Auckland, and possibly other parts of New Zealand, almost certainly have more cases of COVID-19 in the community than the four new cases confirmed yesterday.
Prime Minister Jacinda Ardern activated a resurgence plan late yesterday, placing all of Auckland back under alert level 3 restrictions from today until midnight on Friday to allow time for contacts to be traced and tested.
Zealand (Danish: Sjælland, pronounced [ˈɕɛˌlænˀ], Swedish: Själland), at 7,031 km2, is the largest and most populous island in Denmark proper (thus excluding Greenland and Disko Island, which are larger). Zealand has a population of 2,319,705 (as of 1 January 2020).It is the 13th-largest island in Europe by area and the 4th most populous. It is connected to Funen by the Great Belt Fixed Link, to Lolland, Falster (and Germany from 2028) by the Storstrøm Bridge and the Farø Bridges. Zealand is also linked to Amager by several bridges. Zealand is linked indirectly, through intervening islands by a series of bridges and tunnels, to southern Sweden.
Copenhagen, the capital of Denmark, with a population between 1.3 and 1.4 million people in 2020, is located partly on the eastern shore of Zealand and partly on the island of Amager. Other cities on Zealand include Roskilde, Hillerød, Næstved and Helsingør.
Despite their identical names in English, the island is not connected historically to the Pacific nation of New Zealand, which is named after the Dutch province of Zeeland.
New Zealand is on alert as COVID-19 returns. This is what we need …
Coronavirus disease 2019 (COVID‑19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December 2019 in Wuhan, Hubei, China, and has resulted in an ongoing pandemic. As of 12 August 2020, more than 20.2 million cases have been reported across 188 countries and territories, resulting in more than 739,000 deaths. More than 12.4 million people have recovered.Common symptoms include fever, cough, fatigue, shortness of breath, and loss of smell and taste. While most people have mild symptoms, some people develop acute respiratory distress syndrome (ARDS) possibly precipitated by cytokine storm, multi-organ failure, septic shock, and blood clots. The time from exposure to onset of symptoms is typically around five days, but may range from two to fourteen days.The virus is primarily spread between people in close proximity, most often via small droplets produced by coughing, sneezing, and talking. The droplets usually fall to the ground or onto surfaces rather than travelling through air over long distances. However, the transmission may also occur through smaller droplets that are able to stay suspended in the air for longer periods of time in enclosed spaces, as typical for airborne diseases. Less commonly, people may become infected by touching a contaminated surface and then touching their face. It is most contagious during the first three days after the onset of symptoms, although spread is possible before symptoms appear, and from people who do not show symptoms. The standard method of diagnosis is by real-time reverse transcription polymerase chain reaction (rRT-PCR) from a nasopharyngeal swab. Chest CT imaging may also be helpful for diagnosis in individuals where there is a high suspicion of infection based on symptoms and risk factors; however, guidelines do not recommend using CT imaging for routine screening.Recommended measures to prevent infection include frequent hand washing, maintaining physical distance from others (especially from those with symptoms), quarantine (especially for those with symptoms), covering coughs, and keeping unwashed hands away from the face. The use of cloth face coverings such as a scarf or a bandana has been recommended by health officials in public settings to minimise the risk of transmissions, with some authorities requiring their use. Health officials also stated that medical-grade face masks, such as N95 masks, should be used only by healthcare workers, first responders, and those who directly care for infected individuals.There are no proven vaccines nor specific antiviral treatments for COVID-19. Management involves the treatment of symptoms, supportive care, isolation, and experimental measures. The World Health Organization (WHO) declared the COVID‑19 outbreak a public health emergency of international concern (PHEIC) on 30 January 2020 and a pandemic on 11 March 2020. Local transmission of the disease has occurred in most countries across all six WHO regions.
But until we can identify the chain of transmission, New Zealanders should prepare for restrictions to remain in place for longer.
All four new cases are within one family in South Auckland, with no links yet discovered to quarantine or border facilities. But family members work in different places across different suburbs, which means the restrictions need to apply to the whole city.
New Zealand is on alert as COVID-19 returns. This is what we need …
When Melbourne found itself in a similar position a month ago, the city’s strategy was to lockdown specific suburbs. Unfortunately this failed to contain the virus.
Mapping COVID-19 spread in Melbourne shows link to job types and ability to stay home
Quick return to restrictions
Swift and decisive action is important, and we support the decision to place stricter conditions on Auckland and to return the rest of the country to alert level 2. We should all be very cautious.
Everyone working at the border or in managed isolation will be tested and pop-up stations have opened across Auckland to carry out mass testing. But it is quite possible someone within the wider contact network of the cases has travelled outside Auckland. People who have travelled to Auckland in the last two weeks should act as if they are under level 3 restrictions and stay home from work.
Whether we are in Auckland or not, we should all resume social distancing, working from home if we can, and wearing a mask if possible when we go out. If we do the right things now, there’s a good chance we will be able to contain this community outbreak before it spreads too much further.
We’re going to need to do a lot of testing to work out how far the virus has spread. It’s more effective at this stage to target high-risk groups rather than testing people at random. People with symptoms or people who have been identified as close contacts of known cases should be prioritised for testing.
If you are offered a test or you don’t feel well, you should get tested, but if you feel fine, just stay at home.
Rapid contact tracing is going to be key to getting the virus under control. Our recent modelling shows that if we can trace and quarantine 80% of contacts within two days on average, it will go a long way to containing the outbreak.
A new community case of COVID-19 in New Zealand is a matter of when, not if. Is the country prepared for it?
Contact tracers are also doing backward tracing – finding the source of infection so we know how many other cases are out there – as well as forward tracing, which means quarantining contacts so they don’t pass the virus on.
For Auckland, moving to alert level 3 reduces the number of contacts most of us have. This will make the job easier for contact tracers over the coming days as they may only have to trace one or two contacts per person rather than ten or more.
Everyone should now draw up a list of where they’ve been and who they’ve seen for the last two weeks. This is also a wake-up call to redouble our efforts to keep diaries of activities and to use the NZ COVID Tracer app to keep a record.
The Tracer app has the added advantage that the Ministry of Health can automatically notify anybody who has visited the same location as a confirmed or potential case. We encourage Aucklanders in particular to check their apps, diaries and bank accounts to compile as much detail as possible of places they have visited or people they have met over the last 14 days.
What happens next
What happens next really depends on the results of the contact tracing investigations already underway. There is a lot of luck involved in the early stages of an outbreak like this one. If we are lucky, many of those infected may not have yet have passed the virus on.
But it’s also possible there may have been a superspreading event, for example at a workplace or social gathering. In that case, there could be a large number of cases already out there. Although the alert level is currently in place until Friday, we should be prepared for this to be extended, depending on how many cases we find in the next three days.
Back in February, when we had our first cases of COVID-19, the situation was very different. We had an open border and most cases were international travellers or their close contacts.
We were also getting around 80 new cases a day by the time we went into lockdown in March. This time we have locked down with a smaller number of cases and we still have strict border restrictions in place.
This should give us confidence that if we all do the right things, we will be able to get the outbreak under control much faster than last time.