Waikato towns enter Alert Level 3 – Expert Reaction

Parts of the Waikato region will enter Alert Level 3 tonight in response to two recently confirmed cases in Raglan and Hamilton.

The two cases are known contacts of each other, but they have not yet been linked to the ongoing outbreak in Auckland. The areas of Raglan, Te Kauwhata, Ngāruawāhia, Hamilton City and Huntly are covered under the bespoke lockdown settings, which will reviewed again in five days’ time. Last night, an Auckland-based truck driver who travelled to Palmerston North also tested positive for Covid-19.

The SMC asked experts to comment on the announcement.

Associate Professor Donna Cormack, Te Kupenga Hauora Māori, University of Auckland, comments:

Kia mataara

“Today’s news of positive cases in the Waikato region is concerning, and as always our aroha is with those whānau who are impacted by COVID-19, and with all of those in the broader community who are working hard to keep us safe.

“Te Rōpū Whakakaupapa Urutā supports parts of Waikato moving to at least Level 3 for a period of time, until we know more about the situation. We need time for communities to be able to access vaccination and to acheive an equitable vaccination rate as a result of the inequity that was built into the initial rollout.

“As the numbers of people in our communities that are testing positive for COVID-19 increases, it is also important that whānau are vigilant – kia mataara. There are important things we can each do to play our part to slow the spread of this virus to our whānau, and to the wider hāpori. These are things that we can do, irrespective of the government’s decision about levels, to protect and support our communities. Our advice is:

  • If you are sick, have been to any location of interest, or are living in a suburb with cases – get tested. This is how we about where COVID is in our communities, slow the spread and individuals and whānau impacted by the virus
  • Keep your bubble as safe and as tight as you can and avoid social events with others outside of your bubble
  •  If you are able to, stay at home or work at home – especially if you have health conditions that could be more of a problem with COVID
  • If you do go out, wear a mask, physical distance from others, and remember to regularly wash hands or sanitise to reduce the risk of spreading the virus
  • If you do need healthcare, it is important to know that this is still available – hospitals are open for emergencies, and primary care is still operating

“Vaccination remains an important tool in our response. If you can, get vaccinated. If you have been taking a ‘wait and see’ response, it is okay to change your mind. Times like this are a reminder that it is important that we support all our whānau, check in on how whānau outside your bubble are doing, show care and manaaki for those who test positive and to all those who have not been vaccinated.

“Information about vaccination is available on The Whole Truth.

“Me aroha tētahi ki tētahi,
Kia mataara.”

Conflict of interest statement: “I’m a member of Te Rōpū Whakakaupapa Urutā.”

Dr David Welch, Senior Lecturer, Centre for Computational Evolution and School of Computer Science, University of Auckland, comments:

“With an increase of cases and in particular unlinked cases over the last few days, it is clear that L3 is not working to eliminate the outbreak. Modeling suggested that the move from L4 to L3 was a risk. We have not landed on the right side of that risk. L3 does still greatly contain the outbreak and any growth in case numbers will be slow. If vaccination rates continue to increase, they will eventually combine with L3 restrictions to begin to reduce case numbers, but that is a long slow process with many more weeks at L3.

“To achieve elimination in the short term, it would require a move to Level 4. Elimination proved to be the best strategy through the first part of the pandemic and  continues to be the best until all communities within Aotearoa reach high levels of vaccination.”

No conflict of interest.

Dr Amanda Kvalsvig, Epidemiologist and Senior Research Fellow, Department of Public Health, University of Otago, Wellington, comments:

“The recent cases illustrate that it’s not only important to have a high overall vaccination uptake, it’s vital to support vaccination for those who have not been well-served by the standard vaccination and outbreak control approaches. These groups often include people who might be at a high risk of becoming infected and passing the infection on. Community-led, culturally safe provision of care can make an enormous difference in supporting people to contribute to the Covid-19 response.

