Coronavirus: How does New Zealand stack up against World Health Organization's 'criteria' for lifting restrictions

Kiwis will learn on Monday whether New Zealand's lockdown is extended or if we transition to the less full-on, but still restrictive, alert level 3.

Just as the decision to enforce the lockdown - which requires New Zealanders remain at home and non-essential businesses close - wasn't made lightly, any loosening of restrictions will only be made if the data and advice from health officials adds up.

As countries, like New Zealand, Spain, Italy and Germany, begin considering easing restrictions, the World Health Organisation (WHO) has warned against doing so too quickly and not putting human health at the forefront of any decision.

"Control measures must be lifted slowly, and with control. It cannot happen all at once," WHO Director-General Dr Tedros Adhanom Ghebreyesus said on Tuesday.

"Control measures can only be lifted if the right public health measures are in place, including significant capacity for contact tracing."

As part of an updated strategic advice package, the Director-General provided six "criteria" for countries to consider when deciding to lift restrictions. These will help countries transition to or maintain "a steady state of low-level or no transmission".

Here's a look at where New Zealand is heading on each criterion.

"Transmission is controlled"

Potentially the most obvious criteria is ensuring widespread community transmission isn't occurring. This is where authorities are unable to ascertain how someone became infected with the SARS-CoV-2 virus. If officials can understand where the virus originated and who else may be exposed, meaningful, specific actions can be undertaken to identify the infected, isolate them, and trace their contacts.

That's the "key information" New Zealand's Director-General of Health Dr Ashley Bloomfield said New Zealand needs to know.

"If we can’t immediately link [cases] to an extant case or cluster, then we need to do a forensic analysis and find out very quickly where they’ve come from and have a very quick and close look at all the possible contacts there and put a ring-fence around it," he said on Tuesday.

New Zealand's most recent data shows community transmission is not rampant - at least not on the surface.

The Ministry of Health advises only 2 percent of cases in the country are from community transmission. Most cases in the country (55 percent) are the result of someone becoming infected by an already known case. Prime Minister Jacinda Ardern said on Wednesday that only a "handful" of cases each day aren't being quickly linked to an existing cluster. 

But the origin of 4 percent of cases is still unknown. That's dropped significantly, however, with the ministry engaging on Thursday in a close analysis of 23 cases with unknown origins recorded since March 24. They found the majority of cases were related to a confirmed case and only four were deemed to have been acquired in the community.

The origin of many clusters is also not yet determined, including New Zealand's largest at Marist College, Auckland.

People who have contracted the illness overseas or from someone who has recently travelled makes up the second largest proportion of cases at 39 percent. That's fallen over recent weeks, a sign that New Zealand's border controls are keeping new cases of the virus out.

Dr Ashley Bloomfield.
Dr Ashley Bloomfield. Photo credit: Getty.

There has also been a trend downwards in overall cases being reported each day. On Thursday, 15 cases were recorded, the fewest since the lockdown was imposed and far fewer than the 89 reported at the virus' peak.

That occurred despite an overall increase in the number of people being tested.

"We will be more confident once we know about each of those new cases that has been appearing really from the last week and as we go into this week, and, also, if we continue to get reasonable testing rates of people with any symptoms and we’re still not finding additional cases, that will provide us with an even greater level of assurance," Dr Bloomfield said on Tuesday.

"Health system capacities are in place to detect, test, isolate and treat every case and trace every contact"

There are three main areas here: Testing, tracing contacts and treating the infected.

Currently, the Ministry of Health says: "Testing is available to people with respiratory symptoms suggestive of COVID-19 infection (including the acute onset of cough with or without fever)."

That removes previous requirements for someone to have a travel history, be a contact with a confirmed or probable case or have a fever. 

However, while testing has increased - the result of that broadened criteria and more labs processing tests - experts like epidemiologist Sir David Skegg have called on the Government to introduce surveillance testing, where samples of the population are tested for the virus to determine levels of community transmission and potentially catch any silent outbreaks..

In a blog post, a group of experts from the University of Otago say on top of testing people with severe or mild symptoms, there needs to be the capability to test those with a "higher level of exposure to potentially infectious people" such as supermarket workers or transport operators. To confirm elimination of the virus, we could even go as far as to test sewage, which has previously been used to detect outbreaks of the likes of norovirus and measles.

Specific surveillance testing began on Thursday in a Queenstown supermarket where 300 people were swabbed. This testing could soon also be happening in south Auckland and Waikato.

Dr Bloomfield is assured by the spread of testing across most regions and ethnicities in New Zealand. Data is only available publicly up to April 8 and can be found here.

