It has become somewhat of a casual mantra that the arrival and subsequent spread of the most recent, contagious and deadly of the Covid-19 variants, known as Delta, in New Zealand was inevitable.
If this was to be believed it meant that elimination strategy of zero tolerance to the virus was no longer fit for purpose and that the mitigation strategy (suppression) was more appropriate. This was, of course, linked to actively promoting full vaccination.
But the facts say something different. Certainly the Labour government was firmly committed to zero tolerance (not to be confused with zero cases or infections) when Delta’s arrival in Auckland from Sydney was first discovered in August. The country quickly and firmly went into a national Level 4 lockdown. Between 4 and 11 October it then abandoned zero tolerance in Auckland for mitigation.
This abandonment followed a poor judgement call to drop Auckland down to Level 3 too early, ignoring the warnings of modellers, and then panicking when the previously declining daily case numbers suddenly increased exponentially.
This, and the accompanying narrative constructed to rationalise it, is discussed further in my BusinessDesk published article (2 November) https://businessdesk.co.nz/article/opinion/the-politics-of-pandemic-traffic-lights.
The Government’s decision-making shifted from the focus on the health of people to politics. In doing so it forgot that the health of the population backed by science is good politics while shifting to political considerations is bad politics.
It meant that whereas, prior to its u-turn over zero tolerance (elimination), the Government was saying that Delta spread could be prevented, it is now saying that spread is inevitable. But the Government had options and exercised the wrong ones.
The arrival of the Delta variant in Aotearoa is directly linked to the loosening of international border control through the trans-Tasman travel bubble in April. There were strong calls for the bubble from both sides of the Tasman Sea (and not confined to business interests). However, according to polls at the time, a small majority of New Zealanders disagreed with the border opening.
The instincts of the slight majority proved to be correct although this is with the benefit of hindsight. When the travel bubble opened was too early to require full vaccination; both countries it had only commenced for vaccination for limited staged groups in February.
The bigger failure, however, was in June when there was a Delta scare in Wellington with an infectious Sydney visitor on a weekend visit. He had his first vaccine dose before coming to Wellington. At that point preferably the bubble should have been discontinued.
Failing discontinuation there should have been a requirement that only fully vaccinated Australians and New Zealanders could cross the Tasman. Had that been the case the Sydney case that brought Auckland and the rest of the country to a halt in August would not have arrived and Auckland would not be experiencing what it is now.
This was a significant error of judgement by government and the Ministry of Health. In June the greater contagiousness of this variant was well known in New Zealand. The arrival of Delta in New Zealand was not inevitable. But what about post-arrival spread?
Domestic border failings
Having unintentionally but avoidably allowed Delta into Auckland, until late September the Government’s response was excellent. But there were serious problems with domestic border control made worse when the rest of the country became safe to first lower to Level 3 and then to Level 2.
The main problem was the failure to require essential workers and other approved people crossing the border north and south of Auckland to provide evidence of full vaccination.
The two Auckland women who irresponsibly and unlawfully travelled through Northland thereby leading to its alert level being raised to Level 3 did so through forgery. But, had there been a requirement to be vaccinated in order to cross the border, they would not have got through.
Furthermore, the system was so poor that while the women had to show that they had been tested they didn’t have to show the result of the test. In both cases tests subsequently revealed infectiousness but it was too late.
The two Auckland truck drivers going to Northland and Palmerston North followed the rules. But both were unvaccinated. Had there been a vaccination requirement the fears and need for extra testing that subsequently arose would not have materialised. The Christchurch Delta cases were the result of a person lawfully returning from Auckland but unvaccinated and infectious.
Covid-19 Minister Chris Hipkins came up with a weak excuse for not requiring evidence of vaccination claiming that this would put too much pressure on border control. Nonsense. Those crossing the border in and out of Auckland are presently required to provide verification that they have taken been tested. Providing vaccination verification is not more onerous.
