Staged easing of Auckland’s restrictions – Expert Reaction

Aucklanders are to stay in Alert Level 3, but some restrictions will be eased over time in a three-step plan, starting from tomorrow.

Up to 10 masked people from two households can mingle outdoors in the first stage. Early childhood education, recreation, and small events will also be possible – albeit with restrictions. The second stage will involve retail and public facilities reopening with rules, and gatherings limited to 25. In stage three, gatherings will widen to a 50-person limit and schools will fully open. Cabinet has signalled it will review each step weekly before confirming any move.

The SMC asked experts to respond to the news.

Professor Shaun Hendy, Dept of Physics and Te Pūnaha Matatini, University of Auckland:

“This relaxing of restrictions will see more spread and more COVID cases in the community over the coming weeks. These new freedoms should reduce the risk of superspreading compared to Level 2, but still open up considerable opportunities for new spread. The government will be hoping that any growth in cases that result is slow enough that vaccination can get ahead of the outbreak, before it puts significant strain on our testing and tracing system, not to mention our hospitals.

“The next steps in the plan, which involve reopening retail and even some hospitality, really won’t be safe until the vaccination programme is very well advanced. This will probably not be the case until well into November. Until then or unless vaccination take-up accelerates, Auckland is unlikely to be able to return to Level 2 and there is a greater risk that restrictions will be be needed in other parts of the country. The best thing we can do now is get vaccinated or encourage our friends and family to do so.

“Meeting other families and friends outside is lower risk, but definitely not zero risk, so it will be important that people who choose to do so exercise caution and wear masks. If you are not vaccinated I would suggest avoiding meet ups until you’ve at least had your first shot and if you are meeting friends or family ask them whether they have had theirs yet. Fully vaccinated people are far less likely to catch the virus if exposed and less likely to pass it on, so meet ups of vaccinated people pose far lower risks. This move really does put the responsibility for preventing spread in the hands of the public, so it is vitally important that everyone does their bit.”

Conflict of interest statement: “Shaun Hendy leads Te Pūnaha Matatini’s COVID-19 modelling programme, which receives funding from MBIE’s Covid Innovation Fund and the Tertiary Education Commission. He has received funding from the America’s Cup to advise the organisers on their COVID-19 mitigations.” 

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

“The roadmap looks like a significant increase of risk for wider transmission, given that there is still ongoing community transmission with unlinked cases.

“Preventing spread of COVID in the community requires two components: minimising the number of interactions and also minimising the chance of transmission for those interactions that do still occur. Allowing people to meet up in groups of up to 10 people and with two households is a significant increase in the number of interactions and the number of possible pathways for COVID to spread. Something that could mitigate this would be an expectation that people only meet up with a limited number of households in total, or a limited number per week.

“Even with people only meeting up in pairs, this change moves us to a situation where the Auckland is essentially reconnected from a contagion point of view.

“Limiting people to meeting outside will help to reduce the risk of transmission when people do meet up but that is a case of playing Russian Roulette with fewer bullets in the gun as opposed to minimising the number of times you play it. While the risk of transmission depends on the exact details of interactions (e.g. are people talking, eating, wearing masks), the early days of the NSW Delta outbreak saw reports of transmission occurring from only glancing interactions as people moved past each other.”*

“Given that there is still ongoing community transmission, with new unlinked cases discovered most days, including from people who were often unaware that they were infectious, there seems to be an implicit assumption in this move that the contact tracing and targeted public health efforts are sufficient to completely ring-fence the remaining community transmission.

“This move has also come at a point where there are still large sections of the community with very low vaccination numbers, in particular Māori and of course younger people for whom vaccination is not yet an option.

“The return of children to ECE, with bubbles of up to ten, is also concerning since infants and toddlers cannot currently be vaccinated, and unlike the wild type COVID of last year, there is plenty of evidence that Delta both infects and has significant health risk for children.

