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International advice on managing COVID-19 – Expert Reaction

New messaging on lockdowns from a World Health Organisation special envoy has caused some confusion.  

This morning, WHO spokesperson Dr Margaret Harris tried to clarify their position on lockdown strategies. But with a widening gap between our COVID-19 landscape and the rest of the world’s, how useful is international advice for New Zealand?

The SMC asked experts to comment. 

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

“One of the many lessons from the COVID-19 response is to very cautious about acting on advice from overseas organisations.

“Confronted with public health threats, New Zealand has traditionally looked to leading health agencies based in the Western world, notably the US Centres for Disease Control and Prevention, Public Health England, and the European Centre for Disease Prevention and Control, in addition to the World Health Organisation (WHO). These agencies have all let us down badly during the current COVID-19 crisis. Their risk assessments of COVID-19, and proposed responses, have been either absent or frequently wrong.

“The WHO performs many vital roles in supporting health gain across the globe, but its advice on COVID-19 has frequently been poor. WHO was late to declare COVID-19 a Public Health Emergency (of International Concern) and a global pandemic.

“WHO staff have at times advised against closing borders, mass masking, and now use of lockdowns. These are exactly the measures that have saved New Zealand and many other countries from the worst effects of the pandemic. The WHO needs more resources to help it do its job better in future.

“At the heart of this problem, WHO has never seemed to grasp the value of the elimination approach which is being successfully pursued by New Zealand, most states in Australia, and much of East and South-East Asia.

“The elimination approach uses tight border management and short, sharp lockdowns as a way of eliminating COVID-19 transmission in the community. This is a very different approach to the prolonged lockdowns used in Europe and North America that can only suppress the virus, which then returns when the lockdown is eased.

“Part of the problem is that WHO and the other major organisations we have traditionally relied on for advice are based in Europe and North America and have tended to see the pandemic from their own regional and frequently dysfunctional perspective.

“New Zealand is now looking East and learning from countries such as Taiwan that have mounted a particularly successful pandemic response that has not only protected public health but also ensured a more rapid economic recovery.

“COVID-19 is having many profound effects on this country, and one of them may be to reinforce that New Zealand is part of the Asia-Pacific region. As we are seeing, our region can forge an independent and successful direction in response to a major global health challenge like the current pandemic. Perhaps this new sense of agency will support successful responses to climate disruption and other existential threats faced by humanity?”

No conflict of interest.

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

“The elimination approach that Aotearoa New Zealand has taken to COVID-19 is unusual worldwide and means the balance of risks we face is different to other locations. Consequently, the control measures used here may need to differ from those used elsewhere.

“An example of an uncommon risk being important in Aotearoa New Zealand is the case of the man who went through managed isolation only to test positive about 5 days later. Eventually health authorities determined that he most likely was infected by touching a rubbish bin lid shortly after another case in the facility touched the same bin lid. This would be the first documented case internationally of so-called fomite transmission, although delayed airborne transmission in the vicinity of the bin cannot be ruled out (again, this is a rare form of transmission).”

“The point is that in most parts of the world where COVID is more prevalent, this type of transmisison event would make essentially no difference to the size or trajectory of the outbreak and could be ignored. But in Aotearoa New Zealand, it could be the difference between zero community cases and a new community outbreak. We thus need to be more aware in New Zealand to these rare events, and tune our response to account for them, while perhaps ignoring coarser measures that are being recommended elsewhere.”

No conflict of interest.

Professor John Hopkins, Professor of Law specialising in Law and Disasters, University of Canterbury, comments:

“When considering international advice, we have to take into account the different legal frameworks that each country operates under.

“The current “successful” approaches at present are border controls, invasive contact tracing, and strict laws around individual freedoms. These are epitomised by New Zealand and Taiwan. However, in the absence of a Taiwanese legal framework which allows for tracking without consent, if the border breaches (which it will) we only have the option of old school contract tracing and/or lockdowns.

“New Zealand’s approach, although effective, is using 19th century pandemic control measures, despite the 21st century vulnerabilities like mass international travel and internationalised supply chains.

“Taiwan shows that you can operate without lockdowns using 21st century technology, but it requires a legal framework to do so, and trust in authorities to use this power fairly. The question is whether NZ wants to go down this road.”

No conflict of interest.

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

“New Zealand is in a very different position to most other countries and so our response will sometimes look different.

“However, the WHO advice about lockdowns is largely consistent with the way New Zealand has used them. In the August outbreak, stay-at-home orders were used in combination with a range of measures including widespread testing, effective contact tracing and good quarantine systems. These were targeted to the Auckland region and for a relatively short period of 19 days. After this, restrictions were relaxed and the rest of the outbreak was controlled with a test-trace-isolate approach. This avoided the need to use Level 4 and allowed the rest of the country to stay at Level 2. This is a good example of how a potentially explosive outbreak can be stamped out with a minimum of disruption.

“When the August outbreak was first detected on 11 August, there was no clear link to the border and modelling showed that up to 50 people could already have been infected with the virus. This meant it would take several days to track down and test all these people, and trace and isolate their contacts, by which time even more people would be infected. In a situation like this, it is better to act early and have a relatively short period of strict targeted restrictions than to wait until the outbreak gets much bigger needing a longer and more widespread lockdown. An example of this is Melbourne, which waited several weeks before imposing restrictions in July, and is still in the equivalent of Level 3 more than 3 months later.

“The WHO advice is that lockdowns should be the last resort and should be targeted and used in combination with other measures. But if you know you are going to need a lockdown, it is better to do it sooner rather than later.”

No conflict of interest.