New COVID-19 cases – Expert Reaction (Updated)

This post was updated on 18 June. The original 16 June post is below these new comments.

Another case of COVID-19 has been confirmed in New Zealand.

The man has been in a quarantine facility in Auckland since arriving in the country on on June 13. He wore a face mask on all his flights.

The SMC asked experts to comment on the case.

Associate Professor Patricia Priest, Department of Preventive and Social Medicine, University of Otago, comments:

Note: Patricia also discussed the borders in an SMC briefing.

“This is an example of what we want to see – cases being picked up while they are still in quarantine. Our current strategy cannot stop people infected with SARS-CoV-2 arriving in the country, but we need to pick them up before they enter the community and ensure that they don’t leave quarantine until they are not infectious.

“As long as we continue to allow people to fly to New Zealand from countries where there is community spread of the virus, we will see the occasional case picked up in quarantine if our systems are working. However, if they are detected in quarantine and managed appropriately from there, they won’t cause spread into the community.”

No conflict of interest declared.

Associate Professor Lynn McBain, Head of Department of Primary Health and General Practice, University of Otago, Wellington, comments:

“I am not surprised there has been another reported case and expect there to be more as long as people are entering NZ from areas where there continue to be Covid cases (i.e. most of the world). This underlines the importance of the current system of 14 days of managed isolation and regular checking of symptoms and testing.

“Unfortunately for people requesting compassionate consideration for early release from isolation, this also underlines the risks, and having worked so hard to reduce transmission I am supportive of the decision to stop exemptions on compassionate grounds.

“We are all focused on the 14 days – I would urge some caution and social distancing, sticking to small numbers of known people after this time in isolation even at day 15/16 and so on.

“Mask wearing on flights is not going to fully stop transmission but it certainly will reduce risk.”

No conflict of interest declared.

Dr Sarb Johal, psychologist, comments:

Note: these comments are excerpted from a blog post.

“What we have been experiencing in Alert Level 1 has been the extension of a cocoon of security that we built in our own homes when we were asked to stay home during lockdown. The bubble of our homes extended to the bubble covering the entire country.

“For most of the time over the past few weeks, we haven’t been thinking about it so much – we carry on reasonably happily because we were confident that systems were working and that we were, for all intents and purposes, COVID-19 free, and that we could trust the systems in place to protect us if the threat emerged again.

“And because many – but not all of us – were able to let go of much of that anxiety, it meant that we could let go of thinking of every little thing in our lives and concentrate on what we have to do each day. If we were not in our little bubble but checking and rechecking everything that happened in our life for risk – as if we were back in Alert Level 3 or 4, we would never get anything done. So, to a certain extent, being in the bubble frees us.

“But on Monday, that bubble popped, and we felt it.

“It’s not good when it happens, but mistakes do occur. And unfortunately, these can have consequences that mean the world suddenly feels a lot more unpredictable and uncertain again. It’s important that we can be assured that mistakes are being addressed, and that we can get good information about the size and the nature of the actual risk, rather than this being stoked by our threat-detecting brains reaction to events as if they are life-threatening and can provoke big emotional reactions.

“Get control over your threat detecting system by engaging your calming system – watch this video to find out how.”

No conflict of interest declared.

Dr Dougal Sutherland, Clinical Psychologist, Victoria University of Wellington and Umbrella Health, comments:

“Anxiety, frustration, and anger are likely to be felt keenly by our team of 5 million in response to the news of the three new cases of COVID-19, including the two women who travelled the length of the North Island. We’ve come so far and worked so hard to get to Level 1 and now we could lose it all. These emotions are real and they’re valid. It’s important that we acknowledge how we feel rather than pretending something different. But our feelings don’t have to dictate what we do. We can choose how we respond rather than simply reacting to our emotional state. Now is a time for us to reflect on our values: how do we want to be in life, how do we want others to remember us in 12 months’ time after the COVID crisis has passed? Then let these values help us choose how to respond in this situation.

“It’s important to remember that we’ve done this before and we know how to cope when COVID rears its ugly head and, should the worst happen, how to cope if we have to go up a Level or two. Yes it’s annoying and frustrating. Yes it can make us worry about our health and the health of our loved ones. Yes it could put our livelihoods at risk. But now, perhaps more than ever, is the time to stand together as a team. We’ve done it once and we can do it again. The new cases this week may serve as a reminder that COVID is still rampant in the rest of the world and that we shouldn’t rest lightly on our laurels.”

No conflict of interest declared.

16 June

Two new cases of COVID-19 have been confirmed in New Zealand, both linked to international travel.

The two women arrived from the UK together on the 7th of June, and were granted a compassionate exemption from isolation to travel to Wellington on the 13th.

The SMC asked experts to comment on the cases.

Associate Professor Arindam Basu, College of Education, Health & Human Development, University of Canterbury, comments:

“Identification of the two new cases signals the importance of continued testing and contact tracing. The fact that the one of them was “symptom-free” highlights the need for being cautious about asymptomatic and pre-symptomatic people.

“Overall, risks of new infections emerging within the community and emergence of clusters still remain low but one cannot be careful enough. This is a reminder that the pandemic is not over and none of us are safe until all of us are safe. So, hand washing, cough hygiene, and as far as practicable, maintaining safe distance and wearing a mask when attending large gatherings and in public transport are useful.”

