Jacinda’s Gladys Moment

Thursday, 21 October 2021, 6:05 pm
Opinion: Ian Powell

Gladys Berejiklian is an experienced Australian Liberal Party politician. First elected to the New South Wales Parliament in 2003, in January 2017 she became the state’s 45th Premier. Just over three years later she had to confront her greatest crisis – the coronavirus pandemic that we know as Covid-19.

Berejiklian proved to be a competent leader in the pandemic response. This included playing a leading role in the state premiers (mainly Labour Party) forcing federal Prime Minister Scott Morrison to take a responsible position (no mean feat). But then came the much more contagious deadly Delta variant.

She had a really bad ‘moment’. She blinked. In contrast to the other Australian states which were faster and harder, she first delayed for too long before responding. Then her eventual lockdown response was too soft and variable, resembling something like a mix of Levels 2 and 3 in New Zealand. The inevitable outcome was chaos with a massive increase in daily infections (cases), unsustainable pressure on its hospitals, and an increasing death rate.

Victoria followed through a combination of the effects of infected cases crossing the border from New South Wales and lockdown fatigue (including breaches and large protests). All other states succeeded in avoiding this disaster by sticking to faster and harder but ultimately shorter elimination lockdowns.

The Berejiklian response contributed to a nearly doubling of the Covid mortality rate in Australia. Deaths per million have increased to 61 per million which still compares well internationally but is dismal compared with New Zealand’s 5 per million.

Trans-Tasman travel bubble

There is a lesson to be learned from how Delta came to New Zealand demonstrating that the harm it does can be either avoided or contained. Prolonged Delta surges are not inevitable.

Delta came here through the trans-Tasman travel bubble. It appears from polls that a small majority of New Zealanders disagreed with the bubble right at its beginning. Their instincts proved to be correct. I say this as someone who was cautiously supportive of the bubble.

The bigger failure, however, was back in June when there was a Delta scare in Wellington with an Australian visitor on a weekend visit who tested infectious on his return to Sydney. That person did the right things, particularly contact tracing. He also had his first vaccine dose before coming to Wellington.

At that point there should have been a requirement that only fully vaccinated Australians and New Zealanders could cross the Tasman. Had that been the case the Delta case that brought Auckland to a halt would not have arrived when it did and we would not be going through what we now are.

New Zealand’s initial elimination response

New Zealand’s response to the first Delta case in Auckland, as articulated by Prime Minister Jacinda Ardern, was based on the successful elimination strategy of zero tolerance (not to be confused with zero cases) of community transmission. That success was a remarkable achievement with only 28 deaths in total (2 of which were under Delta to date).

Had our response been like the United Kingdom’s there would have been over 10,000 deaths; if like Sweden – around 7,000 deaths; or like if Australia – around 310 deaths (over half pre-Delta).

The response was ‘fast and hard’ with the expectation of being shorter with a national lockdown at the highest alert level (4). The focus of ‘fast and hard’ is largely on preventing as much people movement as possible.

The results were impressive. After little more than a week the growth in Delta daily cases ceased to increase (peaking at 82) and, with fluctuations, declined. Further, apart from very small initial cases in Wellington, Delta was confined to Auckland. This enabled the country outside Auckland to move quickly to Level 3.

Then, as the rest of the country soon moved further down to Level 2 (with no cases being reported) inexplicably Auckland was lowered to Level 3. At the time Government was enthusiastic about the progress and fulsome with its praise for public compliance including in Auckland. There was no major concern expressed about breaches of the restrictions in Auckland.

On 24 September, a few days after the start of Level 3, Auckland had its first single digit (9) number of daily cases and its second a further four days later (8). By 28 September the rolling 3 day average was 13. This was all due to Level 4.

But the impact of dropping to Level 3 first hit Auckland on 29 September with the case numbers leaping to 45. Thereafter it fluctuated between the 30s and 70s but with an overall upwards trend. Then, on 19 October, there was a dramatic increase from 57 to 87 in Auckland (a further 7 in neighbouring Waikato bringing the national total to 94 compared with 60 the previous day).

