The difficult days of Levels 4 and 3, where fear forced compliance, will look easy next to the Government’s challenges once Covid is under control, says Peter Dunne

Mixed messages plagued the Level 4 lockdown from start to finish.

The original “Flatten the curve” ambition hardly matched the bold “Go early, go hard” rhetoric attached to it, so was quickly replaced by the aim to “eliminate” Covid-19 from New Zealand.

But we were later to learn that “eliminate” did not mean getting rid of the virus here, rather, it was a clinical term, just one more step on the way to eradication of the virus. It transpires what was being talked about was more akin to bringing Covid-19 under control and keeping it that way.

The “official Covid-19 announcements” on radio and television about what was permissible under Level 4 and what was not were often confusing and contradictory, smacking very much of being made up as we went along. All the while, we were supposedly sustained by gushing almost daily press conferences patronisingly telling us how “we’ve all done this together”, when, in reality, we had no choice in the matter.

But, be all that as it may, in the end it counted for little because the public fear generated by Covid-19 meant that New Zealanders complied overwhelmingly with the strictures imposed, so that after five weeks we have moved to alert Level 3.

However, the same sense of official confusion is still there. For example, on the morning of April 26, the Minister for Senior Citizens was announcing that Level 3 meant that senior citizens would have the same rights as everyone else, “to go to work, to exercise and to access essential services like supermarkets and banks.”

While the Minister was confidently saying “these guidelines will give peace of mind to New Zealanders”, the signs were already anything but. By the end of the day retirement village operators were saying the change in Alert Levels would not change things greatly for those in retirement homes and villages. In any case, according to the Retirement Villages Association, it was not possible to have a one size fits all response and the level of freedoms to be now enjoyed by residents would come down to the policies of the individual facilities in which they lived.

While the original move to Level 4 was understandably swift and consequently forgivably chaotic, there is no excuse for the shift to Level 3 … to have been likewise.

The next day, a radio “official Covid-19 announcement” proclaimed that full details about how Level 3 would work would be made available on April 28 – the same day it came into force.

So much for enabling people to plan with confidence in advance! Meanwhile, in the background, the Director-General of Health, the unelected official with all the power, was darkly warning that the move to Level 3 was no reason “to slacken off the effort”.

While the original move to Level 4 was understandably swift and consequently forgivably chaotic, there is no excuse for the shift to Level 3, five weeks later, during which there has been plenty of time to properly plan the transition, to have been likewise.

In the meantime, New Zealanders are shifting their focus from the lockdowns to what happens next. Research New Zealand’s latest tracking survey shows that 65 percent of New Zealanders’ main worry is now about their job security, and how they will meet their ongoing mortgage and rent payments. Ninety percent are now expressing concern about the increasingly parlous state of the economy, and about one third of those are extremely concerned about our economic future.

Overall, people are now much more concerned about economic recovery than they are about contracting the virus.

All this confirms it is now going to be much harder than before to sustain the anti Covid-19 campaign based on fear and bold ambitions. Already, it seems people are less likely to be tolerant of the (still) heavy restrictions under Level 3, than they were with the absolute restrictions of Level 4.

While the Government still seems wedded single-mindedly to a strict public health approach, the public seems to be shifting increasingly to a wider focus on their households, jobs, and futures, with perhaps a still latent but growing sense that our leaders are not yet paying enough attention to the country’s future beyond Covid-19.

This is going to make both the duration and policing of Level 3 that much more difficult, as the fear and impatience about the need to do something about Covid-19 continue to give way to a broader and probably more deep-seated fear and impatience about facing the future and getting back to normal. 

The small business, hospitality and local tourism sectors, engine rooms of the domestic economy, employing so many people, are already edgy and extremely keen to get back to a form of normality. So too are the various sporting codes.

While they have all been able to take advantage of various short-term government assistance packages and wage subsidies, they all know that their real futures depend on the ability to get back to their core business as soon as possible, and not on the continued receipt of subsidies which must come to an end one day.

… it beggars belief that at a time of the greatest health crisis the country has ever seen, doctors’ surgeries could be facing closing down, with GPs losing their jobs.

These groups will become more and more frustrated at being left treading water indefinitely, especially as Covid-19 numbers plunge. So, just holding the line, as we have been, will no longer be good enough.

Part of the new world that lies ahead will revolve access to community-based health services, particularly general practice and mental health services.

The numbers of GPs have been growing steadily in recent years – up just over a third from 4,176 in 2009 to just on 5,500 today. But, as the 2015 Health Workforce Survey rather worryingly pointed out, about 42 percent of our GPs are overseas-trained, and the profession is ageing, with around 47 percent aiming to retire by 2025. Covid-19 has exacerbated this potentially difficult situation as a recent survey carried out by the Royal New Zealand College of General Practitioners shows.

That April 2020 survey showed that, of the GPs who responded, 67 percent have seen their working hours reduced; 23 percent have either been laid off, or are about to be, or had their hours reduced, and the remaining 10 percent are locums unlikely to find work during the month.

Now it beggars belief that at a time of the greatest health crisis the country has ever seen, doctors’ surgeries could be facing closing down, with GPs losing their jobs. Yet this is what is happening.

This is not just because the Level 4 lockdown has made it difficult for people to get out to see their doctors. It is also because there has been no sport, meaning been fewer sports accidents and injury-related incidents, leading to a sharp fall in the numbers of consultations. Also, the cancellation by District Health Boards of elective and non-urgent surgical procedures has meant a substantial drop in patient follow-ups required.

By the end of March clear warnings were being given to the Government about this deteriorating situation and the need for some assistance to retain enough GPs to ensure that future needs could be met.

In response, the Minister of Health announced two funding packages, totalling $45 million, to assist GPs, but a row has subsequently broken out between the Government and the Medical Association over a third potentially $22 million package to help keep general practices afloat.

The Medical Association told the Epidemic Response Select Committee last week that, in addition to the $45 million already announced, it had been expecting payment of a further $22 million which it had agreed with health officials to help GP practices survive.

However, it claimed, that despite the agreement with the Ministry, this additional payment was now being held up by Cabinet. That was in part confirmed by an obfuscating response from the Prime Minister that “I don’t consider there’s been a delay. There has already been support, and that support has totalled $45 million, and that doesn’t include the access GPs had to the wage subsidy as well.”

On a more positive note, the Government announced last week a $40 million package to provide free access to health and addiction services for 1.5 million people.

If previous experience is any guide, there will be a surge in mental health cases post Covid-19 that will last for some years after the immediate crisis has passed.

But, in terms of overall community needs, the General Practice and mental health announcements are comparatively modest – certainly in comparison to the more than $107 million committed in the same week to meeting the ongoing needs of people sleeping rough.

These two examples highlight some of the problems that lie ahead for the Government in managing the post Covid-19 environment. Over the next few months and beyond many similar tensions will emerge in other areas as well, as the Government’s resources and capacity to respond so open-endedly as it has been doing to date, come under mounting pressure and constraint.

The difficult days of Alert Levels 4 and 3, when everything was done by press conference announcement or regulation, where fear forced compliance, and few dared argue will begin to look easy and straightforward by comparison.

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