Potential lessons from the Taiwan and New Zealand health responses to the COVID-19 pandemic.

Approaches to preventing or mitigating the impact of the COVID-19 pandemic have varied markedly between nations. We examined the approach up to August 2020 taken by two jurisdictions which had successfully eliminated COVID-19 by this time: Taiwan and New Zealand. Taiwan reported a lower COVID-19 incidence rate (20.7 cases per million) compared with NZ (278.0 per million). Extensive public health infrastructure established in Taiwan pre-COVID-19 enabled a fast coordinated response, particularly in the domains of early screening, effective methods for isolation/quarantine, digital technologies for identifying potential cases and mass mask use. This timely and vigorous response allowed Taiwan to avoid the national lockdown used by New Zealand. Many of Taiwan's pandemic control components could potentially be adopted by other jurisdictions.

Protecting school communities from COVID-19 and other infectious disease outbreaks: the urgent need for healthy schools in Aotearoa New Zealand.

Nil.

Comparing COVID-19 pandemic health responses in two high-income island nations: Iceland and New Zealand.

AIMS: We aimed to compare COVID-19 control measures, epidemiological characteristics and economic performance measures in two high-income island nations with small populations, favorable border control options, and relatively good outcomes: Iceland and New Zealand (NZ). METHODS: We examined peer-reviewed journal articles, official websites, reports, media releases and press articles for data on pandemic preparedness and COVID-19 public health responses from 1 January 2020 to 1 June 2022 in Iceland and NZ. We calculated epidemiological characteristics of the COVID-19 pandemic, as well as measures of economic performance. RESULTS: Both nations had the lowest excess mortality in the OECD from the start of the pandemic up to June 2022. Iceland pursued a mitigation strategy, never used lockdowns or officially closed its border to foreign nationals, and instead relied on extensive testing and contact tracing early in the pandemic. Meanwhile, NZ pursued an elimination strategy, used a strict national lockdown to stop transmission, and closed its international border to everyone except citizens and permanent residents going through quarantine and testing. Iceland experienced a larger decrease in gross domestic product in 2020 (relative to 2019) than NZ (-8·27% vs. -1·22%, respectively). In late 2021, NZ announced a shift to a suppression strategy and in 2022 began to reopen its border in stages, while Iceland ended all public restrictions on 25 February 2022. CONCLUSIONS: Many of Iceland's and NZ's pandemic control measures appeared successful and features of the responses in both countries could potentially be adopted by other jurisdictions to address future disease outbreaks and pandemic threats.

Indoor air quality, largely neglected and in urgent need of a refresh

While outdoor air quality is managed under the Resource Management Act 1991, which sets National Environmental Standards for outdoor air, no equivalent legislation exists for indoor air quality. The World Health Organization (WHO) recognises that healthy indoor air is a basic human right, stating that the quality of the air people breathe in buildings is an important determinant of health and wellbeing.3 According to the Environmental Protection Agency (EPA) in the United States (US), indoor air pollutant levels are typically two-to-five times higher than outdoor levels, and in some cases exceed outdoor levels of the same pollutants by a 100 times.4 Globally around 2.6 billion people still use solid fuels and kerosene for cooking, and the United Nations notes that indoor and ambient air pollution are the greatest environmental health risk.3 Time spent indoors combined with higher indoor concentrations of pollutants make the health risks associated with poor air quality usually greater indoors than outdoors. While initial public health efforts focused on measures to reduce fomite transmission, such as hand-washing, it is now well-recognised that airborne exposure is the predominant transmission route of SARS-CoV-2 (the virus that causes COVID-19).6 International consensus on airborne transmission was achieved in part through cutting-edge research conducted by New Zealand experts, but New Zealand health authorities have been slow to apply this key insight beyond border settings.7 It is imperative that national bodies responsible for the control of the pandemic incorporate the importance of airborne transmission to inform an evidence-based strategy and implement a range of highly effective measures that can prevent airborne transmission of the SARS-CoV-2 virus and other respiratory pathogens, including influenza.8-9'1011 The most effective approach to lowering concentrations of indoor air pollutants, including any pathogens that may be in the air, is usually to increase ventilation,12 exchanging polluted indoor air for cleaner outdoor air. Pollutant standards for heating and cooking appliances, particularly for appliances that use unflued gas should also be considered.20 An investment in clean indoor air could bring benefits other than reducing COVID-19 transmission, including reduced sick leave and school absenteeism caused by other respiratory infections, particularly influenza and other allergies.21 Less absenteeism-with associated adverse effect on productivity-could save companies significant costs.22 Furthermore, there is growing evidence that improved ventilation can improve cognitive functioning of workers and students,23 which can improve both wellbeing, sleep and productivity.24 Ventilation can also reduce indoor moisture particularly in homes, which wifi reduce exposure to respiratory allergens and irritants such as dust mites and mould, resulting in reduced incidence of asthma, rhinitis and allergy symptoms.

A kia ora, a wave and a smile: an urban marae-led response to COVID-19, a case study in manaakitanga.

