After seven weeks of lockdown in Auckland, unlinked cases are on the rise, new Covid-19 patients are popping up in the Waikato and elimination looks to be on the verge of failure, Marc Daalder reports
Analysis: The discovery of three new Covid-19 cases outside the Auckland boundary at the weekend - two in the Waikato and one an Auckland-based truckie in Palmerston North - was the latest bit of bad news in the Government's desperate struggle to eliminate the Delta outbreak.
New Zealand's fourth-largest city is now at Level 3 as well as its largest. The number of unlinked cases over the past 14 days is 23, the highest total since the Government began reporting this statistic on September 14.
On Sunday alone, 15 new unlinked cases were reported. Although many of these will be linked up to the cluster with time, the sheer number of people showing up through surveillance testing is troubling. Given several people have by random chance gone to Middlemore Hospital for unrelated issues and tested positive for Covid-19 in just the past couple of weeks, it's hard to escape the sense that the outbreak in Auckland is much more widespread than test results have yet shown.
"This is what it looks like, gradually shifting up a gear for the virus. At Level 3, it will assume some new equilibrium [in daily case numbers] which may be quite a bit higher than what we're seeing now," University of Otago epidemiologist Michael Baker told Newsroom.
End of elimination no herald of freedom
While critics of the elimination strategy might see this as flagging an early return to pre-Covid-19 freedoms, that's misguided. Experts are clear and unanimous that it is far too early for Auckland to return to Level 2 and that doing so would see the health system quickly overwhelmed. Those experts were backed up by the Prime Minister's Chief Science Advisor on social media on Saturday, who said there was "clear consensus on this".
Baker doubled down on his opposition to a Level 2 move on Sunday.
"There's no case at all for moving down to Level 2 in Auckland at the moment," he said.
Vaccination rates in Auckland are higher than in other parts of the country, but still far too low to stop the Delta variant from spreading and overwhelming hospitals. Even the National Party's 70 percent double dose threshold for abandoning lockdowns will only be reached in the last week of October. The 90 percent rates the Government has said it wants are more than six weeks away, given that far fewer than 90 percent of eligible Aucklanders have received their first dose so far.
Instead of a move to Level 2, abandoning elimination would see Auckland left in Level 3 for longer, until vaccination rates reach the threshold at which the Government is confident the virus can be controlled through softer measures like contact tracing and testing.
When Auckland first stepped down to Level 3, Baker said the move could see Auckland stuck in some form of lockdown "till Christmas". He brought that up again in his conversation with Newsroom on Sunday.
"We had said maybe flippantly, a while ago, that Auckland will be in Level 3 till Christmas. But that may not be too far from the truth," he said.
"I don't like saying that because I know it's creating misery for some people. Particularly for those at the bottom of the heap. But the alternative is we would have widespread transmission with our really, still very low vaccine coverage - particularly in Māori and Pasifika.
"Only 30 percent of Māori have had two doses of vaccine. We would rapidly overwhelm our health system in the current circumstances."
Suppression is surrender, to Baker. There's no epidemiological reason why Delta couldn't be eliminated.
"Technically, elimination is still possible. It's just whether there is the political and social will to do it."
If Level 3 restrictions are extended even a single day, then Auckland will have endured New Zealand's longest lockdown. The Government feels pressure from Aucklanders for a path forward - something Jacinda Ardern indicated would be provided at Monday's 4pm post-Cabinet press conference.
Despite the understandable frustrations from Aucklanders, there is little data to back the notion that compliance is eroding. An anti-lockdown protest over the weekend garnered only 2000 attendees in a city of 1.6 million. More people were vaccinated in Auckland on Saturday than attended the protest. Certainly the violent scenes from Melbourne aren't being replicated here and cellphone movement data from Apple and Google shows patterns similar to previous Level 3 lockdowns in the supercity.
Nonetheless, the Government has been clear that it is taking the exhaustion of Aucklanders into account. On Sunday, Ardern ruled out a return to Level 4 for Auckland, which would massively aid the elimination effort.
Returning to elimination
If she still did want to eliminate Delta, what remains on the table?
Baker says a rethink of the on-the-ground strategy is needed. The Government's efforts are clearly not reaching the communities affected by the recent outbreak - that's not just the conclusion of Baker, but of a host of epidemiologists and Māori and Pacific health researchers in a blog post published before the discovery of the Waikato cases. Baker's colleagues Amanda Kvalsvig and Nick Wilson helped author the post, as did Māori public health expert Sue Crengle, Pasifika public health expert Collin Tukuitonga and NZ Drug Foundation director Sarah Helm.
The experts argued that greater financial support was needed for those in Level 3 lockdown, particularly marginalised groups. Better engagement with those groups is also needed.
"Covid-19 infection appears to be established in groups who experience deprivation and marginalisation, notably people living in emergency and transitional housing (many of whom have substance use dependencies and mental distress). Controls operating at alert Level 4 were not able to extinguish such transmission, suggesting that we need a fresh approach," the blog post said.
"Multiple factors are likely to be contributing to this situation, including insufficient engagement with affected people, families, and groups; lack of trust in officials; and the multiple effects of long-term poverty, deprivation and crowded and precarious housing."
The post called for an overhaul of the way the response engages with marginalised communities.
"We need a different strategy and a rapid refresh based on what we know about the virus and also really getting those representatives from the marginalised groups around the table to say, 'How do we stop this virus transmitting in those groups?' If we can't do that, that is the nucleus of what will sustain the outbreak," Baker told Newsroom.
Efforts to target testing and contact tracing around unlinked cases popping up in a handful of Auckland neighbourhoods have fallen flat. While pronouncements from the Beehive Theatrette podium by Ardern and Ashley Bloomfield may motivate some New Zealanders to get tested or scan QR codes, they aren't universally effective.
"It has concerned me, the slightly anodyne quality of the 1pm press conferences. For people like me, it's great. But none of what we're doing is really reaching those marginalised groups in Auckland," Baker said.
The end goal of that engagement would be to massively expand testing in affected communities and rapidly contact trace each new unlinked case that is found. If there really is more widespread community transmission out there, it must be quickly found and stamped out.
The consequence of failing to refresh the response would be a gradual increase in the number of new unlinked cases (and therefore, down the line, new cases overall as well). Eventually the case count would stabilise at a new equilibrium under Level 3, but the virus would be so well entrenched that it couldn't be eliminated and would threaten to spiral out of control if restrictions were eased before high vaccination rates are achieved.
Clearly, the current strategy isn't working. The 15 unlinked cases reported on Sunday represented the highest daily total in more than a month.
The Government now has a stark choice before it: To try something new to corral Delta and eliminate the virus once again, or to resort to suppression and all of the lengthy restrictions, rising hospitalisations and social discontent that comes with it.
