New COVID-19 cases in NZ community – Expert Reaction

Four COVID-19 cases have been confirmed in one Auckland family from an unknown source.

From noon on Wednesday, the city will move to Alert Level 3 restrictions, and the rest of the country will move to Level 2: the restrictions will last until at least midnight Friday.

The city’s non-essential businesses must shut down by then, and gatherings of more than 10 people are prohibited. Non-residents may leave Auckland but are asked to watch their health and report any possible symptoms.

The SMC asked experts to comment.

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

“This is disappointing but not entirely unexpected.

“Different alert levels between different parts of the country is a sensible approach in the circumstances. But this is something we have not previously seen.

“Minimising movement between regions is now more important. People shifting out of the cities to sit out the last lockdown at the bach was a problem last time. Now it risks not only putting undue pressure on stretched rural health services, it also risks introducing the virus into communities at lower alert levels, where it can spread more easily.

“For the same reasons, those returning to regional and rural areas after time in Auckland should act as if they were at Level 3, at least until the extent of the outbreak becomes clearer.”

No conflict of interest declared.

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

“Region specific alert levels are new, but there are others with infection around the country as, in Level 1, people travelled and therefore conditions of community transmission prevailed. Now is the time to make use of the NZ COVID Tracer app and contact tracing.

“Expect new cases to emerge over the next two weeks.

“Masks are must because wearing a mask will offer barrier protection from you to the others. Particularly wear one if you are out and about, e.g., in public transport or in supermarkets. Washing hands and respiratory precautions are needed.”

No conflict of interest declared.

Associate Professor Siouxsie Wiles, University of Auckland, comments:

“It’s obviously disappointing to have cases of community transmission again in New Zealand. But we knew this could happen at some point. Now the race is on to find the source of the cases and break any chains of transmission. Moving Auckland straight to Alert Level 3 and the rest of the country to Alert Level 2 gives us the best chance of stamping out the virus quickly. Any delays just mean more opportunities for the virus to spread further. We only have to look to Victoria to see how catastrophic any delays can be. People need to prepare themselves for these restrictions being in place for longer than 3 days if more cases come to light or the source of the infection proves difficult to pin down. My message to all New Zealanders is not to panic. We’ve stamped out the virus before and we will do it again.”

No conflict of interest.

Dr Andrew Chen, Research Fellow, Koi Tū: The Centre for Informed Futures, The University of Auckland, comments:

“The announcement of four new cases in the community is a timely reminder that we all need to be engaged with contact tracing processes. We don’t need to panic, but it reiterates the message that COVID-19 can reappear and we will need to continue to maintain and collect contact tracing records for awhile. This means keeping good records of who we have been in close contact with, and where we don’t know who the people around us are, keeping records of where we have been at what times. When new cases appear in the community, contact tracers will want at least two weeks worth of records to help them identify who else may have been exposed to the virus.

“There are a number of tools that you can use to help collect and record this information. The most important is the government’s NZ COVID Tracer app, which can help you keep logs of your movements by allowing you to scan QR codes for businesses. Registering for the app provides the Ministry of Health with up-to-date contact details in case they need to call you, which is already helpful in itself. Importantly, the app can also be used to help notify you if your logs indicate that you have been in the same place at the same time as someone infected with COVID-19 (through an exposure notification mechanism). The app helps contact tracers notify people more quickly, which can help reduce the spread of the disease if people then isolate or get tested more quickly too. This may be especially important in cases where there may be a lot of possible contacts, and the manual approach of calling each person may take too long. The app now also has a manual entry functionality that allows users to enter records for places that do not have QR codes available. Based on the design of the app and the rules governing how the data is handled, the privacy risk is very low and it should be safe to use.

“If you cannot or do not want to use the NZ COVID Tracer app, there are other digital tools that can be helpful, such as turning on Google Maps Timeline on Android smartphones, using other QR code or location tracking apps like Rippl, or taking photos of the buildings that you enter (which will automatically have a timestamp associated with it). A pen and paper diary method is also fine for keeping your own records. These are still valuable in the event that you are diagnosed with COVID-19 and need to provide information on your close contacts to a contact tracer. However, it is important to note that these methods will not allow the Ministry of Health to automatically inform you about exposure risks relevant to you.

“This is also a timely reminder that businesses should display the NZ COVID Tracer QR code, so that their customers and visitors can easily add to their records. This is an important part of protecting both your customers as well as your employees, so that they can be identified and notified quickly in the event that there is an exposure risk.”

Conflict of interest statement: I have met with the Ministry of Health and provided some advice, but have no financial relationship.

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

“This is disappointing news, but it’s not unexpected as we’re dealing with an extremely infectious virus that can exploit any loophole on offer. Moving up to Alert Level 3 in Auckland will keep everyone’s bubbles small, and it will also help the contact tracing system because with fewer contacts, it will be easier to identify and quarantine the close contacts of each case.

