Thursday, 21 October, 2021

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 has ranked as one of the best in the world. We have been living in a parallel world, one of a small handful of countries to follow an elimination strategy. That strategy has meant that we have had very few COVID-19 cases and deaths. And when I say very few, I mean it. Until August this year, there had been just over 2,800 confirmed cases and 26 deaths. We have lived much of the pandemic with daily life almost unrestricted. As someone who follows the global situation closely it has been surreal. I’ve spent much of this pandemic worried that New Zealanders were becoming complacent to the threat posed by COVID-19. Then in the middle of August, the delta variant arrived from Australia. In a little over two months our confirmed cases have risen to over 4,700 and two more people have died. Now we’re beginning to experience what happens when delta and inequality collide.
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New Zealand’s first confirmed case, reported on Feb. 28, 2020, came via Iran. Less than a month later, a state of emergency had been declared and our borders closed to all but New Zealand citizens and permanent residents. At the time, there had been less than 30 confirmed COVID-19 cases, all in people traveling to New Zealand from overseas. But by March 25, that number had grown to 205 confirmed COVID-19 cases, including the first with no link to international travel. At 11:59 p.m. that day, the whole country began one of the world’s strictest lockdowns. The majority of New Zealand’s 5 million residents stayed at home, many supported by a government wage subsidy scheme. People were only allowed out for grocery shopping, medical appointments, and exercise.

Read more: Inside One of the World’s Longest Lockdowns

We emerged from lockdown 11 weeks later, on June 9, with no active COVID-19 cases. The only restrictions that remained were those at the border. Government officials and public servants spent the lockdown scaling up our capacity to do PCR testing and contact tracing. They also established a hotel quarantine system managed by the New Zealand Defense Force, where international arrivals spend their first 14 days in the country. Our first brush with COVID-19 had resulted in a total of 1,154 confirmed cases and 22 deaths.

Since June 2020 a force of thousands has worked hard to keep the virus at bay at New Zealand’s border. No system is perfect, so we’ve had incursions. But each time our ‘go hard and early’ approach of using lockdowns, wastewater testing, and genomic sequencing alongside PCR testing, contact tracing, and isolation of all cases and contacts, has quickly seen us get back to elimination. Because of this we have enjoyed 464 days of no workplace closures over the entire pandemic. Our children have been in school, and we’ve safely enjoyed concerts, festivals, sports, and indoor dining. We even had a quarantine-free travel bubble with Australia and the Cook Islands, until the outbreak in New South Wales put a stop to that. It’s been hard to know what to say to friends, family, and acquaintances overseas who’ve spent so much of the pandemic living under restrictions, experiencing illness and the deaths of loved ones.

Back in March 2020, plenty of international journalists asked me why New Zealand had acted as it had. The answer was simple. We’d watched China build pop up hospitals in a matter of days and seen doctors in Italy having to decide which of their patients would live and die. With fewer intensive care beds than Italy, massive inequality, and high rates of diabetes and other diseases, we knew our health care system would be quickly overwhelmed.

Following an elimination strategy has been good both for our health and economy. It’s no surprise, then, that 85% of New Zealanders have consistently backed the strategy. Not everyone has been happy about it though, and the limited capacity of our hotel quarantine system continues to leave thousands and thousands of New Zealand’s diaspora unable to return home. There have been daily calls from media columnists, talkback hosts, and various businesses for us to loosen restrictions and “learn to live with the virus.”

Despite all that, at 11:59 p.m. on Aug. 17, 2021, the government moved the whole of New Zealand back into its strictest form of lockdown. A single case of COVID-19 had been identified in the community in Auckland. The reasons for the move were clear. It wasn’t immediately obvious how the virus had got through our defenses, or how long it had been circulating in the community. It was also likely to be the more infectious and dangerous delta variant. And while New Zealand has been rolling out the Pfizer vaccine, limited supplies meant only a small percentage of people were fully vaccinated.

The government was right to be cautious. Genomic sequencing soon showed that the delta variant had arrived in New Zealand from a traveller returning from Australia. The virus hadn’t been circulating in the community very long, but someone infectious attended a large church gathering a few days before the first known case had become symptomatic and got tested. It’s easy to wish that one of the earlier cases had got themselves tested instead of assuming their symptoms weren’t COVID-19. Things may well be quite different now if we’d caught the outbreak before the super-spreader event happened.

