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Prof. Ian Civil Reports on COVID-19 Response in New Zealand

Prof. Ian D. S. Civil, BSc, MBChB, FRACS, FACS, FACS(Hon), Associate Professor of Surgery, University of Auckland, and a general and vascular surgeon and director of trauma services, Auckland City Hospital, New Zealand, describes his country’s response to the COVID-19 pandemic.

New Zealand has some unique geographic and political advantages with respect to pandemic response. We are a long way from other countries and so have some warning time, and our unicameral political system means decisions are made once for the country and do not need to be relitigated multiple times in different jurisdictions. In that light the Government weighed the options of letting the disease play out here with the likely effects on our health system but more limited effects on the economy and the reverse situation. Our government chose the latter, and on March 25 New Zealand went into Level 4 lockdown. Essential services remain in operation, and everyone else stays at home. We may leave the house to walk, run, bike but must stay local and avoid contacting anyone else within less than two meters. We are still in that lockdown now, but next Tuesday we will move to Level 3, which is similar to Level 4, but businesses and schools can resume, provided they can offer contactless services or environments. Apparently 400,000 people are expected to resume work on Tuesday.

At the hospital level, the first two weeks were spent on rigorous planning, particularly in relation to aerosol-generating procedures. Since then it has been a waiting game. All elective operations and most clinics were stopped. The amount of "unmet need" in the community remains unknown, but as New Zealand has for many years had overt rationing of health care to ensure care for those who would benefit most, the overall situation has been well tolerated. The idea of offering advanced intensive care to patients with advanced comorbidity would never be contemplated, even without COVID-19, so it is of little surprise that only a handful of COVID-19 patients have been in the intensive care unit, and all but two of the deaths have occurred either in regular hospital settings or in the community.

Figure 1 shows the number of active cases and the number of positive tests. Today more than 6,000 tests were administered, and only three people tested positive.

Civil FIGURE 1

All deaths have been in patients older than 70 years of age, and the majority have been among patients in their 80s and 90s. See the following Figure.

Civil FIGURE 4

The entire number of COVID-19 cases in the whole country in hospital today is shown in the following table.

Civil Table 3

And finally, the percentage of intensive care unit beds occupied today is as follows:

Civil FIGURE 9

So, New Zealand has avoided being physically ravaged by COVID-19, but of course the economic consequences of shutting down the country are immense, and it’s unclear to me how we are paying for it. The government has mobilized $52 billion so far, which is equivalent to $10,000 for every man, woman, and child. We will get back to business internally over the next one or two months, but if the rest of the world is unable to buy our exports, it will be a grim picture. And, of course, New Zealand relies on tourism, and that source of revenue has come to halt until a vaccination or cure becomes available; nor will we be able to travel. Hence, the financial consequences will be dire either way.

Still, it will be great to be able to socialize more normally soon and good that our health services and staff remain capable and well, but it will be a long time here before life resembles 2019. We have been enormously fortunate, though, that we have a popular and collaborative leader who has brought our country along with her and a competent and calming Director General of Health (my intern 30 years ago, he reminded me last year!) who together have steered our ship of state through some very rough waters.

COVID-19 has seen an enormous world experiment in how to combat a pandemic in the 21st century. Which approach proves to be best remains to be seen, but hopefully none are too disastrous, and we get back to a more thoughtful and reflective world in 2021.