When the world stopped turning
In 2020, life came to a screeching halt. All hopes and plans were cancelled as the world fell victim to a virus that, 12 months ago, was unheard of. Our series Year of Covid-19 looks at how the world went dark in an extraordinary effort to stop the virus. Brittney Deguara, Hannah Martin and Felippe Rodrigues report.
Eerie empty streets across the globe became iconic illustrations of the pandemic. The bustling Times Square in New York City was quiet. Rome’s Spanish Steps without traffic.
Most of the world – New Zealand included – went into lockdown.
The only way to stop the virus spreading was to eliminate opportunities for it to pass between people. That meant perspex screens at shopping counters, social distancing on buses and trains and, at its most extreme, orders for people to stay at home.
China was the first tomove. By the end of January, before restrictive measureswere introduced around theworld, the country closed all its schools and non-essential workplaces, cancelled public events, placed restrictions on gatherings, halted public transport, and restricted regional travel. Mass maskingwas also required.
Italy was one of the first outside China to go completely dark. After its first two cases were reported in January – both with travel history to Wuhan – infections soared. At the beginning of March therewere 1128 cases; by the end of the month, infections had grown to 101,739. Going into December, 1.5 million cases had been reported.
Outbreaks ravaged the regions of Lombardy and Veneto in the north and northeast, before spreading to the rest of the country.
‘‘On a psychological level, I have to say I still have not recovered,’’ Lombardia nurse Cristina Settembrese said in October of the loss of life experienced in March and April.
Mass deaths accompanied the spread. Daily death tolls – which spiked at 969 deaths in a single day – resulted in Italy surpassing China for themost Covid fatalities.
Leaving home was reserved for limited circumstances, sporting events were halted, and checkpoints were set upwithin city centres. Italy’s hospitals were at a point of collapse.
In the span of amonth, almost every country had introduced public health measures to combat the spread of the virus.
Europe quickly became the epicentre of the pandemic, resulting in the European Commission closing the borders of 26 states to all non-essential travellers.
Oxford University developed a measure for the stringency of measures in different countries. China’s initial lockdown in Januarywas ranked 69.91 out of 100, at a time when other jurisdictions were yet to make any drastic changes.
The province of Hubei, where Wuhan is located, endured the brunt of the restrictions imposed. But despite getting Covid under control, restrictions in China have never really eased. In some parts of the country, stay-at-home requirements akin to New Zealand’s alert level 3 continue.
Italy’s initial restrictionswere also assessed at 69.91. By the end of March, theywere 91.67, among the highest in the world at the time.
As the pandemic spread through Europe, other countries imposed control measures. Travel restrictions earned some of the highestmarks – 87.96 for France a week after the borders closed, 76.85 for Germany, and 81.48 for Belgium.
After relaxing restrictions during the northern summer, new outbreaks in these countries are pushing governments to reconsider locking down.
New Zealand’s response fluctuated over time. The initial lockdown – imposed at the end of March and ranked 96.3 – was the most intense period of restrictions throughout the year.
The nationalmoves down to level 3 in April, level 2 inMay, and level 1 in June saw the rating fall from 87.04 to 39.81 to 25.93.
When cases were found in the community in August – putting an end to the 102-day case-free streak – restrictions returned. Auckland moved to alert level 3, the rest of the country to level 2. In one day, New Zealand’s stringency index went from 22.22 to 68.98.
In comparison, Sweden’s scores reflected its relaxed approach to Covid, with restrictions similar to those imposed in NZ under level 2, or the so-called level 2.5. But restrictions have barely moved for Swedes since April, and reached their highest in December at 68.52.
At the same time, when the US reached record levels of deaths in the aftermath of Thanksgiving, some states remained open.
As countries moved in and out of lockdown, theWHOcontinued to warn against the sustainability of
these measures, despite the director-general acknowledging the benefits. ‘‘Where these measures are followed, cases go down. Where they are not, cases go up,’’ Tedros Adhanom Ghebreyesus said in July.
