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In Queensland, the strategy has been swift, sharp lockdowns in response to any sign of an outbreak. Photo by PATRICK HAMILTON/AFP via Getty Images
In Queensland, the strategy has been swift, sharp lockdowns in response to any sign of an outbreak. Photo by PATRICK HAMILTON/AFP via Getty Images

SocietySeptember 5, 2021

What are the lessons for NZ from battles against delta around the world?

In Queensland, the strategy has been swift, sharp lockdowns in response to any sign of an outbreak. Photo by PATRICK HAMILTON/AFP via Getty Images
In Queensland, the strategy has been swift, sharp lockdowns in response to any sign of an outbreak. Photo by PATRICK HAMILTON/AFP via Getty Images

Delta presents a substantially more challenging foe to eliminate. The experiences of other jurisdictions offer examples we can learn from, writes epidemiologist Jennifer Summers.

The delta variant has been called a game-changer, and in a lot of ways it is. Vaccines may be less effective against this variant of Covid-19 and delta is much more infectious than other forms of Covid-19 we have experienced in New Zealand. We need to use all the tools in New Zealand’s arsenal to combat delta. One of the best ways of doing this is by looking into how other jurisdictions are responding to delta.

Why are we so worried about delta? 

Delta originated in India in October 2020 and in that time has become the most dominant strain of SARS-CoV-2, the virus that causes Covid-19. delta produces a higher viral load in the lungs of those infected, meaning that there are more viral particles inside the person infected with this variant. This results in delta having both a shorter incubation period and being more infectious than other variants. delta is also causing more serious illness with increased risk of hospitalisation. The further worry with delta is that it appears to be more resistant to vaccines, meaning that the vaccines are not quite as good at preventing infection and less effective in stopping transmission from a vaccinated person to someone else.

Epidemiologists often talk about reproduction number or R0, and this refers to how many people will be infected by each case. Delta has a R0 of 5-7, meaning a delta case will on average infect around 5 to 7 other people. To put this into perspective, delta has a higher reproduction number than many other viral infections such as influenza (Ro=1-3),  Ebola (Ro=2) and the original strain of SARS-CoV-2 (R0=2.8). Nevertheless, it is not as high as chicken-pox (Ro=10-12) or measles (Ro=12-18). Given all these features of delta, New Zealand’s control of Covid-19 is being put to the test by our delta outbreak and this threatens our ability to continue with an “elimination strategy”.

What’s happening in Australia?

Australia is in the midst of its largest outbreak in the Covid-19 pandemic, largely fuelled by the delta outbreak in New South Wales. Even with various state border restrictions, this outbreak has spread into other Australian states/territories and also New Zealand. New South Wales officials initially decided against a strict lockdown within the greater Sydney region, and this has most likely resulted in the prolonged outbreak, with serious pressure put on Sydney’s health system.

Queenslanders have experienced a variety of snap lockdowns over the last several weeks as they respond to delta. Unlike NSW, the lockdowns in Queensland have been strict and imposed with short notice. For the last several weeks, Queensland has managed to keep the number of Covid-19 cases in the community to less than 10 per day. Queensland has recently begun building its own dedicated regional Covid-19 quarantine facility, much like the successful Howard Springs Facility in the Northern Territory.

South Australia has also managed to keep their Covid-19 cases low, with daily cases not reaching double-digits since June 2021. A state-wide snap lockdown in July keep the delta outbreak in the community from spreading widely. This lockdown was similar to New Zealand’s alert level four, with strict restrictions.

Western Australia and the Northern Territory have had few reports of recent community cases of Covid-19. While they have both experienced delta cases, they have both used various localised lockdowns to reduce transmission. The remaining state of Tasmania has the advantage of being an island and has managed to keep delta out of its population. However, officials are still aware of the risks posed by delta, and are planning for an outbreak scenario, known as the “Delta Shield’“. This would involve a snap lockdown and mandated public health measures such as restrictions on gatherings and mask use.

How is delta affecting other jurisdictions?

Taiwan is often used as a model example for its relatively successful response to the Covid-19 pandemic. However, in April 2021 Taiwan experienced its largest Covid-19 outbreak, involving multiple clusters connected to international flight crew and a quarantine facility in the capital city of Taipei. When the delta variant was found at the tail-end of this outbreak, Taiwanese officials used a localised lockdown to reduce transmission of the virus, rather than a nationwide lockdown (which has never been used in Taiwan). The Taiwanese are now reporting zero cases of Covid-19 in the community.

When we look at other jurisdictions in Asia, we can see that there are a wide range of successes and failures when dealing with delta outbreaks. For example, Malaysia, Japan, South Korea and Vietnam are all experiencing record numbers of Covid-19 cases, largely driven by delta. Whereas recent outbreaks largely fuelled by delta are being quelled in Singapore (soon to be moving away from a “zero-tolerance approach to Covid-19) and China (using a mixture of localised lockdowns/restrictions and mass testing). Like New Zealand, Hong Kong uses an elimination strategy, and so far has not had a delta outbreak. Any reports of Covid-19 cases swiftly results in localised lockdowns and tight restrictions.