This was biggest daily increase (94) since the pandemic first came to New Zealand. The rolling 3 day average had increased from a low of 13 to its highest ever figure of 65 (as of 19 October).

Meanwhile the Delta-free rest of the country has to remain in Level 2 because the virus variant is running amok in Auckland.

Modelling advice ignored

NZ Herald science reporter Jamie Morton has published a very good insightful article (19 October) based on a recently published report by and interview with Covid-19 modellers Te Pūnaha Matatini:

https://www.nzherald.co.nz/nz/covid-19-delta-outbreak-could-staying-at-level-4-have-quashed-this-surge/2MDT4ZLXUNRIYOEMJSEYKQZDXE/?utm_source=newsletter&utm_medium=nzh_email&utm_campaign=Premium_News_Briefing_Newsletter&uuid=97598f7744474446ad8308f8e9419f05

The modellers charted possible ‘optimistic’ and ‘pessimistic’ scenarios. The former involved Auckland staying at Level 4 for 60 days when almost all trajectories for spread should be either contained or eliminated. Under this scenario Auckland would now be in its first week of Level 3.

Based on past and recent experience it is reasonable to assume that Level 3 would have continued for a further week, at most, another week before lowering to Level 2. By then, with a question mark around Waikato, the rest of the country could have gone to Level 1.

Under the ‘pessimistic’ scenario the modellers assumed Auckland moved to Level 3 on 16 September (6 days before it did). Their consequential trajectories followed closely what Auckland is now experiencing.

This modelling was given to government three weeks after Delta arrived and before the decision to lower Auckland to Level 3. Sadly, instead of accepting this advice from modellers it had confidence in, Government chose to disregard it. This was the Prime Minister’s ‘Gladys moment’.

The consequence of this ‘moment’ is that, after having defeated it, exponential growth is now back with a vicious vengeance. Now Auckland is likely to remain in lockdown for weeks longer than it otherwise would have been.

The ‘moment’ also required a rewriting of recent history in order to rationalise these decisions.

Rewriting the political narrative

In order to rationalise its decision-making the Government is now trying to change its public political narrative. From applauding Aucklanders for their sticking to the rules and commending the success elimination was achieving, it is now blaming the upsurge of daily infections on breaches.

There have been breaches such as the infamous party of the ‘entitled’ affluent young and the two public demonstrations associated with the far right religious businessperson Brian Tamaki. Both were likely virus spreaders. But, as bad and irresponsible as these are, breaches an overstated sub-set of the Delta spread drivers.

Moving to Level 3 had two main effects. It increased the movement of people quite considerably compared to the more restrictive Level 4. Second, it encouraged complacency. It occurred at a time when the Government, Health Ministry and experts had been expressing a high level of confidence with the success of Level 4. When driven by the sense that Auckland must be over the worst of Delta, complacency is a logical trap for many to drift into.

This then has a compounding effect on the disproportionately high number of people living in economically deprived communities who are unvaccinated and often living in overcrowded circumstances. Many, although not all, are Maori or Pasifika.

Under the elimination strategy the Government had justifiably argued that it was necessary to protect our public hospitals because they didn’t have the capacity to cope with a Delta upsurge.

Now, with the strategy abandoned in Auckland, its political narrative has changed to public hospitals can cope because of the introduction of ‘surge’ staffing in intensive care units. The problem is that affected medical specialists and nurses do not share this newly discovered public relations confidence.

Border control system failings

One of the frustrating things about the Government’s pandemic response was the inability to make uncomplicated decisions in some areas which would have made a difference. Previously it had been slow on recognising the added protection that masks provided for example.

Under Delta there has been some basic (but fixable) failings in border security around Auckland that have impacted negatively. There should have been a requirement that all those eligible to cross the border, primarily essential workers, were vaccinated.

The two Auckland women who travelled through Northland thereby leading to its alert level being raised to Level 3 did it through forgery. Those working at the border should not be blamed for this deception. But, had there been a requirement to be vaccinated in order to cross the border, they would not have got through.