BACKGROUND: When COVID-19 emerged, there were well-founded fears that Maori (indigenous peoples of Aotearoa (New Zealand)) would be disproportionately affected, both in terms of morbidity and mortality from COVID-19 itself and through the impact of lock-down measures. A key way in which Kokiri (a Maori health provider) responded was through the establishment of a pataka kai (foodbank) that also provided a gateway to assess need and deliver other support services to whanau (in this case, client). Maori values were integral to this approach, with manaakitanga (kindness or providing care for others) at the heart of Kokiri's actions. We sought to identify how Kokiri operated under the mantle of manaakitanga, during Aotearoa's 2020 nationwide COVID-19 lockdown and to assess the impact of their contributions on Maori whanau. METHODS: We used qualitative methods underpinned by Maori research methodology. Twenty-six whanau interviews and two focus groups were held, one with eight kaimahi (workers) and the other with seven rangatahi (youth) kaimahi. Data was gathered between June and October 2020 (soon after the 2020 lockdown restrictions were lifted), thematically analysed and interpreted using a Maori worldview. RESULTS: Three key themes were identified that aligned to the values framework that forms the practice model that Kokiri kaimahi work within. Kaitiakitanga, whanau and manaakitanga are also long-standing Maori world values. We identified that kaitiakitanga (protecting) and manaakitanga (with kindness) - with whanau at the centre of all decisions and service delivery - worked as a protective mechanism to provide much needed support within the community Kokiri serves. CONCLUSIONS: Maori health providers are well placed to respond effectively in a public-health crisis when resourced appropriately and trusted to deliver. We propose a number of recommendations based on the insights generated from the researchers, kaimahi, and whanau. These are that: Maori be included in pandemic planning and decision-making, Maori-led initiatives and organisations be valued and adequately resourced, and strong communities with strong networks be built during non-crisis times.

The lived experience of hotel isolation and quarantine at the Aotearoa New Zealand border for COVID-19: A qualitative descriptive study.

Hotel-based Managed Isolation and Quarantine (MIQ) is a key public health intervention in Aotearoa New Zealand's (NZ) COVID-19 border control strategy for returning citizens and permanent residents. We aimed to investigate the experience of transiting through MIQ in NZ, to inform future refinements of this type of system. A qualitative thematic analysis method was utilised to explore experiences in depth with seventy-five individuals who had undergone MIQ in NZ between April 2020 and July 2021. Participants were interviewed by telephone or Zoom or completed an online qualitative questionnaire. Interviews were audio recorded, transcribed and coded; questionnaire responses were sorted and coded. All data were subjected to thematic analysis. Three main themes described the key elements of the participants' experience of MIQ that influenced their overall experiences: 1) The MIQ process, 2) MIQ Hotels, and 3) Individual experience. The variation in participants' overall experience of MIQ was strongly influenced by their perceptions of how well the MIQ process was managed (including communication, flexibility, and compliance with disease prevention and control measures); and the quality of the hotels they were allocated to (in particular hotel staff, meals and information). This valuable insight into the experience of individuals in NZ MIQ hotels can inform better planning, management and implementation of the MIQ process for NZ and adds to the literature of countries utilising such strategies to minimise the transmission of COVID-19, whilst protecting the wellbeing of those using the system.

Failures of quarantine systems for preventing COVID-19 outbreaks in Australia and New Zealand.

OBJECTIVES: To identify COVID-19 quarantine system failures in Australia and New Zealand. DESIGN, SETTING, PARTICIPANTS: Observational epidemiological study of travellers in managed quarantine in Australia and New Zealand, to 15 June 2021. MAIN OUTCOME MEASURES: Number of quarantine system failures, and failure with respect to numbers of travellers and SARS-CoV-2-positive travellers. RESULTS: We identified 22 quarantine system failures in Australia and ten in New Zealand to 15 June 2021. One failure initiated a COVID-19 outbreak that caused more than 800 deaths (the Victorian "second wave"); nine lockdowns were linked with quarantine system failures. The failure risk was estimated to be 5.0 failures per 100 000 travellers passing through quarantine and 6.1 (95% CI, 4.0-8.3) failures per 1000 SARS-CoV-2-positive travellers. The risk per 1000 SARS-CoV-2-positive travellers was higher in New Zealand than Australia (relative risk, 2.0; 95% CI, 1.0-4.2). CONCLUSIONS: Quarantine system failures can be costly in terms of lives and economic impact, including lockdowns. Our findings indicate that infection control in quarantine systems in Australia and New Zealand should be improved, including vaccination of quarantine workers and incoming travellers, or that alternatives to hotel-based quarantine should be developed.

Wearing one for the team: views and attitudes to face covering in New Zealand/Aotearoa during COVID-19 Alert Level 4 lockdown.

INTRODUCTION Mass masking is emerging as a key non-pharmaceutical intervention for reducing community spread of COVID-19. However, although hand washing, social distancing and bubble living have been widely adopted by the 'team of 5 million', mass masking has not been socialised to the general population. AIM To identify factors associated with face masking in New Zealand during COVID-19 Alert Level 4 lockdown to inform strategies to socialise and support mass masking. METHODS A quantitative online survey conducted in New Zealand during April 2020 invited residents aged ≥18 years to complete a questionnaire. Questions about face masking were included in the survey. The sample was drawn from a commissioned research panel survey, with boosted sampling for Maori and Pacific participants. Responses were weighted to reflect the New Zealand population for all analyses. RESULTS A total of 1015 individuals participated. Self-reported beliefs were strongly related to behaviours, with respondents viewing face masking measures as 'somewhat' or 'very' effective in preventing them from contracting COVID-19 more likely to report having worn a face mask than respondents who viewed them as 'not at all' effective. The strongest barriers to face mask use included beliefs that there was a mask shortage and that the needs of others were greater than their own. DISCUSSION Highlighting the efficacy of and dispelling myths about the relative efficacy of mask types and socialising people to the purpose of mass masking will contribute to community protective actions of mask wearing in the New Zealand response to COVID-19.

Case-Fatality Risk Estimates for COVID-19 Calculated by Using a Lag Time for Fatality.

We estimated the case-fatality risk for coronavirus disease cases in China (3.5%); China, excluding Hubei Province (0.8%); 82 countries, territories, and areas (4.2%); and on a cruise ship (0.6%). Lower estimates might be closest to the true value, but a broad range of 0.25%-3.0% probably should be considered.