RESUMEN
BackgroundIn response to the COVID-19 pandemic, some countries in the Asia-Pacific Region used very intensive control measures, and one of these, New Zealand (NZ), adopted a clear "elimination strategy". We therefore aimed to compare key health and economic outcomes of NZ relative to OECD countries as of mid-June 2021. MethodsThis analysis compared health outcomes (cumulative death rates from COVID-19 and "excess death" rates) and economic measures (quarterly GDP and unemployment levels) across OECD countries. ResultsNZ had the lowest cumulative COVID-19 death rate in the OECD at 242 times lower than the 38-OECD-country average: 5{middle dot}2 vs 1256 per million population. When considering "excess deaths", NZ had the largest negative value in the OECD, equivalent to around 2000 fewer deaths than expected. When considering the average GDP change over the five quarters of 2020 to 2021-Q1, NZ was the sixth best performer (at 0{middle dot}5% vs -0{middle dot}3% for the OECD average). The increase in unemployment in NZ was also less than the OECD average (1{middle dot}1 percentage points to a peak of 5{middle dot}2%, vs 3{middle dot}3 points to 8{middle dot}6%, respectively). ConclusionsNew Zealands elimination strategy response to COVID-19 produced the best mortality protection outcomes in the OECD. In economic terms it also performed better than the OECD average in terms of adverse impacts on GDP and employment. Nevertheless, a fuller accounting of the benefits and costs needs to be done once the population is vaccinated and longer-term health and economic outcomes are considered.
RESUMEN
ObjectivesTo identify COVID-19 outbreaks and border control failures associated with quarantine systems in Australia and New Zealand and to estimate the failure risks. Design, setting, participantsObservational epidemiological study of travellers transiting quarantine in Australia and New Zealand up to 15 June 2021. Main outcome measuresThe incidence of COVID-19 related failures arising from quarantine, and the failure risk for those transiting quarantine, estimated both per 100,000 travellers and per 1000 SARS-CoV-2 positive cases. ResultsAustralia and New Zealand had 32 COVID-19 related failures arising from quarantine systems up to 15 June 2021 (22 and 10, respectively). One resultant outbreak involved an estimated 800 deaths and quarantine failures instigated nine lockdowns. The failure risk for those transiting quarantine was estimated at 5.0 failures per 100,000 travellers and 6.1 failures (95%CI: 4.0 to 8.3) per 1000 SARS-CoV-2 positive cases. The latter risk was two-fold higher in New Zealand compared with Australia. The full vaccination of frontline border workers could likely have prevented a number of quarantine system failures. ConclusionsQuarantine system failures can be costly in terms of lives and economic impacts such as lockdowns. Ongoing improvements or alternatives to hotel-based quarantine are required.
RESUMEN
AimsTo identify the extent of the provision of water and soap for hand washing in public toilets at the time of the COVID-19 pandemic. To also make comparisons with a pre-pandemic survey that included a sample of the same facilities. MethodsWe collected data from 400 toilets that were open to the public; all those in three contiguous city council territories (228) and a further convenience sample of 172 around the rest of New Zealand. Comparisons were made with the data on the same facilities included in a 2012/2013 survey. ResultsFor all the toilets in this survey, 2.5% had no water for hand washing and 14.8% had no soap. There was COVID-19 related health messaging signage in 19.5% of toilets, with posters of the COVID-19 QR code used to facilitate contact tracing in 12.3%, and generic hand washing signage in 1.8%. The hand washing water had "no touch" activation at 28.0% of toilets and at 18.5% for toilet bowl flushing. Toilet bowl lids were not present at 32.8%, and 2.3% of toilets had damage which would impair their functionality (eg, broken toilet seats). For the 128 sites that had also been examined in the previous survey, this new survey found significantly increased provision of soap (risk ratio = 1.47; 95%CI: 1.25 to 1.72), but no increased provision of water. ConclusionsDespite the serious threat of the COVID-19 pandemic, the majority of hand washing facilities in public toilets sampled required tap touching, and did not have health messaging. Nevertheless there has been some modest improvements in soap (but not water) provision since the previous survey eight years before.
