Public health teams on the frontline in Auckland say Level 4 won’t make a difference but as case numbers rise, pressure for a “circuit-breaker” measure will follow, Marc Daalder reports
Analysis: In less than a week, a move to Level 4 in Auckland has gone from “not something the Government is considering” to something that is being “actively considered”.
The latter comments were made by Director-General of Health Ashley Bloomfield while speaking to TVNZ’s Breakfast on Monday. Later that day, Jacinda Ardern announced Auckland would remain at Level 3, Step 1, but conceded that a hard “circuit-breaker” lockdown had been considered and was still on the table.
“What it’s fair to say is that we will always keep under review our settings. Whilst that’s been our decision today [not to move to Level 4], we are going to do what we’ve always done and constantly look at what’s occurring, what the outbreak is telling us, what we can learn from the nature of the outbreak,” she said.
“If all of that data changes, then the advice may well change.”
Level 4 pressure mounts as outbreak spreads
Ardern now finds herself in a delicate balancing act. More and more experts are, by the day, joining the chorus of those calling for a move to Level 4. This isn’t in an attempt to regain the elimination status, but merely to briefly and harshly suppress cases that are rising at concerning rates, to allow the vaccination rollout to finish up.
The Government has said that, right now, it doesn’t think that sort of measure would actually make a difference. Most of the new cases we are seeing, Ardern said, are among households that are not following the Level 3 rules and are mixing bubbles indoors. If they aren’t following the rules at Level 3, why would they at Level 4?
She backed up that analysis by saying the Auckland Regional Public Health Unit, which is dealing with the outbreak on the ground and knows the intimate details of each new case, was also opposed to a circuit-breaker at this stage.
However, the outbreak is spreading.
“We now have cases in 124 suburbs. They are across the entire geographical spread of Auckland,” Ardern said.
As the virus continues to sprawl out across Auckland, it will find people who are following the Level 3 rules but who might not have been exposed to the virus at Level 4. Right now, these cases make up a minority of each day’s tally, according to the Government. But exponential spread means that could soon change, in turn changing the calculus against Level 4.
This isn’t a foregone conclusion. There are a couple of other possible outcomes. The best case scenario is that cases don’t go exponential. Already, the growth in cases seems to have slowed over the past few days. That could be natural variability or it could be a sign that the virus is finding its equilibrium at Level 3 in Auckland, and that we can expect a steady or only slightly growing number of new cases each day.
That would give the vaccine rollout time to catch up and Auckland could smoothly transition in a month or two’s time from letting the stay at home orders do the heavy lifting to letting vaccines shoulder the burden.
The other alternative is more worrying. There is always the possibility that the virus spreads faster by making it into vulnerable and marginalised communities who are unvaccinated and who may not be willing or able to follow the Level 3 rules. In other words, the outbreak could still go exponential, but in places and communities where a move to Level 4 would not significantly dampen spread.
Vaccinating to protect the health system
All of this consternation around cases is rooted in a keen sense of how vulnerable New Zealand’s health system is. The Health Minister Andrew Little confidently hosted a briefing last week, saying the system would be ready for a surge of cases once the country loosens restrictions and a 90 percent double dose rate is reached. But he couldn’t answer questions about the crucial coming weeks, in which vaccine rates are lower and cases are continuing to rise.
“The system here is well prepared. [However], any system will be overwhelmed if the numbers become too great,” Andrew Connolly, the Ministry of Health’s Chief Medical Officer, conceded at the briefing.
The Government is bullish about Auckland’s chances of hitting a 90 percent first dose rate in the coming days. But Ardern said about 5 percent of vaccinated people don’t get their second dose, meaning the first dose figure really needs to hit 95 percent if 90 percent of Aucklanders are to be double dosed.
Those rates also cloak the low rates among Māori and Pasifika – particularly young Māori and Pasifika. Nationwide, just two thirds of eligible Māori have received a first dose, compared to 85 percent of the general population.
In other words, an equitable 90 percent is still a while away – and the risk that the health system gets overwhelmed is rising by the day.
That’s the source of the pressure for a snap Level 4.
“An immediate ‘circuit breaker’ response is desperately needed to allow as much time possible for people to get vaccinated, given the risk of exacerbating adverse outcomes for vulnerable groups including Māori and Pacific communities already heavily impacted by the Delta outbreak,” Dianne Sika-Paotanu, a University of Otago immunologist and Pacific health expert, said.
“We desperately need to buy more time to drive vaccination rates up even further as quickly as possible, and to give more time for our hospitals to be ready for what’s coming.”
Expect this advocacy to continue as cases rise. The question for Ardern will be at what point the case for a circuit-breaker adds up and whether she thinks we can vaccinate our way out of the crisis before the calculus changes.