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Theroadtolevel4andback

AreviewofdecisionmakingontheCovid-19alertlevelsAugust2020

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AboutTailriskeconomicsTailriskeconomicsisaWellingtoneconomicsconsultancy.Itspecialisesintheeconomicsoflowprobability,highimpacteventsincludingfinancialcrisesandnaturaldisasters.Tailriskeconomicsalsoprovidesconsultingserviceson:

• Theeconomicsoffinancialregulation

• Advancedcapitaladequacymodelling

• Stresstestingforlargeandsmallfinancialinstitutions

• Regulatorycomplianceforfinancialinstitutions

• Generaleconomics.

Tailriskispreparedtoundertakeeconomicsanalysesofpublicpolicyproposalsonadiscountedorprobonobasis.PrincipalIanHarrison(B.C.A.Hons.V.U.W.,MasterofPublicPolicySAISJohnsHopkins)hasworkedwiththeReserveBankofNewZealand,theWorldBank,theInternationalMonetaryFundandtheBankforInternationalSettlements.Contact:IanHarrison–PrincipalTailriskEconomicsharrisonian52@gmail.comPh.0221753669043848570

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TableofcontentsPartone:Introduction 4Parttwo:Keyconclusions 8Partthree:Analysisleadinguptothelockdowndecision

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Partfour:Alertlevels3and4decisionpaper

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Partfive:Fromlevel4tolevel1

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Partsix:Otherdocumentsinfluencingdecision-making

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Partseven:Humanrightsimplications

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Parteight:Equityatthecentreofthenationalresponse

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Partnine:Thebordercontrolissue 164Partten:AnoteonSweden 190

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Theroadtolevel4andbackPartone:IntroductionThisreportprimarilyfocusesontheanalysisandreasoningbehindthedecisiontomovetotheCovid-19alertlevel4on26March2020,andthesubsequentmovesbackthroughthelevels.Itislargelybasedonanexaminationofthelargescale‘proactive’releaseofofficialdocuments,butalsoconsidersotherrelevantsources.Thecontext,ofcourse,isthatthepolicieswereasuccess.Againstmostexpectationstheviruswaseliminated,atleastuntilrecently.Therewasanelementofluckinthis,becausethisisa‘sneaky’virus,andasymptomatictransmissioncanseetheviruspopbackupevenwhentherehavebeennocasesforweeks,andthereisalwaysariskattheborder.However,theoutcomeisnottheonlymeasureofsuccess.Theuseofsustained,butverycostly,bruteforceagainstanearlystageepidemicshouldwork,butthatdoesnotmeanitwasnecessarilythebestpolicyifasimilaroutcomecouldhavebeenachievedwithalesscostlystrategy.Theofficiallineisthatitwasallnecessary,andthatthehardlockdownsavedNewZealandfromimpendingdisaster.ThefollowingisaRNZreportonwhatthePrimeMinistersaidata5April2020briefing.

ShecitedscientificmodellingbyRodneyJonesthathadestimatedtherecouldbe4000confirmedcasesbythisweekend,butmeasurestakenbythegovernmenthadlimitedthattojust1000.

"Those3000fewercasesshowsthedifferencethatcumulativeactioncanmake.ThreethousandfewerpeoplesickwithCovid-19,3000fewerpeoplepassingthevirusontoothersandintoothers,"shesaid.

Thesenumbersprovedverylittle.TheJonesprojectionhasnotbeendisclosed,soitisnotpossibletoassessitsmeritsandtoseewhatthecounterfactualthatgenerated

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the4000infectionswas.Itcouldhavebeena‘donothing’scenario,withnocontacttracingandisolation,noleveltwoandthreerestrictionsandnospontaneouspopulationbehaviouralchange.

However,thePrimeMinisterwassimplywronginimplyingthatthelockdownreducedcasenumbersby3000by5April.Thatwasimpossiblebecausethereisalagbetweenapolicyactionthatreducesinfectionsandthetimeacaseisactuallyrecorded.Thisgapwasthoughttobeabouttwoweeksonaverage,thoughsomecaseswillcomethroughmorequickly.By5Aprilthelockdownhadonlybeenineffectfor9days,andcouldonlyhavehadalimitedeffectonthenumberofrecordedcases.

Oneimportantpurposeofthisreportistohelpprovidesomeex-postaccountabilityfordecisionsthatweremadequickly,withlittletransparency,andwithouttheconsultationandtestingthatwouldnormallyaccompanypolicymeasuresofthemagnitudeofmovingtoalertlevel4.InparticulartherequirementtocompleteRegulatoryImpactAssessmentswasdroppedon20March2020,justpriortotheconsiderationoftheCabinetpapersupportingthemovetolevel4on23March2020.TheexemptionappliestoallCovid-19measuresupto31August2020.Whiletherewasalogictodroppingtherequirementintheheatoftheearlydecision-makingprocess,itisdifficulttoseewhytheexemptionhadtoextendtotheendofAugust.ToadegreethisreportattemptstofillthegapintheTreasury’soversightrole.Wehavetriedtobecomprehensiveandhavelargelylettherelevantofficialandadvisorypapersspeakforthemselves,ratherthanjustprovidingoursummaryassessments.Thiswillhelpreadersmaketheirownassessmentswithouthavingtowadethroughamountainofpapers.WherewehavebeencriticaloftheMinistryofHealth,otheradvisersanddecisionmakers,wehavetriedtobemindfulofthefactthatdecisionswereoftenbeingmadeundertimepressure,inafast-movingsituationwheretherewasincompleteinformation.Wehavetriedtoavoidahindsightwisdom.Themaintestwashowtheanalysisandjudgmentsstoodupagainstwhatwasknown,orshouldhavebeenknown,atthetime.Wethinkthatwearereasonablywellplacedtodothat.WefirstbecameinvolvedwhenwecheckedtheMinistryofHealth’sepidemicmodellingonoraboutthefirstofApril,whenwedidnothavemuchmoreinformationthanwasavailabletodecisionmakerswhenthelevel4decisionwasmade.Itwascleartoustherewassomethingverywrongwithsomeofthemodellingandthattherewasasignificant

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elementofhypeinthepublicmessaging.Thatanalysiswasreleasedinthereport‘Alookbehindtheheadlines’1.Thisreportfollowsandbuildsonourinitial,partial,assessments.

Thisisacomplexstoryandreasonablepeoplecancometodifferentconclusionsaboutwhatwas,andwasn’t,done.Thispapermaybehelpfultothosewhowanttoknowwhathappenedbeforeformingaview.However,thisisacriticalreviewandcomeswithourtakeontheevidence.Italsoreflectsourpreferenceforevidencebasedpolicies,informedbymodelling,becausethatisourbackground.Wearelesscomfortablethansomewith‘seatofthepants’decisionmaking.

Aswellasthewalkthroughthedecision,monitoringandbackgrounddocuments,thereportalsoexaminestherationalebehindthefocuson‘equity’,whichhasbeenidentifiedasthe‘centrepiece’oftheNewZealandCovid-19strategyinseveraldocuments.Othermatters,particularlythebordercontrolissueandthehumanrightsimplicationsofthelockdownandotherrestrictions,arealsoconsidered.Humanrightsisnotournormaldomain,buttherestrictionsimpactedonthehumanrightsofmostNewZealandersinsignificantways.Thiswouldonlybelawfuliftheinterventionswerebothnecessaryandproportionate,andthisinvolvesanassessmentofboththecostsandthebenefitsofeachintervention.Weconsiderwhetherthesetestsweremet.Thereportisorganizedasfollows:Parttwopresentssomekeyconclusions.Partthreereviewsanalysispresentedindocumentsleadinguptothedecisiontomovesuccessivelytolevels3and4.Partfourdiscusses,indepth,thekeydocumentbehindthelevel3and4decisions.Partfiveexaminesthedocumentssupportingthemovestoalertlevelsthree,twoandone.PartsixreviewsthemathematicalmodellingandotherbackgroundpapersthatinformedtheMinistryofHealthdecision-making.Partsevenreviewstheevidenceunderpinningthe‘equity’focusofthepandemicstrategy.InparticularitlooksattherelevantpartoftheOtagoCovid-19Research

1TailriskEconomicsTheMinistryofHealth’smodelingoftheimpactoftheCoronavirusonNewZealand:Alook

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GroupanalysisthatpurportstoshowthatMaoriandPacificdeathrateswouldbemuchhigherthantheEuropeanpopulation.ATePanahaMatatiki(TPM)report,whichcametoasimilarconclusion,isalsoreviewed.Parteightlooksathumanrightsconsiderations,andtherationaleforimposingastateofemergency.Partninediscussesthebordercontrolissue.RecentmodelingbyTPMonquarantiningeffectivenessisreviewed.ParttencommentsontheSwedishexperience.

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Parttwo:SomekeyconclusionsDecisiontomovetolevelfourprecipitousThedecisiontomovetoalertlevelfourwasmadeprecipitously,withoutanyconsiderationoftheoptions.Themovewasmadedaysafterthemovetolevel2,whichwasintendedtobeinplaceforupto30days.Workwasonlyjuststartingonthedetailoflevel3,andmovingtolevel4hadnotbeenseriouslycontemplated.Thesituationhadnotchangedunexpectedlyinthethreedaysbetweentheleveltwoandlevelfourdecisions.Whathadchangedwaswhowascallingtheshots.LegallyitshouldhavebeentheDirectorGeneralofHealth,buthebentwiththepoliticalwind.Thedecisionpapertomovetolevelsthreeandfourwasanobvioussham.Therewasnorealevidence,setagainstobjectivecriteria,tosupportalevelfourmove.Therewasasuddendeterminationtohavealockdownregardlessoftheevidenceandthecosts.ThismayhavebeencausedbyalackofconfidenceintheMinistryofHealth’smanagementofcontacttracingandtheirlackofanalyticalcapacity.AslateasMarch16thecontacttracingcapacitywasonly10perday,withplanstoscaleitupto50.(Partsthreeandfour)NoanalysisofthecostsandbenefitsofdifferentinterventionsNodetailedquantitativeassessmentwasevermade,before,duringandafterthelockdownoftheimpactofdifferentinterventionsonvirustransmissionrates.Therewasnoattempt,atall,toassessthecostofthelockdownbeforethedecisionwasmadetogotoalertlevel4.Thediscussionwaslimitedtojustasinglelinetotheeffectthatthecostswouldbeverylarge.NodecisiontomovetoaneliminationstrategyThealertlevel4decisionwasmadetosupportasuppressionstrategy,whichwouldhaveinvolvedcontainingthevirussothehealthsystemwasnotoverwhelmed.Theeliminationstrategyjustemergedoverthenextweekorso.Therewasnoformaldecisiontochangethestrategyandnoassessmentoftherespectivecostsandbenefitsofeliminationandsuppressionstrategies.(Partfour)Theissueappearedtohavebeenbrieflyconsideredbyofficialssomeweekspreviously.TheyconcludedthattheworsteconomicoutcomewouldbeasuccessfuleliminationoutcomethatresultedinNewZealandsubsequentlybeingisolatedfromtherestoftheworld.(Partthree)

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StrategicthinkingmostlylimitedtoslogansTherewaslittlestrategicthinkingandanalysisbeyondarecitationofslogansandmantras:‘Keepitout;stampitout;manageit’;‘gohardgoearly’,‘breakthechainsoftransmission’,werethefavorites.Simplesloganshavetheirplaceinconveyingcomplexideas,butthesloganswereoftenallthattherewas.MinistryofHealthanalysisoftenlackedanalyticalcontentandaseriousconsiderationofrelevantevidenceThereislittleevidencethattheMinistryhadthecapacitytomodelCovid-19,ortocriticallyassessothermodelingevidenceputbeforethemordecision-makers.Notasinglemodelhasbeendeveloped.ThelackofMinistrycapacitymeantthatthegapwasfilledbychancersand‘influencers’.DirectorGeneralmadeafalseandmisleadingstatementonmodellingApressreleasebytheDirectorGeneralofHealthclaimingthatdecision-makingwasbasedonrobustmodellingmademultiplefalseandmisleadingstatements.(Partsix)MinistryinitiallybungledthecontacttracingprogrammeTheMinistry,initially,didnotunderstandthedifferencebetweenafluepidemic,whichmovesveryquicklyandwillsoonoverwhelmanycontacttracingcapability,andtheCovid-19epidemicwherecontacttracingshouldhaveanongoingrole.Contacttracingworked(just)WhiletheMinistryapparentlylosttheconfidenceofdecision-makersoncontacttracing,itdidgetitsacttogether,justintime,andcontacttracingprobablyplayedasignificantroleinreducingcasenumbers.TheepidemicwasundercontrolbeforethelockdownThecasedataonthetimingofinfectionssuggeststhattheepidemicwasundercontrol(withareproductionrateofabout1)beforethelockdownbegan.Butbecauseofthelagfromthepointofinfectiontowhencaseswerereported,thatcouldnothavebeenknownatthetime.(PartSix)SomeofthebigcallswerepossiblyrightUnderthepressureoftime,thestressofwhatwasperceivedtobealoominghealthcatastropheandalossinconfidenceintheMinistry,decisionshadtobemade,andweremadeongutfeelratherthananalysis.Sometimesaninstinctivedecisioncanbetherightone.Inourviewadecisiontomovemorequicklytolevelthreewasareasonablecall,atthetime.Butwhiletherewaslittletobegainedbywaitingfor

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toolong,twoorthreedaystoputamoreefficientandequitableinterventionframeworktogetherwouldhavebeentimewellspent.Contrarytosomeofthemorehystericalclaimsatthetime,NewZealandwasnotontheedgeofanimpendingcatastrophe.Bordercontrolswereworkingwellandpeoplewerealreadychangingtheirbehaviourtoreducetheirrisks.AndsomewerewrongThedecisiontoclosedownallbut‘essential’businesseswaslargelythewrongcall.Inparticularthecaseforclosingdownthebuildingandconstructionindustrywasparticularlyweak.OfficialssuggestedthatthisindustryremainopenbutCabinetinsistedonclosingit.Decisionsshouldhavebeenmadeonthetransmissionrisksposedbybusinesses,notwhethertheywere‘essential’ornot.InourviewtheepidemiccouldhavebeenbroughtundercontrolwithsomethingliketheinterventionlevelsadoptedinAustralia,butwithoutthecoercion.Therewouldhavebeenverylittledifferencetothenumberofcasesanddeaths.Thecostofthismistakewasprobablyintheorderof$7billion.Thismayseemlikeasmallnumberinthecurrentenvironment,butitisnottrivial.MovementstolowerlevelsweretooslowItquicklybecameapparentthattheepidemicwasundercontrolandthatsomerelaxationwasinorder.However,therewasaprecommittmentto4weeksatlevelfour.Thebasisforthefourweekswasnevermadeclear,butitappearstoberelatedtotheDirectorGeneral’smisunderstandingofthelengthofaninfectioncycle.Heseemedtothinkthatitwas14daysandthatheneededtwocyclestoseehowinfectionratesweredeveloping.HowevertheCovid-19infectioncycleisabout5-6days.The14dayspossiblyreferstothequarantineperiod,whichiscalculatedasthetimefor99percentofinfectiouscasestoemerge.Thereportingduringlevels4and3almostwillfullyseemedtoignoretherapidprogressthatwasbeingmade,andtherewasnoseriousanalysisofthedata.Thismayhavebeenmotivatedbyareluctancetoadmitthatthelevel4interventionswereanoverreaction.(Part5)CabinetwasmisledonthehumanrightsimplicationsofthemovestolevelthreeandfourInthelevel3and4decisionpaperitwasstatedthattherewerenohumanrightsimplications.Thiswasafalsestatement.PriortothelockdowndecisiontheDirectorGeneralofHealthhaddiscussedatsomelengththehumanrightsimplicationsofmuchlessintrusivemeasures,andinsubsequentpapersintrusionsonhumanrights

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wereconsideredtobeveryserious.ThestatementinthedecisionpaperappearstohavebeenanattempttorushthemeasuresthoughwithoutCabinetbeingalertedto,orremindedof,thehumanrightsimplicationsofwhattheyweredoing.Thelackofanyconsiderationofhumanrights,initself,raisesthepossibilitythatsomeofthemeasureswereunlawful.Itisnotenoughtosimplyassert,aftertheevent,thatallofthemeasureswerealldemonstrablynecessaryandproportionate.Ithastobedemonstratedforeachorder.(Partfour)DirectorGeneralmadeafalseandmisleadingstatementonhumanrightsimplicationsofthe‘stayathome’orderTosupporthisdecisiontoissuea‘stayathome’ordertheDirectorGeneralimpliedthatthiswassupportedbymodellingoftheimpactofvoluntaryandmandatorymeasures.Thiswasfalseandmisleading.Therewasnosuchmodelling.(Partseven)SomemeasuresmayhavebeenunlawfulbreachesofhumanrightsItcanbelawfultoderogatefromhumanrightsinahealthemergency,butonlyifthemeasuresaredemonstrablynecessaryandproportionate,andifeachmeasureisindividuallyassessedagainstthosetests.ItisnotavalidtesttosaythatbecauseCovid-19representsaseriousrisktohealth,allmeasurestakentocombatitarenecessarilylawful.Inourviewsomeofthemeasurestakendidnotmeetthenecessaryandproportionatetests.Thesearequitestrongtests.Measureshavetobe‘demonstrably’necessary.Iflessintrusiveoptionsareavailabletheyshouldbepreferred.Measureswithatrivialimpactontransmissionratesshouldnotbeimposed.Bansonswimmingandfishingfromtheshore,andsomerestrictionsonfuneralnumbersareamongsttheinstanceswherethenecessaryandproportionatetestswereprobablynotmet.(Partseven)HumanRightsCommissionignoredhumanrightsimplicationsofthelockdownTheonlyreferencestoconstraintsonfreedomsintheinitialreportbytheCommissionweretoconstraintsonprisoners’freedomsTheCommissionerdidhoweverreacttotherushedpassingoftheCovid-19PublicHealthEmergencyAct(Partseven)

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MaoriandPacificunlikelytobedisproportionatelyaffectedinanunrestrainedepidemicContrarytoclaimsmadeinresearchpapersbytheOtagoCovidResearchGroupandTePunahaMatatiki,MaoriandPacificwouldbeunlikelytohavedisproportionatelyhighdeathtollsinanunrestrainedcovid-19epidemic.ThereasonisthatthediseasedisproportionatelyaffectstheagedandasmallerproportionofMaoriandPacificareinthemostvulnerableagegroups.ThisshouldbalancetheincreasedriskduetothehigherrateofcomorbiditiesinPacificandMaori.(Partseven)ScopetoeasebordercontrolsatlowriskThereisscopetoeasesomebordercontrols,allowingentrytohighvaluevisitorsfromlower-riskcountries.Thereislimitedscopeto‘save’thetouristindustry,intheshortrun,butpartsoftheeducationexportindustrycanbesalvagedatverylowrisk.(Parteight)ModellingsetuptofavouraconservativeapproachtoquarantiningRecentmodellingofquarantiningbyTePunahaMatatiki,apparentlyatthebehestoftheMinistry,wassetuptofavourthe14dayquarantineperiodovershorteralternatives,whichweredescribedas‘ineffective’.Thiswasmisleading.Thetailofthe‘infectionness’distributionwastruncatedtomakethe14dayquarantineappearlessrisky,withonetransmissionthoughquarantineevery600days.Amoreconservativeassessmentmightbemorelikeoneeverythreetosixmonths.Thereisscopetoreducequarantinerequirementsforsomereturneesataverylowrisk.(Partnine)

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Partthree:AnalysisleadinguptothelockdowndecisionNotethatthisreviewisbasedthedocuments,madeavailableinthe‘proactive’releasesfrom8May2020,andonotherdocumentsmadeavailableontheCovid-19andtheMinistryofHealthwebsites.Assuch,itprovidesonlyapartialunderstandingoftheanalysisandthinkingthatwasgoingonbehindthescenes.However,itdoesgiveusasenseoftheinformationthatwasbeingpresentedtodecision-makers,andhowtheirdecision-makingwasbeingframed.AssumingthattheMinistryofHealthhadanincentivetodisclosethebestofitsanalysis,itisalsoprobablyareasonablerepresentationofthebreadthanddepthoftheirthinking.Therelevantdocumentsprovidedinthe‘proactive’releasesfrom8May2020arereviewedinchronologicalorderfocusingontheirrelevancetotheeventualdecisions.Manydonotprovidemuchinformationandaredescribedonlybriefly.Thedocumenttrailstartedon28January2020.28January2020ProposedAmendmenttotheHealthAct1956-NovelCoronavirusThepapersoughtapprovalformakingcovid-19anotifiabledisease.Thepaperprovidedabackgroundonthecoronavirusandmadethefollowingstatement:Todate,whilecasesofhumantohumantransmissionhavebeenreported,provisionalinformationsuggeststhediseasedoesnotappeartobespreadeasilybetweenpeople.Atthisstage,theMinistryofHealth’sIncidentManagementTeamhasassessedtheriskofthediseasebeingimportedtoNewZealandaslow.However,thesituationgloballyischangingdailyandmoreneedstobeknownaboutthestrainofthediseasetodeterminehowsignificantthepublichealthriskis.Inaddition,symptomscantakeuptotwoweeksfrominfectiontodevelop.Thestatementthatthediseasedidnotappeartobespreadeasilybetweenpeoplewasobviouslywrong.Itshouldhavebeenevident,frompubliclyavailableinformationatthattime,thatthediseasewasrelativelycontagious.Chinahadjustimposeditslockdown.Similarly,theassessmentthattheriskofbeingimportedintoNewZealandwaslowisdifficulttounderstand.Itwasreportedthatcaseshad

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appearedintheUS,Korea,Japan,Thailand,SingaporeandAustralia.ItwouldhaveonlytakenoneinfectedvisitorforittobeimportedintoNewZealand.Underthepaper’srecommendations,though,itwasstated:thatwhiletheriskofspreadtoNewZealandislow,thecurrentoutbreakinChinaofnovelcoronavirusiscapableofbeingtransmittedbetweenhumanbeingsandposesapotentiallyseriousrisktopublichealth;Whichsuggestsamoreseriousrisk.Overall,however,theassessmentmayhavereflected,andcontributedto,afeelingofcomplacency.Itwas‘overthere’,andnotreallyNewZealand’sproblem.Thiswasperhapsunderstandable.Itwasveryearlydaysinthedevelopmentofthepandemic,andtheMinistrywasstillfeelingitsway.ThereisadescriptionoftheMinistry’sresponsestothepotentialrisks,whichbeganon6JanuarywithadvicetoDHBs.Healthadvicecardswerebeingmadeavailableatborders.TheGovernment’sInteragencyPandemicGroupconvenedon24January.AgreementtomakeCovid-19anotifiablediseasewasobtained.Therewasabriefassessmentofhumanrightsimplications.TherearehumanrightsimplicationsarisingfromthispaperalthoughnothinginitisinconsistentwiththeNewZealandBillofRightsAct1990duetothelimitsontherightbeingreasonablelimitsjustifiedundersection5oftheAct.NothinginthepaperisinconsistentwiththeHumanRightsAct1993.Therewasnodiscussionofwhathumanrightscouldbelimitedbywhatpotentialactions,andwhytheseactionswouldbe‘reasonable’.

1February2020NovelCoronavirus:UpdateandEnhancedBorderMeasuresThiswasaminuteofCabinetdecisionstoenhancebordermeasures.Thepaperwasnotreleased.2February2020PhasesoftheNewZealandInfluenzapandemicplanasappliedtothe2019covidresponse

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Thisisatwopagespreadsheetthatsetsoutepidemicresponsephasesandassociatedactions.Thephaseswere:

• Planforit;• Keepitout;• Stampitout;• Manageit.

Inthe‘stampitout’phase,whichstartswhenthefirstcaseisidentifiedandtherearethenclustersofcases,theactionsare:Thoroughcontacttracing;preparebusinesscontinuityplans,bordersurveillence,monitorhealthlinecalls,internationalreportingandmonitoringhealthlinecalls.Inthe‘manageIt’phase,whenthereis:‘increasedandsubstantialtransmissioninthegeneralcommunity’Theresponseswere:considerissuingepidemicnotice;activaterecoveryplans;ensurestaffwelfareandmovefromcontacttracingtogeneralwelfare.Therewasnosuggestionthathighlyintrusiveandcostlymeasurescouldberequiredtomanageanoutbreak.The‘plan’pointedtoacriticalweaknessintheMinistry’sthinkingbuiltaroundtheirinfluenzaepidemicplan.Inaninfluenzaepidemicthevirusspreadsveryquickly,andthereislittleroleforcontacttracingoncethevirustakessufficientholdinthe‘manageit’phase.Covid-19,ontheotherhand,movesmoreslowlyandcontacttracingcancontinuetobeeffective,alongsidesocialdistancingmeasures,asthenumbersgrow.Covid-19requiresadifferentperspectiveontheroleofcontacttracingandtheresourcesrequiredtomakeiteffective.Itshouldnotberegardedasjustalowresourcetripwire,tobeabandonedsoonintothe‘manage’itphase.Ratheritrequiressubstantialresourcestobepre-positionedtogiveitasignificantongoingrole.ThesuccessfulAsiancountriesrealisedthisearlyon.TheTaiwanese,HongKongandKoreanstoriesofthesuccessfulimplementationoflargescalecontacttracingresponsesarewellknown.Cambodiawasanother,littleknown,successstory.Itputtogetheracontacttracingforceof2,900earlyon.Theyhad191casesandnodeathsbytheendofJuly.IcelandstartingalmostfromscratchattheendofFebruaryputaformidable,oldfashionedcontacttracingsystemtogether.Incombinationwithvoluntarysocialdistancingandafewrulesitbroughtthevirusundercontrol.Iceland

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isbetterknownforitsearlywidespreadtesting.Thatonlyhelpedalittle.Itwasthecontacttracingthatdidthebulkofthework.Toillustratetheongoingroleofcontacttracing,supposetheNewZealandbasicreproductionrate(R)is2.0(oneinfectiongeneratestwomoreinfectionsintheabsenceofbehaviouralchanges),whichwillresultinabout70percentofthepopulationbeinginfectedinthreemonthsorso.TobringtheepidemicundercontrolRmustbereducedtobelow1.NowassumethattheGovernmentwishestogetRdownto0.7.Thistargetwouldallowingsomemarginforuncertaintyandwouldmakereasonablyrapidprogresstowardsaneliminationtarget(ifthatwasthegoal).TheGovernmentcanrelyonvoluntarychangesinsocialdistancingandrelativelyunintrusive(comparedtoafulllockdown)socialdistancingtools.Assumethesewillonlyreducecontactsby40percent,reducingtheeffectiveRto1.2.Casenumberswillsteadilygrow.Addinganeffectiveandtimelytesting,contacttracingandisolationsystemcouldreducethereproductionrateby,say,40percenttobringthereproductionratedowntoabout0.7.However,thisassumesthatthecontacttracingresourcesaresufficientandeffective.Ifthereareonlyresourcestotrace25casesand50appear,thentheeffectivenessofthetracingsystemimmediatelyfallsbyhalf.Inthenexttransmissioncycle(whichcouldbeabout6days),therearemorecases,theeffectivenessfallsfurther,andsooncontacttracinghaslittleimpactontheepidemictrajectory.ItthenbecomesnecessarytoimposemorerestrictionstogetRdownto0.7.3February20202019NovelCoronavirusResponseUpdateThefocuswasprimarilyonborderclosureissues.TheOfficeoftheScientificAdvisortothePrimeMinister,andtheMinistryweretoprovidetoweeklyupdatesonepidemiologyoftheepidemictoMinisterswiththepowertoact. Theviruswasdescribedashavingamortalityrateof2-3percent,with20percentofthoseaffectedsufferingamajorillness.ThiswasanearlyestimatebasedonChineseexperience.Laterestimatesintheliteraturepointedtomortalityratesbetween0.5-1percent,buttherewasnoupdateofthisinformationinlaterreports.

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4February2020ResponseissuesupdateThispaperwasmainlyconcernedwithissuesarisingfromborderrestrictionsonChinaaffectingthetourismandeducationexportsectors.4February2020HealthadviceoncheckingpeopleareselfisolatingThiswasatechnicalpaperfocusingonselfisolationrequirements.5February2020UpdateThiswasmainlyconcernedwithsupplychainissuesrelatingtotheChineselockdown.5February2020HealthadviceonprotocolsfollowingfirstcaseconfirmationofnovelcoronavirusThiswasapreparenessdocumentmainlydirectedtomanagingthepublicrelationsaspectofjustthesingleinitialevent.Itdidnotaddresssubsequentactions.10February2020CabinetminuteonupdateNosubstantiveinformation.17February2020CabinetminuteonupdateNonewrelevantinformation.5March2020TabletopexerciseThispaperreportedonsomescenarioanalysistotestthecapabilityofhandlingclusteroutbreaksinaresthome,aMarae,andanAucklandPacificcommunity.Themainfocuswasonconductingtheseexercisessensitivelyandappropriately.The

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sessionwasassessedasproductiveandfurtherexercisescoveringarangeofissueswereplanned.Documentsonthoseexerciseswerenotreleased,andthereisnoevidencethattheworkwasdonebeforethemovetolevel4.The‘tabletop’exerciseappearstohavebeentheonlyanalysisrelatingtotesting,tracingandisolationcapabilities.Thereappearstohavebeennoassessmentoftheadequacyofcontacttracingandisolationcapacity.Itstillappearedthatofficialsregardedwidespreadtransmissionasinevitable,withtracingscrappedoncetheepidemicgotunderway.9March2020RequesttomakeCOVID-19aQuarantinableDiseaseundertheHealthAct1956Thequarantinablediseasedesignationwouldonlyaffectincomingpassengersfromoverseas.Itisstatedthata‘risk-based’approachwastakenanditwasclaimedthatthebenefitsofthemeasureoutweighthecosts.WhiletherearelimitedcasesinNewZealandandthepriorityremains‘keepitout’,theadditionalhealthriskofdomesticimportationofthevirusoutweighstheriskofdisruptionatdisembarking.Theriskofdisruptioncanbemitigatedtosomeextentbyborderagenciesworkingtogetherwithhealthofficials,asnow,toensureeaseofimplementationandclarityofcommunicationtoaffectedgroupssuchasairlinesandairports.Thereisnoevidencethattherewasanygenuinerisk-basedassessment.Itappearsthattheclaimthatadditionalhealthrisksoutweighedthecostswasjustanassertion.Aconvincingcasecouldhavebeenmade,fairlyreadily,butitappearsthatthecapacityorinclinationtodotheanalysiswaslacking.TheMinistrywasreleasedbyTreasuryfromtherequirementtoprovideanimpactanalysis,tobackuptheirassessmentthatthebenefitsoutweightedthecosts.Asnotedintheintroduction,impactanalyseswereabandonedacrosstheboardon20March2020.Noimpactanalysishasbeenprovided,andonthefaceofit,noneoftheexistinggroundsforexemptionsfromtheregulatoryimpactanalysisrequirementsapplybecausethismeasurecouldhavesignificanteconomicandsocialimpacts.RatherthantriggeringtheSupplementaryAnalysisRequirementsatthistime,theRegulatoryQualityTeam(Treasury)recommendsthattheongoingmonitoringofthecostsandbenefitsoftheuseofthesepowersispartoftheimplementationofthisproposal.Theongoingmonitoringdoesnotappeartohavebeendone.Asweshallseethereisnorecordofanyimpactassessments,ormoreformalcostbenefitanalysesof

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measuressubsequentlytaken.Costsandbenefitswereneverseriouslythoughtabout,letalonemonitoredorassessed.Inourviewthereleasefromtheimpactassessmentrequirementwasamistake.Itreleasedofficialsfromanyobligationtothinkaboutwhattheyweredoinginastructuredanddisciplinedmanner.Iftheywereawarethattheyweresubjecttotheimpactassessmentdisciplinethenwemighthaveseensomethingbetterthanwhatwasawoefullyinadequateanalyticalperformance.HumanRightsImplicationsTheproposalsinthispaperhaveimplicationsundertheNewZealandBillofRightsAct1990.:TheMinisterattestedthattheintrusionswerereasonableandproportionate.Havingregardtotheriskstopublichealthandsafetyfromanypotentialoutbreak,IamsatisfiedthatinclusionofCOVID-19andcoronaviruscausingsevererespiratoryillnessasquarantinablediseasesisreasonableinthiscase.ThelimitationsonrightsarejustifiedinlightofthepublichealthriskandareproportionategiventhepotentiallikelihoodandconsequencesofthespreadofCOVID-19inanyoutbreakinNewZealand.ThereisnorecordthattheMinisterwasmadeawareofanyassessmentoftheriskstopublichealthandsafety.

10March2020CriticalissuesAdhocCabinetCommitteepaperTheoverallmessagewasthatallwasinhand.Borderrestrictions,forChina,hadbeeninplacesince2February.Contacttracingandisolationwere‘intensifying’.However,therewasawarning.Managingandslowingthespreadwillrequiremakingdecisionsonamenuofinterventions-includingcancellingmassmeetings;closingschools,restrictingmovements.Butnothingevenapproachingahardlockdownwassuggested,orevenalludedto.Thereisnoevidencethatmuchworkwasbeingdoneonthesemeasures.Therewasinformationonwhatagenciesweredoingandwhatresourcesweredeployed.Theresourcesdevotedtotheresponselookedimpressive.Asummaryofthestaffnumbersinvolvedispresentedintable2.Thetotalisabout480.

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Table1:Covid-19relatedstaffnumbersAgency StaffnumbersinvolvedBorder 100Health 70intheresponseteam.Todoubleinnexttwoweeks.30-50

moreinsupportNEMA 29MBIE 65

SimilarnumberfromimmigrationTreasury 3511March2020PublichealthmodellingandscenariosThiswasthefirstsignofanyanalysis.Itwasatwopage,hardtoread,dashboardstyleschematicoverviewofarangeofinformationincludingthefollowing:

• Thereisnoevidenceoftransmissionoccurringinthecommunity.Nooutbreakshaveoccurredinparticularlocations,suchasahospital,agedcarefacility,acorrectionalfacility,oracommunityevent.

• BasedonthecurrentsituationoutsideofChinaandavailableevidence,ESRassessesthelikelihoodofwidespreadoutbreaksinNewZealandtobelow.

ESRisaCrownresearchentityspecialisinginthescience‘relatingtopeopleandcommunities’.Theirreport,iftherewasone,hasnotbeendisclosed,soitisnotclearhowtheycametotheconclusionthattherewasalowriskofwidespreadoutbreaksinNewZealand.Theirassessmentwasobviouslywrong.TheESRcontinuedtoprovidereportstotheMinistryposttheimpositionofthelockdown.Wehaveexaminedthesereportsinpartsix.Togetaheadofthatstory,theywereverycautiousandmostlyvacuous.InformationwasprovidedonUKandAustralianworstcasescenarios.Someofthenumberswerefrightening,butItwasnotexplainedthatthesewereunrestrainedepidemicprojections,assumingnogovernmentactionsatall,andnochangesinpopulationbehaviour.Norwasanyapparentattemptmadetoassessthereasonablenessoftheassessmentsdrivingtheresults.Thesourcesoftheseprojectionswerenotgiven.Theinformationprovidedwas:UK“reasonableworstcase”scenario:

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• Infections:80%ofpopulation• 20%ofworkforceoffsickatpeakofepidemic

Twopiecesofinformationwereredacted.WesuspectthattheinformationcamefromUKauthoritieswho,fromourreadingoftheUKSAGE(ScienticAdvisoryGroupsforEmergencies)minutes,appearedtobeheavilyinfluencedbythenownotoriousLondonImperialCollegemodelling,whichwediscussinpartsix.Australia“severe”scenario:

• Infections:70%ofpopulationThisassumesanunrestrainedepidemic.

• Hospitalisation:14%ofinfected;• ICU:5%ofinfected• Casefatalityrate:3%ofinfected

Thisdeathratewasamultipleofthemostlikelyoutcomeofaround0.5-1.0percent,givenwhatwasknownatthetimeaboutAustraliandemographics.

• Outbreaklength:10months¬40%ofworkforceaffectedbyillnessorcaringforsickatpeak.The40percentfigurewasanexaggeratednumberandnotconsistentwiththeoutbreaklengthassessment.

Notably,noNewZealandassessmentwasprovided.Ontheeconomiceffectsthereisaschematicandqualitativerepresentation(figure1below)oftheNewZealandeconomyupto2023,withdifferentworldwideandNewZealandpandemicoutcomes.TheworstoutcomeforNewZealandisasuccessfulkeepitout,stampitoutcampaign(thegreenline),whichinvolvesNewZealandisolatingitselffromtheworlduntilthepopulationisvaccinated,whiletherestoftheworldsuffersaglobalpandemic.ItwasconcludedthatNewZealand’songoingeconomicisolationwouldbemoreeconomicallydamagingthanawidespreadNewZealandepidemic.Thisoutcomeisnotbackedupbyanydetailedanalysis,butitsuggeststhatatleastsomeofficialswerethinkingthatthedirecteconomicconsequencesofaNewZealandpandemicwerenotthatsevere,andthatlongtermisolationwouldhavemoreseriouseconomicconsequences.ResponsestrategyThesecondpagerevealssomethingaboutthestrategicthinking,whichiscapturedbythediagraminfiguretwo.Theobjectivewastoensurethathealthsystemcapacitywasnotexceeded.Butthatwasfarasitwent.Therewasnoattempttoquantifywhatthehealthsystemcapacitywas,andwhatthatmeantintermsofthe

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numberofcasesadaythatcouldbehandled.Diditmean,forexample,thatwecouldhandleapeakof500casesaday,or10,000?Figureone:Officials’Economicscenarios

Figuretwo:Schematicrepresentationofhealthcarebasedstrategy

Thekeypointsofthestrategyaredescribedas:

1. Delaythearrival2. Flattenthepeakandthecurve

Thebestwaytosupportthehealthcaresystemandtheeconomyistospreadtheload.Thisissummedupwiththeslogan.Thismeansgoearly,gohard,staythecourse

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Whichisprettyvacuouswithoutanyinformationorunderstandingofwhat‘gohard’means.Butitappearsthatatthispoint’gohard’didn’tmeanveryhard.Withtheappearanceofmultipleclustersthesuggestedactionswereto:

• encourageemployerstoconsideralternativewaysofworking• Promotesocialdistancingandconsiderrestrictingmassgatheringsandclosing

publicvenuesinaffectedareas• Considerfeasibilityofplacingrestrictionsonaffectedareas• Consideractivatingcommunity-basedassessmentcentresasappropriate

Andwiththestartofcommunityorsustainedtransmission:

• Consideraddedlegislativemeasurese.gspecialpowersundertheHealthActandEpidemicpreparednessacte.gcanrequirecancellationofmassevents,workplaceclosures,imposeinternaltravelrestrictions

• Considerimposingastateofemergency• Reviewtravelrestrictions• Consideradvisingpeopleathighrisktostayathome• Activatecommunitybasedassessmentcentres• DHBdeferelectiveprocedures

Therewasnomentionofacrosstheboard‘stayathome’requirementsoranycluegivenastotheextentoftheworkplaceclosures.Withsustainedandintensivetransmissionpossiblemeasureswere:

• Removetravelrestrictions,

Presumablybecausetheywerenolongerservingapurpose.

• Majorprioritisationofhealthservices• Promotecareinthecommunity.Noteamajorpartofthecommunitylikelytobe

affectedbyillnessorbycaringathome.Thestrategywasmainlytolivewiththeconsequences,intermsofcasenumbers,buttherewasnoquantificationoftheeffectsintermsofdeathsandpressureonhealthresources.Itisdifficulttounderstandwhatthelargenumberofpublicservantsdevotedtothecovid-19responseweredoingifthiscriticalinformationwasnotavailable.

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11March2020PublicInformationThisisaninformationpiecetotheadhocCabinetCommitteepieceonthepubliceducationmeasuresthatwereunderway.

11March2020AllofGovernmentsystemThiswasashortinformationpieceonhowtheinvolvedagenciesfittedtogetherandwhowasdoingwhat.March122020COVID-19–AdviceonMassGatheringsUptothispointtheMinistryhadbeenprovidingadviceonmassgatherings.Norestrictionswererecommendedinthispaper.Itwasnotedhowever:Whentransmissionbecomessustainedinthecommunity,andthepeakoftheepidemicisstillsomeweeksaway,cancellationofpublicgatheringshouldbeactivelyconsidered.Datafromseasonalandpandemicinfluenzamodelsindicatethatduringthemitigationphase,cancellationsofpublicgatheringsbeforethepeakofepidemicsorpandemicsmayreducevirustransmission.Othersocialdistancingmeasuresmayinclude:a.closureofschools/universitiesb.stoppingpublicgatherings(suchaspublicgatherings,suchassportevents,concerts,religiousevents,largesocialevents(charityfunctions,Universityhalls)andconferences)c.closingplacesofworkwhereinfectionhasbeenidentifiedd.mobilityrestrictionsintoandoutoftownsandcities.Thiswasareiterationofthestrategyoutlineinthe11Marchpaper.16March2020COVID-19ResponsetoMassGatheringsThispapersoughttoprovideclarificationtoorganisersofmassgatheringsonwhateventsshouldandshouldnotbecancelled.Theresponseobjectiveswerealsoarticulated.

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OurpublichealthstrategyseekstodelaytheonsetofcommunitytransmissionofCOVID-19,andtolimittheinfection’sspreadifcommunitytransmissionoccurshere.Themainsignificanceofthispaperwasanextensivediscussionofhumanrightsimplicationsofpossiblemeasures.Thisadviceispresentedinpartseven.March162020Fundingofcovid-19responseMoneywasnoobjectatthispoint.$40millionwasallocatedtocontacttracing.March172020Systemsarchitecture(HealthSystempreparedness)Thisisathreepagesummaryoverview.Oneofthethetake-outsfromthisdocumentwasthattherewaslittleenthusaismforlong-termborderrestrictionsbecauseoftheireconomiccosts.Anacrosstheboardborderclosurewasmentioned,butthiswasjustinpassing.Therewasafocusonhealthsystemcapacity.Testingcapacitywasat700adayandwouldIncreaseto1500adayby22March.Contacttracingcapacitywasestimatedat10activecases,scalingupto50.Itisnotsurewhethertheymeantthatthecapacitywas10newcasesaday,orwhethertheycouldhandlejust10casesintotal.Eitherwaytherewaslittlecapacitytomanageaseriousupsurgeincases.Thesecondpartofthedocumentsetoutthestrategy.Thiswaslabelled‘suppression’asopposedtothe‘mitigation’alternative.Thepreferredsuppressionstrategywascapturedbytheslogans:OurstrategyisfocusingonkeepingCovid-19out,stampingitoutandslowingitdown.AndOurstrategyistopreventwidespreadoutbreaks.The‘analysis’wassupportedbyafigureillustratingtwoepidemiccurvesshowninfigurethree.

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Figurethree:Epidemiccurves

Theorangecurveisdescribedasanunrestrictedepidemicandthebluecurveisa‘mitigation’strategycurve.Thesuppressionstrategyisthewigglygreenline.Thestrategyrevolvesaroundborderrestrictions,intensetesting,aggressivecontacttracingandstringentselfisolationandquarantine.Physicaldistancingwillalsoberequiredtovaryingdegreesasweproceedalongthispath.Thedistinctivefeatureisthatsuppressionallowsayo-yo-inginthestrengthofpolicyinterventions.Thestringentisolationandquarantinereferstoindividuals,nottoamassquarantine.Shouldoutbreaksoccurasuppressionstrategyaimstoreverseepidemicgrowththroughtougherpublichealthmeasuresegbystrengtheningphysicaldistancing.Andwhencasenumbersfalltherestrictionscanbeeasedslighly.Thebasicideaistokeepcasesfromexceedingthedottedlinewhichisdrawnatabout80,000cases.Wearenottoldaboutthetimeperiodthe80,000refersto.Isitperday,orpermonth?Asthetimeperiodsonthehorizontalaxisareinsegmentsof10days,the80,000probablyreferstoatendayperiod,inwhichcasethedailytargetwouldbe8,000casesaday.Itisnotclearwhethertheyhadthisnumberinmind,orwhethertheyhadthoughtaboutthelimitveryclearly.Andthisiswhatwassaidonthecostsandbenefitsofthestrategy.AsupressionpolicydoesinvolvesignificanteconomicandsocialdisruptionbutmanyliveswillbesavedandmorepeoplewillremainwelltooperatethehealthsystemandtheeconomyThisapproachisdistinctfromamitigationpolicywhichinvolvesfocussingonthesizeofthepeaki.eamovefromthebluetotheorangeline.

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Exceptthisisnotwhatthebluelinewasactuallyshowing.Thefigure,reproducedbelow,wastakenfromamodellingreportfromtheOtagoCovidResponseGroup(OCEG).Itshowstheimpactofdifferentassumptionsaboutthereproductionrategeneratedbyanonlinecalculator,Covidsim.Thelowerbluelinejustshowsthatalowerreproductionratehasalowerpeakcaseratewithoutanymitigation.Itisnotamitigationcurve.Asdiscussedinour‘ALookBehindtheHeadlines’report,Covidsimwasnotsuitableforassessingpolicyoptions,becauseitdidnotallowthesettingstobeadjustedovertime.Thesolutionwastobuildabettermodel.Itmighthavetakenacoupleofdays.Butofficialsdidnotdothat.Theirresponsewastodrawinawigglygreenline.Andthatwasthesumoftheiranalyticaleffort.The‘plan’,initsentirety,wasto‘dosomepolicyinterventionstuff’andifthatworked,do‘abitlessofsomestuff’andthen‘dosomemorestuff’oncethecasenumbersincreaseagain,andsoonuntilavaccinecomestotherescue.Figure3:OCRGepidemiccurves

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18March2020CVDPaper:COVID-19:AllofGovernmentPlanforMaximisingCompliancewithSelf-IsolationThispapersoughtagreementtoanapproachtomaximisingcompliancewithselfisolation.Thefocuswasonthepeoplerequiredtoisolate,notonthewholecommunity.Anenforcementcapacitywasrequiredfor:‘thosefewpeople;whochosenottocomplywithself-isolationrequirements’Wherepeoplecannotmanagetoisolateathome,therewillneedtobemoregovernmentinterventiontomanageandmonitortheirisolation,includingisolationfaciliiesatscale.Thisisintendedforthemostvulnerableandhigherriskpeople.Inparticularthosewhohavedirectcontactwithaconfirmedcaseand/orhaveneedsorhaveneedsorcircmstnces,thatmeansthatself-isolationisnotanoption.Thefocuswasonvoluntarycompliance–withisolationnotbeingseenassomethingtobefearedandavoided.Therewasareporton50policevisitson17March.Ofthe50visits,twopeoplewerenotathome,andonepersonwasnon-compliant.Itisnotclearwhetherthoseathomewerecompliantornot,butthedatadoesnotpaintapictureofwidespreadnon-compliance.Therewasadiscussionof‘planstodevelopplans’forlargescaleisolationandquarantiningfacilities.18March2020NotingpapertoadhocCabinetcommitteeCOVID-19ContactTracingThispaperprovidedanupdateonworkunderwaytoscaleupcapacityforcontacttracing,andoutlinedthenewmodelbeingexploredforestablishingacentralcontacttracingcoordinationhub.Thefollowingcommentstillsuggestsalackofurgencyaboutthescaleofthetestingrequiredbeyondtheinitialphase.Contracttracingisacriticaltoolinmanaginginfectiousdiseasebreakoutsandpandemics.Themainpurposeofcontacttracingistosupportthe‘StampItOut’pandemicresponsephase.TheWorldHealthOrganizationhasrecommendedthatthedurationofcontacttracingbeextendedforlongeroverthecourseoftheCOVID-19outbreak.TheproblemhereisthatMinistryhadnoanalyticalframeworkforassessingmodellingtracingcapacity.Iftheyhad,theissueoftestingcapacityandperformancewouldhavebecomeevidentmuchearlier.Intheevent,thecontacttracingcapacity,combinedwiththemoderatesocialdistancingmeasuresandthepublic’shygieneandvoluntarysocialdistancingturnedouttowork,butthatwasnotknownatthe

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time.TheMinistry’sperceivedinadequaciesandlackofurgencyoncontacttracingopenedthedoortotheproponentsofextremelockdownmeasures.March182020DecisionPaper:COVID-19MassGatheringsThispaperprovidedfurtherguidanceonmassgatherings. March212020MaoriresponsepackageThisprovidedinformationonsomefundingfromtheMOFforvariousMaoriCovid-19spendinginitiatives.Movingtolevel220March2020CurrentstatetrajectoriesandinterventionsSignedbyBrookBarringtonChiefExecutive,DepartmentofPrimeMinisterandCabinet,JohnOmblerCovid-19AllofGovernmentControllerThispaperwasthealertlevel2decisiondocument.Itstartedwithareviewofthecurrentsituation:

• NewZealandisgoinghardandgoingearly.On19MarchborderrestrictionsweremaximisedtolessentheriskofNewZealandimportingcasesofCOVID-19.Wearerampinguptesting,contacttracingandself-isolationrequirements.

