Covid 19 coronavirus: How contained is the outbreak and how close are we to level 1?

ANALYSIS

The current outbreak appears to be well contained, but it would be a bold and daring call to announce today that the country will move to level 1 next week.

That is despite the nearly 300,000 tests that have been performed in recent weeks and the decreasing number of new cases.

It has been a week since there were more than five new cases in one day outside of the Managed Isolation and Quarantine (MIQ) facility. There was only one new community case yesterday despite 10,000 tests, and nearly half of the 152 cases in this outbreak have now recovered.

The group has 150 people and more cases are expected, but they are not too worrying if they fit the puzzle we already know.

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Question marks on some cases

There are only two cases that have a different Covid-19 strain from the group. One is believed to be historical and the other caught Covid-19 in an elevator at an MIQ facility. None have transmitted the virus.

There are four groups with the same strain as the group but with no epidemiological link, which means that links in the chain of infection between the group and each group are missing. But most of the contacts in each group have already been tested.

The largest is associated with the Mt Roskill Evangelical Community Church. The group has 24 positive cases and 625 identified contacts; 68 of them so far have not been evaluated, while 84 people who could be contacts have yet to be contacted.

There are five cases involving the GP practice of former Cook Islands Prime Minister Dr. Joe Williams. Of the 222 contacts identified, 23 have not been tested.

The others are a botanical group of five cases and a man who presented to the North Shore Hospital emergency department with severe symptoms, who has two other Covid-positive people in his chain of transmission. Only one contact from these groups has not been tested.

And of the 10 bus trips that potentially led to Covid-19 throughout Auckland, nine of the 34 contacts have not been proven.

The outbreak’s 178 close contacts (out of 3,162 in total) that have yet to be reached may have been spreading Covid-19 during Tier 2 relative freedoms this week.

But the risk is mitigated by the 19 days Auckland residents spent at alert level 3, when everyone should have stayed home.

It’s also comforting that close contacts have been isolated regardless of whether they tested negative. This recognizes how infectious people can be for a few days before testing positive.

The effective response of the Government

High levels of evidence also increasingly suggest that the back of the outbreak has ruptured, although the source remains a mystery.

The last three and a half weeks have seen an effective resurgence plan in action, particularly with massive testing and contact tracing.

The government has also tightened controls by introducing mandatory QR codes in businesses and on public transport, stricter rules for wearing masks, and plans to implement a CovidCard test in the community and at an MIQ facility.

But it would still be a great move to go to level 1 next week.

Given the incubation period, the test results generally indicate the prevalence of Covid-19 for a week, so the impact of moving Auckland to level 2.5 will not manifest itself until next week.

Jumping to level 1 without seeing how level 2.5 has fared would be inconsistent with the government’s precautionary approach thus far.

The risk of rapid transmission at level 1 is also much higher because it is effectively a normal life, without limits of social gathering, without physical distancing requirements, without masks, but with closed borders.

That’s why CEO of Health Ashley Bloomfield previously wanted two full two-week incubation cycles at Level 2 before moving to Level 1.

Such a precaution may not be necessary if the evidence remains high and contact tracing is continually improving.

This outbreak may have been detected earlier if 4,000 daily tests had been conducted in the community and periodic tests of border workers, for which the Government tried without success.

The decline in community testing was due in part to changes in late June, in which people with symptoms were told not to get tested unless they were connected to foreign travel, a border facility or a positive case.

By the time Prime Minister Jacinda Ardern tried to remedy this with a “say yes to the test” message on August 3, the current outbreak was already spreading.

That shortcoming is being addressed in the new testing strategy to ensure continuous testing of people with cold and flu symptoms, as well as those connected to higher-risk locations or individuals.

Ardern could decide to put the rest of the country on a more relaxed alert level, given the lack of transmission outside Auckland.

But she has already said that it is better to have the whole country on the same stage when it comes to lower alert levels.

This offers more protection for people traveling in and out of Auckland, and also eliminates the need for travel exemptions, which has caused the government more than a few headaches.

If the Government continues its previous practice of scheduling the alert level setting in two week blocks, we will see at least another week at the 2.5 / 2 level.

Tightening fatigue may be brewing, especially for the hospitality industries and events outside of Auckland, but judging by recent support for putting Auckland on alert level 3 last month, a public uprising it is far from imminent.