Once someone tests positive, anyone who may have realistically been exposed to them needs to be contacted and isolated. Overseas experience has shown this step is pivotal, as reducing the amount of time someone may be walking around in the public with the illness means less time for others to become infected.

Having the rapid contact testing in place when we leave the lockdown is another point Sir David raised on the parliamentary Epidemic Response Committee on Tuesday. He said without it and surveillance testing, officials were playing Russia Roulette with Kiwis' health.

"I'm concerned the public health authorities have not yet completed the tasks that are needed to ensure we are on a path to elimination."

Testing in Queenstown.
Testing in Queenstown. Photo credit: Newshub.

It's been suggested by infectious disease expert Dr Ayesha Verrall that New Zealand needs to be able to trace about 1000 cases per day, a number we aren't yet at. 

There is work way underway, however, on mobile phone applications with tracking abilities which would show what other phones someone has been close to. Dr Bloomfield has been clear that would only support the about 220 staff working on contact tracing, but a similar application in Singapore, called TraceTogether, has been very effective. 

Ramping up New Zealand's ability to contact trace will help officials understand the origin of some infections and therefore provide more information about possible community transmission.

A report into the country's contact tracing ability for Dr Verrall has been presented to the Ministry of Health and the Government and will be soon be made public.

If we do find severe cases of the illness, our hospitals need to be ready to respond.

New Zealand hasn't seen the overloading of the health system as other countries have, which is likely the result of the lockdown. Modelling prior to the lockdown showed that without the significant action implemented, the country could have seen more than 30,000 hospitalisations. 

There's also now fewer active cases of COVID-19 in New Zealand than those that have recovered, taking pressure off hospitals.

Emergency departments remain open and GP clinics are conducting consultations virtually.

A rendering of the virus.
A rendering of the virus. Photo credit: Getty.

"Outbreak risks are minimised in special settings like health facilities and nursing homes"

New Zealand currently has five significant clusters - meaning clusters with more than 10 cases - in aged residential facilities. One of those, Rosewood rest home, has cases at Burwood hospital, where six of New Zealand's nine deaths have occured.

To ensure rest homes are capable of limiting the virus' spread, two reviews are underway. The first will see the rest homes with outbreaks looked at and with their response to the virus reviewed, while the second is a targeted inspection by the Ombudsman. The Aged Care Association says all new rest home residents will be tested.

One of the key tools DHBs have to combat the spread of the virus is personal protective equipment or PPE. 

While the Ministry of Health has consistently said that New Zealand has a large supply of PPE, Newshub has heard from medical professionals frustrated by not being allowed access to full kits or to wear their own gear. The Ministry says there are guidelines, informed by international experience, for the use of PPE that DHBs are following. 

New Zealand has also set up multiple community-based assessment centres (CBACs) around the country to provide greater access to tests for people and to reduce the number of people going to GP clinics or hospitals.

"Preventive measures are in place in workplaces, schools and other places where it’s essential for people to go"

This is about having a plan for businesses and facilities when restrictions are lifted.

After nearly four weeks in lockdown, New Zealanders have a fair grasp of the safety measures necessary to limit the spread of SARS-CoV-2. But if we were to move to alert level 3, some slight loosening of rules would occur.

Full information can be found on the Government's COVID-19 website, however, under alert level 3 businesses can open but staff "cannot physically interact with customers". The delivery of goods is allowed - as are drive-thrus - but any business that requires a customer-facing function, like retail or some bars, cannot operate.

Schools will only be open to up to Year 10s on a voluntary basis, while public venues will continue to be closed. Healthcare services remain virtual.

People should also maintain physical distancing measures while exercising.

Ardern announced details of alert level 3 on Thursday.
Ardern announced details of alert level 3 on Thursday. Photo credit: Newshub.

"Importation risks can be managed"

New Zealand is requiring anyone entering the country to be quarantined in a Government facility for at least 14 days, the virus' incubation period. Only Kiwis can also enter the country, meaning there are fewer and fewer people coming to Aotearoa each day, especially with airlines pulling out of travel routes. 

Prime Minister Ardern has signalled these tight border measures will last for a long period of time.

"Communities are fully educated, engaged and empowered to adjust to the 'new norm'"

The final criteria presented by the WHO is that communities are engaged and educated about the requirements imposed in their "new norm".

The New Zealand Government is doing this via its Unite Against COVID-19 marketing campaign, which has a significant presence both online and on traditional media.

Daily press conferences held typically by the Director-General of Health and Prime Minister have become essentially appointment viewing for many.

New Zealanders' engagement with the information being provided through these channels about the virus as well as the restrictions on them is reflected by relatively high compliance with the lockdown rules. 

The Government is also supporting several mental health initiatives and applications for people struggling to cope during the pandemic.