Nursing & Health Sciences Department

Bicol University
POLANGUI CAMPUS GEC 17 – Science, Technology, & Society
Polangu, Albay. Kim Jim F. Raborar, RN, LPT, MAEd (c)

References: Petherick A Kira B Hale T et al.

Variation in government responses to COVID-19.
INFOGRAPHICS ON “Combating a Pandemic: What can we learn from successful
https://www.bsg.ox.ac.uk/research/publications/variation-government- countries (37)”
responses-covid-19 By: Allessandria Daphne S. Bagacina BSN 2A Polangui Campus
ho.int/westernpacific/news/feature-stories/detail/new-zealand-takes-early- Submitted to: Kim Jim F. Raborar on 30 January 2021, for GEC Science,
and-hard-action-to-tackle-covid-19 Technology, & Society.
Lessons from New Zealand's COVID-19 outbreak response
In the absence of a vaccine for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or of highly effective pharmaceutical treatments for COVID-19, countries have implemented a large range of non-
pharmaceutical interventions to control the spread of the virus.1 These interventions differ in their level of stringency (ie, the severity of the measures) and their ultimate objective (eg, prevent health systems being
overwhelmed, suppress incidence to low levels, or reduce incidence to zero and keep it there). With many countries facing epidemic resurgence, evaluating the impact of different strategies implemented in the early phases
of the pandemic is crucial for developing an effective long-term response.

New Zealand adopted a set of non-pharmaceutical interventions aiming to bring COVID-19 incidence to zero.2 In The Lancet Public Health, Sarah Jefferies and colleagues3 describe the impact of New Zealand's national
response on the transmission of COVID-19 using two detailed sets of data: (1) the features of 1503 laboratory-confirmed and probable cases and (2) the list of all patients tested for SARS-CoV-2 in New Zealand between
Feb 2 and May 13, 2020. The authors showed that many transmission chains started from younger imported cases, with a total of 575 imported cases and 459 import-related cases, and reached more vulnerable parts of the
local population further down the chain (eg, residents of residential care facilities). Locally acquired cases were older, came from lower socioeconomic backgrounds, and were more likely to be associated with severe
outcomes than imported cases (crude odds ratio 2·32, 95% CI 1·40–3·82). The authors highlight that transmission chains were spread out across the country, with the highest incidence in popular tourist areas, and large
transmission events such as weddings led to transmission chains containing multiple age groups. Similar dynamics have been reported elsewhere—eg, in Europe where young adults were infected upon visiting ski resorts
and returned with the infection to their countries.4 The reconstruction of detailed epidemiological links is paramount to improve understanding of the spread of SARS-CoV-2 and keep close surveillance on settings with
high risk of transmission.

Identifying transmission chains before they spill over into vulnerable populations relies on detecting new importations, finding existing transmission chains through widespread testing and contact tracing, and isolating
new cases and quarantining their contacts. Jefferies and colleagues highlight that this was achieved in New Zealand thanks to the rapid improvements in testing capacity and case management: by late April, the time from
onset of symptoms to notification had been reduced from 9·7 days (95% uncertainty interval 8·8 to 10·7) to 1·7 days (1·2 to 2·2), and the time from onset to isolation from 7·2 days (6·3 to 8·2) to −2·7 days (−4·7 to −0·8),
meaning that people were isolating an average of 2·7 days before illness onset. Therefore, cases were isolated from the community promptly, reducing the risk of onwards local transmission. From mid-April onwards,
higher-risk groups were targeted for tests by population testing surveys to avoid undetected circulation of the virus. Nevertheless, the authors report only 25 asymptomatic infections in the dataset, which corresponds to
1·7% of all cases. This is much lower than the commonly reported proportion of asymptomatic infections in COVID-19 outbreaks, which varies between 20% and 40%.6 This finding suggests that many asymptomatic
individuals remained undetected despite targeted testing of groups less likely to show symptoms in the late phases of New Zealand's epidemic. Comparing setting-specific serosurveys and surveillance data could reveal the
profile of infections that New Zealand's surveillance system struggled to identify, thus highlighting an area for improvement in the infection detection process. This could also indicate whether the detection of
asymptomatic infections should be a priority, as recent genomic epidemiology studies suggest many introductions did not result in transmission chains,7 which might be linked to a lower infectiousness of asymptomatic
individuals.