Furthermore, the system was so poor that while the women had to show that they had been tested they didn’t have to show the result of the test. In both cases tests subsequently revealed infectiousness but it was too late.

The two Auckland truck drivers going to Northland and Palmerston North followed the rules. But both were unvaccinated. Had there been a vaccination requirement the fears and need for extra testing that subsequently arose would not have materialised. Even requiring a negative test result would have prevented the drama that eventuated. This was a systems fault; not a fault of border workers or the drivers.

And then there is Raglan which triggered the subsequent Waikato spread and elevation to Level 3 where it currently remains. This was a case of a person driving into Auckland on a secondary road and then returning infected. Understandably police don’t have the capacity to cover all secondary roads. But if concrete blocks used for roadworks (or containers) had been used then most likely the transgression would not have occurred and Waikato would not have gone into lockdown.

These are basic flaws that could have been promptly fixed. For example, on the Kapiti Coast I drive past hundreds of concrete blocks weekly with the construction of Transmission Gully. For some inexplicable reason there is a blockage in central government thinking on these straightforward solutions.

What the Gladys moment means for Aotearoa

The elimination of community transmission strategy has been very effective in New Zealand since its inception in March 2020 including in the Delta response. It has been successful against Delta in most Australian states; it prevented the exponential growth of Delta in Auckland (until it was abandoned) and Waikato (so far); it worked in Northland; and it prevented the spread of Delta in the rest of New Zealand.

Delta was allowed to come into New Zealand due to the wrong decisions being made over the trans-Tasman travel bubble. The loss of control in Auckland, along with the temporary entry into Northland and its continued lower presence in Waikato, are the consequence of poor policy-making and decisions. Both its entry into New Zealand and surge in Auckland were not inevitable.

From a situation where light could be seen at the end of the tunnel, now (as a result of poor political decision-making) we are at risk of this being a train coming in the opposite direction at least for Auckland and potentially for the rest of Aotearoa.

Infections are now widely spread across over 120 suburbs; the capacity to maintain effective testing and contact tracing is at risk of being overwhelmed (already sub-clusters have had to be discontinued); the number of ‘mystery’ cases not linked to known cases is surging upwards (from between 5 to 15 to September to approaching 200 in October); and the well-performing Auckland public health unit is exhausted.

The tragedy is that this was not inevitable; with better policy settings and decision-making it was avoidable.

Possum in the headlights or circuit breaker

Ardern and her government have with justification prided themselves on following the science and being good communicators. This has changed with its ‘Gladys moment’. It is no longer following the science at least at the level required to prevent the pandemic from harming New Zealanders and risking the overwhelming of our health system.

Its previous excellent communication now ranges from poor to uneven. The abandonment of elimination was announced without explanation (that came a week after with a new misleading narrative). Confusion was caused by the introduction of “steps” within alert levels and compounded by muddled references to “traffic lights”.

Beginning with the decision to come out of Level 4 too early and compounded by the unnecessary abandonment of elimination in Auckland, the Government’s confusing policy settings are starting to make it look like a possum in the headlights.

Should Auckland return to Level 4? The science says yes in the context of a desperately needed circuit-breaker. However, a stronger lockdown would now take longer to turnaround the Delta threat than it would have if the advice of the Government’s independent modellers had been accepted back in September.

Going to Level 4 would require Government to recognise that by having a ‘Gladys moment’ it made the wrong judgement call. This is likely to be a political bridge too far.

First published here https://otaihangasecondopinion.wordpress.com/2021/10/21/jacindas-gladys-moment/..

© Scoop Media

Ian Powell

Otaihanga Second Opinion is a regular health systems blog in New Zealand.

Ian Powell is the editor of the health systems blog 'Otaihanga Second Opinion.' He is also a columnist for New Zealand Doctor, occasional columnist for the Sunday Star Times, and contributor to the Victoria University hosted Democracy Project. For over 30 years , until December 2019, he was the Executive Director of Association of Salaried Medical Specialists, the union representing senior doctors and dentists in New Zealand.

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