Covid 19 Delta outbreak: Not out of the woods – Expert Sir Brian Roche on the challenges in coming months

The head of an expert group advising the Covid response says all the systems are in place to manage Delta cases all over the country – but how that plays out in coming months remains to be seen.

Sir Brian Roche, chair of an independent continuous improvement group, also welcomed the Government picking up a number of recommendations in his latest report, though he added many of them could have been implemented sooner.

He has for more than a year been imploring the Government to increase testing and contact-tracing capacities, and did so again in a a letter and report to the Covid-19 Response Minister Chris Hipkins on September 23 that called into question the Government’s preparedness for Delta.

Other recommendations included vastly boosting health infrastructure to manage more cases in hospitals, MIQ and in home isolation, more engagement with Māori service providers, and a new pandemic response unit to oversee and be accountable for the whole system.

All but the latter have been adopted, though Roche said some recommendations took longer to be actioned than he would have liked.

“As a generalisation, it would always be good if the system could move more quickly, but the system is under enormous pressure,” Roche told the Herald.

From today, the country moves into the traffic light framework, where the use of the vaccine pass will mean greater freedoms for vaccinated people than for the unvaccinated.

The impact on the Delta outbreak is hard to predict, but cases in Auckland are expected to trend up, and cases will then crop up all over the country after city’s boundary is loosened from December 15.

The virus could seed into unvaccinated pockets to an extent that puts pressure on the health system, but it could also hit a vaccinated wall and fizzle out.

“We going to have a virus that is more widely spread across the country into areas that have not experienced it, [but] I don’t have any particular dread about the next few months,” Roche said.

“It is not without risk; I don’t think anyone is suggesting otherwise. We’re not out of the woods yet, and much of what was in the report is still relevant for the future.

“But I feel confident we will be able to cope. That’s what has happened to date, and we have no reason to think that will not continue.”

'On the face of it, the system is all ready to go'

His group’s report landed at a time when the number of daily cases in the current outbreak dropped to single digits, and a return to zero cases in Auckland was still on the cards.

It outlined aspects of the response that had not been up to scratch, including the “very poor level of preparedness of hospitals for Delta”, a lack of funding for Māori providers, and limited testing capacity that could have ended up “compromising early outbreak containment”.

A month later, the Government announced $120 million for Māori health providers to boost the vaccine rollout for Maori, and two months later, it launched a new system for taking care of cases in home isolation as well as rapid antigen testing (RAT) for businesses and, by buying them in pharmacies, for the general public.

People would be more likely to use RAT, however, if they didn’t have to pay for it, which is the UK system.

“That’s an option that remains open to the Government,” Roche said.

“But we could ill-afford the sort of experience we had on saliva testing.The big win here is [Associate Health] Minister [Ayesha] Verrall really pushing hard and getting substantial resource for RAT. It’s a critical tool in our toolkit.”

A question mark remains, however, over contact-tracing capacity.

Roche said his questions around capacity to the ministry have been answered in the same reassuring but vague way that the Ministry of Health has responded to media inquiries.

“We get the same sorts of answers, really. We can saythe contact-tracing capacity has increased, and it is increasing. But the great unanswered question is the adequacy of what we have.”

He disagreed with the ministry’s view that the contact-tracing system wasn’t overwhelmed at the start of the outbreak, when it was meant to be able to manage the contacts for 1000 cases a day but came under intense pressure with only 80 a day.

Nor had he seen any contact-tracing metrics for the outbreak, which the ministry has also continued to withhold from the Herald despite intervention from the Ombudsman following an Official Information Act request.

“We’re not seeing those metrics either. [But] Minister Verrall, as one of the architects of this, I think we’re in pretty safe hands with her in an oversight capacity.”

A key question is how the system will respond to a case in rural New Zealand in a lowly vaccinated region that is far from a hospital or ICU unit.

Roche said the Department of Prime Minister and Cabinet had been conducting regional tests for certain scenarios, though he didn’t know specifics.

“They’re taking what I’d described as quite a forensic approach to the level of resource available. On the face of it, the system is all ready to go,” he said.

“But it’s now likely to spread across the country, and ultimately it’s going to come down to the availability and resilience of the health system. There’s been good planning, there is a level of preparation.

“Will it be enough? That will be displayed in real time in the next few weeks, few months.”

His team’s report also called for a greater focus on tackling the inequities that are exacerbated by the disease.

“Issues of equity are pretty fundamental because the virus affects some more disproportionately than others. We should be recalibrating the system to reflect that,” he said.

“There’s been much more work done in recent months with local and community groups, iwi-based groups specifically, to try and actually address those inequities.”

Recurring themes: reactive not proactive, unclear accountability

His team’s report repeated issues raised in earlier reports from him or members of his team in the past 14 months, as well as those in a review led by Security Intelligence Service director Rebecca Kitteridgeinto last year’s outbreak.

Common themes across those reports include a Government that’s too reactive rather than planning in anticipation of what might happen.

“That’s the point that we’ve made, consistent with the theme of ‘let’s try and move from being totally reactive to more proactive’. We should be seeking to learn from the rest of the world and be more prepared,” Roche said.

Another – reiterated in the review of two home isolation deaths – is fragmentation across the health system and the Covid response, a lack of visibility across the whole system, and unclear accountability due to the many agencies involved.

“It’s no great secret that there have been real tensions within the system. If you want to optimise things, then having a sort of a whole-of-system view is really critical,” Roche said.

“At the moment, it happens through the perseverance and goodwill of individuals. We just say that needs to be systemised.”

But Hipkins has rejected setting up a singular Covid response agency.

“We keep the structure of the response under review all of the time, but the one of the challenges is that the nature of the response keeps changing,” he told the Herald.

“How much time do you spend constantly reorganising people every time the nature of the response heads in a different direction? We’d be better to get people focused on the work that needs to be done, as opposed to which umbrella they sit underneath.”

Roche said it was up to the Government what it did with his group’s advice.

“Our work is an attempt to de-risk issues, and that’s what we’ll continue to do.

“We’re in a really good position relative to many others in the world – 44 deaths to date. So while we may have an ambition to be better, what we’ve achieved is very good, and we should be very respectful of that.”

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