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The Lancet

An aggressive approach has enabled New Zealand to end community transmission of SARS-CoV-2. Sophie Cousins reports. New Zealand recorded its first day of no new cases of coronavirus disease 2019 (COVID-19) early this week, more than a month after its strict lockdown began. At the time of publication, New Zealand had recorded fewer than 1500 confirmed cases of COVID-19, and 20 deaths. On March 23, a month after the country had recorded its first case, New Zealand committed to an elimination strategy. A few days later, Prime Minister Jacinda Ardern announced a strict national lockdown when it only had 102 cases and zero deaths. Her swift decision making won international praise, including from WHO. New Zealand's decision to pursue an elimination approach was a vastly different approach to usual pandemic planning, which has historically been based on a mitigation model and focuses on delaying the arrival of the virus, followed by a range of measures to flatten the curve of cases and deaths. Michael Baker, professor at the University of Otago's department of public health in Wellington, who has been advising the New Zealand Government on its response, said implementing a full lockdown—involving the closure of schools and non-essential workplaces, a ban on social gatherings, and severe travel restrictions—enabled the country to consider elimination. “I think it was the right decision; we had to go hard”, he said. “The two biggest benefits of pursuing an elimination strategy is that you have few cases and few deaths and you can get business back up and running. The alternative was that we are stuck with the virus and stuck between mitigation and suppression. Suppression is pretty grim.” While the strategy has had its critics, for Baker, the evidence was overwhelming that elimination could be achieved. Baker said the full lockdown allowed the country to get key systems up and running to effectively manage borders, and do contact tracing, testing, and surveillance. Since Jan 22, more than 150 000 people have been tested in a country of just 5 million. Testing has been focused on people with symptoms, with tracing of both close contacts and casual contacts. However, more widespread testing is now being introduced. The Ministry of Health is in discussion with districts to arrange testing of specific communities who are at higher risk of acquiring the virus such as those in aged residential care and health-care workers. Testing samples from sewerage is also being considered to monitor control and elimination. The response has also been one that placed science, leadership, and careful language at the forefront. Siouxsie Wiles, associate professor and head of the Bioluminescent Superbugs Lab at the University of Auckland, said one of the country's key successes has been the way in which COVID-19 was framed to the general population. “In other countries, people have been talking about war and battle, which puts people in a negative and fearful frame of mind”, she said. “The official response here has been guided by the principle that you do not stigmatise and that we unite against COVID-19.” Ardern has regularly appeared on social media, smiling and sharing parts of her personal life under lockdown but without underplaying the seriousness of the situation, which has helped to build public trust. Baker agreed that language was a crucial part of the response. He said that how the country communicates the concept of elimination will be important going forwards. Wiles agreed. “We don't want the public to feel like they are being lied to. Elimination to everyone means that it is gone. But in epidemiological terms, it means bringing cases down to zero or near zero in a geographical location. We will still see cases…but only cases in people who have arrived from overseas.” Travellers from abroad will be quarantined as part of efforts to prevent transmission in New Zealand. As New Zealand now eases its restrictions and its economy slowly reopens, there are discussions about how it can open up its borders while ensuring that everyone is protected, particularly susceptible populations. Australia, which is having similar success to New Zealand but is not publicly floating the idea of elimination, has been in discussion with its neighbour about reopening travel between the two countries. Baker envisions that, in time, a small number of countries in the region will reach an agreement to enable travel with specific control measures in place. Officials have pleaded for vigilance as breaches of the shutdown rules continue to rise. When the country loosened some of its restrictions last week, some fast-food outlets ran out of food as people flocked in huge numbers to get burgers and fries. “We are nearly there. We are not at the finish line yet”, Wiles said. “We won't see how successful we have been for a few weeks yet.”

New Zealand eliminates COVID-19