“We know that lockdowns are very effective and this approach worked very well for us the first time around. Adding mass masking (face coverings) to the COVID-19 toolbox will shorten the time it takes to regain control of viral spread. Coughing into a mask seems more likely to reduce infection risk than coughing into your elbow as previously advised. The aim is to return to Alert Level 1 and regain elimination status, but that won’t happen overnight: even after we stop seeing new cases it’ll take time and extensive testing to be sure the virus is once more under control.

“A key action from Government now is to ensure that people who need to go into isolation or quarantine are supported to do so, including financial support and help with practicalities like food shopping. We won’t get on top of outbreaks if people who should be isolating are forced to keep going in to work so they can feed their families.”

No conflict of interest declared.

Dr David Welch, School of Computer Science and Centre for Computational Evolution, University of Auckland, comments:

“In order to find the source of these latest cases, or any future community transmission, an important tool we have is genetic surveillance. This means that all positive swabs should immediately be sent for genetic sequencing, whether they are found at the border or in the community. The community cases can then be compared to all other cases to find a close match, which would suggest a likely chain of transmission, and aid contact tracing.

“Genetic surveillance has been occurring but not all positive samples are being sent for sequencing, and sometimes the delay in sending in samples is considerable. Several sequencing labs are available and ready to sequence any samples at short notice with a rapid turnaround.”

No conflict of interest declared.

Dr Sarb Johal, clinical psychologist, comments:

“With the news tonight that there are four new cases of COVID-19 in South Auckland, and that Auckland is entering Alert Level 3 from Wednesday at noon for three days (at least), and the rest of the country is going to Alert Level 2, people will be trying to remember what this means. Here’s the link to the behaviours expected at those Alert Levels. They may get finessed a little over the next day or so, but Level 3 in this context of a regional lockdown essentially means people staying at home and not leaving or entering the city. Schools will be closed.

“The four cases means that we are unsure as to what is going on in Auckland right now. So it’s reassuring to see that there will be a campaign of mass testing starting tomorrow, as well as continued contact tracing to both find the source of the outbreak, and understand what may be going on in the community. To get to the bottom of this may take more than three days, but we will know more as events unfold and tests return over the next 48 hours or so.

“For the many of us that hoped that New Zealand had managed to eliminate COVID-19 for the long term, this news will come as a disappointment, For some, it will provoke anger, perhaps feeling that the system has failed. At the moment, we just don’t have enough information to come to any conclusions about that.

“What we do know is that compared to other nations, we in New Zealand have gone a very long time between controlling the first outbreak, and now this second outbreak, whatever forms this takes in the end. And it’s the unpredictability and the uncertainty which will be to the forefront of our minds over the next short time, and we look to see what exactly has happened, and what this might mean for us. Whether we are in Auckland, have loved ones in Auckland, or also adapting again in the rest of New Zealand.

“If you haven’t been washing your hands as frequently as you might have been, step that up. If you haven’t been using the COVID-19 Tracer App as much as you could have been, it’s time to step that up. If you’re a business owner and you’ve stopped displaying your QR code, sort that out. Control what you can control. It’s only by acting together, for each other, that we get on top of this again.

“We can sometimes think that we were lucky. I urge you not to underestimate the effective actions we all took to get this under control last time too. This took work, hard work and sacrifice. The virus is tricky, contagious, invisible, and has a long incubation period.

“We have a limited window to get this right again. And it will probably happen again after this too. This will be the pattern. Be prepared. Take effective action. Do it now. React responsibly and swiftly, with small actions that added up can save us from suffering even bigger consequences.”

No conflict of interest declared.

Dianne Lummis, Programme Leader Masters of Psychotherapy- Child and Adolescence, AUT, comments:

“Families should take the time to reassure children and vulnerable family members that they are safe and that this is just a precautionary measure designed to protect the whole of Aotearoa’s whanau.

“Children may be very sensitive to their family’s increased anxiety or tension following lockdown levels being raised and it is important to support them during this time. Children may have a number of feelings at this time, including; fear, anxiety, sadness and anger and it is important for adults to help put this short-term lockdown in perspective. It is normal for children, and adults to feel dysregulated as another change to their routine (following the previous lockdowns and the recent school holidays) impacts them so suddenly.

“Children and adults need to take the time to address the feelings generated by the rapid changes and uncertainty and to reassure one another and be kind.”

No conflict of interest declared.

Professor Shaun Hendy, University of Auckland, comments:

“Four new cases of COVID-19 have been detected in one family in South Auckland. There are no known links to travel or to managed isolation and quarantine facilities. This means there are almost certainly other active cases of COVID-19 present in Auckland at the moment, so it is important that we behave accordingly. Auckland will move to Level 3 on midday Wednesday, which will immediately reduce transmission if we follow the rules and stick to our bubbles.

“Moving to Level 3 also reduces the number of contacts most of us have, which will give our contact tracers a much easier job over the coming days. It would also be worth Aucklanders checking their apps, diaries, and bank accounts to make a list of places they have visited or people they have had contact with over the last fourteen days. If you can, you should also wear a mask when going to the supermarket. Remember that not everyone can wear a mask, so wear yours if you can to protect them.

