The Government will entrust contact tracers with the mission of stamping out the Delta outbreak, but the consequences of failure are disastrous, Marc Daalder reports
Analysis: Less than an hour after Jacinda Ardern announced Auckland would move to Level 3 from Tuesday night, epidemiologists and disease modellers formed a party line on the issue: It was a “calculated risk”.
This exact term was used by University of Otago epidemiologist Michael Baker, University of Auckland physicist and Te Pūnaha Matatini disease modeller Shaun Hendy and Hendy’s modelling colleague and University of Canterbury mathematician Michael Plank.
Ardern and Director-General of Health Ashley Bloomfield were adamant on Monday that they still expected to reach zero cases. But the experts Newsroom has spoken to aren’t so sure – and the consequences of failure could be disastrous.
Contact tracers shoulder the burden
The Government’s view is that Level 4 has done its job. New daily cases peaked at 83 in late August. We’re now nearly a month on and they’re far lower. Almost all of the new cases each day are household contacts of an existing case. But enough are novel cases in new households to spark another round of household transmission, prolonging the long tail of the outbreak.
Perhaps the reality the Government has not quite found the words to admit is that Level 4 has done as much as it can do. That’s certainly Baker’s view.
“The pattern of unexpected cases is not really about what alert level you’re at,” he said.
“I think the concern at the moment is we’re just not doing enough targeted testing to really stamp out these remaining lines of transmission.”
That hyper-targeted approach can be carried out at any alert level and the hope is that Level 3 could stymie whatever minimal undetected transmission might be out there until testing and tracing catches up.
In other words, the Government has shifted the burden of stamping out the outbreak from the robust stay-at-home orders to the country’s contact tracing teams, hoping that a mix of Level 3 restrictions and mediocre vaccination rates will allow them to catch up to Delta.
“It’s a calculated risk. It’s a decision to back the contact tracers,” Hendy told Newsroom.
“In some ways, you always would. If they think they can do it, they’re probably the folks that are best placed to understand what’s happening on the ground. So perhaps not unreasonable to back contact tracing. Let’s cheer them on.”
Ardern compared the situation to previous times Auckland has been at Level 3 to stamp out an outbreak. In August last year and February this year, the less stringent lockdown brought cases back down to zero.
Delta alters that calculation – it’s why the Government moved the country to Level 4 in the first place – but Ardern’s emphasis on vaccination seems to indicate she hopes the supercity’s vaccine uptake could counteract Delta’s added transmissibility.
Hendy isn’t so sure. With only 31.5 percent of the population fully vaccinated as of September 14, Auckland’s rates give it a boost but don’t do enough to reduce the transmissibility of the virus to that of the variants combatted in previous outbreaks.
In order to achieve that effect, Hendy says we’d need rates closer to the United Kingdom’s, where 65 percent of the population is fully vaccinated.
“Just because Delta is Delta, you need quite high coverage before it brings it down to what we were dealing with last year,” he said.
Government’s terrible dilemma
All of the experts spoken to by Newsroom still believe it is possible for New Zealand to reach zero cases again on our current path. But they say another outcome is also possible – and maybe even more likely. What would that look like?
It would start in seven to 10 days, with a slight uptick in cases. Before that point, case numbers could fall further as the last impacts of Level 4 continue to be felt. But if new cases start to pop up in early October, ahead of Auckland’s planned step down from Level 3, the Government will be faced with a stark choice: to return to Level 4 or to embark on a new path by abandoning the elimination goal.
“What I think is still a fairly likely alternative is that, at alert Level 3, we start to see the numbers creep up,” Baker said.
“And then it will be a real dilemma about whether to just stick with Level 3 for several months until we’ve got very high vaccine coverage. To get enough people doubly dosed could take almost till Christmas.”
Faced with this dilemma, the Government may struggle to put Auckland (or other parts of the country, if the virus has leaked out) back into Level 4. Vaccination rates aren’t high enough, but they’re rising. And Aucklanders will have been in some form of lockdown for seven straight weeks.
But the only alternative to yo-yoing back into Level 4 would be this long-term, medium-level lockdown while we vaccinate as fast as we can. This would be a tacit admission that elimination is over. It would involve case numbers rising, as well as hospitalisations and deaths. But it would protect the health system from utter collapse.
Such a situation would also open up the Government to further pressure to relax restrictions. Those who have been in lockdown for weeks will struggle to stomach many more months in the same straits.
That would be a disastrous mistake.
Up to this point, New Zealand has only experienced Covid-19 as a theoretical threat. At most, on any one day, we have registered a few dozen cases. At most, in any one outbreak, we have seen a couple of hundred people hospitalised. Just 27 people have died from the virus here.
Relaxing restrictions too early, while most of the population is still not fully vaccinated, would open us up to the reality of Covid-19. That’s a world where Auckland’s hospitals are full to bursting, where nurses are lucky to end their shifts without being infected, where dozens of people are dying every day.
In the United States right now, where a similar proportion of people have had one shot and the rate of double-dosed people is 70 percent higher than in New Zealand, 2000 people are dying each day. Proportionally, that would be 30 deaths a day in New Zealand, or 10,000 in a year.
New Zealanders have been shielded from the reality of Covid-19 by the Government’s adept handling of the pandemic and the success of our elimination strategy.
This new, riskier step by the Government opens up the largest potential cracks in that shield since the dark days of March 2020, when so much was uncertain.
Moving to Level 3 raises the possibility that the Government will be confronted with the choice of a jump back to Level 4 for an uncertain amount of time or a three-month Level 3 lockdown.
On the other hand, perhaps Level 4 was just delaying the inevitable anyway. Or perhaps the contact tracers will come through in the end and we’ll be able to enjoy spring and summer at Level 1, rather than huddled in our homes at Level 3.
Whatever the case, we’ll know in two weeks’ time.