Further, if Hipkins was right (he’s not) then there was another means. Get the Director-General of Health to issue a health order requiring those otherwise approved for crossing the border to be fully vaccinated and advising that there would be legal consequences if they didn’t. Employers of those who need to cross the border could have been advised of significant legal penalties should they fail to ensure compliance.
And then there was Raglan which triggered the subsequent Waikato spread and elevation to Level 3 where it currently largely remains. This was a case of a person unlawfully driving into Auckland on a secondary road and then returning infected. Understandably police don’t have the capacity to cover all secondary roads.
But if concrete blocks used for roadworks (or containers) had been used then most likely the transgression would not have occurred and Waikato would not have gone into lockdown. Roadworks requiring concrete blocks are a common feature on New Zealand roads.
Contrasting Australian responses
Australia provides contrasting experiences of what determines whether Delta spread is inevitable or not. According to Australia’s Department of Health, as of 4 November, there were 20,975 active cases (755 community transmitted in the previous 24 hours).
All but 157 (20,818) of these active case were in two states (New South Wales and Victoria) comprising over 99% of the country’s total. Over the previous 24 hours there were 741 community transmission cases (98%) in these states. Proportionately the two states comprised around 58% of Australia’s population.
Both states didn’t have a zero tolerance approach (Victoria did initially but changed when overwhelmed by the combined effects of infections crossing the NSW border and compounded lockdown fatigue leading to non-compliance and spreader protests).
Of the remaining 157 active infections, 144 were in the Australian Capital Territory including Canberra (12 of which were in the previous 24 hours). This was hardly surprising given that ACT is surrounded by NSW.
Queensland, the third most populated state, had 12 active cases (2 community transmitted in the previous 24 hours). Western Australia, South Australia and Tasmania have no active cases at all (Delta did arrive in the first two but not the third). This leaves Northern Territory with only one active case (none in the previous 24 hours).
In other words the states and territories representing around 42% of Australia’s population (including ACT) have been able through elimination (zero tolerance) to prevent Delta spread. But the two states that didn’t have a zero tolerance approach failed abysmally.
Further, as a consequence of their Delta spread, the federal government shifted vaccine supply towards NSW and Victoria at the expense of the rest of the country. Whereas both states have now achieved over 80% fully vaccinated, the overall Australian rate is only 66%.
To put it another way, the parts of Australia following zero toleration of Delta were disadvantaged by this relative lack of vaccine supply. Consequently they relied more on the public health elimination strategy beginning with fast and hard lockdowns of limited duration. As occasional cases were reported this response was reinforced by short sharp localised measures similar to the current situation in northern Northland) .
It worked; no spread.
U-turn on zero tolerance
When New Zealand had its first Delta case in August Jacinda Ardern’s government was clear. Zero tolerance was the right response. In justification it looked to the success of the rest of Australia rather than the failure of NSW and Victoria.
This worked while they continued with it. After the inevitable early increase, daily cases declined as low as single digit and it was contained within Auckland. It only faltered after an overconfident government ignored independent modelling and lowered the alert level to 3 too early.
This led to the inevitable resurgence of Delta causing panic within government and the poorly explained decision to reject zero tolerance in Auckland.
Spread due to wrong judgement calls
Ironically zero tolerance has succeeded in containing virus spread outside Auckland with the most serious province being Waikato; but still, with one exception to date, only single digit daily cases. But cases outside Auckland are primarily due to system failures in border control.
It was wrong calls in policy and operational decisions that allowed Delta to spread out of control in Auckland. This began with the trans-Tasman bubble when both countries had low vaccination rates and failing to respond effectively with the Wellington scare in June.
It was made worse by domestic border failures, the fatal decision to lower Auckland’s alert level too early (thereby prolonging the total lockout length generating greater public angst), and then the u-turn on zero tolerance in Auckland.
There was nothing inevitable about the Delta spread in Auckland. We only needed to look across the Tasman beyond the two disastrous eastern states to see this.
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
Original Source: https://thedailyblog.co.nz/2021/11/07/guest-blog-ian-powell-was-delta-spread-inevitable-in-new-zealand/