“We will experience true population resilience when everyone is connected to resources they need to sustain their health and wellbeing. That need will vary from person to person. People who have been marginalised and excluded need outreach and comprehensive support not only for vaccination, but also for housing, food security, income, healthcare, and other resources they need to stay safe from Covid-19. It’s good to see the Prime Minister signalling a pivot to a new approach that is focused on people in urgent need of support. This integrated approach to health is the key to navigating our way through the pandemic. We all win because this approach has multiple co-benefits, improving other serious public health problems (e.g., mental distress and harmful housing conditions) alongside sustaining our very good Covid-19 track record through the months ahead. Compared to the billions spent on the pandemic response, the funding required for this type of initiative is minimal, but it pays for itself over and over.”

No conflict of interest.

Dr Dion O’Neale, Principal Investigator, Te Pūnaha Matatini; and Lecturer, Physics Department, University of Auckland, comments:

“The new Alert Level 3 areas in the Waikato region seem to have been created with a slightly different purpose, and with somewhat different rules and expectations, compared with the Auckland AL3 region.

“The Auckland region Alert Level 3 area serves two purposes: it requires behaviour changes of people in the region — supressing local spread — in addition to limiting movements in and out of the region through a relatively hard boundary with enforced checkpoints — reducing opportunities for transmission to other parts of the country.

“The use of small areas at Alert Level 3 within the broader Waikato region seem more geared towards the behaviour change aspects of AL3 than on limiting inter-regional movement and reducing wider transmission risk.

“The density of interconnecting links within Auckland make it necessary to include all of the supercity, and some of the surrounding areas, within the Alert Level Boundary. Within the wider Waikato region there is a similar pattern of interconnecting links, but in the case of Waikato these links are spread over an area that is much larger than just Hamilton City.

“Hamilton City itself is relatively geographically small, with large numbers of people moving in and out of the area each day. This makes it infeasible to define only a small area around Hamilton (and nearby areas such as Huntly and Ngāruawahia). Part of the reason for this is the large number of road connections through the Waikato, but another factor is making sure that people can still access essential services such as shops food and healthcare and can get to work, where appropriate.

“In such a situation, one possibility is to ask people within an area of concern (like Hamilton city or Raglan) to change their behaviour locally and to limit their movements where possible, but without imposing harder restrictions on travel. In such a case, one has to hope that there is limited community transmission and that contact tracing can be used to rapidly ring-fence any infection before it can spread to other regions.

“The alternative to a geographically limited area around the currently known Waikato cases would be to define a much wider regional boundary with the goal of also preventing spread to other regions. In this case, data on people’s regular movement patterns suggests that the region would likely need to include almost all of the Waikato district, and maybe even part of the Ruapehu region.

“One important factor in preventing spread, is that people when people are moving between regions, they need to ‘take their Alert Level with them’ and always act as if they are at the highest alert level for any area they have visited in the last two weeks. A person moving between AL2 and AL3 still has an AL3 risk profile, even when they move into an AL2 area. This means they need to be limiting their contacts to their bubble, wearing a mask, and not going to cafes or bars, even when such things would otherwise be acceptable at the lower alert level.

“People who have been in any of the Waikato AL3 areas in the previous week will need to be acting like they are at AL3, wherever they happen to be now. This includes people who might have travelled recently, with the start of school holidays, where we typically see a surge of people travelling from Hamilton and surrounds, to other locations.

“I haven’t seen any details added to the map on the MoH website for the new AL3 areas yet, but given the proposed ‘soft’ boundaries they seem like they might be more relevant to helping guide people when they should be acting like they are at AL3 — even if they aren’t currently within those areas — than to preventing inter-regional spread.”

Note: Dr O’Neale co-authored a paper on the regions most vulnerable to Covid spread from Auckland during the early stages of this delta outbreak.

Conflict of interest statement: I, along with others from Te Pūnaha Matatini, are funded by Department of Prime Minister and Cabinet to provide advice on the COVID response and from a Health Research Council grant to look at equity related to COVID in Aotearoa.

Dr Dianne Sika-Paotonu, Immunologist, Associate Dean (Pacific), Head of University of Otago Wellington Pacific Office, and Senior Lecturer, Pathology & Molecular Medicine, University of Otago Wellington, comments:

“Delta is still transmitting and continues to move beyond borders in Aotearoa New Zealand. Although vaccination rates have improved, focus and momentum must continue, with work underway to increase accessibility and reduce barriers for those needing the COVID-19 vaccine still needed – this also applies for COVID-19 testing and prevention efforts.

