The Government’s decision to open the borders while continuing to stamp out every case of Covid-19 will further stretch already strained public health teams, Marc Daalder reports
Analysis: Public health officials who have been worked to the bone over the past 18 months are staring down the barrel of years of further burdensome contact tracing and case management.
By deciding to progressively open the borders in 2022 and continue to deal with Covid-19 incursions through contact tracing, testing and case isolation, the Government has put a heap more work on the plates of strained public health staff.
That’s despite the results of multiple reviews of responses to Covid-19 clusters which found the contact tracing system can struggle to deal with fewer than two dozen cases spread out over two weeks.
“I think that we need to have greater capacity and I think the events of New South Wales – who were deemed to be the best contact tracers – show that capacity and capability to surge is going to be critical if we are to respond to any outbreak,” Sir Brian Roche, author of one of the reviews, said at the Government’s reopening forum on Thursday.
This isn’t a knock against the hard work done by our public health teams. When a single case wandering through Wellington for a weekend can produce 2500 contacts, it’s easy to see why it might be difficult to identify and reach out to every single person who even a handful of cases have been in contact with.
Add in the fact that public health staff have been doing this seven days a week, non-stop for 18 months – first tracing contacts in the March and April outbreak, then in August, then in small incursions in October, November, January, February and June, and all the way through tracing contacts of those who test positive in MIQ as well – and the strain is understandable.
Indeed, that was the other conclusion of one of those reviews. Roche’s investigation into the February cluster “identified evidence of tiredness and burnout across the response, at all levels. Many individuals volunteered that they were tired and burnt out, others stated on questioning that they were tired, and others manifested clear signs without necessarily recognising it themselves or attributing them to tiredness and burnout.”
That was echoed by Collin Tukuitonga, a public health academic who also works part-time at the Auckland Regional Public Health Service (ARPHS) in a strategy role. Recalling a briefing from the director of ARPHS, William Rainger, late last year, Tukuitonga said, “They were forced to postpone pretty much everything that they would normally do in the public health space. Smoking awareness, other disease surveillance, all of that sort of stuff.
“Remember, we didn’t have many cases at the time. It wasn’t like a massive number of cases. In other words, that to me is a signal that the system is tired. If we get a Delta variant go awry, I think we’re going to be up against it. And I know some places are going to struggle more than others.”
Tukuitonga said the Northland case in January required resources from ARPHS to be redirected to Northland’s public health unit, which struggled with even the contacts of a single case.
“I think we’re running at capacity or over capacity and if we are faced with a large number of cases, I think we’re going to be in trouble.”
But the Government’s strategy is likely to see a greater number of Covid-19 cases arriving in the community than we have seen over the past year-and-a-half. While efforts will be made to limit the inflow – through maintaining full MIQ requirements for unvaccinated travellers or those coming from high-risk countries – there’s an expectation that cases will arise and have to be stamped out.
“It sounds like it’s a matter of when rather than if,” Tukuitonga said. “I totally understand what the Government is saying: That we have to expect this to happen, that we can’t be shut away forever, that we’ll get the odd incursion and hopefully we can get on top of it. But as I said, the system is tired. We can’t keep doing that forever.”
Tukuitonga’s solution is identical to that proposed by Roche and by Sir David Skeggs, who chairs the expert panel advising the Government on how to reopen: increase contact tracing capacity now.
“As a country, we need to be thinking about surge capacity. Where are we going to get additional people to contact trace, to support testing, to follow up, to do all of those things quickly? Which means, to me, that we need to train and prepare and have these people ready and available even if we don’t need them,” he said.
Roche made a similar point to Newsroom on Thursday.
“I think it’s fair to say that we’re going to live with Covid for a very extended period of time – certainly not months but years,” he said. “To recognise the human reality of people who are actively engaged and just the management of that through some form of rotation and all of that. I think that work’s well underway. The health sector is like every other sector: It’s busy. You try and get a builder. You try and get a plumber.
“As we look forward to the issue of sustainability over the next few years, we are going to have to think really laterally about how we use specialist health resource supported by trained resource. We’ve just got to be smarter about how we get the best out of people but not put them under inhumane strain. I think the ideal is to have a core set of people and that we surge with appropriately skilled [people].”
One of the action items for the Government in Skeggs’ recent trio of reports was to begin scaling up health system capacity in anticipation of new cases and small outbreaks.
Chris Hipkins, the minister responsible for the Covid-19 response, said the Government was working on surge capacity.
“We can increase our capacity for contact tracing and as we saw in the Wellington case where we contact traced one case and about 2500 people. We can scale up where we need to,” he said.
“But of course we need to keep vigilant about that, we need to keep making sure that we’re scenario planning, because every scenario is different.”