Monday 24 February 2020 12:03pm
The likelihood of New Zealand remaining coronavirus-free is low and the country should be preparing for a pandemic, a University of Otago, Christchurch infectious diseases specialist warns.
Currently there are no cases of coronavirus disease (now referred to as COVID-19) in New Zealand. However, in an editorial in today’s issue of the New Zealand Medical Journal (NZMJ), Professor David Murdoch suggests the country’s health and research sector needs to prepare for spread of the outbreak here as this outcome is likely.
“The likelihood of maintaining this [coronavirus-free] status is low and now is the time to be preparing for an anticipated upsurge in respiratory disease in the community and increased pneumonia hospitalisations.”
Professor Murdoch is Dean of the University of Otago, Christchurch and an international expert in infectious diseases. He is also co-director of One Health Aotearoa, a collaborative group of scientists that focus on the interplay between the health of humans, animals and the environment, including ‘zoonosis’ or infectious diseases that originate in animals and spread to humans. Professor Murdoch wrote the NZMJ editorial with One Health Aotearoa co-director Nigel French, who is a Distinguished Professor of Food Safety and Veterinary Public Health at Massey University.
Professor Murdoch says the New Zealand’s Government and its health and research resources should now be working together in preparation for an anticipated outbreak. He says despite considerable efforts are being made by the country’s health system to prepare as best it can, although we will only know how successful they have been in the aftermath of a coronavirus pandemic, if this does arrive. Public health units, primary care and hospitals and getting prepared, and testing for the new coronavirus has already been established in several diagnostic laboratories.
The New Zealand Influenza Pandemic Action Plan has been in existence since 2002 with several subsequent revisions and it provides a framework for pandemic responsiveness. While focused on influenza, it contains many principles that should apply to the current COVID-19 epidemic, Professor Murdoch says. “There is also a chance that transmission of COVID-19 may coincide with our next seasonal epidemic of influenza, creating additional pressure on the health system.”
New Zealand has an added pressure as a gateway to many small South Pacific nations with less ability to deal with a pandemic, he says.
Professor Murdoch says based on available information, COVID-19 is a disease that ranges clinically from a mild respiratory syndrome to life-threatening pneumonia, affecting both lungs, with severe disease associated with increasing age and other existing conditions.
Latest case fatality rate estimates for COVID-19 are about 2 per cent, more than in the influenza H1N1 2009 pandemic (less than 1 per cent), but less than SARS (10 per cent) and MERS (40 per cent). The transmissibility of COVID-19 is similar to influenza, but much less than measles. There has been little information about the impact in children, raising questions about whether severe disease is less common in this age group, Professor Murdoch says.
While the precise origin of the virus is yet to be determined, epidemiological evidence indicates that several zoonotic transmission events occurred in December 2019 at Wuhan’s Huanan Seafood Wholesale Market with the virus most closely related to a coronavirus from a Horseshoe Bat.
Professor Murdoch says episodes of zoonotic spill-over leading to sustained transmission of new infectious diseases in humans, such as COVID-19, appear to be increasing in frequency.
“Understanding the complex systems that drive the spread of such disease is essential for informing strategies to tackle emerging and re-emerging infectious diseases. This usually requires responses from multiple disciplines and an awareness of what is happening globally. Consequently, professionals and researchers from a wide range of disciplines must work together and with communities to prevent and control infectious disease impacts through actions at all levels.”
The “One Health” approach is based on groups working together, and New Zealand has the opportunity to be a global leader in this transdisciplinary approach, Professor Murdoch says.
“This approach makes particular sense in New Zealand given the country’s relatively isolated island ecosystem vulnerable to introduced pest and pathogens, economic dependency on agriculture and the physical environment, well-connected scientific community and an existing indigenous Māori world view and knowledge system that emphasises holism and interconnectivity between humans, animals and the environment.”