• Allconfirmedcasesareimportedorclosecontactswiththem.• WedonotknowwhethercommunitytransmissionisoccurringinNewZealand.

Epidemiologistsconsideritlikelythereissome‘silent’transmissionoccurringinthecommunity.However,wehavenothadanyseriouslyillpatientswithCOVID-19pneumonia,whichgenerallydevelopsover2-3weeksfrominfection.

Itthenadoptedamorestridenttone.Thenext2-3weeksiscriticaltoNewZealand’sCOVID-19response.Ourabilitytostampitoutdependsonrampinguptestingtoidentifycases,scalingupcontacttracingandenforcingself-isolation.Weareactingrapidlyonallthreefronts.

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Ifcommunitytransmissionbecomeswidespreadwewillhavelosttheopportunitygainedbyclosingtheborder.Internationaladviceisthatforeachcasewemaybemissingnine.Evenwithnofurtherimportedcases,ifwehavemissedearlycasestransmittingsilently,wecouldsuddenlyfacean exponentialriseincasesashashappenedelsewhere.Tominimisethelikelihoodofthisoccurring,decisiveactionisneededimmediately. ThepublichealthofNewZealandersisthetoppriority.Maintainingpublichealthmayrequireustomoveupthealertlevels.Theeconomicandsocialimplicationsofmovingupthealertsystemareverysignificant.Theframeworksetstheseoutatahigh-level. Wefaceastarkchoice.IranandItalyshowdramaticallywhathappenswhenactionistakentoolatePossibletradjectoriesofnewcasesweresetoutinthefollowingfigure.Doinglessresultedin500casesadaybyApril17;stayingatlevelonewouldseeabout120;andlevel2wouldreducethisto50-60Itisnotclearhowthesenumberswerecalculated.Theycouldhavebeenjustmade-up,orgeneratedbyasimpleepidemiccalculator.Thelownumbers,thelackofdetail,andthelackofanyexplanationofwhythealertlevel2interventionswereapparentlysoeffectivemaynothaveinspiredconfidence.Otherprojections,andinparticulartheRodneyJonesestimates,mayhaveappearedtobemoresophisticatedandconvincing.Figurefour:casetrajectories

TheonlysignofanyanalysisinthepaperwasasetofgraphscomparingNewZealand’sexperiencefromthedateofthefirstcasewiththosefromaselectionofcountries.TheAustralianexampleisshownbelow.Thepoint,wepresume,wasto

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illustratethatNewZealandcasenumberscouldgrow.Beyondthat,thesesortsofcomparisonsarenotverymeaningful,astheydependonhappenstanceonthearrivalofoverseascasesandtheprogressofthevirusinoverseascountrieswhichwillimpactonthenumberofimportedcases.Forexample,NewZealand’sepidemicappearstobedevelopingmorerapidlythanAustralia’s,intermsofthenumberssubsequenttothefirstcase,butthatisonlybecauseAustraliajusthappenedtohaveacoupleofearlycasesatthebeginningofFebruary,whichdidn’tappeartoresultincommunitytranmission.Itsupsurgeinimportedcasesdidn’treallystartuntilwellintoMarch,nottoofaraheadoftheNewZealandimportedcaseupsurge.Butthisisnotreadilyapparentfromthefigure,anditlookslikeNewZealandcasesaregrowingmorevigourouslythanAustralia’satthesametimeintheprogressionofcasenumbers.Ournewcasesatday22wasabout10,andAustralia’swas0.Thisreportingdatawasmisleadingandmayhavespookedsomedecision-makers.Figurefive:NewcasecomparisonUK

Figuresix:NewcasecomparisonsAustralia

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Figureseven:NewcasesadaySingapore,TaiwanandHongKong

InterventionsIntheinterventionsectiontherightthingsweresaid.EvidencefrompublichealthshowsthatweneedasuiteofinterventionsappiedtogetherifwearetocontainCovid-19.Eachsupportlevelthereforcontainsanintegratedsetofmeasureswhichbuildontheactionsofthelevelbelow.ItwasrecommendedthatNewZealandmovecompletelytolevel2andremainthereforupto30daysinitially(ouremphasis).Itwasalsorecommendedthatschoolsmakethelastweekoftermteacheronlydaystoprepareforteachingremotely.Inpracticaltermsthefollowingwasbeingdone:GuidanceisbeingwrittenforallofthemeasuresinLevel2.Itisalsotimetobegindetailingtheactionsweareplanningforlevel3.Wemustofferthepublicassuranceonwhentheycanexpectfurthermeasures.Thisappearstobeanadmissionthattherehadbeennodetailedplanningforlevel3andamovementtolevel4hadnotevenbeenthoughtabout. Theappendixsetoutthetriggersformovingtohigheralertlevels;themeasuresateachlevel;andthesocialandeconomicconsequences.Thesearesetoutintheirentirety.

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Level3Triggers

• Diseaseincreasinglydifficulttocontain• CommunitytransmissionoccurringOR• Multipleclustersbreakout

Keymeasures

• 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 Comparedtothelevel3thatwaseventuallyadopted(onthewaydownfromlevel4)thiswasarelativelysoftlevel3.Itdidnot,forexample,closeshops,barsandrestaurantscompletely.Nevertheless,theimpactswereseenassubstantial.Impactondailylife

• Severedisruptiontotheeconomy• Socialinteractionsseverelylimited• Travelmaybesignifciantlyaffected• Significantworkandschoolabsentism• Optionsforchildrenofessentialworkers

Level4Triggers

• Diseaseisnotcontained• Sustainedandintensivetransmission

Keymeasures

• Stateoflocalornationalemergencydeclared• Populationinstructedtostayathome• Domestictravelrestrictionsimposeddependingonareasofoutbreakandrisk• Businessesclosedexceptforessentialservices(supermarkets,pharmacies,clinics)

andlifelineutilities• Rationingofsuppliesandrequisitioningoffacilitiespossible• Publictransportseverelylimited• Majorreprioritisationofhealthcareservices

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• Triagingofpatientsto“COVIDclinics,orhome,whootherwisewouldbehospitalised Impactondailylife

• Extremeeconomicandsocialdisruptionanddislocation• Significantnumberofdeaths• travelmovementseverelyrestricted• Optionsneededforchildrenofessentialworkers

Therewasnosignallingthatthesemeasurescouldhavelegalandhumanrightsimplications.

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Partfour:Alertlevels3and4decisionpaper23March2020Covid-19:Movingtoalertlevels3and4Theargumentsandsupportinganalysisformovingtoalertlevels3and4aresetoutinthedocumentCovid-19:Movingtoalertlevels3and4dated23March2020,threedaysafterthedecisiontomovetoalertlevel2,andthedecisiontostayatthatlevelforupto30daysThepaperwaspreparedbytheAll-of-GovernmentCOVID-19StrategyandPolicyGroup.Inthispartwesetoutalloftherelevantargumentsforthealertlevelmoves,commentingasweproceed.Thestoryturnsouttobeconsistentwiththewidespreadunderstandingofwhathappened.ThePrimeMinisterviewedacasenumbercurveshowingasteepincreaseincasesnumbers,gothypedup,andwithasmallcircleofsupporters,pushedthroughanew‘gohard,goearly’response-thelockdown.Thetestwastobethefirstevidenceofcommunitytransmission.Therewasthenamadscrambletofigureoutwhatalockdownmeantandhowtodoit,andtorushoutsomethingthatmightpassforadecisionpaper.Thecontentofthepaperwasasfollows:TheNewZealand’sapproachtorespondingtoCOVID-19TheCOVID-19pandemichasdramaticallychangedtheworldandNewZealandinaveryshorttime.Theworldisfacingapublichealthemergencyandaneconomiccrisis–adoublecrisisunprecedentedfor100years.OurgeographicaldistancedoesnotprotectNewZealandfromthiscrisis.Theworldwas,andis,facinganeconomiccrisisbutasignificantpartofthatcrisiswasgeneratedbyactionstakenbygovernmentstodefeatthevirusratherthanthepropertiesofthevirusitself.COVID-19posesauniquethreattohumansandourwayoflife.Wehavenobaselevelofimmunityashumanshavenotpreviouslybeenexposedtothenovelcoronavirus.Thereisnovaccineandnoproveneffectivetreatments.Becauseofthis,therisktothepublichealthofNewZealandersisveryhighandislikelytoremainsountilscientistshavefoundavaccineoreffectivetreatments.Whilescientificknowledgeisincreasingdaybyday,vaccinesandtreatmentsmaybe12-18monthsawayThereisnodiscussionhereofthenatureandextentofhealthrisksposedbythevirus.Itisoverwhelminglyarisktotheaged.85-90percentofdeathshavebeenin

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the70+agegroups,anddisproportionatelyinthosewithexistingmedicalconditions.Thereisamuchsmallerrisktotheeconomicallyactive,andsotherewouldnotbeahugeimpactonthefunctioningoftheeconomy,beyondamonthorsoatthepeakoftheepidemic,evenifitwereallowedtoruncompletelyunimpeded.Inthatrespectitcouldbelessdisruptivethantheinfluenzaepidemicof1918.Inits16MarchreporttheOtagoCovidReasearchGroupestimateddeathswouldbebetween9,000and11,000iftheviruswasallowedtoproceedunhindered.However,thisdidnotcontainanestimateoftheincreaseinthenumberofdeathsifthehealthsystemwereoverwhelmed.Deathsamongsttheeconomicallyactivecouldbearound1500,butonlyifpeopletooknomeasurestoprotectthemselvesandtherewerenosocialdistancingmeasuresatall.Therewasnoassessmenthereoranywhereelseoftheburdenofthedisease,whichcanbemeasuredintermsofyearsoflifelost(YLL).YLLisametricwidelyusedbyhealthprofessionaleconomiststoassesstherelativeseriousnessofadisease,toassistinmakingdecsionsabouttheamountofresourcesthatshouldbedevotedtocombattingit.OnaYLLbasisalargelyunrestrainedCovid-19epidemicisprobablyonlyabout10-20percentasseriousasthe1918fluepidemic.COVID-19israpidlyspreadingaroundtheworld,particularlyinEuropeandtheUnitedStates.Todate,EastAsiancountriesandterritorieshavebeenmosteffectiveatcontainingCOVID-19throughaggressiveandeffectivecontainmentmeasures.NewZealandneedstotakesimilar,andurgent,actionifwearetoavoidexponentialgrowthrateswhichquicklyleadstoanoverwhelmedhealthsystemandhighercasefatalityrates.OnlyChina,ofthesuccessfulEastAsiancountries,resortedtothe‘fulllockdown’,andthatinarestrictedarea.SeveraloftheEastAsiancountriesthattookdecisiveactionputaheavyweightontesting,contacttracingandisolation,togetherwithmoderatesocialdistancingmeasures.The“flatteningthecurve”approachwouldstilloverwhelmourhealthsystemandcouldleadtohighfatalityratesaswearewitnessinginItaly.Wehavethereforeadopteda“suppression”strategywhichfocusesonkeepingCOVID-19out,stampingitoutandslowingitdown.Ouraimistopreventwidespreadoutbreaks.Shouldoutbreaksoccur,asuppressionstrategyaimstoreverseepidemicgrowththroughtougherpublichealthmeasures–egbymoreintensephysicaldistancingandtravelrestrictions.Borderrestrictions,intensetesting,aggressivecontacttracing,andstringentself-isolationandquarantinearefundamentaltothesuccessofthestrategy. Itisnotclearwhatwasmeantbythe‘flatteningofthecurve’approach.Flatteningofthecurvecanmeananythingshortofdoingnothing.Thecurvecanbeflattened

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enough,toreducetheriskthatthehealthsystemisoverwhelmed.Ifitissuccessfulthenthemoreextrememeasurescanbeavoided.Iftheyarenotsuccessfulthenabetterpreparedmove,toasensiblehigheralertlevelcouldstilloccur.Thereisnomentionhereoftheneedtotakestrongermeasurestoprotecttheelderly,inparticularthe35,000inresthomes.OuralertsystemhasbeendesignedwiththisstrategyinmindasitallowsustotightenandloosenmeasuresinresponsetothespreadofCOVID-19.Theaimistoensurethathealthsystemcapacityisnotexceededthroughstrengtheningpublichealthmeasures.

Thisisareasonableaim,butthereisnoanalysishere,oranywhereelse,oftheconsequencesofthehealthsystembeing‘overwhelmed’andhowlongitwouldtaketoreachthatpointunderreasonableassumptions.Itisnotthe‘elimination’strategythatappearedlaterinthelockdownNewZealandisatacriticalmoment.Ifwedonotactsoon,weriskanexponentialgrowthincases.Wethereforemustseizetheopportunitytoapplytoughercontainmentmeasurestoincreaseourchancesofsucceedingatoursuppressionstrategy. Exponentialgrowthincasesisnotnecessarilyamajorissue,foreshadowingacatacyclismicoutcome.Atwopercentgrowthincasenumbersaweekisexponentialgrowth,butitwouldmeanthatcaseshadonlyincreasedbylessthan200percent,overayear.Adoublingeachweekisadifferentstory,butthereisnodiscussionofwhatgrowthratesarelikelyandwhatimpactthealreadyagreedleveltwomeasureswouldhaveonthegrowthrate. Asuppressionstrategydoesincursignificanteconomicandsocialdisruption.Longerperiodsofphysicaldistancingwillberequired.However,manyliveswillbesavedandmorepeopleremainwellsoweareabletooperatetheeconomyandthehealthcaresystem.Thisisareiterationoftheargumentsmadeinthealertlevel2paper.Fromthestart,officials’adviceandGovernmentdecision-makinghasdeliberatelytakenaprecautionaryapproachtoslowtheimportationandspreadofCOVID-19inNewZealand.Measureswehavetakentodate,suchasclosingourborder,haveslowedthearrivalandspreadofthevirusinNewZealand.Thishasboughtustimeto:

• AdvanceourpreparationstorespondtoanoutbreaksothatwecanpreventwidespreadcommunitytransmissioninNewZealand

• understandbetterthevirus’epidemiology,includingtheprevalenceofasymptomatictransmission,and

• learnlessonsfromhowothercountrieshavemanagedoutbreaks,appliedinnovativeandtimelyapproaches,andindoingso,havecontrolledcasefatalityrates.

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ThelongerwepostponecasesinNewZealand,thebetterthehealthcaresystemcanfunction,thelowerthecasefatalityrate,andthehighertheshareofthepopulationthatwillbevaccinatedbeforeitgetsinfected.Thisismostlyself-evident,butthereisnoattemptataquantificationofsomeofthebenefits,suchasthelowercasefatalityrate.Thelogichereisthatifalargenumberofcasesarriveinashortperiodoftime,thenhospitalfacilitieswillbeoverwhelmedanddeathrateswillgoup.Ifcommunitytransmissionbecomeswidespreadwewillhavelosttheopportunitygainedbyclosingtheborder.Internationaladviceisthatforeachcasewehaveidentifiedwehavemissednine.Thesourceofthe‘internationaladvice’isnotdisclosed,anditisnotclearwhatrelevanceitwouldhavehadtoNewZealand.Thenumberofunidentifiedcasesinacountryattheearlystageofanepidemic,withsomeinterceptionofimportedcasesandcontacttracing,willbelowerthanincountriesatalaterstageoftheepidemicandnocontacttracing.Asecondpieceof‘evidence’onundocumentedinfectionswas:AstudybasedondataofChina’sCOVID-19infectionspriorto23JanuaryfoundthatmostCOVID-19infectionswereundocumentedandnotidentifiedbecausetheinfectedpersonsexperiencednooronlymildsymptons.ThereportingoftheChinesestudywaspartial,anddesignedtooverstatetheextentofunreportedinfections.Therelevantpartoftheabstractread:Weestimate86%ofallinfectionswereundocumented(95%CI:[82%–90%])priorto23January2020travelrestrictions.Perperson,thetransmissionrateofundocumentedinfectionswas55%ofdocumentedinfections([46%–62%]),yet,duetotheirgreaternumbers,undocumentedinfectionsweretheinfectionsourcefor79%ofdocumentedcases.ThesefindingsexplaintherapidgeographicspreadofSARS-CoV2andindicatecontainmentofthisviruswillbeparticularlychallenging.Ifyoureadpasttheabstract,however,adifferentpictureemerges.Thepaperactuallyreportedontwosetsofmodellingsimulations.Thefirstwasfortheperiod10-23January,reportedabove.Thesecondwasfrom24Januaryto8February,whenthereweretravelrestrictionsandanincreaseincareseekingbehaviourasthepublicbecameawareofcoronavirusrisk.Overthisperiodtheestimateofthepercentageofcasesthatweredocumentedincreasedfrom14percent(aseventooneratioofunreportedtoreported)to65percent(aratioof0.5).ThisistheresultthatshouldhavebeenreportedintheCabinetpaper,because

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itbestreflectedtheNewZealandsituationby23March.Travelrestrictionswereinplace;thepublicwasawareofthedisease;andreportingprotocolsshouldhavebeenmorerobust.ThismispresentationoftheevidencemayhavehadanimportantimpactonMinisiters’andofficials’thinking.With66reportedcasestheymighthavethoughttherewerenearly600undiscoveredcases,ratherthan33basedonthemostrelevantChineseevidence.Theconclusionfromthisdiscussionheightenedtherisk.Eveniftherewerenofurtherimportedcases,ifwehavemissedearlycasestransmittingsilentlywecouldsuddenlyfaceanexponentialriseincasesashashappenedelsewhereintheworld.Thefollowingsectionprovidedtheanalysisthatdrovethedecisionstomovetolevel4.AssessmentofCOVID-19inNewZealandItishighlylikelythatcommunitytransmissionisoccurring.Thatwasnosurprise.Withalargenumberofimportedcasestheremusthavebeenatleastonecaseofcommunitytransmission.Butthatdoesnotnecessarilymeandisaster.Itjustmeansthatcontacttracershavebeenunabletolinkittoaknowncase.Itisalsolikelythattherewouldhavebeencommunitytransmissionpriorto20March,whenthealertlevel2decisionwasmade,sonothinghadreallychangedoverthethreedays.Asat22Marchthereare66confirmedcasesinNewZealand.Thereareconfirmedcasesin16outof20healthdistricts.Upuntil20March2020,allcaseswereconnectedwithaconfirmedCOVID-19cases.Thisisnolongertrue.Sevencasesnotifiedinthelastfewdaysandunderinvestiagationasat22Marchhadnointernationaltravelhistory.

Someofthesemayhaveeventuallyturnedouttohaveatravelhistoryoncetheinvestigationswerecomplete.

AconferenceinQueenstownon9-13Marchisacommoneventamongsevenconfirmedcases.Theremaybeadditionalunknowncasesconnectedwiththisevent.Thesourceofexposureisbecominglessclear.Itishighlylikelythatcommunitytransmissionisalreadyinplaceoritissoontobecomemorewidespread.Itislikelythatcaseshavealreadybeenmissedduetothemildnatureofthediseaseinmanyindividualsandtheearlyfocusoninternationaltravel.Lastweekthecasedefinitionwaswidenedtoallowforclinical

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discretion.ThischangehasleadtomoretestingandgreaterdiscoveryofCOVID-19casesinNewZealand.Escalationinthepublichealthresponseisrequiredifwearetoavoidtheimpactseeninothercountries.Theconclusion,thatahugeescalationinthepublichealthresponsewasrequired,wasalargeleapfromsomeveryscantyevidence.Thetestthatseemedtobeingappliedtothemovetolevelthreeborelittlerelationshiptotheteststhatweresetoutinthelevel2decisionjustthreedaysbefore,Thisisdiscussedfurtherbelow.Othercountriesshowwhatcanbeachievedwhenanationactsquicklyanddecisivelywitheffectivemeasuresandhighcompliance.Wemustcontinuetoleanfromtheexperienceofothercountries’trajectories.TheexperienceofIranandItalyillustrateswhatcanhappenifactionistakentoolateandhealthsystemsbecomeoverwhelmed.TheexperirncesofSingaporeandTaiwan,bycontrast,illustratewhatcanbeachievedbyanislandnationwhichactsquicklyanddecisivelywitheffectivemeasuresandhighcompliance.ExperienceoverseasdemonstratethatthereisnosingleapproaahthatiseffectiveinreducingCOVID-19.AseverelockdowntoreducephysicalcontactmanagedtocontainandcontrolthespreadinChina.Implementingextensive“tracktraceandtreat’measureshavebeeneffectiveinSingapore,TaiwanandSouthKorea.ThepaperdidnotdiscusswhyNewZealandshouldgowiththeChinesemodelratherthanthelessintrusiveandcostlyapproachesoftheotherAsiancountries.Chinaisanauthoritarian,sometimesviciousregime,whichplacesnoweightonhumanrightsandtheharmaseverelockdownmayinflicitonitscitizens.WeconsiderNewZealandandAustraliagoodcomparatorsduetosimilarhealthandsocialsystems.OurcontainmentstrategiestodatehavebeensimilartothoseinAustralia.IfwelookatthenumberofcasesinNewSouthWaleswearenearthesameplacetheywereon11March2020.ItappearsthatweareonasimilartrajectorytoNewSouthWales.Ifthiscontinueswecouldhaveapproximately350casesinabout10daystime.TheNewSouthWalescasenumbersdidnotnecessarilyshowthattheirsituationwasoutofcontrol.CasesweregrowinginAustraliabecauseanincreasingnumberAustralianswerereturmingfrominternationalhotspotsatthetime.Providingmostofthesewerebeingpickeduprelativelyquickly,andnottoomanyinfectionswerepassedontothewidercommunity,thenthesituationwascontrollable.RespondingtothecurrentsituationandoutlookCabinethasconsistentlyrespondedtoofficialsadviceonmeasuresforCOVID-19containmenttodate.Thesituationisrapidlychangingandofficialshaveaccordinglyadaptedtheiradvice.

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Asnotedabovenothingofsubstancehadreallychangedinjustthreedays.Whathadchangedwashowthesituationwasbeingperceived,andwhowasincontrolofthenarrative.MovingtohigherlevelsOfficialsrecommendescatingtoahigherlevelinitiallywiththepotentialtode-escalateattheregionallevelbasedonevolvingepidemiology.Thereareanumberofconsiderationsformovingbetweenlevelsatanationallevel.Notallconditionswouldhavetobemettojustifyamove.Thelevelthreetestswereamendedfromthetestssetthreesaysearliersotheywereeasiertomeet:

1. Diseaseincreasinglydifficulttocontainbecameincreasingnumbersofnewcaseseachday.WiththehighnumberofreturningNewZealanderstherewouldnaturallybeanincreaseincases,sothiswasnotaveryrelevanttest.

2. Communitytransmissionoccuringbecamehighlikelihoodofcommunitytransmission,Whichisalowertest.

3. Multipleclusteroutbreaksbecameconfirmedclustersoutsidehouseholds.Whichisalsoalowertest.

Thelevel4testswerenowdescribedas:

A. RapidlyincreasingrateofnewcasesAgainthistooknoaccountoftheinevitableriseincasesfromreturningNewZealanderswhichwasbeingmanagedbyquarantineorisolationrequirements.Therewasnosuggestionthatthisapproachwasnotworking.

B. CommunitytransmissionconfirmedinmultiplelocationsThisdoesnotaddresswhatconstitutescommunitytransmissioninmultiplelocations.Isitasinglecaseormany?Howmanylocationsdoyouneedfortheretobemultiplelocations?Accordingtotheappendixtherewerefourcasesofcommunitytransmissioninthreelocations.

C. HealthsectorconcernsaboutdatatimelinessandaccuracyDataisneverfullyaccurateortimely,butitwasnotexplainedwhythismattercouldbeofsuchimportancethatitcouldplayamaterialroleinthealertleveldecision.Andwhoseconcernsinthehealthsectorshouldcountinthisevaluation?Onedisgruntleddoctor,ormany?

D. Contacttracingbecomeslessfeasible

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Thereisnoanalysisofwhethercontacttracingwasbecominglessfeasibleandwhatwasmeantby‘lessfeasible’.Thisdidhoweverpointtoalackofconfidenceinthecontacttracingsystem.

E. HealthsectorcapacityunderpressureClearlybyMarch23therewasnopressureonthesystem.

F. Publicnon-compliancewithexistingcontainmentmeasuresCompliancewasalwaysgood,andtherewasnoopportunitytoassesscomplianceunderunderlevel3.

Thesepreconditonswereafairlyfundamentalmovefromthetriggerssetjustthreedaysearlier.Theywerethatthe‘diseaseisnotcontained’andtherewas‘sustainedandintensivetransmission’.Settingupthedecisionisthewarning:Ifcommunitytransmissionbecomeswidespeaadwewillhavelostthisopportunitygainedbyclosingtheborder.Oncecommunitytransmissionisestablishedthenumberofcaseswilldoubleevery5days.

Thereisnoindicationofwherethe5daysdoublingperiodcamefromandwhatpolicyandbehaviouralactionsittookintoaccount.Afivedaydoublingisanunconstrainedrateofgrowth,ignoringtheimpactofspontaneousbehaviouralchanges,level2and3measures,andtestingtracingandisolation.Thestatementgavetheimpressionthatunlesstherewasanimmediatemovetolevel4arunawaysituationwasinevitable.ItiscriticalthatNewZealandactsdecisively.Earlyactionwillincreaseourchansesofpreventingexponentioalgrowthincasenumbersandmultipleclustersofcasenumbers.Itistruethatearlyactionincreasesyourchances.Theissueisbyhowmuch.Ifyouhavea95percentchanceofavoidingsustained(high)exponentialgrowthatlevel3,withtheoptionofmovingtolevel4shoulditprovenecessary,isitworthmovingtolevelfour,forasustainedperiodoftimeimmediately,toimprovethoseoddsto,say,97percent?

Officialsbelievethattheconditionsformovingtolevel3havebeenmet.Thegroundswere:

• Increasingnumberofimportedcasesandanincreasedgeographicaldispersion

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Geographicaldispersionwasnotsetoutasacriterionsothegoalpostsappearedtohaveshiftedagain,justinthespaceofafewpages.

• CasesoverpreviousdayssuggestthatcommunitytransmissionishigherlikelyWhichisimpossibletodisprove.

Alertlevel4Thecaseforlevel4was

• NewZealandhasseenaraidriseinimportedcasesandanincreaseingeographicalspreadofCOVID-19

• CasesoverrecentdayssuggestthatcommunityspreadofCOVD-19ishighlylikely.

Whichwasidenticaltothelevelthreetests.Theydidnotbotheractuallyapplyingthelevelfourtestssetoutearlierinthedocumentbecause:AmovetoLevel4isinevitableintheneartermItwasinevitablebecausethedecisonhadobviouslybeenmadetomovetolevel4,regardlessoftheevidence.

ThepublichealthobjectiveApparentlytherewasachangeinthepolicyobjectiveTheprimarypublichealthobjectiverightnowistobreakthetrainofcommunitytransmission,ratherthansimplyslowingthespreadofCOVId-19.‘Breakingthetrainofcommunitytransmission’couldmeananything.Itdependshowmuchofthecommunitytransmissionyouwanttobreak,andhowquicklyyouwanttodoit.Anobjectiveofreducingthereproductionratetobelowonewillinvolvebreakingcommunitytransmissionratesgraduallyovertime.Itcanbeachievedwithlessintrusiveinterventions.Butanobjectiveofextinguishingthediseaseassoonaspracticablypossible,andatallcosts,isadifferentpropositionandrequiresstrongercontrolmeasures.Thetoneofthepaperisthattheofficialswereleaningtowardsthelatterapproach,butitwasnotclearhowthis‘new’approachwasmeanttofitwiththesupressionstrategysetoutatthebeginningofthedocument,andwhethertherehadbeenamovetoaneliminationstrategy.

Giventhebarestatementonthepublichealthobjective,andthelackofanysupportingdiscussion,itisnotclearthatMinisterswouldhavebeenawareofwhattheyweresigningupto.

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Ourassessmentisthattheimpactofmovingtolevel3isunlikelytobesufficienttoachievethebreakincommunitytransmission,andthattheconditionsformovingfromlevel3tolevel4maybemetnoworinafewdays.

Thereislittleevidencethatofficialseverdidanyanalysisoftherelativeeffectivenessoflevel3versuslevel4,oreventhoughtveryseriouslyabouttheissue.Iftheobjectivewastogettherateoftransmissionbelowone,thenthereweregoodargumentsthatalevel3intereventionwouldsuffice.Thereisnoevidencethatclosingdownall‘non-essential’workplaceswasnecessarytogetthetransmissionratebelowone.Critically,therewasnodiscussionofthecostsoflevel4(otherthatanadmissionthatitwouldbeverycostly)andnoassessmentofthemarginaleffectivenessofeachofmeasurerelativetoitscosts.OfficialswantedtoexcludebuildingandconstructionfromthelockdownHowever,evenintheapparentlyhypedatmosphereofthedayofficialsknewthatclosingthebuildingandconstructionindustrywouldachievelittle,butatasignficantcost.Thereasonsareobvious.Builderstendtoworkinsmallgroups;canmoreeasilysociallydistance;areoftenworkingoutside;anddonotoftenrelyonpublictransport.Intheappendixtothedecisiondocument,whichsetouttheessentialandnonessentialbusinesses,buildingandconstructionandsupportingactivitiesweredefinedasessentialactivities.This‘advice’,wasoverturnedbyCabinet.Thetimeonlevel4Theonlystatementofthetimeofthelevel4lockdownwas:WeconsiderthatanymovetoLevel4wouldbeforaminimumof4weeks.

Thereisnodiscussionofwhyaminimumof4weekswasrequired,noristhereanyevidencethattheissuehasbeenanalysedinanyotherpaper.AscrambletoimplementationItisclearthatalevel4interventionhadnotbeenseriouslythoughtaboutuntilafewdaysbeforethedecision,andthatlittlepreparationhadbeendone.WearenotreadytomovetoLevel4today,butoverthenext24-48hours,weareworkingthroughanumberofcriticalquestionsaroundhowLevel4wouldgetimplementedifaquickdecisionwastaken.Theseinclude;Thelegislativepowersandenforcementandcomplianceregime,includingthepossibilityofnewlegislationImplementationissues,suchasfurtherdefiningessentialservicesand

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establishinganoperationalregimeandclearcommunicationstomakethisworkwellEconomicandsocialsupportandothermitigations,required.ThecostsThepublichealthcaseformovingtoLevel3isclear.However,manyofthemeasuresthatLevel3requiresareexpensive,disruptiveandinconvenient.TheywillmeanrealharmandhaveextremelysignificantsocialandeconomicimplicationsforNewZealanders:peoplewillbecomeunemployed,beunabletopaytheirbills,gooutofbusiness,andtherewillbepsychosocialimpacts.Thereisnoattemptatanassessmentofthemagnitudeoftheseimpacts,thoughfairwarningwasgiventhattheeffectswouldbelarge.Thelackofinformationpointstothelackofpreparationandthelackofananalyticalframework.Andthisiswhatwassaidabouttheadditionalimpactoflevel4initsentirety.Themostimportanteconomicinterventionwecanmakeistoensurethatthehealthsystemisoperatingatmaximumcapacity.Workisunderwayacrossmultiplefrontsonthisaspectandinvestmentheregivesthehighestbenefitofallinterventions.Thiswassimplyanevasion.Theissuewasthemarginaleconomicconsequencesofthedecisiontomovetolevel4,notwhatthehealthsystemcandoto‘help’theeconomy.Eveninitsownterms,‘ensuringthatthehealthsystemisoperatingat‘maximumcapacity’doesn’tmakemuchsense.Wepresumethatwhattheyweretryingtosayhere,isthatifworkersgetsick,ahealthsystemworkingatmaxiumumcapacitywillgetmoreworkersbacktoworksooner.Thisimpactwouldbeminor.Onlyaverysmallproportionofthoseintheworkforcewouldneedhospitalcareandsocouldbenefitfromamoreefficientsystem.Thepapergoesontodiscusssomeofthemitigationsforsomeofthoseaffectedbythelockdown.Butthismostlyaddressedthedistributionaleffectsofthepolicies.Itdoesnotgototheunderlyingeconomiccosts.ItwasagreedthatdeclaringastateofemergencyundertheCivilDefenceEmergencyManagementAct2002isthepreferredapproachtoallowthemeasuresinLevel4.HumanRights,GenderImplicationsandDisabilityPerspectivesItwasstatedthattherearenohumanrights,gender,ordisabilityimplications.

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Thisstatementonhumanrightswas,putbluntly,alie.Thehumanrightsimplicationsofthemeasureswerewellunderstood.Itappearsthatthepaper’ssponsorsdidnotwantCabinettothinkaboutthehumanrightsimplicationsofwhattheyweredoing.Summingupthecaseformovingtolevel4.Theevidencebasewas

• AsingleChinesepaperontheprevalanceofsilenttransmissionofthedisease.Thecontentofthepaperwaseithernotreadormisrepresented.

• Thefactthatfouror(seven)casescouldnotbetraced.Therewasnoassessmentoftheeconomiccosts.Itisobviousthatthealertlevelassessmentwasasham.Thedecisiontomovelevelfourhadalreadybeenmade.March232020CabinetminuteofDecisionTheminuteoftheCabinetDecisionprovidesfurtherinformationonthedecisionmakingprocess.ItwasnotedthatCabinet:hassoughtconstantreassurancethatNewZealand’stestingregimeisadequate,andthatthegovernment’sexpectationsinthisregardarebeingmet.Andundernote18itwasfurther noted:thattesting,contacttracing,andoversightofself-isolationandquarantinearefundamentalworkstreamstothestrategyatanylevel,andMinisterswillneedtobeespeciallyconfidentaboutthedeliveryoftheseaspects;Thesenotesprobablyreflectedalackofconfidenceinthecontacttracingsystem.24March2020BriefingonessentialservicestoAdhoccabinetcommitteeonCovid-19responseThedecisiontoclosedownallbut‘essential’serviceswasrushedandleftseveraldecisions,onwhatwasanessentialservice,upintheair.TheCabinetpaperdidset

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outthefollowingsetof‘principles’fortheidentificationofessentialservicesbutthesewerenotveryinstructive.Indecidingwhichservicesneedtocontinue,wehavebeenguidedbythefollowingprinciples:81.1Publichealthisparamount,soweneedtominimiseriskstopublichealth.81.2WemustcontinueourresponsetoCOVID-19.81.3WemustensurethenecessitiesoflifeforeveryoneinNewZealand.81.4Wemustalsomaintainpublichealth,safetyandsecurity.The24Marchpaperprovidedinformationformoredecisionsonwhatwasessentialandwhatwasnot.Italsoarticulatedthelogicbehindtheframework. NewZealandmovestoLevel4(thehighestofthealertlevels)from11.59pmonWednesday,25March2020.Atthislevel,theobjectiveistolimitmovementandinteractionofpeople,sothatwecanbreakchainsoftransmission.MovingtoLevel4isanopportunitytocontrolthespreadofCOVID-19,meaningweneedtomakesureanymovementofpeopleforworkisabsolutelynecessary,andaccepttheconsequenteconomicimpacts.Whilethereisanobviouslogicinreducingtheinteractionofpeopletocontrolthevirusthecaseforreducingthemovementofpeopleislessclear.Travellingwithoutinteractingwithpeopleisnotariskfactor,butthethinkingbehindmanyofthecontrolsthatwereimposedsuggeststheGovernmentthoughtthatitwas.Thismayhavereflectedthekindofthinkingfromoverseasjurisdictionsthatreliedonmasstransitforgoingtowork,andwherehighpopulationdensitiesmeantthatevengoingforastrollonthestreetcouldmeancloseinteractions.InNewZealand,withitshighrelianceonprivatetransport,andlowpopulationdensity,restrictingmovement,assuch,shouldhavebeenlessimportant.Thestatementthatwewould‘accepttheeconomicconsequences’isafairsummaryoftheapproach.Donotattempttobalancethecostsagainsttheimpactonthespreadofthevirus.Butallow‘essential’activitiesThecriticaltestmovedfrom,whatimpactanactivityhasonviralspread,towhatwas‘essential’.Thefirstrecommendationwasthatdairieswereessentialbecause:DairiesareakeyavenuethroughwhichwecancontinuetoprovidefoodtopeopleinNewZealandwhileatLevel4.Therewillbepeopleforwhomaccessingadairyiseasierthanaccessingasupermarket,andalsoreducesloadonsupermarkets(whichwemayeventuallyneedtomanagethroughmeasuressuchasstaggeredentrytosupermarkets,withpeoplewaitingintheirownvehicles).Itwillsupportpeopletostayclosertotheirhouseholdandreducetheneedfortravelacross/beyondsuburbsandtownsifthealternativeisa

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supermarket.Inadditiondairieswillreducethenumberofexposurepointswithothermembersofthepublicthanwilloccurinsupermarkets.Someone,apparentlyhadasoftspotfordairiesbecausethecaseforthembeing‘essential’wasabitthin.Dairiesmainlysellcigarettes,drinksandsnacks.Theyarenotakeyavenueforthedistributionof‘essentialfoods’,exceptforafewruralcommunities.Itwasarguedthatthehealthriskswerelow:Thepublichealthriskassociatedwithoperatingdairiesisnotgreaterthanoperatingsupermarkets,whichalsosellfast-movingconsumergoods.Itispossibletooperateadairywithappropriatehealthmeasuresinplace:Butbutchers,bakersandgreen-grocersdidnotmakethecut.Wedonotthinkbutchers,bakeriesorsimilarretailersofspecialisedfoodneedtoremainopentothepublicatLevel4.Supermarketsanddairiesshouldbeabletosupplybasicfoodneedsforfourweeks.AllowingalargenumberofsmallfoodoutletstoremainopenatLevel4wouldcreatehealthrisksthatwedonotthinkarejustifiedgiventherearealternativeavenuesthroughwhichthesameorsimilarfoodcanbeobtained.Thelogichereescapesus.Ifdairiescouldoperatewithappropriatehealthmeasuresinplace,thensocouldthesebusinesses,whichwereprovidingmore‘essential’products.Supermarketssellallsortsof‘non-essential’goodswhichremainedonsale.Thesmallbusinesscompetitorsofsupermarketsweredisproportionatelyaffected,notjustbecauseofthelossofincomeduringthelockdown(whiletheirsupermarketcompetitorsprospered),butbecausetheywereatriskoflongertermdamageifconsumerschangedtheirbuyinghabitstowardssupermarkets.ItwasalsorecommendedthatliquoroutletsandfooddeliveryservicescouldoperatebutthesewereknockedbackbytheAdHocCommittee. Sometimestheexcessiveeconomiccostofapplyingthe‘essentialservice’metricwasexplicitlyacknowledged.TheTiwaismelterwasallowedtocontinuetooperate.Thesmelterwouldincursignificantandirreversiblecostsifitweretoshutanditwouldbeapeopleintensiveandlongprocess.Itisrecommendedthesmelterbeexemptfromclosure.NZ Butonlyverypartialproductionwasallowedinthepulpandpaperindustry.

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Allproductionshouldceaseexcepttomaintaintheminimumproductionneededtodeliveressentials(egtoiletpaper).Fornon-essentialservices,plantsshouldbesafelyshutdownbutonlyinawaythatallowsforproductiontorecommenceeasily. Methanexwasallowedtooperatebutonlyatalevelsufficienttomaintaindomesticgassupply.Themarginalriskofmaintainingfullproductiondidnotappeartohavebeenconsidered. Primaryindustrywaslargelyexempt,butonlygrudginglyandatacost.MinisterO’Connormadeitcleartothesectorandindustryleadersthat,atatimewhenmanyotherbusinessesarenotabletooperate,theirbeingabletocontinueisaprivilege,notaright.Theywerelucky.Processingcouldhavebeenlimitedtojustsupplyingthedomesticmarket.Theexportoutputcouldhavebeenshuttered.Otherthanthosebusinessesinvolvedinessentialservicesorasdiscussedunderlargeindustrialplants,exportersshouldbeshuttingdown.Exportingbyitselfshouldnotbearelevantcriterion.TheemphasismustbeonachievingthehealthoutcomesforLevel4.Theideathatotherindustries,whichonthefaceofitposedaloweredlevelofrisk(meatprocessingisaparticularlyhighriskindustry)couldprovidesafetyassurances,wasnotentertained.Inpartthiswasbecausetherushedimplementationmeantthatthedetailedworkhadnotbeendoneandinpartitwasattitude.Economicharmwasalmostagoodthingbecauseitdemonstratedthatwewerethetoughestintheworld.Thefollowingpaperswereafurther‘tidyup’followingtherushedimplementationoflevel4.Theywerehoweversignificantbecausetheyaddressedthehumanrightsimplicationsofthelockdown.1April2020COVID-19:Section70(1)(f)HealthAct1956noticetogiveeffecttoLevel4restrictionsonself-isolationathomeMOHtoMinisterofHealth ThepurposeofthisreportwastoprovidetalkingpointstotheMinisterontheDirectorGeneralofHealth’sproposednoticeundersection70(1)(f)theHealthAct1956.Thenoticewouldrequirepersonstobequarantined,givinglegaleffecttotheAlertLevel4resquirementtoself-isolateathome.

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Theself-isolationrequirementhadbeenrepresentedasalegalmandatoryrequirement,whenitwasnot.Itisnotclearwhathappenedhere.WastheDirectorDirectorGeneralreluctanttoissueageneralstayathomenotice,becausehedidnotthinkhehadthelegalpowertodoso?Orhadtheintentbeentoimposeamandatoryrequirementandhehadmistakenlyfailedtodoso?Iftherewasjustamistakeitwasnotacknowledged.Rathertheneworderwasrepresentedasanecessaryfurtherstep. Thekeypointswere:•CentraltoNewZealand’sfour-levelCOVID-19AlertsystemisarequirementthatallpeopleinNewZealandself-isolateathomeunlesstheyareessentialworkers.•InitialreportsfromthePoliceandHealthlinesuggestthatwhiletherehavebeengoodlevelsofself-isolation,therecontinuetobepeoplewhoarenotadequatelyself-isolating,orwhoareunclearabouttheself-isolationrequirements.•ThePrimeMinisterhaspreviouslyreassuredthepublicthattheyneednot“police”theirneighbours’adherencetothelockdownandthatthegovernmentwillplaythatrole.•Thereisasignificantriskthatnon-compliancewillresultinthecontinuedtransmissionofCOVID-19,frustratingtheobjectivesofmassisolationi.e.tobreakthechainoftransmissionandeliminateCOVID-19inNewZealand,leadingtocontinuedpublichealthriskandtheneedtoextendAlertLevel4.•TheDirector-GeneralofHealthassessesthattheseriskswarrantissuinganoticeundersection70(1)(f)oftheHealthAct1956torequirepersonstobequarantined,givingeffecttotheAlertLevel4restrictionsonself-isolation.TheNewZealandGovernment’sapproachtodatehasfocusedoncommunity-endorsedcompliance,supportedwithstrongcommunicationsandclearguidance,backedupbyregulatorswhoarewillingandabletoenforceusingstrongsanctions.Thisnoticewillnotfundamentallychangethatapproach.Thenoticedidfundametallychangetheapproach.Itwasamovefromvoluntarycompliancetoonebackedbycoercion.Therewasnoacknowledgementherethatshiftingfrom‘voluntary’compliancetocoercionraisedhumanrightsissues.2April2020Notingpaper:covid-19Self:isolationorderunders70(1)(F)healthActToAdHocCommitteeonCovid-19Response.FromDavidClarkThisnotingpaperrepeatedtheaboveargumentsfortheselfisolationorder.ThefollowingappearstobeDirectorGeneral’sfullriskanalysissupportingthenotice.

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Intheabsenceofavaccinetheonlyeffectivestrategiesaretoreducemixingofsuspectibleandinfectiouspeoplethroughearlyascertainmentofcases(testingandcontacttracing)andreductionofcontact.ModellingoftheepidemicinNewZealandhasanalysedtheextentofcontactreductionovervarioustimelines,accountingfordifferentreproductionnumbersthatNewZealandwouldneedtoachieveinorderto‘flattentheepidemiccurve’andindeedeliminatetheviruswhichisthecurrentobjectiveunderlevel4.ThismodellingjustifiestakingastringentapproachtowardsphysicaldistancingfortheentirepopulationonthebasisthatifthecurrenteradicationstrategyfailsthenthehealthoutcomesforNewZealandcouldbeverysevere.DirectorGeneral’sfalseandmisleadingstatementonmodellingTheDirectorGeneral’statementsonthemodellingweremisleading,ifnotoutrightfalse.ThestatementswerealmostcertainlybasedontheOtagoCovidResearchGroup(OCRG’s)modellingthatwecritisedin‘Alookbehindtheheadlines’TheOCRGdidnomodellingoftherelativeimpactofvoluntaryversusmandatorysocialdistancing,asisimplied.Indeed,theymadenoassessmentsofanyofthealertlevelmeasures.TheOCRGassumedthattherewasnocontacttracingwhichismeanttobethecentreofthepolicyresponse,sothatanyconclusionsthatcouldbedrawnfromthemodellingontherequiredamountofcontacttracingwouldhavebeenoverstated.TheDirectorGeneraland/orhisstaffeitherdidnotunderstandthemodellingordeliberatelymisledtheMinister.TheDirectorGeneraldidnotshowthattheorderwasdemonstrablynecessaryasrequiredbylaw.

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Partfive:Fromlevel4tolevel1Thispartisdividedintothreesections.

A. Updateandmonitoringreports.Thesegiveasenseofhowprogresstowards‘breakingthechainsoftransmission’wasbeingassessed.

B. MSPreports.MSPisthecrownentitythatcollectedcaseinformationandmaderiskassessments.

C.Decisionpapers.

