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This was 2020.

The year of Covid-19

Part III

When the World stopped turning

Lockdowns across the Planet

Eerie empty streets across the globe became iconic illustrations of the Covid-19 pandemic.

The only way to stop the virus spreading was to eliminate opportunities for it to pass between people. That meant perspex screens at shopping counters, social distancing on buses and trains and, at its most extreme, orders for people to stay at home.

China was the first to move.

By the end of January, before restrictive measures were introduced around the world, the country closed all its schools and non-essential workplaces, cancelled public events, placed restrictions on gatherings, halted public transport, and restricted regional travel. Mass masking was also required.

Italy was one of the first countries outside of China to go completely dark.

After its first two cases were reported in January - both with travel history to Wuhan - infections soared. At the beginning of March there were 1128 cases, by the end of the month, infections had grown to 101,739. Going into December, 1.6 million cases had been reported.

Outbreaks ravaged the regions of Lombardy and Veneto in the country’s north and northeast before spreading to the rest of the country.

Hospitals in Italy quickly became overwhelmed as Covid-19 case numbers increased by hundreds daily. Luca Bruno/AP Photo

“On a psychological level, I have to say I still have not recovered,’’ Lombardia nurse Cristina Settembrese said of the loss of life experienced in March and April.

Mass deaths accompanied the spread. Daily death tolls - which spiked at 969 deaths in a single day - resulted in the European country surpassing China for the most Covid fatalities.

Covid-19 cases and fatalities in Italy

At first Lombardy and Veneto were cut off, but it wasn’t long until restrictions blanketed the country.

Bergamo became the epicentre of Lombardy's outbreak. Deaths quickly crept into the hundreds as the virus spread around the region. Luca Bruno/AP Photo

“There won’t just be a red zone … there will be Italy,” Italian Premier Giuseppe Conte said.

"Our grandfathers were drafted to go to war; we're being asked to stay at home," Foreign Minister Luigi Di Maio said.

Leaving home was reserved for limited circumstances, sporting events were halted, and checkpoints were set up within city centres. The country’s hospitals were at a point of collapse.

In the span of a month, not only did Italy’s lockdown increase in severity, almost every country in the world had introduced public health measures to combat the spread of the virus.

Life in many countries around the world changed dramatically from March 1 to March 31. Freedoms once enjoyed like meeting friends for a coffee, or even taking the kids to school, were removed, and stringent measures imposed to try and stop the virus ravaging communities.

The stringency of measures on March 1

Europe quickly became the epicentre of the pandemic, resulting in the European Commission closing the borders of 26 states to all non-essential travellers.

“The less travel, the more we can contain the virus,” European Commission President Ursula von der Leyen said.

Lockdowns varied in severity around the world.

Oxford University developed a measure for the stringency in different countries.

This graph tracks the changes in the Oxford Stringency index over time in selected nations.

First, China.

China’s initial lockdown in January was ranked 69.91 out of 100, at a time when other jurisdictions were yet to make any drastic changes.

The province of Hubei, where the epicenter of the pandemic Wuhan is located, endured the brunt of the restrictions imposed.

But despite getting Covid under control, restrictions in China have never really eased off.

In some parts of the country, stay-at-home requirements akin to New Zealand’s Alert Level 3 are ongoing.

The second epicenter of the pandemic, Italy’s initial restrictions at the beginning of March, were assessed at 69.91 by Oxford.

By the end of the month, they were 91.67, among the highest in the world at the time.

As the pandemic spread through Europe, other countries imposed control measures. The ban on foreign travellers and movement restrictions earned some of the highest markers - 87.96 for France a week after the borders closed, 76.85 for Germany , and 81.48 for Belgium .

After relaxing restrictions during the northern hemisphere summer, new outbreaks in these countries are pushing governments to reconsider locking down.

New Zealand’s response fluctuated over time. The initial lockdown - imposed at the end of March and ranked 96.3 - was the most intense period of restrictions throughout the year.

The national moves down to level 3 in April, level 2 in May, and level 1 in June saw the country’s rating decrease - 87.04 to 39.81 to 25.93. Eased restrictions reflected successful containment and strides taken towards elimination.