No conflict of interest.

Dr Amanda Kvalsvig, Senior Research Fellow, Department of Public Health, University of Otago, Wellington, comments:

“These two new cases illustrate very vividly how quickly rules and guidelines can unravel when they collide with real life. We’re now in a situation where potentially hundreds of people have travelled for several hours in an enclosed space with someone who was infectious. There is an enormous amount of ‘mopping up’ to do to make sure that all potential transmission chains have been extinguished. It’s also notable that one of the people who tested positive had no symptoms. The potential for hidden cases makes this infection very challenging to control.

“A situation like this could so easily trigger a major outbreak and take us back to where we were in March. Inevitably, some travellers will have COVID-19 infection and inevitably, some of those will be making the long trip back because they need to be with family at a sad time. There will be more cases like this one in the future.

“The government needs to insist that international travellers wear masks to prevent those who are infectious from breathing virus into the air around them. Mask wearing can’t replace handwashing, isolation, and the other measures but it could make all the difference between a situation we can control, and going back to lockdown.”

No conflict of interest.

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

“These cases are obviously a reminder about the ongoing risk of imported Covid-19 cases. There will be a continuing demand for travel into New Zealand for compassionate and economic reasons. Most inbound travellers are vulnerable to being infected in their home country because of widespread ongoing Covid-19 transmission in most parts of the world.

“New Zealand needs to be confident that all steps in these quarantine processes are robust and scrutinised to ensure that protocols are carefully followed. One important safeguard that does not appear to be routinely used is facemasks. In most countries it would be mandatory to wear facemasks on aircraft, in border and quarantine facilities, and where people are allowed to leave such facilities before their quarantine period has been completed. Mask use provides an important additional line of defence that New Zealand should be using.”

No conflict of interest.

Professor Ilan Oshri, Graduate School of Management, University of Auckland, comments:

“My take on this is from a strategy and risk mitigation perspective. We are beyond the point of forming a strategy to fight COVID-19. Now success is about the pedantic implementation of the strategy that the government formed and ensuring that the strategy addresses all possible aspects of risk mitigation.

“We understand now that both implementation and strategy were not bullet proof. First, following Monday’s new COVID cases, the strategy had to be updated with a logical step to return a negative test before releasing from quarantine. Secondly, government officials failed to follow the strategy formed by the government and allowed travelling in NZ without the 2 weeks quarantine. This is probably the first dent in the so-far seamless execution of COVID-19 by the government.”

No conflict of interest declared.

Professor Michael Plank, Te Pūnaha Matatini and University of Canterbury, comments:

“The new cases announced today shouldn’t come as a great surprise. With several hundred Kiwis returning from overseas each week, it was always likely that we could get new cases at some stage.

“However, the fact that the two people travelled outside their quarantine facility is significant as there is a chance they might have come into contact with others. This reinforces the importance of our contact tracing system and, crucially, everyone keeping a record of where they’ve been and who they’ve been in contact with. Where possible, people should use the NZ COVID tracer app as this means the Ministry of Health will be able to notify them immediately if they’ve visited the same place as someone with COVID-19.

“One of the cases had mild symptoms but put them down to something else. This is a timely reminder not to soldier on with cold or flu symptoms, instead get a test and stay at home until you get the results.

No conflict of interest.

Jacqui Maguire, Registered Clinical Psychologist, comments:

“Whilst many New Zealanders will hopefully calmly respond to this news, there is likelihood anxiety may rise amongst some. With international comparison, fear of hidden community transmission, a second wave and consequential return to lockdown likely to precipitate those fears.

“Anger may also be generated against a permeable border despite current quarantine efforts. It is important that leadership acknowledge anticipated fear whilst re-iterating messages of public safety and the importance of public health guidelines.”

No conflict of interest.

Dr Christopher Gale, Senior Lecturer, Department of Psychological Medicine, University of Otago, comments:

“From the mental health perspective, any crisis is a marathon, not a sprint. The event itself and the associated distress, destruction and mortality then is associated with a period of resilience followed by a prolonged increase in anxiety, depression, and trauma related symptoms in a minority of persons. This means that you expect initially that the number of people with mental health problems will decrease in the short term but increase in the medium to long term.

“Most of the knowledge we have, however, is based on short events: for example, earthquakes, forest fires, and terrorist incidents. What we may have now is two more confirmed cases of an illness many had thought was eradicated from New Zealand.

“This could lead to people being more anxious, and having more symptoms: for others, it could lead to a sense of betrayal that the pain our society has suffered was wasted.

“What we may find is that people are less trustful and less willing to adhere to a return to social distancing. The long term economic consequences from the lockdown are beginning. People are fearful of a loss of occupation, income and purpose. For many, this is not a fear, this is reality. Regaining an agreement as a society to social distancing, if that happens, will be a greater challenge now that the celebration of no cases is moderated by people from other countries being documented with the virus.”

No conflict of interest.

Professor Mick Roberts, Professor in Mathematical Biology, Massey University, comments:

Now we are in level one, the value of R is well above one. That means that any community transmission could result in the onset of a large epidemic, and a return to lockdown. To prevent this: test, trace and isolation is more important than ever.”

No conflict of interest.