Proactive Release The following item has been proactively released by the Rt Hon Jacinda Ardern, Prime Minister: COVID-19 Current State, Trajectories and Interventions © Crown Copyright, Creative Commons Attribution 4.0 International (CC BY 4.0) SENSITIVE COVID-19 – Current state, trajectories and interventions 20 March 2020 To: Chair Cabinet 1. Assessment of current situation • se d Pr oa ct iv el y • ea • el • New Zealand is going hard and going early. On 19 March border restrictions were maximised to lessen the risk of New Zealand importing cases of COVID-19. We are ramping up testing, contact tracing and self-isolation requirements. 1 All our confirmed cases either travelled from overseas or were close household contacts of an ‘imported case’. However, we are seeing an uptick in imported cases around the country (refer to graph below). We do not know whether community transmission is occurring in New Zealand. Epidemiologists consider it likely there is some ‘silent’ transmission occurring in the community. However, we have not had any seriously ill patients with COVID-19 pneumonia, which generally develops over 2-3 weeks from infection. The next 2-3 weeks is critical to New Zealand’s COVID-19 response. Our ability to stamp it out depends on ramping up testing to identify cases, scaling up contact tracing and enforcing self-isolation. We are acting rapidly on all three fronts. If community transmission becomes widespread we will have lost the opportunity gained by closing the border. International advice is that for each case we may be missing nine. Even with no further imported cases, if we have missed early cases transmitting silently, we could suddenly face an exponential rise in cases as has happened elsewhere. To minimise the likelihood of this occurring, decisive action is needed immediately. R • 1 Currently almost 8000 people or households are in self-isolation. 1 SENSITIVE 2. Three possible trajectories Three possible trajectories for New Zealand 500 Minimal action (UK track) Numberof new cases Perday se sures el 2 1 an/Singapore 10 Week3 Weeu Weeks WeekG Week 5, Mord: 20 Mord: 27 April 3 April 10 n1 w" New Zealand has a stark choice. Iran and Italy show dramatica ppens when action is taken too late. Their health systems are overwhelmed whic rming case fatality rates. The UK appears to be following Italy?s trajectory with a . UK only began responding Ial growth in cases occurred. Following the Zealand may follow the path of Australia, where community transmission urr in New South Wales. New Zealand needs to act decisively to increase containment mea want to stay on the trajectories of Singapore and Taiwan, notwithstanding cultural di As Attached are charts which provide ar data points comparing countries from the date of their ?rst cases. 3. Interventions The attached COV intensity, ie increasing levels of restriction on the movement and interaction of people. om IC health shows that we need a suite of interventions applied together if we are 'n lD-19. Each alert level therefore contains an integrated set of measures which builds . ework sets out four alert levels, which are triggered depending on the risk and spread of COVID-19. These alert levels can be applied to towns, cities, TLAs, regions or the whole country. For instance, Dunedin could be at Level 4, while the rest of the country is at Level 2. In a worst-case scenario, the whole country would be set at Level 4 for several months. It would be very dif?cult to sustain nation- wide Level 4 for an extended period. At present, the whole of New Zealand is at Level 1, but we have already applied parts of Level 2, namely maximum border restrictions and tightening of restrictions on mass gatherings. We 2 SENSITIVE recommend New Zealand move completely to Level 2 immediately and remain there for up to 30 days initially. The move to Level 2 reflects the heightened risk of importing COVID-19 cases at this time as many New Zealanders return home from overseas and we see an uptick in reported cases here. In addition, we recommend making the last week of term teacher-only days to allow schools to prepare for teaching remotely. Details will need to be worked through with the Ministry of Education. The key changes in moving from current settings to a full Level 2 are: • • se d • Encouraging workplaces to actively consider alternative ways of working (eg remote working, shift-based working, physical distancing within the workplace, staggering meal breaks, flexible leave arrangements) Activating business continuity plans to support alternative ways of working and to prepare for possible disruption should the alert level rise to 3 Recommending New Zealanders postpone or cancel non-essential domestic travel Advising high-risk individuals (such as those over 65 and those with comorbidities) to stay at home. ea • R el This is a fast changing situation that calls for strategic judgment in a context of uncertainty. The broad approach has to be one of least regrets. That means a bias towards acting sooner rather than later if in doubt, to avoid the need for even tighter restrictions later. y We can move between alert levels as containment of COVID-19 allows, ie we have the ability to flex. If we are successful in the next month(s) and are confident the risk of spread is very low, we could potentially go back down to Level 1. ct iv el We note that a lift to Level 2 will require advice on