A:Updatesandmonitoring30March2020SituationupdateThiswasadashboardstyletwopagereport.CurrentstateModellingoftheunmitigatedprogressionofCOVID-19showsthepeakis5/6monthsaway.Theimpactofourcurrentmitigations,ifsuccessful,showswecanflattenthepeak,andavoidreachingitentirely,ifwecankeepupreasonablecontrols.Thesecontrolswouldnotnecessarilybethefulllevel4measures.Thismodelassumesendingthecontrolmeasuresafterninemonths,whichpushesthepeakintoMarch2021.ThisshowsthattheywerestillrelyingontheinadequateOCRGmodelling,whichmighthavesaidthatthepeakwouldbe5/6monthsawayiftherewerelimitedinterventionsandnocontacttracing.Iftheyhadactuallyruncovid.simatlevel4settingsthentheywouldhavefoundthatcasenumberswouldhavequicklydroppedtolowsinglefiguresinalttlemorethanamonth.Theproblemisthatofficialssimplydidnotunderstandthemodelling.Theonlystatisticalinformationontheprogressoftheepidemicwasasinglegraphshowingdailyandtotalcases.Therewasnointerpretationofthedata.Othertopicsbrieflysummarisedwere:

• ICUcapacity:Sufficentbutworkingtomeetanticipateddemand• PPSresources• Healthcareworkforcesupply• Labtesting• HealthBudget:$261.3mallocated

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• Contacttracing:Somenumbersonactivity9April2020SituationupdateCovid-19strategyNewZealandispursuinganeliminationstrategytomanageCOVID-19.SuccessunderthisstrategymeansthatCOVID-19isfullyeliminatedorreducedtoasmallnumberofcases,thelargemajorityofwhichare“imported”andlinkedtointernationaltravel.ThelevelofCOVID-19willbemanageablebythehealthsystemuntilavaccinebecomesavailable.Theeliminationstrategywasnowcementedin. Summaryofprogress Atpresent,weareprogressingwellagainstthisstrategy.Despitebroadeningthecasedefinitionfortestingandincreasingtestingvolumes,wehavenotobservedanaccelerationintherateofnewcases.ThemajorityofcaseshavebeenacquiredoverseasorareclosecontactsofsomeonewhoacquiredCOVID-19overseas.Approximately2%ofcasesarepotentialcommunitytransmission.Casesareanticipatedtogrowovercomingweeks;howeverweremainwellbehindothercountriesintheexpectedprogressofCOVID-19.Thissummaryandtherestofthereportwasalmostbereftofanyseriousanalysisofthedataandtheirsignificance.Bythisstageitseemedclearthattheviruswasalreadyundercontrolwiththereproductionratebelowone,whichwasthecriticaldecision-makingmetric.However,officialsdidnotseemtorealisethis.ControlmeasuresAchievingandmaintaininganeliminationstrategyrequiresthedeploymentofarangeofcontrolmeasurestostoptransmissionfromoccurring,detecttransmissionwhereitdoesoccur,andtrackandcontroloutbreaks.Thesecontrolmeasuresinclude:•Bordermeasuresandrestrictionsontravel•Self-isolationandquarantineofconfirmedandsuspectedcases•Physicaldistancingforthewholepopulation•Rigoroustestingandcommunitysurveillance•Intensivecontacttracing. Thiswasjustarecitationofthehighlevelpolicydescriptionwithnonewinformation.CurrentStateAdashboardinformationsetshowedjust:Totalcases,MaoricasesandPacificcases

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ChangeincasesovertimeTherateofnewcasesasat9AprilisthelowestsinceMarch21.Wearenowonday4ofconsecutivedeclinesinnewcases.Thatwasthefullextentoftheinformationprovided,withnoattempttolookbehindtheheadlinenumbersandassesstheirsignificance.MeasurestoachieveeliminationBordermeasuresStatusSelfisolationandquarantiningworkingwell.NewarrivalsinNewZealandcontinuetobeonlyNewZealandcitizensandpermanantresidents.Thesepeoplearecloselymonitoredandscreenedduringdisembarcation.Thosewhoareasymptomaticcantraveldomesticallyonlyiftheycanoutlineselfisolationplansthatmeetstrictcriteria.Iftheydonotmeetthesecriteriatheyarerequiredtostayinmonitoredself-isolationaccommodation.Thosewhoaresymptomaticontheirreturnarerequiredtobetestedandquarantinedinaspecialisedfacilityfor14days.Thesestatementsweresignificant.On9Aprilselfisolationwas‘workingwell’.Afewdayslatertherewasaswitchtomanagedisolationforallreturnees.Theassessmentofselfisolationwasbasedonpolicechecksthatshowedthatonlyoneof50weredefinitelynon-compliantandtwowerenotathome.Thereappearstohavebeennoattempttoassesstheextentthathomeisolationwasleadingtocommunityspread.Thiscouldhavebeendonebymatchingcontacttraces.12April2020SituationUpdateThesummaryofprogressinthisreportwasalmostwordforwordidenticaltothe9Aprilreport.Managedisolationandquarantinefornewarrivalswasstillassessedas‘workingwell’April152020WeeklymonitoringreportThiswasthefirstweeklymonitoringreport,followingadirectivefromCOVID-19MinisterialGroup'stoAll-of-Governmentofficials: to develop a set of measures and regular reporting that will inform future decisions on changing Alert Levels or the overall strategy, and to report them regularly. Thematterstobereportedwere:

1. Cases,testsandsourcesoftransmission;

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2. Sufficientcapacityintestingandcontacttracing;3. Whetherselfisolationisbeingadheredto;4. Whetherthereiscapacityinthehealthsystem;5. Effectsontheeconomyorsocietymoregenerally;6. Publicattitudestowardsthemeasuresandextenttowhichpeopleaccept

andabidebythem.Thereportexplainedtheapproachtaken.Theapproachtakentohowfuturedecisionsaboutalertlevelsshouldreflectthebroaderapproachtodecision-makingtodate.Thatisariskbasedapproachthatappliesjudgementlookingacrossarangeoffactors.Therewasnobroadrisk-basedapproach.Thedecisiontomovetolevel4wasmaderegardlessoftheconsequencesandoftheevidence.Thisapproachismoreappropriatetoacomplexsituationthanalternativessuchasquantitativecostbenefitanalysis.Acostbenefitstyleapproachmaynotfullycapturethedynamicnatureoftheinformationandchoicesavailableatanypointoftime.Forinstancesomeoptionswillbebecomeunavailable)suchasgoingbacktogethealthbenefitsiftheeconomicbenefitshavebeenprioritized.Costbenefitanalysesmightvaryinthetheirquality,butinprincipletheycancapturethe‘dynamicnature’ofdecision-making.Onceanappropriatemodelisbuiltitcangeneratenewresultsinseconds,ifnewinformationisinputted.Someformofcostbenefitshouldhavebeenanessentialinputindecision-making.Attheleastitrequiresmoredisciplinedthinkingthantheinstinctivereactionthatdrovethelockdowndecision.Theargumentthatthis‘approach’todecision-makingsomehowpreservedoptionsisspurious.Ifhealthbenefitsarepreferredovereconomicbenefitsthentheoptiontospendthemoneythatitcosts,onsomethingelseinthefuture,isforgone.Covid-19casesandconfidenceintestingandsourcesoftransmissionThenumberofnewcaseshasflattened.Timetakentodoublehassloweddown.Iftherewasuncontrolledspreadwewouldexpecttoseeadoublingapproximatelyeverythreedays.Thenumberofnewcaseshadnotflattened,theyhadfallensubstantially.Itisnotexplainedhowmuchthetimetakentodoublehadsloweddown.Norwasitexplainedwherethe3daydoublingtimeforanuncontrolledspreadcamefrom,andwhyitislowerthanthe5dayscitedinpreviousdocuments.Asustained3daydoublingrateishighlyunlikelyinNewZealandbecauseitwouldsuggestthatwehaveoneofthehighestreproductionratesintheworld.

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Analysissuggeststhat2-3weeksagotherewasundetectedcommunitytransmissionbutwedidnotknowhowwideitwas.Ourhighnumberoftestandlowproportionofpositivetesttogetherwiththelownumberofhospitalpresentationincreasinglysuggeststhatthereisnotwidespreadcommunitytransmissionatthistime.Theoutcomesclearlyshowedthattherewasnowidespreadcommunitytransmissionwhenthelevel4decisionwasmade.Widespreadcommunitytransmissioncanbedifficulttorootoutanddoesnotalmostdisappearinafewweeks.Therearegapsinthedata–significantnumbershavemissinginformation,somehavebeenunderinvestigationforalongtime.Thissomewhatreducesourconfidenceinthedataoncommunitytransmission.Thisisanattempttoputanegativespinonwhatwasagoodnewsstory.Themissinginformationactuallybiasedtheassessmentinanegativeway.Ifalinkhasbeenmissedthenthisisrepresentedasanunexplainedcase,whichwasviewedasabadsign.19April2020UpdateThesummaryofprogressreportwaswordforwordidenticaltothepreviousupdate.23April2020UpdateThesummaryofprogressreportwasalmostidenticaltothepreviousones,exceptthattheproportionofpotentialcommunitytransmissioncaseswasincreasedfrom2percentto5percent.Ithadactuallybeensteadilyincreasingoverthepreviousweeks,butnoonehadnoticed,orbotheredtoamendthefigure.And,afterweeksofsayingthat‘casesareexpectedtogrowovercomingweeks’,whichwasentirelyuninformativeaslongastherewastheprospectofasinglenewcase,thiswasamendedto‘newcasesareexpectedtoflattenoverthecomingweeks’.Whichpresumablymeantthattherewouldbenoreductionindailycasenumbers.Undertheheading‘Changeincasesovertime’wearetold‘Therateofnewcasescontinuestoflattenout’.itisnotimmediatelyclearwhattheymeantbythis.Newcaseshadbeenfalling,not,assuggested,remainingrelativelystable.Thesourceof

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themuddleappearstobethattheywerelookingatthetotalofcases,whichisapparentinthescreenshotfromthereport,notnewcases.Figureeight:Casereporting

23April2020WeeklymonitoringreportUndertheheadingCOVID-19inNewZealandthereisjustsomegeneralinformationwithlittleanalysis,thoughconfidencewasexpressedaboutlimitedcommunitytransmission. Newcasenumbershavedeclinedfurtheroverthepastweek.Wecontinuetohaverelativelyfewseriouscases,andrelativelylowincidenceofcasesamongsttheparticularlyvulnerableelderlypopulation.Wehaveincreasingconfidencethatwehavelimitedcommunitytransmissionandthatwehavenothadalargenumberofcasesthathavenotbeentested.Therehavebeensmallnumbersofcasesofcommunitytransmission(locallyacquiredfromanunknownsource)eachday(0–4dailycases).Datahasbecomemorecomprehensiveoverthepastweek.Ourhighnumberoftests(seepageontestingandtracing),lowproportionofpositivetestsandnegativesentineltestingresults,togetherwithourlownumberofhospitalpresentations,increasinglysuggeststhatthereisnotwidespreadcommunitytransmissionofthevirusatthistime.TherewereinternationalcomparisonsofcasenumberswithSingapore,Israel,Denmark,Finland,Norway,AustraliaandSouthKoreaprovided.Therewasnocomparativeanalysis.

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26April2020SituationUpdateThesummaryofprogresswasidenticaltothepreviousupdate(thoughthepercentageofcommunitycaseswasupdatedonthisoccasion).30April2020UpdateAnidenticalsummaryofprogressagain.3May2020UpdateIdenticalagain6May2020WeeklymonitoringreportOnthecasenumbersitwasreported:caseswereconsistentlyfewerthanfiveperday.Thelastrecordedcaseswereon1May.Levelsofundetectedcommunitytransmissionhavefurtherreduced.Acaseon25Aprilwaslistedasunderinvestigation.Weunderstandthisinvestigationhasnotbeencompletedwithalinktoanothercaseidentified.Therearecasesofpotentialcommunitytransmissionreportedon29Apriland30April.Anew,potentiallyinformative,datasetwaspresentedintheirfiguretwo(ourfigurenine)whichshowedthecasedatabythedateoffirstonsetofsymptoms,andbythedatethecasewasreported.Itsuggestedthattheaveragelagwasabout10days.Itwasaccompaniedbyafootnotethatsayssymptomsappear2-12daysafterinfectionwithanaveragelagof6days.Thesignificanceofthetableisthatitprovidesabettermeasureoftheeffectivenessofpolicyinterventionsthanrecordedcasenumbers,whicharedatedwhentheyarerecorded.However,theaggregatedatapresentedinthisreportisnotthemostinformativebecauseitdoesnotdistinguishbetweenoverseasanddomesticcases.OverseasinfectionsobviouslycannotrespondtoNewZealandpolicyorbehaviouralchanges.FortunatelythisdatawascollectedandisavailableontheESRwebsiteandispresentedinthefigurebelow.Thefigureshowsthedatabydateoftheappearanceofsymptoms,fordomesticinfectionsrepresentedbytheorangeand

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greenbars.Theimportantpointstonoteisthatthesecasesarerelatativelyfew,butreducedmoreslowlythanoverseas-relatedinfections.Figurenine:Dailycasesreportedandsymptomonsetdates

Wecanusethisfiguretoascertainwhentheinfectionsoccurredbyassumingtheaveragetimebetweentheinfectionandtheappearanceofsymptomsisabout6days.Unfortunatelyitisdifficulttoreadthedatesonthefigure,butthepeakdayforoccurrenceofsymptomswas23March.Taking6daysoffthattakesusto17Marchforthepeak.Thenumbersthenbasicallywentsidewaysuntil22March.Thissuggeststhatcontacttracingandvoluntarybehaviouralchanges,withpossiblyacontributionfromtheleveltwomeaures,broughttheepidemicundercontrolbeforethelevel4measurestookeffect.Levelthreerestrictionswouldhavemadeasubsequentcontributiontothereductions,thoughenhancedcontacttracingwouldalsohavehelped.Itisnotpossibletoascertainwhatmarginalcontributionthelevel4restrictionswouldhavemade–itwasprobablysmall.Oncethelevel4restrictions(andlevel3also)wereremovedtherewasnoupwardmovementincasenumbers.

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Figureten:Dailydomesticandforeigncasereportingandsymptomonsets

Whatisnoteworthyhereisthatwhilethefirstfigurewaspresentedtherewasnocommentonitssignifcance.Further,theESRfigurewasnotpresentedatall.Perhapsitdidnotsitwellwiththenarrative,thatlevel4‘saved’NewZealand.Orofficialsweresimplyincapableofinterpretingthedata.Therewasacomparativegraph,shownbelow,onthepercentageofcasespertest,whichconfirmedthatNewZealandwasmatchingthesuccessfulTaiwanese,AustralianandKoreanexperiencesatanearlydate.Figureeleven:Percentageofpositivetestresults

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10May2020SituationupdateUnchangedfromthepreviousreport.Thereissomeinformationontestingandcontacttracing,particularlyontheperformanceagainstthetracingperformancetargets.12May2020SituationupdateThereisreportingonasymptomatictargetedtestinginsectorsmostatrisk–frontlinehealthandpolice.Therewasonepostivecasewherethesourcecouldnotbeidentified.ThereweresevenpositivecasesamongstAucklandairportworkers13May2020WeeklymonitoringreportAfter14daysatlevel3,wehavenotseenanycasesattributabletorelaxedrestrictionsornon-compilance.Onlythreenon-importedcaseshavesymptomonsetdatesinMayandthesearehealthcarestafforhouseholdcontactsconnectedwithresthomeclusters.Thereisdetailofcasesovertheprevious14daysbysourceoftransmission.Thedateoftheonsetofsymptomsisprovidedforthemostrecentcaseineachcategory.ThereisalsoabreakdownbyDHBandbysourceoftransmission.Astheaggregatenumberswereclosetozerothiswasnotinformative.14May2020SituationupdateNewZealandcontinuestoprogresswellagainstthestrategy.Thenumberofactivecaseshascontinuedtosteadilydecline,withdailynewcasesatzeroorremaininginthelowsingledigits.WidertestingbyDHBshasnotfoundunknowncases,givingconfidencethatcasesareconfinedtohouseholds,andknownandmanagedclusters.WearewellplacedaswemoveintoLevel2,whilecontinuingtocloselymonitornewcases,andemphasizingtheneedforcontinuinghygieneandphysicaldistancingmeasures.

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17May2020MonitoringreportNewZealandcontinuestoprogresswellagainstthestrategy.Thenumberofactivecaseshascontinuedtosteadilydecline,withdailynewcasesatzeroorremaininginthelowsingledigits.Barswillbepermittedtoopenfrom21May.BythenwewillbeinapositiontobeconfidentthatCOVID-19casescontinuetobecontainedsincethemovetoLevel3.Wecontinuetoemphasisetheneedforhygieneandphysicaldistancingmeasures.Bythispointtherewaslittletosay.21May2020MonitoringreportNewZealandcontinuestoprogresswellagainstthestrategy.Thenumberofactivecaseshascontinuedtosteadilydecline,withdailynewcasesatzeroorremaininginthelowsingledigits,andallnewcurrentcasesarelinkedtoknownclusters.WiderasymptomatictestingbyDHBscontinuestoreturnnegativeresults,givingincreasedconfidencethatcasesareconfinedtoknownclusters.

24May2020MonitoringreportThisisidenticlaltotheabove.

26May2020MonitoringreportDelayfromtheappearnceofsymptomstocaseconfirmationappearstobedowntoacoupleofdays.

27May2020MonitoringreportTwenty-eightdaysaftertheshifttoAlertLevel3,wearenotawareofanycasesattributabletorelaxedrestrictionsornon-complianceunderLevel3or2.

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B:ESRReportsESRisaCrownresearchentitythatprovidednationalandinternationalCovid-19intelligencetotheMinistry.ThiswasthebodythatadvisedtheMinistryinlateFebruary2020thattheriskofanoutbreakinNewZealandwaslow. ItcontinuedtoprovidetheMinistrywithriskassessmentsthroughthelockdownperiod.ThesereportswereusedbytheMinistryinitsriskassessmentsandapparentlymadeavailabletotheDirectorofCivilDefencetoaidherassessmentsoftheneedforextensionstothestateofemergency.Thefirstreportmadepubliclyavailableisdated3April2020.AtthatdatetheassessmentoftheriskoftranmissioninNewZealandwas:RiskoftransmissionMostcasesinNewZealandtodatearelinkedtointernationaltravelandsubsequentclosecontact,thereisaccumulatingevidenceoflimitedcommunitytransmissionbutatthistimenoevidenceofwidespreadsustainedcommunitytransmissioninNewZealand.Basedonthecurrentdomesticsituation,theglobalsituation,theavailableevidence,includinglimitedevidenceofpre-symptomaticspreadandsuperspreadereventsthelikelihoodoflimitedtransmissioninNewZealandisVERYHIGH,thelikelihoodofsustainedtransmissionisMODERATE-HIGHandthelikelihoodofwidespreadoutbreaksisLOW-MODERATE.Thisassessmentassumesthatcasesaredetectedinatimelymannerandthatinfectionpreventionandcontrolmeasuresareimplementedpromptly.However,ifthevirusisnotrapidlydetected,infectioncontrolmeasuresarenotinplace,orifthereissignificanttransmissionfromasymptomaticormildcases,thelikelihoodoffurthertransmissionincommunitysettingswouldbeconsideredVERYHIGH.PublichealthriskGiventheassessmentofthelikelihoodofimportation,thelikelihoodoftransmissioninNewZealandandthepublichealthimpact,theoverallpublichealthriskfromthiseventisconsideredHIGH.Overalltheassessmentwasnotveryinformative.Thereisnoanalysisoftheactualoutcomesupto3April2020,andtheESRweremostlyjuststatingtheobvious.Iftherewasaprospectoffurtherimportedcases,andsomedomesticcases,thenofcoursethelikeihoodoffurtherlimitedtransmission(atleastonecase)wasveryhigh.Andwhilethelikelihoodofwidespreadoutbreakwasratedaslowtomoderate,thiswassufficientlycaveatedtogivethemanoutiftheirassessmentturnedouttobewrong,oriftheMinistrywantedtopaintagloomierpicture

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ImportationriskTherewasalsoanassessmentofimportationrisk,whichwassignificantinlightofthesubsequentmovetoimposeaquarantineonallreturningNewZealanders.EvenwiththecontainmentmeasuresinplaceinothercountriesandthebordermeasuresandcontainmentmeasurescurrentlyinplaceinNewZealand,thelikelihoodofcaseshavingbeenimportedintoNewZealandremainsHIGH.Whichisatrue,butalsoavacuousstatement.OfcoursethelikelihoodofcaseshavingbeenimportedintoNewZealandwashigh.Howelsecouldcouldtherehavebeencovid-19inNewZealand?.TherealsoremainsaHIGHlikelihoodoffurtherimportationsfromanyfurtherreturningtravellers,duetohighratesofinfectionworldwide.Whichisanothertritestatement.Iftherearealargenumberofreturningpassengersthenthelikelihoodthatatleastonewouldbeinfectedwillbehigh.Butthereisnoevidenceofanyassessmentofthecontrolissuesdesignedtomitigatetheriskofonwardtransmissionduetofailureofselfisolationorquarantineprotections.ThereportgaveustheimpressionthattheESRwasjustmanufacturingquotable‘highrisk’assessmentstoorderfortheMinistry.ThemostusefulpartofthereportwasadescriptionofastudyontheChineseexperienceApre-peerreviewedstudyinwhich4950closecontactsofcasesinGuangzhouwerefollowedupandtestedeveryseconddayuntilapositiveresultwasobtainedorquarantinewascomplete,found126(2.9%)wereconfirmedtobeinfected.Probabilityofinfectionincontactsincreasedwithbothageofcontactsandseverityofinfectionincases,from1.8%(0-17years)to4.2%(60oroveryears),andfrom0.33%forasymptomatic,3.3%formild,to6.2%forsevereorcriticalinfectionTheevidencethattransmissionbyasymptomaticcaseswaspossible,butthatthelikelihoodislowisanimportantpieceofevidence,particularlyrelevanttothebordercontrolissue.

30April2020ESRAssessmentTherewasasecond,twopage,assessmenton30April2020.TherewasnodiscussionoftheNewZealanddataatall.A‘precautionary’approachwastaken,whichweassumedmeantaheavybiastonegativeassessments.Theassessment,wasjustarepetitionoftheir3April2020assessment.

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ImportationriskEvenwiththecontainmentmeasuresinplaceinothercountriesandthebordermeasuresandcontainmentmeasurescurrentlyinplaceinNewZealand,thelikelihoodofcaseshavingbeenimportedintoNewZealandremainsHIGH.TherealsoremainsaHIGHlikelihoodoffurtherimportationsfromanyfurtherreturningtravellers,duetohighratesofinfectionworldwide.Thereisnodiscussionofhowtheycametothis‘highrisk’conclusiononfurtherimportations.Andtherewasnoexplanationofwhatwasmeantby‘furtherimportation’.Iftheymeanthatsomeoneinquarantinewilldevelopthevirussometimeinthefuture,thentheoddswereobviouslyhigh.Butiftheymeantthatthereisarisksomecaseswillgetthroughthequarantineandinsufficientnumberstopresentamaterialrisk,thenthisisadifferentstory.TransmissioninNewZealandTherewasanotherassessmentofriskoftransmissioninNewZealand,whichwaswordforwordidenticaltotheoneinthe3Aprildocument,despitethemarkedchangeinthenumberofnewcasesoverthatperiod(from75tojust3).Butagainthereisnodiscussionofthenumbersandhowtheycametotheconclusionthattheriskshadnotchangedfrom3April2020.TheinterpretationoftheirassessmentsbecomesfoggierbecausetheESRneverexplainwhattheymeanbytheirqualitativeassessments.DoesriskoflimitedtransmissioninNewZealand,forexample,refertoonecase,orten,andoverwhattimeperiod?Overthenextweekornextyear?Anddoeslow-moderateriskmeana10percentchanceora50percentchance?Withoutthenecessaryprecisioninthesedefinitionstheseassessmentswerelargelymeaningless,butopentoabusebythosewantingtooverstatetherisks,anddownplaytheprogressthatwasbeingmade.PublichealthimpactTheassessmentofthepublichealthimpactwasasfollows:ThepublichealthimpactisconsideredHIGHbothforpublichealthstaff,thewiderhealthsectorandthecommunity.AsanassessmentofwhatwashappeningattheendofAprilthiswasobviouslywrong.Therewerefewcasesandthehospitalswereoperatingwellbelowcapacity.Itisdifficulttounderstandwhattheycouldhavebeentalkingabout.

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PublichealthriskGiventheassessmentofthelikelihoodofimportation,thelikelihoodoftransmissioninNewZealandandthepublichealthimpact,theoverallpublichealthriskfromthiseventisconsideredHIGH.Againthisisthesameasthe3Aprilreportandthereisnotashredofevidencetosupporttheassessments.RequirementsforreducingthepublichealthriskassessmentThenwearetoldwhatwasrequiredforthepublichealthrisktoreduce.Fortheoverallpublichealthrisktoreduce,therewouldneedtobeademonstrablereductionineitherorboththeprobabilityandimpactofCOVID-19ontheNZpopulation.Intheeventofanydoubt,forexampleduetoinsufficientevidence,thehigher-riskoptionisselectedaccordingtoprecautionaryprinciples.Theprobabilityofinfection,includingsustainedandwidespreadtransmission,dependsonexposurefromfurtherimportationevents,andfromwithinthecommunity,susceptibilityofthecommunitytoinfectionandinfectiousness.Impactdependsonthenumberandseverityofinfections,andthecapacityandcapabilityofthehealthsystemtorespondtomanagecasesandsuppressoutbreaks.Thisignorestheactualevidence,ismostlyvacuous,andhidesbehindthe‘precautionary’principletoavoidmakingamorepositiveassessment.Thereisthestandardrecitationofriskreductionrequirements.Thekeyrequirementsforriskreductionare::•Robustsustainablebordercontrolmeasurestoreduceimportationofnewcasesandpreventonwardtransmissionfromanyimportation•Capacityforwidespreaddiagnostictesting,rapidcontacttracingandisolationacrossallDHBs•Implementationofanepidemiologicallyrobustsurveillanceplanincludingsyndromicsurveillance,sentinelsurveillanceandacommunitysamplingstrategytoenablerapiddetectionofchangesindisease,andunderstandcommunityprevalence,susceptibilityandtransmission,includingthecontributionofasymptomaticandpresymptomaticinfections•Healthsectorcapacityformanagementofcasesacrossthespectrumofseverityincludingrequirementforintensivecare,withappropriateprotectionofstaff.Butwiththeexceptionoftherathermeaninglessbordercontrolassessment,noassessmentsaremadeofprogresstowardsthese‘key’requirements.ReviewsashamThesereviewswereanobvioussham.TheMinistryjustcommissionedreportswithsome‘helpful’highriskassessments.Theyprobablydidnotwant,anddidnotget,anactualreviewoftheevidence.TheERMdulyobliged.

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C:Movingtolevelsthreeandtwo-policypapers12April2020EstablishingaContacttracingassurancecommitteeThisreflectedthegovernment’songoingconcernthatcontacttracingneededtoberobust. 15April2020AlertLevelFrameworkforLevels1,2,and3:DetailsThispapersoughtagreementtoanimplementationframeworkformovingfromalertLevel4toloweralertlevels.Therewasanawarenessoftheeconomicandsocialcostsofthealertlevels. ItiscriticaltomitigatethesocialandeconomicimpactsoftheAlertLevels,totheextentpermissiblewithinaneliminationstrategy,andgivenextantpublichealthrisks.Weknowtheserestrictionsarecausingsevereeconomicdisruptionandhardship,andthreatensocialwellbeingaswellaspublicacceptabilityofthemeasuresiftheyarenotseenasproportionate. Butitwasargued: Asuccessfuleliminationstrategy,ifquicklyachieved,isthebestwaytolimittheeconomicimpactofCOVID-19.Ofalltheeconomicscenariosinofficials’forecastanalysis,thisstrategyinvolvesnominalGDPrecoveringthefastestandstrongestoverthenextfouryears. ThisisprimarilybecauseitassumesalongperiodatAlertLevels1and2fromJune2020.Thisreinforcestheobjectivesofthispaper–tode-escalateAlertLevelsinawaythatminimisesthechancesofafuturere-escalation.Ifminimisingofthechancesofafuturere-escalationisindeedtheobjective,thenthewayaheadwouldbeclear.Stayonlevelfourfortheforseeablefuture.Reducingthechancestoanacceptablelevelwouldhavebeenamoresensiblewaytodescribetheobjective.Aquickeliminationoftheviruswouldbethebestimmediateoutcome,butitwoulddependonhowquick.Therewasnoanalysisofdifferentstrategiesoverdifferenttimehorizons.Italsodependsontheimpactofasuccessfuloutcomeonsubsequentactions.Ifthispromptsaresponsetoseparatefromtherestoftheworld,thenofficials’previousassessmentwasthiscouldbeaworstcaseoutcome.

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ThereferencetotheTreasuryScenarioswasmisleading.TheTreasuryforecastswerenotfinelytunedenoughtodifferentiatebetweenrelativelyshortperiodsinlockdown4.Butiftheyweretheywouldhaveshownthatshorterisbetter,andthelowerthealertlevelthebetter.Treasurydidnotknowhowlongthelockdownsandotherrestrictionswouldlastsotheysimplyguessedatdifferenttimeperiodsandassessedtheeconomicconsequences.Thepapergoeson. TheoverallprincipleofthecontrolsundereachAlertLevelisthatweadopttheleastrestrictivemeasurescommensuratewithmanagingthepublichealthrisk,asexpressedinthecurrentAlertLevelframework:This‘principle’doesgetusveryfar.Italldependsonwhatismeantbymanagingthepublichealthrisk,whichisneverspeltout.Itisjustassumedthatthecurrentalertlevelisthecorrectresponsetotherisk. WewanttoallowformoresocialandeconomicactivitywhenmovingfromAlertLevel4to3,becausetherearelowerpublichealthrisks.However,wecannotloosenallrestrictionsorloosenthemtoofarinLevel3,becausethereisstillaheightenedriskthediseaseisnotcontained Therewasnoexplainationofwhatthis‘heightenedrisk’meantandhowthisassessmentwasmade.Operationalisingthe‘framework’TheprincipalmatterstobetakenintoconsiderationindeterminingwhetherthegovernmentcouldstepdownfromAlertLevel4wereexplainedtotheCovid-19MinisterialGroupon9April.Theconsiderationswererepeatedinthisdocument,butthereporttotheMinisterialGroupwasnotreleased.Whilethereisalistofconsiderations,thereisnoanalyticalcontent,oranycluegivenastohowtheconsiderationsaretobebalanced.Thecriticaldeterminantwasthehealthriskperspective,whichintheendcomesdowntotheDirectorGeneralofHealthbeing‘satisfied’.AndtheDirectorGeneralhasnoincentivetobe‘satisfied’.Ifcasespickup,thenhemightbeshoulderedwiththeblame.Bettertostallaslongaspossible. HealthriskcriterionThereissufficientdatafromarangeofsourcesincludingtestingandsurveillancethatpublichealthexperts,statisticiansandmodellerscanhavereasonablecertaintythatundetectedcommunitytransmissionisunlikely,

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Thissetsaveryhighbar.Thereisalwaysariskofundetectedcommunitytransmission,unlessthediseasehasbeeneradicated.Ifthistestwasactuallyfolloweditcouldhavemeantmonthsinlevelfour. Nodocumentsettingouthowthetestwouldbeappliedhaseverbeendisclosed.Itappearsthatthetardinessofthemovefromlevel4,whenitshouldhavebeenclearthatcasenumbershadfallenabruptly,andwhenAustraliahadshownthatwidespreadworkplacelockdownswereunnecessarytobringtheepidemicundercontrol,wasdrivenbythis‘undetectedcommunitytransmission’mantra.Thereissufficientrigorousandrapidcaseidentificationandcontacttracing,withsurgecapacityavailableinthecaseofanoutbreak.Againnodocumenthasbeendisclosedonhowthisconsiderationwouldbeassessed.Norhasanyconsiderationeverbeengiventohowitmapswiththelowriskofcommunitytransmission.Ifthelockdownistobemaintaineduntilnewcasenumberswereverylow,thenthereislessneedforahighcontacttracingcapacity.Ourself-isolation,quarantineandbordermeasuresarerobustandadheredto, andThereiscapacityinthehealthsystemmoregenerally,includingtheworkforceandICUcapacity(plustheavailabilityofPPEforthoseforwhomitisrecommended),Itwouldhavebeenself-evidentthatthiswasaneasytesttomeet.ThenthereisthebroaderrangeofconsiderationsfortheGovernmenttoweigh:

• Evidenceoftheeffectsofthemeasuresoneconomyandsocietymorebroadly,

• Publicattitudestowardsthemeasuresandtheextenttowhichpeopleandbusinessesunderstand,acceptandabidebythem,and

• considerfairness,equityandpublicacceptanceofanyrestrictionson

activities,andjustifyallmeasuresfromascientificperspective,butbalancetheoverridingpriorityofmanagingthepublichealthriskwithenablingasmuchsocialandeconomicactivityaspossible,andreducetheimpactontheeconomy’slong-termrecovery.Wehaveseennoscientificjustificationformostofthemeasurestakenandourassessmentofthevariousmonitoringreportsshowsthattherewasnoseriousinterestinanalysingtherelevantdata.

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Thenthereisanargumentforretaininggeographictravelrestrictions.Theseextendedbubblesmustbewithinthelocalareatominimisetheriskofspreadingpersontopersontransmissionbetweengeographicareas. PeoplewillneedtobereadytorevertbacktotheirhouseholdbubblesifwehavetoreturntoLevel4. Thisdoesn’treallyexplaintheneedforgeographicrestrictions.CaseswerealreadygeographicallydispersedinNewZealand,soitwasnotamatterofkeepingthevirusoutofcertainareas,sotheycouldhavemorepermissiverules.Providingpeoplekepttothesocialdistancingrules,thenthegeographicalspreadoftheextendedbubbleshouldn’thavematteredmaterially.Thecontacttracingsystemwasbythensetuponanationalbasisandsogeographiclocationofanewcaseshouldn’thavematteredtoomuch.RecreationalrestrictionsForrecreationalactivities,atLevel3,theproposedsettingsaresimilartoLevel4.Thisreflectsthecontinuedrestrictionsonpersonalcontactneededtomanagethehighpublichealthrisk.Limitedsafe(lowinjuryrisk)sportandrecreationalactivitiescanbeundertaken,wheretheyareclosetohomeanddonotinvolveadditional‘bubbles’(ienocontactsportormixingwithothersoutsideextendedbubbles), orwhichriskrequiringsearchandrescue.Fishingoffalocalwharf,forexample,ispermittedifphysicaldistancingcanbemaintained.Theinitialrestrictionsonrecreationalactivitiessuchasfishingoffwharvesthatdidnotinvolveanextensionofbubblesorbreachedphysicaldistancingrequirementswasoneofthelesscomprehensiblepartsoftheregime.Therestrictionon‘risky’activitieswasatfirstexplainedbytheneedtoclearhospitalcapacityforaninfluxofcoronaviruspatients.Itveryquicklybecameevidentthatthatinfluxwasn’tgoingtoeventuate,butittookquitesometimeforthestorytochange.Thenitbecamethepressureitwouldplaceonsearchandrescueresources.Itisnotobviouswhythiswouldbeasignificantissue,giventhelownumberofsearchandrescueevents,andwhythiswouldhaveanimpactonCovid-19risk.Oneexplanationisthatitwouldtieuppoliceresources,whichwouldotherwisebeprojectingthecoercivethreatbehindthesocialdistancingrestrictions.InourviewreducingthedegreeofintimidationintheregimewasagoodnotabadthingPopulationimplications TheimpactofCOVID-19onpopulationgroupsisnotyetclear.However,wedoknowthatsomegroupshaveahigherincidenceoftheriskfactorsthatleadtosevereillnessfromcontractingthedisease,especiallyMāoriandPacificpeople,olderpeopleandthedisabilitycommunity.

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Themajorimpactonpopulationgroups,intermsoftheseriousnessoftheoutcomeswasoverwhelminglyclearatthepointthereportwaswritten.Itprimarilyaffectstheaged.Theimpact,intermsofdeathrates,ontheworkingpopulation,andespeciallyonchildrenisverylow.TheMaoricaseincidencewasabouthalftherateoftheEuropeanandotherpopulation. Onelarge‘disadvantaged’groupwasmissed.Onanage-adjustedbasismalemortalityisabouttwicethefemalerate.ThelockdownatLevel4andtherestrictionsatLevels2and3willalsodisproportionatelyimpactonsingleparenthouseholds,andthereforewomen,inaneconomicandsocialsense.Itisalsolikelythatfamilyandsexualviolencewillincrease,underthelockdownandalsoinlightoftheeconomicdownturnwithmorejoblessnessexpected,withadisproportionateimpactonwomenandchildren. Thereisnomentionhereoftheimpactonsmallbusinessownerswhohavedisproportionatelybornethecostofthelockdown.Manyhavelosttheirincomes,andwouldberunningataloss,andriskthedemiseoftheirbusiness. HumanrightsTherewasadiscussionofhumanrightsimplicationsofthemeasures.Ratherthantherebeingnohumanrightsconcerns,aswasthepretenceon23March,theyturnouttobeverysignificant.TherestrictionsimposedatLevels3and4oftheAlertsysteminvolvethemostsignificantandwidespreadinterferencewithhumanrightsinNewZealandinlivingmemory. Thereisadiscussionofthelegalityoftherestrictions,thatwediscussindetailinPartseven.20April2020ReviewofCovid-19alertlevel4CabinetpaperfromOPM

Thepaperbeginswithareviewofprogresstowardselimination.

WehavelearnedthatourLevel4restrictionsareveryeffective.TheyhaveslowedthespreadofthevirustoagreaterextentthanthemostoptimisticscenariointhemodellingfromProfessorShaunHendy’steamthatwehavebeenusing.ThisisgoodevidencethatoursystemsforcontrolworkwellProfessorShaunHendry’steamwasTePunahaMatatiki(TPM).Wewereextremelycriticaloftheirmodellingin‘Alookbehindtheheadlines’.Themodellingwas

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designedtopromotethecaseforahardlockdownandotheroptionsweresimplycalibratedtofail,orwerenotreportediftheylookedtoofavourable.Therewaslittleanalyticalsupportforthekeyreproductionrateassumptionsandthemodellingdidnotexplicitlyaccountfortesting,contacttracingandisolation.Whenthemodellingwaspubliclyreleaseditwasalreadyapparentthatitwasover-estimatingcasegrowthoutcomes,andthatitshouldhavebeenrecalibratedtoproduceloweroutcomesfortheloweralertlevels.Hendry’sresponsetoourcriticismswasjustthat‘wedidnotunderstandthemodel’.Hedidnotengagewiththespecificcriticisms.ItdidnotoccurtotheOPM,intheirassessment,thatiftheoutcomeswerebetterthanthemostoptimisticmodelling,thenthemodellingwasflawedandthelevel4measureshadbeentooconservative. WehavealsodefinedwhatLevel3lookslike.Wehaveexplainedthatitmeansthatweareinasituationwherethereisahighriskthatthediseaseisnotcontained,wherecommunitytransmissionmightbehappening,andwherenewclustersmayemergebutcanbecontrolledthroughtestingandcontacttracing. Thisdefinitionborealimitedrelationshiptothereality,andwassoelasticastojustifyalmostanything.Thediseasewasobviouslybeingcontained.On20Aprildailycasenumbersweredowntoabout10andtherehadbeenacleardownwardtrajectory.Atleastonecaseofcommunitytransmissioncouldoccuratanytimeunlessthediseasehadbeeneradicated,sothispossibilitydoesnotusefullydefinelevelthree. Tothathighleveldescription,wehavenowaddedasetofdetailedcontrolsthatareprincipled,science-based,proportionateandmoreequitablethantheemergencyrequirementsofLevel4.Whichissomethingofanadmissionthattheemergencyrequirementswerenotprincipled,science-based,orproportionate.

TimingoptionsThreetimingoptionswereproposed.

• 22ndAprilinlinewithinitiallockdownannouncement• Extendlockdownforfivemoredays.

TheextrafivedaysatLevel4willincreaseourconfidenceinthepositivetrendsweseeinthedata.Therewasnoassessmentofhowmuchconfidencewouldbeincreasedwithanadditionalfivedaysofdata.

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AlsoitwouldmoderateconcernsofasuddenincreaseinmovementsinthecommunityoverAnzacweekend.Thisargumentwaslargelyspurious.Ashouseholdswouldstillbelargelyinlockdown,therewouldnotbeaholiday-drivenincreaseinmovements.Ifanythingtheholidaywouldreducetheincreaseintravel.

Therewasnoassessmentofthemarginalcostofextendingthelockdown.TakingtheTreasury’sroughestimates,thecostwasabout$150millionaday.$600millionisasignificantsumtopayfortheDirectorGeneraltocontemplatejusthowmuchmorecomfortablehewasfeeling.

• ExtendtheLevel4controlsforafurthertwoweeks.

Inthisscenario,therewouldbestillfurtherconfidenceintermsofthetrajectoryofcasesandthechancesofunexpectedoutbreaks,butitwouldcomeatsignificantadditionalcosttooureconomy,ourbusinessesandworkers,andtheirfamilies.Further,withsuchlownumbersofcasesnowbeingreported,thisoptionrunstheriskoferodingthesupportofthecommunitythatwepresentlyenjoy.

TheassessmentprocessTherewasaperfunctoryreviewofsomeoutcomes.Thenumberofnewcaseshasfallensharply,andthenumberofpatientswhohaverecoverednowoutnumbersnewcases.Casesofcommunitytransmission,i.e.wherethetransmissionpathisunknown,accountforthreepercentofcasesoverall. ThebestavailableestimatesarethatunderourLevel4restrictions,eachinfectedpersoninfects0.48others(thismeasureisknownasR0),indicatingthattherestrictionsreducethespreadofthevirusbyabout80percentrelativetoanaverageR0seenoverseasof2.5.Thisisafurtherindicationthattheresponsewasdisproportionatelystrong.AhigherR0,wouldstillhavehavebroughttheepidemicundercontrol.BenefitsoftheeasingOverall,atLevel3,weexpectthatabout400,000peoplewhohavebeenunabletoworkduringthelockdownwillbeabletogobacktowork,leavingaboutonemillion(40percentoftheworkforce)stillunabletowork.Businessesthatcannotoperateremotelywillbeabletoopenwheretheycanoperatewithinpublichealthguidelines.Withverylimitedexceptions,customersmaynotenterbusinesspremisesOurLevel3restrictionsarestillconstraining,reflectingthefactthatitiswiseforustoerronthesideofcaution.Iviewthemoverallasbeingproportionatetothechallengeswefaceatthisstageoftheresponse.Theywerebuiltfromthebestavailablepublichealthadvice.

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This‘bestavailable’publichealthadvicewaspresumablyreflectedintheDirectorGeneral’s‘satisfaction’.Therewasnoevidenceofanysupportinganalysis.InlinewiththerequirementssetbyCabinetlastweek,theDirector-GeneralofHealthhasconfirmedheissatisfiedthat:a.Thereisalowbutresidualriskofcommunitytransmission.Thenumberofnewcasescontinuestodropevenwithhighlevelsoftesting;allbutasmallnumbercanbelinkedtoexistingcases.Thereisconfidencethatsuchcasesarebeingidentifiedeffectivelyandthereforereasonablecertaintythatthereislittleundetectedcommunitytransmission.b.Thereissufficientcapacityintestingandcontacttracingtorespondtoasurgeindemand;contacttracingmeetstheWHO’sguidelinesforresponsiveness.c.ThereisstrongsupportandcomplianceforcontrolmeasuresamongNewZealanders,andnoreasontobelievethiswillchangesignificantlyasaresultofmovingAlertLevel.d.ThehealthsystemhassufficientcapacitytorespondtoCOVID-19andhasidentifiedsurgecapacityandcontingencyplans;however,thewiderimpactsonhealthoutcomesfornon-COVIDpatientsisanincreasingconcern.TheassessmentThisreviewofoursituationcansupporteitheracautiousrelaxationofcontrolsnationwide(thepotentialforregionalcontrolsisdiscussedfurtherbelow),oracontinuationofLevel4foranadditionalperiodtofirmupourconfidenceinthedataandparticularlyinplaceswherewehaverelativelylessinformation.Eitherpathisconsistentwithoureliminationstrategy,solongaswemaintaintheflexibilitytogobacktoLevel4ifrequired ItisuncertainhoweffectiveourLevel3measureswillbeinslowingthespreadofthevirusTheuncertaintyaroundlevel3isbecausetherehadbeennoanalysisoftheimpactsofthelevel4restrictionsbytheMinistry. Thebestavailableestimatessuggestthatifourcontrolmeasuresarenotsufficientlyeffective,wewillneedtoreturntoLevel4onseveraloccasionsforshortperiodsovertherestofthisyear,anduntilthereisavaccineoratreatmentthatrenderstheviruslessdeadly.Ontheotherhand,ifourLevel3measuresplusourpublichealthmeasurescontinuetobeaseffectiveastheyhavebeen,thenwecancontinuewithoureliminationstrategywithoutgoingbacktoLevel4.This‘bestavailable’evidenceappearstohavebeentheTPMmodellingdiscussedbelow.ThisisillustratedinthegraphbelowthatshowstwoscenariosfromProfessorShaunHendy’smodellingteamforwhatmighthappenifwemovedtoLevel3fromApril23.

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Figuretwelve:TPMcasemodelling.

• TheredlinesimulatesmoreeffectiveLevel3controls.Eachinfectedpersoninturninfectslessthanoneother(R0=0.94).Youcanseethatreportedcasenumbersstaylowandcontinuetodecline.Thiswouldbesimilartowhatwehaveseeninrecentdays,ie,asmallnumberofcasesthatareswiftlyisolatedandtraced.•ThebluelinesimulateslesseffectiveLevel3controls.Eachinfectedpersoninturninfectsupto1.22others.Theseshorttermresultsforeshadowthestartofthefamiliarandunwelcomespikeofexponentialgrowth. This‘analysis’wasbasedonsomeimplausibleestimates,fromamodellingteamwithatrackrecordinoverestimatingcasenumbers.IfR0hadfallentoabout0.5,andonly400,000arereturningtowork,undercontrolledconditions;whiletheothermeasuresareonlymarginallyreduced;andwhilecontacttracingisbecomingincreasinglyeffective,thenitwashighlyimplausiblethatamovementtolevel3wouldincreaseR0to1.22,orto0.92.Morelikelyitwouldincreaseto0.6or0.7.HowTPMarrivedattheirestimateshasnotbeendisclosed.Itislikelythattheyweremadeuptogeneratethedesiredconservativeresults.Theconclusionthatshouldhavebeendrawnfromthetableisthattheconsequencesof‘gettingitwrong’werenotveryserious.Ifthereproductionratewasindeed1.22thentherewouldonlybeaslowdivergenceinthecasenumbers,andthereproductionnumbercouldbeboughtbacktounderonewithatweakinthebusinesslockdownrequirement.Everyaspectofourcontrolsgoesintoreducingthespreadofthevirusinthe

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community.Workisongoingtobetterunderstandwhichinterventionsreducethespreadatthelowestsocialandeconomiccost.Inthemodelling,themostimportantinfluencesontherateofspreadarethespeedoftesting,contacttracing,andisolationofthoseexposedtothevirusandtheirclosecontacts.ThisappearstobeareferencetotheTPMmodellingagain.Thismodellinghasnotbeendisclosed.Theydidappeartoupgradetheironlinecalculatortotakeaccountofcontacttracing,butthelinkagesweresubjective.Becauseofthelagbetweeninfectionandthedevelopmentofsymptoms,itwilltakeabouttwoweeksunderLevel3tostartseeingwhatthenewtrackofcasenumberswillbe.Butthemodellingillustratesthatthelongerweareinlockdown,themoreconfidencewecanhavethatwearereallyontopofthespreadofthediseaseanditwon’tmakeacomebacksothatwehavetoreturntoLevel4togetitbackundercontrol.Thisisillustratedinthechartbelow,withalongextensiontolockdownfortwofurtherweeksbuyingusmoretimeevenifLevel3controlsplusourpublichealthmeasuresturnouttobelesseffectivethanwehope.Atwoweekextensionwouldbeaveryprecautionaryapproach,basedonaconcernthat,despitetheevidence,theremaybeundetectedcommunitytransmission.ThefigureactuallyshowedthatevenifyoubelievedtheTPMreplicationnumbers,theextensionofthelockdownwouldnotbeconsequential.By1Julytherewouldbeabout3casesratherthanabout1.Thedifferencecouldeasilybehandledbytestingandtracing.Figurethirteen:TPMsixweeklockdown

Therewasareviewofhowsomecountrieswerecomingoutoflockdown,emphasisingtheircautiousapproach.Butasthecasenumberswhentheystarted

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easingwerenotshownthiswasnothelpful.Itisonethingtobecautiouswhenyoustillhavedozensorhundredsofcasesadayandareproductionratejustbelow1,andanotherwhenyouhavejustahandfulandareproductionnumberof0.5AustraliaismentionedashavinganexperiencethatisbroadlyequivalenttoNewZealandbuttherewasnomentionthatthiswasachievedwithoutalevel4lockdown. HumanRightsTherewastherecitationoftheimpactonhumanrightsseeninpreviousdocuments.Butthereisanextensionofthediscussiontointernationalhumanrights. Asforinternationalhumanrightsobligations,therightsprotectedbytheInternationalCovenantonCivilandPoliticalRightsarefullyreflectedinBORA.SeveralrightsaffirmedintheInternationalCovenantonEconomic,SocialandCulturalRightsarealsoengagedbymeasuresdiscussedinthispaper.Theseinclude:a.Therighttowork(article6).b.Therighttothehighestattainablestandardofphysicalandmentalhealth(article12)whichrequiresstatestoprevent,treatandcontrolepidemicillnesses,andalsoaccesstoelectiveprocedures.c.Therighttoeducation(article13). Thejustificationfortheimpostionofhumanrightsinterventionsisthattheoutcomes:couldnotbeachievedinamannerthatallowsforgreaterlibertyandenjoymentofmovement,associationandassemblyrights.PublichealthadviceisthattheLevel3measures,andtheassociatedrestrictions,arenecessarytopreventthespreadofCOVID-19.Thefactthatthemeasureswerebeingeasedfromlevel4wasarguedtobeevidenceofaproportionateresponse.Asaprotectionagainstoverreach: Therelevantgovernmentdepartmentswillkeepallrestrictivemeasuresunderconstantreviewtoensuretheyhaveafirmlegalbasis,aresufficientlywell-defined,canbedemonstrablyjustifiedinthecircumstances,andremainproportionatetothethreatposedbyCOVID-19.TheSolicitor-General,supportedbyaninter-agencyprocess,willensurethatongoingreviewstakeplaceandreportbacktoCabinetonaregularbasis.Thereislittleevidencethatthesehumanrightsbasedreviewsoccurredasisevidentinthenextpaper.HumanrightsarediscussedfurtherinPart9.

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24April2020Huntingunderalertlevel3 Thisdocumentconsideredrestraintsonhunting.Theanalysiswasasfollows:5Forittobeallowed,anyhuntingunderAlertLevel3wouldhavetobeconsistentwiththegeneralprinciplesforrecreationalactivityunderAlertLevel3:5.1havingalow-riskofinjury5.2undertakenaloneorwithinyourextendedbubble5.3involvingnomotorisedrecreation(onlyappliedinthecontextofwaterrecreationtodate)5.4involvingnotraveloutsideyourregion.TheDepartmentofConservationdoesnotbelieveitispossibletoallowhuntingonpubliclandsinwaythatfitswiththerulesandintentofAlertLevel3.Formanypeoplethe‘mostlocal’huntingopportunityonpubliclandswillstillbehoursaway.Facilitiessuchaspublictoiletswillnotbeavailable.Limitsontimeofaccesstopubliclandandclosureofhuts,intendedtoreduceriskandneedforsearchandrescuewouldneedtoapplytohunting,wouldseverelyreducethescopeforhunting.DOCexpectsthatwerehuntingallowedtherewouldbesignificantnon-compliancewiththeselimits,forwhichenforcementwouldbeimpossible.Therationalewasaconcernoveraccidentsandsearchandrescue.Thereareaveragesof1,030huntinginjuries,116huntersinvolvedinsearchandrescueincidents,and4.7deathsperyear.Althoughtheseincidentsoccurconsistentlythroughouttheyear,thereisaconcentrationbetweenMarchandJune,correlatingwiththepeakhuntingseason.Noconsiderationwasgiventothefactthatthehospitalswerequiet,andthathunters’deathswerenotarelevantconsideration,foracovid-relateddecision.Gamebirdshootingalsodidn’tpassmuster. OfficialsbelievethatthereisnowaytoundertakegamebirdshootinginawaythatfitswiththeprincipleofLevel3.Itisaninherentlysocialactivitythatinvolvesclosehumancontact.Itisalsonottypicallyusedtomeetsubsistenceneeds.Theimplicationthatitisimpossibletododuckshootingwhilemaintainingsocialdistanceisobviouslyabsurd.Itdoesn’ttaketwopeopletopullatrigger.