When cases were found in the community in August - putting an end to the 102-day case-free streak - restrictions returned. Auckland moved to alert level 3, the rest of the country to level 2. In one day, New Zealand’s stringency index went from 22.22 to 68.98.

In comparison, Sweden’s stringency scores reflected the country’s relaxed approach to Covid, with restrictions similar to those imposed in New Zealand under Level 2 or the so-called Level 2.5.

But restrictions have barely moved for Swedes since April, and reached its highest since the beginning of the pandemic this December at 68.52 points while New Zealanders have minor restrictions.

At the same time, when the US reached record levels of deaths in the aftermath of Thanksgiving gatherings, the country’s disparate response kept some states open.

As countries moved in and out of lockdown, the WHO continued to warn against the sustainability of these measures, despite the director-general acknowledging the benefits. “Where these measures are followed, cases go down. Where they are not, cases go up,” WHO director-general Tedros Adhanom Ghebreyesus said in July.

Lockdowns worked to drastically reduce the infection reproduction rate. Researchers in New Zealand found the reproduction rate of the country’s largest cluster at the time dropped from 7 to 0.2 in the first week of alert level 4 alone, and daily infections dropped dramatically.

Similar research was conducted in Wuhan, where the first lockdown measures were rolled out, and found a significant decrease in infections.

“We’ve clearly avoided that exponential growth the modelling showed would have happened if we’d done nothing,” Director-General of Health Dr Ashley Bloomfield said in April.

Modelling from the University of Auckland’s Te Pūnaha Matatini suggested 80,000 people could have died if immediate action wasn’t taken, and 89 per cent of the population would have been infected within 400 days.

Lockdowns weren’t the desired response for all. Taiwan, which has been praised for its successes, showed it was possible to contain the virus without crippling the economy.

WATCH: Taiwan has drawn from lessons learned during the SARS epidemic to mount an effective and immediate response to the 2019 novel coronavirus outbreak, using three major steps. NXAS

Drawing on lessons learned from the 2003 SARS pandemic, Taiwan curbed its Covid-19 death rate to just 0.3 deaths per 1 million people.

“Taiwan was much better prepared than [New Zealand] for a pandemic, had better border control early on, made better use of mass masking, and has continued to be ahead of [New Zealand] in use of digital technologies to support pandemic control,” public health experts from the University of Otago wrote in December.

Apart from a few public health measures - mass masking among them - life in Taiwan remained relatively normal during the pandemic. Paula Bronstein/Getty Images

Sweden also opted against lockdowns, but its outcome was dramatically different.

The Swedish Government never ordered a shutdown, day care centres and primary schools remained open, and so too did stores and restaurants. The nation of 10 million quickly emerged as a country completely out of step with the rest of Europe and most of the world.

While it did not ignore the pandemic - banning gatherings exceeding 50 people and nursing home visits early on - it opted to continue with daily life as much as possible, in the hopes achieving herd immunity would quell the virus.

Swedes were told by authorities to prioritise hand washing, physical distancing and staying home over wearing face masks, and as neighbouring countries closed their schools, businesses and borders, more than 30,000 people gathered in Stockholm in March for the final of the Eurovision Song Contest.

The liberal ‘trust-based’ approach has had its backers, but it has also contributed to the country seeing a much higher death toll than its neighbours.

As of December 9, Sweden’s deaths per 100,000 people was 70.38.

The rate was ten times higher than that of nearby Norway, with 6.77 deaths per 100,000. Denmark similarly saw a lower rate, with 15.5 deaths per 100,000 people.

In stark contrast, New Zealand’s deaths per 100,000 is just 0.51 per 100,000 people.

The United States has been among the worst-affected countries.

For months, it has reported the most infections and fatalities in the world.

University of Otago’s Krause explains health policies across the US are dictated more by state policy than federal.

In contrast, New Zealand’s response has been unified, consistent and widely-praised. The country’s unicameral system empowered rapid decision-making.

“That has served us well right through the responses,” Bloomfield says.

