This Sunday marks one year since the Ministry of Health confirmed the country’s first case of COVID-19 infection.
At the time, New Zealand was the 48th country to have a confirmed case of COVID-19. One year on, the virus has spread across the globe and the world as we know it has drastically changed as a result of the ongoing pandemic.
The SMC asked experts to reflect on this milestone.
- Bird’s-eye views of the pandemic in New Zealand
- The development of COVID-19 vaccines
- Data, modelling, contact tracing, and genomic testing
- Personal wellbeing and work
Lesley Gray, Senior Lecturer, Department of Primary Health Care & General Practice, University of Otago, comments:
“As we near the one-year anniversary of the first Covid-19 case in Aotearoa New Zealand, we can reflect on the relative ‘freedoms’ New Zealanders have had over the course of the last year, unlike countries such as the United Kingdom or the US, where vulnerable individuals have been sheltering-in-place for best part of a year already. Most of us are aware of the actions needed to ensure any community cases are traced quickly to avoid or minimise any form of stay-at home/lockdown: masks, hand hygiene, staying home if unwell (even if you have mild symptoms) and tracking our movements, ideally through the NZ Covid Tracer app.
“We reflect on the loss of 26 people to COVID-19 in New Zealand and the more than 2,200 people who have experienced COVID-19 – most of whom have recovered, and yet a smaller number have significant ongoing ‘long Covid’ health issues. While most of us are ‘doing ok’, let us not forget the many in New Zealand who are still ‘doing it hard’ following job loss, reduction of working hours, etc., and those who fulfil essential roles, especially those at and near the border. Those who were unable to be with loved ones and those who lost loved ones during this time.
“We have learnt much in this year and have the benefit of a very speedy development of Covid-19 vaccines. As we move towards the population roll-out of Covid-19 vaccines in New Zealand, I would urge anyone who is unsure about whether to get the vaccine, to think through what are the key reservations and as yet unanswered questions and take those questions to a trusted health professional to discuss.“
No conflict of interest.
Dr Collin Tukuitonga, Associate Dean Pacific, Faculty of Medical and Health Sciences, University of Auckland, comments:
“COVID-19 has had a dramatic impact on the lives and livelihoods of people all over the world since its emergence in early 2020. From its origins in Wuhan, China, it spread globally, and the first case of COVID-19 was reported in Aotearoa/New Zealand on 28 February 2020. Our response to COVID-19 has been hailed as one of the most effective in the world.
“One important consequence of the COVID-19 pandemic has been the restriction of the movement of people within and between nations. Furthermore, people have been forced into very restrictive ‘lockdowns’ as a way of reducing the transmission of the pandemic. In Aotearoa/New Zealand, we are fortunate to have had high levels of public approval of the ‘elimination’ strategy and the majority of the people have adhered to the advice of our leaders and health officials to remain at home. This has been a key feature of the success of our national response.
“Apart from the negative health, social and economic impacts of COVID-19 on human populations, the pandemic has clearly demonstrated the importance and relevance of science and scientists. Population (public) health and epidemiology disciplines have enjoyed a popularity not seen in decades and some scientists have become national celebrities. Interest in public health and epidemiology training has increased dramatically and public health practitioners are no longer shy to declare their chosen profession.
“We are fortunate to have a Prime Minister and Government that has accepted the advice based on science and supported evidence-based policy making. Prime Minister Ardern has shown how strong, decisive and empathic leadership can achieve and she continues to enjoy the support of most New Zealanders despite the efforts of opposition political parties and selected media outlets. Her continued support for our neighbours in the Pacific islands has been exemplary. She has high approval in the realm nations of the Cook Islands, Niue and Tokelau.
“Pasifika communities have responded well; there were high rates of testing and good mobilisation in response to the Auckland August cluster.
“At the one-year anniversary of the COVID-19 pandemic, we can be pleased with our efforts and the beginning of the national vaccination programme is a reason for optimism. The full impact of the COVID-19 vaccination programme on the global pandemic is yet to be fully manifest. It is likely to reduce the risk of COVID-19 transmission, although the pandemic is likely to continue to threaten the people of Aotearoa/New Zealand because the virus will continue to circulate elsewhere in the world. As long as COVID-19 exists somewhere in the world, nobody is safe.
“Looking back, despite the high death toll and profound impact of the disease on human populations, we can be pleased that science has allowed us to triumph over adversity.”
Conflict of interest statement: Dr Tukuitonga is a member of the Ministry of Health’s COVID-19 Technical Advisory Group and is a board member of the Quality and Safety in Health Commission.