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HumanrightsOnhumanrightstherewasthefollowingstatement:ThehumanrightsimplicationsofrestrictingrecreationalactivitywerepreviouslyconsideredthroughpreviousadviceontheAlertLevelframework.TheMinisterofSportandRecreationsimplythumbedhisnoseatthePrimeMinister’spromisetokeepretrictionsunderconstantreview.TherewasnoongoingconsiderationoftheBillofRightsandinternationalhumanrightslaw. 4MayCOVID-19:PreparingtoreviewNewZealand’slevel3statusThispaperprovidedtheMinisterofHealth’sviewonhowthefactorsformovingtoalertleveltwoshouldbeassessed.Itrepeatedwhatwherebythenastandandsetofcriteria.AmovetoLevel2shouldbecontingentonconfidencethat:

• therehasbeennosignificantcommunitytransmissionofCOVID-19withinthepreceding28days(twoinfectioncycles);

• publichealthsurveillance,includingtesting,isrobustandcanprovideassurancethatcommunitytransmissionwillberapidlydetected;

• anycasesorclustersarecontainedandcontrolled;• contacttracingmeetsthestandardof80percentofcontactstracedwithinthree

daysofapositivetestbeingconfirmed;and• publicconfidenceintheGovernment’sapproachremainshigh,asmeasuredby

surveysandcomplaintstotheCOVID-19ComplianceCentre 6May2020PreparingforAlertLevel2OPMCThispapersoughtfinalagreementtotheoverallguidanceandrestrictionsthatwouldapplyatAlertLevel2,tosupportapublicreleaseofarevisedAlertLeveltableon7May.Thepapersetoutchangestoproposedalertlevel2restrictionsandmessagingthathadbeenagreedtoonApril15.Amongstthechangeswassomeencouragementtotravelbasedoneconomicconsiderations.

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Therearesignificanteconomicimpactsofcontinuingtodiscouragerecreationandtourismtravel.FortheyearendedMarch2019,totaltourismexpenditurewas$40.9billion,ofwhichdomestictourismexpendituremadeup$23.7billion.Asawhole,tourismcontributed$16.2billion,or5.8percentofGDP.ThetourismandaviationsectorshavebeensomeofthehardesthitasaresultofCOVID-19.Airpassengervolumeshavereducedbyaround97percent.Iamproposingthatweremovethe‘minimisenon-essentialtravel’advisoryandinsteadadvisepeopleto‘travelsafely’.

8May2020Covid-19EliminationstrategyforAotearoaNewZealandOn8May2020thisdocumentwasreleasedontheMinistry’websiteundertheDirectorGeneral’ssignature,articulatingthestrategy.Itread:TheGovernment’soverallstrategy…iselimination.ThatistoapplyarangeofcontrolmeasuresinordertostopthetransmissionofCOVID-19inAotaroanewZealand;EliminationdoesnotmeaneradicatingtheviruspermanantlyfromNewZealandratheritmeansbeingconfidentwehaveeliminatedchainsoftransmissioninourcommunityforatleast28daysandcaneffectivelycontainanyfutureimportedcasesfromoverseas.Itwasstillnotclearwhatwasmeantbyelimination.Doeseliminatingchainsoftransmissionmeanthattherehasn’tbeenasingledomesticcase(outsideborderquarantine)for28days?Ordoestheplural‘chains’meanthatsmallsporadicoutbreakscouldstilloccurbuttheviruswillstillbeeliminated?Heidentifiedthepillarsofthepolicy.Bordercontrolsareakeytoolforstoppingtheintroductionandspreadofnewcasesfromoverseas.Weanticipatebordercontrolsbeingprogressivelyrelaxedasitbecomessafetodoso,forexampleifweareconfidentthatothercountrieshavealowrateofcommunitytransmission.Furtherworkwillbeneededtoestablishcriteriaforthis.Robustcasedetectionandtransmission.Successfulcontacttracingmeansthat80percentofthecontactsofapersonaretracedandquarantined.StrongcommunitysupportofcontrolmeasuresThemostimportantmeasurestorestrictthespreadwillremainphysicaldistancing,goodhygiene;stayinghomeifsick,andPPEifrequired.Thereisnomentionofthemandatorymeasures,stillinplaceatthetime,thatwereultimatelybasedoncoercion.Therewasnomentionofthe‘equitybeingatthecentreoftheresponse’sloganthatappearedinseveralMinistrydocuments.

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10May2020AssessmentoffactorsformovingtoCOVID-19AlertLevel2:updatedfinaladviceThisisthereportfromtheDirectorGeneraltotheMinister.TheDirectorGeneralinitiallysaidthatthecriteriaformovingtolevel2havebeenmetbuthestillrecommendedadelayonsomeoftheeasings. Myinterimassessmentbasedontheavailableevidenceat8MayisthatonbalancewehavemetthecriteriaaboveandNewZealandisontracktomovenationallytoLevel2ontheCOVID19Alertscale,beginning13May(twoweeksafterenteringLevel3).However,thestepfromLevel3toLevel2isasubstantialoneandtherearerisksfromthemovetowardsLevel3thatneedtobeconsidered,andmyinterimviewissubjecttothefollowing:Level2createsasubstantialcumulativepublichealthriskfromtheaggregateeffectofrelaxationofmultiplecontrolmeasures.Weshouldalsobecognisantthatthelatestcasenumbers,whileencouraging,onlyrelatetoalimitedamountoftimespentatLevel3. Therefore,thetransitiontoLevel2shouldnottakeplaceallatoncebutshoulddelaythemostriskyactivitiesforatleasttwoandpossiblyfourweeks,toensureweareabletomonitortheeffectsofthefirstsetofchanges,andthatthecumulativeincreasedriskismanagedappropriately. Therealititywasthatthemovefromlevel4to3wasaneasydecision.Mostofthelevel4measureswereunnecessaryanditshouldhavecomeasnosurprisethattherewasnoimpactoncasenumberswhentheywereeased.Themovetolevel2,however,wasabiggerstepandtheDirectorGeneral’snervousnesswasunderstandable.TherewasalengthydiscussionofthereasoningbehindtheDirectorGeneral’sassessment,buttherealityisthatwiththeverylowcasenumbers,theshortrunoutcomeswereessentiallyrandom.Fromanepidemiologicalperspectivemoretimeisalwaysbetter,butonlyalittle,andthathastobeweighedagainstknownhighcostsofretainingrestrictions.Thereisafurtherdescriptionofelimination. ItisimportanttobeclearthateliminationdoesnotmeaneradicatingthevirusfromNewZealand,butrathereliminatingcommunitytransmissionundereachoftheAlertLevels,withanycasesorclustersrapidlycontainedandcontrolled.Wewillknowwehaveachievedthisaimforaparticularlevelwhenwehave28dayswithnosignificantunexplainedcasesofcommunitytransmission(i.e.twoconsecutiveincubationperiods)andanycasesandclustersarewellcontrolled.

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Thisconfirmsthattherewasnorigidrulethatcomnunitytransmissionmustbezero.Afew,butnotasignificantnumber,ofunexplainedcasesarepermissible.Thesignificantpartofthedefinitionisthatthetargetmustbeachievedateachalertlevel,andthenover28days.IfNewZealandweretoreverttohigheralertlevelsagainthenthissuggeststhattherewouldbealongtimeinlockdown.Itmighttake,say,amonthtogetbackdowntoasmallnumberofcasesinalevel4lockdown;then28dayswouldhavetobespentatlevelfourtomeetthe28dayrulebeforemovingtolevelthree;thenanother28dayswouldhavetobespentatlevelthree;atotalofthreemonths,ifallwentwell.Itwasneververyclearwherethe28daytestcamefrom.ItisnottwoconsecutiveincubatingperiodsastheDirectorGeneralseemedtothink.Itistwoquarantineperiods.Theaverageincubationperiodisabout5-6days.Thequarantineperiodof14daysisthetimebywhichsymptomswillhaveemergedin99percentofcases.ContacttracingThereisadiscussionofprogressinmeetingcontacttracingtargets.Themostrecentdatafromtheperiod13April-4Mayshowsthatwearewellonthewaytoachievingthetargetsforthetimefromonsetofsymptomstoaswabbeingtaken,andthetimefromreceiptofaswabtonotificationofatestresult(48hourand24hoursrespectively).Encouragingly,wearealreadymeetingthetargetforcontacttracing,withjustover80%ofclosecontactsofnewcasestracedwithintwodays.However,therewasstillnoanalysisofwhetherthetargetismeaningfulandnohintthatamodelhadbeendevelopedtohelpassesstheeffectivenessofthecontacttracingeffortinanoutbreak.Itiseasytomeetthe80percenttargetwhenthereareoneortwocasesaday(andwhenthenumberofcontactspercasehadfallenfrom15-20to4).Butitcouldbeadifferentstoryiftherewerethreeorfoursuperspreadereventsinquicksuccession,andthereweretwohundredcasestodealwith.‘Wargaming’asevereoutbreakcouldalsoprovideavaluabletestofcapacity,buttherewasnohintthatthiswaseverconsidered. 25May2020ReviewofCovid-19alertlevelcontrolsThispapersetoutbroadpathstolevel1inthecontextofreviewingthestagedapproachtotheintroductionoflevel2.Therewerethreepossibletimingsforthelevelonemove:June22,July6,andJuly20.TheDirectorGeneral’srecommendation

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wasthatthereshouldbeatleast28daysatthefullversionoflevel2beforeconsideringmovingtolevel1.Heconfirmedthatthemovetolevel3hadnotledtoaspikeincasesandthathehad‘increasedconfidence’thatundetectedcommunitytransmissionwashighlyunlikely,soitwasappropriatetomovemorequicklytofullyimplementlevel2.Withrespecttothemovetolevel1thetoneofthepaperwastowardsalessconservativeapproach,withanemphasisontheeconomiccostsandthestrainonthesociallicence. OptionC(themostconservative)wouldbemoreeconomicallycostlythananeasingofrestrictions,andwouldplacegreaterstrainonoursociallicence.Asnotedinpreviousreview,ourrestrictionsarebeingseenasmismatchedwithourlowcasenumbers,ratherthantheircause.Stickingwithourcurrentcontrolswouldrequireustocontinuetomakethiscase,anditrunstheriskoferodingthestronglevelsofbuy-inweseefromthepubliciftherestrictionscometobeseenasunnecessary.MaintainingthemoreintricatecontrolsofOptionCalsocreatescomplexitiesinenforcementandcommunication. ItisapparentthatweshouldmoveasquicklyaswesafelycansinceAlertLevel2issignificantlymorecostlythanAlertLevel1.Physicaldistancingonpublictransportnetworksandinworkplacesinparticularcontinuestodepresseconomicactivitybylimitingworkforceparticipationandproductivity,aswellassocial,culturalandcommunityactivities.AroughestimatefromtheTreasuryisthattheeconomiccostsofthreeweeksatAlertLevel2comparedwithAlertLevel1amounttoaround$1.4binlostoutput.Thosecostsdon’tincludethepressureonbusinessbalancesheets,particularlytourism-relatedandhospitalitybusinessesthataremostaffectedbyphysicaldistancingrules.Therewasdiscussiononhowmanydaystospendatlevel2:Atthemoreriskaverseend,wecouldrequireaperiodof28dayssincethelastlocallyacquiredcasewasinfectious.Thisimplieszeronewlocallyacquiredcasesforaboutamonth,andislikelytomeanwealsohavezeroornearzeroactivecases.WehadourlastlocallyacquiredcaseonMay22,aninfectionwithinoneofourclusters.Alessconstrainingguidewouldbespending28daysatthefullLevel2,withcontinuinglowcasenumbers,allacquiredoverseasorlinkedtoknowndomesticcases,beforeamovetoLevel1.ThisistherecommendedapproachoftheDirector-GeneralofHealth.Itdoesnotrequirezerocasenumbers(althoughweexpectcasenumberstobeconsistentlylow).ItdoesrequirethatwestopthetransmissionofCOVID-19inourcommunity,andtobeconfidentthatwecaneffectivelycontainanyfutureimportedcases. Therewasabriefreviewofbordermeasures:

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GlobalconditionscontinuetobesuchthatcurrentborderrestrictionsandexceptionsshouldremaininplaceuntilfurtherdecisionsaretakenbyCabinet. Wearecontinuingtolookatthepre-conditionsfordevelopingasafetravelzoneinitiallybetweenNewZealandandAustralia,andwithaneyetowardsthePacific,oncethatcanbedonesafelyandthosecountriesarereadytodoso.Thisisofcourseonlypartofourapproachtore-openingtotheworld.Induecourse,safetravelzonescouldbeextendedtootherCOVID-freecountriesasconditionsallow.Wewillcontinuetoworkwithotherpartnersandwithinternationalaviationbodiestobeasreadyaswecanbetomoveaspublichealthconsiderationsallow. Bythemselves,whetherweareatAlertLevel1or2doesnotdeterminewhetherornotasafetravelzonewouldbepossible.However,theparticularrestrictionsthatapplyateachLevelwillberelevanttoimplementation.Forexample,thephysicaldistancingrequirementsatLevel2wouldmakeflightsalessviablecommercialprospectandairportmanagementmorechallenging.HumanRightsAsalwayshumanrightsconsiderationswereanafterthought.Theydidnotplayaroleintheconsiderationofthespeedofthemovetolevel1. 28May2020Covid-19:Publichealthcontrolmeasuresatalertlevel1DirectorGeneraltoMinisterTheadvicefromtheDirectorGeneralwasthatNewZealandshouldmovetolevelone,withnolimitsongatheringsandsocialdistancing,after28daysofnocommunitytransmissioninafullyimplementedlevel2.Thatis,noearlierthan26June.3June2020Covid-19alertlevel1OfficeofthePrimeMinisterThispapersetupadifferenttestformovingtolevel1.Itwasnonewcasesfor28days,not28daysofnocasesinthefulllevel2.TherewasnomentioninthispaperoftheDirectorGeneral’sadvice.ThepermissivenatureoftheAlertLevel1controlsreflectitispredicateduponhavingeliminatedchainsoftransmissionandtherehavingbeennonewcasesfromcommunitytransmissionforatleast28days.Ifthathasbeenachieved,andwehaveconfidenceinour

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bordercontrols,thereistheoreticallynoneedforrestrictionsonpeople’smovements,interactionsoractivities.

8June2020ReviewofAlertlevel2OfficeofPrimeMinistertoCabinetInthisCabinetdecisionpaperthePrimeMinisterwasdeterminedtomovemorequicklythanpreviouslyanticipated.Thismayhavebeenpromptedbytheblacklivesmatterproteststhatignoredtherestrictionsoncrowdnumbers.TheproblemwashowtodealwiththeDirectorGeneral’sadvicetodelaythemovebytwomoreweeks.Whenwelastconsideredtheseissuestwoweeksago,wechosethefastestoptionforliberalisingAlertLevel2controls.Aspartofthatdecision,weindicatedthatwewouldconsideramovetoLevel1nolaterthanJune22,andsettheexpectationthatourreviewtodaymaynotinvolvesubstantialchange.However,thesituationhasprogressedmorepositivelythanweexpected.Withongoingzerocasenumbersandourgrowingconfidenceinthesituationastimepassessincewelastsignificantlyloosenedcontrols,itisprudenttobringforwardadecisiononLevel1tomitigatetheeconomicandsocialimpactsofourAlertLevelcontrols. TheDirector-General’spreviousadvicewasthatamovetoLevel1shouldnotbeconsidereduntilatleastFridayJune26,28daysafterfullyimplementingLevel2controls.However,thedatanowavailableshowsthatoursituationismorepositivethanpreviouslythought. Ittakesabouttwoweeksforchangesincontrolstostartshowingupincasenumbers.SowecanbeconfidentnowthattheeffectsofthemovetoLevel2onMay14andthereopeningofbarsonMay21arereflectedinthezerocasenumbers.Inthenextfewdays,anyimpactsofourmovetoliftgatheringlimitsto100peopleonMay29willbegintobeseen.Confidenceaboutimpactoftheopeningofbarswasabitofastretch.Withthetwoweekdatalagfromthebaropeningstherewereonlyafewdaysofexperienceofthenewsituation.However,therewas‘additional’informationintheformofepidemiologicalmodelling.InrecentdaystwodifferentacademicgroupsusingdifferentmethodologieshaveindependentlyestimatedtheprobabilitythatNewZealandhaseliminatedCOVID-19.Bothsuggestaround95percentorhigherconfidencethatwehavenowachievedelimination,whichinthiscontextmeansthatthereareatpresentnocontagiouspeopleinNewZealand.

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ThemodellingbyagroupofOtagoresearcherswasfirstpublishedon20MayandwouldhavebeenknowntotheDirectorGeneralwhenhegavehisadvice.itwasnotnew.ThePrimeMinister’sadviceonthatpointwasmisleading.TheOtagomodellingreliedontwoassumptions:thattherearenonewexternalcases,andthatthereproductionratedoesnotgoabove1.Giventheuncertaintiesaroundtheseassumptions,itwaspossiblyastretchtoclaimwith95percentcertaintythattherewouldnotasinglecaseinNewZealandbyaspecifieddate.ThemodellingbyTePunahaMatatiki,whichcameouton5June,appearstohavebeencommissionedfortheoccasion.ThePrimeMinisters’sOfficemayhavebeenfrustratedwiththelackofanalyticalsubstancebehindtheDirectorsGeneral’sadviceandcameupwiththeirown‘helpful’analysis.Thekeyoutputinthepaperwasthefollowinggraphthatshowedtherelationshipbetweenthenumberofdayswithoutacaseandtheprobabilityofelimination,withanoptimisticandapessimisticscenario.Theoptimisticscenariowasveryoptimisticassuminga75percentdetectionrate.The‘pessismistic’detectionrateof20percent,wasarguablynotthatpessimistic,givenahighprevalenceofasymptomaticcases.Themodelalsoassumednoexternalcases.However,thecustomerdidn’twantapessimisticstory,sotherewasnosensitivitytestingoflowerdetectionrate.Figurefourteen:TPMtimetoelimination

Inlightofthe‘new’evidence,theDirectorGeneraldutifullycameintoline.

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Overall,theDirector-General’sinterimadviceisthatNewZealandhasmettheidentifiedpublichealthcriteriaagreedbyCabinetonMay4fordecisionsonmovingAlertLevels,andisontracktomovetoAlertLevel1intheweekbeginningJune8.

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PartSix:Otherdocumentsinfluencingdecision-makingTheMinistryreferencesanumberofdocumentsthatitsaysassisteditinitsdeliberations.Theyarereviewedinthreegroups:AModellingcommissionedbytheMinistryBPublicHeathStrategyTeamdocumentsCOtherdocumentsA:CommissionedmathematicalmodellingOn30MarchtheMinistryreleasedfourreportsonthemathematicalmodellingoftheCovid-19epidemicallbytheOtagoCovid-19ResearchGroup(OCRG).Thereleasewasaccompaniedbyalengthypressreleasethatpurportedtoshowtherolethatthismodellingandotherinformationplayedinthedecisiontomovetolevel4.Inthispartwefirstbrieflydescribedthemodelling,beforemovingtoanassessmentofthestatementsmadeinthepressrelease.27February2020ModelledEstimatesfortheSpreadandHealthImpactofCovid-19inNewZealand:RevisedPreliminaryReportfortheNZMinistryofHealthThefirstreportwasanattempttoestimatedeathratesinanunrestrainedepidemic,basedonunderstandingsofdeathratesfromChina,andby‘eye-balling’afigureinanunpublishedAustralianpaper.Thisproducedarangeofdeathestimates,overayear,ofbetween5800and37,000dependingontheassumptionsonthedeathratesandthereproductionnumberifnopolicyactionsweretaken,andthepopulationdidnotchangeitsbehavior.Thehighnumbersassumeda2percentdeathrate(basedonanearlierWHOestimate),whiletheirownestimateof0.75percentwasthemorecrediblenumber.Animportantpartofthisreportwastheestimatesofdeathsbyethnicgroup.Asdiscussedinparteight,theseestimatesappeartohavebeenmanipulatedtoproduceexaggerateddeathoutcomesforMaoriandPacificpopulations.

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March162020PotentialAge-SpecificHealthImpactsfromUncontrolledSpreadoftheCOVID-19PandemicontheNewZealandPopulationUsingtheCovidSIMModel:ThisreportpresentedresultsfromsimulationoftheonlineCovidsimmodelthatwediscussedin“AlookbehindtheHeadlines”.Itreporteddeathratesandanumberofotherhealthsystemoutcomes,assuminganunrestrainedepidemic,reproductionnumbersof1.5and2,andanoveralldeathrateof0.25percent.TheseassumptionswereprovidedbytheMinistry.Thelowerdeathrateassumptionsuggests,thatatthispoint,theMinistrywasinterestedincalmingdownmorealarmistclaimsabouttheimpactoftheepidemic.Theresultsshowthatthelowerreproductionratedoesn’timpactonoveralldeathsverymuch,butspreadsthemmoreevenlyovertheyear.Thereare8200deathswithaR0of1.5,and11,000withaR0of2.Nearly90percentofdeathswouldbeinthe65+agegroup.Thereisnoinformationinthismodelontheeffectofspontaneouschangesinbehavior,buttherewasanawarenessthatcontainmentmeasureswellshortofalockdowncouldbesuccessful.Thepotentiallyhighhealthburdensuggestedbythismodellingworkmaysupportveryintensivecontrolmeasures,especiallygiventheChineseevidencethatthesecanbesuccessful.Whileitisanopenquestionaroundthegeneralisabilityofalloftheseapproachestoothercountries,thereisalsoevidenceoutsideofmainlandChinafromSingapore,HongKongandTaiwanthatintensivecontainmentagainstthespreadofSARS-Cov-2canbesuccessful.

March202020SupportingtheCOVID-19pandemicresponse:SurveillanceandOutbreakAnalyticsThispaperprovidedanoverviewofthesubjectareaandusefulchecklists.Itwasprobablysomethingthatcouldandshouldhavebeencommissionedseveralweeksearlier.Itreferenceamodelingreport“ModellingofthePotentialHealthImpactfromCOVID-19ontheNewZealandPopulationUsingtheCOVIDSIMModel:ConfidentialPreliminaryReporttotheNZMinistryofHealth”thathasnotbeendisclosed.Themodellingapplicationssuggestedinthatreportwerelisted:•Theinvestmentin,andtimingof,“keepitout”interventionseg,travelrestrictionsandotherbordercontrolmeasures(whichareparticularlyrelevanttoislandnationssuchasNewZealand)

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•Theinvestmentin,andtimingof,“stampitout”interventionseg,contacttracing,isolationofimportedcasesandquarantineforthosepotentiallyexposed.•Theinvestmentin,andtimingof,“manageit”interventionseg,hygieneandsocialdistancinginterventionsaswellasadaptinghealthservicestotheincreaseddemand•Theinvestmentinresearchontreatmentsandvaccinations.Thelatterisparticularlyrelevantifthediseaseislikelytobecomeseasonal(eg,asperpastpandemicstrainsofinfluenza).AstheMinistrydidnotappeartocommissionanyreportsafterMarch24,theneither:

• Itplacedlittleweightonepidemicmodelling,or• Itworkedoutthattheycouldrunthecovidsimmodelwithouttheexpense

ofgoingthroughtheOCRG,or• Itdiscoveredthatcovidsimwasnotfitforpurposeaswearguedin“Alook

behindtheheadlines.Eitherwaynofurtherworkwasdone.TheMinistry’sPublicHealthResponseStrategyTeamGroupneverevenreferredtotheOCRGmodelling,ormadeanysubsequentuseofCovidsim.TheteamneverproducedanymodellingoftheirownMarch232020PotentialHealthImpactsfromtheCOVID-19PandemicforNewZealandifEradicationFails:Thisisthereportwecritiquedinour‘Alookbehindtheheadlines’report.Asthisreportwasproducedon23March,whenthedecisiontomovetolevel4hadeffectivelybeenmade,itplayednopartinthedecision-making.Itwasabackfillingandapublicrelationsexercisedesignedtosupportthedecision.Itwasdesignedtoshowthatafailedresponsewouldhavepotentiallycalamitousresultswithover14000deathsinthemostextremeexample.Themostmoderateoutcome,withjust7deaths,wasneverreported.Themodellingdidnottakeintoaccountcontacttracing,testingandisolationandtherewasnoattempttomodeltheimpactofvariousinterventionsandvoluntarysocialdistancing.Itdidnotattempttorealisticallymodelafailederadication.March242020PotentialWorstCaseHealthImpactsfromtheCOVID-19PandemicforNewZealandifEradicationFailsThisreportwasanotherpublicrelationseffort,designedtoproducebiggernumbersthantheMarch23report.Anumberofassumptionswerechanged,including

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increasinginfectionsfromoffshorebyafactorof10,increasingdeathratessubstantially,andassumingthatthewholecontainmenteffortwouldbereducedtoloweringcontactsby25percentforjusttwomonths(lessthanaplausiblespontaneousreduction),beforegivingupcompletely.Anyreferencestoothersuccessfulcontainmentoptionsweredroppedfromthediscussion.27600werenowexpectedtodie.OCRGsupplantedbyTePunahaMatatikIItappearsthattheOCRGwassupplantedbyTePunahaMatatikiformodellingsupport.TheCOVID-19surveillanceplandated19May2020states.TheprincipalquantitativemodellingisbeingconductedbyTePūnahaMatatini(TPM),withdataprovidedfromarangeofgovernmentagenciestoallowmodellingofnetworks,andtheanalysisofscenariosfortheeffectivenessofAlertLevelsaswellasdifferentcharacteristicsoftheunderlyingdisease.CaseinformationisprovidedtoTPMresearcherstosupportthiswork.ThisrolewasnotclearlydisclosedandanymodellingdonefortheMinistryhasnotbeendisclosed,exceptwhenTPMhaschosentomakeapublicreleaseofselectivemodellingexercises.Theearlier,publiclyreleasedversionofTPM’smodelingwasopaque,clearlybiasedtoproduceafavouredoutcomeandnotfitforpurposeforpolicyinterventionmodelling.Theydohaveanonlinecalculator‘TakeControl’,thathasnowbeenmodifiedtoaddresstheconcernsweraised.30March2020ModellingPressreleaseThe30Marchmodellingpressreleasewasinmanyrespects,inaccurate,misleadingandmostlyoutrightfalse.Itwasdesignedtogivetheimpressionthatmuchrelevantandsoundly-basedmodellinghadbeendone,whenthiswasatoddswiththereality.Thefollowingreviewsthestatementsintherelease.

AseriesofmathematicalmodelswarningoftheconsequencesforthelackofearlyactiontopreventthespreadofCOVID-19reinforcetheimportanceofthecurrentlockdownandothergovernmentmeasures.

Themodellingshowsthatwithouttheactionscurrentlybeingtaken,theuncontrolledspreadofCOVID-19wouldexactahighpriceinNewZealandintermsofitsimpactonourhealthservices,includingourintensivecareunits,anddeaths”saysDrAshleyBloomfield.

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Thesestatementsweremisleadingandinsomerespectsfalse.Themodelsmostlywarnedoftheconsequencesoftakingnoactions.Therewasnomodellingthatcomparedtheeffectsofalockdownwithlessintrusivemeasures.Therewasnomodellingoftheconsequencesofdelaysintakingspecificactions.TheMinistryofHealthtodaypublishedaseriesofmodelling-alllookingathowarangeofmeasurescanhelpreducetheimpactofCOVID-19.

Thisstatementwasfalse.Threeofthereportslookedatoutcomesthatwereunrestrainedbyanypolicymeasureorvoluntaryreductionsincontacts.The23Marchreportlookedatvoluntaryandmandatorymeasuresthatreducedcontactsby25percentand50percent.Theseassumptionswerenotlinkedtoanyspecificpolicymeasures.

Themodellingwascontinuallyupdatedasmorerealworldevidencecouldbeincorporatedandtheimpactofdifferentinterventionscouldbeconsidered.Whatisconsistentacrossallthemodelsisthatwehadastarkchoice–letthevirusspreaduncheckedandseelargenumbersofNewZealandersgetsick,ourhealthsystemoverrunandmanypeopledying,ortakingfirmmeasurestosavelives.

Thisstatementwasatleastmisleading.Theknowledgeofkeyparametersdidnotchangemateriallyfromtheinitialanalysis.WhatdidchangewastheMOH’sneedforbigscarynumbers.Thenumberofdeathsincreasedfrom8,000-10,000intheMarch16modelto27,000onApril24withoutanychangeinwhatwasknownaboutthevirus. AllofthescenariosshowanunacceptablelevelofdeathsinNewZealandwithoutstrongaction.

Thiswasfalse.OneofthescenariosintheMarch23papershowedjust7deaths.

Evenwiththesortsofstrongmeasureswehaveinplacetostampoutthevirusthemodellingisstillpredictingtherecouldbeaheavytollonourhealthsystemandlossoflife.

Thisstatementwasfalse.Therewasnoattempttomodeltheimpactofalevelfourlockdown.

Thereismoreonthethecontentofthemodelling,whichmakesitreasonablyclearthattheMinistrydidn’tunderstandthetechnicallimitationsoftheon-linecalculatormodellingthatwasdone.

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ThemodellingandadviceproducedfromitisinlinewiththeinternationalscientificconsensusonCOVID-19andthesortsofresponsesmostcountriesarenowtakingtofightthevirus.

Itwasinlinewiththeoftenuninformedreactiveapproachtakenbymanygovernments.Officialmodellingofspecificpolicyinterventionsappearstobethinontheground.Wehaveyettoseeamodelwithrobustandplausibledata,buttheymayexist.TheSwedishauthoritiesdidacomprehensivesearch,andtheydidn’tfindanythingeither.

Mostcountriesweredrivenbycircumstancesthathadgotawayfromthemandafollowtheleaderapproach.Morecarefulconsiderationoftheevidenceseemstobemoreprevalentincountriesthathavenottakenthedraconianlockdownapproaches.Lockdownisjustasloganwhichcancoverarangeofpolicyintensities.Manycountriesdidnotshutdownworkplacesandtheyweregenerallysuccessfulincontrollingtheiroutbreaks.OnlyabouthalfoftheEUcountriesevenwentasfarasimposingstayathomeorders.

ConclusionAllofthesubstantivestatementsinthepressreleasewerefalseormisleading.ThepressreleasewasanobviousefforttopropuptheGovernment’slevelfourlockdowndecision,withsomeanalyticalsupport.B:PublicHealthResponseStrategyteamdocumentsTheMinistry’sCOVID-19PublicHealthResponseStrategyTeam,waspresumablychargedwithprovidingtheintellectual‘grunt’behindtheMinistry’sresponsetoCovid-19.FiveoftheeightmemberswerefromtheOtagoPublicHealthSchool.

30March2020OverviewofapproachestoCOVID-19pandemiccontrolinAotearoa/NewZealandThestatedaimofthisreportwastoprovideinputintostrategicdecisionmaking.Asthedocumentwasdatedwellafterthedecisiontomovetoalertlevel4,itappearsthatoneofthepurposeswastoprovideex-postsupportforthatdecision.

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Inadditiontosomegeneralbackgroundmaterial,whichshouldhavebeenwellknownby30March,thereportprovided:

• anoverviewofthedifferentstrategiesforcontrollingthepandemicinthenext12monthsthatweretheoreticallyavailableatthetime

• potentialoptionsforhowwemightdecidetomovebetweenstrategies.Mostofthiswassurpassedbyevents.Themostrelevantpartofthepaperwasthediscussionontherelationshipbetweenalertlevels,controllevelsandoutcomes.Thefulldiscussionwasasfollows.ControlmeasuresarecurrentlyenactedinAotearoa/NewZealandthoughthe4-levelCOVID-19AlertSystem.WeareconfidentthatthecumulativeimpactofallthecontrolmeasuresenactedatAlertLevel4bringsthereproductionnumberunder1,andthisissupportedbyinternationalexperienceandevidence.28,29Thefirstreference2wastoastudyontheWuhanexperienceintheepidemic.Theresponsesweredividedinto5periodswithvaryingdegreesofseverity.Theyappearedtoshowarelationshipbetweenseverityandthereproductionrates.Howevertheauthorsofthatreportdidnotdrawstrongconclusions.Thestudyhasseverallimitations.First,theChinesegovernmentimplementedmultipleinterventionsatthesametimeorinashorttimeframetocontroltheoutbreak,andthusindividualstrategiescouldnotbeevaluated.WhileWuhanshowedthatextremelyhardlockdowns(harderthanNewZealand’salertlevel4)work,thepaperdoesnothavemuchtosayaboutthepossibleeffectivenessofmoremoderateresponsesinNewZealandcircumstances.Thesecondpaper,alsousingWuhandata,appearedtoshowthatthereproductionratefelltonearonebeforethehardlockdownmeasureswereimposed.Thestrategyteampaperwenton:However,itiscurrentlynotclearhowmucheachofthespecificcontrolmeasuresimpactonthereproductionnumberofCOVID-19.Ideallywewouldhavedataonthisandwouldbeabletoidentifyandapplytheleastrestrictivecombinationofmeasuresthatwereneededtoreducethereproductionnumber.

2PanA,LiuL,WangC,GuoH,HaoX,WangQ,HuangJ,HeN,etal.AssociationofPublicHealthInterventionsWiththeEpidemiologyoftheCOVID-19OutbreakinWuhan,China

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Forexample,ifweknewthatcaseisolationreducedthereproductionnumberfromR2.5toR2.0andcontacttracingresultedinafurtherR0.5reductionetcthenwecouldmakechoicesaboutmeasuresthatbalancedthebenefitsofspecificcontrolmeasureswiththeharmsofthem.Finally,theimpactofotherCOVID-19AlertLevels(eg,Level3andLevel2)onthereproductionnumberofCOVID-19isunknownatthispoint.ThismeansthatreducingalertlevelscomeswithrisksofincreasingtransmissionofCOVID-19andneedstobedonewithhighqualitysurveillance,casemanagementandcontactsystemsinplace.Aprecautionaryapproachwithslowgraduatedreduction,withafocusonminimisinginequities,wouldbemostappropriateinthefaceoftheseuncertainties.Inotherwordstheydidn’tknowanythingabouttheimpactofpossiblestrategies.Onlythatalevelfourlockdownwouldwork.ThepossibleconclusionfromthesecondWuhanpaperthatafulllockdownmightbeunnecessarywasignored.EvidencethatlowerlevelinterventionshadworkedinanumberofAsiancountrieswasnotconsidered.Norwasmodellingbasedonsocialnetworkingstudies(whichwasinthereferences),whichsuggestedlessextremeinterventionswouldwork,considered.Under‘Nextsteps’thereisthefollowing:Furtherworkisneededtodetailallthestrategiesincludingcontrolmeasurestoimplementthem,transitionsbetweenstrategiesandlevelsofcontrolmeasures,risksandbenefits,andequityimplications. Thereisnoevidencethatthisworkwaseverdone.Insteadthefollow-upwasyetanotheroverviewdocument.7April2020Aotearoa/NewZealand’sCOVID-19eliminationstrategy:anoverviewThispaperwasmainlyconcernedwithestablishingprinciplesforaneliminationstrategybasedaroundtheTreatyand‘equity’concerns.TherewasalmostnoanalysisofwhatwashappeninginNewZealand,ortheworld,andnotelsemuchthatwouldguidepolicyinterventions.Thefollowingsectionondecision-makingprinciplesgivesaflavourformostthecontentofthereport:Part1:Decision-makingprinciplesfortheCOVID-19responsePlanningandcoordinationoftheCOVID-19responsemustbeginbyrecognisingtherolesandresponsibilitiesofthehealthsystemandtheCrown,forandwithMāori.Theseareaffirmed

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throughTeTiritioWaitangiandtheDeclarationontheRightsofIndigenousPeoplesaswellasmorerecentlyintheWai2575InquiryandtheinitialfindingsoftheNewZealandHealthandDisabilitySystemsReview.ThesefoundationalandhealthsystemsdocumentsrecogniseMāorisovereignty,therightofMāoritomonitorandevaluatethedecisionsandactionsofgovernment,theprimacyofMāoriaspirationsforethicaldecisionmakingandpractice,therightstoprotectionofMāorihealthandwellbeing,andthesystemresponsibilitiesfortheeliminationofhealthinequity.RecognisingthefundamentalprinciplesandobligationsprovidedbyTeTiritioWaitangi,werecommendthattheequityprincipleisprioritisedconsistentlyacrossalllevelsofthestrategicresponsetoCOVID-19.Wealsoconsidertheimportanceofmaximisingwellbeingbenefitswhileminimisingharm.EquityprincipleTheequityprinciplerequires:equitableaccesstothedeterminantsofhealth;accesstohealthcare:andqualityofcarereceived.Equitableoutcomesalsorequireequitableprocesses,andtimelyevaluation,measuringandmonitoring.CurrentandpersistenthealthinequitiesinAotearoa/NewZealandaremoststarkforMāoriandPacificpeoplesandthosethathaveaccesstofewersocioeconomicresources.TheCOVID-19pandemiccancreatenewhealthinequities(systematicandunintended)andexacerbateexistinghealthinequities,particularlyforMāoriandPacificcommunities.TheseinequitiescanoccurdirectlythroughCOVID-19diseaseimpactsaswellasfromnon-COVID-19adversehealthimpactsthatareexacerbatedorcreatedbythepandemicthroughhealthsystemandhealthdeterminantdisruption.COVID-19diseaseisalsolikelytohaveadifferential(andpotentiallyinequitable)impactonothersubpopulationsinAotearoa/NewZealand.Thisincludesthosedefinedbyagegroup,gender,migrationandlabour-forcestatus,thepresenceofunderlyingchronichealthconditionsanddisability.WeprioritisetheequityprincipleinouranalysisoftheCOVID-19controlmeasuresandmitigationresponses.WellbeingprincipleThewellbeingprincipleconsiderstheopportunitytomaximisehealthbenefits(theprotectionofpopulationhealthandwellbeing)andminimisehealthrisks.WeightingofprinciplesTherelativeweightingoftheseprinciplesmayvaryatdifferentstagesofthestrategy.However,whereprinciplesareinconflict,theequityprincipleisprioritisedinourcontrolmeasures.Intermsoftheactualepidemicthereisahighleveldiscussionongettingthereproductionratetobelow1toachieveelimination,withoutanyrecognitionthatbyApril6,thereproductionratewasalreadybelow1.

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Thereisashortsection,inanappendix,ontheinternationalevidence.ItislimitedtoChinabecauseitthatistheonlycountrythathadachieved‘elimination.’Theexperiencesofanumbercountries,particularlythatwereontheirwaytoachievinglowcasenumbers,consistentwithelimination,wereignored. ThepracticaladvicefromtheChineseexperienceisthefollowing.Itisimportanttonotethatinaneliminationstrategy,lifting/relaxingcontrolmeasuresfollows,ratherthancoincideswith,zerocases.Forexample,Wuhanstartedtoliftlockdownson29March2020,11daysaftertheirfirstdaywithnonewconfirmedcases.BasingatimingstrategyonhappenstanceinasingleChinesecitywashardlyacomprehensiveanalysisOnnextstepswehave:Theeliminationstrategyhasbeenactivatedveryrapidly,withoutthedetailedpolicyandtechnicalscrutinythatwouldnormallyprecedesuchamajorinitiative.Furtherworkisneededto:examinethespecificcontrolmeasuresneededtodeliverthestrategyindetailincludinganyevidenceofeffectivenessandtheequityimpactsofthem.Itmaybepossibletoenhancemeasurestoaddressequityandaltercurrentlevelsofcontrolmeasureswithoutendangeringelimination.Weneedtoplanarisk-basedapproachtoliftingcontrolmeasuresassumingsuccess,orallowforincreasedintensityofcontrolmeasuresifneeded.Againthisworkwasneverdone.InsteadtheStrategicGroupmusthavespentweeksmuddlingaroundwithhighlevelpapers,oftencentredonvagueequityconcerns.ThispaperwasadaptedunderthesametitleintotheMinistry’sEliminationStrategydocumentthatappearsonitswebsite.Itisdated7Aprilbutitisnotclearwhenitfirstappearedonthesite.Thefirstpartofthepaperrepeatstheprinciplespresentedabove.Thesecondpartdescribesthestrategyandsetsouttherationaleforelimination.MotivatingreasonsforeliminationinNewZealandhaveseveralbenefitsandrisks.1. Eliminationisawell-recognisedoutbreakstrategythathassuccessfullyendedother

epidemicsinAotearoa/NewZealand.Asanexample,Aotearoa/NewZealandhadpreviouslyeliminatedmeasles(thiswasdefinedbyWHOasnonewcaseshavingoriginatedhereforthreeyears).

Covid-19isnotthesameasmeasles.

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ThereisearlyevidencethatintensivecontrolmeasureshavebeeneffectiveinachievingCOVID-19elimination-levelcontainmentinothercountries-particularlyChina,asdescribedintheappendixofthisdocument.2.EliminationispossibleinAotearoa/NewZealandbecauseoftheearlyentryintoAlertLevel4.EliminationisalsopossiblewithlowerlevelsofinterventionasevidencedbyseveralEastAsianexperiences.

However,thisdoesprovideriskstopopulationwellbeingandhealthequitythroughinequitableaccesstoprimaryandpreventativecare,aswellasanimpactonhealthdeterminants,particularlyeconomic.3.Eliminationisahigh-effortstrategy,butitgivesAotearoa/NewZealandthepotentialtoavoidadditionalhealthinequitiesfromCOVID-19specifichealthimpactsforMāoriandPacificpeoples,andthoselivinginsocioeconomicdeprivation.Thisalignswiththeequityprinciple.Withmostcasescomingfromoverseas,COVID-19casesinMāoriandPacificpeoplesiscurrentlylow(comparedtoEuropean).OtherstrategieswouldlikelymeaninequitiesareseeninCOVID-19specificoutcomesaswellastheimportantequityimpactsofastrainedhealthsystemandthedeterminantsofhealth.Thereisnoevidencethatastrongsuppressionstrategywouldhaveamarkedlydifferent‘equity’outcome.Itisimportanttorecogniseimplementingeliminationhasadifferentsetofequitychallengestomanage.Thisincludeseconomicimpactsandthepotentialfordelayedmanagementofotherhealthconditions.4.TheconsequencesofuncontrolledspreadofCOVID-19aresevere,withpotentialdeathsinthetensofthousands.Elimination(atthisstageoftheAotearoa/NewZealandresponse)hasthepotentialtopreventsubstantialpermanentCOVID-19relateddisabilityanddeath.Itcanalsoprotectthosethatsupportanddeliverourhealthcaresystemandallowotherhealthcareactivitiestoresume.Thisrationaleisirrelevant.Thealternativetoeliminationwasnotuncontrolledspread.5.Elimination(ifsuccessful)hasthepotentialforstricttransmissioncontrolmeasureswithinAotearoa/NewZealandtobeliftedearlier.Thismeanshealthcareandaccesstothebroaderdeterminantsofhealthcanresume,leadingtoenhancedequityandwellbeing.(Notedisruptiontotheeconomyandhealthserviceswhilerespondingtothepandemic,aswellasongoingchallengesofnewcasesfromoverseaspresentanequitychallengeuntilaCOVID-19vaccineisavailable.)

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Astrongsupressionpolicywouldhaveallowedstricttransmissioncontrolmeasurestohavebeenliftedearlier.6.MostcomponentsofaneliminationstrategyareneededinotherCOVID-19strategies.Some,suchassurveillanceandcontacttracing,areuniversal.Theeliminationstrategyhasthepotentialforsubstantialhealthbenefitsforwellbeingandequitygainedbyimplementingallstrategycomponentsearly.7.Thereareimportantpotentialco-benefitsthatresultfromsuccessfulelimination.TheseincluderecognitionofthespecialrelationshipbetweenAotearoa/NewZealandandPacificnationsandterritories.EliminationofCOVID-19inAotearoa/NewZealandsupportsprotectionofthesePacificnationsandterritoriesfromCOVID-19impactsandrelateddeterminantsofhealth(inadditiontootherin-Pacificstrategiessuchasbordercontrolandcommunityprotection).Theseco-benefitsonlyworkiftheeliminationiscompleteandsustainedInterventionlogicTheinterventionlogicforeliminationofCOVID-19wasdescribedasreducingthereproductionratebelow1,andthefollowingschematicoverviewwasprovidedonhowthiscouldbeachieved.

Figurefifteen:Interventionlogicforelimination

Therewasnomentionofthehardlockdownmeasuresunderalertlevel4.

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AdditionalconsiderationsUnderAdditionalConsiderationsforeliminationofCOVID-19inAotearoa/NewZealandthereisthefollowing:Eliminationisdifferentfromotherstrategies.Notbecauseofthespecificcontrolmeasuresused,butinthetimingandintensityofthesemeasures.Therearefurtherconsiderationsforimplementingtheeliminationstrategy.•Thisstrategyrequiresmultipleandcomprehensivecontrolmeasuresimplementedathighintensity,asnosinglecontrolmeasurecanbecompletelyeffective.•Anadvantageofthiscomprehensiveapproachisthatcontrolmeasureshavethepotentialtoamplifyoneanotherwhenusedincombination:forexample,prohibitionofmassgatheringsenhancesthefeasibilityoftracingallcontactsofacase.•Anunusualfeatureofthisstrategyisthatmaximalcontrolmeasureintensityisinitiatedatatimewhentherearestillveryfewcases.Otherstrategiessuchasmitigationhavemaximalcontrolmeasureintensityduringthetimeperiodwiththemostcases.Thisisbecauseofthedifferentaimsofeachstrategy.•Aftertheinitialphase,thesecontrolmeasuresmaynotneedtobeapplieduniformlyacrossthecountry.Dependingoncircumstances,regionalorlocalvariationmaybeappropriate,(ie,forisolatedcommunities).However,travelrestrictionswillneedtocontinueforanextendedperiodtopreventcasescomingintothecountry. TransitionsThereareanumberofpotentialpathwaysoutofeliminationdependingonthesuccessorotherwiseofthestrategy.ThetransitionifCOVID-19containmentissuccessful(definedinTable1)istoamaintenancephase.Thiswouldinvolve:●ongoingintensivesurveillanceandmonitoringtodetectanybreaches,linkedtocapabilityandcapacitytorespondinatimelywaythatlimitstransmission●stagedliftingofcontrolmeasureswithinAotearoa/NewZealand-ideallyfromtheleastriskytransitioningthroughtothemostrisky(thissequencingwouldneedtobedeterminedaspartoffurtherwork)●intenseandsustainedborderrestrictions,asthesewouldnowbeourprimarydefence●theultimateendofthisstrategy,allowingliftingofbordercontrols,wouldbethroughpopulationvaccinationtoobtainherdimmunity.Ifeliminationdoesnotappeartoworkthetransitionsaremorecomplex,andcontextspecific.SomepossiblepathwaysareinFigure2below.Thesemaychangedependingonspecificcircumstances.Furtherworkisrequiredtodeterminespecificcriteriaforthedecisionsinthesepathways,particularlytheassessmentofequity. Inshortitwasaprettylightweightstrategy.Acollectionofsomemuddledthinkingandhighlevelstatementswithlittleanalyticalcontentandveryshortonthespecifics.TheonlyoverseascomparatorwasWuhaninChina.

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ControlmeasurestodeliverCOVID-19strategies:Educationsectorevidencereview13April2020ThisworkingpaperpresentsareviewofevidencerelatingtoCOVID-19andeducationsettings.Thekeymessagewas:

RecentlyemergingevidencesuggestsclosureofeducationinstitutionshasalimitedroleinreducingCOVID-19morbidityandmortality.Bestcasescenariomodelling,whichmaynotapplytoAotearoa/NewZealand,suggestsitmayreduceCOVID-19by2-4percent.Realworldevidencefrompreviouscoronavirusoutbreaks(SARS)andoneevaluationoftheimpactofclosingschoolsinJapanonCOVID-19donotsuggestalargeimpactofclosingschoolsonreducingcoronavirusinfections.