Lockdowns worked to drastically reduce the infection reproduction rate. Researchers in New Zealand found the reproduction rate of the largest cluster at the time dropped from 7 to 0.2 in the first week of alert level 4, and daily infections dropped dramatically.
Similar researchwas conducted in Wuhan, where the first lockdown measures were imposed, and found a significant decrease in infections.
‘‘We’ve clearly avoided that exponential growth the modelling showed would have happened if we’d done nothing,’’ New Zealand director-general of health Ashley Bloomfield said in April.
Modelling from the University of Auckland’s Te Pu¯naha Matatini initially suggested 80,000 people could have died if immediate actionwasn’t taken, and 89 per cent of the populationwould have been infected within 400 days.
Lockdowns weren’t the desired response for all. Taiwan, which has
been praised for its success, showed it was possible to contain the virus without crippling the economy. Drawing on lessons learned from the 2003 Sars pandemic, Taiwan curbed its Covid-19 death rate to just 0.3 per 1million people.
‘‘Taiwan wasmuch better prepared than [New Zealand] for a pandemic, had better border control early on, made better use of mass masking, and has continued to be ahead of [New Zealand] in use of digital technologies to support pandemic control,’’ public health experts from the University of Otago wrote in December.
Sweden also opted against lockdowns, but its outcome was dramatically different. While it did not ignore the pandemic – banning gatherings exceeding 50 people, and visits to nursing homes – it opted to continuewith daily life, in the hopes that achieving herd immunity would quell the virus.
Its liberal ‘‘trust-based’’ approach has had its backers, but it has also contributed to the country seeing amuch higher death toll than its neighbours. As of December 9, Sweden’s death rate per 100,000 people was 70.38.
Thatwas 10 times higher than nearby Norway, with 6.77 deaths per 100,000. Denmark’s ratewas 15.5 per 100,000, and New Zealand’s just 0.51.
The United States has been among the worst affected. Formonths, it has reported the most infections and deaths in the world.
When its cases surpassed 5min August, themeasures differed drastically from state to state. South Dakota had no physical distancing ormask requirements, and even allowed an event to go ahead with 250,000 attendees.
At the same time, Californians were living with mandatory mask requirements, and New York was slowly emerging from a strict lockdown.
The pandemicwas treated as a political issue, rather than a nationwide health problem.
In contrast, New Zealand’s response has been unified, consistent and widely praised. Its
unicameral political system empowered rapid decision-making.
‘‘In the space of six or seven weeks, we took the public in New Zealand from a situation wherewe had an emerging global threat to asking them to stay at home for four weeks, and they did it,’’ Bloomfield says. ‘‘I think there’s a real lesson in the importance of consistent, clear messages repeated often through a range of channels.’’
One of the biggest achievements, in the opinion of University of Otago biochemistry professor Kurt Krause, was how the Government worked with, and took advice from, health professionals.
Krause, who is from the US, says health and government there appeared towork together at the beginning, but were soon at loggerheads. ‘‘[The] government [was] trying to muzzle a number of infectious disease spokespersons. There was a struggle.’’
Therewas no unified population adhering to expert advice either, no team of 328.2million. But this might not ever have been possible.
‘‘The US is too big,’’ Krause adds. But public health measures such as physical distancing and more effective lockdowns could have helped, he believes.
New Zealand’s size played a big
role in its success. ‘‘That was the thing that really helped us,’’ Dr Arindam Basu, a public health expert from the University of Canterbury, says.
Our response happened incrementally – borders were closed in March, the alert level system was introduced and rolled out days later, and managed isolation and quarantine facilities were set up. Kiwis in Wuhan and around the world were repatriated, labs prepared for an influx in samples and contact tracing teams buckled down.
The unprecedented move to level 4 – complete lockdown – was a necessary step, modelling expert Professor Shaun Hendy says. ‘‘We knew some drastic actionwas needed in order to avert a significant crisis for the country.’’
