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1.
Aust N Z J Public Health ; 46(3): 292-303, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1722991

ABSTRACT

OBJECTIVE: In 2020, we developed a public health decision-support model for mitigating the spread of SARS-CoV-2 infections in Australia and New Zealand. Having demonstrated its capacity to describe disease progression patterns during both countries' first waves of infections, we describe its utilisation in Victoria in underpinning the State Government's then 'RoadMap to Reopening'. METHODS: Key aspects of population demographics, disease, spatial and behavioural dynamics, as well as the mechanism, timing, and effect of non-pharmaceutical public health policies responses on the transmission of SARS-CoV-2 in both countries were represented in an agent-based model. We considered scenarios related to the imposition and removal of non-pharmaceutical interventions on the estimated progression of SARS-CoV-2 infections. RESULTS: Wave 1 results suggested elimination of community transmission of SARS-CoV-2 was possible in both countries given sustained public adherence to social restrictions beyond 60 days' duration. However, under scenarios of decaying adherence to restrictions, a second wave of infections (Wave 2) was predicted in Australia. In Victoria's second wave, we estimated in early September 2020 that a rolling 14-day average of <5 new cases per day was achievable on or around 26 October. Victoria recorded a 14-day rolling average of 4.6 cases per day on 25 October. CONCLUSIONS: Elimination of SARS-CoV-2 transmission represented in faithfully constructed agent-based models can be replicated in the real world. IMPLICATIONS FOR PUBLIC HEALTH: Agent-based public health policy models can be helpful to support decision-making in novel and complex unfolding public health crises.


Subject(s)
COVID-19 , COVID-19/epidemiology , Disease Progression , Humans , New Zealand/epidemiology , Public Health , SARS-CoV-2 , Victoria/epidemiology
2.
International Journal of Disaster Risk Reduction ; : 102779, 2022.
Article in English | ScienceDirect | ID: covidwho-1593714

ABSTRACT

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.

4.
Lancet Glob Health ; 10(1): e142-e147, 2022 01.
Article in English | MEDLINE | ID: covidwho-1575199

ABSTRACT

There is increasing evidence that elimination strategies have resulted in better outcomes for public health, the economy, and civil liberties than have mitigation strategies throughout the first year of the COVID-19 pandemic. With vaccines that offer high protection against severe forms of COVID-19, and increasing vaccination coverage, policy makers have had to reassess the trade-offs between different options. The desirability and feasibility of eliminating SARS-CoV-2 compared with other strategies should also be re-evaluated from the perspective of different fields, including epidemiology, public health, and economics. To end the pandemic as soon as possible-be it through elimination or reaching an acceptable endemic level-several key topics have emerged centring around coordination, both locally and internationally, and vaccine distribution. Without coordination it is difficult if not impossible to sustain elimination, which is particularly relevant in highly connected regions, such as Europe. Regarding vaccination, concerns remain with respect to equitable distribution, and the risk of the emergence of new variants of concern. Looking forward, it is crucial to overcome the dichotomy between elimination and mitigation, and to jointly define a long-term objective that can accommodate different political and societal realities.


Subject(s)
COVID-19 Vaccines , COVID-19/prevention & control , COVID-19/epidemiology , Disease Eradication/methods , Humans , Pandemics/prevention & control , SARS-CoV-2 , Vaccination
5.
The New Zealand Medical Journal (Online) ; 134(1546):8-16, 2021.
Article in English | ProQuest Central | ID: covidwho-1543338

