Photo: Government of New Zealand

Exiting Alert Level 4 – Expert Reaction

New Zealand will move from Alert Level 4 to Alert Level 3 at 11:59pm on Monday, 27 April, Prime Minister Jacinda Ardern announced this afternoon.

Last week, the Government established four criteria that must be met before the country could move to Alert Level 3 restrictions:

  1. We know that community transmission is under control, and the transmission rate is very low.
  2. We have robust measures at the border stopping new infection.
  3. We have tracing and testing capacity to shut down any new outbreak.
  4. We have supplies for, and capacity, in the health system.

The SMC asked experts to comment on today’s decision, with reference to these criteria.

Professor Michael Baker, Department of Public Health, University of Otago, Wellington, comments:

Today’s announcement about stepping down the response levels is a welcome one. Last month New Zealand made the big decision to adopt an elimination goal in response to Covid-19 and go into a very tight lockdown which effectively began on 26 March. That move has achieved much in terms of reducing virus transmission and giving us time to get key systems working to ensure we can sustain elimination.

“The discussion now is all about coming out of level four in a way that provides a high level of certainty that we will achieve elimination. This is very different to coming out of lockdown in most countries where the goal is just to suppress transmission rather than achieve elimination.

“There are reasons we need to be cautious. The modelling work conducted by Te Pūnaha Matatini (TPM) suggests we need two more weeks in lockdown to improve the chances of virus elimination. There are also concerns about partial opening of schools and early childhood centres at level three when there is uncertainty about the role of children in Covid-19 transmission. That said, the move to level three on 28 April is probably a manageable compromise. We need to get businesses working again for the health of people and the economy.”

No conflict of interest.

Associate Professor Garry Nixon, Department of General Practice and Rural Health, University of Otago, comments:

“New Zealand’s rural towns are older, have a higher proportion of Māori, and higher levels of socioeconomic deprivation, than the rest of the country. Those of us who work in them, are acutely aware of how poorly resourced rural health services are, and how they will struggle to deal with high numbers of Covid-19 cases. We are very fortunate that the work of Government, our public health colleagues and all New Zealanders, has to a large extent, kept these communities free of Covid-19.

“There is obviously some nervousness as we move to loosen the measures that have clearly worked. A careful and gradual approach, based on the best science we have available, is the right one. This needs to be accompanied by a willingness to raise the alert level again if at any point it becomes clear that this is the right thing to do.

“It was reassuring to hear today that ongoing surveillance testing will target rural, Māori and Pacific communities; and that contract tracing will be well resourced at a local, as well as a national level. Government has decided to move the country as a whole between levels, but there may be times in the future when it’s appropriate to have different levels in different areas, with an emphasis on reducing movement between communities.”

No conflict of interest.

Associate Professor Malcolm Campbell, GeoHealth Laboratory, University of Canterbury, comments:

“One key aspect of our response to Covid-19 continues to be understanding where the virus is being transmitted. Regardless of how the decision could have turned out today, we really do need to keep track of our movements. This means we should keep a diary of where we’ve been and who we’ve been with for the foreseeable future.

“If we ever become infected with Covid-19 or a close contact of someone who has the virus, tracing 80% of all our close contacts within three days is the ‘gold standard’. We can all help speed this up by tracking our movements. To remind us where we’ve all been, we could use social media check-ins, google location history, or, if we have been shopping, we can look at our receipts or credit card / EFTPOS records.

“There has also been discussion about technology and apps as one solution to controlling the pandemic. But, let’s not forget, we need Covid-19 testing for any apps to work. No tests, no point in an app, because these apps rely on testing. The apps are only ever a support to the hard work of testing and contact tracing.”

No conflict of interest.

Associate Professor Arindam Basu, University of Canterbury, comments:

“As Prime Minister Ardern stated today, the effective reproduction number is now less than 0.5 (~0.48). If you contrast this to the situation roughly one month back, this number was around 2, and the infection was taking on an exponential growth.

“In the absence of a vaccine and without using drugs, we in NZ have been successful in containing the epidemic using strong public health measures. When you combine this with increasing numbers of tests and contact tracing, the claim that community transmission is under control and transmission rate is low is fully justified.

“Contact tracing works best during the ‘tail’ of the epidemic, either during the first phase when the epidemic is ‘rising’ or situations such as this in New Zealand when the infection is ‘dying out’. We have ramped up our contact tracing at this stage and this will ensure to interrupt the chain of transmission of new outbreaks, as contact tracing and isolation will quickly bring the effective reproduction number under control. We may continue to see some new clusters emerge but they can be quickly addressed and mitigated.”

No conflict of interest.

Professor Nigel French, Massey University and co-Director of One Health Aotearoa, comments:

“I fully support the government’s decision to delay leaving Level 4 for a further week. The evidence to date from multiple sources indicates that community transmission is low, and declining – but we still have infectious, and potentially incubating, individuals in the population. If we allow contact between us to increase too much and too soon, these could generate further waves of infection. Maintaining our strict border controls and ramping up testing and tracing puts us in a strong position to block transmission, both across the border and within the community.”

No conflict of interest.

Dr James Ussher, Immunologist and Clinical Microbiologist, University of Otago and Southern Community Laboratories, comments:

“Diagnostic laboratories currently have capacity to test approximately 6500 samples per day, and are working to further increase their capacity. This is almost twice the seven day running average of testing volumes. Therefore, diagnostic laboratories currently have capacity to increase testing volumes.”

No conflict of interest.