COVID-19 Pandemic Notes

Global COVID-19 Pandemic

Outbreak started just over five years ago, evolving rapidly in January and February. It was a hugely disruptive event unfolding in real-time.
Ashley Bloomfield recalls waking up at 03:00 AM, worried about giving bad advice during the pandemic.
Before the pandemic, when asked what the worst thing that could happen in his role, Ashley responded, "probably a global pandemic."
The National Health Coordination Center was established in January with Dr. Caroline McElnay.
The first COVID-19 case in Aotearoa, New Zealand, was identified after Ashley had to cut short a mountain biking trip in the South Island.

The Spanish Flu Outbreak

The last huge outbreak before COVID-19 was the Spanish flu outbreak about a century prior.
The Spanish flu outbreak didn't start in Spain but on pig farms in the American Midwest.
The virus moved from pigs to humans and was carried to Europe by US Soldiers going to World War I.
It became known as the Spanish flu because news wasn't censored in neutral Spain, and the King of Spain contracted the flu.
The plan was for an influenza pandemic, but COVID-19 was a coronavirus that behaved differently, and it had initial delays in reporting.
The WHO initially recommended against stopping international travel, but New Zealand shut its border on March 17 to everyone except New Zealanders.
New Zealand took a precautionary approach, differing from WHO advice.
Early evidence suggested droplet spread, but it was actually aerosolization (fine droplets) that spread the virus.
Singing was one of the best ways to spread COVID-19 as it projects aerosols.

Global Health Security Index

A global health security index assessed capabilities across 195 countries just before the pandemic.
The USA was ranked as the best-prepared country, followed by The United Kingdom. New Zealand was ranked thirty-fifth with a score of 54.
Experts like Nick Wilson and Michael Baker noted New Zealand's poor preparedness.
Actual events during the pandemic showed that political willingness to listen to advice and make good decisions was crucial.

Pandemic Planning

New Zealand had a pandemic influenza plan, but it was not suited for a coronavirus pandemic.
The plan has been updated to incorporate lessons from COVID-19.
By March 17, the border was closed, and options were considered to avoid overwhelming the health system, as seen in Northern Italy and The United Kingdom.

Elimination vs. Control

Two key choices for dealing with an outbreak are control and elimination.
Initially, New Zealand aimed for control, trying to lower numbers and manage them with public health interventions like isolation, quarantine, testing, and contact tracing.
Vaccines and treatments were not initially available.
Other diseases, such as polio and measles, have been eliminated, and smallpox has been eradicated.
Eradication is different from elimination, which reduces a disease to zero in a region for a prolonged period without fully eradicating it.
SARS CoV-one was eradicated after the outbreak in the early 2000s.
WHO declared COVID-19 a pandemic on March 11, 2020.
The response required a whole-of-government effort, including business support and border closures.
The prime minister presented the alert level framework, and a lockdown was initiated shortly after.
Leadership is defined as an invitation to collective action, with New Zealanders largely complying with stay-at-home orders.
Communities, organizations, iwi, and Pacific groups mobilized to support each other.

Objectives

Prevent illness and deaths, particularly among vulnerable populations such as Maori, Pacific peoples, and those with disabilities or pre-existing conditions.
Protect the healthcare system and healthcare workers, learning from situations in The United Kingdom and Northern Italy.
Protect the economy by implementing a strong public health response.
Protect Pacific countries, learning from a measles outbreak in Samoa in the prior year.
Modeling was used, and expert advice was crucial.
Close communication was maintained with Australian counterparts.
New cases per million people were monitored, and the first wave of COVID-19 occurred from March to April with the original virus.
The United Kingdom experienced around 900 to 1,000 deaths from COVID-19 every day during the initial outbreak.
New Zealand had its first death on March 29 and only 56 deaths in the first two years.
The goal was to prevent people from becoming unwell, ending up in hospital, and dying.
In the 1918 pandemic, the death rate among Maori was nine times higher than non-Maori.
Maori communities acted quickly to protect their people.

