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Volume 29, Number 9—September 2023
Historical Review

Improvements and Persisting Challenges in COVID-19 Response Compared with 1918–19 Influenza Pandemic Response, New Zealand (Aotearoa)

Jennifer SummersComments to Author , Amanda Kvalsvig, Lucy Telfar Barnard, Julie Bennett, Matire Harwood, Nick Wilson1, and Michael G. Baker1
Author affiliations: University of Otago, Wellington, New Zealand (J. Summers, A. Kvalsvig, L. Telfar Barnard, J. Bennett, N. Wilson, M.G. Baker); University of Auckland, Auckland, New Zealand (M. Harwood)

Main Article

Table

Comparative summary of distinct features of 1918–19 influenza pandemic and the COVID-19 pandemic hazard and responses, New Zealand*

1918–19 influenza pandemic
COVID-19 pandemic
Similarities
Hazard and effects (both globally and in NZ, where data available)
Caused by influenza virus H1N1 Caused by SARS-CoV-2 Likely zoonotic origins for the pandemic viruses
RNA virus that showed relatively slow 
genetic drift through mutation Global infection fatality risk of 0.1%–2.0% up to June 2021 (28); NZ infection fatality risk 0.79% (estimated, January 2021 before vaccination) (29) Transmitted between humans as a respiratory viral pathogen
Probably originated in domestic and 
wild birds (30,31) RNA virus showing rapid genetic shifts through mutation and recombination, including within-host evolution during chronic infection of immunocompromised patients (32) Immunologically naive population
Moderately transmissible, with R0 
estimated at 2.4–4.3 (33) Probably originated in bats (31) High proportion of population infected
Incubation period of ≈a few hours to 2 d 
reported in a large US civilian hospital 
in 1918 (34) and general influenza 
estimates of 1–4 d (35) Highly transmissible with estimated R0 of 9.5 for Omicron variant (36) Marked ethnic health disparities experienced globally. For example, in NZ, notably higher death rates in the Māori population
Global case-fatality risk ≈1–2.5% 
(20,37) Incubation period estimates differ by variant, with one meta-analysis reporting a pooled mean incubation time of 6.6 d (38) Higher death rates in men internationally
Global infection fatality risk >2% (28) Global estimate for case fatality risk of 1.12% as of July 26, 2022 (1). NZ case-fatality risk of 1.15 in 2020 (before vaccines), reduced to 0.09% as of July 2022 (with high vaccine coverage) (3) Post-acute infection syndrome common
Infection gives long-term immunity (39) Infection gives protection that fades over ≈3 y (40)
Net effect is symptomatic infection in 
≈8% of population each year (41) Net effect is reinfections are common (3)
Short, intense pandemic wave, with 
some smaller waves in subsequent 
years Repeated, prolonged pandemic waves
Relatively more severe illness in young 
adults and elderly Relatively more severe illness in elderly and immunosuppressed
Devastating spread of infection from NZ 
to surrounding Pacific nations
 Regional border quarantine measures probably limited spread from NZ to South Pacific jurisdictions
Response in NZ
Lack of strategic response Highly strategic national control response (elimination for first 20 mo of pandemic) with vigorous public communication Large community/voluntary sector mobilization
No use of external border controls Use of tight external border controls (in the first 2 years) Use of physical distancing through closure of public facilities, businesses, schools, and cancellation of large public events, although less systematically in 1918–19
No specific test for pathogen available Accurate diagnostic test and organized testing program Some use of internal border controls
Limited use of case isolation and contact
quarantine Active contact tracing and quarantining of contacts No specific curative treatment initially (although supportive management and treatment options for COVID-19 sufferers were developed, including antivirals)
Limited infection control in institutions Infection prevention and control in health care and aged care Iwi, hapū and marae-led care and support† (7,8,42)
No specific vaccine available Highly effective vaccines in late 2020 (within 1 year) Royal Commissions of Inquiries to investigate pandemic responses
Lack of economic and social support 
from government Extensive economic and social support from government
No widespread mask-wearing Requirements (mandates) to use masks in some settings to limit transmission

*For greater detail of the hazards, response, and various impacts of the two pandemics in NZ, see Appendix Table 1. NZ, New Zealand; R0, basic reproductive number. †Indigenous Māori language terms: iwi refers to tribe and hapū refers to subtribe. Marae (meeting grounds) are the focal point of Māori communities and are a complex of carved buildings and grounds that belongs to a particular iwi, hapū, or whānau (family).

Main Article

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1These senior authors contributed equally to this article.

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