Looking elsewhere, Iceland has one of the highest Covid-19 vaccination rates in the world, with around 84% of the eligible population fully vaccinated (much higher than the rate of about 30% in New Zealand). However, like Australia, Iceland is now experiencing its largest Covid-19 outbreak, caused by delta. Many of the recent cases are occurring amongst the fully vaccinated, in what is known as breakthrough infections. Breakthrough infections are also driving the large delta outbreak in highly vaccinated Israel

What does this mean for New Zealand?

New Zealand is one of a number of nations still using a Covid-19 elimination strategy. However, delta has made this much more difficult to follow. It is clear from other nations that a swiftly executed lockdown (whether localised or nationwide) can be effective in dealing with delta outbreaks along with other public health measures, such as physical distancing, vaccination and mass mask use. This is why our government quickly put New Zealand into a nationwide lockdown following the confirmation of just one community case in Auckland last month.

Current research suggests that being vaccinated can reduce the full impact of infection from delta, by reducing infections and serious complications. However, relying on high-vaccine uptake in the population is not enough to tackle delta, as both Iceland and Israel have shown.

New Zealand should consider new public health measures, such as having purpose-built quarantine facilities like Queensland and the Northern Territory. This will help reduce the risk of future MIQ failures. Other possible improvements to New Zealand’s defence against delta include tweaking our alert level system, mandating QR code scanning, increasing wastewater testing and improving ventilation management.

Delta is the biggest challenge to date for New Zealand maintaining its elimination approach. However, the benefits of elimination means New Zealand keeping cases and deaths relatively low. This is important given that the long-term effects of long Covid are still unknown and we want to protect tamariki who are largely unvaccinated. We want to avoid a health system overload (like in New South Wales) and prevent severe health inequities. We also want to protect New Zealand from new Covid-19 variants which may be worse than the delta variant.

The delta variant of Covid-19 will continue to be a challenge to New Zealand’s elimination strategy in the long-term, perhaps until even better vaccines become available. Fortunately, other jurisdictions show it is possible to control delta outbreaks and New Zealand still has a range of options for improving our response in the future.

Jennifer Summers is an epidemiologist at the Department of Public Health, University of Otago, Wellington. This piece is based on a post at the department’s Public Health Expert blog 

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Ross Murray.
Ross Murray.

The Sunday EssaySeptember 5, 2021

The Sunday Essay: New York City, September 11, 2001

Ross Murray.
Ross Murray.

Twenty years ago, Rae Lamb was in Manhattan preparing for a health fellowship. When a plane flew into one of the towers, she rang the newsroom back in New Zealand.

The Sunday Essay is made possible thanks to the support of Creative New Zealand

Original illustrations by Ross Murray

Mention 9/11 and most people respond by telling you where they were on the day. It’s one of those events that people remember quite clearly. And in quite a bit of detail. My whānau and I are no exception.

I was at a meeting in Manhattan, on the Upper East Side by Central Park. I had left my husband and sleeping 10-year-old in the hotel in Midtown so I could attend the first day of orientation to a one year Harkness Fellowship. We had spent the weekend as tourists in New York, including a visit to Wall Street and the financial district where we gazed at the twin towers. On that sunny morning of 11 September 2001 our biggest concern was missing out on a Yankees/Red Sox baseball game due to torrential rain the night before.

Twenty years on and my memories of the day are still acute. Our meeting had barely begun when we were interrupted and told a plane had flown into one of the towers. My first thought was that it was a small plane. It seemed beyond comprehension that it could be a commercial jet filled with passengers and deliberately flown into one of New York’s tallest buildings. Switching on the news and seeing the truth of it on the television, there was the growing realisation this was something big and horrible and it was not over.

Phone calls quickly followed. First to the family in mid-town, to check on them. Then waking the family in New Zealand in the middle of the night to say we were safe. Roused from sleep they had no idea what had happened. When I rang the Radio New Zealand newsroom in Wellington, the overnight subeditor was surprised to hear they had a reporter in New York. I told her I would go downtown to see what I could find out.

It’s around 15 years since I quit journalism. 2001 was meant to be a year out, completing the fellowship as a health researcher. But the news instinct kicked in. It drove me on that day, just after the second tower fell, to head downtown with a colleague to witness and report on what was going on. For my husband, also a journalist, it was a day spent in Midtown, not that far from it all, supporting our daughter whose request for waffles for breakfast switched to asking whether Afghanistan and the United States were at war. He had to turn off the television as it was distressing her. For a 10-year-old from New Zealand it was unfathomable.

