Singapore's increasing coronavirus cases is a warning of what might happen in New Zealand should officials take their eye off the ball, a leading scientist has warned.
After being hailed as an early success in the fight against COVID-19, the southeast Asian nation has experienced a 'second wave' of infections, centred on crowded migrant worker communities. It now has more confirmed cases of the disease - almost 27,000 - than any other country in the region.
While New Zealand currently appears to have virtually eliminated the virus' transmission in the community, the fact it can spread without causing symptoms means we can't be certain it's gone.
New modelling by researchers at Te Pūnaha Matatini has found Maori and Pacific communities, cut off from the kind of access to healthcare others enjoy, are particularly at risk from a second wave here.
"Maori and Pacific people in New Zealand have a lot more unmet health needs," said Shaun Hendy of the University of Auckland, who contributed to the new modelling.
"We know that with COVID-19, evidence overseas shows people with comorbidities are more likely to die - with other diseases. So if you have unmet health needs in the first place, then you're more at risk from the disease.
"Also, Maori and Pacific people tend to have less access to healthcare. They tend to be working in circumstances that are more precarious - they may not be able to take time off work to take a test, they might not be able to afford that. Or they might live a long way from a testing centre. So they're both at risk [of getting] the infection, and at higher risk of having an undetected infection."
If those communities have regular contact with others who have more access to healthcare, a new outbreak is likely to be picked up quickly - but despite its reputation as something of a melting pot, Auckland - where most of the country's Pacific people live - is quite segregated, the researchers say.
"COVID-19 is a disease that does target inequality," said Prof Hendy. "We've seen examples in many countries where disadvantaged communities have suffered more than more privileged communities."
In the US, which has had more confirmed cases and deaths than anywhere else in the world, African-American communities have been hit three times harder when it comes to infections and six times in terms of deaths.
"In Singapore, there was a large secondary outbreak in a migrant worker community - that community is housed in quite crowded dormitory conditions, doesn't necessarily have access to good testing, and also is a community that doesn't have a lot of job security, so a lot of disincentives for self-isolating for two weeks if your employer's not going to pay you for that period.
"We do have to be mindful of that - we've seen it play out that way overseas, and we've got to make sure it doesn't play out that way in New Zealand."
While the Government's initial "one-size-fits-all" approach has worked so far, the researchers say a particular focus on disadvantaged communities will be required to make sure COVID-19 doesn't come back - but so far they've been left out. That includes making sure anyone, no matter where they live or their financial situation - has access to rapid testing and without fear they'll lose their jobs if they need to go into self-isolation.
"The important consideration we must be cognisant of is that New Zealand is the gatekeeper to the Pacific Islands," added Maryann Heather, GP and senior lecturer in pacific health at the University of Auckland
"There is a lot of travel between New Zealand and the Pacific countries by the Pacific community each year, as well as the close ties with New Zealand in varying capacities like foreign aid and assistance.
"If COVID-19 were to spread to the other Pacific nations, this could be severe and they would not be able to cope with the overwhelming stress on health services. This was evident by the recent measles outbreak in Samoa in 2019. We in New Zealand have an obligation to protect our Pacific Island nations as they are looking to New Zealand for how we are handling the pandemic and what guidelines we have in effect."
The Te Pūnaha Matatini modelling was published online ahead of peer review.
