Covid-19 response Minister Chris Hipkins said yesterday that New Zealand could not sustain Covid control measures like lockdowns forever.

Speaking on TVOne’s “Q+A”, he said there had to be other alternatives, and the Government had been exploring them.

He did not say what they might be.

“What we’ve got to do is work out how we can continue with an elimination strategy, with some things changing, including the fact that we can’t sustain doing level four lockdown every time there’s a community outbreak,” he said.

But also in the same interview, he appeared to suggest that the elimination strategy itself might need to be re-considered.

“I think we still want to try and drive Covid out of it as much as we possibly can,” he said.

“That hasn’t changed.

“It’s the basis of elimination is that you drive it out wherever it pops up.

“I think we still absolutely want to do that.

“And that’s exactly what we’re trying to do at the moment.

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“The reality, though, is that with a virus that can be infectious within twenty-four hours of someone getting it, that does change the game a bit.”

Q+A: “Given Delta’s infectiousness, is elimination still a viable strategy?”

Hipkins: “Look, Delta does raise some big questions that we’re going to have to grapple with; less than 24 hours between someone getting it and passing it on to others. That’s like nothing we’ve dealt with in this pandemic so far. And that does change everything. It does mean that all of our existing protections start to look less adequate and less robust as a result of that. So we’re looking very closely at what more we can do there. But, yes, it does raise some pretty big questions about what the long term future of our plans are.”

Hipkins’ comments come ten days after the Government’s “Reconnection to the World” Forum, which was centred around advice from its Strategic Covid-19 Public Health Advisory Group.

The chair of that group, Sir David Skegg, in a letter released the same week as the Forum had advised Hipkins on June 10 that the elimination strategy was still viable and, “indeed, optimal” as international travel resumes.

“It does not mean “Zero COVID”, but it does mean stamping out clusters of COVID-19 as they occur,” said Skegg.

“The strategy should be reviewed regularly.

“Continuation of a successful elimination policy will require decisions about processing travellers and strengthening public health measures within the country.”

Skegg told POLITIK yesterday that we were learning more about the Delta variant every day.

“ In our third report (dated July 27), we mentioned the deteriorating global situation and the new evidence suggesting that the Delta variant will be more difficult to control by testing and contact tracing alone,” he said.

“The experience of NSW and Victoria since then has also been instructive.

“So I am sure there will be further discussions later in the year about the elimination strategy and other options.  

“Until the vaccination roll-out is completed, the case for maintaining our elimination strategy is compelling.  

“It is also important to bear in mind that the challenge we are facing right now, with our first community outbreak in nearly six months, is dealing with an outbreak in a still mainly unvaccinated population. 

“The situation will be different when most people are vaccinated – but heaven knows what the virus will be doing by then!”

But even vaccination comes with its own questions.

A  study this month by the United States Centres for Disease Control found that in a Massachusetts town,  of 469 COVID-19 cases, 346 (74%) occurred in fully vaccinated people.

Testing identified the Delta variant in 90% of specimens from 133 patients.

But though the vaccines may not prevent disease, they may prevent hospitalisation.

In June, the British Government body, Public health England, reported that their analysis suggested the Pfizer vaccine was 96% effective against hospitalisation after two doses.

And that may prove to be the key statistic and where the emphasis starts to go, not on how many cases but on how many hospitalisations.

Skegg made it clear in his group’s three letters to the Government that the New Zealand health system was still poorly resourced to deal with any large outbreak of a disease such as Covid-19.

In an Official Information Act response last week, the Ministry of Health said

that in April last year (when the first lockdown had just begun), there were 358 Intensive Care Unit (ICU) capable beds across the DHBs.

The Ministry said that In February 2021, it was estimated there were 284 ICU and high dependency beds in public hospitals.

The response to the OIA request said that the Ministry undertook additional planning last year  to “support surge ICU capacity.”

“This planning found that additional ICU capacity could be brought online if necessary,” the response said.

“This capacity includes resourcing other beds to be ICU-capable and using beds in private hospitals.

“This would lift overall ICU-capable bed capacity to more than 550 beds.”

In short, there has been no move by the Government to increase the number of permanent ICU beds in hospitals since Covid first struck.

But that is where the focus is increasingly likely to go.

Singapore has already begun thinking along these lines.

In June, three Ministers, the co-chairs of the country’s Multi-Ministry Task Force, said  while the bad news was that Covid-19 might never go away, the good news was that “it is possible to live normally with it in our midst.”

“The virus will continue to mutate and thereby survive in our community,” they said.

“One example of such an endemic disease is influenza. Every year, many people catch the flu. The overwhelming majority recover without needing to be hospitalised and with little or no medication.

“But a minority, especially the elderly and those with co-morbidities, can get very ill, and some succumb.”

They said that because the chances of falling very ill from influenza were so low, people lived with it.

The key to living with Covid would be vaccination.

“With vaccination, testing, treatment and social responsibility, it may mean that in the near future, when someone gets Covid-19, our response can be very different from now,” they said.

That might mean that an infected person could recover at home rather than hospital because, with vaccination, the symptoms would be mostly mild.

There might not be a need to conduct massive contact tracing and quarantining of people each time infection was discovered.

People could get themselves tested regularly using a variety of fast and easy tests.

“And instead of monitoring Covid-19 infection numbers every day, we will focus on the outcomes: how many fall very sick, how many in the intensive care unit, how many need to be intubated for oxygen, and so on. This is like how we now monitor influenza.”

Currently, New Zealand has 71 Covid cases, six of whom are in hospital, but none are in intensive care.

It is now known whether they were vaccinated or not.

But the numbers are small compared with previous studies of flu patients in New Zealand hospitals.

In 2012 a study of flu patients in the Auckland Counties District Health Boards found that From May to August 1370 patients were recorded with severe acute respiratory infections, including 38 who were admitted to an intensive care unit. Seven died.

It is still far too early to expect New Zealand to start regarding Covid as something akin to flu.

But clearly, it is an idea that Hipkins is beginning to think about.

“We’re still aiming for elimination at this point, and I think that we do need to give it a really good go and see if we can drive it out again,” he told “Q+A”.

“It’s absolutely our number one priority at the moment.

“It’s absolutely what we’re focused on.

“But we also need to drive up our vaccination rates.

“And we’re really focused on doing that with recalibrating our vaccine campaign so that it can continue despite the level four lockdown; in fact, we’re doing more vaccinations now than we would have been had it not been for the lockdown.

“So we’re very focused on thinking and making sure that we are preparing for a different kind of a future at this point.

“We don’t really know what that will look like.”

Hipkins said, simply, the higher the vaccination rate, the more options the country would have, but we could not sustain lockdowns forever.

“So, at some point, you do have to have other alternatives. And we’ve been exploring those,” he said.

“So there will be different settings at the border, which will bring with them a different risk profile as well.

“But what we’ve got to do is work out how we can continue with an elimination strategy, with some things changing, including the fact that we can’t sustain doing level four lockdown every time there’s a community outbreak.”

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