It's been more than 80 days since New Zealand's first case of Covid-19 was announced. Our Government has been globally lauded for squashing the virus – but did it get everything right? Science reporter Jamie Morton talks to four experts who have been prominent voices throughout our coronavirus saga: Otago University epidemiologist Dr Ayesha Verrall; University of Auckland microbiologist Associate Professor Siouxsie Wiles; Te Punaha Matatini physicist and modeller Professor Shaun Hendy; and the Prime Minister Jacinda Ardern's chief science adviser, Professor Juliet Gerrard.
Broadly, how do you feel New Zealand has responded to this pandemic?
Siouxsie Wiles (SW): Really well. I think we should be proud of how our '"team of five million" pulled together to stop the spread of the virus here. It has clearly been a very difficult time for lots of people, but I'm grateful to all the essential workers who had to leave their bubbles so that the rest of us could stay in ours.
Shaun Hendy (SH): In a few weeks I hope we'll be able to say that "we knocked the bastard off", as we are on track to be one of just a handful of countries that eliminate the virus. Many other countries will be faced with multiple waves and multiple lockdowns, possibly for several years, and that is going to be very tough. We had a bit more warning than the rest of the world, but then we moved very quickly as case numbers began to mount. Early on, I did wonder whether it would be possible here to emulate China in eliminating the disease, but the public responded very positively to make the lockdown a success and this has put us in an enviable position. We now have much more control over our future and we have an opportunity to get back to something resembling normal life much sooner than the rest of the world.
Juliet Gerrard (JG): I'd tend to agree with the international commentary that we have collectively done a great job. The very low number of new cases in the last week is extremely encouraging and supports the view that everyone's efforts to stick to the lockdown really did break the chains of transmission and eliminate the virus. We still need to be vigilant, but it is hard to imagine that we could have been in a better position at this stage. Tino pai.
Ayesha Verrall (AV): It has been effective and I think that is the most important thing. And I think we have leant heavily on collective action, as opposed to other countries that have focused more on case-based measures.
At the outset, was New Zealand unprepared to deal with a pandemic? Were there measures we should have had in place but didn't?
SW: Yes, or at least a pandemic of this nature and that was clear from how badly we had scored in a recent global analysis of pandemic preparedness. But in many ways that may have contributed to our success, as several countries that had very good plans in place have fared far worse than us, perhaps because they had a false sense of security that they were prepared.
SH: The research community really needed a Centre of Research Excellence or a National Science Challenge with an infectious disease focus. It still staggers me that Sir Peter Gluckman's panel dismissed a Science Challenge for infectious disease because they believed our science capability in this area was not up to scratch. In the event, the University of Otago's School of Public Health has really stepped up, along with many other infectious disease experts around the country, but much of this work has not been funded. My organisation, Te Pūnaha Matatini, has been very proud to support Siouxsie Wiles, New Zealand's leading science communicator, and to contribute to filling the gap in modelling capability, but we've done that by diverting resources from other activities. We should have had an interdisciplinary science organisation in place to coordinate and resource these activities well before the pandemic hit.
JG: Very few countries are fully prepared to deal with a one in 100 year event, but places that had encountered SARS outbreaks were arguably the best prepared to deal with Covid-19. Like many other countries, our pandemic plan was based on a hypothetical flu pandemic, but was written in a way that meant it could be adapted to Covid-19 as we learned more about it. This stood us in good stead. Hindsight tells us what would have been helpful to have in place earlier - and top of my list would be a centralised data management system which is transparent and accessible.
AV: I discovered from documents that our contact tracing capacity was just 14 cases a day when we first had the outbreak. That capacity had to be built extremely quickly in the face of the pandemic. In a more general sense, we had more fragmented public health institutions. A lot of the surveillance expertise outside of the Ministry of Health had to be drawn from academics and DHB specialists. That's an area where the balance needs to be addressed.
What were critical points in our response that allowed New Zealand to get on top of the pandemic here?
SW: We were fortunate in that we had time to see how the pandemic was progressing overseas and how different actions taken by different countries made a great deal of difference to the numbers of cases and deaths. It was clear that we only had a small window of opportunity in which to act, if we wanted to quickly bring the outbreak under control and prevent what was happening in countries like Italy which had far better hospital capacity than we did.
SH: Communication has been absolutely critical. From the Prime Minister to the person on the street, everyone has understood and embraced the national strategy to eliminate the Covid-19. In other countries, it has been clear that poor communication and coordination has allowed the pandemic to take hold.
JG: Careful monitoring of events overseas allowed New Zealand to see that the "manage it" phase of our plan was not appropriate for Covid-19. Recognition of this by Director-General of Health Dr Ashley Bloomfield led to the key insight that we should maintain the "keep it out" and 'stamp it out' phases of the pandemic plan and in so doing shift to an elimination strategy. This was a critical strategic choice. Beyond that, the great work that our lab scientists, led by ESR, did to get testing up and running and scaled in time to meet the need was vital. Similarly, the work done to get contact tracing up and running and performing in a nationally co-ordinated way has been critical, and the work of Ayesha Verrall was pivotal here.
