The Government is now looking to change the Covid-19 response to suit a new high-caseload, high-vaccination world where elimination is unlikely to be reached, Marc Daalder reports
Analysis: Covid-19 Response Minister Chris Hipkins has effectively ruled out a return to Level 4 in Auckland, in doing so disappointing public health experts who had urged the Government to engage in a hard “circuit-breaker” lockdown.
Instead, he warned that Aucklanders would have to prepare for more cases of the virus and that the Government will be changing Covid-19 measures to take into account both higher vaccination rates and the reality that cases are likely to spike.
New measures for new strategy
Among the changes: a potentially accelerated timeline for changes to MIQ requirements for incoming, vaccinated travellers and move away from placing community cases in MIQ facilities, as the expected rise in cases would otherwise exhaust availability in the system.
“We are actively considering our MIQ settings in light of the fact that we are unlikely to get back to zero cases in the New Zealand community,” Hipkins said during the 1pm Covid-19 update.
“Obviously there are a few further things for us to work through on that including, for example, what we do with travellers who want to come back via Auckland but then move to other parts of the country. So we’ve got some work to do there, but I think you can expect to see us talking more about that fairly soon.”
Later in the press conference, he flagged further changes to MIQ.
“As we do see the number of cases increasing – and we are expecting to see the number of cases increasing – the sustainability of putting everybody who is a positive case into MIQ starts to seriously be drawn into question. We have been working for some time now on a home isolation model for positive cases.”
That marks a return to the days of March and April 2020, when all community cases either isolated at home or were hospitalised if they got sick enough. But at that stage, MIQ facilities didn’t exist. Now they do, but there aren’t enough rooms to hold the number of cases the Government is expecting.
“In the last peak that we saw, a couple of weeks back, we went to the peak of what we could do in terms of MIQ. I don’t envisage that we will go above and beyond that, so we will now be looking at other ways of isolating people,” Hipkins said.
“Ruling out Alert Level 4 will effectively also rule out Alert Level 1, leaving Aucklanders in the worst of both worlds with a large number of restrictions and a large (and growing) number of cases, hospitalisations and deaths.
– Amanda Kvalsvig
That peak came on August 29, with 83 new cases. That Hipkins now expects that figure to be met or exceeded is telling. Last Monday, Director-General of Health Ashley Bloomfield had said the strategy was to still keep case numbers low.
“Keeping the case numbers as low as possible, even if it’s not zero, is absolutely material, and it is material to this transition, both when we can do it, and also doing it safely,” he said at the time.
Yet now the Government is planning for cases in excess of 83 a day and has few qualms that the daily case numbers could double every couple of weeks at the current rate the outbreak is growing. Hipkins’ admission on this front is novel, as both Bloomfield and Jacinda Ardern had previously avoided getting too specific about their expectations for the direction of the outbreak.
The exit strategy for Auckland is now vaccination, as the outbreak there threatens to spiral out of control.
“It would be fair to say that the advice we are getting is Covid-19 is spreading in Auckland and the number of locations we are seeing cases popping up is growing and the diversity of the parts of the community that are being infected with Covid-19 is also increasing and vaccination is absolutely important at this point,” Hipkins conceded.
“We are seeing good high vaccination rates in Auckland but I cannot stress enough that we want to push harder and faster with vaccination in Auckland. It will make a difference and it will be a very important part of the pathway to less restriction for Auckland. There is no question about that.”
Experts push for Level 4
Since the Government decided last week to lower restrictions in Auckland (in a low-risk manner) even as cases and hospitalisations were on the rise, the outbreak has progressed exactly as experts forecast.
“If, as is likely, case numbers continue to grow, it will become progressively harder to keep the outbreak contained to Auckland. The rest of New Zealand should prepare for the inevitability of community transmission. Regions that experience outbreaks may need to be put under restrictions like those in Auckland,” University of Canterbury mathematics professor and Te Pūnaha Matatini disease modeller Michael Plank said at the time.
That day, 29 new cases were reported. On Wednesday, the number was 55. Since Plank’s warning, Northland and more of the Waikato have been put into Level 3.
The Government is now planning for a high-caseload, high-vaccination future, hoping the latter cancels out the former. But experts are now pleading for restrictions to be raised in Auckland or risk the health system being overwhelmed in a matter of weeks.
“Renewed effort needs to go into suppressing transmission. To safely loosen restrictions further (such as to the proposed Step 2 of the Auckland roadmap), community transmission needs to be lower and the number of fully vaccinated people much higher,” University of Auckland modeller David Welch warned on Wednesday.
“These trends show that it’s time to talk about a circuit-breaker,” Amanda Kvalsvig, an epidemiologist at the University of Otago, agreed. “A move back to Alert Level 4 is the best and probably only chance of reversing these highly-concerning trends that are all moving in the wrong direction. Vaccination is not going to happen fast enough to reverse these trends and we need to buy time.”
When presented with this advice, Hipkins basically ruled out a return to Level 4.
“That’s not something the Government is considering,” he said.
And what if the health system were to be threatened as cases and hospitalisations rise?
“The Government is doing a variety of plans and the Prime Minister is already committed to … coming back and speaking to you about what that pathway looks like.”
Kvalsvig, ahead of the Wednesday press conference, expressed disappointment at the notion the Government would rule out Level 4.
“Before deciding on Aucklanders’ behalf that they’re too tired of lockdowns, let’s hear from Aucklanders. Let’s also hear from Māori, Pasifika, people with underlying conditions, people who are marginalised, and children and their advocates. They’re the ones carrying the highest risk if Covid-19 is allowed to spread before vaccination rollout is complete,” she said.
“Ruling out Alert Level 4 will effectively also rule out Alert Level 1, leaving Aucklanders in the worst of both worlds with a large number of restrictions and a large (and growing) number of cases, hospitalisations and deaths. That situation is no good for businesses either. We’ve seen this pattern play out again and again in multiple countries.”