Professor David Murdoch, Dean and Head of Campus, University of Otago, Christchurch, and Co-Director, One Health Aotearoa:
“I first heard about Aotearoa’s first confirmed case of COVID-19 while at a conference in Melbourne. Little did I know this would be my last overseas trip for a while. Like so many people, I have been surprised at how little I have missed the regular international travel that had been such a major feature of my career.
“What else have we learnt over the past year? The list is very long, but here are some notable items.
“We have learnt that some basic public health measures (such as physical distancing, good hygiene, and lockdowns) can really make a difference. The speed at which the strict nationwide lockdown in March/April 2020 brought the outbreak under control surprised even the staunchest proponent.
“We have learnt about the critical roles of diagnostic testing and the laboratory staff that perform the tests. The work of medical laboratory scientists is often under-appreciated, yet these professionals have played a vital part in the national pandemic response.
“We have learnt about the power of rapid genomic testing. The ability to fingerprint positive COVID-19 tests in near real-time has greatly aided contact tracing, outbreak investigation and decision-making about alert levels. The Institute of Environmental Science and Research (ESR) and their collaborators deserve a big shout out for their fantastic work in setting up the genomic testing system in Aotearoa. We need to now apply this resource to other infectious diseases as an ongoing service.
“We have learnt that it is possible to create and deliver new safe and effective vaccines at extraordinary speed and scale. While we had started seeing a more streamlined process for vaccine development over recent years, especially since the 2013-2016 West Africa Ebola outbreak, the sheer pace and scale of development of so many COVID-19 vaccines has impressed almost everyone. Even a few months ago, we would have been surprised to know that millions of doses of safe and effective COVID-19 vaccines had already been administered globally. Vaccine development has changed forever.
“More than ever, we, as a country, need to be much better prepared for future infectious diseases risks. A COVID-19-like pandemic had been predicted for some time, yet the world was not well-prepared. COVID-19 has taught us the value of the critical connection between science, policy and leadership. This partnership needs to be continued and actively developed as we move on from this pandemic.”
Conflict of interest statement: Member, COVID-19 Vaccine Strategy Taskforce, NZ Government. Member, COVID-19 Vaccine Strategy Scientific and Technical Advisory Group, NZ Government. Member, Advisory Group, Vaccine Alliance Aotearoa New Zealand (VAANZ). Independent Member, Clinical Trials Steering Committee, University of Oxford COVID-19 Vaccine. Member, COVID-19 Expert Advisory Network, Ministry of Health.
Dr Nikki Turner, Director Immunisation Advisory Centre, University of Auckland, comments:
“This year feels very different from last year, in a good way. While the pandemic continues to rampage around the world, we are starting to see genuinely positive signs of it abating in some places. There have been many learnings that are helping public health measures be more effective, such as variants of lockdowns, social distancing, PPE and border controls. The exciting newcomer now is the availability of vaccines.
“In less than a year we have available licensed COVID-19 vaccines. This is incredible progress and the speed of their development can be credited to an amazing international effort.
“So, how have we managed to get vaccines so fast?
“Firstly, science has come a long way since the early days of vaccine development and we have had real breakthroughs in design – particularly with the newer RNA and vector-based vaccines that are leading the way.
“Secondly, international cooperation supported by significant financial backing has helped to overcome roadblocks that have traditionally slowed vaccine development down. Processes that were previously run sequentially have been run in parallel.
“Some of the factors enabling the rapid development of COVID-19 vaccines include:
- The fact that the large pivotal trials were able to enrol large numbers of willing participants easily, and because COVID-19 disease is so prevalent, clinical data was able to be collected very fast.
- Manufacturing plants were established at large cost, taking a financial risk before they knew if the vaccines would work, but it meant they were ready to scale up production rapidly as soon as the clinical trials show success.
- Authorisation bodies reviewed data as it arrived, to speed up the processes.
“And now that vaccines are here, how much of a difference will they make?
“We can rightly be excited at this time, because these vaccines are a major step forward we need in managing to control the COVID-19 pandemic long term. However, they are not a panacea to rapidly return to life as we knew it.
“For us here in New Zealand, the vaccine we have approved to date (PfizerBioNTech) comes with impressive safety and effectiveness data both from the clinical trials and now from extensive use in many, many millions of doses. We can be confident it has an excellent safety profile and it is highly effective against symptomatic disease.
“An important question yet to be answered is how much effect this vaccine, or other vaccines New Zealand may approve, will have against reducing spread of the virus. What we do know though is that COVID-19 vaccines help reduce the effects of the pandemic.
“While I think it is unlikely we can fully keep this virus out of the country once we open up the borders with a well-vaccinated population, I feel very positive we may be able to keep community spread at a low level.
