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6 months after New Zealand’s first COVID-19 case, it’s time for a more strategic approach

Today marks six months since New Zealand’s first COVID-19 case was identified on February 26.

So far New Zealand has been largely in reactive mode, initially during the first elimination stage which finished in early June and now in response to the ongoing Auckland outbreak.

Given the vigorous response to controlling this current cluster, we have a good chance of eliminating community transmission again.

But to maximize our protection against future border control failures and outbreaks, we argue it is time to take a far more strategic approach to this pandemic—and we suggest five key steps New Zealand should take.

Strengths and weaknesses of New Zealand’s response

An effective ongoing response to COVID-19 is an all-of-government challenge. It requires seamless coordination of scientific input, policy design and implementation.

An early shift from a mitigation to an elimination strategy was a major strength of New Zealand’s response.

The combination of border controls with a stringent lockdown, supported by considerable science input, including from the government’s chief scientists, was effective in eliminating community transmission after the first outbreak.

As a result, New Zealand now has the lowest COVID-19 death rate in the OECD and relatively low economic damage compared with other high-income countries.

But there are serious weaknesses, including multiple failures at our managed isolation and quarantine facilities and slow adoption of digital technologies for contact tracing and mass masking.

Challenges ahead

The most pressing challenge is to bring the current outbreak (New Zealand’s largest cluster, with 108 cases) under control. We also need to learn from this new more targeted resurgence response so we can improve our ability to detect and control any future outbreaks.

Genome sequencing and COVID-19 testing of wastewater are promising new surveillance approaches. But we will also need to upgrade the alert level system to integrate the use of face masks and address high-risk transmission venues such as bars and nightclubs and incorporate new knowledge about controlling transmission.

Contact tracing should also be improved through digital technologies, including the COVIDCard.

A second key challenge is to improve the management of our external borders to minimize the risk of introducing the virus. The border is New Zealand’s greatest vulnerability and we need an urgent review of the entire process from pre-travel to post-quarantine.

Last week, the government and the main opposition party both announced new border control policies that include the adoption of digital contact tracing technologies.

Modeling by ourselves and colleagues has been useful for assessing various border control interventions. Options include the use of digital technologies for tracking arriving passengers and staff and monitoring contact patterns.

There are also important questions about how to improve quarantine, the benefits of purpose-built facilities (with proper ventilation and no shared spaces), and shifting isolation and quarantine facilities out of major cities (for example, to an air force base).

A further challenge is planning for the introduction of a vaccine. There is a long list of uncertainties to work through with any COVID-19 immunization strategy, including the extent and duration of immunity and who should be targeted for immunization (assuming limited initial supplies). New Zealand should begin planning now to improve the national immunization register to support vaccine delivery.

Countries pursuing elimination have different science challenges compared with those where transmission is more widespread. They need to shift their focus to include ‘low-probability high-consequence scenarios,” such as the potential role of imported chilled food as a vehicle for the reintroduction of COVID-19 in the recent outbreak (albeit still much less likely than a border control failure).

Five key ways to be more strategic

We propose five key ways New Zealand could be more strategic in maintaining its elimination goal:

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