Surveillance

Surveillance involves collecting, analyzing, and interpreting health-related data, which acts as an early warning system.
It monitors the impact of interventions, tracks progress, and clarifies the epidemiology of problems.
Surveillance identifies differences between groups, regions, genders, ethnic groups, and socio-economic statuses.
Key questions to ask are, "What does this mean?" and "Trends are your friend."
Surveillance is fundamental to population health.

Factors Influencing Illness, Hospitalization, and Death

Infectiousness: How infectious is the virus?
Viruses adapt to become more infectious over time.
The original COVID virus had an effective R value of 2.5, which increased to 4 by the time of Omicron.
Incubation period: How long does it take for symptoms to appear?
Exposure: How many people are exposed?
Preventing exposure is crucial through measures like lockdowns and quarantine.
The first SARS outbreak was less infectious but had a high mortality rate (over 60%).
Controlling disease involves waiting for a vaccine or effective treatments.
In March 2020, experts estimated it would take two to five years to develop a vaccine.
Remarkably effective vaccines were available before the year was out.
Vaccination in New Zealand started on February 18, 2021.
The best way to prevent hospitalization or death is to prevent infection.

Data Collection

Data was collected, analyzed, and reported by ethnicity to inform the response and vaccination program.
Targeted communications were essential as not everyone listened to the same messages or messengers.
Messages must be tailored to specific communities, with feedback gathered and interventions adjusted accordingly.
Equity must be a deliberate focus as it is a core element of population health.
Vaccination played a key role in preventing infection and reducing the severity of the disease.
mRNA vaccines developed by Pfizer and Moderna were remarkably effective.
The flu vaccine, in a good year, might be about 60% effective, while the COVID-19 vaccine was 95% effective at stopping severe disease and 99% effective at stopping death.
Over 90% coverage was achieved for the eligible population (15 and over).
Communication was the most important intervention, not just vaccines.
The 1 PM briefings aimed to communicate directly with the public, providing information about what was known and what was not.
People want to know what is known, what is not known, and when further updates will be provided.
Building trust was a crucial part of the communication strategy.
Essential considerations for effective communication include the what, so what, and now what messages.
Trust is essential in both public health and clinical professions.
New Zealand was the only democracy where trust increased between 2021 and 2022.
Trust cannot be taken for granted, and there is a gap between levels of trust between those who earn more and those who earn less.
New Zealand has high trust in the public service, especially during COVID-19.
Recent surveys show a drop in trust in New Zealand.
People generally trust scientists more than other professions.
With trust comes responsibility for scientists to earn and maintain that trust.

Outcomes and Goals

Population health is about outcomes, not just doing good things.
Excess mortality is the number of people who die in a given year above what is expected based on trends.
New Zealand had negative excess mortality, preventing deaths through its response.
If New Zealand had the same death rates as other countries, there would have been far more deaths.
An analysis of nearly 1,800 deaths from COVID-19 in New Zealand showed a higher risk for Maori and Pacifica.
A major driver of higher death rates was pre-existing conditions such as heart disease, diabetes, and respiratory conditions.
The intersection between non-communicable and communicable diseases is significant.
Preventing and treating non-communicable diseases is crucial for preparing for future pandemics.
Pre-existing conditions explained about two-thirds of the excess mortality among Maori and Pasifika people.
In The United Kingdom, about 850 healthcare workers died from COVID-19 in the first nine months of the pandemic.
The elimination strategy adopted by New Zealand protected the healthcare system.
New Zealand also aimed to prevent the virus from reaching the Pacific, achieving this objective.
The Pacific countries didn't get the virus until about the same time as New Zealand did.

Leadership

Leadership is crucial, with humility being an essential trait for leaders in a crisis.
Agility, constant review, learning, and adjustment are necessary when dealing with uncertainty.
Honest communication and fronting up when things go wrong builds trust.
Being prepared is necessary but not sufficient; great leadership, good decision-making, and clear communication are essential.## Success
Leadership with humility.
Agility to review constantly, and learn, and adjust.
Honest with communication.
Fronting up when things don't go well.
Decision-making and clear communication are essential.
Preparedness is key.