“What a difference a year makes!”
No conflict of interest.
NOTE: The Immunisation Advisory Centre (IMAC) has a contract with the Ministry of Health to delivery education and training to the healthcare sector for COVID-19 vaccines.
Andrew Sporle, Deputy Director, Healthier Lives National Science Challenge, and Director, iNZight Analytics Limited, comments:
“Responding to this pandemic has demonstrated the value of data in modelling the possible spread and impact of the epidemic, as well as informing options for controlling it. New Zealand was fortunate in having high-level expertise in disease modelling and epidemiology that was willing to quickly redirect their efforts from their existing work towards informing the responses to the epidemic.
“Those efforts have also highlighted major deficits in this country’s key data systems and sources, as well as our ability to get robust, regionally-specific information to decision makers when rapid local level information is required.
“The importance of this was highlighted by the hugely disproportionate impact on the Māori and Pacific communities of even our relatively small scale outbreaks. Controlling the epidemic and preventing the inevitable inequitable impacts of community transmission will require robust information getting to regions and communities in a timely fashion.
“A country our size should be able to create a comprehensive and timely information system to inform pandemic response at a national and local level while maintaining individual confidentiality. One year on, we are still a long way from that.”
No conflicts declared.
Professor Michael Plank, Te Pūnaha Matatini and University of Canterbury, comments:
“Over the last year, we have learned a huge amount about the virus, and mathematical models have been one important tool to do that. At the beginning of the pandemic, models were used to produce worst-case scenarios for the number of deaths if we did nothing to prevent the virus spreading. These early models helped prompt action from governments around the world and led to dramatic changes in behaviour. This meant that countries slowed the spread and avoided these worst-case scenarios.
“When New Zealand went into lockdown in March last year, the virus was still surging around the world and we didn’t know whether it would be enough to bring the epidemic under control. Over the following weeks, models helped us measure the effect the Alert Level change was having. Eventually, this gave us confidence that the reproduction number – the number of people infected by an average case – was less than 1. It was at this stage that elimination of the virus in New Zealand became a real possibility.
“We have collected enormous amounts of data about the virus over the last 12 months, but making sense of that data isn’t always easy. Models can help because they can be used to test different hypotheses and see which ones match the data. This has helped us understand the extent to which Covid-19 can be spread by people without symptoms, measure the effect contact tracing can have on case numbers, assess the threat from new variants, and design vaccine roll-outs.
“Over the year ahead, models will continue to be crucial in understanding the level of immunity that vaccination is providing to New Zealand’s population. We need as many people as possible to get vaccinated to protect not only themselves, but others who can’t be vaccinated for some reason or for whom the vaccine doesn’t work. If everyone plays their part, we will have a good chance of reaching herd immunity, where the population is protected against new outbreaks.”
Conflict of interest statement: “I am partly funded by MBIE for research on mathematical modelling of COVID-19.”
Dr Andrew Chen, Research Fellow at Koi Tū: The Centre for Informed Futures, The University of Auckland, comments:
“Digital contact tracing appeared as a relatively new tool in response to the COVID-19 pandemic. Previous efforts had been limited to trials within single hospitals with small groups of people. With the pandemic, suddenly there was a need to deploy these technologies at scale. How could we use technology to help speed up contact tracing while protecting privacy?
“Globally, every country developed a slightly different tool, giving us the opportunity to see what works and what doesn’t. Government IT is slow, costly, and buggy at the best of times, and we have seen large variation in the success of these tools. We have learnt that trust in government and corporations plays a huge role in participation rate, with that trust largely centering on privacy and feared misuse of data. Digital contact tracing also highlighted again the huge digital exclusion challenge that still faces many countries, and a need for governments to really invest in enabling all people to participate fully to the extent that they are comfortable.
“Here in Aotearoa New Zealand, the NZ COVID Tracer app has had a small but important impact in recent months, helping notify contacts of our few community cases that they need to be tested. But early on, the app had very little effective uptake – lots of people signed up, but at one point there were only 10-20k QR code scans a day. It wasn’t until the August/September outbreaks, alongside mandatory display of QR codes for businesses, when the usage spiked up. We are now seeing a healthy, albeit probably still too low, level of participation in the tool, but it appears to help give confidence to contact tracers and government that they can define the boundaries around new community cases.
“Rapid contact tracing can help cut off the chains of transmission and stop outbreaks from growing – the humans in the manual system have demonstrated that they can do an amazing job, and the evidence suggests that the digital tool helps.”
Conflict of interest statement: “I have had interactions with the Ministry of Health around digital contact tracing in an academic capacity, but am not employed or paid by them.”
