As case numbers rise, the Government is no longer trying to find every single contact of a Covid-19 case, Marc Daalder reports
The recent rise in Covid-19 cases has put pressure on Auckland-based public health officials, requiring Public Health Units from elsewhere in the country and the Ministry of Health's centralised contact tracers to provide additional support.
But just 44 full-time equivalent (FTE) staff were employed by the Ministry of Health in the national contact tracing centre as of October 20, according to an answer to a written parliamentary question from National MP Chris Bishop. A spokesperson for the ministry, responding to an earlier request for comment after this article was first published, clarified that this figure doesn't include contracted call centres and seconded staff from other government departments.
Over the course of the outbreak, 1700 staff have been available from the call centres, the spokesperson said. It was unclear how many were actively working in tracing over the past couple of weeks.
The figure raises further questions about capacity in the contact tracing system, which has never been resourced to meet the threshold of being able to trace the 1000 cases per day the Government was tasked with achieving in April 2020. It also appears to show the system has shrunk since the first peak in the present outbreak.
At that stage, hundreds of staff from other government departments and from additional call centres had been brought in to join the effort. The ministry spokesperson said those staff were no longer being used, as the contracted centres and resource-sharing between Public Health Units (PHUs) were enough to manage the caseload. Director-General of Health Ashley Bloomfield said on Tuesday that every PHU in the country was supplying extra capacity to help handle the outbreaks in Auckland and the Waikato.
"I find it quite surprising. Contact tracing has been very important since April 2020, but we have just not had the investment and the focus on it that there should have been," Bishop said.
"I think we're up to four independent reviews now, all of which have made various recommendations, the central point of which is, 'You need to put some extra resource and focus here'. Basically, it would probably best be described as, lip service was paid to those reports. The 44 FTE figure is a reflection of that."
That the Ministry of Health never reached the 1000 cases per day benchmark was officially confirmed by Director of Public Health Caroline McElnay on October 14. She said that just 170 to 180 cases a day would put pressure on the contact tracing system. This aligned with predictions from some of the expert reviews into contact tracing that the system would struggle under a prolonged period of 100 to 200 daily cases.
In response to the rise in cases, the Government has now begun to target contact tracing resources where they can make the most difference. However, this by necessity means the system is no longer operating at peak efficiency. Useful work that could help the Government ring-fence the outbreak has been cut to make room for the critical work that might stop case numbers from exploding.
These changes include a decision to no longer investigate the origins of unlinked cases, but to instead focus on the downstream transmission from each new case. Contacts of cases are much more likely to be classified as casual contacts than close ones. In the first phase of the outbreak, tens of thousands of people with only fleeting exposures were labelled close contacts, but just a handful ended up testing positive.
The casual contacts are also subject to laxer requirements than in the past. They don't need to isolate at home or to get a test, unless they're symptomatic.
Even so, the system has struggled to catch up. As of Tuesday, a quarter of the 3397 known close contacts had yet to receive a first phone call from contact tracers. A similar proportion had not yet returned a first test result.
While the percentage of each day's cases that were infectious in the community has dropped since a peak in early October, the absolute number is rising. Each one of these has the potential to spark a new chain of transmission. The reason they aren't isolated is because they haven't yet been contacted by tracers and told they were exposed.
"The risk [of contact tracing failing] is that you fail to pick up people who should be isolated because they're close contacts and, potentially, the spread of Covid is worse than it otherwise would be," Bishop said.
"We're moving into a new phase of our Covid approach, away from elimination towards suppression, but that doesn't mean contact tracing becomes less important. If anything, you could actually make the case that it becomes more important."