RESUMEN
ImportanceDetermining the best policy on social restrictions and lockdowns for the COVID-19 pandemic is challenging. ObjectiveTo determine the optimal policy response ranging from aggressive and moderate elimination, tight suppression (aiming for 1 to 5 cases per million per day) and loose suppression (5 to 25 cases per million per day). DesignTwo simulation models in series: an agent-based model to estimate daily SARS-CoV-2 infection rates and time in four stages of social restrictions; a proportional multistate lifetable model to estimate long-run health impacts (health adjusted life years (HALYs) arising from SARS-CoV-2) and costs (health systems, and health system plus GDP). The net monetary benefit (NMB) of each policy option at varying willingness to pay (WTP) per HALY was calculated: NMB = HALYs x WTP - cost. The optimal policy response was that with the highest NMB. Setting and participantsThe State of Victoria, Australia, using simulation modeling of all residents. Main Outcome and MeasuresSARS-CoV-2 infection rates, time under various stages of restrictions, HALYs, health expenditure and GDP losses. ResultsAggressive elimination resulted in the highest percentage of days with the lowest level of restrictions (median 31.7%, 90% simulation interval 6.6% to 64.4%). However, days in hard lockdown were similar across all four strategies (medians 27.5% to 36.1%). HALY losses (compared to a no-COVID-19 scenario) were similar for aggressive elimination (286, 219 to 389) and moderate elimination (314, 228 to 413), and nearly eight and 40-times higher for tight and loose suppression. The median GDP loss was least for moderate elimination ($US41.7 billion, $29.0 to $63.6 billion), but there was substantial overlap in simulation intervals between the four strategies. From a health system perspective aggressive elimination was optimal in 64% of simulations above a willingness to pay of $15,000 per HALY, followed by moderate elimination in 35% of simulations. Moderate elimination was optimal from a partial societal perspective in half the simulations followed by aggressive elimination in a quarter. Shortening the pandemic duration to 6 months saw loose suppression become preferable under a partial societal perspective. Conclusions and RelevanceElimination strategies were preferable over a 1-year pandemic duration. FundingAnonymous philanthropic donation to the University of Melbourne. Key pointsO_ST_ABSQuestionC_ST_ABSTo determine the optimal of four policy responses to COVID-19 in the State of Victoria, Australia (aggressive and moderate elimination, tight suppression (aiming for 1 to 5 cases per million per day) and loose suppression (5 to 25 cases per million per day), based on estimated future health loss and costs from both a health system and partial societal perspective. FindingsFrom a health system perspective aggressive elimination was optimal in 64% of simulations above a willingness to pay of $15,000 per HALY, followed by moderate elimination in 35% of simulations. Moderate elimination was optimal from a partial societal perspective (i.e., including GDP losses) in half the simulations followed by aggressive elimination in a quarter. MeaningWhilst there is considerable uncertainty in outcomes for all the four policy options, the two elimination options are usually optimal from both a health system and a partial societal (health expenditure plus GDP cost) perspective.
RESUMEN
BackgroundExcess winter mortality (EWM) has been attributed to both seasonal cold exposure, and to infectious disease. In 2020, New Zealands border management and lockdown measures successfully eliminated community transmission of SARS-CoV-2, and also largely eliminated influenza and many other respiratory viruses. This study investigates the contribution of infections and temperature to EWM and typical extended winter (May to October) deaths in this natural experiment created by New Zealands COVID-19 pandemic response. MethodsWe used age-standardised weekly deaths to measure EWM 2011 to 2019, then used historical patterns to estimate high, medium and low scenario 2020 EWMs. We then modelled typical year and 2020 heating degree day: mortality relationships to estimate relative contributions of cold temperature and infection to typical EWEDs. ResultsEWM 2011 to 2019 averaged 14.7% (low 11.4%, high 20.9%). In contrast, 2020 EWM was estimated at 1.6%, 2.7%, or 3.8% under high, medium, and low spring-summer mortality scenarios. Between 2011 and 2019, temperature was estimated to explain 47% of extended winter deaths, and infection 27%, with the remaining 26% attributable to the interaction between infection and temperature. DiscussionThe society-wide response to COVID-19 in 2020 resulted in a major reduction of winter mortality in this high-income nation with a temperate climate. In addition to influenza, other respiratory pathogens likely also make a significant contribution to EWM. Low cost protection measures such as mask wearing (eg, in residential care facilities), discouragement of sick presenteeism, and increased influenza vaccine coverage, all have potential to reduce future winter mortality. