Now is a good time to address this with Cook Islands finally opening for business on January 13. Understandably there exists anxiety. I would like to make a case for optimism and excitement. Let’s examine the critical factors, writes Associate Professor John Dunn.

Community

This is perhaps the most important. The Cook Islands is almost unique as a nation having had zero Covid and achieving 98 percent vaccination in those 12 and over. It’s extraordinary and I believe due to a sense of oneness and identity. Society is remarkably homogeneous and used to working toward a common goal.

All leaders – whether the Churches, Are Ariki, or Government – have been united and the result is obvious.

True anti-vaxxers are inevitable in any population with some so far down the Facebook rabbit hole they can’t be reached by reason. Facts don’t help. They are thankfully rare in the Cook Islands. One of the more cogent reasons to get vaccinated is for others, especially the children who don’t qualify, and the aged or unwell who remain at risk despite the vaccine. Community at work.

Travellers

This is where the Government has, in my opinion, done extremely well. Initially, arrivals will only be from New Zealand, a controlled, aligned, and trustworthy partner in this exercise and the source of much of our advice and expertise.  While Delta continues to circulate widely geographically, it has not launched exponentially in NZ as many of the modellers had forecasted.

Case numbers appear steady at about 200/day rather than the thousands predicted. This may change but there is cautious hope that the very high vaccination rates (though lagging Cook Islands) may just be doing the job.

Most importantly, passengers will be filtered and scrutinised: only those double vaccinated and shown to be virus-free by extremely sensitive saliva PCR testing close to their flight, are permitted entry. You can’t do better than that.

This is the same strategy I use for all staff and patients in my hospital in Auckland. You can say with confidence at any one time that no one in the building has the virus. It creates a marvellous “safe haven” feel and builds confidence. We will achieve the same for the whole of Cook Islands. Importantly, it also gives the travellers themselves confidence.

Environment

This is underemphasised by mathematical modellers. This virus does not transmit outside. The Cook Islands’ way of life is extremely “ventilated”. We live in the fresh air. Windows and doors are and should be, wide open to provide airflow.

SARS-CoV-2 moves around in aerosol form and easily hitches a ride when left floating about in the stagnant air of a shut-off room.

Talking, especially loudly, singing and coughing are great spreaders. If you must, space yourselves and do it in the breeze. Those SE trade winds are potently anti-viral!

Worst case

There exists a mathematical model which I feel is excessively gloomy. It has unfortunately had wide reporting locally and promoted some unwarranted panic. It is based on loose assumptions and the authors themselves admit it is a “very rough guide”. 

Without debating the clever methodology employed, we can go straight to the conclusions and conclude they don’t make sense.

One scenario predicts up to 2000 cases and 10 deaths on Rarotonga. That’s roughly 20 percent of a universally vaccinated population infected. NZ by comparison has had 9000 cases or 0.18 percent of a partially vaccinated population infected. And a total of 41 deaths among 5 million people.

Therefore the model needs to be taken with a grain of salt. It is important to warn but not helpful to alarm.

Delta is highly transmissible and I agree is likely to seep under the door one day. However, I personally doubt it will result in Armageddon.

More likely

Let’s paint a more probable “virus arrival” picture.

Jim, a 69-year-old retired farmer from Birkenhead, has a negative saliva PCR on Thursday. Later that day he picks up Delta in the supermarket bakery section, eyeing up a cream donut over the shoulder of a recently unemployed unvaccinated individual.

He and his wife Cheryl leave at 0800 Saturday on NZ946 AKL-RAR arriving Friday.

An ei, a nu and a swim later he’s feeling pretty chuffed. This lasts until Monday when he gets a tickly throat and the tiare doesn’t smell as good.

Being a solid citizen, and following Te Marae Ora (TMO) advice, he gets a PCR at the Hospital and then isolates until the result comes back positive later that day.

TMO then take over managing the isolation and check Jim and Cheryl frequently.

She tests positive on Wednesday as does one of the seven resort staff they had contact with who is then also isolated. Fortunately, no one in the well-ventilated restaurant they visited is affected.

All three have minimal symptoms. Being fully vaccinated, their viral load declines rapidly and their ability to pass it on (the Secondary Attack Rate) is limited. Similarly, they don’t get too unwell and don’t need hospitalisation. That’s the vaccine doing its job.

After seven days they are all no longer infectious and after a further short isolation period, Cook Islands TMO and NZ Ministry of Health agree on their repatriation.

Of course, it could be worse. More could be infected and Jim might get really sick or die. However, even then with the measures already in place, there is an excellent chance things will be quickly contained.

Reality

No one knows the future. There is a feeling that globally this virus won’t get suppressed until everyone is vaccinated or everyone has had it. The best news in two years has just come from Japan where Delta may have mutated itself out of existence. Daily cases have dropped overnight from 25,000 to 200.

In Cook Islands (almost) everyone is vaccinated and certainly, everyone arriving will be. It’s as good as it gets. While there may be new variants around the corner our current situation is strong and about to be further strengthened with booster shots and childhood vaccination. We have the opportunity to make hay while the sun shines 

So let’s take a big breath (while socially distanced), re-join the world, and restart the economy.

Associate Professor John Dunn is Honorary Medical Advisor to the Office of the Prime Minister Cook Islands. He is also a visiting surgeon to Rarotonga Hospital and owner of Motu Villas.