ABSTRACT

Accumulating evidence suggests that elimination is probably the optimal initial response to an emerging pandemic disease of moderate or greater severity, at least until vaccines and disease-modifying agents are available.6 The elimination strategy has performed exceptionally well for New Zealand, giving us the lowest COVID-19 mortality in the OECD, a significant increase in life expectancy,7 a relatively high degree of personal freedom for much of the pandemic period and relatively good economic performance.8 The first major upgrade of the elimination strategy was the Reconnecting New Zealanders to the World strategy released on 12 August 2021,9 which proposed a carefully managed increase in inbound travel to New Zealand while continuing with elimination. [...]some of us have argued for continuing with suppression in Auckland while maintaining an elimination strategy for the rest New Zealand, which would require maintaining strong boundary controls around Auckland.13 Principles to guide the ongoing pandemic response There is a series of key principles that can help inform Aotearoa New Zealand's pandemic response, some of which have been articulated in government plans.14 Science-informed strategic leadership One of the strongest lessons from the pandemic response comes from the demonstrated benefits of combining effective political and scientific leadership. Given the ongoing need to meet new challenges in the pandemic response, it would be timely to institutionalise an improved set of processes for decision-making that foster use of evidence, innovation, consensus decision-making, continuous quality improvement and transparency.15'16 These processes could include: convening a cross-party parliamentary group along the lines of the Epidemic Response Committee;17 forming a high-level science strategy ropū (council) to provide the multidisciplinary expertise needed for complex emergencies;and developing a well-resourced COVID-19 research and development strategy. The post-acute effects of SARS-CoV-2 infection (so called "long-COVID") appear to be far more common and severe than for influenza.24 For example, there is the possibility of life-course impacts in the child population through effects on the developing brain.25 If that is found to be the case, then this pathogen may belong in the same category as measles and polio, which create such a burden of illness that they justify efforts for progressive elimination.26 27 One of the biggest unknowns is about the future evolution of SARS-CoV-2 "variants of concern," which may be more vaccine resistant, more infectious and even more lethal.28 The best way to stem SARS-CoV-2 evolution is to rapidly suppress transmission of this virus to very low levels across the globe, which is technically feasible but difficult to implement given inequities with vaccine supply, public health infrastructure and coordination.

6.
R Soc Open Sci ; 8(11): 210488, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1528253

ABSTRACT

New Zealand responded to the COVID-19 pandemic with a combination of border restrictions and an Alert Level (AL) system that included strict stay-at-home orders. These interventions were successful in containing an outbreak and ultimately eliminating community transmission of COVID-19 in June 2020. The timing of interventions is crucial to their success. Delaying interventions may reduce their effectiveness and mean that they need to be maintained for a longer period. We use a stochastic branching process model of COVID-19 transmission and control to simulate the epidemic trajectory in New Zealand's March-April 2020 outbreak and the effect of its interventions. We calculate key measures, including the number of reported cases and deaths, and the probability of elimination within a specified time frame. By comparing these measures under alternative timings of interventions, we show that changing the timing of AL4 (the strictest level of restrictions) has a far greater impact than the timing of border measures. Delaying AL4 restrictions results in considerably worse outcomes. Implementing border measures alone, without AL4 restrictions, is insufficient to control the outbreak. We conclude that the early introduction of stay-at-home orders was crucial in reducing the number of cases and deaths, enabling elimination.

7.
J Infect Dis ; 221(2): 183-190, 2020 01 02.
Article in English | MEDLINE | ID: covidwho-1452713

ABSTRACT

BACKGROUND: Severe influenza illness is presumed more common in adults with chronic medical conditions (CMCs), but evidence is sparse and often combined into broad CMC categories. METHODS: Residents (aged 18-80 years) of Central and South Auckland hospitalized for World Health Organization-defined severe acute respiratory illness (SARI) (2012-2015) underwent influenza virus polymerase chain reaction testing. The CMC statuses for Auckland residents were modeled using hospitalization International Classification of Diseases, Tenth Revision codes, pharmaceutical claims, and laboratory results. Population-level influenza rates in adults with congestive heart failure (CHF), coronary artery disease (CAD), cerebrovascular accidents (CVA), chronic obstructive pulmonary disease (COPD), asthma, diabetes mellitus (DM), and end-stage renal disease (ESRD) were calculated by Poisson regression stratified by age and adjusted for ethnicity. RESULTS: Among 891 276 adults, 2435 influenza-associated SARI hospitalizations occurred. Rates were significantly higher in those with CMCs compared with those without the respective CMC, except for older adults with DM or those aged <65 years with CVA. The largest effects occurred with CHF (incidence rate ratio [IRR] range, 4.84-13.4 across age strata), ESRD (IRR range, 3.30-9.02), CAD (IRR range, 2.77-10.7), and COPD (IRR range, 5.89-8.78) and tapered with age. CONCLUSIONS: Our findings support the increased risk of severe, laboratory-confirmed influenza disease among adults with specific CMCs compared with those without these conditions.


