New Zealand had been looking like it had won the fight against coronavirus with its tough strategy of eliminating community transmission but the emergence of a few new cases has sent parts of the country back into lockdown.
Not many countries remain untouched by COVID-19, but in the places that have reported no cases, what factors are at play?
How have they avoided the global pandemic that’s infected more than 20 million people and killed more than 750,000?
Is the best plan to lock down hard and “beat the crap out of it”, as New Zealand’s Deputy Prime Minister Winston Peters suggests?
Which countries have zero cases?
The list of countries that have not reported a case is short, and for most, there are good reasons why.
Small island nations and territories like Kiribati, Marshall Islands, Micronesia, Nauru, Palau, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu have been able to remain free from the pandemic due to their remoteness, small populations and strong and quick border controls.
Across the Pacific, countries locked down or declared national emergencies in response to COVID-19, in some places before recording a case of coronavirus.
Pacific countries have to deal with additional challenges including slow internet, extremely high operational costs and infrequent transport links, and so some were among the first to impose measures to contain the spread of the outbreak, like restricting entry from coronavirus hotspots.
There are two countries on the list that don’t benefit from the same geography and claim to still have no cases inside their borders.
But UNSW Adjunct Professor Bill Bowtell, one of Australia’s leading public health strategists, was not certain about the accuracy of the numbers from North Korea and Turkmenistan.
“There’s a small group of countries whose figures are just not reliable,” he told the ABC.
Mr Bowtell also praised the response of countries, many across Asia, where there have only been a few cases among large and sometimes dense populations.
Vietnam, Singapore and Taiwan had done particularly well, with firm border control and “serious quarantine,” he said.
“Any country that had experience of SARS and MERS knew what they were doing,” he said.
Impose strong quarantine and ‘clobber cases’
Like many of the countries without any cases, Australia has benefitted from its location in the world.
But authorities here need to pay more attention to how those other countries have kept the virus out, Mr Bowtell said.
New Zealand first eliminated community transmission of the virus by imposing a strict lockdown in late March when only about 100 people had tested positive for the disease.
Some prominent local health experts suggested it was more likely the virus had been quietly spreading in Auckland for weeks, despite efforts to eradicate it with an initial five-week hard lockdown.
Prime Minister Jacinda Ardern said the latest outbreak appeared to be a new strain, which may suggest NZ was successful in its first eradication and the virus had now been reintroduced.
“The sequence of the virus from the current outbreak is not the same as the sequences from community cases in our first original outbreak in New Zealand.
“In other words, not from a dormant community transmission from the beginning of the pandemic.”
Since the return of new infections, New Zealand has reimposed tight restrictions and authorities expect case numbers to climb in the coming days.
But the country will stick with its initial approach as it tries to drive case numbers back to zero.
“Going hard and early is still the best course of action,” Prime Minister Jacinda Ardern said.
On Friday, she said it was better to look at an outbreak situation with restrictions put in place early.
This was in contrast with locations like Hong Kong and Australia.
“Better to assess the situation with restrictions in place,” Ms Ardern said.
Mr Bowtell agreed and commended Ms Ardern’s plan.
He said coronavirus would never be eradicated but eliminating transmission with strict quarantine and isolation measures was the best way to fight the pandemic.
“When a case of coronavirus turns up, probably through problems with quarantine and isolation, you move as swiftly as possible and you clobber those cases,” he said.
“Then you go back to cautious business as usual.”
He also cautioned against taking an approach more like those seen in the US or Brazil, where economic concerns have prevailed over public health measures.
“That would be a recipe for one of the biggest disasters in human history,” he said.
What can Australia learn from overseas?
In Australia, there has been substantial opposition to the elimination strategy from both business and government.
The Prime Minister has said that level of restrictions would double the unemployment rate and the strategy itself was risky.
New South Wales Premier Gladys Berejiklian said eradicating the virus in Australia was unrealistic and powerful business groups have argued trying to completely stamp it out was unachievable and would be too destructive to the economy.
Mr Bowtell, however, strongly advocates the kinds of measures seen in New Zealand and thinks Australia should follow their goal of eliminating community transmission.
“There seemed to be decisions made by the Federal and Victorian governments that they would not learn from and adopt what was going on next door in New Zealand and even closer to home in Queensland and Western Australia,” he said.
“I don’t think the strategies adopted by those two governments have worked out very well.
“We would have been much better off to have adopted the New Zealand approach in the first place.”
In June, NSW, which had been the worst-affected state in Australia before Victoria’s second wave, had three weeks without community transmission, and Mr Bowtell said that was a good target to aim for.
That could again be achieved by shifting to stricter lockdowns, like in New Zealand.
“It’s like extinguishing the embers of a bushfire. It’s better than waiting until the flames are 10 metres high,” Mr Bowtell said.
“It is better than dealing with hundreds of new cases a day.”