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Ashley Bloomfield addresses media on the return of an evacuation flight from Wuhan on February 5, 2020 (Photo: Michael Ng/Getty Images)
Ashley Bloomfield addresses media on the return of an evacuation flight from Wuhan on February 5, 2020 (Photo: Michael Ng/Getty Images)

OPINIONScienceFebruary 25, 2021

One year on from Covid case #1: Five lessons for 2021 and beyond

Ashley Bloomfield addresses media on the return of an evacuation flight from Wuhan on February 5, 2020 (Photo: Michael Ng/Getty Images)
Ashley Bloomfield addresses media on the return of an evacuation flight from Wuhan on February 5, 2020 (Photo: Michael Ng/Getty Images)

University of Otago public health experts Michael Baker, Amanda Kvalsvig and Nick Wilson ponder what we’ve learned about the pandemic over the past 12 months, and how we can improve our response in the future.

Exactly one year ago tomorrow (February 26) the first confirmed case of Covid-19 arrived in Aotearoa New Zealand. Identified only as “a person in their 60s recently returned from Iran”, the case marked the beginning of an extraordinary period in the life of the country.

A year on, what are some of the lessons we have learned about this pandemic? And what are the implications for improving our response in future?

One of the main reasons for asking these questions lies in the legacy value of any improvements we make. That is, the potential for using this crisis as the catalyst for an urgently-needed upgrade to the country’s public health infrastructure, to enhance health, equity, prosperity and sustainability in the long term.

The Northcote Covid-19 testing facility in Auckland, on August 12, 2020 (Photo: Fiona Goodall/Getty Images)

Elimination is the right strategy

Arguably, New Zealand’s greatest lesson is that an elimination strategy is the optimal response for a moderate to severe pandemic like Covid-19. The strategy provides a vivid example of how protecting public health also protects the economy when compared with mitigation or suppression strategies.

This successful approach has required decisive science-backed government action and outstanding communication to create the social licence needed for an effective response.

Prevention remains a fundamental strategy. At a technical level, we have learned Covid-19 transmission is mainly through airborne spread indoors, often from pre-symptomatic people. This highlights the value of mask use and good ventilation.

The risk from contaminated surfaces has been overemphasised. The virus shows large “transmission heterogeneity” (only about 20% of infected cases are responsible for most of the transmission), further underlining the importance of preventing super-spreading events.

Ongoing vaccination challenges

Another key lesson was how quickly the world developed highly effective, safe vaccines. The new messenger RNA (mRNA) vaccines are performing particularly well.

But the Covid-19 endgame remains uncertain. Plausible global scenarios range from endemic infection (like seasonal influenza) to eradication (like SARS, smallpox, rinderpest and two of the three serotypes of poliovirus).

Newly emerging SARS-CoV-2 variants increase transmission risk and will probably reduce vaccine effectiveness over time, requiring vaccine reformulation.

A co-ordinated international effort to ensure equitable distribution of vaccines will not only protect the most vulnerable, it will also provide the best hope of containing the pandemic.

The first vaccines being administered at Jet Park in Auckland (Photo: Supplied)

Five challenges for 2021 and beyond

Aotearoa faces five key challenges over the next year to weather the pandemic and deliver a valuable and lasting public health legacy.

1. Improving border biosecurity

Preventing the re-introduction of Covid-19 into the country remains the single most important short- to medium-term challenge to sustained elimination of the virus.

There are obvious benefits in taking a highly systematic approach to this process by considering the entire journey of travellers: from their week prior to departure, their flight to New Zealand (during which they can become infected), their two-week stay in MIQ facilities (where again they can become infected), and the period after leaving MIQ when they remain at elevated risk of being infectious.

The goal of having no infected people arriving in the country should become increasingly realistic. This should allow for the careful introduction of quarantine-free travel with other parts of the world that have also achieved elimination.

Investing in a purpose-built but versatile quarantine facility offers important short- and long-term benefits.

2. Enhancing outbreak detection and management

For the foreseeable future, New Zealand will need to maintain and enhance its systems for rapid detection and control of Covid-19 outbreaks as a backup measure for border failures.

Promising enhancements include the use of daily saliva testing of border workers and wastewater testing to detect community transmission sooner, as well as continuing improvements to contact tracing.