Thepapermayhaveprovidedusefulinputonschoolclosuremeasures15April2020ConsequencesandmitigationstrategiesforCOVID-19controlmeasuresThispapersynthesisestheevidenceforandequityimplicationsofaselectionofcontrolmeasuresneededtodeliveraCOVID-19pandemicstrategyinAotearoa/NewZealand.Itconsiderstherisksassociatedwithcontrolmeasuresattheircurrentsettings(mainlyclosuresrelatedtotheLevel4COVID-19Alertlevel)andoptions(includingrisksandbenefits)forliftingeachmeasure,aswellashigh-levelrecommendationsfortheoverallpackageofcontrolmeasures.Whatfollowedwerelargelyjuststatementsoftheobvious,orunsupportedassertions,withnoattempttoengagewiththespecificsofthelockdownsituation,ortoquantifyanyoftheeffects.Thefocuswasalmostentirelyon‘disadvantaged’groupswiththepresumptionthattheywouldbefurtherdisadvantagedbythelockdown.Therewereseveralrecommendationsonmeasurestodealwiththese‘issues’butmostlytheyrelatedtosocialpoliciesoutsidetheMinistry’spurview.Therewasnothingthatwouldbeofmuchvalueinmakinganevidence-basedassessmentofthecostsandbenefitsofopeningup.

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Caseandcontactmanagement:monitoringandreportingtoachieveandsustaineliminationofCOVID-199May2020Thistopicwasoneofthemostimportantaddressedbythestrategyteamascasemanagementandcontacttracingwasatthecentreoftheeliminationeffort.Butwhilethedocumentwasdated9Mayithadlittletosaythatwasn’talreadysaidintheVerralreport,orcouldn’tbereadilydownloadedfromanynumberofonlinepublications.ItwasmainlyacollectionofhighlevelstatementsTherewasnoreferenceatalltoNewZealanddataanditdidnotaddresskeyissuessuchas:howmuchcapacitydoyouneed;whatarethecriticalperformanceindicatorsandhowtheyshouldbecalibrated;howNewZealandhadperformedagainstthoseindicators;andwhatmoreneededtobedone.Therewasnoreviewofcasemanagementexperiencesinothercountries.Therewasnomodellingofthecaseinterventionprocess,orasuggestionthatamodelshouldbedeveloped.Therewereonlysixreferences.Therewasalistof11recommendationspriortode-escalationbutnoneofthesewerequantifiedandtherewasnoguidanceonhowtheycouldbeaggregated.Thereportwouldnothavebeenveryusefulotherthanasahighlevelprimer,andtoemphasisetheneedforspeedinthecontacttracingprocess.

2May2020COVID-19inchildrenThiswasareviewoftheliteratureonthesusceptibilityofchildrentotheinfection;theseverityofinfections;andtheircontagiousness.Itwasausefulcontributionintermsofbuildingabackgroundunderstanding.

C:Otherinformationsources

Otherkeyinformationsourceswerethe16-24FebWHOjointmissiontoChina,theUniversityofAucklandreport,andthe18MarchpublicationfromImperialCollege,London,(aWHOCollaboratingCentreforInfectiousDiseaseModelling),whichwasparticularlysignificantin

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informingthedevelopmentofNewZealand’sAlertlevelsandthedecisiontomovequicklyfromAlertlevel3toAlertlevel4.

TheImperialCollegereportof‘18’March2020TherewasnoImperialCollegereportdated18March2020.WeassumethattheMinistrywasreferingtothe16MarchReport9-Impactofnon-pharmaceuticalinterventions(NPIs)toreduceCOVID-19mortalityandhealthcaredemandThiswasthereportthatmodelled510,000UKand2.2millionUSdeathswithoutanyintervention(orchangesinbehaviour),andiscreditedtopushingUKGovernmentthinkingtowardsalockdown,andchangingPresidentTrump’smind.TheImperialCollegemodellingteammodelledtwosetsofinterventions,combiningdifferentsetsoffivepolicyinterventions:isolationofcases;quarantine;closureofschoolsanduniversities;socialdistancingoftheover70s;andgeneralsocialdistancingpolicies.Averymoderatesetofinterventions,buildingherdimmunityovertime,weredescribedas‘mitigation’.Itreduceddeathsbyhalf.Astrongersetofpolicies,describedas‘suppression’showedthatan‘optimal’subsetofthefivepoliciescouldreducedeathstorelativelylowlevels(5000-10,000).A‘suppression’policywasrecommended.SuppressiondidnotrequireworkplacelockdownsWhiletheseImperialCollegeresultsareassociatedwithahardlockdownwiththeclosureofallworkplaces,thesocialdistancingassumptionsdidnotactuallyrequireworkplaceshutdowns.Theassumptionwasthatworkplaceinteractionswouldonlyhavetobereducedby25percent.A25percentreduction,ormore,couldeasilyhavebeenaccommodatedbyvoluntaryworkingathomeandsocialdistancingrulesintheworkplace.Further,themodeldidnotprovidefortestingandcontacttracing.Othermodellingassumptions,suchascompliancewithisolationrequirements(only50percent)wereadmittedlypessimistic.Morepositiveassumptionscouldhaveaffectedtheresultssignificantly,reducingtheneedformoresevereinterventions.Oneoftheshortcomingsofthepaperisitdidnotreportonanysensitivityanalysisthatwouldshowtheimpactofthechangeinkeyassumptions.IftheMinistryhadactuallyreadandunderstoodthereport,theywouldnothaveciteditasprovidingsupportforworkplacelockdowns,andwouldhaverealisedthatitdidnotprovideforcontacttracingwhichwasmeanttobeatthecentreofthenewZealandeffort.

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TheImperialCollegemodelhasnowbeenlargelydiscredited.Itwasa13yearoldinfluenzamodel,notstructuredtoaddresssomecriticalCovid-19modellingissues,andhadsignificantflawsinthemodelcode.

TheWHOjointreportonChinaTheMinistrynodoubtdidreadtheWHOreport,whichcameouton28February2020.buttheydidnotquicklygrasponeofthekeylessons.Ifyouwereseriousaboutcontacttracingthenyouneededtodevotesubstantialresourcestothetask.Sometake-outsfromthereportare:ContactTracingChinahasapolicyofmeticulouscaseandcontactidentificationforCOVID-19.Forexample,inWuhanmorethan1800teamsofepidemiologists,withaminimumof5people/team,aretracingtensofthousandsofcontactsaday.Contactfollowupispainstaking,withahighpercentageofidentifiedclosecontactscompletingmedicalobservation.TheWHOrecommendedforothercountries:Prioritize active, exhaustive case finding and immediate testing and isolation, painstaking contact tracing and rigorous quarantine of close contacts; Rapidlytestnationalpreparednessplansinlightofnewknowledgeontheeffectivenessofnon-pharmaceuticalmeasuresagainstCOVID-19;incorporaterapiddetection,largescalecaseisolationandrespiratorysupportcapacities,andrigorouscontacttracingandmanagementinnationalCOVID-19readinessandresponseplansandcapacities Asdiscussedabove,aslateas16 March New Zealand had the capacity to deal with ten cases a day, and were’scaling up’ to a capacity of 50.

This rather gushing section of the report may have impressed.

AchievingChina’sexceptionalcoveragewithandadherencetothesecontainmentmeasureshasonlybeenpossibleduetothedeepcommitmentoftheChinesepeopletocollectiveactioninthefaceofthiscommonthreat.Atacommunitylevelthisisreflectedintheremarkablesolidarityofprovincesandcitiesinsupportofthemostvulnerablepopulationsandcommunities.Attheindividuallevel,theChinesepeoplehavereactedtothisoutbreakwithcourageandconviction.Theyhaveacceptedandadheredtothestarkestofcontainmentmeasures–whetherthesuspensionofpublicgatherings,themonth-long‘stayathome’advisoriesorprohibitionsontravel.

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OfcoursetheChinesepeopledidnothavemuchchoice.Chinaisanauthoritarianandsometimesviciousregime.NorwastheChineseresponseconsistentwiththeNewZealandapproachtoauthoritarianismrecognizedintheNewZealandinfluenzaplanningdocument Onlyasalastresortcanhumanrightsbeinterferedwithtoachieveapublichealthgoal.Suchinterferencecanonlybejustifiedwhenallofthenarrowlydefinedcircumstancessetoutinhumanrightslaw,knownastheSiracusaPrinciples,aremet.ItwasnotclearwhatconclusionsweredrawnfromtheWHOreport.IthadbeenoutforfourweeksbeforethesuddenconclusionthatsomethingapproachingaChinesestylelockdownwasnecessary.OurtakeisthatinitiallytheMinistrywasreluctanttogodowntheChineseroutebecauseofBillofRightsActconcerns.TheiractionshadtobecompatiblewiththoseacceptableinafreeanddemocraticsocietyandChinaisnotfreeanddemocratic. TheUniversityofAucklandReportItisnotclearwhatUniversityofAucklandreporttheMinistrywasreferringto.

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Partseven:HumanRightsImplicationsAsthisreportwasbeingfinalisedtheHightCourtreleaseditsjudgmentontheBorrowdalecase.Thatcaseaddressedaseparateissuefromthatconsideredinthispart:whethertherewasalegalbasisforthecommandsto‘lockdown’.Thecasedidnotaddresstheissuesofwhetherthemeasureswereallnecessary,reasonableandproportionateresponsestotheCovid-19publichealthemergency.Borrowdalesimplyacceptedthattheywereandthematterwasnotargued.ThisdidnotmeanthattheissueofwhethersomemeasuresmayhavebeenexcessiveandanunlawfulintrusiononhumanrightshasbeensettledbyaNewZealandCourt.Sothereadershouldreadon.Inourdiscussionofthe23Marchlevels3and4decisionpaperabovewenotedthatitwasstatedthattherewerenohumanrightsimplicationsfromthelockdownmeasurestobetaken.Thatwassimplyfalseandwasknowntobefalse.Thehumanrightsimplicationshadalreadybeendiscussedatlengthinthe16Marchpaperandinthe15Aprilpaper‘AlertLevelFrameworkforLevels1,2,and3’itwasstatedthat:TherestrictionsimposedatLevels3and4oftheAlertsysteminvolvethemostsignificantandwidespreadinterferencewithhumanrightsinNewZealandinlivingmemory.NewZealandBillofRightsActAlimitedcapacitytolimithumanrightsinresponsetoahealthemergencyisprovidedforintheNewZealandBillofRightsActinsection5:TherightsandfreedomscontainedinthisBillofRightsmaybesubjectonlytosuchreasonablelimitsprescribedbylawascanbedemonstrablyjustifiedinafreeanddemocraticsociety.

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‘Demonstrablyjustified’,isofcourse,opentoawiderangeofinterpretations.However,thereareconstraints,requirementsandguidanceunderinternationallaw,whicharealsodirectlyrelevanttoanassessmentoftheNewZealandmeasures.ThesearesetoutintheSiracusaPrinciplesontheLimitationandDerogationProvisionsintheInternationalCovenantonCivilandPoliticalRights.Whiletheseprinciplesarenevermentionedinanyoftheassessmentsofhumanrightsissuesitisobviousfromthelanguageandtestsappliedthatthedrafterswereawareoftheprinciples,andtosomeextenttookaccountofthem.

WhilemostofthediscussionsofhumanrightsimpactshavebeenframedintermsoftheirlegalityundertheBillofRightsAct,itwasalsoacknowledgedthattherewereprotectionsunderinternationalhumanrightslawthatneededtobeconsidered.Inthe20Aprilpaper‘ReviewofCovid-19alertlevel4’toCabinetfromOPMCitwasstated:SeveralrightsaffirmedintheInternationalCovenantonEconomic,SocialandCulturalRightsarealsoengagedbymeasuresdiscussedinthispaper.Theseinclude:a.Therighttowork(article6).b.Therighttothehighestattainablestandardofphysicalandmentalhealth(article12)whichrequiresstatestoprevent,treatandcontrolepidemicillnesses,andalsoaccesstoelectiveprocedures.c.Therighttoeducation(article13).Inthispartweraisesomeofthequestionsthatarisewhenassessingthelegalityofimpositions.Whenthesuccessorlegislation,theCovid-19PublicHealthResponseActwaspassed,theAttorneyGeneralreleasedthelegaladvicethatarguedthatthelegislationwasconsistentwiththeBillofRightsAct.Wepayparticularattentiontotheargumentsinthispaper,asitisthefirsttimethatactuallegaladvicewasmadepublic;itpresentsthelegalsituationgoingforward,anditrepresentedthemostmatureversionofthedefenceofsomeoftheactions.Weproceedasfollows:Sub-partA.setsoutthemostrelevantpartsoftheSiracusaPrinciples.Sub-partBreviewsthehumanrightsassessmentsmadeinvariouspapersuptotheintroductionoftheCovid-19PublicHealthResponseAct.Sub-partCreviewstheopiniononthelegalityoftheCovid-19PublicHealthResponseActSub-partDaddressestheimpositionoftheStateofEmergency.Sub-partEconsiderstheresponsesfromtheHumanRightsCommissioner.Sub-partFdiscussestheFinanceandExpenditureCommitteereportontheCovid-19PublicHealthResponseAct.

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Sub-partGlooksatthedecisiontosuspendregulatoryimpactassessments.Thereisaconnectionwithhumanrightsassessmentsbecauseitisnotpossibletomakeameaningfulassessmentofproportionalitywithoutsomeformofimpactassessment.

A:TheSiracusaPrinciplesontheLimitationandDerogationofProvisionsintheInternationalCovenantonCivilandPoliticalrightsThefollowingaretherelevanttests.GeneralInterpretativePrinciplesRelatingtotheJustificationofLimitations2.ThescopeofalimitationreferredtointheCovenantshallnotbeinterpretedsoastojeopardizetheessenceoftherightconcerned.

3.Alllimitationclausesshallbeinterpretedstrictlyandinfavoroftherightsatissue.7.Nolimitationshallbeappliedinanarbitrarymanner.

8.Everylimitationimposedshallbesubjecttothepossibilityofchallengetoandremedyagainstitsabusiveapplication.10.WheneveralimitationisrequiredinthetermsoftheCovenanttobe"necessary,"thistermimpliesthatthelimitation:(a)isbasedononeofthegroundsjustifyinglimitationsrecognizedbytherelevantarticleoftheCovenant,(b)respondstoapressingpublicorsocialneed,(c)pursuesalegitimateaim,and(d)isproportionatetothataim.Anyassessmentastothenecessityofalimitationshallbemadeonobjectiveconsiderations.

11.Inapplyingalimitation,astateshallusenomorerestrictivemeansthanarerequiredfortheachievementofthepurposeofthelimitation.

12.TheburdenofjustifyingalimitationuponarightguaranteedundertheCovenantlieswiththestate.17.Legalruleslimitingtheexerciseofhumanrightsshallbeclearandaccessibletoeveryone.

18.Adequatesafeguardsandeffectiveremediesshallbeprovidedbylawagainstillegalorabusiveimpositionorapplicationoflimitationsonhumanrights.19.Theexpression"inademocraticsociety"shallbeinterpretedasimposingafurtherrestrictiononthelimitationclausesitqualifies.

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25.Publichealthmaybeinvokedasagroundforlimitingcertainrightsinordertoallowastatetotakemeasuresdealingwithaseriousthreattothehealthofthepopulationorindividualmembersofthepopulation.Thesemeasuresmustbespecificallyaimedatpreventingdiseaseorinjuryorprovidingcareforthesickandinjured.

DerogationsinaPublicEmergency39.AstatepartymaytakemeasuresderogatingfromitsobligationsundertheInternationalCovenantonCivilandPoliticalRightspursuanttoArticle4(hereinaftercalled"derogationmeasures")onlywhenfacedwithasituationofexceptionalandactualorimminentdangerwhichthreatensthelifeofthenation.41.Economicdifficultiespersecannotjustifyderogationmeasures.

44.AstatepartyderogatingfromitsobligationsundertheCovenantshallimmediatelynotifytheotherstatespartiestotheCovenant,whichithasderogated;.

48.AstatepartyavailingitselfoftherightofderogationpursuanttoArticle4shallterminatesuchderogationintheshortesttimerequiredtobringtoanendthepublicemergencywhichthreatensthelifeofthenation.

50.OntheterminationofaderogationpursuanttoArticle4allrightsandfreedomsprotectedbytheCovenantshallberestoredinfull.Areviewofthecontinuingconsequencesofderogationmeasuresshallbemadeassoonaspossible.

Stepsshallbetakentocorrectinjusticesandtocompensatethosewhohavesufferedinjusticeduringorinconsequenceofthederogationmeasures.

StrictlyRequiredbytheExigenciesoftheSituation51.Theseverity,duration,andgeographicscopeofanyderogationmeasureshallbesuchonlyasarestrictlynecessarytodealwiththethreattothelifeofthenationandareproportionatetoitsnatureandextent.

52.Thecompetentnationalauthoritiesshallbeunderadutytoassessindividuallythenecessityofanyderogationmeasuretakenorproposedtodealwiththespecificdangersposedbytheemergency.

53.AmeasureisnotstrictlyrequiredbytheexigenciesofthesituationwhereordinarymeasurespermissibleunderthespecificlimitationsclausesoftheCovenantwouldbeadequatetodealwiththethreattothelifeofthenation.

54.Theprincipleofstrictnecessityshallbeappliedinanobjectivemanner.Eachmeasureshallbedirectedtoanactual,clear,present,orimminentdangerandmaynotbeimposedmerelybecauseofanapprehensionofpotentialdanger.

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56.Effectiveremediesshallbeavailabletopersonsclaimingthatderogationmeasuresaffectingthemarenotstrictlyrequiredbytheexigenciesofthesituation.

57.Indeterminingwhetherderogationmeasuresarestrictlyrequiredbytheexigenciesofthesituationthejudgmentofthenationalauthoritiescannotbeacceptedasconclusive.

SomeGeneralPrinciplesontheIntroductionandApplicationofaPublicEmergencyandConsequentDerogationMeasures62.Aproclamationofapublicemergencyshallbemadeingoodfaithbaseduponanobjectiveassessmentofthesituationinordertodeterminetowhatextent,ifany,itposesathreattothelifeofthenation.Aproclamationofapublicemergency,andconsequentderogationsfromCovenantobligations,thatarenotmadeingoodfaithareviolationsofinternationallaw.

Takentogethertheseprinciplesrepresentamoredemandingsetofconstraintsthanamereinsistencethatanimpositionbe‘demonstrablynecessary’.Thelatterslideseasilyfromthetongueortext.Areadingoftheprinciples,ontheotherhand,ismorelikelytopromptseriousthoughtandmorerobustassessments.Someofthekeyprinciplesare:

• Theonusofprooflieswiththegovernmenttodemonstratethenecessityandproportionalityofthemeasures.

• Remediesmustbeavailablewhenmeasureshavebeenexcessive.• Assessmentsmustbeobjective.• Limitationsshouldnotbearbitrary• Eachmeasureshallbeassessedindividually.

B:DiscussionsofHumanRightsinpolicypapers16March2020COVID-19ResponsetoMassGatheringsThefollowingisthediscussiononhumanrightsinthispaper.Ifthereisanepidemicnoticeissuedandthegovernmentdecidestocancelamassgathering,thedecisionmakerwillalsoneedtoturntheirmindtotheNewZealandBillofRightsAct1990.UnderthatActeveryonehastherighttofreedomofpeacefulassembly,andtherighttofreedomofassociation.Thoserightswillbesignificantlylimitedbyanygovernmentdecisiontocancelmassgatherings.ThelimitationswillaffectNewZealandersanddisruptdailylife.Itwillbenecessarytobesatisfiedthatanysuchlimitationsarenecessaryand

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proportionate,suchthattheycanbedemonstrablyjustifiedinafreeanddemocraticsociety.Inparticular,thelimitationsshouldimpairthoserightstonogreaterextentthanisreasonablynecessaryinordertoachievetheobjective.

ThisproposalaroundmassgatheringscomplieswiththerightsandfreedomscontainedintheNewZealandBillofRightsAct1990andtheHumanRightsAct1993.Theadviceappendedtothispaperaboutissuinganepidemicnoticeraisessignificantrightsissuesthataresetoutinthatappendix.TheappendixdiscussedtheprocessesforissuinganepidemicnoticewhichactivatesthepowersavailabletotheDirectorGeneralofHealthtocancelmassmeetings.Therangeofpowersunderdifferentlegislationwasalsosetout.Thetestforissuinganoticeisthat: the Prime Minister is satisfied that the effects of an outbreak of a quarantinable disease (as defined in the Health Act 1956) are likely to disrupt essential government and business activity in New Zealand. Beforeissuinganepidemicnotice(whichisdonewiththeagreementoftheMinisterofHealth),thePrimeMinistermustconsidertheDirectorGeneral’sadvice.TheDirectorGeneral’sadviceonthedisruptionstoessentialgovernmentandbusinessactivitywas:AfulloutbreakinNewZealandhasthepotentialtodisruptgovernmentbusinessandimpacttheeffectiveoperationofthejudiciary,executiveandlegislaturethroughtheimpactofthediseaseandtheapplicationofmeasurestocontainitsspread.ThecontinuedeffectiveoperationofGovernmentisbestservedifthehealthimpactsofCOVID-19aremanagedandminimised.TheeconomicconsequencesofCOVID-19andthemanagementofitare,andwillbe,considerable.AfulloutbreakinNewZealandhasthepotentialtohaveadevastatingimpactonoureconomythroughdisruptiontointernalandexternalmarkets,supplychainsandworkers.Thesearesweepingandunsubstantiatedassertionsthatwerenotbackedbyanyanalysisthatwehaveseen.Importantly,theassessmentdoesnotdistinguishbetweentheeconomicimpactofthevirusitself,bothinNewZealandandoverseasandtheimpactofthemeasurestakeninNewZealandtocontrolit.TheeconomicimpactofaNewZealandepidemicwaslikelytobelessthan‘devastating’.Thereasonisthatthevirusverydisproportionatelyaffectstheaged.Itwouldhaveonlyamoderateimpactontheworkingagepopulation(intermsofdeathsandseriousillness),andvirtuallynoneatallontheyoung.Therewouldbe

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lossinproductionduetosomesicknesses,(manywouldhaveonlymildsymptomsandwouldstayathomefortwoweekstoprotectfellowworkers,andotherswouldgetoveraflu-likeboutinacoupleofweeks),andsomeabsenteeismduetofearofitsconsequences(thoughthiscouldbemitigatedbyprovidingaccurateinformationoftherisksposedbythevirus),andbyallowingolderemployeestoworkathome.Bycontrastthe1918NewZealandfluepidemicprimarilyaffectedtheyounger(20-40yearolds)andkilled0.7percentofthepopulation.Whiletherewassomeshorttermdisruptionitdidnotappeartohavehadmuchofasustainedimpactontheeconomy. Thepotentialimplicationsofthebroadsweepofpowerswereunderstood:ThepowersarevastandbroadrangingandlimitrightsandfreedomsintheNewZealandBillofRightsAct1990.Thepowerstosearchandseize,detainandrequiretreatmenttobetakenaresomeofthemostpowerfulthatastatecanexertoveritspeople. ThesignificantnatureofthepowerscanonlybejustifiedwhentheseriousnessoftheharmthatcouldflowfromanoutbreakofthequarantinablediseasespreadinginanoutbreakinNewZealand.Forapublichealthemergencytojustifyderogatingfromhumanrights,thesituationshouldbeofanexceptionalandtemporarynature.ThesepowersmustbeexercisedinawaythatisconsistentwiththeNewZealandBillofRightsAct.Thismeansthatindividualdecisionsthatlimitfundamentalrightsmustbenecessaryandproportionatetotheobjective(oflimitingthespreadofCOVID-19).ItisrecommendedthatthenoticebepromptlyrevokedwhenthePrimeMinisterissatisfiedthattheeffectsoftheoutbreakarenolongerlikelytodisruptessentialgovernmentalandbusinessactivity.Itwasobvious,atanearlypoint,thattheoutbreakitselfwasnolongerlikelytodisruptgovernmentandbusinessactivity.Thenoticewasnotpromptlyrevoked.SafeguardsTherewasadiscussionofsafeguardsandprocessesinplaceforthePrimeMinistertoissuetheepidemicnotice.ThereareimportantsafeguardsandformsofParliamentaryscrutiny,particularlythefollowing:ThePrimeMinisterisrequiredtonotifytheHouseofRepresentativesassoonasreasonablypracticablethatanepidemicnoticehasbeenissuedorextended.

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TheHouseofRepresentativeshastheopportunitytoscrutiniseordersmadeduringanepidemic.Thisprovidesalayerofswiftscrutiny,whichenhancesthelegitimacyoftheorderswithoutimposingimpracticalrequirements.Thesearejustproceduralsafeguardswhichwillnotconstrainagovernmentdeterminedtopursueacourseofaction. Inaddition,whiletheissuingofanepidemicnoticewouldallowthemodificationorrelaxationoflaws,lawsthatprotectfundamentalrightsandfreedomsarepreventedfrombeingmodifiedinthisway. Thisargumentwasdisingenuous.TheprimarypointoftheepidemicnoticeisthatitallowstheDirectorGeneraltooverridefundamentalrightsandfreedoms.Thelawmaynotbemodified(becauseitallowsforexceptions),butitiseffectivelyplacedinabeyance,whichisequivalenttoamodification.ConstraintsontheDirectorGeneralDecisionswillbemadeconsistentwiththeMinistryofHealth’sGuidanceontheuseofSpecialPowersdevelopedaspartofthecontingencyplanningforCOVID-19.Thisisacriticaldocumentbutithasnotbeenmadepubliclyavailable.Itshouldhavebeen.TherewasnomentionoftheSiracusaPrinciplesthatconstrainlimitationsonhumanrightsinapublicheallthemergency.2April2020Notingpaper:Covid-19Self-isolationorderunders70(1)(F)healthActToAdHocCommitteeonCovid-19Response.FromDavidClarkThisnotingpaperrepeatedtheaboveargumentsfortheselfisolationorder.ThefollowingappearstobetheDirectorGeneral’sfullriskanalysissupportingthenotice.Intheabsenceofavaccinetheonlyeffectivestrategiesaretoreducemixingofsuspectibleandinfectiouspeoplethroughearlyascertainmentofcases(testingandcontacttracing)andreductionofcontact.

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ModellingoftheepidemicinNewZealandhasanalysedtheextentofcontactreductionovervarioustimelines,accountingfordifferentreproductionnumbersthatNewZealandwouldneedtoachieveinorderto‘flattentheepidemiccurve’andindeedeliminatetheviruswhichisthecurrentobjectiveunderlevel4.ThismodellingjustifiestakingastringentapproachtowardsphysicaldistancingfortheentirepopulationonthebasisthatifthecurrenteradicationstrategyfailsthenthehealthoutcomesforNewZealandcouldbeverysevere.TheDirectorGeneral’sstatementsweremisleading,ifnotoutrightfalse.ThestatementswerealmostcertainlybasedontheOtagoCovidResearchGroup’s(OCRG)modellingthatwecriticisedin‘AlookbehindtheHeadlines’TheOCRGdidnomodellingoftherelativeimpactofvoluntaryversusmandatorysocialdistancing,asisimplied.Indeed,theymadenoassessmentsofanyofthealertlevelmeasures.TheOCRGassumedthattherewasnocontacttracingwhichismeanttobethecentreofthepolicyresponse,sothatanyconclusionsthatcouldbedrawnfromthemodellingontherequiredamountofcontacttracingwouldhavebeenoverstated.TheDirectorGeneraland/orhisstaffeitherdidnotunderstandthemodellingordeliberatelymisledtheMinister.TheDirectorGeneraldidnotshowthattheorderwasdemonstrablynecessaryasrequiredbylaw.15April2020AlertLevelFrameworkforLevels1,2,and3Thediscussiononhumanrightsstartswiththepropositionthatlimitationsonrightsareunlawfulunlesstheycanbedemonstrablyjustified.Itnotesthemeasuresthatraisehumanrightsissues:

• Restrictionsongatheringscouldlimittherighttomanifestreligionorbeliefinworship,observance,practiceorteaching,particularlyincommunitywithothers,affirmedinsection15oftheBillofRightsAct1990(BORA).

• Restrictionsongatheringslimittherighttopeacefulassemblyaffirmedinsection16ofBORAandpotentiallyfreedomofassociationins17.

• Travelrestrictions,bothdomesticallyandattheborderandthenationwideenforcedquarantineorder(generallyconfiningpeopletotheirhomes,withlimitationsonpeople’sfreedomtoswim,surf,hunt,trampetc)alllimitfreedomofmovementaffirmedinsection18ofBORA(andfreedomofassemblyandassociation).

• Allmeasureshavethepotentialtolimittherighttobefreefromdiscriminationaffirmedinsection19(1)ofBORA,duetotheirpotentialdisproportionateimpacton

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somegroups(particularlypeopleoffaith,Māori,Pacificpeoples,olderpeople,peoplewithdisabilitiesandwomen).

• Restrictionsongatheringscouldlimittherightsofethnic,religiousorlinguisticminoritiestoenjoytheculture,toprofessandpracticethereligion,ortousethelanguage,ofthatminorityaffirmedinsection20ofBORA.

• Theenforcedquarantineofnewarrivalsinspecifiedmanagedfacilitiesmayamounttoanarbitrarydetentioncontrarytosection22ofBORAand/orlimitstherightstofreedomofassembly,associationandmovement.Themannerinwhichcontrolsareimplementedinplacesofdetentionforpublichealthreasonscouldaffecttherightofpersonsdeprivedoflibertytobetreatedwithhumanityandrespectfortheinherentdignityoftheperson.

Thefurtherpossibleimpositionsonhumanrightsidentifiedinthe20Aprilpaper,(therighttowork,toaneducationandtohealth)werenotconsideredatall.Also,thereisnomentionofpossiblelimitationsontherighttochosewheretoliveprotectedunderarticle12(1)oftheCovenentEveryonelawfullywithintheterritoryofaStateshall,withinthatterritory,havetherighttolibertyofmovementandfreedomtochoosehisresidence.

ManyNewZealandershaveasecondhomebuttheywereforbiddentoshifttheirresidencethereduringthelookdown.Otherswerenotallowedtomovetoanewhouse.

SolicitorGeneral’sadviceTheAttorneyGeneralcametotheviewthatthetestintheBillofRightsActonthelimitationsontheaboverightshadbeenmet.HisassessmentreliedonadvicefromtheSolicitor-General.TheSolicitor-Generalprovidedgeneraladviceonhumanrightsissuesstemmingfromthenationwidequarantineorder,andthequarantineofallnewarrivalsinspecifiedmanagedfacilities.Ontheformer,sheadvisedthatifhealthexpertsassessedthatvoluntarycompliancewithstay-homeguidancewasnotsufficienttocontrolthespreadofthevirus,becauseuniversalcomplianceisrequired,thenthenecessityfortheorderwouldhaveaproperevidentialfoundationandtheorderwouldprobablynotbreachrightsintheBillofRightsAct.Theexistenceofexceptionsandexclusionswithinthenationwideorderwasimportanttotheanalysis.TheuseoftheSolicitorsGeneral’sgeneraladvice(ifitwasaccuratelyconveyed)wasdisengenous.Thewordingwas‘ifhealthexpertsassessedthatvoluntarycompliancewithstayathomeguidancewasnotsufficienttocontrolthespreadofthevirus’,not

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thatthe‘healthexperts’hadassessedthatvoluntarycompliancewasinsufficient.WeknowthattheDirectorGeneraldidnotdoanassessmentofvoluntaryversusmandatory‘stayathome’regimes.Weknowthathetriedtofakeanassessment,byreferingtosomemodellingthatwasonadifferenttopic.Asitseemsclearthatnoobjectiveassessmentwasmade,asrequiredundertheSiracusaprinciplesitfollowsthatthestay-at-homeorderwasunlawful.TheSolicitor-Generalsaidthattheexistenceofexceptionsandexclusionswasimportanttotheanalysis,butitisnotexplainedhow.Presumablytheargumentwasthatiftheorderswerenotasdraconianastheycouldhavebeen,thenthissufficientlymitigatedhumanrightsconcerns.Ifameasureisnotgrosslydisproportionate,thatdoesnotmeanitisproportionate.NecessaryandproportionatetotheobjectiveTheissueofwhetherthemeasureswerenecessaryandproportionatedependsontheobjective.Thiswaslooselydescribedinthepaperas: preventingwidespreadoutbreaks,andshouldtheyoccur,toreverseepidemicgrowth Inmoreprecisetermstheobjectivecouldbedefinedasreducingthereproductionratetounderoneinasustainedmanner.Socertainmeasureswouldbenecessaryiftheywererequiredtoreducethereproductionratebelowone.Butadditional,ormorerestrictivemeasures,whichreducedthereproductionrateto0.5wouldnotbenecessarytosecurethatobjective.Itmightbearguedthattherewasapublichealthrationaletoafasterpathtoelimination,becauseitwouldmeanfewercases,seriousillnessesanddeaths.Thispossibilityisillustratedintabletwo.Fromastartingpointof100infectionsitshowstheaggregatenumberofcasestoeliminationwithdifferenteffectivereproductionrates.Areproductionrateof0.5representsthehardlockdownandamoretargetedapproachwithamuchmorelimitedimpactonhumanrightscouldhaveaneffectivereproductionrateof0.7.Alevel4interventiontakes7cycles(aboutsixweeks)Alevel2to3interventiontakes13cyclesandanadditional231cases.Thedifferenceis133cases,whichmightresultinoneortwoadditionaldeaths.Itisdifficulttoarguethatthelevel4interventionisnecessaryandproportionate.

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Tabletwo:ReproductionrateandchangeincasesR-eff. Infection

multiplier5cycles

InfectionMultiplier10cycles

Cyclestoelimination

AggregateNumberofcasestoeliminationor13cycles

2 32 1024 NA 16382001.25 3.1 9.3 NA 85950.7 0.17 .03 13 2310.6 .08 .006 9 1480.5 .03 .0009 7 98ShockandaweOnefactorthatmayhavebeenonofficials’mindsisa‘shockandawe’effect.Adisproportionateresponsewas‘necessary’toimpressonthepublictheseriousnessofthesituation,thestrongbehaviouralchangesrequiredtoaddressit,andsohelpsecurethenecessaryvoluntarycompliance.Wewillleaveittolawyerstoponderwhetherthisisalegitimateargumentthatjustifiedthewidespreadintrusiononrights.Thedecision-makingprocessToassesswhetherthemeasureswerenecessaryandproportionateitisappropriatetoconsidertheactualdecision-makingprocess.Ifitwasbasedonacarefulandobjectiveweightingoftheevidence,themeasuresmightbelawful,eveniftheysubsequentlyturnedouttobesomethingofanoverreaction.Butiftheyweretheresultofalastminutepoliticallydrivenpanic,whererelevantevidencewasignored,orhadnotbeenproduced,thenthemeasuresprobablywouldnotbelawful.Recall,asdemonstratedinpartfour,officialadvicethatthebuildingconstructionindustryshouldbeexcludedfromthelockdownwasoverturnedbyCabinet.Thataction,orrathertheDirectorGeneral’saction,wouldnothavebeenlawful. OnquarantiningTheSolicitor-Generalwasmindfulofadvicefromhealthofficialsthatthepreviousarrivalsregime(whichinvolvedmandatoryquarantinebutgenerallyatpeople’shomes),didnotmeettheheightenedobjectiveofpreventingnewvectorsoftransmissionandmaintainingcompletecontroloverthemainpathwaythroughwhichCOVID-19caseshaveemerged.Itdidnotthereforefullyoradequatelystopthespreadofthevirus.GivingweighttotheDirectorGeneral’sexpertassessmentastowhatisnecessarytoprotectpublichealthinthe

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currentcircumstances,sheconcludedthatadirectionforquarantinewithinmanagedfacilitiescouldlawfullybemade.ThereisnoevidencethattheDirectorGeneralofHealtheverturnedhismindtowhatquarantiningrequirementswere‘necessary’.Therewasnoanalysisatallinthe10Aprilpaperthatrecommendedsupervisedquarantine.Justdaysbefore(seepartfive)theexistingmeasuresweredescribedasworkingwell.Whathadchangedwasthat‘athome’quarantininghadbecomeamediastory,andtherewasapoliticalimperativetolooktough.By10Aprilthevirushadalreadybeenbroughtundercontrolwiththeexistingpolicy,thatdidprovideforthequarantiningofhighriskindividuals.Therewasnoevidencethathomequarantiningpresentedamaterialrisktothepublic.Again,theSolicitor-Generaldidnotaskfordocumentationthatmightsupport‘healthofficial’s’assertions.CompulsoryexaminationsShewasalsosatisfiedthattheprovisionsforcompulsorymedicalexaminationwouldauthorisereasonablesearches,sowouldnotconstituteabreachofs21ofBORA(righttobefreefromunreasonablesearches).Therewasnoargumenttosupportthisview.TheissueisconsideredinmoredetailintheopiniononthelawfulnessoftheCovid-19PublicHealthResponseBill.AssurancesgoingforwardTherelevantgovernmentdepartmentswillkeepallrestrictivemeasuresunderconstantreviewtoensuretheyhaveafirmlegalbasis,aresufficientlywell-defined,canbedemonstrablyjustifiedinthecircumstances,andremainproportionatetothethreatposedbyCOVID-19.ItisimportantfortheSolicitor-General,supportedbyaninter-agencyprocess,toensurethatsuchongoingreviewtakesplaceandreportsbacktoCabinetonaregularbasis.Inourreviewofthedocumentswedidnotseeasinglecasewheretheindividualmeasureswerereviewed.Iftherewereanyconcernstheyallhadtowaituntiltherewasapoliticaldecisiontomovealertlevels.

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22April2020OfficeoftheAttorney-GeneraltoCabinetBusinessCommitteePowersandauthorisationstogiveeffecttoAlertLevel3Thefollowingisthediscussionabouthumanrightsrelatingtothemovetoalertlevel3.TherisksofCOVID-19continueatahighlevelwhichmeansthatwhilewecanallowsomerelaxationofcontrolstherearechoicestobemadeandthereisarationingexercisetobedonetoassistthosechoices.Therationingexerciseisprimarilybasedonpublichealthconsiderationsbutitisalsorelevantandpermittedtoincludeotherconsiderationssuchastheleastimpactoncivillibertiesandreducingeconomicimpacts.Thissuggeststhatatleasthumanrightswerebeingconsideredinthemix.Thesubstantiveimpactofthemovementtolevel3wasontherighttowork.Thiswasrestoredto400,000workers.Therewasabriefwordonpublicscrutinyandaccountability.Astimepassesitisimportanttoemploy,asmuchaspossible,theusualmeasuresofpublicscrutinyandaccountability.ThroughoutthisemergencytheGovernmenthasemployedmultiplemechanismstomaintaintransparencyandlegitimacy.Publicationofdecisionsandnoticesthroughvariouscommunicationchannels,dailypressconferencesandguidancematerialhaveallcontributed.Therewasverylittleopportunityforpublicscrutiny,andlittleaccountabilty.Therelevantdocumentswereonlyreleasedwithlonglags.Publicmessagingisnotthesameasaccountabilityandscutiny.Therewasstillnorequirementtoproduceregulatoryimpactassessments.Limitsonrightsorfreedomsarepermissibleiftheyarereasonable,prescribedbylaw,anddemonstrablyjustifiedinafreeanddemocraticsociety.Thelimitsmustbeinproportiontotheobjectiveoftheorder,namelypreventingthespreadofCOVID-19andprotectingthepublichealthandlivesofNewZealanders.Underlevelthreethehumanrightsissuesweresimilartothoseunderlevel4andtherewasare-runoftheargumentsinthe15Aprilpaper.However,thelanguagediffersinsome(possiblykey)respects.Thisisalegitimateobjective,whichcouldnotbeachievedinamannerthatallowsforgreaterlibertyandenjoymentofmovement,associationandassemblyrights(and/ortheminorityrightsormanifestationofreligion/beliefrights).PublichealthadviceisthattheLevelThreemeasures,andthereforetherestrictionsimposedbytheorder,arenecessaryto

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preventthespreadofCOVID-19.Themeasureshavebeentailoredtoallowbusinesses,services,andschoolstooperatetothegreatestextentthattheycan,withoutsignificantcontactwiththepublicandtheaccompanyingriskoftransmission. Theobjectivehaschangedfrompreventingwidespreadoutbreaksandreversinggrowth,topreventing‘thespreadofCOVID-19’.Thissetsalowerbar.Ifameasurecouldconceivablystoponetransmissionthenitcouldbe‘justified‘ Therewasafocusontheimprovementscomparedtolevel4:Additionalexceptionsandexclusionstotherequirementtostayathomeallowpeopletomoveoutsidetheirhomestoaccessservicestheyneed(beyondthosesimplyprovidingthenecessitiesoflife),obtainfreshairandexercise,andhavefurthercontactwithothers,includingforone-offlifeevents;allassessedwithinthenecessarypublichealthframeworkandappropriatelybalancedagainstrisktopublichealth.Thisdemonstratesaproportionateandlawfulresponse,whichallowsformovementandassociationandactivitiesthathaveasufficientlylowriskofcontactandtransmissionofthevirus.TheGovernmentwasobviouslysenstivetocomplaintsthatitsmeasuresweredisproportionate,buttheclaimthatallofthemeasureswere‘allassessedwithinaframeworkandappropriatelybalancedagainstriskstopublichealth’doesnotringtrue.Theframeworkandassessmentshavenotbeenreleased,butwedoubtthatanymeaningfulframeworkandindividualpolicyassessmentsthatbalancedhumanrightsagainsthealthoutcomesexisted.IfitdidtheGovernmentcould,forexample,havedefendeditsdecisiontorestrictfuneralstojust10,byreferencetotheMinistry’sriskassessment.Insteaditrapidlycaved,whenitwasapparentthattherestrictionmadelittlesenseandwasobviouslydisproportionate.Intheinterestsoftransparencyandaccountabitytherelevantdocumentsshouldhavebeenreleasedwiththelevel3decisions.Therewasadiscussiononacontinuingbanonreligiousservices.Iwouldhaveconcludedalsothatallowingsmallgatheringsforcommonlyheldreligiousservices(whichwouldneeddefinition)couldbejustifiedundertheBillofRightsActatAlertLevel3,ifforashortperiodoftime.However,thathasnotbeennecessarybecausethepolicyintentionatAlertLevel3istoconfinepermittedsmallgatheringstobiglifemoments(suchasfunerals)whichcouldnotwaitorbedoneonlineandtolimitsocialgatheringswhichcanleadtoclustersofthevirus.Thelogichereappearstobethatthereisa‘budget’forinteractions,thatwasusedupbythe‘funeralallowance’,sosmallreligiousservicesmissedout.

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Anyprimafaciediscriminationthatmaypotentiallybeestablishedwouldbeindirect.Whileindirectdiscriminationturnsverymuchonitsfacts,weanticipateitwouldbejustified,giventhestrongpublichealthimperativeagainstwhichthediscriminationwouldbeanalysed. SeveralrightsaffirmedintheInternationalCovenantonEconomic,SocialandCulturalRightsmayalsobeengaged.Thelimitationsontheserightscanbejustifiedforthesamereasonsputforwardabove.TheCovenantrightsengagedinclude:Therighttowork,asasignificantnumberofpeopleareunabletoengageintheirnormalemployment(article6).90.2.Therighttothehighestattainablestandardofphysicalandmentalhealth(article12),forexamplethroughlimitationsonaccesstoelectiveproceduresandotherhealthcarenotdirectlyrelatedtoCovid-19(althougharticle12alsorequiresstatestoprevent,treatandcontrolepidemicillnesses,andsoalsoprovidessomebasisforthemeasuresintheorderundersection.Therewasnofurtherdiscussionofthelimitationsontheserightsandwhethertheywerenecessaryandproportionate.C:Covid-19PublicHealthResponseActLegalAdviceThemostrelevantanddetailedconsiderationofthehumanrightsimplicationsofCovid-19measuresisthelegaladvice,dated11May2020,whichassessedthebroad-reachingpowersconferredundertheCovid-19PublicHealthResponseBill.TheadvicewaswrittenbyJeffOrr,ChiefLegalCounsel,OfficeofLegalCounselTheadvicestartswiththecontentoftheAct,whichissetouthereforeaseofreference.ThecontentoftheActPurposeThePurposeoftheActistosupportapublichealthresponsetoCOVID-19that—(a)prevents,andlimitstheriskof,theoutbreakorspreadofCOVID-19(takingintoaccounttheinfectiousnatureandpotentialforasymptomatictransmissionofCOVID-19);and(b) avoids,mitigates, or remedies the actual or potential adverse effects of the COVID-19outbreak(whetherdirectorindirect);and(c)isco-ordinated,orderly,andproportionate;and(d) has enforceable measures, in addition to the relevant voluntary measures and publichealthandotherguidancethatalsosupportthatresponse.Section8providestheprerequisitesformakingorders:

Asection11ordermaybemadeunderthisActonly—

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(a)while an epidemic notice undersection 5of the Epidemic Preparedness Act 2006 is inforceforCOVID-19;or(b)while a state of emergency or transition period in respect of COVID-19 under theCivilDefenseEmergencyManagementAct2002isinforce;or(c) ifthePrimeMinister,bynoticeintheGazette,afterbeingsatisfiedthatthereisariskofanoutbreakorthespreadofCOVID-19,hasauthorisedtheuseofsection11orders(eithergenerallyorspecifically)andtheauthorisationisinforce.Section9providesthattheMinistermaymakeasection11orderwiththefollowingrequirements:(1)(a)theMinistermusthavehadregardtoadvicefromtheDirector-Generalabout—(i)therisksoftheoutbreakorspreadofCOVID-19;and(ii) the nature and extent of measures (whether voluntary or enforceable) that areappropriatetoaddressthoserisks;and(b) theMinistermay have had regard to any decision by the Government on the level ofpublichealthmeasuresappropriatetorespondtothoserisksandavoid,mitigate,orremedythe effects of the outbreak or spread of COVID-19 (which decision may have taken intoaccountanysocial,economic,orotherfactors);and(c)theMinistermusthaveconsultedthePrimeMinisterandtheMinisterofJustice,andmayhaveconsultedanyotherMinisterthattheMinisterofHealththinksfit;and(d)beforemakingtheorder,theMinistermustbesatisfiedthattheorder isappropriatetoachievethepurposeofthisAct.(2)NothinginthissectionrequirestheMinistertoreceivespecificadvicefromtheDirector-Generalaboutthecontentofaproposedorderorproposaltoamend,extend,orrevokeanorder.TheActallowstheDirectorGeneraltomakeanorderinasingleterritorialauthoritybutonlyifitisurgentlyneeded.Section11setsouttheordersthatmaybemade:

(a)torequirepersonstorefrainfromtakinganyspecifiedactionsthatcontributeorarelikelytocontributetotheriskoftheoutbreakorspreadofCOVID-19,orrequirepersonstotakeanyspecifiedactions,orcomplywithanyspecifiedmeasures,thatcontributeorarelikelytocontributetopreventingtheriskoftheoutbreakorspreadofCOVID-19,including(withoutlimitation)requiringpersonstodoanyofthefollowing:

(i) stay in any specified place or refrain from going to any specified place:

(ii) refrain from associating with specified persons:

(iii) stay physically distant from any persons in any specified way:

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(iv)refrainfromtravellingtoorfromanyspecifiedarea:(v) refrain from carrying out specified activities (for example, business activities involvingclosepersonalcontact)or requirespecifiedactivities tobecarriedoutonly inanyspecifiedwayorincompliancewithspecifiedmeasures:(vi)beisolatedorquarantinedinanyspecifiedplaceorinanyspecifiedway:(vii)refrainfromparticipatingingatheringsofanyspecifiedkind,inanyspecifiedplace,orinspecifiedcircumstances:(viii) report for medical examination or testing in any specified way or in any specifiedcircumstances:(ix)provide,inspecifiedcircumstancesorinanyspecifiedway,anyinformationnecessaryforthepurposeofcontacttracing:(b) in relation toanyplaces, premises, crafts, vehicles, animals, or other things, to requirespecified actions to be taken, require compliance with any specifiedmeasures, or imposespecifiedprohibitionsthatcontributeorarelikelytocontributetopreventingtheriskoftheoutbreakorspreadofCOVID-19,including(withoutlimitation)anyofthefollowing:(i)requirethingstobeclosedoronlyopenifspecifiedmeasuresarecompliedwith:(ii)prohibitthingsfromenteringanyportorplace,orpermittheentryofthingsintoanyportorplaceonlyifspecifiedmeasuresarecompliedwith:(iii) prohibit gatherings of any specified kind in any specified places or premises, or in anyspecifiedcircumstances:(iv)requirethingstobeisolated,quarantined,ordisinfectedinanyspecifiedwayorspecifiedcircumstances:(v)requirethetestingofthingsinanyspecifiedwayorspecifiedcircumstances.Theseareverysweepingpowers.AslongasthereissomeconnectionwiththeriskofspreadofCovid-19theGovernmentcanstopeveryonefromdoinganything,orrequirethemtodoanything.AllthatisrequiredisthePrimeMinister’sandtheMinisterofHealth’swishestotakeanaction.TheadviceAfteraconsiderationofthefreedomsandrightsimpactedbytheordersthathadbeenimposeditconcludedthat:‘theBillappearstobeconsistentwiththerightsandfreedomsaffirmedintheBillofRightsAct.”ThestartingpointisasummaryofthepurposesoftheBill. TheBillempowerstheCrowntocontinueitsprecautionaryapproachtopreventingandlimitingtheriskoftheoutbreakofCOVID-19inNewZealand,particularlyatloweralertlevelsandastheriskoftransmissionreducesovertime.Indoingso,theBillrecognisesthe

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highlycontagiousnatureofCOVID-19,alongwiththepotentialforasymptomatictransmission,andprovidesforcontinuedapplicabilityofnecessarypublichealthmeasures.Thisdescription,arguably,allowsamoreexpansiveinterpretationofthepowertointrudeonhumanrights,becausethepurposeistoempowera‘precautionaryapproachtolimitingtheriskoftheoutbreakofCovid-19.A‘precautionary’approach,isvagueandcanbeusedtojustifyalmostanything.TheActitselfmakesnomentionofthis‘precautionary’approachwhichswaystheadvice.Furthera‘precautionary’,approach,ifoverused,maynotbeconsistentwiththeSiracusaPrinciples.Principle54provides:Theprincipleofstrictnecessityshallbeappliedinanobjectivemanner.Eachmeasureshallbedirectedtoanactual,clear,present,orimminentdangerandmaynotbeimposedmerelybecauseofanapprehensionofpotentialdanger. HumanrightsimplicationsItisacknowledgedthatthepowerscouldhavesignificanthumanrightsimplications.ItisimportanttoacknowledgeattheoutsetthatthepowersintheBillallowforthemakingofordersthatmayimposeseriouslimitationsontherightsandfreedomsenshrinedintheBillofRightsAct.ThebackdroptothisBillisanunprecedentedpublichealthemergencythatrequiresanumberofexceptionalpowersthatwouldbeunlikelytobejustifiedinordinarycircumstances.Inthiscontext,itremainsimportanttoscrutiniseeachlimitonarightorfreedomcarefullytoensurethatitisjustifiedinthecircumstances.Tojustifytheselimitationsitisfirstarguedthatthetriggersfortheuseofthepowersinthemselvesprovideprotectionagainstdisproportionatemeasures.Afairlystrongtestisproposed:Inourview,forapublichealthcrisistojustifysignificantintrusionsonprotectedrightsandfreedomsthesituationmust:a.beofanexceptionalandtemporarynature;b.poseanactualorimminentthreat;andc.affectallbranchesofthelifeofthecommunity.WeconsiderthattheprovisionsintheBillthattriggertheuseofordermakingpowersincorporateeachofthesefactors.Mostimportantly,undercl8itwillonlybepossibletousethesepowersinrelationtoCOVID-19.ThereisnoquestionthattheglobalCOVID19pandemicconstitutesanexceptionalsituationthatposesanactualorimminentthreataffectingallbranchesofthelifeoftheNewZealandcommunity.