AV: The lockdown was the decision that gave us the best chance to get ahead of the virus and reverse what was bound to become a very rapid increase from there. It's been the definitive moment so far. Prior to that, there was restricting travel from China, which was the boldest decision at that point. There were no key points at which testing and contact tracing ramped up, but they were other key things.
Do you feel the result for New Zealand could have been a much different one, had the country waited longer to go into lockdown, or to close the borders?
SW: Yes, there is no doubt that the longer a country takes to act, the more transmission chains there are, the more and longer lockdowns are needed to bring the outbreak under control. Like us, many countries are easing restrictions, but unlike us, they do not have community transmission of the virus under control so I expect we'll see their case numbers begin to rise again and with it the number of people dying. It's heart-breaking.
SH: It was essential that we took those actions when we did. If we had waited longer our contact tracing and testing capability, both so important for containment and elimination, may well have been overwhelmed.
JG: Yes - and there is lots of evidence for this offshore in countries who waited longer. The many scenarios that we could have been in are playing out in real time overseas.
AV: The longer we waited, the worse it would have been, and the higher the cases. We may never have got control of the virus. Just remember, at that point, we were already beyond our contact tracing ability when we went into lockdown and there were two or three cases that we suspected to be community transmission. I think it would have almost certainly been a different outcome and a just a matter of days could have made all of the difference.
What are the big things you feel that New Zealand has already learned from this experience?
SW: I hope that everyone has learned the importance of a robust and well-funded health system, and just who our "essential" workers really are. We owe them our respect and gratitude. But more than that, we owe them a living wage. I do hope this experience helps us as a society adjust our ideas of what we value.
SH: It shows that we don't always have to be a follower; there are times when New Zealand can lead the world and show everyone else what is possible. I hope we can harness the momentum from our Covid-19 response to lead the world in a green recovery that tackles climate change and inequality.
JG: We have learned that a solid policy framework needed to be adapted at pace as we learned what tactics were working best overseas. That clear communication of complex science and difficult policy choices is vital to galvanise collective action. And I hope that decisive collective action can make a positive difference for all us, which might help us tackle other problems - like rethinking plastic use and tackling climate change.
AV: This has been an example where we have mounted one of the best responses in the world because we have pulled together. For health agencies, it's been about getting over some of our preconceptions about how the ministry, DHBs and public health units all relate to each other. There's a lesson that we can achieve more for people if we have a more active ministry, in terms of more central co-ordination and more co-operation and sharing of information.
Is it too soon to state – as some overseas news media outlets have – that New Zealand has won the battle against Covid-19?
SW: I think it's a bit too premature to say we have "won". So many other countries have seen a second wave of infections. I hope we don't see that here in a few weeks' time.
SH: We are very close. We haven't seen a wave of new infections from the level 4 to level 3 transition, and for many weeks we have only seen cases related to known clusters or from international travel. There is still a chance that undetected transmission is occurring, but if we keep our testing rates up and have another few weeks of no new cases then we can be confident that we have eliminated the virus. It is important that we remain vigilant, however, particularly as we open up the borders, and there will no doubt be introductions in the future.
JG: Yes. Progress has been fantastic but it is still likely that we have stray cases out there, and we need to stay vigilant to avoid returning to square one. It is a bit like a snakes and ladders board. We are nearly at the finish but it is not too late to slide down a giant snake.
AV: We shouldn't say that at all because it is hubristic. This virus is a force of nature and we should not over-state our success because we will have to work at control for our foreseeable future, one way or another. While we should be an example to the world, we should also want to avoid any triumphalism.
Do you feel trust in experts by the Government and the public - as well as trust in Government by the public - were crucial factors here?
SW: Yes, I do think trust in experts and the government was important for our response. But so were values. All around the world people are using the same evidence and acting differently based on what they value. In some places governments and their advisors are also cherry-picking from the evidence to support their choices. There are a vocal minority of experts who would have seen us take a different path so I think it's important for experts to also be transparent about their values so that people can see the lens through which their expertise is offered.
SH: One of the key elements of our success has been the accessibility of both our politicians and the experts advising them. A few key experts, including Ashley Bloomfield, Siouxsie Wiles, and Michael Baker, have made themselves available every day to keep the public as briefed and as well informed as our politicians. This openness has been hugely important in establishing trust.
JG: Absolutely - both were critical elements of success.
AV: It's easy to take those things for granted in New Zealand, but when you look at the very difficult situations other countries are facing, it's important. There was only a small minority of people protesting lockdown here, in the face of the science. When it comes to a deadly outbreak, misinformation can have really deadly consequences.