Wednesday, October 6, 2021

covid reality...

 We should brace ourselves for the likelihood that the Covid-free haven we've been enjoying is goneburger and not coming back.

It might return, if this Delta outbreak is extinguished - an increasingly unlikely prospect.
It might also return via vaccination - by mid-December at the earliest - but in a different form.
Getting there is what Prime Minister Jacinda Ardern is calling the transition, which has been broadly interpreted as abandoning elimination as vaccination coverage increases.
It certainly seemed like elimination had been abandoned.
There was the shifting of Auckland from alert level 4 to 3 while there were still pockets of community transmission.
There was Monday's decision to allow Auckland households to mingle outdoors at the same time as case numbers were trending up.
Then, yesterday, areas outside the Waikato boundary were left at level 2 despite new cases popping up.
It left an impression of a Government that used to throw everything at the virus, but had decided not to anymore. Ardern was waving the white flag.
But she wasn't. And regardless of whether it's still elimination, the aim is still to stamp out every case in the pursuit of zero cases.
The majority of Delta cases in recent weeks have been among gangs members and rough sleepers - marginalised communities that are more distrustful of authorities. Photo / Duncan Brown
The majority of Delta cases in recent weeks have been among gangs members and rough sleepers - marginalised communities that are more distrustful of authorities. Photo / Duncan Brown
The complication is that the virus has seeded into marginalised populations - gangs and rough sleepers - who don't care what alert level it is.
They make up the majority of cases in recent weeks, the first ones emerging before Auckland's shift to level 3.
Why keep 1.6 million people at level 4 when the cases and their contacts would behave the same way, regardless of what alert level it is?
They aren't easily ring-fenced either, with new cases consistently popping up in south and west Auckland.
Here are the case numbers in the suburbs of concern for the fortnight to Tuesday: fewer than 10 each in Favona, Papakura and Mt Eden; 12 each in Henderson and Mt Wellington; 18 in Clover Park; 23 each in Manurewa and Mangere.
This is also why level 3 has been kept in Auckland.
Cabinet decided on Monday that some outdoor socialising in Auckland wouldn't undermine public health efforts to find and isolate the remaining cases in these suburbs.
It's meant to make level 3 more palatable without making a huge difference to the public health threat. It's not like gang members will suddenly think, "Oh, we can have outdoor picnics now."
The move is still not without risk, but Ardern decided it was one worth taking.
Also playing a hand was the impact of the long weeks in lockdown, and the potential crumbling of public compliance - though there has been little sign of that, nor any advice to Cabinet indicating it was imminent.
Ardern could have pulled Aucklanders back into level 4, and likely would have if the virus was out of control - but case numbers haven't exploded.
And while it may seem like everything is unravelling, there was only one unlinked case yesterday.
Cases haven't died out either. Reaching every corner of marginalised communities is a complex task.
Here's some insight, from Auckland public health medicine specialist Nick Eichler: "Always remember that we couldn't get back to zero because Covid took hold in the communities that 'mainstream' society forgot. Our current situation is entirely due to poverty, housing and colonisation."
Public health teams are still trying to stamp out the virus.
As of Tuesday, they had completed testing at 37 out of 50 transitional and emergency housing facilities, boarding houses and community housing providers in Auckland.
Cases in those facilities are now understood to be more ring-fenced than those connected to gang members.
Because they're distrustful of local or health authorities, gang leaders Sonny Fatu and Harry Tam have been brought in to try to encourage testing, vaccination, and cooperation with contact tracers.
Gangs are also connected to the latest spread in the Waikato.
One reason the new cases outside the boundary didn't trigger a level 3 move was because their source is known.
Another is the vaccination coverage which, while low, is increasing.
This is Ardern's transition. The higher the vaccination coverage, the fewer restrictions will be needed.
But while coverage is still relatively low, the risk of uncontrolled transmission remains. Aucklanders shouldn't expect step two of the level 3 easing - including the opening of customer-facing businesses - anytime soon.
As Covid-19 modeller Professor Michael Plank says, managing Delta in the community in a way that keeps health services from being tsunamied is a "very narrow path" to tread.
It's entirely possible that the tsunami will come, entombing Auckland and potentially other regions in level 3 until mid-December, which is the earliest timeframe for 90 per cent coverage.
Such a potential scenario means that the Government must put all its energies into the public health teams fighting the outbreak, and into the unvaccinated communities most at risk - in particular young Māori and Pasifika.
Avoiding the tsunami would mean missing the Covid misery that has enveloped most of the world for the last 18 months.
And it would mean a smooth transition to a new normal, centred on high vaccination levels.
It wouldn't be the same as the level 1 bliss we've previously enjoyed, but the hope is that it wouldn't be too dissimilar.

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