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AdviceasprotectionAfutherprotectionistheneedtoreceiveadvice.Withrespecttoreasonablenessandproportionality,wenotethatbeforemakinganordertheMinisterofHealthmustreceivetheadviceoftheDirector-GeneralofHealth,haveregardtothefactorssetoutincl8A(2)(b),andconsultwithotherMinisterialcolleagues.

ThecriticalpointhereisthattheprotectionaffordedbytheroleoftheDirectorGeneralofHealthhadbeensubstantiallydiluted.UndertheHealthActtheagreementoftheDirectorandtheMinisterofHealtharerequired.AprincipledDirectorcouldstanduptoanoverlyexcitedMinister,ortheMinistercouldreininarogueDirector.NowtheMinistersimplyhastoreceiveadvice.Andofcourse,under9(2),theMinisterdoesnotevenneedtoseektheDirector’sadvice.ForthisprotectiontobeeffectivetheDirectorGeneralwouldhavetohavesomebackboneandbepreparedtoadvisetheMinisteragainsttakingadisproportionateaction.Theadvicewouldalsoneedtobeimmediatelypublished.Thereisnosuchrequirement.AppropriateThereisanexpressrequirementfortheMinistertobesatisfiedthatanyorderisappropriatetoachievethepurposesoftheBill.Appropriateisaweakertestthatproportionate.Proportionateshouldleadtoaconsiderationofcostsandbenefits.Appropriatecouldmeananything.FurthersafeguardsTheBillalsoincludesseveralsafeguardstoensurethatordersarereasonableandwillgonofurtherthannecessaryinthecircumstances.ThereisnoexpressprovisionintheBillthatordersmustbereasonableandgonofurtherthannecessary.Therecouldhavebeen.TheBillcontainsanexpressrequirementfortheMinisterofHealthandDirector-Generaltokeepanyordersunderreview(cl13(5)).Thisdoesnotmeanthattheywill.Therewasnoongoingreviewprocesswhenthelevel4lockdownwasimposed.Andthereisnostandardtoguidethereview.OrdersmadeundertheBillarealsotemporaryinnatureTheycanbeextendedatwill.OuranalysisoftheextensionsoftheStateofEmergencyshowedthatitwasextendedcontinuallywhentherewasobviouslynojustificationfordoingso.

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KeyfeaturesignoredTheanalysisdidnotconsidertwokeyfeaturesoftheBill.First,isthecompletelygeneralandsweepingcapacitytomakeorders.ThispowerissimilartothatintheCivilDefenceEmergencyAct.Thegeneralpowersaremoreunderstandablehere,becausethisActhadtobecraftedtomeetawiderangeofemergencyevents.WithCovid-19,however,thekindsofinterventionsthatmightbenecessaryarenowwellunderstood,soitisnotclearwhyageneralpowerisrequired.Second,theconstraintsandremediesintheCivilDefenceEmergencyActagainstoverreacharelacking.TheprovisionsinthatActare:InachievingthepurposeofthisAct,beforeproposing,recommending,oradoptinganyprovisionsorregulationsinrelationtoanyfunctiondescribedinsubsection(2),anypersondescribedinthatsubsectionmust—

(a)haveregardto—(i) the extent, if any, to which the provisions or regulations are necessary to achieve thepurposeofthisAct;and(ii)othermeansinadditiontoorinplaceoftheprovisionsorregulationsthat,underthisActor any other enactment, may be used in achieving the purpose of this Act, including theprovisionofinformation,services,orincentives;and(iii) the reasons for and against proposing, recommending, or adopting the proposedprovisionsorregulationsandtheprincipalalternativemeansavailable,oroftakingnoactionifthisActdoesnotrequireotherwise;and(b)carryoutanevaluation,whichtheMinisterortheCivilDefenceEmergencyManagementGroupissatisfiedisappropriatetothecircumstances,ofthelikelybenefitsandcostsoftheprincipalalternativemeans;Ifthereisoverreachthereistheprospectofcompensation.Apersonwhohassufferedlossordamage,asaresultofanyactionormeasure….,mayrecovercompensationfromtheCrowniftheactionormeasurewassuchthatthegooddone,orlikelytobedone,bytheactionormeasureforthatpersonwasdisproportionatelylessthanthelossordamagesufferedbythatperson asaresultofthatactionorthatmeasure.TheaboveprovisionappearstobearesponsetotheSiracusaPrinciples.ThelackofsimilarprovisionintheCovid-19ActraisesthepossiblythattheActisnotlawful.

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MakingordersTheopinionthengoesontoconsiderwhetherthereareappropriatesafeguardsintheprocessformakingtheorders.Itisconsideredwhetherparticular,selected,ordersarelawful. ThereisnodiscussionofthelackofsafeguardsintheActdesignedtoensurethatthereisaseriousconsiderationofthenecessityandproportionalitytests.

Section11-Righttorefusetoundergomedicaltreatment Section11oftheBillofRightsActaffirmsthateveryonehastherighttorefusetoundergomedicaltreatment.

Clause10(a)(viii)oftheBillallowsfororderstobemaderequiringpeopletoreportformedicalexaminationortestinginanyspecifiedwayorinanyspecifiedcircumstances.

Weconsiderthattherighttorefusemedicaltreatmentisengagedbycertainformsofmedicalexamination,andparticularly,atestforCOVID-19 Clause10(a)(vii)primafacielimitstherighttorefusetoundergomedicaltreatment.Whereaprovisionproposesalimitonarightorfreedom,itmayneverthelessbeconsistentwiththeBillsofRightsActifthelimitisreasonableandjustifiableintermsofs5ofthatAct.

ThetestsOrrappliesareasfollows:

a.doestheprovisionserveanobjectivesufficientlyimportanttojustifysomelimitationoftherightorfreedom?ifso,then:i.isthelimitrationallyconnectedwiththeobjective?ii.doesthelimitimpairtherightorfreedomnomorethanisreasonablynecessaryforsufficientachievementoftheobjective?iii.isthelimitindueproportiontotheimportanceoftheobjective?

Thepurposeofcl10(a)(viii)istoensurethatappropriatepublichealthcontrolmeasurescanbeappliedinrespectofpeoplewhomayhaveCOVID-19,andalsothatpublichealthauthoritiescancollectinformationaboutpotentiallyunknownvectorsoftransmissioninthecommunity.

ThecollectionofthisinformationisclearlynecessaryandrationallyconnectedtothewiderobjectiveofprotectingagainstfutureoutbreaksofCOVID-19.Thisargumentismostlywrongonthefacts.Itisnotnecessarytotesteveryonetogetastatisticialpictureoftheprogressofthevirus.Thereisahighlevelofvoluntarytesttakingandafewomissionsdonotmatterfromastatisticalaccuracy

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perspective.Inmanycasesthekeystatistics,suchasthenumberofcases,donotrelysolelyontesting,butalsoonclinicalhistoryandbackgroundfactors.

Publichealthconcerns,particularlyasitrelatestoinfectiousdiseases,haveexplicitlybeenheldtobeasufficientlyimportantobjectivetojustifyalimitontherighttorefusemedicaltreatment.3

Thecasereferenceisacaseinvolvingthefluoridationofwater,anddidnothaveanobviousconnectiontotheissueofforcingamedicalinterventionwhenthereisaninfectiousdisease.

Withregardtotheproportionalityofthelimitontheright,wenotethatanoutbreakofCOVID-19wouldhaveextremeconsequencesforpublichealthandwellbeing.

Thisdoesnotaddresstheissueofwhethermandatorytestingwouldhaveanimpactonthecourseofthepandemic.Testsarenotwhollyaccurate(possiblyatleast20percentoftestsarefalsenegatives),anddecisionstoisolateandquarantinearestillmade,notwithstandingtheresultsofatest.

WhiletheBillempowersorderstobeissuedinrespectofmedicalexaminationandtesting,itdoesnotrequireapersontoundertakeanyparticularongoingformoftreatment.Inthisway,theBillcontinuestopreservethescopeofpersonalautonomyandbodilyintegrityasfarasispossiblewhilemaintainingpublichealth.

Thisirrelevant.Theissueiswhethertheycanbecompelledtotakeatest.Inpracticeitisprobablynotpossibletoforcesomebodytotakeatest.

Sections16,17and18–Freedomofpeacefulassembly,freedomofassociationandfreedomofmovementTheserightsarecloselyconnected,andtogethertheyprotectcoreaspectsofcivillifeinNewZealand,enablingpeopletofreelygoabouttheirdailylives.Inrelationtotheserights(astheyareaffectedbytheBill)wenotethefollowing:

• thechoiceofmethod,place,andtimeofpeacefulassemblyisintegraltothefreeexerciseofthatright;

• theambitoffreedomofassociationis“broadandencompassesawiderangeofassociationalactivities…”Ithasbeenheldtoincludetherightofanindividualtoassociatewithanyotherindividual.Freedomofassociationprotectsinformalassembliesandparticipationincommunitylifegenerally;

3New Health New Zealand Inc v South Taranaki District Council [2014] NZHC 395 at [86].

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• freedomofmovementincludestherighttouseroadsandmovethroughpublicplaces.

Clause10oftheBillsetsouttherangeofmattersandkindsofrequirementsthatcanbeimposedbyanorderissuedundercl8Aor9oftheBill.Anumberoftheserequirements(andcorrespondingpowersofenforcement)appeartoprimafacielimittheabovecivilanddemocraticrights.Particularlyby:

• requiringpersonstostayinaspecifiedplaceorrefrainfromgoingtoanyspecifiedplace;

• requiringpersonstorefrainfromtravellingtoorfromanyspecifiedarea;• requiringpersonstobeisolatedorquarantinedinanyspecifiedplace;• requiringpersonstorefrainfromparticipatingingatherings;• requiringpremisesorotherthingstobeclosedoronlyopenifspecifiedmeasures

arecompliedwith;and• prohibitinggatheringsofanyspecifiedkind,inanyspecifiedplaceorinany

specifiedcircumstances.

AssessmentapproachisnotvalidThisisnotavalidwaytotestthelegalityofrequrementsthatcanbemadeundertheAct.Eachorderhastobeassessedindividually,astotheirnecessityandproportionality.Itisnotappropriatetosaythattheyhavesimilarkindsofhumanrightsimpactsandhencecanbeassessedasagroup.

Thestandardrecitationoftheseriousnessoftheimpositionsfollows:

Together,thepotentialrequirementsthatcanbeimposedviaordersundercl10oftheBillcould,ifappliedtotheirfullestextent,imposearguablythemostextremeandsignificantlimitationsonNewZealanders’abilitytofreelygoaboutourdailylivesashasoccurredinmodernNewZealandhistory.Theirbroadscaleandscopehavethepotentialtosignificantlyimpactonpeople’sabilitytosocialise,dobusiness,andmovefreely.

Nevertheless,anddespitethepotentialdegreeoftheserestrictions,theBillmaybeconsistentwiththeBillofRightsActifthelimitationsarenecessaryandcanbejustifiedinafreeanddemocraticsociety.

Orrposesthejustificationintermsoftheimportanceoftheobjective.

Thepurposeoftheseprovisionsistoprevent,reduce,oreliminatetherisksofanoutbreakofCOVID-19.Thisoccursinthecontextofanextraordinaryglobalpandemicandinrespectofavirusthathasbeenshowntohaveextremeimpactsonpublichealthandwellbeing.Thefullextentofthecharacteristicsofthevirusarenotyetfullyknownbutwhatwedoknowis:

a.thevirusishighlycontagious;b.ithasanincubationperiodofupto14days;c.asymptomaticpeoplemaybecarriers;and

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d.althoughtheeffectofcontractionbyanyindividualvaries,intheworstcasestheeffectisveryseriousrequiringhospital,andsometimesICU,levelcare.

Thesefactorsmeantheutmostcautionmustbetakentoprotectpublichealth.

Thissmatteringofinformationaboutthenatureofthevirusdoesnothavemuchdirectbearingonthequestionofproportionality,orevenofnecessity.Orrisperhapsjusttryingtoshowthatheknowssomethingaboutthesubjectmatter.

Arethelimitsrationallyconnectedtotheobjective?Therestrictionsonpeople'sabilitytoassemble,associateandmovefreelyisrationallyconnectedtothepurposeoftheBill:preventing,reducing,andeliminatingtherisksofCOVID-19.

Thevirusistransmittedthroughphysicalproximity.Therestrictionstargetphysicalassociationandmovement,andtherebylimittheabilityofthevirustospreadbetweenpeopleandthroughoutthecountry.

Theconstraintsonmovementwerenotalwaysrationallyconnectedtoreducingtherisksofcovid-19.Limitsonmovementmakesensewhenoneareahasthevirusandanotherdoesnot.Ifthevirusisspreadthoughoutthecountry,however,thecaseforlimitsonmovement,assuch,makeslesssense.Ifthemovementisbycrowdedpublictransportthenitmaybenecessarytoclosedownthistransport.However,ifthemovementisbyprivatevehicleandsocialdistancingisobservedduringthejourneyandatthedestination,thenthereisnoadditionalrisk,andthereisnorationalconnection.TheformerMinisterofHealthobviouslythoughsowhenheusedacartogotoexercise.Thenextquestionis:

Dothelimitsimpairtherightsorfreedomsnomorethanisreasonablynecessaryforsufficientachievementoftheobjective?

Thediscussionstartswiththestatement that:‘Parliamentisentitledtoappropriatelatitudetoachieveitsobjectives.(CanadavJTI-MacDonald[2007]2SCR610at[42]–[45])Thecitedcaserelatedtoconstraintsontobaccoadvertising,whichdoesnotseemthatrelevanttomeasuresthatimpactoncovid-19.Theimportantpointhereisthatwithhumanrightsprotections,Parliamentortheexecutivearenotautomaticallyentitledtoa‘certainlatitude’.Theburdenofproofofnecessitysitssquarelywiththoseimposingtheconstraint.iftherearealternatives,withfewerhumanrightsimplications,thatwillsecuremostofthebenefits,thentheyshouldbetaken.And

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wearenottalkingaboutjusta‘certainlatitude’here.TheActprovidesuntramelledpowertoimposeanythingonthecitizenry.Theissuehereiswhetherthemeansareminimallyimpairingoftherights,andwhetherthemeansproposedarecarefullytailoredtotheobjective.TheBillisdesignedtoenabletheCrowntocarryonwithitsprecautionaryeliminationstrategy.Thisrequiresthecarefulongoingmanagementoflatentrisks,evenasthevirusreacheslowerlevelsofpresenceortransmissioninNewZealand,duetothehighriskthatthevirusposestopublichealth.BythiswethinkitismeantthattheBillwaseffectivelydesignedtoimposenocontraints,becauseanyconsiderationofproportionalityandnecessityhavetobeviewedagainstthe‘precautionaryeliminationstrategy’.Onthismetricallactionsarenecessaryandproportionate,andbycontructionhavetheminimumimpactonhumanrights.ThisinterpretativeapproachisalmostcertainlyinconsistentwiththeSiracusaprincipleNo.2.2.ThescopeofalimitationreferredtointheCovenantshallnotbeinterpretedsoastojeopardizetheessenceoftherightconcerned.

AndasnotedabovetheActmakesnomentionofaprecautionaryapproach.Notably,embeddedwithintheBillareseveralsignificantproceduralandsubstantivesafeguards.Thesetogetherprovideahighdegreeofassurancethatorderswillbeimposedonlya. whereariskoftransmissionremains;

Thisjustduckstheissueofwhetherthemeasuresareproportionate.Asitishighlyunlikelythattransmissionwillbeeradicatedworldwide,therewillalwaysbeariskoftransmission,sotheabsolutepowercanbeexercisedfortheforseeablefuture.b. inconsiderationofthevariouspublichealthconcerns,rightsaffected,andwidersocial

interestsatstake;

Thisisjustgoingaroundincircles.Theimpositionsmustnecessarilybetheminiumumnecessaryandproportionate,becausetherightsaffectedhavebeen‘considered’.Thereisnoevidence,throughlevel4andlevel3,thathumanrightsconsiderationswerebalancedagainstepidemologicalconsiderationsinasystematicway.Thelevels3and4decisionpaperdidnotevenacknowledgethattherewereanyhumanrightsissues.Inotherpapershumanrightsconsiderationswereanobligatory

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afterthought,ratherthanbeingatthecentreofdecision-making.Thisdoesnotprovideconfidencethatrightswillbegivensufficientconsideration,orindeedanyconsideration,inthefuture.c. throughmeansthatprovidesignificantpublicandParliamentaryoversightofanyorder

promulgated;

TheBill’slegislativeprocessgivesthelietothatclaim.ThesuspensionoftheRegulatoryImpactassessmentsandthelatereleaseofdocumentsdolikewise.andd.foraperiodoftimenolongerthan2yearsafterthecommencementoftheAct,unlessrepealedearlier.Twoyearsisalongtime,whichthegovernmentconcededwhenitwasreducedtothreemonths.Notablyalso,theBilldoesnotalloworderstobemadeinrespectofcorecivilanddemocraticinstitutions.Noorderrequiringpremisestoclosemaybemadeinrespectofaprivatedwellinghouse,Parliament,thecourts,judge'schambers,orprisons.Thisislargelyirrelevanttoaconsiderationofrestrictionsonmovement.However,seconddwellinghouseswereeffectivelyrequiredtoclose.Oncelockeddownintheirinitialdwellinghousepeoplewerebannedfrommovingtotheirsecondhouse.Finally,thediscretionarypowerthattheBillgivestotheMinisterofHealth(andDirectorGeneralofHealthinlimitedcircumstances)toissueordersmustbeexercisedconsistentlywiththeBillofRightsAct.Thisisanothercircularargument.ThepointoftheopinionistoassesswhetherthederogationsfromtheBillofRightsActarejustifiable,nottoassumethattheyare,justbecausethereisaconsistencyrequirementintheAct.

Overall,arethelimitsindueproportiontotheimportanceoftheobjective? TheBillprovidesforunprecedentedlimitsonfreedomofassociationandmovement.However,thisisinthecontextofaglobalpandemicandhighlytransmissiblevirusthatinsomeoftheworstcasescanhaveveryseriouseffectsrequiringICUlevelcare.ThepowersenabledundertheBillthereforereflectthesignificantriskthatCOVID-19posestopublichealthandwellbeingandanyordersmadewouldneedtobeproportionatetothatrisk.Asnotedabovean‘overall’testisnotthecorrecttest.Everyimpositionhastobejustifiedintermsofitscontributiontotheobjectiveandanditsimpactonhuman

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rights.Becausesomemeasuresmaybejustifeddoesnotmeanthatallmeasuresarejustified.Ifthe‘overall’approachistakenthenthiscouldjustifypracticallyeveryorder.TheSouthAfricans,forexample,went‘hard’takingaprecautionaryapproach.Amongstotherthingstheybannedthesaleofcigarettesandalcohol,andbanneddogwalking,cyclingandjogging. Weareoftheviewthat,forthesereasons,thelimitsthattheseordersmayplaceontherightstofreedomofmovement,peacefulassemblyandassociationarejustifiedunders5oftheBillofRightsAct.FreedomfromdiscriminationWenotethatthereisscopeforordersunderthisBilltohavedisproportionateimpactsoncertaingroupsprotectedfromdiscriminationunders21oftheHumanRightsAct1993(forexample,theelderly,orpeopleinonepersonhouseholds).Weconsiderthatthepowertomakeordersthatmightapplydifferentlytodifferentgroupsisclearlyjustifiableonpublichealthgrounds;howeverwewouldexpectdecision-makersundertheBilltotaketheseimpactsintoaccountwhenconsideringwhetheranorderisanecessaryandproportionatemeasuretofurtherthepublichealthresponse.

Thiswasjustanassertionwithouteventhepretenceofanysupportingargument.

Section21–Righttobefreefromunreasonablesearchandseizure Section21oftheBillofRightsActaffirmsthateveryonehastherighttobesecureagainstunreasonablesearchorseizure,whetheroftheperson,theirpropertyorcorrespondence,orotherwise.Therightprotectsanumberofvaluesincludingpersonalprivacy,dignity,andproperty.

Thefollowingistheargumentonthecontentiouswarrantlesspowersofentryprovision.

The purpose of the search authorised at cl 17(3) is to ensure that any risks posed by gatherings (in breach of the requirements of an order) that are taking place in private dwelling houses or marae can be identified and enforcement action taken to mitigate the risk. There is an extremely high public interest in limiting and preventing the outbreak of COVID-19 in New Zealand, which can be readily spread by large private social gatherings.

Itisunusualforaconstabletohaveawarrantlesspowerofentrytoaprivatedwellinghouseormarae.Thisisbecauseofthehighexpectationofprivacythatcitizensplaceontheseplaces.However,theexceptionalnatureoftheriskposedbyCOVID-19doesjustifysomelimitsonthisexpectation.

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Thissimplydoesn’taddressthekeyissue.Whycan’ttheconstablegetawarrant?Theremightbeagoodanswertothisquestion,buttheadvicedoesnotprovideit.

Theotherissueiswhetherwarrantlessentryistrulyneceesary.Inalowriskenvironmenttheoddsthatanindividualtrangressionwilladdtotransmissionriskareextremelyremoteandonlypartialcomplianceisnecessarytosecureanappropriateoutcome.Further,thepurposeoftheentryisjusttoissueadirection.Inmostcasesthiscouldbeissuedatthedoor.Entrywouldnotberequired. Socialgatheringsinparticularposeahighriskofwidespreadtransmission(irrespectiveofwhethertheyoccurinaprivateorpublicplace)andrequirecarefulmanagementinthepublicinterest.Thisisincontrasttootherbreachesofanorderthatmightoccurinaprivatedwellingormarae,whichhavelesssignificantsocialconsequences,andwherewarrantlessentryisnotpermitted.

ItisnotexplainedwhatotherbreachescouldoccurinadwellingorMarae.Itwouldseemthatthepermissiblenumberiseitherbeingexceeded,oritisnot.

Clause20–powertodirectpeopletoprovideinformation Thepowersundercl20foranenforcementofficertorequireapersontoprovideidentifyinginformationsupportsthemtoefficientlycarryouttheirenforcementfunctionsundertheAct,suchasissueinfringementnoticesinrespectofbreachesortogiveeffectivedirections.

Thereisonlyanegligibleprivacyinterestinrevealingidentifyinginformation.Forthesereasons,thePolicepowertodirectapersontoprovideinformationisnotanunreasonablesearchunders21ofthebillofRightsAct.Section22–Thisisnotunreasonable.

Libertyoftheperson Section22oftheBillofRightsActaffirmsthateveryonehastherightnottobearbitrarilyarrestedordetained.Thepurposeoftherightnottobearbitrarilydetainedistheprotectionofhumandignity,autonomyandliberty.Totriggertheconceptofdetentiontheremustbea“substantialintrusiononpersonalliberty”,whetheraphysicaldeprivationorastatutoryconstraint.TheCourtofAppealhasheldthat:“Anarrestordetentionisarbitraryifitiscapricious,unreasoned,withoutreasonablecause:ifitismadewithoutreferencetoanadequatedeterminingprincipleorwithoutfollowingproperprocedures.”

Forthisreason,arbitrarinessshouldnotbeequatedwith“againstthelaw”,butshouldbeinterpretedmorebroadlytoincludeelementsofinappropriateness,injusticeandlackofpredictability.

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Thenotableomissionfromthisdiscussionisanyconsiderstionofclause11(a)(i).whichpurportedlyallowsthemassdetentionoftheentirepopulation,forapotentiallyunlimitedperiod.Insteadtheanalysisisrestrictedtojustthequarantiningandisolationprovisions.Inpart4weconsideredtheDirectorGeneral’sjustificationofthelockdown.Hegavetheimpressionthatvoluntaryandcompulsorycompliancehadbeenmodelled,showingthenecessityofthecompulsoryapproach.Thatwasdeceptive.Therewasnosuchmodelling.Clause10(a)(vi)authorisesthatordersundertheBillcanrequirethatanypersonbeisolatedorquarantinedinanyspecificplaceinanyspecificway.Whereanenactmentisinconsistentwiths22,therecanbenoroleforjustificationunders5.Theterm“arbitrarily”isintendedtoprovideameasureofthereasonablenessofstatutorypowers,aswellastheexerciseofthosepowers.AtissueiswhetherthereissufficientjustificationfordetentionandwhethertheBillcarefullycircumscribeswhomaydetainaperson,forhowlong,andunderwhatconditions.

Inourview,cl10(a)(vi)isnot“arbitrary”forthepurposesofs22oftheBillofRightsAct.Inreachingthisview,wehavetakenaccountofarulingoftheEuropeanCourtofHumanRightsregardingthedetentionofindividualssufferingfromaninfectiousdisease.

InEnhornvSweden,21theCourtheldthatsuchdetentionswillonlybejustifiedif:

a.theresponseisproportionatetothethreatthediseaseposestothegeneralpublic;b.themeasureisameasureoflastresort;and c.thedetentionmustbeliftedassoonaspossibleasthepersonnolongerposesathreattothepublic.

Weconsiderthatthesefactorsaremetinthepresentcase.RequiringapersonwhohasbeenexposedtoCOVID-19(forexamplethroughtravellingtocountrieswherethereisahighoutbreakofthevirus,orwhoiswaitingforresultsofatest)isreasonableandnecessaryasitwillensurethatthepersoniskeptapartfromotherpersonsduringtheperiodthattheywouldbecapableofpassingonthevirus.Similarly,itisreasonabletoremoveapersonsufferingfromCOVID-19tohospitalwherethepersoncanbeisolatedfromotherpersonsandreceiveappropriatemedicaltreatment(whereconsentedto).ThesupportforthisistheMinistry’sadvice:TheMinistryofHealthhasadvisedthatapersonwhomaybeexposedtoCOVID-19(forexamplethroughinternationaltravel)needstobeself-isolatedforupto14dayswhichistheknownincubationperiodofthevirus TheMinistry‘sadviceonlyjustifiedhomeisolation.Itdoesnotaddresstheissueofrequiringisolationinamanagedisolationfacility,whichiscompulsoryfor

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internationaltravellers.ItisdisturbingthatOrrwasnotawareofthenatureoftheisolationorder,thathewasadvisingwaslegal.Iftheadvicehadaddressedtheissue,itwouldhavehadtoexplainwhyitwasrationalandproportionatetoallowhomeisolationforthosewiththevirus(ninetyfivepercentofthoseinfectedwereallowedtorecoverathome)whilethosecomingfromoverseaswithasmallchanceofbeinginfectedareplacedinmanagedisolation.Currentlynoattemptismadetodistinguishbetweentravellersfromhighriskandlowriskcountries.TheriskofatravellercomingfromChinahavingthevirusmightbe1:10,000,000,buttheriskfromtheUS1:200.Intheformercasetherisktothepublicisclosetonil,soa14dayquarantineisnotproportionate. WethereforeconsidertheBillappearstobeconsistentwiththerightnottobearbitrarilyarrestedordetainedaffirmedins22oftheBillofRightsAct. CompulsorymanagedisolationforpositivecasesWiththelatestoutbreakallpositivecaseswererequiredtogointomanagedisolation.Thisisamuchgreaterintrusiononhumanrightsthanselfisolation.TheDirectorGeneralexplainedthatthechangewastoshowjusthowseriousthegovernmentwasaboutcombattingthevirus.Publicmessagingisnotavalidjustificationofaderogationfromhumanrights.TheDirectorGeneralattemptedtowalkthisbackbyexplainingthatitwouldreducethepossibilitythatclosecontactsinafamilywouldbesubjecttomultiplehomeisolationperiodsasothermembersofthehouseholdbecamepositivecases.Thismayexplainwhysomecasesmayprefermanagedisolationiftheywereoffereditbutdoesnotexplainwhyitisnecessaryinallcases.Section27(3)-rightstojusticeinproceedingsagainsttheCrown Section27(3)oftheBillofRightsActprotectstheabilityofanindividualtobringaproceedingagainst,ortodefendcivilproceedingsbroughtby,theCrownandtohavethoseproceedingsheardinthesamemannerinwhichcivilproceedingsbetweenindividualscanbeheard.Clause33oftheBillimportsfromtheHealthAct1956theexistingprotectionfromliabilityforpersonsactingundertheprovisionsofthatenactmentandappliesthemtotheBill.Undertheseprovisions,anindividualactinginpursuanceofanyoftheprovisionsoftheActisprotectedfromcivilorcriminalliabilityunlesstheyhaveactedinbadfaithorwithoutreasonablecare.Wenotethatthismeansthatliabilitycanstilllieagainstanindividual,andaccordinglytheCrown,incasesofbadfaithornegligence.Weconsiderthisimmunitytobeconsistentwiths27(3)oftheBillofRightsAct.NotablynoattemptismadetoarguetheconsistencyoftheimmunitywiththeBillofRightsAct.AlmostcertainlythatisbecauseOrrcouldn’tthinkofanargument.The

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advicehasignoredtheSiracusapriniples,whichallowforeffectiveremediesfordisproportianateactionsmadeingoodfaith.56.Effectiveremediesshallbeavailabletopersonsclaimingthatderogationmeasuresaffectingthemarenotstrictlyrequiredbytheexigenciesofthesituation.AsnotedabovetheprovisionintheActcontrastswiththeprovisionintheCivilDefenceEmergencyAct,whichprovides:Apersonwhohassufferedlossordamage,asaresultofanyactionormeasure….,mayrecovercompensationfromtheCrowniftheactionormeasurewassuchthatthegooddone,orlikelytobedone,bytheactionormeasureforthatpersonwasdisproportionatelylessthanthelossordamagesufferedbythatpersonasaresultofthatactionorthatmeasure.DepartmentalDisclosurestatementTheDepartmentalDisclosureStatementthataccompaniedtheBillgavethefollowingresponsestothestandardquestions:Arethereanypubliclyavailableinquiry,revieworevaluationreportsthathaveinformed,orarerelevantto,thepolicytobegiveneffectbythisBill?NOArethereaspectsofthepolicytobegiveneffectbythisBillthatwerenotaddressedby,orthatnowvarymateriallyfrom,thepolicyoptionsanalysedintheseregulatoryimpactstatementsNOArethereaspectsofthepolicytobegiveneffectbythisBillthatwerenotaddressedby,orthatnowvarymateriallyfrom,thepolicyoptionsanalysedintheseregulatoryimpactstatements? NOHasfurtherimpactanalysisbecomeavailableforanyaspectsofthepolicytobegiveneffectbythisBill?NO Forthepolicytobeaffectedbythisbill,isthereanalysisavailableon:

(a) thesizeofthecostsandbenefitsNO

(b) thepotentialforanygrouptosufferasubstantialunavidablelossofincomeorwealthNO

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Thesuccessionof‘nos’istelling.D:TheStateofEmergencyAstateofnationalemergencywasdeclaredon26March2020.Thisactivatedsweepingemergencypowers.Becausethepowersarepotentiallysosweepingtheyareonlybeinplacefor7days,andanyextensionmustbejustified.AdeclarationorextensionofastateofemergencyismadeontheadviceoftheDirectorofCivilDefenceandEmergencyManagement.Therationaleforthedeclarationon26Marchwas:TheeffectofthedeclarationisthatthecontroloftheresponsetoCOVID-19willbemanagedatthenationallevelandwillensurelocalandregionallevelcompliancewithinstructionsissued.TheaimistoensurethehealthsystemcapacityisnotexceededthroughstrengtheningpublichealthmeasuresandsupportingtheenforcementofCOVID19interventionstoreduceandeliminatesustainedandintensivetransmissionofthedisease. Theaimwastosupportasuppression,notaneliminationstrategy.TheDirectorofCivilDefenceandEmergencymanagementmadethefollowingdeclaration. I,asDirectorCivilDefenceEmergencyManagement,advisethattheemergencyis,orislikelytobe,ofsuchextent,magnitude,orseveritythatthecivildefenceemergencymanagementnecessityordesirableinrespectofitis,orislikelytobe,beyondtheresourcesoftheCivilDefenceEmergencyManagementGroupswhoseareasmaybeaffectedbyCOVID-19.Thisassessmentassumedthattheepidemiccouldspinoutofcontrolnecessitatingemergencypowerstorequisitionresources,assistintheprovisionofnecessities,andsoon.Giventheearlyandhardmeasuresimposedthiswasnotalikelyoutcome,butinthecircumstances,withsomanyunknowns,a‘precautionary’response,toensurethatresourceswereinplaceinatimelymanner,wasunderstandable.Theemergencypowerscouldalsobeusedtosupportsocialdistancingmeasures,thoughitwasnotclearwhatsupportwasneededinadditiontothoseavailalbleundertheHealthAct.Unless,possibly,becausethereweredoubtsaboutthepowerstheDirectorGenenalofHealthwaspurportingtohaveunderthatHealthAct. On23March2020,thePrimeMinisterannouncedtheNewZealandthreatlevelforCOVID-19isnowlevel3,andwillmovetoLevel4at11.59pmonWednesday25March.

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ACOVID-19Level4threatlevelmeans,thebestadvicewehaveatthemomentisthat,itislikelythatthediseaseisnotcontainedandthereissustainedandintensivetransmissioninNewZealand.I,asDirectorCivilDefenceEmergencyManagement,andmyofficialsconsiderdeclaringaNationalStateofEmergencyisanappropriateactiontotakeinresponsetoCOVID-19.Itwillenableustorespondbyallmeansnecessaryasthesituationdevelopsandhavefullaccesstotheresourcesavailabletopreservehumanhealth,societyandtheeconomy. Thestatementthatthediseasewasnotcontainedandthattherewas‘sustainedandintensivetransmission’wasanoverstatementtosaytheleast.Theadvicethattherewas‘sustainedandintensivetransmission’wentwellbeyondtheadvicethatsupportedthemovetolevel4.Theevidencewasthattherewerefourcasesofcommunitytransmission.Thesourceofthe‘best’advicewasnotdisclosed,anditappearsthattheDirectordidnotmadeanenquiryastothetruestateofaffairs,orwasdeliberatelymisled.AsaStateofEmergencylastsforsevendaysitwassuccessivelyamended.31March2020FirstextensionThefollowingprovidesthejustificationforthefirstextension.NewZealandiscurrentlyatCOVID-19alertlevel4.CasesofCOVID-19continuetoriseinNewZealand,with589confirmedandprobablecasesasat0900hourson30March2020,andevidenceofsomecasesofcommunitytransmission.Therangeofinterventionsrequiredunderalertlevel4mayrequireimmediateaccesstopowersmadeavailableundertheCivilDefenceEmergencyManagementAct(CDEMAct)duringastateofnationalemergencyWiththefollowingcaveatThepowersavailableinastateofemergencyaresignificant,andmustonlybeusedwhenreasonablynecessary. Andthisiswhattheyhaddone:Sincethestateofnationalemergencywasdeclared,CDEMActpowershavebeenusedtorequisitionacarparkforCOVID-19testinginCanterburyandtoensureCDEMGroupshavetheirEmergencyOperationCentresandwelfarestructuresactivatedtotheappropriatestandard.ConstableshavealsohadaccesstotheCDEMActpowerstoreinforcetheGovernment’sself-isolationrequirements.Andtheoutlookwas:

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AstheCOVID-19pandemiccontinues,thelikelihoodofneedingtouseemergencypowersincreases.Forexample,thepowersmaybeusedtoensuretheappropriatemanagementoffuelandfoodsothatcommunities,particularlyvulnerablegroups,havewhattheyneed.Theremayalsobeongoingandheighteneddemandandcompetitionforresourcesataregionallevelthatrequiremanagement/interventionatanationallevel.Thissomewhatoverstatedthelikelihoodofabigepidemicthatwouldrequiretheuseofemergencypowers.ThenumberofnewcaseshadnotincreasedgreatlysinceMarch26,thoughtherewasstillconsiderableuncertaintyabouthowtheepidemicwouldevolve.Ontheneedforastateofemergency:Thenuancedrelationshipbetweenthealertlevel4andthestateofnationalemergencywillnotlikelybecleartoNewZealanders.Ifthestateofnationalemergencyisnotextended,itwilllikelycausepublicconfusionandpossiblysendasignalthatthesituationisnotasseriousasitis.ThiscouldunderminetheGovernment’sresponseandcompromisetheoutcomestheGovernmentistryingtoachieve(i.e.causepeopletofollowtheinterventionsmoreloosely,ornotfollowthem).MaintainingastateofnationalemergencywouldclearlysignaltoNewZealandersthatthereremainsahighriskoffurthersustainedandintensivetransmissionofCOVID-19.ItisnotclearthatawishtosupporttheGovernment’smessagingisavalidreasonforextendingthestateofemergency.Probablynot. 6April20202ndextensionCases of COVID-19 have continued to rise in New Zealand, with 1,039 combined confirmed and probable cases as at 0900 hours on 5 April 2020, and evidence of community transmission. Thedatawasshowingthatby6Apriltherewerefewsignsofcommunitytransmission.Thefocusjustontheriseincasesmissestherateofchangeincases,whichiswhatwasimportant.ItappearsthattheDirectorwasreluctanttoacknowledgeanygoodnews.Whatwhatwasbeingdone:.On29March2020,IdirectedallCDEMGroupstoactivatetheirCDEMarrangementsinsupportoftheresponsetoCOVID-19.SincetheStateofNationalEmergencywasfirstdeclared,CDEMGroupshaveusedCDEMActpowerstodirectnon-essentialbusinessestoclose,directfreedomcamperstorelocate,requisitionacarparkforCOVID-19testing,andclosesomeroads.

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Therewere11pettyinterventions,mostlyagainstfreedomcampers.Oneruralroadwasclosed,cuttingoffaccesstoaforestparktohunters. Onebusinesstradingnon-essentialproductswasdirectedtostoptrading.Therationaleonthelattercasewas:Tostopanactivitywhichmaysubstantiallycontributetotheemergency(COVID-19))Toceasemembersofthepublicmakingnon-essentialtripsbyclosinganon-essentialactivity.Therefore,minimisedriskofinfectionofothers.Asingletradercouldnothave‘substantiallycontributed’totheemergency. Thediscussiononthejustificationfortheextensionwas:Eachweek,officialsconsiderawiderangeoffactorswhenformulatingadviceonwhetheritisnecessarytoextendtheStateofNationalEmergency.a)whetherthestatutorytestshavebeenmet;(theseare)

• anemergencyhasoccurredormayoccur;and• the emergency is, or is likely to be, of such extent,magnitude, or severity

that the civil defense emergency management necessary or desirable inrespectof it is,or is likelytobe,beyondtheresourcesof theCivilDefenseEmergency Management Groups whose areas may be affected by theemergency.

b)theseverityandimpact/consequencesofthecurrentsituation/emergency;c)thedegreeofcomplexityofthenecessaryresponse(includingtheneedforcoordinationatthenationallevel);d)thepotentialneedforpowersundertheCDEMActtomanagetheresponse;ande)theeffectivenessofmeasuresinplacetomanageandeliminateCOVID-19.WhilethenumberofcasesofCOVID-19continuetoriseinNewZealand,andthereisevidenceofcommunitytransmission,Iacknowledgethenumberofnewconfirmedandprobablecasesdetectedeachdayappearstobeslowing.OnSunday12April,atotalof18newconfirmedandprobablecaseswerereported,downfrom29casesthepreviousday.Despitethis,weneedtomaintaincurrentrestrictionsonmovementsupportedbythepowersundertheCivilDefenceEmergencyManagement(CDEM)Actifwearetofullyrealisethebenefitsofthemeasuresinplace.Itwasgettingreasonablyclear,especiallyonthecasenumbers,thatthetestsforanextensionofthestateofemergencywerenotbeingmet,buttheDirectorappearedloathetodrawthatconclusion.

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20April20203rdExtension Thejustificationforthisextensionwas: Whilethenumberofnewconfirmedandprobablecasesappearstobeslowing,maintainingaStateofNationalEmergencywillenableustorespondasnecessaryshouldthesituationchange,andensurewecontinuetohavefullaccesstotheresourcesavailabletopreservehumanhealth,societyandtheeconomy.Bythisstagethenewcasenumbershaddroppedtolessthantenadayandtherehadbeennocaseofanunlinkeddomestictransmissionformorethantwoweeks.Theprospectsofanoutbreakseriousenoughtorequireastateofemergencywereextremelylow.Itwouldtakeacoupleofmonthsforthecaseloadtogrowtothatlevel.However,theyappearedtobebusy.Theinterventionfortheweekwas:NoiseControlOfficersabletorespondtonoisecomplaintsinordertomaintainlawandorderandensurethatthereiscompliancewithnationalAlertLevel4measures(physicaldistancing/isolation)duringStateofNationalEmergency.

27April20204thextensionThejustification:AsDirector,CivilDefenceEmergencyManagement,IconsiderextendingtheStateofNationalEmergencyisanappropriateactioninresponsetotheongoingandseriousimpactofCOVID-19.Whilstthenumberofnewconfirmedandprobablecasesiscontinuingtoslowanddecline,theriskCOVID-19posestoNewZealandremainshigh,andcommunitytransmissionmaystillbeoccurring.Therehadbeennouseofpowersbycivildefencegroupsintheprevious7days.TheStateofNationalEmergencyexpiresonWednesday29Aprilat12.21pm.AnextensiontoaStateofNationalEmergencyshouldonlybemadeifthesituationremainsanemergencyandtheemergencyis,orislikelytobe,ofsuchextent,magnitude,orseveritythatthecivildefenceemergencymanagementnecessaryordesirableinrespectofitis,orislikelytobe,beyondtheresourcesofCivilDefenceEmergencyManagementGroupswhoseareasareaffectedbytheemergency Thisplainlywasn’ttrueatleasttwoweeksbefore,andwasn’ttruewhenthisextensionwasrecommended.

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May20205thextensionThejusificationThepublichealthriskposedbyCOVID-19remainsanemergencyasdefinedbytheCDEMAct,towhichwemustrespond.WhilstthenumberofnewconfirmedandprobableCOVID-19casesiscontinuingtoslowanddecline,theMinistryofHealthassessesthattheoverallpublichealthriskforNewZealandremains‘high’andtheWorldHealthOrganisationriskassessmentoftheglobalsituationremainsat‘veryhigh’.ThereferencetoahighriskinNewZealandisprobablyareferencetooneofthevacuousESMreportsdiscussedinPart5.TheWHO’sassessmentoftheworldsituationwasirrelevanttoaconsiderationofriskforNewZealandandthenecessitytoextendthestateofemergency.NewZealandwaseffectivelyclosedofffromtherestoftheworld. Inaddition,therestrictionsrequiredtoreducethespreadofCOVID-19areresultinginsignificantandcomplexconsequencesacrossarangeofsectors.ManagingtheseconsequencesrequirescarefulnationalcoordinationandapplicationofCDEMknowledge,measuresandpracticestohelpguardagainst,preventandreduceanyharmsorlossthatmaybeassociatedwithCOVID-19,andwhichareatalevelbeyondthatofindividualCDEMGroupstomanage.Therehadbeennouseofpowersbycivildefencegroupsintheprevious7days.ObviouslyitisbeyondthecapacityofindividualCivilDefencemanagerstodonothing.TheoverallCOVID-19responsestrategyiselimination.EliminationdoesnotmeaneradicatingthevirusfromNewZealand,butrathereliminatingcommunityleveltransmissionwhilstcontaining/controllingthosecaseswhichdooccurinawaywhichensuresanyfurthercommunityleveltransmissionispreventeduntilavaccineisavailable.Thecontinuedoccurrenceof/orpotentialforuncontrolledcommunitylevelspreadofCOVID-19isonefactorforconsiderationonwhetherthestateofemergencyneedstoremaininforce.RemarkableeffortshavebeenundertakentocontrolthespreadofCOVID-19.TheDirectorGeneralofHealthhasnowstatedthatontheevidencecurrentlyavailableheisconfidentthat,thereisnowidespread,undetected,communitytransmissionofCOVID-19occurringinNewZealand–aprinciplerequirementtoallowthemovefromAlertLevel4to3.Thiswaslittlemorethancheerleading.Itwasobviousthatthenearandmediumtermpotentialforuncontrolledspreadwasextremelyremote.Thesolereportedactionovertheweekwastorequireapersontostopcampinginapublicparkandtomovetoalocalmotorcampforemergencyshelter.

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6May20206thextensionThejustificationthepossibilitythatcommunitytransmissionmayre-emergeremains,particularlyduetotherelaxationofthepublichealthmeasuresbetweenAlertLevels4and3,andthepublic’slevelofcompliancewiththenewmeasures.Theneedforsuchpublichealthmeasuresindicatesthattheemergencyremains.ThenextweektheDirectorgaveupthecharade.IfaStateofEmergencywasevernecessary,itwasextendedwellbeyondthedateitshouldhaveexpired.ThiswasnotconsistentwiththefollowingSiracusaprinciplesonstatesofemergency.

• AstatepartyavailingitselfoftherightofderogationpursuanttoArticle4shallterminatesuchderogationintheshortesttimerequiredtobringtoanendthepublicemergencywhichthreatensthelifeofthenation.

• Theprincipleofstrictnecessityshallbeappliedinanobjectivemanner.Eachmeasureshallbedirectedtoanactual,clear,present,orimminentdangerandmaynotbeimposedmerelybecauseofanapprehensionofpotentialdanger.

E:InquiryintotheoperationoftheCOVID-19PublicHealthResponseAct2020ReportoftheFinanceandExpenditureCommitteeJuly2020ThisenquiryintotheCovid-19PublicHealthResponseActwasconductedbytheFinanceandExpenditureCoommitteeratherthanthelogicalbody,theEpidemicResponseCommittee.TheobviousreasonisthattheGovernementwantedatamereport.IthadamajorityontheFinanceandExpenditureCommitteeandthatiswhatitgot.TheFinanceandExpenditureSelectCommitteereportwasmainlyconcernedwithproceduralandenforcementconsiderationsandonlyfocusedonissuesthatwouldariseinalertlevels1and2.DespitethelargenumberofsubmissionsconcerningthesweepingandunconstrainedpowersundertheAct,thereportdidnotseriouslyconsiderthisissue.InsteaditjustreliedonanassurancefromtheAttorney-General.

