Testing times An inside story of

New Zealand’s Covid-19 response system was in crisis before a formidable workforce fought back. Eugene Bingham reports.

Many of the details are hazy, lost in the fog of a chaotic time that, when Dr Joshua Freeman looks back on it, he can only shake his head. He’s pretty sure it was Friday, March 20, but admits he might be a day or two out. ‘‘I remember registering it was a Friday afternoon and that it would have been good to have had the discussion earlier in the day!’’ Freeman recalls.

Exactly when it was may be forgotten, but what was going on then certainly isn’t. New Zealand was facing a critical point in its fight against the growing threat of Covid-19, and a crucial part of the defence system was at breaking point.

Freeman, clinical director of microbiology and virology at the Canterbury District Health Board, picked up his phone. He rang colleagues around the country, in particular Gary McAuliffe, medical director of Labtests, and Associate Professor James Ussher, from Otago University’s Department of Microbiology and Immunology.

‘‘I remember getting on the phone to Gary and James and saying, ‘How many tests have you done today — and how many have you got left?’’’

Right at that moment, in those hours and days – when people were being encouraged to go and get tested so the country could detect if there was community transmission of the virus — the entire testing system was wobbling.

McAuliffe remembers it as ‘‘a crunch point’’. In fact, there were many crunch points.

The materials relied on to carry out the testing were quickly drying up, and there was no certainty that any more were on their way from overseas.

Swabs used for diagnostic testing traditionally came from northern Italy, an epicentre of the global outbreak. ‘‘All of a sudden, [suppliers told us] ‘We don’t know if and when we can supply you anymore’,’’ recalls McAuliffe.

There was a similar squeeze on materials needed to ‘‘extract’’ the virus from patient samples, one of three critical stages of the testing process, when expected supplies from Switzerland were, overnight, no longer guaranteed.

The country was being told there was capacity for 1800 tests a day – true. Trouble is, there were only enough materials in the country to carry out about 4000 tests in total at that rate.

The maths did not look good. The testing system was days away from grinding to a halt.

Scientists are careful with words and don’t throw around inflammatory comments. But Freeman, McAuliffe and Ussher recognised what was happening, and in comments issued via the Science Media Centre on March 21, called it for exactly what it was: ‘‘The testing labs are in crisis.’’

You only need a passing appreciation for Hollywood disaster movies to know that it’s not really the nature of the threat which makes a captivating story. It’s what happens next.

And what happened next is one of the remarkable stories of New Zealand’s coronavirus ordeal: how a workforce sprung into action; how an unlikely alliance from across the full spectrum of healthcare workers – from lab technicians, to backroom operators working out of make-shift offices in sheds, to school nurses who stepped up to go on the frontline and take nasal swabs from frightened patients – joined forces; how New Zealand’s Covid-19 testing system emerged to become a world-leading effort.

Testing was such an important part of the arsenal to attack the virus. ‘‘Test, test, test,’’ the World Health Organisation implored countries.

But building a testing system of the scale required in a global pandemic does not just happen.

In early January, wary scientists turned their attention to Wuhan, China, and began to do mental calculations of what was going to be required to combat this disease if it exploded. But it was difficult to know.

Freeman says the World Health Organisation mission report on China was a landmark, making him realise how important testing was going to be, and that the plan for a ‘‘traditional’’ pandemic response was not going to be adequate.

‘‘The traditional response was to use your contact tracing and testing for a while, then flag it and go to a mitigation phase. What the WHO report made clear was, you can’t afford to do that. You need to contain it,’’ he says.

What was required was to stamp it out – ‘‘and stamping it out was going to require a high level of testing to identify infections’’.

At the Institute of Environmental Science and Research (ESR) in Wellington, scientists had been monitoring the virus since early January as part of its international surveillance for emerging infectious disease.

Soon after full genome sequences of the virus were shared with the WHO in January, a German virologist, Christian Drosten, began working on kits to test for the infection.

ESR’s clinical virology team leader, Lauren Jelley, says the race was on to get its hands on the primers and probes required for the tests.

ESR’s supplier, John Mackay, from DNature in Palmerston North, scrambled and managed to order kits from the manufacturer in Germany.

They arrived in Auckland on January 29, within two weeks of Drosten’s work being published. DNature quickly got the kits on a late afternoon cargo flight to Wellington, and staff drove down from Palmerston North to personally pick them up from the airport and deliver them to ESR that night. This was precious cargo and time was ticking.

On January 30, Jelley and her virology team got to work validating the kits – making sure they worked properly.

‘‘We were so happy when the testing was done, and we found that the kit worked well. We felt prepared and ready. It was almost like we moved from a theoretical situation into a more tangible comfortable position,’’ she says.

New Zealand was ready to start testing. Other labs around the country – in Auckland, Christchurch and Dunedin – were soon ready, too. Eventually, 13 labs were set up.

In the first week, 23 samples were tested. Everyone was waiting for the inevitable.

And then, on February 28, it came – the first positive, from a person in their 60s who had recently returned from Iran. The test for that first positive was carried out at Auckland Hospital. McAuliffe said it wasn’t a shock by that stage – ‘‘we were expecting it’’. But it kicked off a chain reaction, a flurry of emails to the Ministry of