Subject(s)
Chronic Disease/epidemiology , Influenza, Human/epidemiology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Case-Control Studies , Cross-Sectional Studies , Female , Hospitalization/statistics & numerical data , Humans , Incidence , Influenza, Human/virology , Male , Middle Aged , New Zealand/epidemiology , Prospective Studies , Risk Assessment , Young Adult
8.
Med J Aust ; 215(7): 320-324, 2021 10 04.
Article in English | MEDLINE | ID: covidwho-1389701

ABSTRACT

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.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Disease Outbreaks/prevention & control , Quarantine/organization & administration , Travel , Australia/epidemiology , COVID-19/diagnosis , Humans , New Zealand/epidemiology
9.
Lancet Reg Health West Pac ; 15: 100256, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1364342

ABSTRACT

Background: COVID-19 elimination measures, including border closures have been applied in New Zealand. We have modelled the potential effect of vaccination programmes for opening borders. Methods: We used a deterministic age-stratified Susceptible, Exposed, Infectious, Recovered (SEIR) model. We minimised spread by varying the age-stratified vaccine allocation to find the minimum herd immunity requirements (the effective reproduction number Reff<1 with closed borders) under various vaccine effectiveness (VE) scenarios and R0 values. We ran two-year open-border simulations for two vaccine strategies: minimising Reff and targeting high-risk groups. Findings: Targeting of high-risk groups will result in lower hospitalisations and deaths in most scenarios. Reaching the herd immunity threshold (HIT) with a vaccine of 90% VE against disease and 80% VE against infection requires at least 86•5% total population uptake for R0=4•5 (with high vaccination coverage for 30-49-year-olds) and 98•1% uptake for R0=6. In a two-year open-border scenario with 10 overseas cases daily and 90% total population vaccine uptake (including 0-15 year olds) with the same vaccine, the strategy of targeting high-risk groups is close to achieving HIT, with an estimated 11,400 total hospitalisations (peak 324 active and 36 new daily cases in hospitals), and 1,030 total deaths. Interpretation: Targeting high-risk groups for vaccination will result in fewer hospitalisations and deaths with open borders compared to targeting reduced transmission. With a highly effective vaccine and a high total uptake, opening borders will result in increasing cases, hospitalisations, and deaths. Other public health and social measures will still be required as part of an effective pandemic response. Funding: This project was funded by the Health Research Council [20/1018]. Research in context.

11.
Epidemiol Infect ; 149: e173, 2021 07 30.
Article in English | MEDLINE | ID: covidwho-1347909

ABSTRACT

New Zealand has a strategy of eliminating SARS-CoV-2 that has resulted in a low incidence of reported coronavirus-19 disease (COVID-19). The aim of this study was to describe the spread of SARS-CoV-2 in New Zealand via a nationwide serosurvey of blood donors. Samples (n = 9806) were collected over a month-long period (3 December 2020-6 January 2021) from donors aged 16-88 years. The sample population was geographically spread, covering 16 of 20 district health board regions. A series of Spike-based immunoassays were utilised, and the serological testing algorithm was optimised for specificity given New Zealand is a low prevalence setting. Eighteen samples were seropositive for SARS-CoV-2 antibodies, six of which were retrospectively matched to previously confirmed COVID-19 cases. A further four were from donors that travelled to settings with a high risk of SARS-CoV-2 exposure, suggesting likely infection outside New Zealand. The remaining eight seropositive samples were from seven different district health regions for a true seroprevalence estimate, adjusted for test sensitivity and specificity, of 0.103% (95% confidence interval, 0.09-0.12%). The very low seroprevalence is consistent with limited undetected community transmission and provides robust, serological evidence to support New Zealand's successful elimination strategy for COVID-19.