“The recently identified positive COVID-19 cases prompting the shift of Raglan, Te Kauwhata, Ngaruawahia, Hamilton city and Huntly into Level 3 restrictions, indicates how easily the Delta variant can still spread across regional borders and into other areas at this time, and that without higher vaccination rates, the risk of further outbreaks remains.

“As it stands, unlinked mystery cases of unknown origin have continued to appear throughout the current Alert Level restrictions, which is also of further concern and highlights the need for all to remain vigilant, get vaccinated, get tested, follow the alert level rules and importantly, to reach out and help and support others do the same.

“Any Alert Level shift planning moving forward for the Auckland Region will require careful scrutiny as a high degree of risk remains for all – especially for our most vulnerable communities in Aotearoa New Zealand.

“Moving forward, the adverse health outcomes in Aotearoa NZ already seen with COVID-19 and that are impacting our most vulnerable groups in particular, will require ongoing careful consideration and appropriate responses, so as to prevent any further exacerbation of these inequities.

“Pacific-targeted and -tailored vaccination events and activities recently held that have been Pacific-led and community driven, together with Pacific health providers, have helped improve vaccine accessibility, and vaccination rates and are examples of Pacific-led solutions for Pacific peoples and communities.”

No conflicts of interest declared.

Lesley Gray, Senior Lecturer, Department of Primary Health Care & General Practice, University of Otago, comments:

“The last few days are concerning in that several recent cases were tested because of hospital attendance or a routine surveillance test, which suggests these people were not concerned that they might have acquired COVID-19 in recently weeks. We all have to behave as though everyone around us is COVID-19 positive. Mask, hand hygiene, scanning into venues and keep physically distanced. Finally if you are able to, please get vaccinated as soon as possible.

“It is, however, good to know that the safety net of hospital testing and surveillance testing is picking these cases up and that routine wastewater testing in these new areas were negative in the recent week.

“The vast majority of Aucklanders are playing their part – the rest of Aotearoa New Zealand needs to continue to play their part.”

Conflict of interest statement: Note: Lesley has received a Health Research Council grant for this research: “Improving effectiveness and equity in the operation of COVID-19 ‘self-isolation”

Professor Michael Plank, Te Pūnaha Matatini and University of Canterbury, comments:

“Today’s news that there are cases of Covid-19 in Raglan and Hamilton and that another case has visited Palmerston North is a reminder of the reason the rest of New Zealand is at Alert Level 2. More frequent testing of essential workers crossing the alert level boundary, for example with rapid antigen tests, would help reduce risk. However, the Auckland boundary will never be watertight and while there is community transmission in Auckland, there is a risk a case could pop up anywhere in the country.

“The fact that the Waikato cases don’t have a clear link to the Auckland outbreak and have been infectious in the community for several days is concerning. It suggests there could be additional undetected community cases. Moving this area to Level 3 for five days buys some time for testing and contact tracing to establish how widespread transmission in Waikato is.

“These events show that, even with a relatively small number of cases in Auckland, keeping the virus contained to one city is difficult. If the Auckland outbreak grows much larger, it will become even harder to prevent Covid spreading to other parts of New Zealand. The message is clear: Covid is here and it’s a matter of time before it spreads across the country. The very best way to protect yourself against this virus is to get vaccinated as soon as possible.”

Conflict of interest statement: I am partly funded by MBIE for research on mathematical modelling of COVID-19.

Dr Dougal Sutherland, Clinical Psychologist, Victoria University of Wellington and Umbrella Wellbeing, comments:

“The news today that Hamilton and Waikato are moving back to Level 3 brings us into uncharted waters. This is the first major bounce upwards from Level 2 to Level 3 during our COVID journey. The timing couldn’t be worse as it is the first weekend of the school holidays. Therefore, this increase in alert levels will bring disappointment and changes in plans for many, leading to frustration and anxiety for some.

“Up until now New Zealanders have shown a willingness to trust in the science that lies behind the government’s handling of the COVID response. Maintaining this trust will be a crucial component in going forwards and may help temper the frustration those who are affected may experience.”

No conflicts of interest declared.