New Zealand Data Adds More Pieces To The COVID Puzzle

While clinicians and researchers worldwide have been looking closely at all aspects of COVID-19, the majority of data has been limited to patients admitted to hospital and intensive care units. This has provided insights in severe COVID, but leaves out those with less-severe disease. New research published today has sought to redress the balance.

The Medical Research Institute of New Zealand (MRINZ) COVID team, led by Dr Nethmi Kearns, Clinical Research Fellow, working in partnership with Regional Public Health (RPH), have analysed data on the progression, prognosis, and management of the 2020 alpha strain of all community COVID-19 cases in the Greater Wellington region. 

The team’s study, ‘Clinical and epidemiological characteristics of COVID-19 in Wellington, New Zealand 2020: a retrospective, observational study’ has today been published in The New Zealand Medical Journal. 

The Greater Wellington Region had 96 confirmed COVID-19 cases during the first wave of the pandemic from January-August 2020. Dr Kearns and her team investigated crucial data from these cases, ranging from how and when symptoms presented, the rates of secondary infection within households, the frequency of worsening asthma, and the countries from which COVID-19 was imported. 

Key study findings show that the majority of these first wave cases were those travelling to Aotearoa New Zealand from overseas, and there was no set of overarching symptoms that could accurately predict infection, with a variety of different symptoms presenting from cough to stomach pain. The study also clearly shows how COVID does not provoke severe asthma attacks, a significant and crucial finding for Aotearoa New Zealand, given our high national prevalence of asthma. 

Over 90% of confirmed COVID-19 cases experienced a non-life threatening form of the disease and were managed in the community. Dr Kearns, says that the majority of people with COVID do not need hospital-level care and information on this group obtained from the 2020 alpha outbreak will enable Aotearoa to be better prepared for Delta and other subsequent strains. 

Non hospitalised COVID cases pose challenges to those immediately affected, their whānau, their household, social and workplace contacts and the paramedic and primary care health professionals who provide care during the uncertain period when it is difficult to predict who could deteriorate rapidly. “It is important that the progression of COVID-19 at the less severe end of the spectrum is further explored with new variants of COVID-19.” says Dr Kearns. 

Early border restrictions, mandatory quarantine of international arrivals and clear communication of risk, as seen in Wellington and in New Zealand overall during the first wave, minimised transmission from arriving travellers to at-risk communities. The study supports the assertion that by following the Alert Level guidelines and other public health advice through this first 2020 wave, New Zealand managed to keep transmission within communities to a minimum and protect our most vulnerable population members. 

Dr Kearns, who returned from NHS Scotland to join the MRINZ, says, “The COVID-19 pandemic disproportionately affects our most vulnerable global communities, such as minority ethnic groups, migrant workers, women and gender-diverse communities, and those with lower socioeconomic status.” 

Multiple risk factors intersect to intensify existing inequities, compounded by the structural imbalance present within many worldwide health and support systems. “Ongoing research into preventing and tackling inequity in the diagnosis and management of COVID-19 is a priority.” says Dr Kearns. 

Dr Annette Nesdale, Medical Officer of Health, Regional Public Health, says, “Our collaboration with the MRINZ COVID team supports our public health and equity goals to understand and mitigate the severe impacts of the global pandemic for our local communities.” 

MRINZ and RPH are currently embarking on an observational study into the impacts of Long COVID on physical and mental health across these same community cases, one year after their illness. This is a new and important extension of this research, set to continue to inform public health interventions both here in Aotearoa New Zealand, and internationally, during this and future pandemics. 

Professor Richard Beasley, MRINZ Director says, “The work of Dr Kearns and our MRINZ COVID team is providing important knowledge of the wide range of symptoms in people presenting with mild COVID-19, and the difficulties in developing diagnostic clinical criteria. This research contributes to worldwide efforts to better understand and manage COVID-19, across the spectrum of its severity.”

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