New Zealand has one of the lowest Covid-19 Death Rates at 0.3 %. Here’s what they did.

 
As of April 13, the global case fatality rate as it stands is 6.2%, whereas New Zealand’s is only 0.37%. There is a total of 1.9 million cases and 117 thousand Covid-19 deaths globally.

New Zealand has 1,349 cases and 5 deaths.

The table from Statista below is an excerpt from a long list of countries and their death rates. It only shows the top 13 countries with the highest COVID-19 death rate as of April 9.

The end of the long table shows the following:

New Zealand is number 63, with a death rate of 0.08%. What did New Zealand do differently?

In a word, the New Zealanders are proactive in dealing with Covid-19.

New Zealand was ahead of the Pandemic

On 28 January, as the news of the rapid spread of Covid-19 is hitting the international press,  New Zealand’s Ministry of Health set up the National Health Coordination Centre (NHCC) in response to the outbreak.

Starting February 3, any foreigners who traveled from Wuhan, China, were denied entry. Any Kiwis who went from Wuhan China were quarantined for 14 days.

On February 28, New Zealand had its Covid-19 case. Even before the first case, New Zeland already enacted travel restrictions.

March 21. The government introduced a four-tier response system, and the country was placed on ‘level 2’ response. That involved limitations on mass gatherings and encouraging increased physical distancing. On that date, they only had 52 cases. 

By March 24, the country went to ‘level 4’. Level 4 is a ‘lockdown’ involving closing all schools, non-essential workplaces, social gatherings, and severe travel restrictions. The total cases on that day were 205.

At the same time, a national emergency was also declared, giving authorities additional powers to enforce control measures.

How Different is the New Zealand Strategy?

Instead of escalating the epidemic control as the number of cases goes up, New Zealand did the opposite. They made the hard decision to lockdown at the early stage.

The early lockdown prevented the introduction and local transmission of Covid-19 from the outside. This is critical for a new disease like Covid-19, where no one has immunity.

If they did not lockdown, Covid-19 would have spread fast. Just like in other countries.

What else did they do during the lockdown?

A. Contact Trace

The New Zealanders used their knowledge of the long incubation period of Covid-19. Covid-19 has 5–6 days compared to influenza at  1–3 days. 

They took advantage of the long incubation period for early identification of Covid-19 cases by testing. As the cases were identified, their contacts were known. The contacts were also tested with the positives identified and appropriately quarantined.

In isolating the positive cases, they were able to contain the rapid spread of the epidemic. That strategy has worked in China, Hong Kong, Singapore, South Korea,  and Taiwan.

An information campaign was started that taught preventive measures like cough etiquette and handwashing.   Handwashing facilities were also put in public areas.

B. Health Care Preparation

While in the lockdown phase, the hospitals were prepared for the expected surge of Covid-19 cases. They did the following:

1. Infection control measures were enhanced.
2. Hospital staff and equipment were increased in anticipation of a surge.
3. Expansion of the intensive care units (ICUs) and an increase in the number of ventilators.
4. A rapid expansion of other workforce and support systems (e.g., information systems for case and contact management).

The Economic Risks of a Lockdown and its Reduction

There is an economic cost to a lockdown. Business establishments grind to a standstill. This can destroy small businesses and affect the economy.

To avoid or minimize that, the government responded with a range of interventions including a significant economic support package and restrictions on rent increases.

The criteria for the gradual relaxing the lockdown

1. A high-performing border control.
2. Case and contact follow-up
3. Sufficient testing
4. A system of surveillance to detect a low risk of COVID-19 circulation in the population. (They are thinking about using a cell phone app like in Singapore for contact tracing).

The Back-up Plans

Even with its small number of cases, New Zealand has back-up plans in case the disease continues to spread.

There are preparations for a potential shift to the mitigation strategy where the “herd immunity” is increased. Another is the suppression strategy with a more extended lockdown period.

All of these plans are to “flatten the curve” so that the health care system will not be overwhelmed. That way, even those who are sick but have no infection will still be cared for. 

There is also a ‘safe haven‘ program to protect vulnerable populations. This will entail cordoning of the elderly and those with chronic conditions in their own homes, institutions, and communities.

My thoughts

New Zealand’s early lockdown gave them more time to strengthen their health care system in preparation for a surge. If ever that time comes, they may benefit from the clinical experience of other countries in treating critically ill patients.

It may also be possible that clinical trials with different medications will be done by that time. They can use those results to use the medicines that have shown the best results.

That leads to better patient outcomes, shorter hospital stays, and fewer expenses.

This is also the first country that has an exit strategy from a lockdown. Exit strategies are essential as it gives everyone a goal to aspire for. The light at the end of the tunnel if you may.

New Zealand typifies excellent leadership, and the use of time-tested, science-based disease control measures to control a modern-day pandemic.

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Don’t Get Sick!

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Reference:

New Zealand’s elimination strategy for the COVID-19 Pandemic and what is
required to make it work. NZMJ 3 April 2020, Vol 133 No 1512 ISSN 1175-8716 
Michael G Baker, Amanda Kvalsvig, Ayesha J Verrall, Lucy Telfar-Barnard,
Nick Wilson

Image Credit: Map of New Zealand and Covid-19 outbreak:  New Zealand District Health Board Map (Blank).svg

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