Read more: What We Learned About Genetic Sequencing During COVID-19 Could Revolutionize Public Health

At first, our ‘go hard and early’ strategy again worked well. The lockdown confined the outbreak to Auckland and by Sept. 7, the majority of the country was moving out of restrictions. In those places, kindergartens, school, and universities have reopened. So have cafes, restaurants, bars, and night clubs, though large gatherings are off the table. Our daily cases peaked at 79 and then started to fall. But they didn’t get to zero. Then the daily case numbers started to grow again. By global standards, they are still miniscule. But we started to see cases that weren’t part of households already in isolation. It had begun circulating in communities blighted by decades of growing inequality. After keeping the pandemic at bay for so long it began to feel like delta was going to be hard to eliminate. Indeed, the cordon around Auckland isn’t impenetrable and other parts of the North Island have moved back into lockdown as cases have appeared there.

New Zealand’s elimination strategy has required two really important things: restrictions that would have seemed completely unthinkable just two years ago, and the social license to put those restrictions in place. On Oct. 4, Prime Minister Jacinda Ardern announced a loosening of restrictions—Aucklanders would be able to meet with people from other households outside, for a picnic in the park, say. Arden had asked her health officials to look at which restrictions could be loosened without significantly increasing transmission. We’ve all watched the growing demonstrations against restrictions in Australia. To me, Arden’s announcement signalled a government trying to keep the most effective restrictions in place while maintaining social license.

But it also signaled that we were beginning to transition from the elimination strategy to a new strategy, where we use vaccination and vaccine passports, masks, improved ventilation, rapid testing, and other tools to minimize transmission, together with testing, contact-tracing, and isolation to control transmission chains and clusters as they emerge. We will have to keep cases low or we risk overwhelming our health care system, especially given that so many New Zealanders, especially those in communities most at risk, are not fully vaccinated yet.

Read more: When a Texas County Tried to Ensure Racial Equity in COVID-19 Vaccinations, It Didn’t Go as Planned

There is nothing intrinsically wrong with moving from elimination as a strategy and it was a transition New Zealand was going to need to make at some point. But the safest time to make that transition would have been next year once a vaccine has been approved for children under 12 and when COVID-19 was not in our community. That it is happening with an active delta outbreak means it is dangerous to grant any part of New Zealand all the freedoms we’ve enjoyed for so much of this pandemic.

I’m not sure most people in New Zealand realize what transitioning away from elimination really means to our everyday lives. As I explained, we’ve been living in a parallel world, one largely devoid of the threat of falling ill or dying of COVID-19. But as we’ve seen around the world, controlling delta is hard and will require changes to the way we’ve lived through the pandemic so far. What saddens me most is that for some people it will require weighing whether it is safe for them to do things that, when we were following an elimination strategy, we all could do. Now the message seems to be that they may have to manage their own risk.

What does this look like in practice? Well, take, for example, those people with some forms of cancer. Those who can stay home have to choose between the damage caused by indefinite isolation and the risk of getting seriously ill or dying if they venture out. Those who aren’t privileged enough to stay home take their lives in their hands. That feels to me like a societal failing. And we’ve seen well enough around the world that the burden of COVID-19 just widens inequality. In many countries, access to vaccines and treatments has split along ethnicity and socio-economic lines. Meanwhile, those most at risk of being infected are often those working multiple low-wage jobs.

New Zealand is one of a small number of countries who pursued an elimination strategy for COVID-19. The first to concede was Australia, when the state of New South Wales chose not to attempt to eliminate delta after the virus breached their hotel quarantine system in June 2021. The state of Victoria has had to follow in their footsteps, but much of the rest of Australia is still backing elimination. Perhaps they will be able to hold out until a vaccine is available for younger children. Also still holding out are mainland China and Taiwan. In May 2021, Taiwan experienced a large alpha outbreak and sporadic small community outbreaks of the delta variant which they have been able to contain.

In many ways, New Zealand has tried to tread the path we all should have taken. No one said it would be easy, but that so few countries even tried to stop COVID-19 early on is why we have the delta variant in the first place. And it’s unlikely to be the last variant of concern. Even worse is that 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 choice and one that is causing a humanitarian disaster that should not be allowed to happen. No one is safe until everyone is safe. Future generations will be appalled at how badly we all screwed this up.

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