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TheAttorney-GeneralassuredusthattheHealthAct1956wassufficienttoprovidealegalbasisfortheGovernment’sresponsewhenNewZealandwasinalertlevels3and4.However,theexistingmechanismsintheHealthActwereunsuitedtorespondingtoCOVID-19atalertlevel2orlower.TherewasalengthydiscussionontheGovernment’sstrategyoncompliance:TheGovernment’sstrategywasinformedbyalargebodyofacademicresearch.Thiswasanoverstatement.Therewerethreereferencestoacademicresearch.Theonlyanalysisrelevanttocovid-19wasanempiricalpieceonself-reportedcompliancewithsocialdistancingrequirementsintheNetherlands.Itwasn’tveryclearhowitconnectedwiththecontentoftheNewZealandAct. NewZealandadoptedanapproachtocomplianceknownas“responsiveregulation”.Thecentralnotionofresponsiveregulationisthatregulatorsshouldseekcompliancethroughtheleastintrusiveresponsepossibleandacceptable.Insteadofaimingforcompliancethroughdeterrence-basedstrategies,academicresearchsupportstheadoptionoflesspunitiveandlessrestrictivestrategies.NewZealanddidnotuse‘responsiveregulation’.Insteadthepotentiallyhighlycoercivelevel4measureswereusedalmostimmediately.TherewasnodiscussionoftherelativeeffectivenessofvoluntaryversuscoercivemeasuresdrawingfromtheexperiencesinothercountriesTheNationalpartyminorityontheCommitteethoughtthattheprocesswassomethingofasham.Thisistheirminorityreport.TheNationalPartydoesnotbelievethisinquirywasnecessary,andcouldhavebeenavoidediftheGovernmenthadusedtheperiodbetweenlevel4lockdownandearlyMaytomoreproactivelyframethelegislationitbelievedwasnecessarytomanagetheCOVID-19responseatlowerlevels.Instead,theGovernmentchosetoramthroughlegislationunderurgencywithoutanypublicscrutinydespitetheresultingsignificantcurtailmentofNewZealanders’fundamentalfreedoms.Whileweacknowledgetheneedforaframeworktoreducethespreadofthevirus,therewerealreadysignificantquestionsaboutwhethertheactionstheGovernmenthadtakenundertheHealthAct1956werelegalandtheGovernmentrefusedtoreleasetheadviceithadreceivedonthismatter.WealsobelievethatthebestcommitteetoundertakethisinquirywastheEpidemicResponseCommittee,acommitteespecificallysetupastheoversightcommitteeforCOVID-relatedmatters.NationalbelievestheselectionoftheFinanceandExpenditureCommitteetoundertaketheinquiryandthesubsequentclosingdownoftheEpidemicResponseCommittee

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wasdesignedtoensurethatGovernmentmembershadamajorityonthecommitteeconductingthisinquiry.

F:HumanRightsCommissionResponsesTheHumanRightsCommission’sinitialresponsetothehumanrightsissuesraisedbythelock-downwasareport‘HumanRightsandTeTiritioWaitangi:COVID-19andAlertLevel4inAotearoaNewZealand’,releasedon20April.Thefocuswasnotonintrusionsonindividualhumanrights,butratheronresponsibilitiestothecommunity,togetherwithsomepetgrizzlesaboutthestateofsociety.Itwasmoreofacheerleading,thanacritical,document.HumanrightsandTeTiritioWaitangiarenotonlyaboutrights,theyarealsoaboutresponsibilities.Theyplaceresponsibilitiesongovernmentandothersholdingpublicpower,andtheyalsoplaceresponsibilitiesonindividualstotheircommunities.AstheUniversalDeclarationofHumanRightsputsit,everyonehasdutiestothecommunityinwhichthefreeandfulldevelopmentoftheirpersonalityispossible.Thishumanrightsresponsibilityofindividualstotheircommunities–stayinginourbubbles,socialdistancing,gettingtested,protectingiwi,hapüandwhänau,lookingoutforeachother–wasoneofthestrongestfeaturesofLevel4.Consistentwiththesehumanrightsobligations,thegovernmenthasrespondedtothepandemicwithvigouranddetermination.TheHumanRightsCommissionstronglycommendsthegovernmentforprotectingthehealthandlivesofsomanytangatawhenuaandNewZealanders.Overall,thecountry’ssystemsofhealthprotectionandhealthcarehaveperformedverywell.However,therewere‘significantshortcomings’illustratedby10‘snapshots’onhowthelevel4lockdownimpactedon‘humanrights’;andtheTreaty.The10snapshotswere

• AccesstoPPSforthepeoplemostvulnerabletoCovid-19,suchasdisabledpeople,olderpeopleandthosewithunderlyinghealthconditions.

• Accesstojustice.ThiswasacomplaintthattheHumanRightsReviewTribunalclosedforthedurationofalertlevel4.

• Contacttracing,surveillanceanddata.Therewasaconcernthatnewtechnologytoenhancecontacttracingcouldbeused‘repressively’.

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• DeprivationoflibertyTheonlyconcernherewasthat:peopleheldinprisons,policecells,securementalhealthanddementiaunits,youthjusticefacilitiesandcareandprotectionresidenceswereeffectivelylockeddownfromtheoutsideworld.Researchshowsthatsuchpeoplearevulnerabletocruel,inhumananddegradingtreatment.Thisriskisheightenedwhentheyarecutofffromfullinteractionswithindependentmonitoringagencies,statutoryvisitorsandtheirwhänau.

Therewasanobliviousnesstothefactthatmostofthepopulationwas,tovaryingdegrees,cutofffromtherestoftheworldandhadbeenplacedinhomedetention.

• RacismThishadsomethingtodowithreportedcasesof‘racism’andxenophobiaintheearlystagesofthepandemic,leadingontoconcernsaboutracisminsocietymoregenerally.

• DisabilityThiswasrelatedtosomedelaysinprovidingCovid-19informationinaccessibleformats,andthelackofdisaggregagteddata.

• OlderpeopleOlderpeopleareatriskwhentheirdailylivesandsupportsystemsaredisrupted.Numeroushumanrightsareimplicated,includingtherightstohealthcare,food,anadequatestandardofliving,andaccessibleinformation.

• WomenIntheeraofCOVID-19,womenhavebeendisproportionatelyimpactedbyjoblossesinretail,hospitalityandtourism.Thiswillleadtoariseinpovertyforwomen,particularlyMäori,Pacificandwomenfromethnicminoritygroups,whoworkedinlargenumbersinthoseindustries.

• EmploymentThiscoveredallofthepossibleills,fromaCommissionperspective,inthepostlockdownworld.

TherewasnomentioninthedocumentoftheNewZealandBillofRights,thecontentoftheUniversalDeclarationofHumanrights,andtheSiracusaPrinciples.Therewasnodiscussionofthetensionsbetweentheneedtomanagetheepidemicandtherightsprotectedbythosedocuments.RatherthedocumentreflectedtheCommission’sviewthathumanrightsarenotaboutindividuallibertyandrightsatall,butmostlyabouttherightstocollectivelyprovidedservices.

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Anaboutface?

WhentheCovid-19PublicHealthActwasrushedthroughParliamenttheHumanRightsCommissionerapparentlythensawthethreatofunrestrainedcoercivepowerandreleasedapressstatementonMay132020.

TheHumanRightsCommissionisdeeplyconcernedaboutthelackofscrutinyandrushedprocessfortheCOVID-19PublicHealthResponseBill.

“ForweekstheGovernmenthasknownthatwewouldbemovingtoalertlevel2.Ithasnotallowedenoughtimeforcarefulpublicdemocraticconsiderationofthislevel2legislation.TherehasbeennoinputfromordinaryNewZealanderswhichisdeeplyregrettable

giventhatthelegislationencroachesonthecivillibertiesofNewZealanderswehaveseriousconcernsaboutwhetherthepowersareproportionate"(ouremphasis).

“Intimesofnationalemergencysweepingpowersaregranted.Thereisariskofoverreach.Mistakesaremadeandlaterregretted.

G:RegulatoryimpactassessmentsAnimportantpartoftheCovid-19responsewasthedecisiontosuspendtherequirementtomakeregulatoryimpactassessmentsofCovid-19relatedmeasuresuntilAugust312020.Thissuspensionmayhavebeenpartiallyresponsibleforthelowqualityoftheanalysisanddocumentationsupportingmanyofthemeasures.Thispartreviewsthedocumentsonthesuspensiondecision.Theconnectiontohumanrightsconcernsisthattherequirementtoassessthenecessityandproportionalityofthemeasurestakenwasweakened. 20March2020OralitemforCabinet23March2020:TemporarysuspensionofRegulatoryImpactAnalysisrequirementsfordirectCovid-19responsesTreasurytoMOFThispaperprovidedtalkingpointsforanoralpresentationtotheCabinetmeetingthatapprovedthemovetoalertlevels3and4.Therationaleforthesuspensionwas:

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WehavedevelopedthisproposaltoaddressthecostsanduncertaintiescreatedbyCovid-19proposalsbeingdevelopedatpacewithnotimeforregulatoryimpactanalysis,andnoexemptionintheRIArequirementsforproposalstorespondtoemergencies.TheRegulatoryQualityTeam(RQT)hassofardealtwithfourCovid-19responsesthatundernormalcircumstancesshouldbeaccompaniedbyregulatoryimpactanalysis.Theremayalsohavebeenotherswewerenotmadeawareof,andweexpectmoretocome.RegulatoryproposalsproceedingwithoutRIAwouldnormallybesubjecttoproceduresforinadequateRIAassetoutinCabinetOfficeCircular(17)3,includingconsideringwhetheraSupplementaryAnalysisReport(SAR)isrequired.Wehavebeenconsideringtheseproposalsonacase-by-casebasis,andhavegenerallynotrecommendedSARs,astheseareunlikelytoserveanyusefulpurposewhentheCabinetdecisionsandimplementationareproceedingatsuchpace.Wehave,however,generallyadvisedthattheinterventionsshouldbemonitored,sothattheycanbeadjustedasnecessaryandinformfutureemergencies.SafeguardsontheproposedRIAsuspensionandimplementationarrangementsTheproposalwehavedevelopedtosuspendRIArequirementsfordirectCovid-19responsesincludesmeasurestomitigatetherisksofsuspendingRIA:•itistime-limitedandtightlyfocussedondirectCovid-19responses.•RQTandtheTreasuryCovid-19teamwillworkwithdepartmentstogetavailablerelevantanalysisincludedinCabinetpapers,and•wewillmonitoruseofthesuspensiontoidentifyandaddressissuesthatarise.ThedraftCabinetpaperaddedthefollowing:TheRIArequirementssupportandinformthegovernment’sdecisionsonproposalsforregulatorychange.Theyareaprocessandananalyticalframeworkthatencouragesasystematicandevidence-informedapproachtopolicydevelopment.RoutinepublicationofRegulatoryImpactAssessmentscontributestothetransparencyandaccountabilityofgovernment. Thiscase-by-caseapproachcreateshighcostsintimeanduncertaintyfordepartmentsandtheTreasury,whileaddinglittleornovalueatatimewhendepartmentalresourcesarealreadystretched.ThereisalsoariskthattheapproachunderminestheintegrityoftheRIAprocess.TherearerisksinremovingtheRIArequirementsinthesecircumstances.WhenweareaskedtomakeCabinetdecisions,includingdecisionsthatmaybesignificant,wewillnothavethebenefitofdepartments’analysistohelpusdeterminewhethertheproposalisthebestandmostfeasibleinthecircumstances.However,therisksofnotmakingdecisionsareconsiderable.

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TherewasnodiscussionofwhyregulatoryimpactassessmentshadtobesuspendeduntiltheendofAugust,orwhypasttheinitialflurryofdecision-making,suspensionscouldnotapplyonacasebycasebasisforurgentproposals.Thedecisionstoeasethealertlevelswerenoturgent.Onhumanrightsitwasstated:TherearenoHumanRightsimplicationsfromthispaper.Thiswasnotnecessarilycorrect.Asnotedabovederogationsfromhumanrightsprotectionsrequireanassessmentthattheyarenecessaryandproportionateandthattheseassessmentsmustbeevidence-based.Withoutthedisciplineoftheregulatoryimpactassessmentprocessitwaslesslikelythattheserequirementswouldbemet.30March2020AgencyguidanceThisinformedagenciesofthecabinetdecisionandsetouttherulesfordecidingwhetheraproposalwascovid-19related.Italsoincludedthefollowing:RIAisstillvaluableifitcanbedone,soeveniftheRIAsuspensionapplies,youmaychoosetodoregulatoryimpactanalysistohelpinformMinisters’decisionsIftheproposalisparticularlysignificantandyouhavetheopportunity,doingatleastsomeimpactanalysiswouldhelpinformMinisters’decision-making,andprovideaplatformforfreeandfrankadvice.WedidnotfindasinglecasewhereanagencyproducedaRegulatoryImpactAssessment.

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Parteight:EquityatthecentreofthenationalresponseThroughmanyofthedocumentsreleasedbythePrimeMinisters’officeandtheMinistrythereisarecurringthemethat‘equity’andtheTreatyofWaitangiobligationsshouldbeatthecentreofthenationalresponse.The23Marchalertlevel4decisiondocumentmadethefollowingcase.AsaDepartmentofthePublicService,theMinistryofHealthandothergovernmentagencieshavearesponsibilitytocontributetotheCrownmeetingitsobligationsunderTeTiritioWaitangi/TreatyofWaitangi.MāoriasapopulationgrouphavefaredworstineverypandemicNewZealandhasseen,namelythe1918influenzapandemicandthe2009influenzaA(H1N1)pandemic.The1918pandemicresultedinadeathrateforMāoriof4%,approximatelyseventimeshigherthanthenon-Māorideathrate.RatesofhospitalisationanddeathsforH1N1werealsomuchhigherforMāorithanforotherethnicgroups.Itisevidentfrompreviouspandemicresponsesthatthebusiness-as-usualmodelpreviouslyused-preferentiallybenefitednon-Māoriandfailedtoprotectwhānau,hapū,iwiandMāoricommunitiesfromtheworstoutcomes.ConsiderationofthespecificneedsofMāori,particularlyequityandactiveprotection,shouldbeintegraltotheGovernmentsresponsetoCOVID-19.MāoriareatgreaterriskfrompandemicsthanmanyotherethnicgroupsinNewZealand.Therearemanydifferentfactorsatplay,includingunderlyingsocialandeconomicdisadvantage,agreaterburdenofchronicdiseasesthatincreaseriskofmoreseriousoutcomesfrominfections,suchasinfluenza,andpooreraccesstoandqualityofhealthcare.Thethinkinghere,andinotherpapers,wasthat:thisisapandemic.Maori(andPacific)havebeendisproportionatelyaffectedbypastpandemics.Hencetheywillbedisproportionately,andinequitably,affectedbytheCovid-19epidemic.WhatthismissesisthattheCovid-19epidemicisnotthesameastheearlierepidemics.Negativeoutcomes,andinparticulardeaths,areheavilyconcentatedamongsttheelderly,withtheover70saccountingfor85-90percentofdeathsincountrieslikeNewZealand.

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AstheMaoriandPacificpopulationshaveayoungeragestructurethantheEuropean/otherpopulation,andamuchsmallerproportioninthevulnerable70+agegroup,theexpectationisthattheMaoriandPacificwouldnotbedisproportionatelyaffectedintermsofdeaths.Thereisalsoevidencethatunderlyinghealthissues,withobesitybeingagoodmarkerforrisk,arealsoafactorinexplainingdeathrates,butitisunlikelythatthiswilloutweightheageeffectforMaoriandPacific.Therearetwostudiesthatcometoadifferentview,onebytheOCRGandonebyTPM.Bothareobviouslyflawed,andintheformercaseitmightnotbegoingtoofartosuggestthattheresultsweremanipulatedtoproduceadesiredoutcome.Inthispartwefirstbrieflydiscusswhathappenedinthe1918epidemicandthenturntotheOCRGandTPMpapers.The1918epidemicThefollowingissomepertinentinformationontheepidemic,largelytakenfromRice4,theauthorityonthesubject.

• Theepidemicdisproportionatelyaffectedtheyoungandfit,withthehighestdeathratesinthe20-40agegroup.

• Theepidemiccameonveryquicklyandwaslargelyoverinmostplacesinamonthorso,thoughthetimingdifferedindifferentplaces.

• Therewasnoeffectivetreatmentforthedisease.Themostthatcouldbeofferedinmostcaseswasnursingcare.

• Communitiesoftenlookedafterthemselves,organisingtemporaryhospitalsandsupportingtheillintheirhomes,withvolunteerassistance.

• Socio-economicstatuswasnotadriverofdeathrates.Betteroffsuburbsperformednobetterthanpoorersuburbs.Themostimportantdriverwaspopulationdensity.

• Ruraldeathrateswerehalftheurbanrate,reflectingthelowerpopulationdensity.Lessaccesstocentralhospitalcaredidnotseemtomakemuchofadifference.

• MaorideathrateswereseventimesEuropeandeathrates.Itisnotentirelyclearwhy.Themainpossibilitiesare:Geneticdisposition

4G.W.RiceBlackNovemberCambridgeUniversityPress2005

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Maoriweregenerallymorevulnerabletorespiratorydiseases.EvidencefromdeathratesamongstsoldierssuggestedthatMaoriinthesamesituationasEuropeanshadadeathratethatwastwototwoandahalftimesashigh.DifferentratesofinfectionThereislittleevidenceoninfectionrates,withanaverageof40percentbeingsuggested,whileratesindifferentlocalitiesrangedfrom10to90percent.ItislikelythatMaoricommunallivingandcustoms(thehongiwasalmostoptimizedtospreadthevirus)generatedhigherinfectionratesamongstMaori.DifferenttreatmentItisdifficulttoassesswhateffectdifferentstandardsofcaremade,andbyimplicationwhatmorethegovernmentcouldreasonablyhavedonegiven:thelackofeffectivepharmaceuticaltreatmentoptions;itslimitedresources;andthespeedoftheepidemic.SomeMaoricommunitiesweresimplyoverwhelmedbythevirusandtherewerefewable-bodiedtocareforthesick,whichmayaccountforsomeoftheadverseeffect.SomeEuropeancommunitiesrespondedtoassistthem,butaftertheyhaddealtwiththeirownissues.

Overall,theimpressiongivenwasthata‘businessasusual’modelthatwasatfaultin1918,andthatMaoricouldhavebeenprotected,ismisleading.Thegovernmentreallydidn’thavemuchofamodel,bymodernstandards,fordealingwithpandemicsandprobablycouldonlyhavehadamoderateimpactonoutcomes.

Thelessons,forthecovid-19epidemic,ifany,areprobablylimited.OCRGonhealthinequalitiesItispossiblethatanearlyreporttotheMinistryfromtheOtagoCovidResearchGroup(OCRG)mayhavedriventhe‘equity’concerns.Thereportwasprimarilyconcernedwithprovidinganestimateofdeathsinanunrestrainedepidemic,buttherewasanappendixthatlookedatMaoriandPacificdeathsandhospitalisations.Thekeymessageswerepresentedinthemaintextofthereport..•IfCovid-19followsthesamepatternsaspreviouspandemics,theremaybearelativelyhighandheavilyunequalhospitalisationandmortalityburdenonMāoriandPacificpopulations.•Elderlyareparticularlyatrisk,andMāoriandPacificelderlyevenmoreso,andfromyoungerages.

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Thesupportingdiscussionintheappendixwasasfollows:EthnicdistributionofhospitalisationsanddeathsWeassumeethnicinequalitiesinmortalitywillbesimilartothoseinthe2009InfluenzaA(H1N1)pandemic,ie,thattheriskofhospitalisationwas5timeshigherforMāoriand7timeshigherforPacificpeoples,whiletheriskofdeathwas2.6timeshigherforMāori(95%CI:1.3–5.3)and4.6timeshigherforPacificpeoples(95%CI:2.0–7.2)thanforNZEuropean/Other.Theestimatedethnicdistributionofthehospitalisationandmortalityburdenunderthe“planfor”scenarioisshowninourTableA3-1.Tablethree:Deathsandhospitalisationsbyethnicity Hospitalisation %pop Deaths %popMaori 138,230 16.4 9240 1.2 Pacific 92,130 23.1 8360 2.1 NZ European other

115,580 3.3 16000 0.5

Total 336000 6.8 33600 0.7 Thenumbersofdeathsdolookshocking.MaoriandPacificaccountformorethanhalfoftotaldeathsandabouttwothirdsofhospitalisations.TheMaorideathrateis2.4timestheNZEuropeanrateandthePacific4.2times.Tosimplifythediscussionwefocusondeathrates,butthehospitalisationratesareevenmoremisleading.However,thenumbersarebasedonunreasonableassumptionsand/orwhatappearstobemanipulationoftheresults.Toexplainwhy,weexaminetheiranalysis.Thefirstissueistheassumptionthatthe2009influenzapandemicprovidedareasonablebasisforassessingtheimpactoftheCovid-19epidemic.Thenumbersofdeathsinthatpandemicweresmall,raisingissueswiththerobustnessofanystatisticalanalysis.TheReportfortheMinisterofHealthfromthePandemicInfluenzaMortalityandMorbidityReviewGroup(2010)cametothefollowingconclusion. AlthoughPacificpeopleshadthehighestnumberofpandemicdeathsper100,000amongthefourmainethnicgroups(Figure2),becauseofthesmallnumberofcasesinvolvedtherewasnoevidenceofastatisticallysignificantdifferencebetweenanyoftheethnicgroups.Theirfigurefordeathratesandtheconfidencebandsarepresentedbelow.Whiletheirconclusionmightbestatisticallysound,thePacificresultswereontheedgeof

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significancesotheremightbeareasonableargumentthatPacificweredisproportionatelyaffected.NotsoforMaorithough.Figuresixteen:Fludeathsbyethnicity

TheOCRGcomestoadifferentviewonstatisticalsignificance,basedontheanalysisinapaper5thatadjustedthedataforage.TheMaorideathratewas2.6timestheEuropeanrate.Theconfidenceband(1.3-5.3)isabove1indicatingstatisticalsignificance.Theagedistributionfromtheofficialreportisshownbelow.Thereisadipindeathrateinthe5to14bracketsandastheMaoripopulationismoreheavilyconcentratedinthatbracketthismayaccountfortheageadjustedresults.Figureseventeen:Fludeathsbyage

5WilsonN,BarnardLT,SummersJA,etal.Differentialmortalityratesbyethnicityin3influenzapandemicsoveracentury,NewZealand.EmergInfectDis2012;18(1):71-77.

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However,giventhesmalltotalnumberofdeaths,whichweredifferentiatedbyethnicityandbyage,andthewideconfidencebands,itispossiblethattheirresultisanartifactofthestatisticalmethod.Adifferentresearchermayhavereachedadifferentconclusion.ThesecondissueisthatCovid-19isadifferentdiseasefromtheflu.MaoriandPacificdeathratesintheflucanbehigherbecausetheydonothavethesameacquiredresilienceastheEuropeanpopulation.Covid-19isanewdiseaseandtherecanbenopresumptionthatanyethnicgroupwillfarebetterorworsethanothers.However,thereisevidencethatobesity(andassociatedhealthissues)isamortalityriskfactorforboththeflu6andCovid-19.AsbothMaoriandinparticularPacifichavehigherobesityratesthanEuropeans,theywillbeathigherrisk,allotherthingsbeingequal,inaCovid-19epidemic.ThisdoesnotmeanthattheMaoriandPacificdeathrateswillbehigherinacovid-19epidemic.ThesignificantdifferencebetweenthefluepidemicandCovid-19isintheagedistributionofthedeathrate.Forthefluepidemicdeathratesaresomewhathigherinmiddleageandthereisaspikeintheyoungestagegroup.Bycontrastabout90percentofcoronavirusdeathsareinthe70+agegroup.Mostoftheremainderareaged60-69,anddeathsofthoseunder40arerare.TheagedistributionofMaoriandPacificisyoungerthantheEuropeanpopulationwithamuchlowerproportioninthevulnerable70plusagegroup,sothestartingpointisthatEuropeanpopulationwilldisproportionatelybearthebruntofthedisease,beforeadjustingforcomorbidities.FromdeathratestototalnumberofdeathsEvenifweacceptthattheMaoriandPacificageadjusteddeathrateestimatesof2.6and4.6timestheEuropeandeathratearereasonableestimatesofrelativeriskritisdifficulttoseehowtheaggregatenumberswereproduced,giventhedifferenceinthepopulationstructures.WemultipiedthedeathratesforeachagegroupbythosefactorsandappliedthemtotheMaori,PacificandEuropean/otherpopulationstructures.WefoundthattheoverallMaorideathratewasaboutthesameastheEuropeandeathrateandthePacific50percenthigher.

6ImpactofObesityonInfluenzaAVirusPathogenesis,ImmuneResponse,andEvolution

RebekahHonceandStaceySchultz-CherryFrontiersinimmunity201910:1071

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TablefourillustratestheprocessforMaoriandEuropeans,usingasimplifiedexamplewithhighandlowriskpopulationgroups,andwithMaorideathratesmultipliedby2.6.Tablefour:Simpleexampleofpopulationdeathratescalculations Lowrisk

populationshare%

Highriskpopulationshare%

Deathratelowrisk%

Deathratehighrisk%

Populationdeathrate%

Maori 96 4 0.26 7.8 0.56European 85 15 0.1 3 0.54TheissueiswhyOCRGcameupwithpopulationdeathratesthatwerenearlyidenticaltotheirageadjustedrates.Theyexplaintheirmethodologyasfollows:Theageandethnicdisaggregatedfigureswhichfollowarebasedonmultipleinterpolationsandextrapolations.Asthesenumbersareanumberofstepsremovedfromtheirbases,theycanonlybeveryroughestimates.Whichdoesnottellusmuchaboutwhatshouldhavebeenareasonablymechanicalexercise.SinceCovid-19mortalityappearstoheavilyreflectage-relatedvulnerability,wehavecalibratedMāoriandPacificage-specificmortalitiestoNZEuropean/Otherage-specificmortalitywhencalculatingestimatedethnic-groupspecificage-relatedmortality.Yes,buthow?Calibratingagebandsreducesthestartingageoftheupper“80+years”agebandto74yearsforMāoriand73yearsforPacificpeoples.Thatexplainspartofwhatwasdonewithoneageband,butdoesnottellustherestofthestory.Followingthiscalibration,estimatesforage-relatedmortalityforMāoriandPacificpeoplesunderthe“planfor”scenarioareshowninTablesA3-4andA3-5.InTableA3-5the60+and73+agebandswerecombined,aslowpopulationnumbersinthetopbandresultedinanunstableestimate.. Theirresultsareshownintablefive.

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TableFive:OCRGdeathratesbyage,MaoriandEuropeanAgegroup Deathrate%

EuropeanDeathrateMaori DeathratePacific

0-9 0 0 010-19 0 0 020-29 0 0.1 030-39 0 0.2 0.340-49 0.0 0.7 1.450-59 0.2 2.3 4.660-69 0.7 5.0(60-73) 14.1(60+)70-79 1.4 19.9(74+) 80+ 5.7 Total 0.5 1.2 1.2Itisnoteasytointerpretetheirtablebecauseofroundingsandthedifferentagecategories.Wereverseenginneeredtheirnumberstogetaclearersightonthedifferences.Thedeathrateratioswereallabove2.6.Tablesix:RatioofMaoritoEuropeandeathratesbyagegroupAgegroup RatioofMaori/European0-9 010-19 3.520-29 630-39 6.240-49 15.150-59 11.360-73M/60-69E 7.574+M/70-79E 11.8WethinkthatwhatwasbasicallydoneherewasthattheaggregateEuropeandeathpercentageof0.5percentwasmultipliedbythefactorof2.6togetanaggregatedeathrateof1.3percent,ignoringthedifferenceinagestructures.Theagespecificdeathrateswerethenmanipulatedtogeneratethedesiredaggregatenumber,whichat1.2percentwasclosetothe1.3percent.Themanipulationwascareless.TheyevenforgottoaltertheaggregatePacificdeathratetothedesired2.6,andputitattheMaorirateof1.2intheresultstable.WhethertheOCRGweresimplymuddledorwhethertheyweredeliberatelymanipulatingthenumberstoplayuptheethnicinequalitynarrativewewillleavetothereader.

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WenotethatnotlongafterthereportwaswrittenMichaelBaker,amemberoftheOCRGreceiveda$500,000grantfromthe2020COVID-19andEmergingInfectiousDiseasesGrantFund,whichrequiredthat:ResearchproposalsshouldalignwiththeNewZealandHealthResearchPrioritisationFrameworkanddemonstratethelocalrelevanceofthework,aswellasitsbenefitsforadvancingthehealthofMāoriandPacificpeoplesandreducinghealthinequities. 14April2020EstimatedinequitiesinCOVID-19infectionfatalityratesbyethnicityforAotearoaNewZealandAsecondreportonethnicityinequitieswasproducedbyTePunahaMatatiki(TPM).ThestartingpointistheNewZealandagedistributionsbyethnicgroupandinfectionfatalityratestakenfromreseachontheChineseCovid-19epidemic.Thisdataisreproducedbelow.Figureeighteen:TPMbasedata

Asdiscussedabove,becauseMaoriandPacifichaveasmallershareinthemostvulnerable70+agegroup(3.6percentofMaoriand3.2percentforPacificcomparedto12.6percentforNZEuropean)MaoriandPacificwouldexperiencelowerdeathratesthantheEuropeanpopulationiftheirunderlyinghealthstatuswasthesame.MaoriandPacificdeathsrateswouldbeabout40percentand35percentrespectivelyoftheNewZealandEuropeandeathrate.TPMmakethreeadjustmentsforhealthinequalitiestoadjustthesebaselinefigures.

1. Anadjustmentforlifeexpectancy.MāoritypicallyexperienceadversehealthoutcomesatanearlieragethannonMāori(MinistryofHealthNZ,2019b).Toreflectthis,weadjustedtheage-specificIFR

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estimatesofVerityetal(2020)bythemostrecent(2012-14)estimatesoflifeexpectancyforeachethnicity(StatsNZ2020). ItwasassumedthattheinfectionfatalityratesforMaoriandPacificare8.6percentolder,thantheiractualage,whenapplyingthefatalityrates.

2. AdjustingforunmethealthcareneedsWeobtaineddataonunmetneedsforprimaryhealthcareforeachethnicity(MinistryofHealthNZ,2019a).Theproportionofpeoplewhoself-reportedthattheywereunabletoseeaGPwhenneededwas41.4%forMāori,35.9%forPacificpeopleand30.1%forNZEuropeanpeople.Wetookthesedataasaroughproxyforpotentialunder-reportingofcomorbidconditionsandotherinequitiesandracismwithinthehealthcaresystem.Toaccountforthesedifferences,weweightedtheIFRsforeachethnicitygroupbythesevalues.Theeffectofthisadjustment,asweunderstandit,istoincreasetheMaori/Europeanrelativedeathrateby41.4/30.1or38percent,andthePacificrelativedeathratesby19percent.

3. Adjustingforcomorbidity(reflectinghigherriskfromunderlyinghealth

issues)ToadjustIFRsforcomorbidity,weobtaineddataonrelativeCFRsfrom(ChinaCDC,2020)forfourunderlyinghealthconditionsknowntoaffectCOVID-19mortalityrate,broadlydefinedas:(1)asthma;(2)diabetes;(3)heartdisease;(4)cancer.Inaddition,weadjustedforcomorbidityassociatedwithsmokinginthesameway(Guanetal,2020).Weobtainedage-stratifieddataontheprevalenceoftheseconditionsforeachofthethreeethnicitygroupsinNewZealand.ThebasicideawastofurtheradjustthedeathratestoreflectthedifferentincidenceofunderlyinghealthproblemsinNewZealandethnicgroups.TheproblemforthisanalysiswasthattheChinesedatadidnotseparatelyidentifytheeffectsofageandcomorbidities.Comorbiditiesareastrongfunctionofage,sodeathrateswillbeoverstatedifbothrisksaresimplyadded.Theapproachtakenwasnottosolvetheproblembuttoapplytwodifferentmethodologies,whichdependedonwhetherage(methodi)orco-morbidities(ii),areassumedtobethemoreimportantdriverofdeaths.Theresultsareshowninfigurenineteen.DespitethemorefavourableagestructuretheaggregateMaoriandPacificdeathratesareupto2.7times,and1.9times,theEuropean(usingmodelii).Withmodel(i)theyare1.53and0.96times,respectively,theEuropeanrate

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Figurenineteen:TPMdeathratesbyethnicity

CritiqueoftheapproachAgeadjustmentTheageadjustmentapproachisasimpleandplausiblewaytoaccountfordifferencesinfatalityrisk.UnmethealthcareadjustmentThisadjustmentisnotcredible.Tobeginwiththedescriptionofthe41.4percentofMaoriwerenot‘abletoseeaGPwhenneeded’wasmisleading.The41.4percentwaslargelythefigureforthosewhoself-reportedthatoverthelastyeartheywerenotabletoseetheirnormalproviderwithin24hoursofmakingcontact.The24hourtestdoesnotnecessarilymeanthatthequalityofthecarereceivedwasmuchpoorer.GPscanbefull(butwillpushanemergencyinwhenrequired),somakinganappointmentforthefollowingdaygenerallywillnotbetooconsequential.Andtheremaybeademographicreasonforpartofthedifference.MaoriandPacifichavemoresmallchildren,andwillmorefrequentlygotothedoctor,sotheoddsthattheycan’tbeseenin24hoursinthecourseofoneyeararehigher.ChildlessEuropeansareunlikelytobedisappointediftheyseldomgotothedoctor.Eveniftherewaslessaccesstomedicalcareinnormaltimesthiswouldnottellusanythingaboutaccesstolife-savingcareinanepidemicwhentreatmentwillbefree.Importantly,evenitwereacceptedthatthisdatawasagoodproxyforunmethealthneeds,whichwillhavedeathrateconsequences,thenthiswillalreadybecapturedwithinthelifeexpectancyadjustment.Sotoadjustforitisdoublecounting.

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ComorbiditiesSimilarlythereisdoublecountingforcomorbidities.ThereareareasonswhyMaoriandPacifichavealowerlifeexpectancyandthatis,inpart,becausetheyhaveahigherprevalanceofthecomorbiditiesassociatedwithhigherCovid-19deathrates.ConclusionOurconclusionisTPM’shigherpopulationdeathratesforMaoriandPacificareduetoadoubleortriplecountingofthefactorsthatgeneratehigheragespecificdeathrates.TheyhavenotprovidedevidencethattheirpopulationdeathsrateswouldbehigherthanEuropeandeathratesinacovid-19pandemic.TePunahaMatahiniAstructuredmodelforCOVID-19spread:modellingageandhealthcareinequitiesAsecondmodel,whichalsofocusedonethnic‘inequalities’,wasreleasedbyTPMon15May2020.Therelevanttakeoutsintheexecutivesummarywere:We also consider scenarios where outbreaks occur undetected in sectors of the community with less access to healthcare. We find that the lower the contact rate between groups with differing access to healthcare, the longer it will take before any outbreaks are detected in any groups who experience unequitable access to healthcare, which in Aotearoa New Zealand includes Māori and Pacific peoples Well-established evidence for health inequities, particularly in accessing primary healthcare and testing, indicates that Māori and Pacific communities in Aotearoa New Zealand are at higher risk of undetected outbreaks. Thecontributionhereisthattherecouldbeariskthatethniccommunities,andinparticularPacific,couldbeharbouringcovid-19casesbecausetheyhave‘unequalaccess’tohealthcare,andbecausetheyhavelimitedinteractionswiththerestofthecommunity.Transmissionsinthiscommunitycouldgoundetected,eventuallyresultinginawideroutbreak.Amodelisconstructedtoillustratethis.ItisanattempttoreplicatetheSingaporeansituationwhentherewasalargeoutbreakindormitories,whereforeignworkersarecrammed10ormoreinaroom.Noattemptwasmadetocalibratethemodelonanyrelevantevidence.Insteadthemodeliscalibratedtogeneratethedesiredoutcome.Theproblemisthatthecalibrationsweresetsotheyborenoresemblancetoreality.Itwasassumedthatonly5percentofinfectionsarepickedupbecausetheyarenotbeingmonitored,compareto75percentinthenon-Pacificcommunity,andthatonly

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1percentofPacificinteractionsarewiththerestofthecommunity.Thelastassumptionisobviouslyinaccurate.Pacificarenotanalmostcompletelyclosedcommunity.Ontesting,weknowfromtheMinistrytestingdatathatPacificare,ifanythingovertested,notseverelyundertestedasintheTPMmodelling.Tableseven:TestingratesbyethnicityEthnicity Testrateper1,000 %positiveMaori 38 0.3Pacific 46 0.4Other 35 0.8Asian 22 0.6Total 35 0.7Thisinformationwasreadilyavailable.TPMwouldhaveknownaboutit,andshouldhavereportedit.Butiftheyhad,thatwouldhavescuttledtheanalysisandtheheadlineresults.Sotheyignoredit.Thereportwasreleasedandreportedinthemedia.TheNZHeraldstorywas:HealthinequitycouldposeamajorrisktopoorercommunitiesifCovid-19surgedinNewZealand,accordingtonewmodelling.InNewZealand,statisticsshowedthatMāoriandPacificpeoplehadlessaccesstohealthcareandweremuchmorelikelytohaveunmethealthneeds.

"ThisnotonlyputsMāoriandPacificpeopleathigherriskiftheydogetinfected,itmeansthattheymaynotbeabletogetatestiftheyneedone,"Hendyexplained.

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Partnine:ThebordercontrolissueIntroductionRecentlySirPeterGluckman,HelenClarkandRobFyfeissuedaCentreforInformedFuturespamphet‘Re-engagingNewZealandwiththeWorld’whicharguedforthestartofa‘conversation’onthebordercontrolissueandsetoutsomeoftheconsiderationsandarguments.ThecontextwasthePrimeMinister’sapparentunwillingnesstoevencontemplatethemostminoreasingofborderrestrictions.On30Juneshesaid.

I'veseentodayandacrossthepastweek,callsforourborderstobeopenedtotheworld.Aworldwherethevirusisescalating,notslowing,andnotevenpeakinginsomecountriesyet.Wherecasesexceed10millionglobally,anddeaths-halfamillion."

"Theideathatweshouldopenourborderinthisenvironmenthasaprice,andthatpricecouldbeasecondwaveofCovid-19inourcountryatworst.Atbest,addedrestrictionsfortherestofus."

"Thereisatimeinthefuturewherewewillbeopeningourborders,buttosuggestthattimeisnow,whenthevirusisgettingworse,isfrankly,dangerous.

Thiswasalarmist.Theviruswasnot‘raging’thoughalloftheworld.InmanyofthecountriesofmostinteresttoNewZealand,thelevelofnewinfectionswasextremelylow.Ifthetimeis‘notnow’toconsiderevenminoreasingsthentherewillneverbeatime.Itislikelythattheviruswillbecomeendemicintheworld,andfuturevaccinesareunlikelytobefullyeffective.

ThecurrentcontextistheVictoriasituation,whichwentfromasituationofapparentlyalmosteliminatingthevirus,towhatappearstobeanexplosiveoutbreakoveraperiodofweeks.Untilweseehowthisnewattemptatsupressionpansoutandwehaveabetterunderstandingofwhyitoccurred,itwillbedifficulttodiscussbordereasinginadispassionatemanner.Thisdiscussionlookspastjustthisparticularsituation,thoughwearemindfulofitslessonsanditsimpactonpublicopinion.AsthisreportwasbeingcompletedtheAucklandoutbreakhasemerged,whichhasputtheGovernmentandmostpeopleinlessofamindtocontemplatebordereasings.

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Re-engagingwiththeworld‘Re-engagingwiththeWorld’raisesthebigissueofrelaxingbordercontrolsfromtheperspectivethatisolationisnotagoodthingandraisessomeoftheissuesaroundsomelimitedopenings.Canweaffordtowaitoutanotheryear,twoyears,orevenmoreinalmosttotalphysicalisolation?Andatwhatcost?Thisisnotjustaffectingtourismandexporteducation,butalsothemanywaysinwhichNewZealandprojectsandleveragesitsplaceintheworld.Andraisesthecriticalquestion.AtwhatpointwillNewZealandacceptlessthanabsoluteelimination?Suchagoalislikelyunrealisticoveralongterm.Evenifahighlyprotectivevaccinationisdeveloped,itmaynotprovideabsoluteprotectionandcoveragewillnotbeabsolute,socaseswillalwaysoccurThiscountryneedsitsglobalconnectivity.Wehavegainedsignificantadvantagethroughourstringentlockdownandearlyeliminationofthevirusallowingthedomesticeconomytoreactivate.Butwewillrapidlyprogresstoapositionofrelativedisadvantageifourtradingcompetitorsareabletoengagewithourcustomersandsuppliersinwaysthatarenotpossibleforus.GeofBertram’sresponseThesethoughtspromptedarathershrillresponsefromGeofBertramreportedinIdeasRoomonJuly7.Forpamphleteers,lobbyistsandoppositionpoliticianstoinsistongettingsuchpromisesnow,whilebeingunwillingtoputinthehardyardsoneconomicanalysistoshowtheyunderstandthecomplexityandconsequencesofwhattheyareaskingfor,isnotagreatconversationstarterHeraisedthedistributionissue–whowouldbenefitandwhowouldlose,whichwasnotaddressedinthere-engagingpaper,andpaintsapictureofaminoritywithvestedinterestswillingtoputthewiderpopulationatrisk.WhenindividualsaccustomedtoglobalhypermobilitydemandanearlyreturntoeasytravelinthenameofordinaryNewZealanders,therestofusareentitledtodemandbetterargumentsthanthispamphlet’svaguegeneralities.

Eachadditionaldegreeofopennessattheborderexposesthemassofthepopulationtoincreasedriskofanewoutbreak,withassociatedmajorcostsforordinarypeople.Thosecostsforthemany,andtheprobabilityoftheiroccurrence,needtobeproperlyweighedagainstthebenefitsforthefewofreducingborderprotections.

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Andhetakesissuewiththepresumptionthatbusinessisolationisnecessarilyseriouslyeconomicallydamaging,beyondtheimpactonthetravelindustry,arguingthatphysicalexportshavenotstoppedandthatvirtualcommunicationcankeepexportersconnectedtotheirmarkets.thepamphletlacksanysubstantialanalysisofwhattheoverallbalanceofcostsandbenefitsoflongtermborderrestrictionswouldbe.Itiseasytofindanguisheddeclarationsofpainfromvestedinterestssufferingdirectpain,especiallyinthetourismandhospitalitysectors.Butthepamphlet’simageofaNewZealandexistingin“neartotalisolation”fromtherestofthewordisridiculouslyoverblown.

Bertram’sstaringpositionseemstobethatthecostsofisolationareworthanyreductioninrisk,butnothoughtisgiventohowmuchmoreriskanyeasingwouldgenerate.Onthedistributionquestionthebenefitsofsomeeasingwillbemorewidelysharedthanhesuggests.Theeconomicbenefitsspreadbeyondtheimmediatelyaffectedsectors,andlargenumbersofNewZealandersdoliketotraveloverseas.Andonlyaminoritydirectlybenefitfromacompleteborderclosure.Covid-19impactsmostlyontheaged.Thoseunder60accountforonly1or2percentofdeaths.

PublicopinionPublicopinionappearstobesolidlybehindborderclosures.AnIPSOSsurveyatthebeginningofJulyfoundthatmostrespondentswereinfavourofkeepingthebordersclosed.Inresponsetothequestion:Doyouthinkthatkeepingourbordersclosedtothefollowingcountriesorregionsthegovernmentisoverreactingorcorrectgiventherisk80percentthoughtthatthepolicywascorrect.85percentagreedwithanAustralianclosure,75percentwiththePacificIslands,and92percentwiththerestoftheworld.However,theresponseswerenotascutanddriedasthesenumberssuggest.Inresponsetothequestion‘Whichwouldbetheonethingthatwouldgiveyouenoughconfidencethatitissafetoopenourborderstoothercountries?’theanwerswere:

• 35percentfocusedoneliminationornocommunitytransmissioninthecountrytheycomefrom.

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• 44percentwouldacceptsomeformofmitigation.26percentwouldacceptatwoweekquarantineandonlytwopercentwereinfavourofmanagedisolation.16percentwouldacceptanegativetest.

• Only16percentwantedtokeepthebordersclosedregardless.Forthemostparttheanswersappeartoberisk-related,suggestingthatanevidence-baseddiscussionmight,eventually,getsometraction.Thepurposeofthispartistocontributetoanevidence,risk-based,conversation.Westartareviewofthedecisionsbehindthecurrentrules.NextthereisareviewofadiscussionbythePrimeMinister’sChiefScientificAdviserwhichraisedsomeofthepertinentissueswhenarisk-basedapproachtoborderopeningswasstillonthetable.Itgivesaninsightintothecontentandqualityofofficialthinkingatthetime.

Nextthereisabriefdiscussionofwhatsomeothercountriesaredoing,withafocusonIceland.Fourth,weprovideouranalysis.Whilethebordercontrolissueissometimespresentedasasingleyesornodecision,inrealitythereareanumberofdecisionpointswithdifferentbenefitsandrisks.Fifth,wepresentandcritiquetwoanalyticalstudiesofquarantiningoptions.ThecurrentsituationForeignersThestatusquoisthatthereisaneartotalbanonforeignvisitors,datingfrom19March.Initiallythebordercontrolswereseenasatemporarymeasuretobuytime.Strengtheningtheborderwillbuytime….In30daystimeministersmayneedtobereadytoliftbordercontrols….onthebasisthatNewZealandmaybepreparedasitneedstobe.ContinuingbeyodthatpointmayincreasehardshipinNZwithoutcommensuratebenefits.ManagedisolationmandatoryTheminimum14dayquarantine,ormanagedisolation,forreturningcitizensandpermanentresidents,cameintoeffecton10April2020.Prior,tothatreturneescouldselfisolateiftheywerenothighrisk,andtheyhadthecapacitytoeffectivelyselfisolate.Justpriortothedecision,1150wereinmanagedisolationandquarantine,and4000wereinselfisolation.Theregimewasdescribedasbeinghightrust,butwasassessedas‘workingwell’.

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Thepolicyshiftseemstohavebeendrivenbypoliticalresponsetoamediafuroreovernon-compliancewiththeselfisolationrequirementratherthananyassessmentoftherisk.TheargumentsforthechangeintheCabinetpaperwere:

• Asat7April45percentofcaseshadahistoryofrecentinternationaltravel.Mostoftheremainingcaseshadahistoryofclosecontactwiththosecases.The45percentwastheshareoftheaggregatenumberofcases,whichwasnotrelevanttowhatwashappeningatthetime.Thenumberofimportedcaseswouldhavedroppedsharplyby7April.Therewasnoanalysisoftherelevantdata,whichisisthenumberofclosecontactswhohadbeeninfectedfromanimportedcaseinhomequarantine.

• ReturningNewZealandersposeahighhealthriskasthediseasespreadsoffshore.Therewasnoassessmentoftheriskposedbyreturneesinhomequarantine

• AnyimportedcasewouldriskreintroducingimportedtransmissionThisislogicallytrue,buttheissueiswhethermanagedisolationwouldmakemuchdifference.

• Althoughithasbeenproposedthatpolicedoacomplaincecheckwithin24hoursofarrivalthishasproveddifficulttooperationalise.Itwouldnotberocket-sciencetooperationalisesomeformofcompliancecheckifthatwerenecessary.Thepolicedidnothavetobeinvolved.Theonlycomplianceassessmentreportedbythepolicesuggestedthatthecomplianceratecouldhavebeenashighas98percent.

• itwouldbemoretargetedthanprioritisingcompliancemonitoring.Thisisanoddargument.Ratherthancheckonpeopleperiodically,itismore‘targeted’tocheckonthemallthetimebylockingthemup.

Whatshouldhavebeendoneis:identifythenumberofreturneeswhobecamepositiveinisolation;thenumberofmembersofthehouseholdwhowerealsoinfected;andcritically,measurethenumberofcommunityinfectionsthatcouldbelinkedbacktothoseisolatinghouseholdsthroughcontacttracinginformation.Theinformationshouldalsohavebeendifferentiatedbythecountrysourceoftheinfection.Thisinformationwouldhaveallowedanassessmentofwhethertherewasaproblem,andifnecessary,howtoaddressit.