the implications of actively considering alternative ways of working (such as for the education sector) and details for high-risk populations which will be advised to remain at home. 4. Implications of interventions oa The public health of New Zealanders is the top priority. Maintaining public health may require us to move up the alert levels. Pr The economic and social implications of moving up the alert system are very significant. The framework sets these out at a high-level. Further support for New Zealand businesses and the well-being of New Zealanders will be needed as we move up and down the alert levels to respond to the economic, employment and social implications. We will need to support the maintenance of social connections and links to the workplace. The government has already acted decisively with New Zealand’s most significant peace-time economic response package. We note that, to date, most of the economic hardship related to COVID-19 has been related to the global economy, rather than as a result of public health measures in New Zealand. 3 SENSITIVE 5. Public Communications Good public communications will promote adherence to the measures we implement, while minimizing the number of people who take unnecessary, and potentially damaging, actions above and beyond those required. • • We are going hard and going early We have taken decisive action, but the risk of importation remains high, and there is a real possibility community transmission could occur. We are taking all practical steps needed to stamp out these cases and minimize the risk of COVID-19 spreading. New Zealanders should stick to these measures – it will take all of us to unite against COVID19. ea • • se d The public need to trust our response and have confidence that the measures are appropriate, so we must be provide information on the measures we are taking and the reasons for them. With the announcement of Level 2 restrictions, we will reinforce: el Guidance is being written for all of the measures in Level 2 – for example who is classified as a highrisk individual advised to remain at home, and what defines essential domestic travel. • • oa • y • We are actively planning stricter measures that will be needed if we experience community transmission. These measures will include school closures, non-essential business and venue closures and transport restrictions. These will be put in place if we identify any community transmission, clusters of infection or experience any increasing difficulty in containing COVID-19. The restrictions may be put in place at local, regional or national levels. We still only have isolated imported cases, but we are ramping up our testing significantly and continuously monitoring for any signs the situation could be worsening. We are planning for the worst. These measures are not required now, and you should only act on them when the Government advises you to. ct iv el • R It is also time to begin detailing the actions we are planning for level 3. We must offer the public assurance on when they can expect further measures. These communications should reinforce: Pr Such warnings are likely to exacerbate alarm and panic, and may have consequences, including further stockpiling, removal of children from schools, and greater internal travel, as people relocate to be with families. However, increasing panic is likely regardless, and without such information, communities are more likely to respond and act on rumours than official advice. Instead, we must reinforce the consequences of these actions, including the harm they can pose to vulnerable people in their networks (including the elderly) and wider society. We should offer hope, that the measures are temporary and give us a chance to avoid an outbreak, and build solidarity, reinforcing the need to unite against COVID-19. Continued early engagement with and public support from key stakeholders will assist. 4 SENSITIVE RECOMMENDATIONS We recommend you: Note the attached COVID-19 alert levels which contain specific triggers based on COVID-19 risk and spread, and response measures Note that the alert levels increase in intensity, ie they impose increasing levels of restriction on the movement and interaction of people with consequent impacts on the daily lives of New Zealanders se d Note that the alert levels may be applied to a town, city, TLA, region or the whole country Note that different parts of the country may be at different alert levels at one time Note that there is a risk of some ‘silent’ community transition occurring and that decisive and rapid action is needed to stamp that out or slow the spread should it be occurring y Brook Barrington R el ea Move completely to Level 2 as soon as practicable and remain there for up to 30 days initially, and in addition make the last week of term teacher-only days to allow schools to prepare for teaching remotely. John Ombler ct iv el Chief Executive, Department of Prime Minister and Cabinet oa COVID-19 All of Government Controller Pr Ashley Bloomfield Director-General, Ministry of Health Juliet Gerrard Prime Minister’s Chief Science Advisor 5 New Zealand COVID-19 Alert Levels 2 1 State of local or national emergency declared Population instructed to stay at home Domestic travel restrictions imposed depending on areas of outbreak and risk Businesses closed except for essential services (supermarkets, pharmacies, clinics) and lifeline