“Although the plan is split into multiple steps, it will be very difficult to tell whether or not contagion is under control before moving between steps. One of the factors that makes outbreaks so difficult to control is the fact that often by the time we know we are on a trajectory of sharply growing case numbers we may already be past the point where interventions like contact tracing or quarantine facilities are able to catch up.

“This is because there is a delay between when people become infected or infectious and when we are likely to become aware of them. At the start of their infectious period, people are pre-symptomatic for a period of about 3 days and some infectious people are asymptomatic entirely, making them very hard to identify. The current outbreak has included a number of examples of people only finding out that they were infected when they turned up at hospital for other reasons and were tested.

“At steps two and three of the roadmap, there is a lot of faith being put in the transmission reduction that comes from people being mostly outdoors, and hopefully vaccinated. The gathering size limits at these higher steps will do very little to slow spread of contagion is someone is infectious.

“Potentially reopening schools in two week’s time, with only older students required to wear face coverings and only older students able to be vaccinated also looks like a significant increase in transmission risk.”

Conflict of interest statement: “I, along with others from Te Pūnaha Matatini, am 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:

“How Aotearoa New Zealand responds and treats the needs of the most vulnerable during this COVID-19 pandemic, will indeed reveal our moral compass as a society and define who we are as a nation for generations to come.

“The Auckland roadmap announced this afternoon by our Government provides an outline of the individual steps and details involved in easing restrictions over the next weeks, with assurance given that ongoing monitoring will be applied moving forward.

“The consequences of any premature changes such as easing restrictions too quickly given our vaccination rates at this time, along with the adverse health impact already seen for our vulnerable in Aotearoa New Zealand, will be dire.

“Border controls will require focus as Delta has continued transmitting through the community and across borders under current Alert Level conditions, with unlinked mystery cases of unknown origin also continuing to appear under these same restrictions.

“If we are not careful, we will be at serious risk of allowing our health system to become overwhelmed, given it was already under strain and burdened even before the COVID-19 pandemic began. One only has to consider the situation in other countries with their high hospitalisations and deaths, for a reality check.

“It has been strongly signalled that increased vaccinations will also be needed to ensure reduced restrictions. High vaccination rates of 90% and beyond, coupled with the appropriate public health steps against Delta, will help avoid future higher alert level lockdown measures – paramount to keeping everyone safe from COVID-19.

“Accelerated vaccination, testing and COVID-19 prevention efforts must continue in a way that reduces barriers and builds trust for people – with the appropriate and targeted approaches focused on getting help and assistance out to those who need it most. Caution and compassion will be needed moving forward, as a high degree of risk remains for all in Aotearoa New Zealand, but especially for our most vulnerable communities.

“Get vaccinated, get tested, follow the alert level rules, and reach out to others and help them do the same – we cannot give up fighting COVID-19.”

No conflicts of interest declared.

Dr Rawiri McKree Jansen (Ngati Raukawa, Ngati Hinerangi), Clinical Director, National Hauora Coalition, comments:

“Matike maranga, maranga ake ai!

“Hard agree: we have to go hard on vaccinations. Hard agree: elimination has served us well, protected us well, and now we have an unrelenting focus on vaccinations.

“And I appreciate the roadmap, and agree that staying at Level 3 is necessary for achieving the lift in vaccinations. The amendments appear proportionate and compassionate.”

No conflicts of interest declared.

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

“We are entering a new phase of the pandemic, where unfortunately community transmission of COVID-19 and ongoing measures to limit it are part of the new normal. Vaccines will blunt the effects of the virus, but we have a long way to go to get the high vaccine coverage we need.

“Accepting that elimination isn’t possible doesn’t mean waving the white flag and letting it rip. Left to its own devices, the virus would spread like wildfire through our unvaccinated and partially vaccinated population, and risk overwhelming our healthcare system. So until the number of people fully vaccinated is much higher, we have no alternative other than to suppress transmission as much as possible. The government will need to pilot a very tricky route that avoids overflowing hospitals.

