NNew Zealand is easing its Covid restrictions, even as a handful of cases continue to circulate in the community, a decision according to experts represents a roll of the dice for a country that has consistently pursued an elimination strategy.
“It’s a gamble,” says epidemiologist and public health professor Michael Baker. “The only phrase I think you’ll hear all epidemiologists and modelers use is ‘calculated risk’. But of course, that implies that you have a number you can apply to it – you could actually call it uncalculated risk.
“It increases the risk that we will not contain the epidemic, but it is difficult to know what this increase is. This is where luck comes in.
Prime Minister Jacinda Ardern announced on Monday that Auckland would come out of its strictest lockdown and move to Alert Level 3. This marks a significant change in restrictions for the city: cafes and restaurants can reopen for social distance delivery and sales, as well as a number of other businesses, and small weddings or funerals can take place.
The change will see an estimated 300,000 more people return to work in their city workplaces – in commercial kitchens, in front of coffee machines, at the greengrocer or on construction sites – and much of that workforce- work is particularly vulnerable to the virus. Those working in the hospitality industry are younger, so they are much less likely to be fully immunized, and many frontline workers are Maori and Pasifika, who are more likely to live in large households and are more vulnerable to serious illnesses from Covid-19.
While New Zealand has managed to significantly reduce cases from the outbreak’s peak of 83 daily cases in August, it has yet to eradicate them completely. In the past week, infections have boomed with a daily average of 17 new cases per day. The country continues to have unrelated or “mystery” cases that have not yet been linked to an existing infection. And because the daily case counts only provide a glimpse into the past – always showing people who were infected days before – it’s impossible to be entirely sure the Auckland outbreak has been successfully contained.
“The epidemic may have been fully eradicated by now – we just don’t know,” Baker said. “Or it could simmer. These undetected transmission chains could simmer. “
When Ardern announced the change, she said: “We are not coming out of level 4 because the job is done, but we are also not moving because we do not believe we can meet the goal of eradicating Covid- 19 – we are moving because level three still provides a cautious approach as we continue to eradicate Covid-19. “
But easing restrictions while these cases still lurk may be the biggest risk the Ardern government has taken to date in its pandemic approach, and the stakes are high. Now the best-case scenario for New Zealand is that elimination works below level 3: that even with more people mixing in the workplace, infections continue to decrease, bringing the country to zero. If that doesn’t happen and cases explode in the coming weeks, Baker is considering two options: one is a return to Level 4, which would pose a huge political challenge to the Ardern government. The other is a pivot to elimination: using restrictions close to level 3 to control the virus until vaccination levels are high enough – a point he says the country is unlikely to reach until after the end of the year.
“Right now, I think we have these pretty tough choices between eliminating it completely or not getting there entirely, and going into this removal approach for potentially a few months,” he says.
“We definitely need to have an informed conversation in New Zealand at some point in time about the conditions under which we would move to removal – assuming we go through this epidemic,” he says. “Because there will be a point. “
Chief Health Officer Dr Ashley Bloomfield remains adamant that elimination is still Aotearoa’s goal. But speaking to RNZ on Wednesday, Bloomfield said the number of cases may not return to zero. “We may not be able to go back to zero, but the important thing is that we will continue to find infections and basically continue to contact, search, test, isolate people in order to stop the circulation of the virus in the community,” and that’s the goal, ”he said.
He said health officials were aiming to achieve a vaccination rate of over 90%. “This is absolutely our new way by which we can get back to the freedoms we had under Level 1,” Bloomfield said.
It will probably take months for 90% of the population to be immunized. At this point, 61% of the total population has had an injection and 32% has had both. While the country vaccinated at a very high rate, rates peaked in August at around 90,000 per day and fell by about half. It is still unclear how easy it will be to reach the 90% threshold or beyond: Government data indicates that among those who have not yet received a vaccine, 20% are not sure or will not receive it.
Asked by radio host Mike Hosking what the next step would be if Auckland continued to see cases over the next two weeks, Bloomfield said: “Let’s cross this bridge when we get there. ”
A dose of luck
“At alert level three, it is still possible to process the last remaining transmission chains,” says Baker. “Unless you’re unlucky.” “
Relying on luck is a tough proposition when it comes to the Delta variant, which is far more contagious than the mutations New Zealand has so effectively eliminated in the past. The country was firmly committed to an elimination strategy, and any level of Covid in the community was intolerable. This strategy has served him well, preserving a strong economy, high employment rate, relative freedom and normalcy in the country, and very few deaths or serious illnesses from Covid-19.
New Zealand is well aware of the worst-case scenario – an outbreak like the Australian state of New South Wales, which started with a looser lockdown. It has produced thousands of cases and now averages 10 deaths per day.
Now, with a level 3 move, the New Zealand score is on the line. “The next two weeks are crucial,” says microbiologist and science communicator Dr Siouxsie Wiles, “because it will take about a week before we do. really understood this little bit more openness at level 3, which it does.
She calls the relaxation of restrictions a “calculated risk” – although it would not have taken one. “If that was my choice, I would say level 4 for a bit longer,” says Wiles. ” [But] I have always been more careful than the government has been.
Wiles and Baker note that the government has access to more detailed information – so it may have a slightly different and more optimistic picture of how the unrelated cases fit together and the spread to be expected in the coming weeks. “I really hope they’re right, because obviously it’s going to be pretty demoralizing having to level up,” Wiles said. “I guess we’ll just wait and see. “
The challenge now will be both luck and compliance. After a month of lockdown, government and pundits are hoping New Zealanders ignore lockdown fatigue and get through another 15 or so Level 3 rules.
“I believe we can eliminate,” says Wiles. “I don’t want people to give up hope. If we all do the right thing, there is less chance of it getting out of hand.