Subject(s)
Blood Donors/statistics & numerical data , COVID-19/epidemiology , COVID-19/prevention & control , Disease Eradication/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Algorithms , Antibodies, Viral/blood , COVID-19/blood , COVID-19/transmission , COVID-19 Serological Testing , Female , Humans , Male , Middle Aged , New Zealand/epidemiology , Prevalence , SARS-CoV-2/immunology , Seroepidemiologic Studies , Young Adult
13.
Australian and New Zealand Journal of Public Health ; 44(2):89-91, 2020.
Article in English | ProQuest Central | ID: covidwho-1260302

ABSTRACT

The risk to human populations from new and pandemic infectious agents has probably never been higher.1,2 Synthetic bioweapons are an additional threat. Two recent publications have speculated on the possibility of island nation refuges closing their borders to protect a human population against a catastrophic pandemic that poses an existential risk to humanity.3,4 The most recent paper described an index based on characteristics of an island nation’s population, location, resources and society. The authors used this index to conclude that Australia and New Zealand are the island nations most likely to be able to be both isolated from the rest of humanity in a pandemic and to also have the resources to reboot a thriving technological society following a pandemic that devastated the rest of global society as we know it, thereby acting as ‘island refuges’.4 Previous analysis in this journal has argued the economic case for border closure by island nations in the face of extreme pandemics.5 This work reported that 100 per cent border closure for six months by New Zealand, that results in the country avoiding any pandemic cases, could have a net present value of NZ$7.86 (US$5.29) billion for its “Scenario A” (involving half the mortality rate of the 1918 influenza pandemic) and NZ$144 (US$96.9) billion for preventing a pandemic with 10 times this mortality. There is evidence for travel restrictions being successful in controlling the spread of influenza between countries, and small islands successfully used protective sequestration and maritime quarantine to avoid the 1918–1919 influenza pandemic ). However, the 1918- 19 pandemic still appeared to reach most of the world’s islands. Drastic measures such as border closure have potentially large benefits (if successful) but also potentially major harmful consequences including economic harm. Some of these potential trade-offs are illustrated by the 2014 Ebola outbreak where the GDP of countries affected fell by 12% during the emergency even without successful complete border closures. The question remains, which pandemics, if any, might ever plausibly justify partitioning a segment of the human population through border closure by island nations to reduce major burdens of morbidity and mortality? It is this question we address in the present commentary.

14.
Sci Rep ; 11(1): 10766, 2021 05 24.
Article in English | MEDLINE | ID: covidwho-1242042

ABSTRACT

We aimed to estimate the risk of COVID-19 outbreaks associated with air travel to a COVID-19-free country [New Zealand (NZ)]. A stochastic version of the SEIR model CovidSIM v1.1, designed specifically for COVID-19 was utilised. We first considered historical data for Australia before it eliminated COVID-19 (equivalent to an outbreak generating 74 new cases/day) and one flight per day to NZ with no interventions in place. This gave a median time to an outbreak of 0.2 years (95% range of simulation results: 3 days to 1.1 years) or a mean of 110 flights per outbreak. However, the combined use of a pre-flight PCR test of saliva, three subsequent PCR tests (on days 1, 3 and 12 in NZ), and various other interventions (mask use and contact tracing) reduced this risk to one outbreak after a median of 1.5 years (20 days to 8.1 years). A pre-flight test plus 14 days quarantine was an even more effective strategy (4.9 years; 2,594 flights). For a much lower prevalence (representing only two new community cases per week in the whole of Australia), the annual risk of an outbreak with no interventions was 1.2% and had a median time to an outbreak of 56 years. In contrast the risks associated with travellers from Japan and the United States was very much higher and would need quarantine or other restrictions. Collectively, these results suggest that multi-layered interventions can markedly reduce the risk of importing the pandemic virus via air travel into a COVID-19-free nation. For some low-risk source countries, there is the potential to replace 14-day quarantine with alternative interventions. However, all approaches require public and policy deliberation about acceptable risks, and continuous careful management and evaluation.


Subject(s)
Air Travel , COVID-19/prevention & control , COVID-19/epidemiology , COVID-19/virology , Contact Tracing , Disease Outbreaks , Humans , Models, Theoretical , New Zealand/epidemiology , Quarantine , RNA, Viral/analysis , RNA, Viral/metabolism , Reverse Transcriptase Polymerase Chain Reaction , Risk , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Saliva/virology
15.
Emerg Infect Dis ; 27(5): 1317-1322, 2021 05.
Article in English | MEDLINE | ID: covidwho-1202381

ABSTRACT

Real-time genomic sequencing has played a major role in tracking the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), contributing greatly to disease mitigation strategies. In August 2020, after having eliminated the virus, New Zealand experienced a second outbreak. During that outbreak, New Zealand used genomic sequencing in a primary role, leading to a second elimination of the virus. We generated genomes from 78% of the laboratory-confirmed samples of SARS-CoV-2 from the second outbreak and compared them with the available global genomic data. Genomic sequencing rapidly identified that virus causing the second outbreak in New Zealand belonged to a single cluster, thus resulting from a single introduction. However, successful identification of the origin of this outbreak was impeded by substantial biases and gaps in global sequencing data. Access to a broader and more heterogenous sample of global genomic data would strengthen efforts to locate the source of any new outbreaks.