Dr Joep de Ligt, Lead Bioinformatics & Genomics, ESR:
“Never before have so many scientists, and indeed the public, worked together towards a common goal – to protect our communities from this virus. As New Zealand’s infectious disease specialists, ESR stepped up its expertise long before the first case in the country. Alongside others, we deployed our diverse spectrum of experts as trusted advisors and began developing the tools we would need. Epidemiologists, analysts, public health physicians, virologists, and many more got to work. From the databases needed to provide the right data to track cases to the diagnostic test needed to find them in the first place.
“On the rise of ESR’s genome sequencing, there is pride from our teams that the words ‘the results of ESR genome sequencing’ have been crucial in some of our most difficult case investigations. One example was the genomic link between the MIQ worker and Auckland student last year, potentially averting further alert level changes.
“But a year ago, many of our tools weren’t even on the radar of most. When we sequenced the first New Zealand SARS CoV-2 genome on March 24, there was little excitement outside of scientific circles. It took a few months to prove its worth, but once it did, it became a cornerstone of our response. Providing this tool is a collaboration both here and abroad. The driving force behind each investigation is driven by larger teams of contact tracers and epidemiologists, but our tools can provide intelligence to confirm or provide the missing pieces of the puzzle.
“As new challenges arise, we develop the technology to assist the health response. From wastewater testing to a national clinical data repository in just four weeks. Keep your eyes peeled as we innovate further and investigate emerging tools. Genome sequencing may just be one of our tools, but we are proud to help wield it for the good of our communities. More than 1700 genomes sequenced to date and counting.”
Conflict of interest statement: Dr De Ligt is part of a Ministry of Business, Innovation and Employment (MBIE) COVID-19 Innovation Acceleration Fund project to sequence the genomes of all of New Zealand’s positive COVID-19 cases and track how the virus spread across New Zealand
Jacqui Maguire, Registered Clinical Psychologist, comments:
“Over the past year, New Zealanders have been required to respond and manage persistent unexpected change, economic instability and loss. Whilst as a country we have been able to live a relatively ‘normal’ life in comparison with our global counterparts, it is important we acknowledge the impact COVID-19 has had on our population. Loss of liberty, financial hardship, business instability, separation from family and a world that is unrecognisable to 12 months prior are not insignificant.
“During lockdown we saw a rise in anxiety, depression, and loneliness. Our younger Kiwis aged between 18 and 34 reported being most distressed perhaps reflecting more stress in their lives, worries over work and money, or struggles juggling childcare. Wellbeing data post May 2020 is not locally available, however international data is showing trends in poorer wellbeing. However, we can be certain everyone’s personal experience of the last year will have varied depending on their location (e.g. those living in South Auckland are more likely to have been impacted), contextual factors, stressors and strengths, past experiences, genetic disposition, habited thought patterns and coping skills.
“As we arrive at the 12-month mark, it is clear that New Zealand has surpassed the acute crisis phase. Instead, we are living amidst a ‘new normal’ of long-lasting uncertainty. However, it has been suggested that many of us are still trying to sprint what has become a marathon, meaning the impact of the pandemic is likely to take a different form in 2021. Research investigating the path of collective psychological response to crisis predicts that disillusionment and exhaustion are likely at this 12-month mark (Myers and Zunin, 2000).
“Disillusionment can be described as our negative emotional response to lost assumptions. For example, we know people are currently experiencing sadness, disappointment, anger and apathy in response to the reality that our world has far from returned to normal. Exhaustion (pandemic fatigue) is characterised by emotional depletion. Feeling so depleted that you have no capacity to give to others or indeed yourself. Not only will exhaustion impact our physical health, it can also impact our performance, relationships, self-care and overall mental health.
“As such, as a population we need to fight the urge of complacency to continue actively supporting our wellbeing. Supportive and reciprocal relationships, focussing on what can be controlled, purposefully noting daily positive events, managing unhelpful thoughts, regulating emotions and engaging in healthy habits are all key psychological tools to help us live well as we endure forward.
“On reflection, it has been unsurprising to see that protecting mental health and wellbeing has received heightened focus in our communities and through media. As a psychologist it is always pleasing to see wellbeing being prioritised, and it is my hope this focus will continue well beyond the COVID-19 pandemic.”
No conflict of interest
Dr Melanie Woodfield, Clinical Psychologist, Auckland District Health Board, and Health Research Council PhD Fellow, University of Auckland, comments:
Parents and parenting
“This year has presented challenges for most New Zealanders, but parents of young children and those engaged in other caregiving roles (perhaps elderly or disabled loved ones) may have been particularly affected.
