The Delta variant is forcing New Zealand to find a safe way out of its “zero COVID” strategy
For much of the pandemic, Aotearoa New Zealand’s COVID-19 response is considered one of the best in the world. We lived in a parallel world, one of the few countries that have an elimination strategy. This strategy has resulted in very few COVID-19 cases and deaths. And when I say very few, I mean it too. As of August this year, there were just over 2,800 confirmed cases and 26 deaths. We experienced a large part of the pandemic with an almost unrestricted everyday life. As someone closely following the global situation, it was surreal. I’ve spent much of this pandemic worrying New Zealanders are becoming complacent to the threat posed by COVID-19. The Delta variant came from Australia in mid-August. In just over two months, our confirmed cases have grown to over 4,700 and two more people have died. Now we begin to experience what happens when delta and inequality meet.
New Zealand’s first confirmed case, reported on February 28, 2020, came through Iran. Less than a month later, a state of emergency was declared and our borders closed to all but New Zealand nationals and permanent residents. At the time, there were fewer than 30 confirmed COVID-19 cases, all in people traveling to New Zealand from overseas. However, by March 25, that number had grown to 205 confirmed COVID-19 cases, including the first unrelated to international travel. At 11:59 p.m. that day, one of the strictest lockdowns in the world began across the country. The majority of New Zealand’s 5 million residents stayed at home, with many benefiting from a government wage subsidy program. People were only allowed out to shop, see the doctor and do sports.
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We came out of lockdown 11 weeks later on June 9th with no active COVID-19 cases. The only restrictions that remained were those at the border. Government officials and officials spent the lockdown increasing our PCR testing and contact tracing capabilities. They also set up a hotel quarantine system administered by the New Zealand Defense Force, which allows international comers to spend their first 14 days in the country. Our first contact with COVID-19 had resulted in a total of 1,154 confirmed cases and 22 deaths.
Since June 2020, thousands of troops have worked hard to keep the virus at bay on the New Zealand border. No system is perfect, so we had encroachments. But every time our “hard and early” approach of using lockdowns, wastewater testing, and genome sequencing alongside PCR testing, contact tracing, and isolation of all cases and contacts, has quickly reverted to elimination. Because of this, we have enjoyed 464 days without job closings throughout the pandemic. Our kids went to school and we enjoyed concerts, festivals, sports and indoor dining. We even had a quarantine-free travel bubble with Australia and the Cook Islands until the New South Wales outbreak put an end to that. It was hard to know what to say to friends, family, and acquaintances overseas who spent so much of the pandemic living under restrictions, experiencing illness, and witnessing the death of loved ones.
As early as March 2020, many international journalists asked me why New Zealand had acted this way. The answer was simple. We had seen China build pop-up hospitals in a matter of days, and doctors in Italy had to decide which of their patients would live and die. With fewer intensive care beds than Italy, massive inequality, and high levels of diabetes and other illnesses, we knew that our healthcare system would quickly become overwhelmed.
Following an elimination strategy has been good for both our health and our economy. It is therefore no surprise that 85% of New Zealanders have consistently supported the strategy. Not everyone was happy about it, however, and the limited capacity of our hotel quarantine system is preventing thousands upon thousands of the New Zealand diaspora from returning home. There were daily calls from media columnists, talkback moderators, and various companies to relax restrictions and “learn to live with the virus.”
Nevertheless, on August 17, 2021 at 11:59 p.m., the government put all of New Zealand back into its strictest form of lockdown. A single case of COVID-19 had been identified in the Auckland community. The reasons for the move were clear. It wasn’t immediately clear how the virus had penetrated our defenses or how long it had been circulating in the community. It was probably the more contagious and dangerous Delta variant as well. And while New Zealand was introducing the Pfizer vaccine, limited supplies meant only a small percentage of people were fully vaccinated.
The government was right to be careful. Genome sequencing soon showed that the Delta variant had arrived in New Zealand from a traveler who had returned from Australia. The virus hadn’t been circulating in the ward for long, but a few days before the first known case became symptomatic and tested, someone was attending a large church meeting. It’s easy to wish that one of the previous cases got tested instead of assuming that its symptoms weren’t COVID-19. Things could be very different now if we had captured the outbreak prior to the Super Spreader event.