The country’s collective efforts - the team of 5 million was the term Prime Minister Jacinda Ardern coined - helped stamp out the virus.

“Kiwis from all walks of life were resolute and determined - determined that this was a war we could eventually win, but only if we acted together.

“The battle is won, but the war is not over,” she said in May as the country prepared to ease restrictions.

Bloomfield says the open, transparent and consistent communication from authorities was the standout public health intervention.

“In the space of six or seven weeks, we took the public in New Zealand from a situation where we had an emerging global threat to asking them to stay at home for four weeks, and they did it.

“I think there’s a real lesson in the importance of consistent, clear messages repeated often through a range of channels.”

One of Aotearoa’s biggest achievements, in Krause’s opinion, was how the Government worked with, and took advice from, health professionals.

Bloomfield agrees. This was a key reason the necessary decisions were made so quickly. The Government had confidence in the science-based advice it was receiving.

Ardern made near-daily appearances for a press conference alongside Bloomfield - which he jokingly likens to daily performance reviews.

Everyday at 1pm, Prime Minister Jacinda Ardern and the Director-General of Health Dr Ashley Bloomfield stood before the nation to deliver the good and the bad news - clusters closed, new outbreaks emerged, and sadly, people died. Fiona Goodall/Getty Images

This is an area where the United States failed.

Krause, who is from the US, says health and government in the US appeared to work together at the beginning, but were soon at loggerheads with each other.

“[The] Government [was] trying to muzzle a number of infectious disease spokespersons. There was a struggle.”

There was no unified population adhering to expert advice either, no team of 328.2 million. But this might not have ever been possible.

Lockdown strategies that were rolled out in New Zealand might not have worked - or been as respected - in New York or even Sao Paulo.

“The US is too big,” Krause adds. But public health measures like physical distancing and more effective lockdowns could have helped, he thinks.

Bloomfield, who was hailed as the ‘curve crusher’ during the pandemic, gives credit to all Kiwis.

“Actually it was New Zealanders who crushed the curve. We set out to flatten the curve and we crushed it because people understood what they needed to do to look after each other and, in particular, to protect our vulnerable populations, and they did it.

“I think it was an amazing, amazing effort.”

Our response happened incrementally - borders were closed in March, the alert level system was introduced and rolled out days later, and managed isolation and quarantine facilities were set up. Kiwis in Wuhan and around the world were repatriated, labs prepared for an influx in samples and contact tracing teams buckled down.

The New Zealand Government's unified, rapid and strong response, led by Prime Minister Jacinda Ardern, resulted in far fewer infections and fatalities than was originally predicted by modelling experts at the beginning of the Covid-19 pandemic. Hagen Hopkins/Getty Images

The unprecedented move to level 4 - complete lockdown - was a necessary step, modelling expert Professor Shaun Hendy says.

“We knew some drastic action was needed in order to avert a significant crisis for the country - that going early, going hard,” he says.

“Act now, or risk the virus taking hold as it has elsewhere,” was the warning issued by Ardern in March.

Professor Shaun Hendy from the University of Auckland calcuated the mass casualties New Zealand could have faced if no immediate action was taken. Thankfully, his team's modelling never became a reality. Abigail Dougherty/Stuff

Bloomfield had the same concerns.

“What we had seen from Europe was we had to go into a lockdown sooner or later, and we felt the sooner the better.

“If you think you need to do something in two weeks’ time, you need to do it today and that’s the advice we gave.”

Bloomfield recalls feeling as though the nation sighed with relief when the move to level 4 was announced.

Usually grid-locked roads were empty, busy shopping precincts quiet. Supermarkets and pharmacies were among the few essential services to open.

Hendy considered New Zealand “lucky” at this point in time. The virus hadn’t yet ripped through communities like it had elsewhere - we were behind.

“That actually turned out to be really crucial to where we are today, which is in a really good position.”

WATCH: The spread of Covid-19 in Europe and the United States, and the fatalities that followed, showed Professor Shaun Hendy what might happen if New Zealand sat by and waited for cases to arrive. But was lockdown the right answer? Abigail Dougherty/Stuff

While New Zealand led the world for the strength and success of its lockdown, it was among the last to acknowledge the importance of masks in suppressing the virus.