New Zealand has relatively high voluntary uptake of its Covid Tracer app, but routine use is poor. An obvious improvement would be to make use of the app mandatory when entering high-risk venues (nightclubs, indoor bars and restaurants, gyms, churches, entertainment venues) and by MIQ workers and recently returned travellers.

The alert level system needs revision to reflect new knowledge about transmission. There needs to be a greater focus on limiting crowding in high-risk indoor environments, promoting mask use (which is effective at reducing transmission) and using more geographically targeted and less disruptive “circuit-breaker lockdowns”.

3. Delivering vaccinations effectively and equitably

Vaccination strategies must prioritise effective border control, protect the most vulnerable and promote health equity. Achieving high coverage will depend on social engagement, community networks, and high-quality, comprehensive information systems such as the upgraded national immunisation register.

4. Establishing an effective public health agency

The pandemic provides a vivid illustration of the need to invest in effective public health infrastructure. A dedicated national agency is needed to create the critical mass of expertise in strategy and delivery that was missing at the start of the pandemic in New Zealand.

Such agencies are increasingly common in high-income countries. It was a key feature in the highly effective Covid response in Taiwan. This agency could provide the critical mass needed to put disease prevention and preparedness at the centre of government activities.

5. Establishing optimal emergency decision-making processes

The effective New Zealand pandemic response benefited from having a government that considered scientific advice and was concerned with well-being. However, the government has been slow to innovate in some areas.

Photo: Kai Schwoerer/Getty Images

An opportunity to reset the system

One of the greatest legacies from this pandemic could be to institutionalise an improved set of processes for decision-making in emergencies that do more to foster learning, innovation, continuous quality improvement and transparency. Key changes would be:

  • political processes that enable highly informed debate and scrutiny while aiming for cross-party support of key response strategies (such as an ongoing epidemic response committee of parliamentarians)
  • advisory processes that ensure high-level, multidisciplinary science input into the all-of-government response (e.g. the formation of a Covid-19 science council/rōpu).
  • a well-resourced research and development strategy to ensure a high level of scientific evidence to shape the response and its evaluation
  • commitment to, and a timetable for, an official inquiry to assess the pandemic response and drive wider system improvements.
More Reading

In summary, the Covid-19 pandemic has provided a profound opportunity for reassessing health, social and economic functioning in Aotearoa New Zealand. It has demonstrated the value of proactive government decision-making to manage threats to population health.

The Covid-19 response provides a model for responding to a wide range of tough societal challenges, including the climate change emergency and growing social inequities.The Conversation

This article is republished from The Conversation under a Creative Commons licence. Read the original article.

Scarlett Corbett, 7, rides past the damaged theatre in the center of Lyttleton after the 6.3 magnitude earthquake, on February 24, 2011 in Christchurch. (Photo: Fairfax Media/Getty Images)
Scarlett Corbett, 7, rides past the damaged theatre in the center of Lyttleton after the 6.3 magnitude earthquake, on February 24, 2011 in Christchurch. (Photo: Fairfax Media/Getty Images)

ScienceFebruary 24, 2021

A decade on, NZ is yet to properly reckon with our tolerance for risk

Scarlett Corbett, 7, rides past the damaged theatre in the center of Lyttleton after the 6.3 magnitude earthquake, on February 24, 2011 in Christchurch. (Photo: Fairfax Media/Getty Images)
Scarlett Corbett, 7, rides past the damaged theatre in the center of Lyttleton after the 6.3 magnitude earthquake, on February 24, 2011 in Christchurch. (Photo: Fairfax Media/Getty Images)

Aotearoa remains stuck in disaster response mode, 10 years after the Christchurch quake, write risk and resilience experts Ursula Cochran, Kelvin Berryman and Hugh Cowan.

How’s progress, New Zealand? Do we still have buildings that could kill 115 people in one go? Yes. Are we still building on liquefiable land? Yes. Do we have essential services in the path of rockfalls and tsunamis? Yes. Are we planning to build on known active fault zones? Yes.