Continue reading: What we learned about genetic sequencing during COVID-19 could revolutionize public health
Our “Go Hard and Early” strategy initially worked well again. The lockdown restricted the outbreak to Auckland, and by September 7, the majority of the country was moving out of the restrictions. Kindergartens, schools and universities have reopened there. Likewise, cafes, restaurants, bars and nightclubs, although large gatherings are off the table. Our daily falls peaked at 79 and then began to decline. But they didn’t come to zero. Then the daily case numbers began to grow again. They are still tiny by global standards. But we started seeing cases that weren’t part of households that were already isolated. It had begun to circulate in communities afflicted with decades of growing inequality. After keeping the pandemic in check for so long, it felt like Delta was going to be difficult to eradicate. In fact, the cordon around Auckland is not impenetrable and other parts of the North Island are cordoned off again as cases have occurred there.
New Zealand’s elimination strategy required two really important things: restrictions that just two years ago seemed totally unthinkable, and the social license to put those restrictions in place. On October 4th, Prime Minister Jacinda Ardern announced that the restrictions would be relaxed – Aucklanders could meet outside with people from other households, for example for a picnic in the park. Arden had asked their health authorities to look into what restrictions could be relaxed without significantly increasing transmission. We have all watched the growing anti-restriction demonstrations in Australia. To me, Arden’s announcement signaled a government trying to maintain the most effective restrictions while maintaining social license.
But it also signaled that we were starting to move from the elimination strategy to a new one where we would use vaccine and vaccine passports, masks, improved ventilation, rapid tests, and other tools to minimize transmission, along with testing, contact tracing, and Isolation to control transmission chains and clusters as they arise. We need to keep cases down or we risk overwhelming our health systems, especially since so many New Zealanders, especially those in the most vulnerable communities, are not yet fully vaccinated.
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There is nothing inherently wrong with moving away from elimination as a strategy and it was a transition New Zealand had to make at some point. But the safest time to make this transition would have been next year, once a vaccine for children under the age of 12 was approved and COVID-19 was not in our community. That this happens with an active delta outbreak means that it is dangerous to give any part of New Zealand all of the freedoms we have enjoyed for so much of this pandemic.
I’m not sure most people in New Zealand know what the transition from elimination really means to our daily lives. As I already explained, we live in a parallel world in which there is largely no risk of falling ill or dying from COVID-19. But as we have seen around the world, controlling the delta is difficult and requires changes in the way we have lived through the pandemic so far. What makes me sad the most is that it is necessary for some people to weigh up whether it is safe for them to do things that we could all do if we followed an elimination strategy. Now the message seems to be that they may need to manage their own risk.
how does it look in action? Take, for example, people with some types of cancer. Those who can stay at home have to choose between the damage caused by the indefinite isolation and the risk of falling seriously ill or dying if they leave. Those who are not privileged enough to stay home take control of their lives. It seems like a social failure to me. And we’ve seen well enough around the world that the burden of COVID-19 only increases inequality. In many countries, access to vaccines and treatments has been divided on the basis of ethnicity and socio-economic considerations. Meanwhile, the most vulnerable are those who work in several low-wage jobs.
New Zealand is one of the few countries that has implemented an elimination strategy for COVID-19. The first concession was Australia when the state of New South Wales decided not to attempt to clear the delta after the virus broke its hotel quarantine system in June 2021. The state of Victoria has had to follow in their footsteps, but the rest of Australia still supports the elimination. Maybe they can hold out until a vaccine is available for younger children. Mainland China and Taiwan are also holding up. In May 2021, Taiwan experienced a major alpha outbreak and sporadic delta variant outbreaks in small communities that they managed to contain.
New Zealand has tried in many ways to go the way we should all have gone. Nobody said it would be easy, but that so few countries have even tried to stop COVID-19 early is why we have the Delta variant in the first place. And it’s unlikely to be the final line of concern. Worse still, while the world now has safe and effective vaccines for COVID-19, they are not available to everyone. Now COVID-19 is becoming a disease of the unvaccinated. That the global supply of vaccines is still limited is a decision that is causing a humanitarian disaster that should not happen. Nobody is safe until everyone is safe. Future generations will be appalled by how much we screwed up all of this.
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