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TheDirectorGeneralofHealth,whowasresponsiblefortheorder,shouldalsohaveconsideredwhy95percentofcaseswhotestedpositivewereallowedtorecoverathome,whentherewasanear100percentchancethattheywereinfectious,whenareturneewith,say,a1:1000chanceofbeinginfectedhadtogointomanagedisolation.Noregulatoryimpactstatementhadbeenpreparedduetothe‘urgencyofthesituation’butthefollowingstatementwasmade:TheimpactswillfallprimarilyontheNewZealandersarrivingeachdayandontheGovernment.ThebenefitsofrespondingfasterbyreducingtheprimaryvectoroftransmissionwithinNewZealandareexpectedtooutweightthecosts.Thebenefitassessmentwasmeaninglesswithoutariskassessment.Ifanassessmenthadbeendoneproperlyitmighthaveresultedinafewadditionalcasesoutsidethehousehold.Thehigherriskcaseswerealreadyrequiredtogointomanagedisolation.HumanrightsThe DGH will issue a notice if satisfied that there is sufficient public health rationale and it is compliant with the New Zealand BORA. ThereisnoevidencethattheDirectorGeneralevermadeanassessmentofthepublichealthrationale.Whatappearstobeafailuretodoso,raisesthepresumptionthatthemanagedisolationorderbreachedhumanrights.17April2020ManagedArrivalsinNewZealandThispaperoutlinedthefinancialandoperationconsiderationsofthemanagedisolationscheme.With200peopleadaythecostwasputat$195millionover6months.5May2020JointpaperonManagedArrivalsTotheMinisterofhealthThiswasmainlyadiscussionofthefinancialrisksrelatingtothenumberofreturnees.

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8June2020Bordermeasuresreviewinthe8Junecabinetpaper Globalconditionscontinuetobesuchthatwecannotreopentheborderinanunrestrictedway.Butthesameborderrestrictionsthatprotectpublichealthandoureconomyalsohavenegativeeconomicandsocialeffects.Flowsofpeoplegenerateexportrevenue,inwardinvestmentandknowledgetransfersforNewZealandfirms.NewZealandearns$17bfromtourismand$5bfromincomingforeignstudentsannually,while390,000businesstripsabroadand340,000businesstripsintoNewZealandplayanimportantroleinfacilitatingtradeingoodsandotherservicesaswellastransferringknowledgeandideas.Overseasworkersalsofillspecialisedrolesinourlabourmarkets,meetskillsshortagesandundertakeseasonalwork.ApaperonexemptionstotheborderregimeisbeingconsideredbyCabinettoday(thispaperdoesnotappeartohavebeenreleased)Maintainingstrictcontrolswhileexploringwaystoincreaseflowsthroughtheborderwhereitcanbedonesafelyshouldbeagoalforthenearfuture.Thiswillrequirecoordinationbetweenagencies,airportsandairlinestoensurethatthenecessaryarrangementsformanagedisolationcanbemade,withappropriatetestingandcontacttracingarrangementstoensurethehealthrisksarewellmanaged.Allofthiswillmakeourbordercontrolsmorecomplex.15June2020Paper:ASustainableQuarantineandManagedIsolationSystemTwocompanionpapersprovidedcontextfortheissuescoveredinthepaper:3.1Thepaper’FutureBorderSettings:PeopleMovementandReconnectionwithInternationalMarkets’providestheoverarchingframeworkforfutureborderpolicy.3.2Thepaper‘DevelopingCOVID-SafeTravelZones’seeksagreementtocoreprinciplesforSafeTravelZonesandsetsdirectionfornegotiationswithAustralia.Thesepapershavenotbeenreleased.Thesecondpaperwouldhavebeensensitive.Thereisabulletpointsummaryofthefirst.

• puttinghealthconsiderationsatthecentreofdecisionsonbordermeasures,bydesigningthehealthpreconditionstobemetandthehealthmeasuresnecessarytosupportsafecross-borderpeoplemovement;

• establishingnewhealthentryandexitpolicyandmeasures,toallowincreasingpeoplemovementattheborder,increasingvolumesasconditionsallowandlayingthegroundworkforafullborderre-opening;

• takingtheopportunitiesandmanagingtherisksaroundreconnectionwithglobalmarkets,tosecuretheconnectivitybenefitsthatsupportsocialandeconomic

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recovery,strengthenrelationshipswithkeytradinghubs,attractinvestment,enablebusinesstravel,andrepositionourexportsectors;

• operationalisingtheworld’ssmartestandsafestborder,toputinplacethepeople,technology,processes,andsystemsnecessaryforsafereconnection;

Intheinterestsoftransparencyandinformedpublicdebatethispapershouldbereleased.TheexecutivesummaryoftheCabinetpaperwas:Since9April2020,allpeoplearrivinginNewZealandarerequiredtoenterquarantineormanagedisolationfor14days,priortoonwarddomestictravel.ThesearrangementsareacriticalpillarofourongoingCOVID-19responseandourbestlineofdefenceagainstfurtheroutbreaksinNewZealand.Untilavaccineiswidelyavailableortestingtechnologyadvancessignificantly,14-dayquarantineormanagedisolationforarrivalswillneedtobeanenduringfeatureofourborderresponsetohelprealisethepublichealthstrategyofeliminatingCOVID-19.Somemeasurestoreducethestrainonisolationfacilitieswereapparentlybeingworkedon,butpossibleinformationonthemwasredacted.Thesense,however,wasthatanyreliefwasalongwayoff.Itisalsopossiblethatwavesofillnesscontinueandimmunityisnotobtained.WorkisunderwaygloballyandinNewZealandtodevelopfastandreliablescreeningandtestingmeasurestomanagetheCOVID-19riskattheborderwhichcouldimpactonthe14dayisolationrequirement.Thiswillalsotaketime,andwewillalsoneedtoputinplacethedomesticsystemsandprocesses,andsecuretheinternationalprotocols,reciprocalarrangements,andassurancesnecessarytosupportthisapproach.Untilthattime,ourbestlineofdefenceagainstfurtheroutbreaksinNewZealandarerobustandsustainablequarantineandmanagedisolationarrangementsforallarrivals.Thetranstasmantravelzonewasmentioned:ATrans-TasmanTravelZonethatallowsustosafelyexemptsomearrivalsfromquarantineandmanagedisolationrequirementscouldhelpmitigatethispressure,butwillnotnegatetheneedforfacilitiestomanagearrivalsfromhigherriskcountries.ButnonumbersweregivenanditwasnotexplainedwhyanunilateraleasingofrequirementsonreturneesfromAustraliawasnotpossible.Therewasnoassessmentofwhetherthe14daymanagedisolationrequirementwasnecessaryinallcases,orofitsefficacycomparedtootheroptions.

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Thepaperwasprimarilyaboutthefinancialandoperationalconsequencesofmaintainingthestatusquo.$298millionwasbeingsoughttofund298arrivalsadayuptotheendof2020.Theestimatedcostwas$5700perstay.Therewasnoregulatoryimpactstatement.“notingtheurgencyrequiredforthegovernmentsresponsetoCOVID-19,aregulatoryimpactstatementhasnotbeenpreparedTherehadbeenmanyweekstoprepareanimpactstatement.Therewasnomentionofhumanrightsimplications.

Someoverseasexperiences

Manycountrieshaveloosenedtheirborderrestrictions.InEuropetheSchengenareacountriesarenowallowingaccesstoothersinthegroupwithvaryingdegreesofease.Asmostofthecountriesnowhaverelativelylownewcaserates(comparedtotheirrespectivepeaks,butnotcomparedtoNewZealand’s)thiswillnotaddmateriallytomostcountry’srisks.Whiletheymightimportsomecases,theywillexportsometoo,sotheneteffectforcomparablecountrieswillbeawash.However,somecountrieswithlowercaseratesarepreparedtotakearisktorescuetheirtouristindustries.Accessisalsoallowedfor16lowriskcountriesoutsidethearea,includingNewZealand

TheUnitedKingdomimposedquarantinerestrictionson2June2020,allowingaccessuptothen.Thenewrestrictionsmadenoepidemiologicalsense,andappearedtobepoliticallymotivated,becausebordercontrolswerepopular.TheGovernmentclaimedthemovewasevidence-based,buttheevidencewasneverforthcoming.TheUnitedKingdomdroppedthepolicyinearlyJulyallowingentryfor60lowerriskcountries(includingNewZealand).TheUKhasrecentlyupsettheEuropeanarrangementsbyunilateralyimposinghomeisolationrequirementsonreturneesfromseveralcountries.SeveralothercountrieshavenowreintroducedquarantinerequirementsascasenumbershaveslowlycreptuparoundEurope.Norway,forexamplerequiresa10dayself-quarantinefortravellersfromcountrieswithanaggregateof20casesper100,000ofpopulationovertheprevious14days.ForNewZealandthatwouldbeequivalenttoanaverageofabout70casesaday.

SomeEastAsiancountriesareeasingsomerestrictionsonbusinesstravelhavingregardtotherisksinthetraveller’shomecountry.

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ArelevantcomparatorforNewZealandisIceland,whichatonepointnearlyeliminatedthevirus,largelybyeffectivecontacttracing.Ithasbeenacceptingvisitors,includingtourists,fromtheSchengenareasinceJune152020.Visitorshavetotakeatest(initiallyfreebutthenattheirownexpense)attheborder,andcanthenproceedtotheiraccommodation.Childrenunder15areexempt,reflectingtheirlowinfectionandinfectivityrates.Ifthetestispositivetheyareinformedthenextdayandarethenplacedinquarantine.Closecontactsmayalsobequarantined.

From15Juneto18Augusttherewere108,000bordertests,7and75activecaseshavebeenidentified(apositivetestrateofabout1:1300)butthepositiveratehasincreasedtowardstheendoftheperiodreflectinganincreaseinEuropeaninfectionrates.TowardstheendofJulytherewasaspikeindomesticcases.SomehavebeentracedtoreturningIcelanders,andafailureintheirbordertesting(twotestsarerequired,butthisdidn’tnecessarilyhappen).Therewasoneinstanceofatouristinfectingaguidewhoinfectedsomeothers.Visitorsstayingmorethan10daysnowhavetotakeasecondtest.Thespikeindomesticcasesseemstohavebeenbroughtundercontrol.

Figuretwenty:Icelanddomesticinfections

Iceland’swillingnesstotakearisktosupporttheirtouristindustryreflectedtheirexperiencewithimportedcasetransmissiontothecommunitywhentheborderwasstillopen,andtouristsdidnothavetoquarantine(uptoApril21).Noneoftheir1900casescouldbetracedbacktotourists.AllcouldbetracedtoreturningIcelanders.AsIcelandwasabletotracethesourceofallbutsevenofits1900cases,thiswasareasonableassessment.Apossiblereasonforthelackoftourist-related

7covid.is

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casesisthattouristshaverelativelyfewclosecontactswiththelocalcommunity.Returnees,ontheotherhandmayincreasetheircontactratesafteratripabroad.

ChiefScienceAdvisor’sanalysisOnMay312020anopinionpiecebythePrimeMinister’sChiefScienceAdvisor,JulietGerrard,andresearchanalystRachelChiaroni-ClarkeappearedintheNZHerald.Looseningcontrolofourborderswasdescribedasa: criticalpartofoureconomicrecoveryandenableindividualstoreunitewithfriendsandfamily.

Butthentheriskswereemphasied.

WeallknownowthatevenasingleimportedCovid-19casecancreateaclusterthatquicklyspawnshundredsmore.

Thisissomewhatoverstated.NewZealandhadhundredsofimportedcases,only13clusters(above10)andthelargestwas103.Thecurrentthinkingisthatonlyaboutoneinfourpeopleinfectedpassiton,with‘superspreaders’pullinguptheaverage.

Thediscussionthenaddressedthecentralquestionofriskmanagementandturnstowhichcountriesshouldbeconsidered,foranopeninguptolargescaletourism.

Sohowdowedecidetoreopenourbordersandwhatconstitutesanacceptablelevelofrisk?

MostNewZealanderswouldprobablyagreethatopeningtheborderforquarantine-freetraveltoallcountrieswouldbetoohigharisktotakeinthenearfuture.

ButtheCovid-19pandemicisplayingoutinverydifferentwaysindifferentcountriesaroundtheglobe,whichmayenableustomakesomesmartchoices.Atthemoment,someplaces–likeTaiwan,HongKong,VietnamandAustralia-aremanagingtostampoutthevirusandhave,likeus,trustworthytestingdatathatrevealsveryfewknowncases.

Thisposesmanyquestions:Whatlevelofriskarewepreparedtotakeinthefaceofapotentialsecondwave?Whenshouldweallowtravelfromcountriesthathaveavoidedanycasesaltogether?Whataboutthosethatonlyhadafewsporadiccasesandcontainedthem?Orcountriesthathadlargeroutbreaksbutmanagedtocontainandeliminatetheviruslikewehave?

Andhowmightwemitigatetheremainingriskwithappropriatebordermeasures?Theexactcriteriaforallowingquarantine-freetraveltoourcountryareyettobedetermined,butsomeobviousfactorstoincludeare:

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•Theprevalenceofactivecases.•Confidenceinthetestingandthedata.•Sustainedorundetectedcommunitytransmission.•Confidenceincontrolmeasures.

WealsoneedtothinkabouttheprobabilitythatacasewouldactuallybeimportedintoAotearoaNewZealand.Wecandosomesimpleestimatesofhowmanypredictedinfectedpassengerswewouldintroduceifwereopenedthebordertodifferentcountriesandpre-COVIDtravellernumbersreturned.Asanexample,theUShasover1millionreportedactivecases.Basedonthesecurrentstatistics,wewouldexpectaroundonein300peoplefromUStohaveCovid-19.If1000peopleweretoarriveonourshoreseachday,wewouldroughlyestimatethattherecouldbe

threeinfectedpassengersfromtheUSeveryday.

Bycontrast,Chinacurrentlyreportsaround70casesdaily,orroughlyonein20millionpeople.Ifthesenumbersarestableandaccurate,itwouldbehighlyunlikelyforaninfectedpassengertoarrivethisyearif1000visitorsarriveddaily.

Thensomeissueswithacase-by-caseapproachtocountryassessmentareconsidered.

Theneedforanuancedcase-by-casesolutionwillneedtobeoffsetwiththelogisticalandadministrativeburdenofconstantcountry-by-countryriskassessment–inarapidlychanginglandscape.

Thiswouldnotbetooonerousaburden.Onlyasmallnumbercountrieswouldbeinitialcandidatesandbeworththeeffort.

Wealsoneedanhonestassessmentofouras-yet-untestedresponsesystemstomanageanewoutbreak.

Fromourassessmentofthedocumentsthisdoesnotappeartohavebeendone.However,thereisthetracingcapacity.Apparentlyitisnow350adaywithasurgecapacityofafurther500.

Anotherissueisthatrequirementsmighthavetobechangedquickly.

Howdowemanagethispossibilityofrapidchange,whilestillgivingasmuchcertaintytotravellersaspossible?

Theanswerisprobablythatcertaintycannotbegiventopassengers.They(andtheairlines)wouldhavetomaketheirownriskassessment.Buttheprospectof

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uncertaintravelwillbebetterforsomethantheprospectofnotravelatall.Theuncertaintywouldprobablyhaveasignificantimpactondemand.

Thediscussionthenturnedtomitigationbytestingandscreeningattheborderanditwassuggestedthatacombinationofmethodsshortofaquarantinewouldbeeffective:

testingforfever,interviewsattheborder,andthestandardPCRtesteitherpriortodepartureoronarrivalwouldgoaconsiderablewaytoreducingtheriskofimportingcases,butnotprovideafullguarantee.

OurRiskAnalysisWeconsider:

• Theneedtoimposea14dayquarantinerequirementonallreturningNewZealanders.

• Thecaseforalmosttotallyexcludingnon-residents.• Thecaseformoreflexibletreatmentofbusinessandeduccationalvisitors.• Travelbubblesmoregenerally.

ReturningNewZealandersThe14dayquarantineTheproblemwiththe14dayquarantineforreturningNewZealandersisthatitisexpensiveandthereisalimitedcapacity.Thecosttogovernmentisabout$5700perperson.Tothatweneedtoaddthecosttothoseinquarantine.Theyarelockedupfortwoweekswitharangeofopportunitycosts.Somemightnotbetoobothered,butforothersitwillbeamaterialimposition.Assumingacostof$1000aweekthecostforasinglequarantineisabout$7700.Therearecapacityconstraints,whichlimitsarrivalstoabout2000aweek,effectivelyexcludinghighvaluevisitors,becausereturningNewZealandersgetpriority.Theissueiswhetherthefull14dayquarantineisnecessaryforeveryone.Ifthatcouldbereduced,orreplacedbyselfisolation,thenthatwouldfreeupcapacityandreducecosts.Non-NewZealanderswouldpaytheirway,andcouldbetreateddifferently.The14dayquarantineruleThe14daysistheWHO’srecommendedquarantineperiodandhasbeenaroundsincetheearlydaysofthepandemic.Itisanestimateofthetimeforsymptomstoemergeafteraninfection.ItisbasedonChinesecaseevidencethatshowedbyday

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14symptomshademergedin99percentofcases.A14dayquarantinewillmissonepercentofcases.However,thisassumesthattheinfectionoccurredimmediatelybeforetravel,whereastherewillbeaspreadinthedaysbefore.Accountingforthislagmightreducethe‘miss’ratetooneinseveralhundred.Thenthereisafurtherriskreductionfromtestingforthevirusatday3andday12.Butbecausethereistheriskoffalsenegatives(anegativeresultwhenthecasereallyisinfectious)testingisnotfullyeffectiveandthereisstillaresidualrisk.WediscusstheserisksfurtherinourassessmentoftheTePunahaMatatikimodellingbelow.Themostimportantriskdriveristheoddsthatareturneewillbeinfectious.Theseoddswillvarywidelydependingonwherethereturneesarecomingfrom.Theodds,basedonanassessmentofcountrycasenumbers,couldbe1:100comingfromthehighriskUS,or1:1millioncomingfromChina.OtherlowriskAsiancountries,andAustralia(ex-Victoria)couldhave(conservative)oddsof1:100,000,withEurope,basedontheIcelandicexperience,oddsofperhaps1:2000.Combinedwiththeoddsthatapositivecasewillslipthrough,thisgivesoddsofaninfectioustravellerbeingreleasedrangingfrom,say,1:10,000to1:3billion.RelyingontestingaloneTableeightworksthroughsomeillustrativerisknumbers,forthelargestvisitorsourcecountries.ThedailycasecountataroundthebeginninngofJulyismultipliedby50toroughlyaccountfor:casesinthepipeline;undertestingandamarginforfuturegrowth(ascasecountsarerecordedwithuptoatwoweeklagafterinfection).Themultiplierof50issomewhatarbitraryandahighernumbercouldbeadoptedtogiveamorecautiousassessmentoftherisks.Dividingbythepopulationgivesanestimateoftheprobabilitythatanindividualtravellerwillbeinfected.Multiplyingbythehistoricalaveragedailyvistorflowandassumingbordertestingthatpicksup80percentofinfectionsgeneratesthenumberofcasesperday.Thesenumbersareverylowformostcountries

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Tableeight:RiskofnewinfectiouscasesbycountryCountry Visitor

numbers2018‘000

Dailyvisitors

DailyCasesEarlyJuly

Impliedcases

Pop‘m

Riskinfected

Numberofdaily‘misses’withtesting80%effective

Australia 1457 4030 2(exVictoria)

100 25 1:250000 .003

China 449 1230 20 1000 1439 1:143900 .00017Japan 101 236 250 12500 126

1:16,800

.003

Korea

93 255 50 2500 51 1:34,000 .0015

Taiwan 42 115 2 100 26 1:450,000

.00005

Hongkong 58 159 20 1000 7 1:46,667

.0007

Malaysia 53 145 10 500 32 1:71,111

.004

Singapore 60 164 5(citizens) 250 6 1:4000 .008India 67 183 30000 1500000 1358

1:905

USA 338 930 40000 2000000 330 1:132 1.40Canada 69 186 250 12500 38 1:4222 .009UK 232 636 600 30000 68 1:2267 0.06Germany 102 280 400 20000

82 1:6074

0.009

Countrycasenumbersareonlyastartingpointinariskassessmentandwouldneedtobesupplementedbyactualexperienceattheborder.Somedataisreleasedonthis,butthepublicdatahasitslimitations,becausetheyrefertothedeparturecountrybeforeentrytoNewZealand.OverJune/July14casescamefromAustralia,butasAustraliawasatransitpointthisdoesn’tnecessarilytellusmuchabouttheriskinAustralia.ThreecamefromtheUSand22fromaseriesofhumanitarianflightsfromIndia.Thissuggeststhatthetruerateofinfectioninthesubcontinentismuchhigherthentheofficialnumbers,whichisnotasurprisegiventhelowrateoftesting.ItalsosuggeststhatthevirusismoreprevalentamongstpeopleconnectedtotravellersthanamongstthegeneralpopulationInpracticearisk-basedsystemwouldnotattempttofinelytunethenumbersbycountrybutmightlumpthemintothreebroadcategories.Lowrisk:someEastAsian

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countriesincludingChina,andAustralia(exVictoria)andthePacific.Mediumrisk:WesternEuropeandCanada.Andtherest.However,quarantiningisrequiredregardlessofwherethereturningNewZealandersarecomingfrom.Ariskassessmentwouldsuggestthatthereisastrongcasefor,atleast,reducingthequarantineperiodforsomereturnees.Areductionto7days,withtwotestswouldfreeuphotelcapacity.Theotheroptionwouldbehomeisolation,withappropriatesafeguardsandtestinginthehome.Asdiscussedabovetheadditionalrisksofhomeversusmanagedisolationwereneverconsideredwhenthemanagedisolationregimewasintroduced.Whilenon-compliancepresentssomeadditionalrisk,evenmakingsomeallowanceforthiswouldstillmeanthattheriskofonwardtransmissionwouldbelow.Thementalitybehindanapparentrefusaltoevenconsidertheseoptions,istwo-fold.First,evenasinglecasegettingthoughwilllead,ifnottodisaster,tothereimpositionofharshhigheralertlevelrestrictions.ThelatterreactionisofcourseintheGovernment’shands.Theseconddriverispolitical.TheGovernmenthassotalkedupthebenefitsandsuccessesofNewZealand’seliminationstrategythatitisfearfulofthepoliticalconsequencesofevenasinglecaseofacommunityinfection.Evenwiththecurrentrestrictionsthereisachanceofcommunityinfection.Restrictionsonshipsandairlinecrewsarenotwatertightandquarantiningdoesnotreducetherisktozero.However,ifthereisjustonecaseofcommunitytransmission,theeasingofrestrictionswillbeblamed.OpeninguptoforeignersAtpresentforeignersare,withafewexceptions,prohibitedfromentry.Thismightbemotivatedbyalackofcapacity,whichcouldbemitigatedbyreducingthedemandassuggestedabove,butthereseemstobealackofinterestinopeningup,nomatterhowsmalltherisk.Theborderscouldbeopeneduptoforeignerswithandwithoutsomeformofquarantine.Testingwouldalwaysbeasensibleoption.Therearefourmaingroupsofforeignvisitors.Business: 312,000Holiday: 1,077,000Vistingfriendsandrelatives:1,050,000Education: 65,000.

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A14dayrequirementwouldchokeoffmostofthebusiness,holidayandvisitingfriendsandrelativemarkets,becauseoftheexpenseandtimeinquarantine.Thiswillhaveasignificantimpactontheforeignvisitormarketwhichaccountsfor5.8percentofGDPand20percentofforeigneanings.Allowingforflow-oneffectstotherestoftheeconomytheimpactontherestoftheeconomywouldbesignificantlyhigherthan5.8percent.However,theavoidablecostsoftherestrictionsaremuchlessthanthis.

• Thepeaktouristseasonisafewmonthsoffsothecurrentconsequencesarelower.

• Evenwithfreeentrythedemandfortravelwillbesignificantlyreducedbecauseofthefearoftravelinacoronavirusworld;fearsaroundbeingcaughtbyasuddenchangeintherules;andrulesimposedbythetraveller’shomecountry.

• TheeffectiverestrictionsonNewZealanders’overseastravelwillincreasethedemandfordomestictravel.

• Someoverseastravelwillbedivertedtootherdomesticexpendituressuchashomeimprovements.

BusinessentrantsAllowingentry,withthecurrentquarantineandentryrules,wouldfacilitatesomeconnectivitytotheworld,withoutthecurrentcumbrousanduncertaincasebycaseprocess.A14dayquarantinewouldchokebackthenumbersseverelybutwouldstillallowtheentryofalimitednumberofhighvaluecases,andashorterperiodforlowerriskcountrieswouldreducethecosts.Muchofthecurrentbusinessmarkethasa‘nicetohave’orarecreationalelementtoitsothedemandfornecessarytravelisprobablyquitelow.EducationvisitorsTheonlymaterialmarketthatwouldbeviablewithalengthyquarantinerequirementiseducationvisitors.AccordingtoEducationNewZealandaggregate‘educationexport’earningsamountto$5billionayear,andtheearningsperpersonisabout$40,000.Becauseofthelongstaysofmosteducationthisisviableevenwitha14dayquarantine,ThemostpositivefeatureofthemarketisthatitisheavilyconcentratedinlowriskAsiancountries.EvenwithoutquarantiningtheriskfromChina,whichaccountsforonethirdofthemarket,isextremelylow,

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Tablenine:LowriskeducationalexportmarketsCountry $mChina 1920Japan 340Korea 300Thailand 120Malaysia 100Vietnam 90Total 2870Source:ICEF28Nov2018

However,theGovernmenthassignalledthatitwillnotbeopeninguptoforeignstudentsfortherestofthisyearandismaking$51millionavailableto‘support’thesector.Giventheverylowrisksposedbyalargenumberofpotentialentrantsitisunlikelythatthesituationwillbeanybetternextyear.SoiftheGovernmentpersistswithitsstrategythesectorcouldpossiblyhavenointernationalstudentsnextyear.Muchoftheprivatetrainingsector,whichisheavilydependentonforeignstudentswillclosedown.Its$10millionassistancepackagewillnotgofar.Manypolytechnicswillcomeunderstrainandtherewillbesignificantjoblosses.$10milliondevotedtodeveloping‘futurefocused’productsmaykeepafewITworkersinjobsforawhilebutprobablywon’tbeasignificantrevenuegenerator.AssessingcostsandbenefitsAfullassessmentoflikelyoutcomesfrombordereasingisbothcomplexanduncertainandobviouslydependsonhowfardowntheriskspectrumtheeasing.Ifacautiousapproachistakenthebenefitsmightbeintheorderof10percentofthepastearningsfromvisitors,say,$2billionayear.Onthecostssidethesewouldbemoderate.Therewillbeanincreaseinthenumberofcasesthatgetbytheborderbuttheimpactonhealthoutcomesandgovernmentreactionsmaynotbematerial.Wemaywelllivinginaworldwheretherewillbeacaseofcommunitytransmissioneverythreemonthsorfourmonthsorso.TheGovernmentappearstoberelyingonTPMmodellingthatputtheoddsofaninfectiouscasegettingthroughat1;1000butthisdependedonthebordercontrolprocessesbeingabsolutelyrobustandignoredthepossibilityofrelativelylessinfectiouscasesgettingthrough.Itunderstatedtheinherentriskswiththestatusquo.Ifaconservativebordereasingincreasedthisfrequencytoeveryeverytenorelevenweeksorso,thiswillnotchangemattersverymuch.Itisnotacasewhere

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thereisachoicebetweennocases,andnolockdownorothersocialdistancingmeasures,andabordereasingthatintroducestheserisks.Modellinganalysis

TheeffectofbordercontrolsontheriskofCOVID-19reincursionfrominternationalarrivals16July2020NicholasSteyn,RachelleN.Binny,ShaunC.Hendy,AlexJames,AudreyLustig,MichaelJ.PlankRecently,resultsfromamodellingexerciseontherisksofbordercontrolswerereleasedbyTePunahiMatatiki(TPM).AsTPM’smodellinghashadamaterialimpactontheGovernment’scoronaviruspolicythinking,weexpectthatthispaperwillbeusedtojustifyacontinuedrestrictiveapproachtoborderopenings.Thereleaseofthepaperwasaccompaniedbyamediareleaseundertheheading:HowNewZealandcouldkeepeliminatingCovid-19attheborderformonthstocome,evenasthecoronaviruspandemicworsensFamouslastwords.Providedpeoplearewellseparatedatquarantinefacilitiesandhaveregularsymptomchecks,ourmodellingsuggeststheriskofaninfectiouspersonbeingreleasedintothecommunityisaround0.1percent-whichmeansforevery1000infectedpeoplewhoarriveattheborder,onepersonwillbereleasedfromquarantinewhilestillinfectious.Covid-19isexplodingoutsideourbordersandeverycountrythatwehavesoughttoeitherreplicateordrawexperiencesfrominthefightagainstCovid-19hasnowexperiencedfurthercommunityoutbreaks.WeneedonlylooktotheexperienceofVictoria,HongKong,SingaporeorKoreatoseeexamplesofotherplacesthat,likeus,hadthevirusundercontrolatapointintimeonlytoseeitemergeagain.

Ashorterquarantineperiodwouldsignificantlyincreasetheriskofaninfectiouspersonbeingreleased.TheswabtestsforCovid-19havequitehighratesoffalsenegativeresults,soevenwithmultipletests,ashorterquarantineperiodcouldmisstoomanycases.

HowmanyarrivalscouldNewZealandcopewith?Pre-Covid-19,therewerearound20,000internationalarrivalsonatypicalday—50timesthecurrentnumberofarrivals.There'sobviouslynowaywecouldquarantinethisnumberofpeople.Oncurrenttrends,thiswouldmeanupto600infectedpeoplepassingthroughattheborderperweek.

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WedisagreewiththerecentclaimbyformerchiefscienceadvisorSirPeterGluckman,formerprimeministerHelenClarkandex-AirNewZealandchiefexecutiveRobFyfethatnewcasesofcommunitytransmissionare"logicallyinevitable"andNewZealandshould

thereforereopenbordersmorequickly.Thetwomainconclusionsintheexecutivesummaryofthemainreportwere:

• A14-dayperiodofmanagedisolationorquarantine(MIQ)withday3andday12testingreducestheriskofaninfectiouscasebeingreleasedintothecommunitytoaverylowlevel.

• Afive-dayquarantineperiodisineffectiveandwouldpresentamuchgreaterrisktothecommunity.

AnalysismanipulatedtogeneratefavouredconclusionsThereportwasobviouslywrittenwithapoliticalmotivation.Bothofthesemainconclusionsweremisleading.Therisksofaninfectiouscasebeingreleasedafter14dayswereunderstatedandtherelativerisksofshorterquarantineperiodswereoverstated.ModelstructureAtatechnicallevelthemodelisreasonablysound.It:

• takesaccountofthelikelytimeofinfectionpriortoarrivel;• accountsforfalsenegativetests;• accountsforinfectionspassedbetweenpassengersinmanagedisolation;• assumesthestandardWHOdistributionofthetimefrominfectionuntil

symptomsemerge.• Assumesthatinfectioussymptomsarepickedupwithalag.

Howeveritisalsoassumedthatthereisnoriskoftransmissiontoquarantiningandhotelstaff,sooneofthemainconduitstocommunityinfectionismissed.Sevenscenariosarerunwithdifferentquarantiningandisolationoptions.Tworelyjustontesting,withaholdingperiodwaitingforthetest.Thefirstonarrival,andthesecondondepartureandonarrival.Threeexaminedifferentquarantineperiods(5,10and14days),withtwotests.Twolookattheimpactofmakinglimitedexemptionsonhumanitariangrounds.Thesescenariosdonotaddmuchtoriskbecauseonlyasmallpercentageofpassengersareassumedtobereleased.Thekeyoutputsare

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• Thepercentageofinfectiouscasesnotdetected• Thepercentageofinfectedarrivalsthatarereleasedwhile‘significantly

infectious’.• Theoddsthataninfectiouspersonisreleasedintotheenvironment.

TheresultsThefirstsetofresultsarepresentedintheirtablepresentedbelow.Thekeyresulthereare:

• Relyingontestingaloneresultsinalargepercentageofmissedcases(47percentforonetestatarrivaland37percentfortestsbeforeandafterarrival).Thisislargelyafunctionoftheassumptionsonfalsenegativesfromtestingimmediatelyafterinfection.Testingisassumedtobealmostcompletelyineffectiveforthefirstthreedaysafterinfection,sopassengersinfectedshortlybeforereturningwillbemissed.

• Thetimeinquarantine(assumingthatthereissometransmissionin

quarantine),doesnothavealargeimpactonthepercentageofmisses.12percentaremissedat5days,8.9percentat10days,and10percentat14days.Beyondapoint,alongerquarantineperiodiscounterproductivebecausequarantineinfectionsoutweighthevalueoftimeinuncoveringinfections.Resultsarenotrecordedfora7dayquarantine,buttheresultswouldprobablybesimilartoa14dayquarantine.

Tableten:Internaltransmissionwithfullaccountingformissedinfections

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Thesecondsetofresults,whichisbasedonthemissesof‘highlyinfectious’cases,presentsadifferentpictureoftheeffectofthetimeinquarantine.Themedianmissrateofhighlyinfectiouscasesafter5daysis10percent,3.3percentat10days,and2.2percentat14days,whenthereissomecrossinfection.Ifthereisabsolutelynoriskofcrossinfection,andnotransmissionthroughstaffthemissratesfallto5.9percentfor5days,0.5for10days,and0.1percentfor14days.Tableeleven:Nointernaltransmission,partialaccountingformissedinfections

Theseresultsillustratehowselectivetheexecutivesummaryandmediareportingwas.Onlythemostfavourable14dayquarantineresultwasreported,andtheleastfavourable(5days)risk.The10dayresultswhichshowedasimilarlylowriskoncertainassumptionswasignored.Thethirdsetofoutputsisameasureofthelikelihoodofcasesbeingreleasedwhile‘significantlyinfectious’.Itiscalculatedfrom:theprobabilitythatacaseisinfectiousinthefirstplace;theprobabilitythatthecaseismissed;andthenumberofreturnees.Thisistheoutputthatgetsthemostattention,butonlyafewoftheseresultsarepresentedinthetext,andonlythentoblowupthecontrastbetweenquarantineperiods.Undera5-dayquarantineperiod,around6.8%ofinfectedarrivalsarereleasedwhilehighlyinfectious.Withrecentarrivalrates(assumingnotransmissioninMIQ)thisequatestoaninfectiouscasebeingreleasedintothecommunityevery9daysonaverage.The10-dayperiodreducesthistoaninfectiouscasebeingreleasedevery100daysonaverage,andthe14-dayperiod(thecurrentscenario)reducesthisevenfurthertoapproximately600days

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Thedifferencebetweenafivedayquarantine,anda14dayquarantinelooksstark.Acasereleasedeveryninedays,versusoneevery600days.The10dayquarantineis6timesriskierthanthe14dayquarantine.However,asweexplainbelowtheseresultwerepartiallyacontrivance,designedtofavourthemoreconservativequarantinepolicy,andtooverstateitseffectiveness.Theseassessmentsassumedthatthereisnotransmissionwithinthequarantinefacility,andthatcasesarenotinfectiousafterthreedaysfromtheonsetoftheinfection.Adjustingfortheseover-optimisticassumptionsincreasesthenumbersofpossiblyinfectiouscasesreleasedandreducestherelativedifferencesbetweenquarantineperiods.ProblemswiththemodellingSmallsampleThemodellingreliedonjusttwoweeksofdatafrom23Juneto4July,withjust21positivecases,tohelpcalibratethetheoreticalmodel.Whileitmayhavebeenappropriatetocirculatethemodelandtheresultstoaspecialistaudience,itwasprematuretoreleaseittothemedia.ThemotivationappearstohavebeenadesiretorushintoprinttocountertheGluckmanarguments.SourceofreturneesnotconsideredThemainsourceofriskfromreturneesistheprobabilitythatthereturneeisinfectious.Thisriskwillobviouslydependonwherethereturneeiscomingfrom,becauseinfectionratesvaryverysignificantlyfromcountrytocountry.Theaverageriskwasestimatedat0.5percent,basedontheobservednumbers,butthiswasdrivenbythecountrysourcecompositionofthereturnees.12werefromflightsfomIndia,3fromtheUS,andfromAustralia.TheAustraliannumbersarenotinformativebecausemanyreturneesfromhigherriskcountrieswillhavetransitedthroughAustralia.However,theIndianflightnumbersindicatehighinfectionratesinIndia,PakistanandAfghanistan(atleastinthethesocialgroupsthereturneesaremorelikelytomixwith).Inthetwoweeksto15August,9caseswereidentifiedinquarantine.Ifthatdataperiodhadbeenusedtheinfectionratewouldhavebeen0.2percent,not0.5percent.Itisobviouslyinappropriatetodrawconclusionsaboutthegeneralriskfromreturneesfromsuchasmallandskewedsample.ReturneesfromChinaposealmostnorisk(possibly1:10,000,000)andmanyEastAsiancountriespresentaverylowrisk(certainlynoworsethan1:10,000).Themodelresultsshouldnotbeusedforan

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assessmentofquarantiningrequirementsforforeignentrants,wherewecanbeselectiveaboutthecountrysource.RiskofFalsePositivesnotconsideredOfthe21cases,14weredetectedbytheday3test,andjustoneintheday12test.Itislikelythatthesinglecasemissedinthedaythreetestwouldhavebeenpickedearlieriftherehadbeenanearliertest.Sixcaseswerepickedupbysymptoms/othertests.Themodelledresultsarelowerthantheactualsforthedaythreetesting(12.2),andhigherforsymptoms(8.6withinternaltransmission).Itisassumedthatallcasespickedupbysymptomsareaccurateandthattherearenofalsepositives.Ascovid-19symptomsaresimilartothosefromacoldorfluthereisariskthataproportionofthesymptomdetectionswerefalsepositives.Therewasnodiscussionofsubsequenttestingofcasesoriginallydiagnosedbysymptomstoconfirmthediagnosis.Falsepositiveswouldhavetheeffectofskewingthemodeltofavourlongerquarantinetimes,becausecaseswiththosesymptomsarepickeduplaterinthequarantineperiod.Themodelwasalreadyoverstatingthevalueofsymptomidentification.AsymptomaticcasesThemodelledshareofasymptomaticcases(45percent)waslessthantheobservedshare(60percent).Thelowertheshareofasymptomaticcasesthelowertheriskofcommunitytransmissionbecausetheyarelessinfectious.ThehigherobservedshareshouldhavebeenusedbecausetheNewZealandreturneeshavedifferentcharacteristics(beingyounger)thanthedemographicoftheinternationalliterature-based45percentestimate.Acriticalassumptionistheinfectiousnessofasymptomaticcases.Themodelassumestheyare50percentasinfectiousassymptomaticcases.Thisisbasedonanestimateusedinonemodeloftheoverallincidenceofdeathsandillnesses,whichinturn,wasbasedontheresultsofasingleChinesestudy8,whichlookstobeanoutlierintheliterature.TheWorldHealthOrganisation’sview,afterconsideringalloftheevidence,isthattheinfectiousnessofasymptomaticcasesisrelativelylow.InourdiscussionoftheESMreportingwenotedtheirreportofastudy(notcitedby

8ChenYWangAYiBetal.TheepidemiologicalcharacteristicsofinfectioninclosecontactsofCOVID-19inNingbocity.ChinJEpidemiol.2020;41:668-672

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them)thatasymptomaticinfectiousnesswasabout10percentofsymptomaticinfectionness.InviewoftheWHOadvice,TKMshouldhaveusedalowerassumption,say10or20percent,forrelativeasymptomaticinfectiousness.Definitionof‘significantly’infectiousbiasesresultsShorterquarantineperiodsoasnottohaveamajorimpactontheprobablityofacasebeingdetected,butamuchmoresignficantimpacton‘significantlyinfectious’(sometimesreferedtoas‘highly’infectiousinthetext)casesbeingreleased.Significantlyinfectiousisdefinedas:‘beingwithinthefirstthreedayssincesymptomonset(orequivalenttimeforasymptomaticcases).Thisiswhenindividualsareassumedtohavepassed93%oftheirtotalinfectiousness.Thisisanarbitraryassumptionthatwasnotbasedonanyevidenceorliteraturereviewonrelativeinfectiousnessatdifferentpointsoftheillness.FromtherelevantWHOdiscussionitappearsthatcasescanbeinfectiousforupto8or9daysaftersymptomonset,withinfectiousnessgraduallytailingofftothatpoint.However,TPMhavesimplycutoffthetailofthedistribution,assumingthetailnottobeinfectiousatall.Infectiousnessatdifferenttimepointsshouldhavebeenweightedtogivebetterriskassessment.Removingthe‘inconvenient’tailfromthedistributionsignficantlybiasestheanalysistorelativelyfavourlonger,overshorter,quarantineperiods. Abettercalibrationofthemodelwouldprobablyshowthata14dayquarantineonlyhasamoderateimpactonrelativerisk,comparedtoa10dayperiodandpossiblya7dayperiod.SummaryTPMhavebothoverstatedandunderstatedtherisksofdifferentquarantiningoptions.

• Theabsoluteriskofacasebeingreleasedretheir14daypreferredquarantineperiod,estimatedat0.1percenthasprobablybeenunderstated.Thisignoredanypossibilityofcrossinfectionsbetweenpassengersandinparticularstaffinfections,and7percentofinfectiousness.Itisdifficulttosaywhatthe‘true’numberis,butprobablyitisamultipleofthe0.1percent.

• Therelativeriskofshorterquarantineperiodshasbeenoverstated.Itispossiblethata10orevena7dayperiodwouldnotmateriallyincreasetheriskformostreturnees.

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• Theriskofcommunityinfectionsfromreturnees,andotherentrantsfromlowriskcountrieshasbeenhugelyover-stated.

EstimatingtheimpactofcontrolmeasurestopreventoutbreaksofCOVID-19associatedwithairtravelintoaCOVID-19-freecountry:Asimulationyearsmodellingstudy.MichaelBakerandothers17June2020Thisisacomplexmodelthatestimatestheriskofanoutbreak(adomesticcase)inNewZealand,fromimportingacasefromAustralia.TheriskofanAustralianimportedcaseappearstohavebeenassessedbeforetheVictorianoutbreak,socanbeconsideredanAustralian,ex-Victoria,riskassessment.WhileonlyAustraliaisassessed,themethodologycanbeappliedtoanycountry.ThemodeltakesaccountoftheriskofanAustralianinfection,theriskoftransmissioninflight,andtheriskthattheinfectionistransmitteddomestically.Theresultsareexpressedintermsoftheyears,onaverage,itwouldtakeforanoutbreaktooccurinNewZealandper100,000incomingtourists.Asthenumberincreasestheaveragetimetoaninfectiondecreaseslinearly.Withnomitigationtheaveragetimeis1.7yearsThistimeperiodisincreasedby:

• ExitscreeninginAustralia:2.2years• Addingfacemasksonaircraft:3.3years• Addingentryscreening:3.5years• PCPtestswithothermitigantscanincreasetheaveragetimefrom4.4to28.6

years.

Thereisacomparisonofa7dayquarantinewitha14dayquarantine,butitisassumedthatthereisnotestinginthesescenarios.The7dayquarantineresultsinaoutbreakevery5.8years,and14daysincreasesitto34.1years.BothfigureswouldbesignificantlyhigherwithtwoPCPtests.Notransmissioninquarantineisaccountedfor,whichwouldreducetheadvantageofalongerquarantineperiod.Aneffectiveoption,withoutquarantining,iswearingamaskfor14daysafterarrivalcombinedwith:symptomreporting,contacttracingandafinaltest.Thisincreasestheaveragetimeto29.4years.Thisresultdependsonanassumptionthatfacemasks

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areveryeffectiveinreducingtransmissionandthereisfullcompliance.Theassumptionsoneffectivenessoffacemasksandcompliancewereoptimistic.

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Partten:AnoteonSwedenTheSwedishapproachtomanagingthepandemic,basedlargelyonvoluntarycompliancewithsocialdistancing,hasreceivedalotofinternationalattention,mostofitnegative.TheSwedeswereaccusedofrunninga‘mad’experimentriskingtensofthousandsoflivesinpursuitofa‘herdimmunity’objective.TheSwedishexperiencewasacautionarytaleagainstnotimplementingahardlockdown.InearlyAprilanopenletterfrommanySwedishacademics,demandingachangeindirection,receivedinternationalmediaattention.Andagroupofresearchersreleasedtheresultsofmodelling,adaptedfromtheLondonImperialCollegemodel.Itprojectedthatthenumberofdeathswouldpass40,000byearlyMayandrisetoalmostalmost100,000byJune.Ahardlockdownwouldreducethelatternumberto30,000.TheSwedishapproachwasbasedonthejudgmentthatitwasimpossibletoeradicatethevirus,andthatwhileahardlockdownwouldsuppressthevirusforatime,itwouldinevitablyre-emergeasthelockdownwaseased.Theywentforapolicythatwassustainableoverthelongerhaul,relyingprimarilyonvoluntarymeasures.Theytrustedthepopulationto‘dotherightthing’,avoidingtheeconomicandsocialcostsofahardlockdown.Herdimmunitywasnottheobjectiveofthepolicybutanaturalconsequenceofallowingalevelofspreadinthecommunity,whileholdingcasesatalevelthatwouldnotoverwhelmthehealthsystem.TheSwedish‘model’hasbeenpartoftheNewZealanddebate.TherewasanopinionpiecebyRodJacksonfromAucklandUniversityintheNZHeraldon27May2020titled‘HasSwedenmadeafatalmistakewithcovid-19?’TheargumentwasthatifSwedenwaspursuingaherdimmunitystrategytheconsequencescouldbedisastrous.Atthetimethearticlewaswritten,thetotalnumberofdeathsinSwedenwas4,000.BasedonJackson’sassessmentoftheproportionofthepopulationthathadalreadybeeninfected(aboutfourpercent),anddeathrateof1percentofinfections,56,000morepeoplewouldhavetodie,beforeherdimmunitywasattained(when60percentofthepopulationhadbeeninfected). Which,Jacksonargued,validatestheNewZealandapproach.

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IfNewZealand,withhalfthepopulationofSweden,hadtakenaSwedish-styleapproachto

Covid-19,ashasbeensuggestedbysome,justdividetheSwedishnumbersbyabouttwoto

workouttheimplications.

Asstatedabove,insteadof21deathstherewouldalreadyhavebeen2000deaths.Ofeven

greaterconcern,thiswouldpossiblyriseto30,000beforeherdimmunitywouldbeachieved,

sometimein2022.

Thepiecewentontoconsidernewinformation.

Aftercompletingthisarticle,anewstudyhasreportedthattheproportionofpeoplein

StockholmwithantibodiestoCovid-19isonly7.3per100people,despiteamuchhigher

deathratethantherestofSweden.

Thisisunfortunatelyconsistentwiththeworst-casescenarioestimatespresentedhere.The

conclusionshouldnowread:"Swedenhasmadeafatalmistake".

Anditconcludes:

Inlightofthisnewevidence,AotearoaNewZealandhasclearlytakentheonlysensibleroute

intheabsenceofavaccineoreffectivetreatment.Australiaandothercountriesneedto

refocuseffortsonthesameeliminationstrategy.

MuchofJackson’sdiscussionwaspartialandsomewasmisleading.Inparticular,JacksondidnotgobeyondthenegativeheadlineswhendiscussingtheSwedishinfectionrateresults.

ThisiswhattheNewYorkTimesreported.

ThefindingswereroughlyinlinewithmodelspredictingathirdoftheSwedishcapital'spopulationwouldhavehadthevirusbynowandwhereatleastlimitedherdimmunitycouldhavesetin,theSwedishHealthAgencysaidonWednesday.

"Itisalittlebitlower(thanexpected)butnotremarkablylower,maybeoneoracoupleofpercent,"TegnelltoldaStockholmnewsconference."Itsquaresprettywellwiththemodelswehave."

ThenumbersreflectthestateoftheepidemicearlierinApril,asittakesafewweeksforthebody'simmunesystemtodevelopantibodies."

Morerecently,studiesoft-testincidence(whichprovideamoreaccurateassessmentofpastinfections)providedsupportingevidencethatSwedenwasstartingtodevelopherdimmunity.

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Whathappenedondeaths

ThefollowingfiguresweretakenfromWorldometer.ThenumberofcasesintiallyincreasedoverMayandearlyJuneastheSwedesre-embracedtestingandcontacttracing,inanefforttoslowtheprogressionofthevirus.Butthentherewasasubstantialreduction.Thedeathratefelldramaticallytolowsinglefigures,reflectingtheSwede’ssuccessinreducingdeathsinelderlycaresituations,thatpreviouslyaccountedfor75percentofthedeaths,andprobablysomeherdimmunityeffect.ThenumberofdeathsbythemiddleofAugustwaslessthan5,800,alongwayfrom60,000.

Figuretwentyone:Swedendailycases

Figuretwentytwo:Swedendailydeaths

WhiletheSwedishexperienceisnotnowdirectlyrelevanttoNewZealanditdoesreflectthepowerofvoluntarymeasures.Theepidemicwasbroughtundercontrolatanearlystage(areproductionrateofabout1)andthehealthsystemwasnotoverwhelmed.ThatisnottosaythattheSwedeswouldnothavedonethingsdifferentlyiftheyhadtheirtimeagain.Theywouldhavetakenstrongermeasuresto

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protecttheelderlyinresthomesandmighthaveleanedagainstthespreadwithcontacttracingearlier.