of fight or flight decisions.</p><p>Breaching these tipping points would be cataclysmic and potentially far more devastating than COVID-19. Some may not enjoy hearing these messages, or consider them to be in the realm of science fiction. But if it injects a sense of urgency to make us respond to climate change like we have done to the pandemic, then we must talk more about what has happened before and will happen again.</p><p>Otherwise we will continue playing Jenga with our planet. And ultimately, there will only be one loser – us.</p>
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