The Government is right in its response to New Zealand’s (Aotearoa) community transmission case of the highly contagious Delta Covid-19 variant. Yesterday, within a few hours of the discovery, It moved fast to an initial hard seven lockdown in the risk area (Auckland and Coromandel) and three days for the rest of the country.
A day later we now know a day later that the genome is the same as the virus currently out of control in New South Wales and that there have been at least nine further cases. As sure as day follows night, this number will increase for some time (initial modelling suggested between 50 and 120 cases at that time and projected to be several hundred) before a corner is turned. Worsening the risk is that the cases are mainly younger people. Consequently it is conceivable that both the national and localised lockdowns will be extended.
On the positive side, the first reported case did the right thing by conscientiously contact tracing and quickly reporting symptoms to his general practitioner. His actions and the Government’s fast and hard response will help combating this deadly variant. The early discovery of the likely index case (a returnee from New South Wales) also helps; described by one expert as the best of the worst case scenarios.
Elimination strategy central
This fast and hard response is central to New Zealand’s elimination strategy towards community transmission. The strategy has been overwhelmingly superior in effectiveness to the alternative mitigation strategy which enables the virus to mutate into more deadly variants thereby causing the second, third and sometimes fourth country-wide waves which Aotearoa has managed to avoid.
The best indicator of the effectiveness of the alternative strategies is mortality rates. As of 17 August, New Zealand had a coronavirus mortality rate of 5 per one million. Compare this with the following countries which have gone with mitigation – United Kingdom (1,955), United States (1,887), Germany (1,105), France (1,638), and Canada (709).
Officially but late in the piece, Australia says it has adopted an elimination strategy. But in some states such as New South Wales, whose government as certain Boris Johnson-type characteristics, has been closer to mitigation. Australia’s death rate per one million is 38.
We should not be too surprised that the mishandling of the Delta variant in New South Wales is behind New Zealand’s situation. New South Wales also appears to be the source of outbreaks in other Australian states, particularly Victoria.
Achille’s Heel perception: vaccines
The Achille’s Heel of New Zealand’s elimination is its vaccination rate. This is an Achille’s Heel based on perception rather than substance. But perception can become reality if encouraged by political opportunism. New Zealand’s vaccination rate is the lowest in the Organisation of Economic Cooperation and Development (OECD).
But New Zealand is also one of the smallest economies in the OECD (smaller European economies were assisted by a whole-of-European Union negotiation with the pharmaceutical companies).
Pharmaceutical companies are driven by profit maximisation. Vaccines to combat a pandemic doesn’t change this situation; if anything its scale accentuates it. Bigger economies are bigger markets and therefore will always be heavily advantaged compared with smaller economies and markets like New Zealand.
Perspective is also required. Vaccines are part of the medium to long-term solution. Even if New Zealand’s vaccination rates had been as high as in the United Kingdom, the same Level 4 lockdown decisions would have been necessary.
Group 3 (vulnerable)
Given this major disadvantage in vaccine supply, New Zealand has done well with its procurement agreement with Pfizer. We have kept up with our overall vaccination rates which are dictated by supply dates largely beyond the country’s control. There is the contentious issue of low vaccination rates for Group 3 (vulnerable people).
More work needs to be done to understand why Group 3 rates are so low. Perhaps it comes down to what being vulnerable means and logistics. Many of those who are vulnerable are those who have difficulty accessing healthcare. It is possible that access difficulty to healthcare might also mean access difficulty to vaccination facilities.
It might also mean that data on where vulnerable people are located is limited. Further, in contrast with cities with greater critical masses, it might be logistically more effective to vaccinate all those in towns (smaller ones at least).
How is Aotearoa placed to cope
There are some differences between this second national lockdown and the first one around 16 months ago. The first one was very effective. The second is dealing with a much more contagious and therefore deadly virus. On the other hand, we now have mask wearing, waste water testing and better contact tracing technology.
Critical to the success of a pandemic strategy is winning the trust and confidence of the public. New Zealand’s elimination strategy has been so obviously successful compared with mitigation in North America and much of Europe. Mitigation leads to the virus returning in a more deadly form in large waves.
Mitigation with delayed and light lockdowns undermines public confidence. This has been witnessed by large demonstrations in the United States and Europe defying lockdowns and other public health measures.
This defiance further aids and abets the spread of Covid-19. In this respect New Zealand is much better placed to respond to the Delta variant than Australia notwithstanding how daunting this threat is.
