The first six months of 2020 introduced Kiwis to Covid-19, saw us forced into a month-long lockdown and then brought us liberation - only for there to be a border blunder and a renewed spate of cases caught in quarantine.

What will the rest of the year bring? In an in-depth interview with the Herald, Otago University epidemiologist Professor Michael Baker said Kiwis could expect the next months to stay relatively quiet for New Zealand - assuming our border measures didn't crack under stress.

Life after elimination

"While you'd have to be pretty brave to predict the future beyond the end of this year with much certainty - I think some of the biggest uncertainties for New Zealand have now been removed," he said.

"We know that elimination has fulfilled its promise, with those key elements of managing our borders, contact tracing, and lockdown.

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"Those three things have been enough to stop the virus - so we know they work - and now we've got additional measures. So I think people can feel very confident that elimination can be sustained."

Modelling has suggested that new cases will continue to trickle in at a rate of about 12 new cases each week, on the back of travel to the country having risen from 1000 per week in mid-May to about 2500 now.

More travellers were also coming from countries dealing with surges in Covid-19 - notably the US and India - as the pandemic surged around the world.

Baker pointed out that New Zealand was in rare company, not just because it had avoided a major outbreak and effectively achieved elimination, but had been spared the setbacks that had been seen in other high-performing countries like Singapore, South Korea, China, and now Australia.

But things have been far from perfect here.

It was only last week confirmed that 51 of 55 travellers given compassionate exemptions to leave isolation early had done so without being tested. That revelation came amid a raft of other flaws and blunders that were exposed over the past few weeks, including the release of two sisters who happened to be infected.

And a major review released this afternoon also found New Zealand's managed isolation and quarantine facilities were under "extreme stress" and unable to respond to increasing demands as more Kiwis returned home.

Currently, there were over 4000 people in managed isolation and the facilities were now in four different cities.

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The Government had 6500 beds available for isolation, with just a week's spare capacity, and the criteria for facilities were high.

The audit found the system needed to be ramped up, and that there should be better oversight of passengers as they were transferred from the airport to managed isolation or quarantine facilities.

"People can feel very confident that elimination can be sustained," Otago University epidemiologist Professor Michael Baker says. Photo / Mark Mitchell

It said an immediate review of the policies of various Government agencies regarding the wearing of personal protective equipment was also required.

Baker however contended that New Zealand was still yet to see a serious setback.

"We've had some scares with quarantine - but that is not the same as an outbreak, and I think you'd have to explain that to people."

Baker figured the way data was being officially reported wasn't doing the country any favours, as the Government didn't formally classify cases detected at the border as different from cases of community transmission.

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New Zealand has only recorded 89 local cases where the source of transmission was unknown - and the most recent of those was back in early April.

"Since we've achieved elimination, all of our cases have generally been diagnosed at the border," he said.

"Yet any international commentary on New Zealand makes it appear that we still have transmission. It's a weakness of the global reporting system that needs to be worked on, and I've spent a huge amount of time explaining to overseas journalists, that, no, New Zealand is not having new outbreaks."

He said the only risk to New Zealand remained a breach in its two-step border barrier, comprised of the two-week quarantine and two tests at the start and end of containment.

"Still, we have to plan for that possibility. Now that we've got more time to get additional barriers in place, we can work on these in a more orderly way."

Time for big improvements

Baker said New Zealand should be running simulations of different outbreak scenarios to test its contact tracing capacity. The Ministry of Health can currently trace around 5000 contacts in a day - a job that's been made easier by the fact that more than half a million Kiwis have signed up to the delayed NZ COVID Tracer app.

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New Zealand's quarantine and isolation systems are under extreme stress, a new audit has found. Photo / Dean Purcell
New Zealand's quarantine and isolation systems are under extreme stress, a new audit has found. Photo / Dean Purcell

Ensuring the health authorities could swiftly stamp out any further incursions would be crucial before New Zealand looked to tweak its border arrangements.

"There are two big questions we face here. One is how we might increase the volume of people coming through quarantine, while figuring out how to manage that in the most effective way," he said.