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSExcess winter mortality (EWM) is a widely observed phenomenon, commonly attributed to physiological responses to short and long-term outdoor and indoor cold exposure (and associated increased air pollution); other seasonal physiology changes; and higher incidence of some infectious diseases. Previous estimates of EWM in New Zealand range from 10.3% to 25.6%, with influenza estimated to make up roughly a third of that excess. Internationally, deaths attributable to cold temperatures are also found outside the traditional winter period, with influenza making a large contribution to cold temperature deaths. Added value of this studyThis study finds that following a successful COVID-19 elimination strategy, which simultaneously prevented the annual winter influenza season, and likely other winter respiratory infections, New Zealand is likely in 2020 to experience less than a third of the usual winter mortality excess. Further, this study for the first time estimates the relative contributions of cold temperature and infection, and the interaction between the two, to New Zealand winter deaths. We estimate that of the 9.5% fewer deaths than in typical years recorded between 1 May and 31 October 2020, 92.5% were prevented by infection control measures; 1.4% by the 1.14{degrees}C warmer than average winter; and 6.1% by the interaction between infection and low temperature. Implications of all the available evidenceInfluenza and other infectious respiratory pathogens appear to make a much larger contribution to winter mortality than previously recognised. Low cost protection measures such as mask wearing (eg, in residential care facilities), discouragement of sick presenteeism, and increased influenza vaccine coverage, all have potential to reduce future winter deaths, and lower overall annual mortality rates.
RESUMEN
BackgroundCardiovascular disease (CVD) is a leading cause of health loss and health sector economic burdens in high-income countries. Unemployment is associated with increased risk of CVD, and so there is concern that the economic downturn associated with the COVID-19 pandemic will increase the CVD burden. AimsThis modeling study aimed to quantify health loss, health cost burden and health inequities among people with CVD due to additional unemployment caused by COVID-19 pandemic-related economic disruption in one high-income country: New Zealand (NZ). MethodsWe adapted an established and validated multi-state life-table model for CVD in the national NZ population. We modeled indirect effects (ie, higher CVD incidence due to high unemployment rates) for various scenarios of pandemic-related unemployment projections. ResultsWe estimated the CVD-related heath loss in NZ to range from 23,300 to 36,900 HALYs (health-adjusted life years) for the different unemployment scenarios. Health inequities for M[a]ori (Indigenous population) were 3.7 times greater compared to non-M[a]ori (49.9 vs 13.5 HALYs lost per 1000 people). Conclusions and policy implicationsUnemployment due to the COVID-19 pandemic is likely to cause significant health loss and health inequities from CVD in this high-income country. Prevention measures should be considered by governments to reduce this risk, including job creation programs and measures directed towards CVD prevention.
RESUMEN
AimWe aimed to estimate the risk of COVID-19 outbreaks in a case study COVID-free destination country, associated with shore leave for merchant ship crews. MethodsA stochastic version of the SEIR model CovidSIM v1.1, designed specifically for COVID-19 was utilised. It was populated with parameters for SARS-CoV-2 transmission, shipping characteristics, and plausible control measures. ResultsWhen no control interventions were in place, an outbreak of COVID-19 in our case study destination country (New Zealand; NZ) was estimated to occur after a median time of 23 days (assuming a global average for source country incidence of 2.66 new infections per 1000 population per week, a crew of 20, a voyage length of 10 days, 1 day of shore leave both in NZ and abroad, and 108 port visits by international merchant ships per week). For this example the uncertainty around when outbreaks occur is wide (an outbreak occurs with 95% probability between 1 and 124 days). The combined use of a PCR test on arrival, self-reporting of symptoms with contact tracing, and mask use during shore leave, increased this median time to 1.0 year (14 days to 5.4 years). Scenario analyses found that onboard infection chains could persist for well over 4 weeks even with crews of only 5 members. ConclusionIntroduction of SARS-CoV-2 through shore leave from international shipping crews is likely, even after long voyages. The risk can be substantially mitigated by control measures such as PCR testing and mask use.