But, if we are to do this, we must stick to our elimination strategy. Softening this strategy will only strengthen Delta as New South Wales is presently experiencing.
Those who advocate mitigation (or something even less than this) argue that countries need to learn to live with Covid-19. But, as pointed out by Auckland epidemiologist Professor Rod Jackson, this actually means learning to die with Covid-19.
Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion.
100% support the government’s swift lockdown. Did not support the opening of travel bubbles and of course within a short time of that, there has been a community outbreak in NZ.
We are not equipped for Delta in our hospitals, as they have been run down in every aspect for years and our health spend per person in NZ has actually decreased per person over the years.
NZ has a ‘team of 5 million’ but appears to be trying to stretch a health care funding of 3.5 million people of 15 years ago. Government failed to continue the same level of funding per person with population growth.
In addition many people coming to NZ are higher needs people aka the very old and people having children in NZ without NZ citizenship which is ballooning health issues in NZ.
We also have a high obesity rate and growing amounts of people with less educational skills, less comprehension skills and growing poverty.
This means we are especially vulnerable to an outbreak.
The police are not fully vaccinated . This shows what a poor minister they have who is meant to be in their corner pushing for their wellbeing. At the other end of the scale those working at supermarkets and other outlets deed to be essential deserve to be moved up,the list of priorities
The jury is still out
The government’s reaction to the latest outbreak is nominally correct, although why the hell did they not have ALL border workers vaccinated months ago? (The likely origin). If they’re lucky they might catch this current outbreak, but the odds are against them:
> It’s the more infectious Delta version
> They don’t know how case #1 caught it, so there are likely unrecognized cases out there in the community. (Most cases are asymptomatic)
> There are tens of thousands of contacts to chase down. One case alone has over 10,000 contacts.
So if we hunt down and isolate all the cases, then phew! We’ve dodged yet another bullet. This gives us more time to vaccinate and so gain a degree of herd immunity.
But if the cases go steadily up, day after day like they are in NSW, despite their more severe lockdown rules, then we’ve lost our grip on this thing. At this point do we just extend the lockdown ad infinitum? How will that work? What will be the economic, social and medical consequences of such a thing? Oh and political consequences…
Bear this key point in mind: The virus will get here eventually, one way or another. Each of use has to face that fact. One can only hope that by the time this happens most of us are vaccinated because the evidence from overseas is that vaccinated people will do just fine, just as long as they’re not medically compromised or near their natural end of life.
Recent research in Australia has found their vaccine has totally destroyed Covid in mice.
Human trials are just beginning.(Griffith University’s Menzies Health Institute.)
I don’t disagree here but…
There was an expectation that 18 months into this pandemic, systems would have been sorted. The Covid helpline takes literally hours to be answered, a website is too generic to be useful.
Covid testing is like March 2020, massive queues and slow result testing.
Risk sites like Ward 65 at Auckland Hospital have not been put on the notification list. At risk people non notified meaning the contact tracing system is flawed.
Border workers and other high risk vaccinations have never been completed and there are few of any consequences for not being vaccinated.
People comply but see others who are not and police seem to be ill equipped or under resourced to deal with breaches. There is no infringement system either. Covid loves kindness.
And as discussed endlessly, vaccinations are too few too late and it appears if the government were willing to pay more for them earlier, this would not be an issue. We saved pennies that cost us pounds.
It seems the governments response has been fight fires with PR and bandaids rather than anticipate and put robust systems in place. And the minister increasingly looks like a possum in the headlights.
Thanks Ian for (another) excellent authoritative review.
Anyone know the link to the legislation legally requiring mask wearing in supermarkets? NZ MOH are now calling it a legal requirement but I can’t find any trace of amendments, emergency laws etc.
It is called the law of common sense obviously something anti vaxer and anti mask wearers do not have much of.
Reasonable question.
Shame you were abused by seemingly the ‘village idiot’
Kevin, Trevor’s response was probably on the back of one of Jody’s previous posts…
“Masks don’t work. Vaccinations don’t work. Shutting NZ off from the rest of the world forever certainly won’t work. Open the gates Jacinda, we all know this is an exercise in futility. People catch disease, people get sick and people die. We all will eventually.”
So was it a genuine question or a loaded question? If genuine, then so be it.
Supermarkets are private businesses. I presume they can mandate any dress code they like inside their premises.
Comments are closed.