Transmission Transparency
“It is not the case that we are waiting for a decline in cases in order to make step down decisions at this point”, RNZ quoted Jacinda Ardern as saying this morning on Cabinet making a decision on whether to confirm the move to alert level 3 step 2 (draft A?) today for Auckland. This is not particularly surprising to hear at this point. The problem is it’s not really clear what exactly we ARE waiting for in order to make these decisions.
The step down decisions to date have been justified by loosening restrictions that the government has said are ‘low risk’ and in areas that they say aren’t really driving transmission. The majority of transmission, we are told, has been from indoor household gatherings. Gatherings that were, and still are, in breach of the level 3/4 restrictions. Not workplaces, schools, outdoor picnics, supermarkets. This seems entirely plausible, we know that indoor high contact settings are by far the biggest risk for Covid transmission. But what we don’t really know is how much the restrictions loosened to date have contributed to it.
Weekly cases are the highest they’ve been in Auckland since the start of the pandemic, and unlinked cases continue to rise. Resources are now being prioritised on isolation of known cases and contacts rather than finding epidemiological links. Again, this makes sense. But what it also means is that we don’t know where a lot of these cases have come from. Whether it’s from rule breakers or from loosened restrictions. Each step down has been accompanied by an increase in cases, but this could well be from people increasingly breaking alert level restrictions as they get more and more tired of them.
So what is today’s decision being made on? I have no doubt the government will confirm the decision to go to 3.2, even as we hit new case highs this week (over 200, go team!), and the justification will be that retail and bigger outdoor gatherings are ‘low risk’ ways of relaxing the restrictions. This is probably relatively true. But it is concerning that all of the experts, and even MoH it seems, have to date advised remaining at the current restriction levels. Low risk isn’t no risk. Any relaxation is likely going to cause extra transmission not just from new permitted activities, but because it sends a message for people to relax just a little bit more. Schools reopened recently and already we have seen multiple schools close due to positive cases. Was there any spread within the schools? Who would know?
Another factor of course is the increasing vaccination rates in Auckland. We have now hit 90% first doses amongst eligible population, which is fantastic, and hopefully will hit it for second doses within weeks. Yet there are still many unvaccinated people, whether too young to be eligible or eligible but hesitant or anti vaxx. We have the highest vaccination rates to date but also the highest case numbers to date, with no sign of them plateauing yet. The vaccine reduces both infection and transmission significantly. But Covid is seeking out the unvaccinated, with the vast majority of cases, and especially hospitalisations, being unvaccinated. It’s clear we still need public health measures, it’s not like we can ignore cases amongst the unvaccinated. The only firm way we know that vaccination rates factor into restriction levels is moving into the traffic light system at 90% of eligible double dosed in all DHBs. Beyond that, even with this rate, it’s unclear what will prompt the moves between red, orange and green lights.
What is probably driving the decision is that the government want to give people a pressure release in what it sees as the lowest risk areas. But resources seem stretched at the moment. Hospitalisations at a high, contact tracing stretched to its limit, as well as home isolation monitoring. People hate lockdown but I suspect they will hate it even more if even a small increase in transmission pushes our system to the brink. The government is trying to walk on a tightrope between public health and public, and business, opinion. Let’s hope they don’t fall off.