‘‘Act now, or risk the virus taking hold, as it has elsewhere,’’ was the warning issued by Prime Minister Jacinda Ardern in March.
Bloomfield had the same concerns. ‘‘What we had seen from Europewas we had to go into a lockdown sooner or later, and we felt the sooner the better.
‘‘If you think you need to do something in twoweeks’ time, you need to do it today, and that’s the advice we gave.’’
Bloomfield recalls feeling as though the nation sighed with relief when the move to level 4was announced. Usually grid-locked roadswere empty, busy shopping precincts quiet. Supermarkets and pharmacies were among the few essential services to open.
Hendy considered New Zealand ‘‘lucky’’ at this point. The virus hadn’t yet ripped through communities as it had elsewhere.
‘‘That actually turned out to be really crucial to wherewe are today, which is in a really good position.’’
While New Zealand led theworld for the strength and success of its lockdown, itwas among the last to acknowledge the importance of masks in suppressing the virus.
‘‘It was disappointing,’’ says Dr Ling Chan, a Dunedin pathologist who helped establish the #Masks4AllOtagomovement to encourage widespreadmask use when theHealth Ministry wasn’t.
Her disappointment stems from the stagnant advice from the ministry, even after theWHO changed its stance. It initially thoughtmaskswould provide a false sense of security.
‘‘There is no black orwhite answer and no silver bullet,’’ Adhanom Ghebreyesus said in April. ‘‘Masks alone cannot stop the pandemic.’’ But they could help reduce its spread. TheWHO realised that in June.
To the dismay of public health and medical professionals, Ardern’s Government didn’t decisively back masks until August.
‘‘The Ministry of Health has been extremely slow tomandate the use of masks ... even after the WHOadvice improved,’’ says University of Otago professor Nick Wilson.
Bloomfield says theministry’s advice aligned with that of the WHO, which targeted countries withwidespread transmission. At the time, New Zealand wasn’t experiencing that.
‘‘[We] had to develop our own mask policy,’’ he says. ‘‘We’ve used masks where andwhen we felt it’s indicated [by the WHO].’’
Chan highlights the impressive uptake ofmasking in Hong Kong – around 99 per cent of the population wore one. Its experience with the Sars outbreak in the early 2000s meant the government and its people knew the importance of this basicmeasure.
Even Australia masked up during the deadly resurgence in Victoria.
So why did New Zealand drop the ballwhen it came tomask recommendations?
Chan thinks itmay have been due to worries over supply. Issues around PPE stock for health workerswere already prevalent, despite assurances from the Ministry ofHealth that masks, gloves, gowns and visors were plentiful.
At the end of August, amandate was rolled out requiring face coverings to beworn on public transport during alert level 2 and above. Use in these settings had simply been recommended before.
‘‘The whole world has continued to learn, and New Zealand is one of those countries where [when] we’ve seen new evidence, we’ve always beenwilling to act on that, and we are,’’ Ardern said.
Mask sales skyrocketed. Further changes came about in November withmaskmandates added to specific settings in alert level 1.
Bloomfield says that, at the beginning of the pandemic, there simply wasn’t enough knowledge of transmission. Asmore evidence emerged, the response evolved.
However, Chan believes the precautions are still underwhelming. ‘‘Whilst the virus is still raging [worse] than ever throughout the world, masking should bemandatory on flights, international airports and public transport – especially in cities where there are isolation facilities – at all alert levels.
‘‘No quarantine system can be perfect, and there are bound to be areaswhere the virus can escape from facilities.’’
Chan describes Covid-19 as a ‘‘sneaky virus’’ that needs a variety of public health measures to combat it – testing, isolation, masking and vaccinations.
The Ministry of Health’s chief science adviser, Professor Ian Town, believes masks on their own aren’t that effective. ‘‘What we need is a real public health response that includes all those other elements we’ve emphasised – washing of hands, avoiding touching your face, staying home if you’re unwell.
‘‘The suite of things is what stops the chain of transmission.’’