Enduring images of the walk down Manhattan include main streets without traffic where previously it was difficult to cross the road. People sitting outside buildings looking at useless cellphones, cars parked haphazardly with the doors open and radios on as everyone sought information. No one seemed to know what to do or where to go. Some found solace in the churches, lighting candles.

As we got further Downtown the pedestrian traffic grew, increasingly dishevelled, distressed people heading up town. We spoke to a priest who told us people had jumped from the buildings, and of efforts to find any survivors. We started to get a sense of the horror ahead.

When the US airforce flew over, we were all frightened and ducked for cover. No one initially knew if it was another attack.

After bluffing our way through the cordon being set up at Canal Street, my colleague and I found a street corner with a working public phone booth, a few blocks back from where the towers once stood. There was lots of debris scattered around, including ash, papers, and shoes.

Rescue teams were setting up a staging post there. They kept coming, hoping to find police and fire service colleagues who had responded before the towers fell, as well as people from inside the towers. Ambulances and paramedics sat waiting for patients who never came, and we heard there were similar scenes at the hospitals where people were queuing to give blood that wasn’t needed. As the day went on it quickly became clear there was no one to rescue – the few survivors had already escaped.

The power was out and it was hot. Local store owners and residents distributed bottles of water and apples. The news from those coming back from ground zero kept getting worse. A fire chief handed out paper face masks but didn’t have enough for everyone, so gave them mostly to the women, including my colleague and me. Putting a mask on again for the first time in last year’s lockdown reminded me of that day when the unseen enemy was asbestos dust rather than Covid-19.

It was pure journalism – hear it, see it and report it. No time, nor the tools to write it down. No chance to check and verify the information with multiple sources. Cellphones didn’t work so I took turns in the queue with rescue workers and locals to use the phone. Every time I got through, RNZ put me live on air.

For much of the day, a shoeless woman, in a dust covered suit, kept us company. She said she was all right, having escaped from one of the towers early. Knowing more now about trauma, thanks to my current role, it’s clear she was in shock. She didn’t seem able to leave and just sat on the kerb for hours before disappearing during the afternoon. I wish I knew what happened to her.

At one point we heard another explosion and the fire crew yelled at us to run back another block. Another building, 7WTC, had come down. It had been burning all day

By evening, heavy machinery had arrived along with reinforcements for the exhausted and devastated rescue crews. It was clear that anyone who was going to get out was already out. The would-be rescuers were unable to help as they wanted to, and many of their colleagues were missing. We decided to leave, knowing we wouldn’t get back through the cordon. As we walked uptown in growing darkness we were saddened to see the impromptu noticeboards that had sprung up, covered in photographs and messages as people began to search for missing loved ones. We were appalled to see street vendors already hawking bits of rock they said had come from the towers and postcards of what used to be.

At Midtown the subway was running. A fellow passenger warned us we might have been exposed to asbestos. When I got back to the hotel, the first thing I did was bag and seal my clothes and shower, before catching up with the family.

It took us three days to get out of Manhattan and return by train to Boston where we were to spend the year. We thought hard about going home to New Zealand. Just as it must be for those caught overseas during today’s pandemic, home seemed the safest option in an uncertain world.

We chose to stay on. In many ways it was a strange year. American flags were everywhere in the immediate aftermath. Our daughter had to swear allegiance to the flag at school. She felt uncomfortable, given she came from somewhere else. In the days that followed, Sikh taxi drivers talked about their fear, based on experience, of being targeted and abused. It took me many months to get on a plane again. When I did, flying was much less of a pleasure, with the ramping up of the security measures we all take for granted now. I still remember my 10-year-old being physically searched in public at a US airport without either parent allowed to support her, when we travelled to spend Christmas with friends in Memphis.

Looking back now, after all these years, moments of kindness and human empathy also stand out. On our return to Boston my daughter started school and her teacher, a stranger, asked how we were. I burst into tears. Now I know why it meant so much. The importance of asking people if they are OK and caring about the answer has been so very evident as we in New Zealand have navigated our way through other life shattering events such as the Christchurch earthquakes and the mosque attack. Most recently the pandemic. We have all learned something about the kindness of strangers.

As we mark the 20th anniversary of 9/11, my family and I will think about those who died, including the rescue workers who later succumbed to asbestos related illness. We hope the years since have been kind to their friends and families.

I have returned to New York three times since 9/11, but I have never returned to ground zero. A few years ago, my daughter visited the memorial where the twin towers once stood. She tells me it is very moving and has been thoughtfully done. I am glad she went but I will never go back down there myself. Twenty years on it still feels like a grave site. This was the last big story I covered as a journalist. People say it must have been the story of a lifetime. It will never feel like that. So many people died.

Rae Lamb is chief executive, Te Pou and Blueprint for Learning, and was formerly deputy health and disability commissioner and a journalist.


Read more in the Sunday Essay series here