Experts react to zero active COVID-19 cases in New Zealand

New Zealand's last active COVID-19 case has recovered, the Ministry of Health confirmed in a statement on Monday. 

There are now no known active cases, indicating the country could be COVID-19 free. 

Public health experts say while this is good news, precautions are still needed. They also weighed in on what it could mean for the country. 

'Welcome news' 

Senior research fellow at the University of Otago's department of public health Dr Amanda Kvalsvig said while it's good news, it doesn't mean the fight is over. 

"This is welcome news, and it’s an opportunity to reflect on the good work that is being done to control COVID-19 in Aotearoa," Dr Kvalsvig said. 

"However, having no active cases isn’t really a meaningful landmark for pandemic control. The numbers of ‘active’ and ‘recovered’ cases don’t tell us how many people are still infectious, and don’t answer the really important question which is whether there is still a virus circulating in the population. 

"If we continue to find no new cases despite ongoing testing, that’s much more informative and so far the results are encouraging.

"Something else to be aware of is that the official definition of recovery from COVID-19 and the reality of the recovery process can be quite different. People recovering from COVID-19 infection are reporting a variety of concerns ranging from feeling unusually tired to more serious postviral complications. 

"True recovery in the sense of feeling completely back to normal may take much longer than expected and this issue will need attention in the weeks and months to come."

Dr Kvalsvig warned that a move to alert level 1 will still need to include border restrictions, meticulous hand washing and possibly wearing masks in public. 

"We’ll need strict border controls for a long time to come, but no control measure is 100 percent effective and we can’t rely entirely on border measures to keep safe. 

"Our new normal at level 1 will still include meticulous handwashing and cough etiquette, staying home if feeling unwell, testing and contact tracing. 

"Level 1 might include some new measures as well. There’s increasingly strong evidence of the value of face coverings (non-medical masks) to prevent people who are infectious but have no symptoms from unknowingly spreading the virus."

She said wearing masks in public places like doctors' waiting rooms and planes and trains is an obvious place to start. 

'Important Milestone' 

University of Otago professor of public health Michael Baker said the lack of active cases shows NZ is on the way to eliminating the virus. 

"Having no active cases is an important milestone on the way to COVID-19 elimination."

Professor Baker stressed the importance of sticking to social distancing even with no cases. 

"These active cases are not themselves a major concern as we know about them and can ensure they are safely isolated. The worry has always been about the undetected cases that can cause outbreaks if we come out of lockdown too swiftly."

Baker said even when the country moves to level 1, it's important to remember COVID-19 still poses a risk worldwide. 

"The threat from COVID-19 obviously remains while this pandemic continues across the globe. This risk will rise again in New Zealand as we gradually increase the numbers of incoming travellers. It will also rise during the coming winter when coronaviruses are more transmissible."

He also called for the use of face masks in public places like planes and public transport. As well keeping up good hygiene such as hand washing and staying home when sick. 

"To improve our changes of preventing outbreaks caused by imported cases, we need face masks for high risk settings where people are tightly packed."

Baker also suggested a public health agency, similar to the US's Centers for Disease Control, dedicated to COVID-19 and other serious health threats. 

'Be proud' 

Clinical psychologist Jacqui Maguire said now is the time to appreciate what we have collectively achieved. 

"In a world screaming of fractious divides, we took collective action to take care of each other, and it worked. Be proud, as research demonstrates authentic pride is associated with increased social support, lower anxiety and a greater desire to help others. Neuroscience also highlights that authentic pride heightens serotonin, which in turn increases motivation for bonding, social support and wellbeing. Feel good about doing good."

However, Maguire stressed that until there is a vaccine, the war on COVID-19 is "not over". 

"Alongside our pride and patience, we also need to keep partial awareness on the future. Until there is a vaccine, the war on COVID-19 is not over. We need to maintain motivation to prevent a second wave outbreak."

She said it's important to look after ourselves as we transition to reduced restrictions. 

"Transition and uncertainty require a large degree of mindfulness of our own and others’ reactions, patience, tolerance, trust and hope. For today however, let’s savour the pride and practice gratitude. For as a nation we stood united and cared for each other. And it worked."

'A return to normality' 

Victoria University of Wellington clinical psychologist Dr Dougal Sutherland said an eventual move to level 1 will help people's mental wellbeing. 

“No new or active cases will herald a return to normality for many, especially once we reach level 1.

"Freely socialising in groups, celebrating and mourning together, going to a concert or gig. For most, this is likely to lead to an improvement in their mental and emotional wellbeing. 

"It is likely we will see a reduction in health-related anxiety concerns over time, although there may be a 'long tail' for this group, especially those with pre-existing mood or anxiety problems which have been exacerbated by the COVID-19 crisis. 

Dr Sutherland warned there may be a "new wave of anxiety and depression" before things get better. 

"Loss of a job can bring with it a loss of personal value and identity. So much of who we are is tied up with what we do. To lose that feels like losing a piece of ourselves. It’s this group of people who will now need our empathy and support. Rebuilding the economy involves rebuilding people's lives, and this may take months if not years.”

 'It is a marathon, not a sprint'

University of Otago senior psychological medicine lecturer Dr Chris Gale said the lack of cases and proposed level 1 rules is good news.  

"The reduction of social distancing and the ability to meet in groups will mean many cultural, religious and sporting events will be able to happen, which will generally enrich society and give many people hope and, one hopes, positive and happy experiences after a time when they have experienced isolation.

"The collected experience of mental health services following any disaster and adverse events is summed up in the phrase: 'It is a marathon, not a sprint'. 

"Many people coped during the acute crisis, but with the perception that the crisis is over the underlying anxiety may not end, and that dissonance can cause significant distress," Dr Gale said

He warned that while the Government increasing funding for mental health and addiction services is good, finding skilled people to meet the demand may be an issue. 

'A balancing act'

University of Canterbury associate professor of health and human development Dr Arindam Basu said the lack of cases doesn't mean there are no risks

"The government has to do a balancing act between science and policy perspectives. Ideally, one would wait for about 28 consecutive days with no active cases, at the end of which it would be considered safe to open up the restrictions completely as the risk of new cases emerging would be minimal by then.

"The easing of the restrictions seem to be happening sooner on practical and pragmatic considerations. But we now have effective disease surveillance, increased testing capacity, and improved contact tracing. With all these things in place, watchful removal of restrictions might be considered safe enough.

"Moving from level 2 to level 1 does not signify that there are no risks of new infections. The source of these new infections would be from people who may be infected without showing symptoms, and may now become mobile.

Dr Basu warned the winter months and the subsequent overcrowding of some indoor venues, such as malls, mean asymptomatic people have a higher chance of infecting others. 

"It would be safest for most people to be watchful and still maintain relatively safe distances when interacting with others, practice hand-washing and respiratory hygiene, and wear masks on public transport to minimize personal risk of infection."

Prime Minister Jacinda Ardern is expected to announce whether the country will move to alert level 1 during her post Cabinet press conference at 3pm on Monday June 8.