Pressure is mounting on the Government to consider an alert level 4 "circuit-breaker" lockdown in Auckland as cases continue to rise and experts warn vaccinations aren't happening fast enough to reverse the trend.
Forty-three new cases of COVID-19 were reported on Tuesday, with 19 unlinked, meaning it's now been nearly two weeks since New Zealand was recording fewer than 20 cases a day. Throughout September, daily cases were mostly in the teens, with some days slightly above and others in the single digits.
Prime Minister Jacinda Ardern said on Monday that the reproduction value (R value - or the average number of people a case will pass the virus on to) of the current outbreak stands at about 1.2 or 1.3, above the "way below 1" where it stood in late September.
That growing trend in cases has prompted a number of epidemiologists and modellers to raise the need for a return to alert level 4.
"These trends show that it’s time to talk about a circuit-breaker," says University of Otago epidemiologist Dr Amanda Kvalsvig. "A move back to alert level 4 is the best and probably only chance of reversing these highly-concerning trends that are all moving in the wrong direction."
"Vaccination is not going to happen fast enough to reverse these trends and we need to buy time."
Auckland is currently in stage one of alert level 3, having left the strictest form of lockdown in mid-September. While people are advised to stay at home as much as possible, and retail and hospitality stores can't have customers come inside, picnics and contactless pick-up is permitted. Around 300,000 people returned to work when Auckland eased to level 3 restrictions.
Dr Kvalsvig says that instead of deciding on behalf of Auckland that they are tired of lockdowns, we should hear directly from them, including "Māori, Pasifika, people with underlying conditions, people who are marginalised, and children and their advocates".
"They're the ones carrying the highest risk if COVID-19 is allowed to spread before vaccination rollout is complete," Dr Kvalsvig says.
"Ruling out alert level 4 will effectively also rule out alert level 1, leaving Aucklanders in the worst of both worlds with a large number of restrictions and a large (and growing) number of cases, hospitalisations, and deaths. That situation is no good for businesses either. We’ve seen this pattern play out again and again in multiple countries."
She wants to see more protections put in place for those experiencing hardships.
"With substantial support measures in place, movement restrictions can be made tolerable for people while chains of transmission are being stamped out," she says.
"This is the most urgent and most important national conversation we can be having right now. At this critical point in our pandemic journey, failing to act decisively will have severe consequences for population health and wellbeing. Any decisions made now need to be highly transparent and guided by the widest possible consultation with the people of Aotearoa."
It's a thought shared by Dr Dion O'Neale, the principal investigator with Te Pūnaha Matatini, which has been doing a lot of the Government's modelling.
He says the current rise in cases is "not just a random spike", but indicates we are "back in a growth phase".
"There’s a strong case to be made for a temporary return to alert level 4 in Auckland as a circuit-breaker to limit transmission for a few weeks while we try to get as many people vaccinated as possible," says Dr O'Neale.
"We wouldn’t expect this to get us to zero cases in a short time, but it would mean that we are able to get more vaccinations to under-protected groups both inside and outside Auckland. It would have the added benefit of allowing contact tracers to potentially ring-fence some more of the sub-clusters in the outbreak, due to the reduced numbers of contacts."
The Prime Minister was asked on Monday whether Cabinet had considered returning Auckland to level 4 in light of the new cases. In her reply, she implied concern about public compliance with those harsher restrictions.
"We consider not only the restrictions but one of our criteria has always been compliance and adherence and the ability to continue to comply," Ardern said.
She said in Australia, where in some states there was a long-stretch of the same restrictions, cases ticked up.
"One of the things in our thinking has been, over time, adhering to really strict restrictions is hard, and you can expect that human behaviour might change."
The Prime Minister said the new roadmap settings were designed to give Aucklanders slightly more freedom, with not much more added risk, for example with picnics outdoors where the virus is less likely to transmit.
Dr O'Neale says in our current situation, "it is very tough to vaccinate our way out of the growing case numbers". Surges in vaccinations, he says, also haven't been distributed evenly across demographics, with rates in rural communities and for Māori still low in many places.
"In addition to not offering complete protection against infection, vaccination takes a couple of weeks to develop a full immune response, even without accounting for the need to have a gap of three or more weeks between first and second doses.
"In contrast, after exposure, people infected with COVID are able to infect others within only a few days. During a growing outbreak, it is easy to have several generations' worth of infections before a surge in vaccinations is able to have an effect on transmission reduction."
Professor Michael Plank, also with Te Pūnaha Matatini, says increasing vaccination rates will slow transmission and turn the tide on case growth "over time".
"However, in the meantime there is a danger that too many cases could mean our contact tracing system struggles to keep up with demand, leading to an acceleration in cases," he says.
"This means we need to do everything possible to minimise community transmission, particular in the next few crucial weeks as we get more people double-dosed."
As of Tuesday, 58 percent of eligible New Zealanders are fully vaccinated with 82 percent having had their first dose. In Auckland specifically, 87 percent have had one jab and 63 percent have had two. That's up from 85 percent and 53 percent a week before.
Ardern, who on Tuesday announced a vax-a-thon to encourage people to get vaccinated, said these rates needed to increase.
"They aren’t high enough yet to feel confident that we can ease restrictions dramatically without seeing a big surge in cases that could overwhelm our health services."
Level 3's effect
Dr O'Neale says stage one of the Auckland alert level 3 roadmap has allowed more social and workplace interactions than previously at that level. Doubling the number of interactions, he says could increase the "pool of possible people who might be infected by more than a factor of ten". That's why he says it is important people continue to minimise their interactions and keep up measures like masks and physical distancing.
Due to the time it takes for the effects of changes in restrictions to be seen, Dr O'Neale says it would be "risky to make further changes that create additional transmission risks".
Ardern on Monday said while there have been some cases at workplaces that began operating at level 3 - such as construction sites and with taxis - it would not be "fair to say that we would have had, say, zero cases or no increases in cases were it not for that move".
No cases had yet been connected to picnics under step one, Ardern said.
Cabinet will next review Auckland's settings on Monday. The next step would see outdoor gathering limits increase and retail businesses opening their doors again.
Dr David Welch, a Senior Lecturer at Auckland University's Centre for Computational Evolution and School of Computer Science, says to safely loosen restrictions further - such as to go to step 2 of the roadmap - community transmission "needs to be lower and the number of fully vaccinated people much higher".
With the R value being about 1.3, he says it can take about two weeks for cases to double.
"Where we currently see about 25 new cases infectious in the community every day, in two weeks we can expect to see about 50, and 100 in a month," Dr Welch says.
"That rate of increase will soon start to put serious pressure on health systems. It will also start to stretch the abilities of the contact tracing teams to track and isolate close contacts.
"Publicly available estimates suggest that the contact tracing system will struggle when there are somewhere between 100 and 200 cases infectious in the community for a sustained period."