An independent expert group told the Government in September that the borders cannot start to reopen until vaccination coverage was “well over” 90 per cent and the shortfall for Māori was addressed.
A September 23 letter from Sir Brian Roche, head of the Government’s independent continuous improvement group, also said bolstering testing and contact tracing was an urgent priority, and the Delta outbreak had shown a “very poor level of preparedness of hospitals”.
The letter and accompanying report is revealed in a tranche of official documents that the Government has dumped today.
“Timing is critical. We need to move with urgency to ensure we do not expose the country and New Zealanders to unnecessary risk and harm,” the report said.
“We are mindful that even the most conservative scenario post-reopening will inevitably involve the virus, in one form or another, making its way into the community for periods of time, or even permanently.
“Such a scenario may have previously been seen as alarmist, but is inevitable, in our view, based on what we observe from the most recent outbreak together with international experience.”
The report also noted how the vulnerable in Auckland were not adequately protected in the current outbreak.
“Assurance is also needed that a phased reopening identifies, supports and protects the vulnerable.
“There have been examples of that not being the case for some sections of the community during the current outbreak. Addressing this will be critical to minimise issues of inequity within the community.”
Roche’s letter, addressed to Covid-19 Response Minister Chris Hipkins, said that the outbreak had “exposed urgent issues with respect to New Zealand’s preparedness for reconnecting”.
“Delta has fundamentally changed the model of preparedness and response and we must adapt accordingly. We do not have a do nothing option.”
Roche said reopening the borders were a four-pronged approach: Vaccination, border processes, public health measures, and the health system safety net.
“Vaccination coverage will need to be well over 90 per cent and it is clear that our New Zealand vaccination programme is failing certain populations, most notably Māori, who are at higher risk of serious disease and death than non-Māori. Addressing such disparities is an urgent priority.”
He called for all efforts to take the vaccine to communities, and for more funding. A month later, the Government announced $120 million to boost Māori vaccination rates.
Roche said more movement across the border was “essential … to address escalating economic and social harms”, including alternatives to MIQ and more saliva testing and rapid antigen testing.
Roche has previously implored the Government for more widespread use of different testing methods, including in a report from September 2020.
He has also previously told the Health Ministry to bolster contact tracing capacity, and did so again in his September letter.
“This has been the subject of recurring recommendations from our reports and needs to be addressed as a priority.
“In addition, ongoing issues with innovation around testing and electronic contact tracing enhancement need to be resolved. Rapid antigen testing is a critical prerequisite – we cannot afford the delays in its introduction that have been experienced with saliva testing.”
The report added that the backlog and testing delays at the start of the outbreak – when people waited up to 12 hours in line – ended up “compromising early outbreak containment”.
“A lack of prioritisation meant that priority workers and key locations of concern were not processed with urgency.
“The ability to detect and respond immediately will be a key element of success. It is our view that rapid antigen testing is introduced for areas that have vulnerable groups, before entry into hospitals, aged residential care facilities, prisons, forensic facilities, and so forth.”
Only yesterday did the Government reveal that rapid antigen testing would soon be available in pharmacies and to more businesses.
Finally, he said the outbreak had exposed how poorly hospitals were prepared for Delta.
“The system’s ability to deal with Delta and other business as usual functions of the health system has been found wanting.
The report added: “DHB Chief Executives and Chairs have recently written to the Minister of Health that they are not confident in the level of preparedness planning.
“The current outbreak has revealed the very poor level of preparedness of hospitals for Delta. Auckland, which has a large and Covid-19 prepared health system relative to the rest of New Zealand, has essentially been stretched to capacity.
“Significant amounts of planned care have been placed on hold. This is unsustainable as the health system must be able to do ‘business-as-usual activity’ as well as be equipped to deal with Covid-19.
“We are seeing from overseas evidence that even at 80 per cent vaccination rates hospitals and health systems are under significant pressure. There is also a lot of evidence that the ‘missing 20 per cent’ are likely to be at high risk of poor outcomes. Current Ministry of Health vaccination data by ethnicity shows this trend extends to New Zealand.”
Roche said the outbreak had also “exposed the shortfall in proper engagement of Māori and Pacific providers in the outbreak and overall response”.
Māori and Pacific providers have consistently been arguing to be a central part of leading the community response, rather than through DHBs, which the Government has conceded has lead to poor outcomes in some regions such as Taranaki.
Roche repeated his concern about the response being reactive rather than prepared in anticipation of the worst.
“The current operating model is failing, and will fail in the even more complex operating environment after re-opening.”
A fully integrated pandemic preparedness and response unit – which he has previously called for – was needed, he said.
“We recommend that this unit is put in place before the end of the vaccination rollout as the current arrangements put the country at unnecessary risk.”