A decade after the Christchurch earthquake, we’ve been busy fixing things, getting lives and livelihoods back in order, and learning as much as we can of what the earthquake had to teach us. We’ve also been hit by more earthquakes, a volcanic eruption, extreme weather events, and a pandemic. There is always something going on in Aotearoa – which is why the country needs a state-of-the-art risk management system. We’re not talking about emergency management. We’re talking about a system that ensures hazards do not become disasters because we’ve weighed up the risks and prepared in advance.

Natural hazard events are inevitable. Disasters are not. Disasters only arise when a natural hazard event occurs in a community that is not prepared and not able to respond effectively or is overwhelmed. A bit of risk management can make a big difference: the US has had 150 deaths from Covid-19 per 100,000 people; by the same measure, New Zealand has had 0.5 deaths. The different ways we prepared and chose to respond to the same hazard have led to markedly different outcomes. Yes, we have some natural advantages, but we made sure we maximised them by using the science and adapting to new developments in understanding.

Risk management involves assessing risks and deciding what to do about them before they happen. Depending on your appetite for disaster, risk can be treated anywhere along a continuum from complete avoidance, to implementing control measures, to transferring the risk, or accepting it (the ACTA framework). Mitigating risk lies between the end-points of avoidance and acceptance and usually consists of control measures such as engineering safer land and structures. These can be perceived as costly, but when assessed over the lifetime of the structures, there is, almost invariably, a good return on investment. The return is even greater if the social costs of not doing the work are considered. Mitigating risks for major events results in elimination of risk for smaller, more frequent events. And, there are social and economic benefits even if the hazardous events never occur. Think of the peace-time advantages of an additional transport corridor out of Wellington regardless of whether it is needed in a major emergency.

Effective risk management also provides huge social benefit – the reduction or elimination of trauma. The mental health issues that persist in Christchurch a decade after the earthquake illustrate why disaster risk reduction is such a worthwhile pursuit from a human perspective. Risk management sounds like an obvious choice. But it does rely on future-focused planning so, if you’ve been busy responding to disasters, it can get deprioritised.

There are many people and agencies across the country working towards risk management goals. New Zealand signalled its intention globally by signing the Sendai Framework for Disaster Risk Reduction in 2015. Excellent national strategy has followed on from this such as the National Disaster Resilience Strategy – a document worthy of wide readership. We are getting to know our hazards through investment in research. Effective communication of research findings is leading to greater community understanding. Recognition of the social cost of disasters is coming to the fore. Initiatives such as the national vulnerability assessment are providing insights into where “hotspots” of critical lifelines occur. Councils are engaging with communities to make their own decisions about risk. Modelling tools have been developed to help make decisions. The Christchurch rebuild has incorporated many resilience measures such as earthquake resistant buildings and treatment of ground to make it stronger.

There is good work being done. But for every strategy document heading in the right direction, there is another that ignores hazard and risk. For every piece of hazard communication, there are things going unsaid. For every hotspot identified, there is a business case waiting to be written or funded. And while Christchurch may be leading the way with resilient design, the rest of the country is taking its time to follow suit. It seems that much of the risk management effort is fragmented and so is not coming to fruition as policy or practice.

What we need now is unifying leadership to co-ordinate our approach to risk management, make better use of what we know, and implement strategies developed by successive governments. The restructure of the Resource Management Act may be a vehicle for this, but there needs to be an all-hazard and all-risk approach. Hazard and risk information must be easily accessible so kiwis can make well-informed decisions about what level of risk they’re willing to live with. Some may still choose to tour an active volcano even when they know there’s a chance of eruption without warning.

The ACTA framework (avoid, control, transfer, accept) must be used in a more systematic manner nationally – tying in to the human, social, natural, physical/financial capitals outlined in Treasury’s living standards framework. The four Rs of emergency management (reduction, readiness, response, recovery) serve us well but emphasis must move from response and recovery to reduction and readiness. There needs to be greater investment in resilience measures. A broader understanding of the social and economic benefits of investment in risk assessment and mitigation will facilitate this. We need to acknowledge that short-term thinking may come at the expense of future lives and livelihoods.

Risk belongs to everyone. It’s not up to central and local government to find all the solutions. We all live here and everyone has a different tolerance for risk – we all need to be part of the conversation. At the moment we are creating new risk all the time. New disasters are waiting to happen. We are stuck in disaster response mode. Instead, let’s prioritise risk management in New Zealand, get onto the front foot, and avert future disasters.