Countries recently praised for their successful elimination strategies are suffering new Covid-19 outbreaks, raising questions about New Zealand’s exposure to a surge in cases, Marc Daalder reports
ANALYSIS: In a matter of weeks, the elimination strategy across Asia and the Pacific has collapsed in rapid fashion.
Taiwan, Vietnam, Fiji, Thailand and Singapore all declared victory over community transmission of Covid-19 at some stage during the pandemic, but have seen a surge of new cases since the start of April.
In just three weeks, Taiwan has seen more new cases than it had detected over the entire course of the pandemic previously. Thailand’s total case count has more than quadrupled since April 1, and it reported nearly 10,000 new cases last Monday – more in one day than in 2020 in its entirety.
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In Fiji, a community outbreak has led to dozens of new cases being discovered each day, when it had before April 16 found just 68 cases since the start of the pandemic. Vietnam, a country of nearly 100 million people, had reported fewer cases of Covid-19 than New Zealand before a small outbreak of the B.1.1.7 variant in January. That outbreak has been dwarfed by the latest explosion in cases, however, with the country now reporting more than 100 cases a day.
All of these countries were praised for their elimination strategies, and yet all have suffered severe community outbreaks that have stripped them of that status in just a few weeks. Is New Zealand just as vulnerable to a surge in cases?
University of Otago epidemiologist Michael Baker says the answer is yes… and also no.
On the one hand, these outbreaks have underscored the importance of robust border defences – and the risks of border failures.
“It’s just a big reminder to keep reviewing our assumptions around all of our systems at the borders. That’s just the most critical area,” he said.
The outbreaks in Taiwan and Singapore have both been traced back to airports and airline employees. In Taiwan in particular, airline workers were housed in an airport hotel that was also patronised by domestic tourists.
Prime Minister Jacinda Ardern emphasised our borders as well, when asked whether New Zealand might be exposed to the same risks as Taiwan.
“Every country is vulnerable,” she said.
“I look to [what happened in Taiwan] and take that as guidance to us, in terms of how we manage, on an ongoing basis, even with the rollout of vaccine and even with testing, how we continue to keep our guard up and not let any vulnerabilities emerge.”
Differences also emerge between the strategies in New Zealand and Australia, and those in Asian elimination nations.
While conventional wisdom has held that Taiwan bested New Zealand in the early stage of the pandemic, given it never had to enter a lockdown, Baker suggested our numerous experiences with community cases have allowed us to hone our public health apparatus. Taiwan, meanwhile, has struggled to scale-up testing and contact tracing in the face of hundreds of new cases a day.
“Because they’ve had fewer outbreaks to deal with, they have not built up their testing and contact tracing capability at the same extent as New Zealand. They’ve done a lot less testing, so that means that when they’re confronted with an outbreak like this, they don’t perhaps have that capability at the same level as New Zealand,” he said.
When confronted with the August outbreak, New Zealand surged testing to swab as many as 25,000 people a day, or five tests for every 1000 people. The same number of days after its own outbreak began to spiral out of control, Taiwan is testing fewer than 20,000 people a day, or 0.75 tests per 1000 people in per capita terms. In fact, New Zealand’s base level of daily testing without cases in the community is, on a population basis, higher than Taiwan’s surged testing.
Another key difference has been a reluctance to impose a lockdown.
“They’ve got quite a high threshold for going to their full Level 4 lockdown. New Zealand does as well, but they have even a higher threshold than us,” Baker said.
Ardern pointed out that dissonance as well.
“We have been willing to [lock down], but we’ve always been willing to do that in a way that Taiwan has tended not to. That hasn’t been part of their strategy,” she said.
“They have had a similar goal to us, but they have got there through a [different] path.”
Baker said: “It’s easy to come to the conclusion that when you’ve got long spells of no cases, complacency does creep in… particularly as vaccines are on the horizon and you’re starting to roll it out.”
But so long as less than even half of the population is vaccinated, New Zealand and other elimination countries remain vulnerable to outbreaks.
Even in the United Kingdom, where 72 percent of the adult population has received at least one dose of vaccine, the country’s expert virus advisory group has warned it could be on the cusp of a third wave of cases fuelled by the new SARS-CoV-2 variant which originated in India. That variant now makes up half of cases sequenced in the UK.
While New Zealand is just as exposed to a border breach of a more transmissible variant of the virus, it appears our cautious and risk-averse approach means we have a better chance of containing any such outbreak. In other words, the Government would likely raise alert levels if new cases were found in the community without an obvious link to the border, or if a cluster linked to the border had begun to spiral out of control.
“New Zealand and Australia have both shown their willingness to do these very short, intense lockdowns if they get unexplained cases in the community,” Baker said.
“Our threshold is appropriately quite low for doing that. History has shown that is the right way to go.”