Saturday, November 27

‘Delta thrives on inequality’: strategies needed in south Auckland, experts warn


Experts say the government should prioritize more health funding and resources for South Auckland, which will remain New Zealand’s ongoing front line in the battle against Covid-19.

They say targeted community-led vaccination, faster testing, and more resources for Middlemore Hospital are top priorities, and more data transparency will be important.

A testing station for the Assembly of God congregations in Māngere.

A testing station for the Assembly of God congregations in Māngere.
Photo: RNZ / Marika Khabazi

Speaking to the Health Selection Committee today, Covid-19 modeler Dr. Rodney Jones said that the Delta variant had exploited a vulnerability in New Zealand.

He said the lockdown was having an effect and that the number of new cases could be expected to continue to decline, but “with Delta it’s what we don’t know that creates the problems.”

“What we have to take out of this experience is that delta thrives on inequality,” he said. “We must ensure that we now deploy public health spending and resources in South Auckland because that will continue to be our front line in the battle against Covid.

“The generation time is only four days from the beginning in the person, index one, until they begin to infect other people and so on. So you don’t have time and in those denser communities, more essential workers, more mobility in a confinement it leaves those communities very vulnerable. “

He said that South Auckland, which has a high proportion of Maori and Pacific inhabitants, “will continue to be our front line” and the strategy must be specifically designed to take that into account.

“This is the outbreak that we feared as early as February 2020 because the different cultural and socio-economic environment of South Auckland makes it a [more] challenging outbreak to deal with.

“You cannot leave any vulnerabilities. Covid finds a way to exploit them, you need the maximum and if you don’t bring your minority communities, you leave a vulnerability.”

Motu’s Executive Director for Economic and Public Policy Research Dr. John McDermott said that while other countries had relied on contact tracing and that had proven successful in fighting the virus at first, Delta was running faster than those. systems in many other countries.

“We have to quickly learn from that and take it into account and apply our resources where the risk is greatest, and if they are in South Auckland for whatever reason, that’s where we need to apply those resources.”

Jones said there were three components in terms of how things could have been, and still could be, better managed.

“I think it has been assumed that the blockades achieved removal; removal really involves a wide range of strategies that we now need to adopt.

“When we did the elimination, we were the first country to pursue elimination. And, you know, in the 1930s we were the first to create a welfare state. I think … we have to be the ones to do this. I don’t I don’t think there are any examples that we can see … this is very specific to us. “

Targeted vaccines

Te Pūnaha Matatini Covid-19 modeler Dr. Shaun Hendy told the select committee that the modeling had estimated that the time to reach elimination via blockages could be reduced by about half by increasing vaccination levels from 30 to 50 percent of the population.

Jones felt that vaccine resources should have prioritized South Auckland immediately, and vaccination efforts should follow a “bottom-up” process of working through communities.

“What we don’t want to do is get stuck in a few weeks and realize that we are losing important communities that remain vulnerable.”

He said the government needed to work with community groups in advance to build capacity for vaccine scaling and public health.

“What we have to see is what vaccination rates we can get to. We have to create that level of protection and that’s the most important thing, and then we have to understand how, even with that level of protection, it is affected.”

He said that as researchers, they have specifically sought Maori knowledge in vaccine planning, especially considering the health inequities that already exist in the system.

“We see ourselves as Covid analysts, so in our models you cannot account for that disparity, but in the way you think about it, it is fundamental. And we have come out to listen, to learn and to get a better appreciation of it. kinds of challenges we face.

‘The Delta variant does not give us time’

Second, there should be more options, including saliva and rapid antigen, in the testing toolkit, Jones said, and they should be approved for faster use.

“PCR testing gives you maximum certainty, but we need companies ready to test, we need communities, we need marae to have the ability to test using rapid tests and saliva tests. So, globally, they are now being used. all kinds of tests, and we need to speed up the approval, we need them now.

“What we have to understand is that this is the first of many outbreaks that we are going to have, this is not the last, so we have to learn from this and how to trust PCR tests, make people wait on them. cars for six hours, leaves us behind.

He said he was initially skeptical about rapid tests, but Covid-19 was an ongoing challenge and Delta required a faster response.

“This is ongoing – 2020 was very fixed, Delta is dynamic – it’s going to leak out, we’re going to have a series of outbreaks and rapid testing should be an important part of the toolkit.

“For the occasional false negative, it’s all those early positives that make the difference.

“We have to find all the cases, and the Delta variant does not give us time.”

Funding for Middlemore

The third priority was an increased investment in Middlemore Hospital. Jones said Singapore was providing the best model in terms of vaccination, with rates exceeding 80 percent of the population, but that they were still dealing with an outbreak of more than 300 cases.

“Those vaccinated are doing much better in terms of ICU hospitalization and use, but Singapore reminds us that we have a long way to go.”

“What we are seeing in Singapore is that people were still taking oxygen, still in ICU. We need to invest a lot in Middlemore, we need more negative pressure rooms.”

Middlemore Hospital

Photo: RNZ / Claire Eastham-Farrelly

He said the hospital had suffered years of underinvestment and also needed the capacity to scale up in the event of an outbreak.

“The advantage that richer countries have is that they start from a better starting point of more ICU beds and hospital beds. What we have today is the function of decades of focus on health and, in a way, we should use this as a way of saying we have to change, “he said.

“Middlemore hospital is one of the least resourced. It is politically difficult to prioritize one area, but Covid is not going away and we are going to be fighting this for some time.”

Transparency

Jones said data based on the onset of symptoms rather than the date of a positive test led to a more accurate model.

He said it was necessary to share more valuable data that the Ministry of Health had.

“I think transparency is incredibly important, and it will anchor expectations and trust in a way. I think we need a lot more transparency, we need really detailed data online that people can access, that people themselves can build models. and access them and begin to understand it.

“This is not something that should be elite, this is what we will have to live with and the more understanding people can build, the better, and that comes through information.”

However, he was ambivalent about whether an independent Covid-19-focused health body could help.

“I will express a personal opinion. I think that from that emergency response led by the Ministry of Health to an ongoing response, there is an argument that we will need to use different tools, and maybe an agency.

“Adding more layers won’t necessarily help if your strategy is wrong on the ground, so they are arguments for and against.”

Hendy said that while model reports sometimes went to the Prime Minister’s Department and Cabinet before being released, investigators had the final say on when and how things were released.

“We try to warn the government. We don’t always let them know, the option is left to us, you know, we have the last word on when we publish things, but we do try and make sure that ministers have been exposed to work … so that understand what’s coming. “


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