utilities Rationing of supplies and requisitioning of facilities possible Public transport severely limited Major reprioritisation of healthcare services Triaging of patients to “COVID clinics” or home, who otherwise would be hospitalised o o o o o o o o Domestic travel advisories issued to avoid areas with clusters or community transmission Public transport limited and physical distancing imposed Educational facilities closed All mass gatherings cancelled Public venues closed (eg libraries, museums, cinemas, food courts, gyms, pools, amusement parks) Restrictions on bars and restaurants (eg operating hours) Alternative ways of working required and non-essential businesses suggested to consider closing Non acute (elective) services and procedures in hospitals deferred and healthcare staff reprioritised o o o o o o o o o Disease increasingly difficult to contain Community transmission occurring OR Multiple clusters break out Disease is contained, but risks growing High risk of importing COVID-19 AND Uptick in imported cases OR Uptick in household transmission OR Single or isolated cluster outbreak o o o o Disease is contained Heightened risk of importing COVID-19 OR Sporadic imported cases OR Isolated household transmission associated with imported cases el o o R o o o o o o o o Entry border measures maximised Restrictions on mass gatherings tightened Recommendations to cancel or postpone non-essential domestic travel Alternative ways of working actively considered (eg remote working, shift-based working, physical distancing within the workplace, staggering meal breaks, flexible leave arrangements) Business continuity plans activated High-risk individuals advised to remain at home (eg those over 65 or those with comorbidities) o o o o o o o o Border entry measures to minimise risk of importing COVID-19 cases applied Aggressive contact tracing Stringent self-isolation and quarantine Intensive testing in high risk settings Physical distancing encouraged in all settings Large mass gatherings cancelled New Zealanders told to be socially responsible: If sick, stay at home Messages promoted on good personal hygiene SENSITIVE Impact on daily life o y o o o Disease is not contained Sustained and intensive transmission ea o o o o o o o o o o el 3 Key measures ct iv 4 Trigger oa Level se d New Zealand’s COVID-19 strategy focuses on keeping it out, stamping it out and slowing it down. These alert levels specify the public health and social measures to be taken and the impacts of those on daily life (note: the table does not include impacts caused by the situation outside of New Zealand). The measures may be updated on the basis of (i) new scientific knowledge about COVID-19 and (ii) information about the effectiveness of intervention measures in New Zealand and elsewhere. The alert levels may be applied at the town/city, TLA, regional or national levels. Different parts of the country may be at different alert levels. In general, the alert levels are cumulative, eg Level 1 is a base-level response. Always prepare for moving up or down the levels. A number of statutes support the measures, in particular the Health Act 1956, the Civil Defence Emergency Management Act 2002 and the Epidemic Preparedness Act 2006. Further detail on relevant legislation is provided in the New Zealand Influenza Pandemic Action Plan (NZIPAP). Pr o o o o o o o o o o o o o Extreme social and economic disruption and dislocation Significant number of deaths Travel and movement severely affected Options needed for children of essential workers Severe disruption to the economy Social interactions sharply diminished Travel may be significantly affected Significant work and school absenteeism Options may be needed for children of essential workers Major disruption to the economy, particularly hospitality, events and tourism sectors Significant disruption to social life Reduced travel within New Zealand Higher work and school absenteeism possible Disruption to the economy Tourism and travel industries significantly affected Some disruption to social life COVID-19 Policy Strategy and Coordination Unit, 20 March 2020 Data up to 18 March 2020 from Johns Hopkins University Number of new cases per day - Selected case studies 800 700 600 ?total cases mgapore IAustralia 400 IUnited Days since first case in country Number of new cases per da land vs United Kingdom (zoom int 00 casestal cases 5 50 IUnited Kingdom 3 40 INew Zealand :Singapore: 313 con?rmed cases, 0 deaths (population 5.8 million) Taiwan: 100 confirmed cases, 1 death (population 23.8 million) Hong Kong: 181 confirmed cases, 4 deaths (population 7.5 million) 5 7 9 Days since first case in country Australia: 568 con?rmed cases, 6 deaths (population 25.5 million) UK: 2626 con?rmed cases, 71 deaths (population 67.8 million) NZ (data to 20 March): 39 con?rmed cases, 0 deaths (population 4.8 million) Data up to 18 March 2020 from Johns Hopkins University Number of new cases per day New Zealand vs Australia 140 120 NZ: day 22 39 to I cases 00 I Australia 01 I New ?9 Number of new cases 710131619222528313437404 46 Days since first case in country Number of new cases per day pore, Taiwan Hong Kong 50 45 4o 35 2 30 tal cases 0 Number of new cases U1 U1 ISingapore I Hong Kong 0 Taiwan INew Zealand Days since first case in country Note: United Kingdom data excludes the UK territories of Gibraltar, Channel Islands and Cayman Islands.