"The other, of course, is when and whether we allow quarantine-free travel to certain countries. It seems certain that there will be other countries that we can open up for.

"Those would be countries like the Pacific Islands, that have never had the virus, or countries that have eliminated it, like Fiji, Taiwan, parts of Australia, and hopefully soon, all of Australia."

For that to happen, he added, any countries we extended our bubble to would need to have a shared defintion of elimination - with a built-in requirement of rock-solid surveillance systems that could effectively detect new cases as they turned up.

"Another thing we could do during this period is carry out a review of our response, and establish a new and dedicated national agency for public health," he said.

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"I think anyone who has looked at the system, or worked within it, would know that this is desperately needed. That we didn't have it was so evident in our response, and it took everything that New Zealand had to manage the pandemic.

"In the end, we did that successfully - but it came at a big cost, in terms of all of the other functions of government and our health system that could not happen over that period.

People getting fresh air outside Auckland's Rydges Hotel, which has been used as a quarantine centre for Covid-19. Photo / Dean Purcell.
People getting fresh air outside Auckland's Rydges Hotel, which has been used as a quarantine centre for Covid-19. Photo / Dean Purcell.

"Ultimately, most of New Zealand would now be looking at what has happened over the last few months, and would recognise there's a huge hole in our capacity that needs to be filled."

A bleak global outlook

For most other countries, Baker summed up the outlook in one word: grim.

"That is because it is only getting started in most countries. I don't know why there was a strange sense of optimism early on, where we thought we were over the peak and going down the other side."

Rather, this pandemic was expected to take years to work its way around the globe, and it so far hadn't deviated from the trajectory scientists predicted back in January.

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"We are learning more about it, and there are some big unknowns – but we expect that it is programmed to infect around 60 per cent of the world's population," he said.

"This is not millions, but billions of people. Estimates are converging on it killing about one per cent of the population, so that's a burden of more than 20 million people who may die from it in the next few years."

At the same time, scientists were trying to answer some of the most pressing questions around Covid-19 and immunity.

One was that there may be some cross-immunity from other coronaviruses that might protect more people than we think.

Another was that there was very little immunity in the population, which could see it ultimately infect 60 to 70 per cent of people on the globe.

A third hypothesis was that there may be long-lasting immunity among people who have been exposed to it.

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"Yet another view is that there isn't, and the virus just keeps circulating, and coming back in waves year after year, cutting a swathe through the population and killing about 1 per cent each time it goes through," he said.

"We are talking here about older people, or those with co-morbidities, who make up quite a large proportion of the world's population."

Residents line up to get tested at a coronavirus testing centre set up outside a sports facility in Beijing. Photo / AP
Residents line up to get tested at a coronavirus testing centre set up outside a sports facility in Beijing. Photo / AP

The one ray of hope was the possibility of getting an effective vaccine, in mass quantities, within the next one to two years.

But even if that could be achieved – vaccines typically take a decade to produce, and it's far from guaranteed one can be found for SARS-CoV-2 – that didn't mean it could bring immunity to older populations.

"Things like flu vaccines actually don't work very well in older people. I'd say there is so much uncertainty in that area that it is generally unpredictable."

Baker was heartened, however, that an increasing number of countries – Scotland and Ireland among them – were seeing merit in New Zealand's elimination approach.

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"Rather than sitting there and waiting for the uncertain development of immunity, they'd be far better to head for elimination, too," Baker said.

"Many countries are moving away from the influenza-based mitigation model to a suppression model, including most countries in Europe, and some states in the US.

"If you can actually get to the point where you've got so little of the virus circulating, then why not go to that next step of elimination? These countries have all of the elements in place to do this, but it comes down to political will, and a degree of infrastructure.

"In the end, I think the world will be split into two camps. Those that are eliminating the virus or heading down that pathway, and which have very little or no transmission – and others that have decided they want to co-exist with the virus in some way, because they think that might be better for the economy.

"Sadly, there are some countries where there's a threat this pandemic is going to push them into failed states, where they cannot sustain all of their essential services, and become at risk of facing civil disorder."