By telling Aucklanders to prepare for a move to the freer traffic light system at the end of November, Ardern is sealing off her own options if the outbreak worsens in the meantime, writes Marc Daalder
Analysis: November 29 is now circled on every desk and wall calendar in Auckland: Freedom Day.
The Prime Minister's announcement on Monday that Cabinet is keen to loosen restrictions after meeting at the end of the month, even if Counties Manukau hasn't quite hit 90 percent fully vaccinated, will be welcome certainty for those who have gone through 12 weeks of lockdown with no respite.
But it also leaves little wiggle room if Jacinda Ardern finds herself in a position where easing restrictions in the city conflicts with even the most optimistic public health advice. How likely is that situation to eventuate? According to modellers, quite likely.
Cases in Auckland have skyrocketed in recent weeks - nearly doubling since Ardern announced the upcoming traffic light system on October 22. Saturday saw a record 206 cases across the country, including 200 in Auckland, and even government ministers concede that number will continue to rise.
New Zealand will soon find itself at a crucial decision point that once loomed over Victoria and New South Wales. After the two Australian states set vaccination targets for easing restrictions, cases spiked, leaving decision-makers nervous about following through with their promises now that the public health situation had shifted so radically. By the time the deadlines actually came around, the outbreaks had eased, however.
Ardern may not be so lucky.
Modelling from both Te Pūnaha Matatini and from the Auckland Regional Public Health Service (ARPHS) project cases will continue to rise through the end of the month at the very least. In fact, so far, we appear to be outpacing the moderate estimates from both models.
The ARPHS estimates, released last week by the Government, say we should see an average of 63 non-ICU beds occupied this week. Already, that figure is at 81.
Director-General of Health Ashley Bloomfield says this doesn't worry him for two reasons. First, he says actual hospitalisations are lower than that - the 81 figure includes people who have Covid-19 but are in hospital for unrelated reasons and those who turn up to the emergency department but are discharged the same day, if they happen to be there for longer than three hours.
Second, he points to ICU numbers, which are about half of what the ARPHS model projected for this week.
"The rate limiting part of hospital care - and it's been given a lot of airtime - is intensive care beds. At the moment, we've got just seven people in intensive care and there are well over 100 intensive care beds in Auckland," he said.
But the Te Pūnaha Matatini modelling tells a more worrying story. That forecast, conducted in early October and looking forward to the end of the year, provided five possible scenarios - very low, low, medium, high and very high transmission. Our cases so far have trended between the high and very high scenarios, which would put us on the path to between 200 and 400 daily cases by the end of the month.
Te Pūnaha Matatini disease modeller Shaun Hendy says, looking back on the work, that he thinks we're most aligned with the "high transmission" scenario. That's because vaccination rates have increased faster than the modellers predicted - though that may be offset by the fact that the model didn't account for waning vaccine immunity with time and predicted that both restrictions and compliance with restrictions would remain stable in Auckland through the end of the year.
"We've continued to tweak the modelling as we get more information. Our best call is probably around the high scenario at the moment," he said.
Given enough time, either of the high transmission scenarios "generally lead to case numbers that would place extreme demands on health system capacity", the modelling paper predicted.
By the end of the year, the "very high" scenario would see 6629 weekly cases and the "high" scenario would see 2054 weekly cases.
The model also looked at hospital occupancy. Based on the Ministry of Health's hospitalisation figures (subject to the weaknesses outlined by Bloomfield), we're fluctuating quite a bit, but definitely not in the low transmission scenarios.
Actual hospitalisation figures were above the "very high" scenario estimates for the first three weeks of October, then dropped from 43 to 27 in the final week. By November, they had recovered to 58 beds occupied - just above the "very high" median estimate of 55 - and we're now at 81.
All of this is based on restrictions remaining flat - but they aren't. The move to Step 2 in Auckland is likely to see greater transmission of Covid-19. Ardern refutes that, saying the types of venues that are opening up haven't seen many infections over the pandemic. But if there was truly no added risk, why hadn't she made this move earlier?
After each previous loosening of restrictions, which Ardern has promised wouldn't lead to more cases, cases have spiked. Maybe there truly isn't more transmission in the venues where restrictions have eased, but that would just mean that the lifting of different rules causes people to relax and compliance to fray just a little further. Either way, Hendy says, expect to see cases rise further in the aftermath of this decision.
That's a point echoed by his modelling colleague and University of Canterbury mathematics professor Michael Plank.
"Easing restrictions in Auckland while cases are doubling about every 12 days is a risky move. The Government is banking on the new freedoms not contributing to a big increase in transmission. However, with 700 cases from the last two weeks remaining unlinked, the reality is we don’t actually know where a significant proportion of our cases are coming from," he said.
"Interactions in a typical retail setting are lower risk than in say hospitality and social gatherings. However, they will still provide opportunities for the virus to spread through the community so some increase in cases is probably inevitable."
In other words, the chances that Cabinet will be staring down the barrel of a rising wave of cases come November 29 are only increasing. That's a dangerous point for a drastic easing of restrictions like moving to the traffic light system.
"Not all of the protections scale with case number size equally well," Hendy said.
"In those October scenarios, we did look at situations where contact tracing essentially falls over and becomes far less efficient. That's something you'd expect at higher case numbers where your contact tracing is just making far less of a dent in reducing onward infection than it might be at lower case numbers.
"Ideally, you'd want to enter into our new systems with these relaxations at low case numbers, knowing that your systems like contact tracing could keep a lid on those case numbers."
Are 200 cases a day, where the high transmission scenario would project we'll be at the end of the month, too many? Hendy says it is.
"The risk is if you go in at very high numbers - where we are now or higher - that those systems really don't give you enough control, they're operating less efficiently and so therefore your overall response is going to be less effective."