Six days after the first known case of Delta in New Zealand, a Cabinet paper from Covid Response minister Chris Hipkins shows how much uncertainty existed in the Beehive.
It showed health authorities knew of 13,000 contacts and more than 300 locations of interest – a fraction of the number they are currently dealing with. Among those were high-risk setting includng churches, health facilities and a University of Auckland ball attended by 500 people.
Hipkins told Cabinet cases had been found in Wellington and known close contacts had travelled elsewhere in the country. About 6500 contacts’ locations had beenb confirmed, of which 100 had South Island addresses.
Accentuating the risk was the dispersal of people across the country ahead of the Level 4 restrictions coming in, Cabinet was told.
Hipkins’ briefings to Parliament underscored the importance of “social licence” – the term denoting public approval for government measures.
With lockdown just six days old, “most people are happy or okay” about Level 4 but there had been a “significant shift from neutrality and joy in July to negative emotions in August”.
“South Islanders are significantly more likely to feel disgust (23 per cent) than the total sample (7 per cent).”
There was also concern over reports from police of non-compliance with Hipkins noting protests and “parties are an ongoing issue”.
Auckland could have exited level 4 lockdown five days earlier, based on advice provided to Government Cabinet ministers from director general of health Dr Ashley Bloomfield.
The briefing, produced on September 12 the day before an alert level review, also advised there was potential for the rest of the country to move to alert level 1 at a later date.
Bloomfield advised the Government Auckland could move to alert level 3 from 11.59pm on Thursday September 16, with a review in just under two weeks on Sunday, September 26.
He said the outbreak was becoming “contained to clearly identifiable communities within South Auckland”, and appeared to have peaked on August 28.
However, the daily numbers had plateaued at around “10 to 20 cases since September 4”.
“We may see a long tail of a few cases, which it will be important to track to minimise the chances of further outbreaks.
“While a move to alert level 3 will increase movement, cases are currently linked, or are being linked to known clusters.
“Two weeks at alert level 3 will provide the necessary surveillance and ability to rapidly respond if there was further transmission outside of clusters or communities of concern in Auckland.”
Bloomfield also recommended ongoing community engagement to build trust and maintain high rates of vaccination in Auckland, particularly in Māori and Pacific communities in South Auckland.
Bloomfield said Auckland could have even moved down on September 14, but the two extra days were needed due to new cases emerging in unknown clusters, reports of bubble breaches and the “long tail of cases”.
Prime Minister Jacinda Ardern instead announced the following day an in-principle decision to move Auckland to level 3 five days later than advised, on September 21.
Bloomfield further advised Cabinet could decide to move the rest of the country to alert level 1, pending no escalation in Auckland’s Covid-19 risk, when it met on September 20.
The Government document dump on alert level restrictions shows ministers were told the restrictions had Bill of Rights considerations.
Exactly what those were was not released – while most of the information was disclosed, the Government redacted what it was told from the documents on the basis it was legal advice.
'Uncontactable' cases presented health system headaches, memo shows
Uncontactable cases presented headaches for the health system when the Delta outbreak intensified in some residential complexes, healthcare facilities and educational centres.
An October 28 memo to Dr Ashley Bloomfield showed private gatherings, even those of the type allowed under level 3, were major drivers of transmission.
“Several cases have been identified in high-risk settings including residential housing and health care settings,” the memo added.
“It has been noted that there are ongoing issues of cases being uncontactable, which are being rectified with the use of finders services.”
The memo from health officials indicated contact tracing was functioning well, even though by this point 2,036 open contacts and 36,352 contacts with an Auckland quarantine address had been recorded.
Hospitals and the health system were coping – but officials warned that hospitalisations might not peak until late November.
It was especially encouraging to see a relatively small number of people needing intensive care, the memo added.
This low rate was probably because the average age of all Covid cases and hospitalisations was only 30, officials said.
What pre-Delta outbreak survey revealed
A study of 976 Aucklanders aged 15 years and over was conducted between March 7-17 after Auckland moved from Alert Level 3 to Alert Level 2.
The majority (75 per cent) of people surveyed by the Government said New Zealand was going in the right direction with the Covid-19 response.
The 12 per cent of people who said we were going in the wrong direction were most likely to be self-employed or thought they were not being told all they needed to know.
They were concerned about the vaccine and about borders opening,12 percent were not sure.
Most people surveyed were positive about the future but there was a group who felt their life was worse than before Covid.
These people are most likely to be 55 years+ and self employed or seeking work.
Only nine per cent of New Zealanders believe that getting the country vaccinated will return life to how it was pre Covid-19.
36 percent expected to continue to undertake health behaviours.
47 percent expected there to be some differences in day to day life compared to pre-Covid-19.
Source: Read Full Article