The lockdown implemented in New Zealand was remarkable for its stringency and its brevity: Jefferies and colleagues show that the daily number of cases dropped below ten in mid-April, less than a month after the first
increase in New Zealand's Alert Level.8 Furthermore, although most of the cases reported by mid-March were imported, almost no further importation was observed 2 weeks after the implementation of the first travel bans
and isolation orders: imported cases represented 58% (95% CI 53–62) of the cases before March 15 but just 38% (36–41) of the total. Control of importations and local transmission in New Zealand was achieved with
stringent non-pharmaceutical interventions implemented rapidly when infection numbers were low: the Alert Level escalated from 1 to 4 in 5 days, when the number of cases had just passed 1000. Such stringent measures
do not always result in a rapid drop of cases: the lockdown implemented in Melbourne on Aug 5, 2020, shows that it can take months before incidence is brought to minimal levels, with measures kept in place until late
September. Long-lasting lockdowns also cause major economic disruption, deterioration of mental health in the population,9 and other indirect health consequences,10 ultimately decreasing population compliance. As
other high-income countries have reported an increasing number of cases since August, 2020, the experience of New Zealand highlights that successful non-pharmaceutical interventions rely on early decisive reactions
from health authorities, performant surveillance systems, and targeted testing strategies as much as stringency.
 New Zealand’s early success in controlling coronavirus disease
2019 (COVID-19) has been described as “crushing the curve”.
Until 15 June, the country had gone more than three weeks
without any new infections. By 2 July, New Zealand had
recorded 1,180 confirmed cases with 22 deaths since the first The need for speed
case on 28 February. New Zealand’s Director-General of
Health Dr Ashley Bloomfield says the country’s strategy was Three days after WHO declared the coronavirus outbreak a
based on speedy testing, contact tracing and isolation, while public health emergency of international concern on 30
rigorously adhering to public health guidance. January 2020, New Zealand began introducing disease
prevention measures and continued strengthening them in
Guided by science and data the weeks that followed. He says their strategy was
At every step of the response, the Government of New influenced by a report from the WHO–China joint mission Gateway to the Pacific
Zealand was guided by public health advice and evolving in February. “This report, including the observation that,
evidence, Dr. Bloomfield says. Technical guidance, The Government of New Zealand called on the entire population to unite as a “team of 5
‘the key learning from China is speed – it’s all about the million” to protect their families, friends and neighbors. Concerned that COVID-19 could be
outbreak updates and risk assessments from WHO played
a key role. speed. The faster you can find the cases, isolate the transmitted through New Zealand to Pacific island countries – which are some of the only
“WHO provided a valuable trove of information, collated cases, and track their close contacts, the more successful places still free of COVID-19 – the Ministry of Health and Ministry of Foreign Affairs and
from many sources, analyzed by WHO’s own experts and you’re going to be,’ helped influence New Zealand’s Trade worked closely with WHO to support their neighbors in the Pacific. This included
presented very clearly,” he says. “The Ministry of Health strategy to ‘go early and go hard’,” says Dr Bloomfield. procuring supplies and providing training to health staff within those countries and via
often used or referred to WHO material in our own
Observing the spiralling epidemic and its devastating remote support.
situation reports and advice to ministers and the public.”
The International Health Regulations (2005), known as impacts in Europe, he says the Government was
IHR (2005), also provided an invaluable framework for “determined to minimize the impact of COVID-19” in New
sharing information about the virus and its evolution, he Zealand. From late February through March, the country
adds. IHR (2005) requires national focal points to share progressively tightened restrictions.
information with WHO and other countries and to build
core capacities for fighting disease outbreaks. COVID-19
has stress-tested these capacities like never before.
Not letting down their guard
Additionally, Dr. Bloomfield credits the key role of WHO
New Zealanders worked together to keep case numbers low and stamp out the virus at home. But they are not resting on that success. New Zealand has not let down its guard, says Dr Kasai.
strategies on disease surveillance and response,
laboratory capacity, infection prevention and control, and “New Zealand continues to be vigilant,” he says. “The Government is rightly cautioning that the virus is still circulating around the world and that New Zealand must work hard to keep it from
risk communication. The strategies were “indispensable in returning. They also must maintain readiness to reintroduce control measures if it does.”
the current pandemic and have stood well the test of
time,” he says. In late June, the authorities in New Zealand detected several imported cases, which have been isolated and their contacts traced to reduce the risk of transmission.
“New Zealand recognizes the very critical role that WHO
plays in public health emergencies and has valued its
global and regional leadership and the sharing of
The lockdown implemented in New Zealand was remarkable for its stringency and its brevity: Jefferies and colleagues show that the daily number of cases dropped
information and expertise throughout the response to
below ten in mid-April, less than a month after the first increase in New Zealand's Alert Level. Furthermore, although most of the cases reported by mid-March were
COVID-19,” he adds.
imported, almost no further importation was observed 2 weeks after the implementation of the first travel bans and isolation orders: imported cases represented 58%
(95% CI 53–62) of the cases before March 15 but just 38% (36–41) of the total.