“However, there is also a chance the disease will have spread to other parts of the country. Because of this everyone in New Zealand should take the necessary precautions, including wearing masks if you can, especially in close indoor settings, hand-washing, and getting tested if you have any of the symptoms.

“Stay safe, and be kind.”

No conflict of interest declared.

Jacqui Maguire, Registered Clinical Psychologist, comments:

“Tonight’s announcement of community transmission without a located source is likely to raise a number of emotions, especially for those in Auckland. Anxiety, fear, anger and disappointment are likely.

“It is important to remember that emotions evolved to provide us with information that could help us make sense of our experiences and guide our behaviour. For example, anxiety alerts us that we are facing a threat and need to act in a way that ensures survival. What does this mean right now – wash your hands, cough into your elbow and if you are in Auckland stick to your bubble. Disappointment signals we have lost something meaningful to us – in this instance our liberty. Take that disappointment and use it as motivation to stick to the rules. Turning away from or suppressing your emotional reactions will only intensify them.

“New Zealand will need time to emotionally and cognitively adjust to this announcement. Hold compassion and kindness for yourself and others as you adjust, reach out and offer support to those around you. Take one day at a time, practice your wellbeing strategies and hold the hope that we will get through this together.”

No conflict of interest declared.

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

“For the first time, different parts of the country are at different Alert Levels. The likelihood is that the majority of cases that are out there are in the greater Auckland region, so it makes sense to take this approach initially. But if the contact tracing and testing discovers that the virus has spread more widely, we need to be prepared for other regions or even to whole country to go to Level 3. In the meantime, it would be sensible to cancel all non-essential travel so we don’t inadvertently spread the virus around the country. And it’s really important nobody travels in or out of Auckland, unless it is to go home.

“Everyone needs to get back to practicing good hand hygiene and social distancing, work from home if you can, wear a mask if you do need go out, and avoid large gatherings. For Aucklanders at Alert Level 3, you also need to stick to your bubble and minimise all non-essential interactions with other people.  It‘s also essential that everyone keeps a detailed diary of their movements, either using NZ COVID Tracer app or your own records.

“We’re going to need to do a lot of testing to work out how far the virus has spread. It’s more effective at this stage to target this to high-risk groups than just do random testing. This means people with symptoms and people identified by contact tracing teams. So if you are offered a test or you don’t feel well you should get tested, but if you feel fine just stay at home.

“The fact that these new cases have no known link to international travel or people working at the border makes the situation more serious. This means there could be several links in the chain and a larger number of cases that we don’t yet know about. That’s why it’s important to take swift, decisive action and move the whole of Auckland to Alert Level 3 as soon as possible. As the Prime Minister also said, the fact that the four cases have several different workplaces in different suburbs means this needs to apply to the whole super city. Melbourne initially attempted to lockdown specific suburbs and it didn’t work.

“The rest of the country in Alert Level 2 should also be very cautious. It’s quite possible a case we don’t yet know about has travelled outside of Auckland and it would be easy for the virus to spread. So everyone needs to get back to social distancing, work from home if you can, wear a mask if you need to go out, and get tested if you feel sick.

“If we do the right things now, there’s a good chance we will be able to contain this outbreak before it spreads too much further.”

No conflict of interest declared.

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

“Many New Zealanders will be responding to the announcement of returning to Lockdown Levels 2 or 3 with fear, anxiety, or even anger. This is normal. We experience these emotions when we are under threat. And we are under threat again.

“Left unchecked fear and anxiety will drive our behaviour. We may act without thinking clearly and panic or lash out. But we don’t have to be ruled by our fear.

“The first thing people should do is stop and take a deep breath. Pause and notice how we’re feeling. Once we’re calm, remember that we’ve done this before. We can remind ourselves of what Levels 2 and 3 were like and what we did to get through them. Then make some plans. Planning gives us back a sense of control. Cancel those non-urgent appointments and buy yourself some time.

“Get into the habit of regularly checking in on yourself. How are your anxiety or anger levels now? Do I need to do something to help soothe myself again?

“We’ve done it before and we can do it again – even though it’s really really annoying to have to do it again!”

No conflict of interest declared.

Lesley Gray, Senior Lecturer, Department of Primary Health Care & General Practice, University of Otago, comments:

“It is vital that people review their own non-pharmaceutical intervention strategies (hand hygiene, physical distancing, contact tracing methods and now, please add in a cloth/fabric mask to your strategies – if in Auckland please wear a mask if you need to access essential services during this time. This is a strategy to minimise possible aerosol spread. The COVID-19 virus is tiny, but it is carried on saliva and it is the saliva that is trapped in layers of fabric, thus reducing the aerosol droplet spread.

“If people believe these strategies can be effective they are more likely to use them. In lockdown level 4, there was a high belief in the effectiveness of masks (which is great).  For contact tracing apps in level 3 there was low indication of uptake and this is borne out by the figures released by Government earlier this week. If less than 700,000 have installed the app – how many of those have never used it, if the app has only been activated some 2 million times in total?”

No conflict of interest declared.