Measles response offers us lessons for Covid outbreak
In 2019 New Zealand had a major measles outbreak affecting 2185 people. Measles has an R factor of 15 and is variably reported as being eight times more infectious than early forms of coronavirus.
A review of the measles outbreak by Sonder and Ryan reveals many similarities to the coronavirus outbreak that would occur a year later in 2020, and now a further year after that in 2021.
The shape of the measles outbreak involved numbers in the ones of thousands similar to coronavirus and included disproportionate infection in Ma¯ ori and Pacific peoples. Auckland was a key region in both outbreaks.
Measles did not require a formal border response (although NZ did export measles overseas) but it did require a community response and a vaccine response.
Both of these responses are very similar for measles and coronavirus and yet it is not clear that either response is significantly better off after the measles “practice run” and so, did New Zealand squander the learning opportunity from the measles outbreak to make changes
and adapt?
The Sonder and Ryan review identifies a number of issues that occurred in 2019 which have been repeated to varying degrees in the 2020 and 2021 coronavirus outbreaks. There were issues with public communication, translation of materials, inability to upscale contact tracing, and problems with quarantine.
Several months into the measles outbreak Auckland Regional Public Health Service (ARPHS) had to reprioritise its focus because 55 cases was an “unsustainable contact tracing load”. Two years later and there are reports 12 cases active coronavirus cases in the Valentine’s Day coronavirus outbreak this year overwhelmed contact tracers.
Social distancing needed to be created during the measles outbreak with on-the-fly rules created for students in schools and on buses, yet little of this seemed to cross over to coronavirus — we mostly just started again.
Vaccine supplies were a problem in the measles outbreak just as they are today, with GPs saying there were not enough vaccines in the right place at the right time.
Procurement, logistics and distribution were learnings we seem not to have easily taken on board.
I do note the vastly different coldchain requirements between the two vaccines but this doesn’t excuse the abysmal fact that we have fewer credentialled GP and pharmacy vaccinators in Auckland now than we did in the 2019 outbreak.
If we probably didn’t learn from contact tracing then we definitely haven’t learned around the need to engage primary care early.
Quarantine and isolation was a problem in 2019, with a backpacker in the Bay of Plenty infecting several others, before flying while infectious on a domestic Air NZ plane and then Cathay Pacific back to her hometown. No one notified Air NZ.
The review made recommendations around contact tracing, outreach for Ma¯ ori and Pacific peoples and vaccine implementation. I am not convinced we fully took these recommendations on board after 2019 and believe we have revisited some of these issues with coronavirus last year and in the current outbreak.
Capturing organisational knowledge is always a challenge but we need to be doing a better job of this with a current virus that is less forgiving than measles.
Dr Shane Reti