Subject(s)
COVID-19 , SARS-CoV-2 , Disease Outbreaks , Genomics , Humans , New Zealand/epidemiology
16.
Journal of the Royal Society of New Zealand ; : 1-24, 2021.
Article in English | Taylor & Francis | ID: covidwho-1124415
18.
Nat Commun ; 12(1): 1001, 2021 02 12.
Article in English | MEDLINE | ID: covidwho-1082056

ABSTRACT

Stringent nonpharmaceutical interventions (NPIs) such as lockdowns and border closures are not currently recommended for pandemic influenza control. New Zealand used these NPIs to eliminate coronavirus disease 2019 during its first wave. Using multiple surveillance systems, we observed a parallel and unprecedented reduction of influenza and other respiratory viral infections in 2020. This finding supports the use of these NPIs for controlling pandemic influenza and other severe respiratory viral threats.


Subject(s)
COVID-19/epidemiology , Influenza, Human/epidemiology , Respiratory Tract Infections/epidemiology , COVID-19/prevention & control , COVID-19/virology , Communicable Disease Control , Epidemiological Monitoring , Hospitalization/statistics & numerical data , Humans , Influenza, Human/prevention & control , Influenza, Human/virology , New Zealand/epidemiology , Pandemics , Public Health , Respiratory Tract Infections/prevention & control , Respiratory Tract Infections/virology , SARS-CoV-2/isolation & purification
19.
N Z Med J ; 134(1529): 26-38, 2021 02 05.
Article in English | MEDLINE | ID: covidwho-1080082

ABSTRACT

AIM: We aimed to estimate the risk of COVID-19 outbreaks in a COVID-19-free destination country (New Zealand) associated with shore leave by merchant ship crews who were infected prior to their departure or on their ship. METHODS: We used a stochastic version of the SEIR model CovidSIM v1.1 designed specifically for COVID-19. It was populated with parameters for SARS-CoV-2 transmission, shipping characteristics and plausible control measures. RESULTS: When no control interventions were in place, we estimated that an outbreak of COVID-19 in New Zealand would occur after a median time of 23 days (assuming a global average for source country incidence of 2.66 new infections per 1,000 population per week, crews of 20 with a voyage length of 10 days and 1 day of shore leave per crew member both in New Zealand 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 combination of PCR testing 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, or a 49% probability within a year). Scenario analyses found that onboard infection chains could persist for well over 4 weeks, even with crews of only 5 members. CONCLUSION: This modelling work suggests that the introduction of SARS-CoV-2 through shore leave from international shipping crews is likely, even after long voyages. But the risk can be substantially mitigated by control measures such as PCR testing and mask use.


Subject(s)
COVID-19 , Communicable Diseases, Imported/prevention & control , Disease Transmission, Infectious , Naval Medicine , Quarantine/methods , SARS-CoV-2/isolation & purification , Ships , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , COVID-19 Nucleic Acid Testing/methods , Communicable Disease Control/instrumentation , Communicable Disease Control/methods , Computer Simulation , Disease Transmission, Infectious/prevention & control , Disease Transmission, Infectious/statistics & numerical data , Humans , Masks , Naval Medicine/methods , Naval Medicine/statistics & numerical data , New Zealand/epidemiology
20.
J Prim Health Care ; 12(3): 199-206, 2020 09.
Article in English | MEDLINE | ID: covidwho-1042176

ABSTRACT

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.


Subject(s)
COVID-19/prevention & control , Coronavirus Infections/prevention & control , Health Knowledge, Attitudes, Practice , Masks , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Adult , Betacoronavirus , COVID-19/epidemiology , Coronavirus Infections/epidemiology , Female , Humans , Male , New Zealand/epidemiology , Physical Distancing , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Self Report , Surveys and Questionnaires
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