“Parenting well isn’t about robotically dispensing information and strategies. If that were the case, we could read a book (perhaps the elusive parenting manual we weren’t handed at birth) and manage bedtimes and morning routines with ease.
“In fact, parenting effectively draws on a parent’s ability to regulate their emotions, and plug into their executive functioning abilities – self-control, planning, anticipating, those sorts of things. That’s much harder to do when a parent is struggling – exhausted, under financial stress, experiencing health anxiety or facing competing work and home school deadlines during a lockdown.
“Parents naturally make attributions about their child’s behaviour – perceptions of, and explanations for their child’s behaviour. When under stress, natural distortions that happen in a parent’s thought process (“my baby is doing this on purpose”, “there’s something wrong with him”, “I am not a good enough mother”) are more likely to ‘stick’. Especially when it’s harder to connect with friends or family who might provide a sounding board around the truth and/or usefulness of these ideas.
“Sticky distorted thoughts and perceptions can result in parents who are dejected, despairing and struggling to hold hope for the future. However, we must acknowledge that Covid-19 has impacted families across New Zealand in many different ways. Some are relatively unaffected, perhaps even relieved when lockdowns happen.”
“For adolescents, wellbeing is often tied tightly to connection with other young people. School is not just a place of learning – for many it’s a place of community. So, while a handful might feel relief, school lockdowns are often tough for teens who are facing assessments and exams coupled with disconnection from their peers. Social media isn’t always awful – it can foster connection for some.”
“A word on those in our community who are sceptical or doubting. Vaccines, lockdowns, whatever it is – let’s remember that anger (and its relatives – indignance, outrage and fury) is usually secondary to other emotions, like fear. It’s often in the context of feeling vulnerability and coercion. Fear that there’s an ulterior motive, fear that it’s unnecessary, fear that it’s harmful. Connecting with likeminded people can validate fledgling ideas that can become part of the group’s fabric. There are powerful unconscious cognitive processes at play, like confirmation bias – a tendency to select and hold on to information that supports existing perspectives. It’s very unhelpful to see these groups in our community as ‘other’ or ‘them’. They are fellow humans, trying to make sense of an overwhelming situation that’s of a global magnitude we haven’t seen before.”
No conflict of interest.
Dr. Paula O’Kane, Senior Lecturer in Human Resource Management (HRM), University of Otago Business School, comments:
“Nearly one year on from the emergence of COVID-19, we in New Zealand have a relatively stable life. But nearly a year ago, we went home to work, to live, to play and to exist. Employees who could worked from home. So, what have we learned from this experiment, and how is or could this change the landscape of working life in New Zealand?
“First, we know working from home was mainly successfully in the pressured COVID-19 context, and that post-COVID-19, it should be more straightforward. The terms ‘remote working’ and ‘working from home’ have become commonplace but what does this really mean? For us, it is workplace flexibility and choice. As we move forward, New Zealand needs to embrace flexibility. Flexibility is more than just working from home – it is one or two days a week at home, it is job sharing and part-time work, it is compressed hours, it is facilitating work-life balance, it is providing choice. Choice also includes providing office space and enabling traditionally working hours. Well implemented, it can be successful on numerous levels.
“At the individual level, there is less commuting, less wasted time, more focus, greater productivity, higher levels of well-being and the potential to create stronger work-life balance. At the organisational level, it requires trust in your employees, strong leadership skills and leaders who can embrace change. Doing this leads to employees who are more in control of their day-to-day routine, which ultimately improves organisational performance.
“There is also less cost in buildings, which in turn might provide more real estate for housing. At an environmental level He Pou a Rangi Climate Change Commission’s 2021 Draft Advice for Consultation advocates for flexible working arrangements to support reducing long-lived greenhouse gases, to work towards decarbonisation and meet the ‘vision of a thriving, climate resilient and low emissions Aotearoa’ (see page 9).
“The New Zealand government has a role to play too. What about working from home tax relief for employees, like that implemented by the UK during COVID-19, or regulations on the total commute time an organisation is allowed? These are just ideas, but they demonstrate that this is not just an organisational issue, but one that requires a systems-level resolution to better society for everyone.
“As we move beyond COVID-19, what will be interesting is the extent to which New Zealand embraces flexibility, compared to countries like the UK and Ireland, or Melbourne where lockdowns lasted much longer, with some people not being to their offices in nearly a year. Will we be left behind, or will we be leaders in flexible work? There are signs flexibility is emerging. Organisations are consulting with staff and employees are being offered choice. The challenge is to embed this throughout New Zealand and make it the norm.”
No conflict of interest.