Covid 19 coronavirus: How contained is the outbreak and how close are we to level 1?

ANALYSIS

The current outbreak appears to be well contained, but it would be a bold and ballsy call to announce today that the country will move to level 1 next week.

That is despite the almost 300,000 tests that have taken place in recent weeks and the ever-dwindling number of new cases.

It's been a week since there were more than five new cases in a day outside of managed isolation and quarantine (MIQ) facilities. Yesterday there was only one new community case despite 10,000 tests, and almost half of the 152 cases in this outbreak have now recovered.

The cluster is 150-strong and more cases are expected, but they are not too worrisome if they fit into the puzzle we already know about.

Question marks over some cases

There are only two cases that have a different strain of Covid-19 to the cluster. One is thought to be historical, and the other caught Covid-19 in an elevator at an MIQ facility. Neither has passed on the virus.

There are four groups with the same strain as the cluster but no epidemiological link, meaning there are missing links in the infection chain between the cluster and each group. But most of the contacts for each group have now been tested.

The biggest is associated with the Mt Roskill Evangelical Fellowship Church. The group has 24 positive cases and 625 identified contacts; 68 of them so far have not been tested, while 84 people who might be contacts are still to be reached.

There are five cases connected to the GP practice of former Cook Islands Prime Minister Dr Joe Williams. Of the 222 identified contacts, 23 have not been tested.

The others are a Botany group of five cases and a man who presented at the North Shore Hospital emergency department with severe symptoms, who has two other Covid-positive people in his transmission chain. Only one contact has not been tested from these groups.

And from the 10 bus journeys that potentially carried Covid-19 all over Auckland, nine out of 34 contacts have not been tested.

It's possible that the outbreak's 178 close contacts (out of 3162 in total) still yet to be reached have been spreading Covid-19 during the relative freedoms of level 2 this week.

But the risk is mitigated by the 19 days Aucklanders spent at alert level 3, when they all should have stayed at home.

It is also reassuring that close contacts have been in isolation regardless of whether they've tested negative. This recognises how people can be infectious for a few days before they test positive.

The Government's effective response

The high levels of testing also suggest increasingly that the back of the outbreak has been broken, even though the source still remains a mystery.

The past three-and-a-half weeks have seen an effective resurgence plan in action, particularly with mass testing and contact-tracing.

The Government has also strengthened controls by introducing mandatory QR codes in businesses and on public transport, stricter mask-wearing rules, and plans to roll out a CovidCard trial in the community and at an MIQ facility.

But it would still be a big move to go to level 1 next week.

Given the incubation period, testing results generally indicate the prevalence of Covid-19 from a week ago, so the impact of moving Auckland to level 2.5 won't come through until next week.

To jump to level 1 without seeing how level 2.5 has fared would be inconsistent with the Government's precautionary approach so far.

Director general of health Ashley Bloomfield. Photo / Mark Mitchell

The risk of rapid transmission at level 1 is also much higher because it's effectively normal life - no social gathering limits, no physical distancing requirements, no masks - but with closed borders.

That's why director general of health Ashley Bloomfield previously wanted two full two-week incubation cycles at level 2 before moving to level 1.

Such caution may not be necessary if testing remains high and contact-tracing continuously improved.

This outbreak may have been detected earlier if there had been 4000 daily tests in the community and regular testing of border-facing workers - which the Government was unsuccessfully striving for.

The decline in community testing was in part due to changes at the end of June, which saw people with symptoms being told not to get tested unless they were connected to overseas travel, a border facility or a positive case.

By the time Prime Minister Jacinda Ardern tried to remedy this with a "say yes to the test" message - on August 3 - the current outbreak was already spreading.

That shortcoming is being addressed in the new testing strategy to ensure ongoing testing of people with cold and flu symptoms as well as those connected to higher-risk places or people.

Ardern could decide to put the rest of the country at a more relaxed alert level, given the lack of transmission outside Auckland.

But she has already said it is better to have the whole country on the same setting when it comes to lower alert levels.

This offers more protection for people travelling in and out of Auckland, and also gets rid of the need for travel exemptions, which has caused the Government more than a few headaches.

If the Government follows its previous practice of scheduling alert level settings in two-week blocks, we will see at least another week at level 2.5/2.

There may be restriction fatigue brewing - especially for the hospitality and events industries outside Auckland - but judging by recent support for putting Auckland into alert level 3 last month, a public revolt is far from imminent.