“It was disappointing,” says Dr Ling Chan, a Dunedin pathologist.

The Ministry of Health conducted a review that found cloth masks may increase the risk of infection in the community. By this point, face masks had been compulsory in Singapore for a month.

Chan helped establish the #Masks4AllOtago movement to encourage widespread mask use when the ministry wasn’t. Her disappointment stems from the stagnant advice from the ministry, even after the WHO changed its stance.

The WHO initially thought masks would provide people with a false sense of security.

“There is no black or white answer and no silver bullet," Adhanom Ghebreyesus said in April. "Masks alone cannot stop the pandemic."

But they could help reduce its spread. The WHO realised that in June.

“In the light of evolving evidence, WHO advises that governments should encourage the general public to wear masks where there is widespread transmission and physical distancing is difficult,” Adhanom Ghebreyesus said at the announcement.

To the dismay of public health and medical professionals, Ardern’s Government didn’t decisively back masks until August.

“The [New Zealand] Ministry of Health has been extremely slow to mandate the use of masks … even after the WHO advice improved,” says the University of Otago’s professor Nick Wilson.

Despite New Zealand’s delayed response, Bloomfield says their advice aligned with that of the WHO’s, which targeted countries with widespread transmission. At that time, New Zealand wasn’t experiencing that.

“[We] had to develop our own mask policy,” he says. “We’ve, I think, used masks where and when we felt it’s indicated [by the WHO].”

The Ministry of Health's view on face masks evolved throughout the year. Dr Ashley Bloomfield and his team didn't tell people to add masks to their Covid-19 tool kit until the resurgence of the virus in the community. Robert Kitchin/Stuff

Chan highlights the impressive uptake of masking in Hong Kong - around 99 per cent of the population wore one. Its experience with the SARS outbreak in the early 2000s meant the government and its people knew the importance of this basic measure.

Even Australia masked up during the deadly resurgence in Victoria.

So why did New Zealand drop the ball when it came to mask recommendations?

Chan thinks it may have been due to worries around supply. Issues around PPE stock for health workers were already prevalent, despite assurances from the Ministry of Health that masks, gloves, gowns and visors were plentiful.

Quality Safety International (QSI), a factory in Whanganui, was producing 200,000 masks a day for a number of clients, including the Ministry of Health. Its machines were operating 24/7.

At the end of August, a mandate was rolled out requiring face coverings to be worn on public transport during alert level 2 and above. Use in these settings had simply been recommended in the weeks prior.

“The whole world has continued to learn, and New Zealand is one of those countries where [when] we've seen new evidence, we've always been willing to act on that, and we are,” Ardern said at the time.

Once masks became mandatory in certain settings and recommended in others, uptake was quick. The streets of Wellington were filled with people wearing masks while going about their daily routines. Rosa Woods/Stuff

Further changes came about in November with mask mandates added to specific settings in alert level 1.

Bloomfield says in the beginning of the pandemic, there simply wasn’t enough knowledge of transmission. He was able to keep up to date with all scientific publications on the virus, an indication of how few resources were available. As more evidence emerged, the response evolved, he says.

However, Chan believes the precautions are still underwhelming.

“Whilst the virus is still raging [worse] than ever throughout the world, masking should be mandatory on flights, international airports and public transport - especially in cities where there are isolation facilities - at all alert levels.

“No quarantine system can be perfect and there are bound to be areas where the virus can escape from facilities.”

Chan describes SARS-CoV-2 as a “sneaky virus” that needs a variety of public health measures to combat it - testing, isolation, masking and vaccinations.

The Ministry of Health’s chief science advisor agrees - masks on their own aren’t that effective. “What we need is a real public health response that includes all those other elements we’ve emphasised - washing of hands, avoiding touching your face, staying home if you’re unwell.”

“The suite of things is what stops the chain of transmission.”

Proceed to part IV

Know your enemy

How science went to war with Covid-19

Part I
Part II
Part V
Part VI