RESUMEN
AimsWe aimed to estimate the risk of COVID-19 outbreaks associated with air travel from a country with a very low prevalence of COVID-19 infection (Australia) to a COVID-19-free country (New Zealand; [NZ]), along with the likely impact of various control measures for passengers and cabin crew. MethodsA stochastic version of the SEIR model CovidSIM v1.1, designed specifically for COVID-19 was utilized. It was populated with data for both countries and parameters for SARS-CoV-2 transmission and control measures. We assumed one Australia to NZ flight per day. ResultsWhen no interventions were in place, an outbreak of COVID-19 in NZ was estimated to occur after an average time of 1.7 years (95% uncertainty interval [UI]: 0.04-6.09). However, the combined use of exit and entry screening (symptom questionnaire and thermal camera), masks on aircraft and two PCR tests (on days 3 and 12 in NZ), combined with self-reporting of symptoms and contact tracing and mask use until the second PCR test, reduced this risk to one outbreak every 29.8 years (0.8 to 110). If no PCR testing was performed, but mask use was used by passengers up to day 15 in NZ, the risk was one outbreak every 14.1 years. However, 14 days quarantine (NZ practice in May 2020), was the most effective strategy at one outbreak every 34.1 years (0.86 to 126); albeit combined with exit screening and mask use on flights. ConclusionsPolicy-makers can require multi-layered interventions to markedly reduce the risk of importing the pandemic virus into a COVID-19-free nation via air travel. There is potential to replace 14-day quarantine with PCR testing or interventions involving mask use by passengers in NZ. However, all approaches require continuous careful management and evaluation.
RESUMEN
AimsWe aimed to determine the length of time from the last detected case of SARS-CoV-2 infection before elimination can be assumed at a country level in an island nation. MethodsA stochastic version of the SEIR model Covid SIM v1.1 designed specifically for COVID-19 was utilised. It was populated with data for the case study island nation of New Zealand (NZ) along with relevant parameters sourced from the NZ and international literature. This included a testing level for symptomatic cases of 7,800 tests per million people per week. ResultsIt was estimated to take between 27 and 33 days of no new detected cases for there to be a 95% probability of epidemic extinction. This was for effective reproduction numbers (Re) in the range of 0.50 to 1.0, which encompass such controls as case isolation (the shorter durations relate to low Re values). For a 99% probability of epidemic extinction, the equivalent time period was 37 to 44 days. In scenarios with lower levels of symptomatic cases seeking medical attention and lower levels of testing, the time period was up to 53 to 91 days (95% level). ConclusionsIn the context of a high level of testing, a period of around one month of no new notified cases of COVID-19 would give 95% certainty that elimination of SARS-CoV-2 transmission had been achieved.
RESUMEN
AimsWe aimed to determine the effectiveness of surveillance using testing for SARS-CoV-2 to identify an outbreak arising from a single case of border control failure at a country level. MethodsA stochastic version of the SEIR model CovidSIM v1.1 designed specifically for COVID-19 was utilised. It was seeded with New Zealand (NZ) population data and relevant parameters sourced from the NZ and international literature. ResultsFor what we regard as the most plausible scenario with an effective reproduction number of 2.0, the results suggest that 95% of outbreaks from a single imported case would be detected in the period up to day 33 after introduction. At the time point of detection, there would be a median number of 6 infected cases in the community (95%UI: 1-68). To achieve this level of detection, an on-going programme of 7,800 tests per million people per week for the NZ population would be required. The vast majority of this testing (96%) would be of symptomatic cases in primary care settings and the rest in hospitals. Despite the large number of tests required, there are plausible strategies to enhance testing yield and cost-effectiveness eg, (i) adjusting the eligibility criteria via symptom profiles; (ii) and pooling of test samples. ConclusionsThis model-based analysis suggests that a surveillance system with a very high level of routine testing is probably required to detect an emerging or re-emerging SARS-CoV-2 outbreak within one month of a border control failure in a nation.
RESUMEN
A SEIR simulation model for the COVID-19 pandemic was developed (http://covidsim.eu) and applied to a hypothetical European country of 10 million population. Our results show which interventions potentially push the epidemic peak into the subsequent year (when vaccinations may be available) or which fail. Different levels of control (via contact reduction) resulted in 22% to 63% of the population sick, 0.2% to 0.6% hospitalised, and 0.07% to 0.28% dead (n=6,450 to 28,228).
RESUMEN
There is large uncertainty around the case fatality risk (CFR) for COVID-19 in China. Therefore, we considered symptomatic cases outside of China (countries/settings with 20+ cases) and the proportion who are in intensive care units (4.0%, 14/349 on 13 February 2020). Given what is known about CFRs for ICU patients with severe respiratory conditions from a meta-analysis, we estimated a CFR of 1.37% (95%CI: 0.57% to 3.22%) for COVID- 19 cases outside of China.