“The roadmap for relaxing restrictions is a reasonable approach, starting with relatively low-risk outdoor gatherings and progressively reopening higher risk settings as the situation allows. But it will be crucial to remain adaptable and responsive to changes in the number cases and the healthcare demand they will generate. It may yet be necessary to adjust or tighten restrictions to prevent cases spiralling out of control. The Australian state of Victoria has gone from around 20 cases per day to 1500 in just 6 weeks, and there are currently 96 Covid patients in ICU. This could happen here and it would put immense pressure on our hospitals.

“The Auckland boundary will remain in place for now. But if, as is likely, case numbers continue to grow, it will become progressively harder to keep the outbreak contained to Auckland. The rest of New Zealand should prepare for the inevitability of community transmission. Regions that experience outbreaks may need to be put under restrictions like those in Auckland.

“While our vaccine rollout is still in progress, we remain extremely vulnerable to out-of-control outbreaks. The government needs to pull out every stop to maximise vaccine uptake, particularly in Māori and Pasifika populations and other groups where coverage is low.”

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

Dr Bodo Lang, Senior Lecturer, Department of Marketing, University of Auckland, comments:

“Reaching vaccination goals through incentives: While New Zealand’s initial response to the Covid pandemic has resulted in minimal lockdowns and comparatively low rates of fatalities and sickness, the delta variant poses a new challenge for New Zealand. And with new challenges new solutions are needed.

“The key to minimising both human and commercial casualties are high vaccination rates, ideally 90% or higher. Mass communication, such as advertising, has its limits when wanting to persuade an audience to engage in a desired behavior. Commercial marketers know that emotional and rational appeals can only convince so many people to change their behaviour. At some point, particularly when faced with consumers who are resistant to change, other strategies need to be pursued. In commercial marketing such strategies can be broadly summarised as ‘sales promotion’. In essence, marketers provide extra incentives for engaging in the desired behaviour. Think: ‘Buy one, get one free’, ‘25% off’ and similar strategies.

“Driving behavioural change in light of the delta virus is no different. Providing clear incentives for engaging in the desired behaviour – being double-vaccinated – has become paramount. Such incentives can take a variety of forms, such as entering people into a Covid lottery or giving out prizes to those who have had two vaccinations.

“However, the incentive that may be the most powerful is to reward those who have been fully-vaccinated by giving them back what they desire the most: regaining greater personal freedom. This can take a variety of forms, such as allowing those who have had two vaccinations to be able to take part in public life again. Think bigger personal bubbles, being able to visit bars, restaurants and cafes, and pursuing other commercial and non-commercial activities to a greater extent again.

“New Zealanders who have failed to be convinced by the government’s emotional and rational arguments thus far are likely to respond to incentives because incentives are personally relevant to them. Conversely, those who are vaccine-hesitant may lack a sense of personal relevance to the virus if nobody in their social network has been affected by Covid.

“One potential danger of using any kind of incentive is to ensure that all New Zealanders have the same opportunity to receive such incentives. For example, those who have already been fully-vaccinated should not be disadvantaged in comparison with those who have been more hesitant. Similarly, the ability to get vaccinated, and therefore receive the incentive, should be maximised through broad community outreach – so as not to disadvantage those New Zealanders for whom vaccinations are less accessible.

“To minimise both the commercial and human casualties from Covid in New Zealand, the next phase of the government’s campaign needs to provide clear, personally-relevant incentives for New Zealanders to become fully vaccinated. If vaccination is our goal, then let’s make being vaccinated even more attractive.”

No conflicts of interest declared.

*This paragraph previously stated that early in the New South Wales Delta outbreak, reported transmission occurred when an infected person walked past people in the street. This was incorrect and was replaced on 5/10/2021 with the statement that NSW saw reports of transmission from glancing interactions.