What the 3-step plan means for the rest of NZ – Expert Q&A

Some of Auckland’s Covid constraints will be eased over time in a three-step plan, starting from midnight Tuesday. But will this increase the Covid risk for the rest of Aotearoa?

Will the Level 2 restrictions outside of Auckland and parts of Waikato afford enough protection? And what will it mean to transition away from the elimination approach?

The SMC asked experts to respond to these questions. 

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

What are the risks of Covid-19 spreading outside Auckland?

“It’s becoming clear that case numbers are growing under alert level 3 conditions in Auckland. While the easing of restrictions announced yesterday may or may not accelerate this growth, it certainly won’t do anything to slow it. The virus has already managed to find a way across the Auckland boundary on at least four occasions, during a period when the outbreak has been relatively small. If case numbers become much higher, it will become more and more difficult to prevent this happening again.

“The change in tack signalled by the government means it is really a matter of time before Covid finds its way to all corners of New Zealand.”

Will Level 2 restrictions give enough protection to the rest of Aotearoa?

“Alert level 2 is sufficient for now, but if a new outbreak takes off in a particular area, that area might need to be put under tightened restrictions similar to Auckland. The virus is most likely to be able to take hold in population groups with low vaccination rates.”

What would it mean for NZ to shift away from the elimination approach?

“As we transition from an elimination to a suppression strategy, the government will have to tread a very narrow path to avoid overwhelming our hospitals. We are relying on a combination of restrictions and immunity through vaccination to prevent cases from growing too rapidly. As vaccination rates increase, restrictions can be progressively eased. But if we relax too much, there is a risk the number of hospitalisations could start to spiral out of control. When the R number is above 1, cases will continue to grow relentlessly until either more immunity – or tougher restrictions – bring it back under 1. Getting vaccination rates up is crucial but will take time, so the government may yet be forced to tighten restrictions to protect our hospitals and our at-risk populations.”

What can the public do?

“Everyone can do their bit by doing two things: First, help and encourage those around you to get vaccinated, whether by having a conversation about the benefits of the vaccine, pointing them towards good sources of information such as their GP, or helping them make a booking and getting to where they need to go. And second, stick to the rules, especially around wearing masks and only meeting people from other bubbles outdoors.

“The lower we can keep community transmission rates, the better chance we have of keeping pressure off our hospitals and getting to the next stage of the roadmap.”

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

Associate Professor Siouxsie Wiles, School of Medical Sciences, Faculty of Medical and Health Sciences, University of Auckland, comments: 

What would it mean for NZ to shift away from the elimination approach?

“The easing of restrictions that evidence shows have a marginal impact on transmission signal a pragmatic transition from the elimination strategy to one of suppression, where we use vaccination and vaccine passports, masks, improved ventilation, rapid-testing, and other tools to minimise transmission, and testing, contact-tracing, and isolation to control transmission chains and clusters as they emerge. It is clear we have to keep cases as low as possible or we risk overwhelming our healthcare system, especially at the moment while over half of New Zealanders are not fully vaccinated.

“I had personally hoped we would be making this transition sometime next year, when vaccines were likely to become available to our under-12s, and without COVID-19 in our community. That it is happening with an active delta outbreak means it would be dangerous to grant the rest of New Zealand the freedoms of alert level 1 that we have all enjoyed since COVID-19 first emerged last year. We have ample evidence that the border around Auckland is not impenetrable, so those freedoms mean the chance of a super-spreader event are too high.”

What can the public do?

“We all need to mentally and physically preparing ourselves for what life with COVID-19 in our communities is going to be like. One preparation we can all be making is to encourage and help those around us to get vaccinated. My worry is that we will see what we have seen in so many countries, and indeed in New Zealand during this outbreak, that the burden will fall on people and communities inequitably. Our transition from elimination to suppression must strive to minimise this.”

No conflict of interest.

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

What would it mean for NZ to shift away from the elimination approach?

“After the muddled and confusing messages on Monday, it’s time for clear and transparent communication from the Government. It’s not an exaggeration to say that decisions being made now could determine New Zealand’s future health and wellbeing for years to come. We need information.

“First, we need to know what the strategy is now: is it elimination or suppression? The two strategies are very different in their aims and objectives. Because this strategy decision is so critical, the Government will need to ‘show its working’ by making available the evidence and criteria underpinning the choice of strategy.

“Second, we need to know how the strategy will be delivered: what is the plan to keep New Zealanders safe until full vaccination and beyond? What resources will be available to protect people that are most at risk, including Māori, Pasifika, people with underlying conditions, people experiencing marginalisation, and all of the children?

“Finally, if the strategy is now suppression, we need to know who was consulted on the change and what they asked for. Landmark policy decisions with a profound impact on health need a participatory decision process, ensuring that those who are most at risk have a voice and a place at the table when key decisions are being made about their lives and health.”

No conflict of interest