Health inequity could pose a major risk to poorer communities if Covid-19 surged in New Zealand, shows new modelling released this afternoon.
Researchers at Te Pūnaha Matatini, New Zealand's Centre of Research Excellence in Complex Systems and Data Analytics, have also found that reopening Kiwi schools would be unlikely to result in more cases.
But increased interaction between kids and parents at the school gate could still present a danger.
The latest model is what's called a "structured" model – or one where researchers try to account for how different we all are from each other: "The ways that people interact with one another, the different ways we are affected if we become ill with Covid-19, as well as the very different access to healthcare that different communities have," said the centre's director, Professor Shaun Hendy.
"For example, children have many more contacts with other children through school, while adults will interact with each other through workplaces. Then at the end of the day we go home and interact with each other."
Many examples from around the world show how Covid-19 hit impoverished communities harder.
Singapore has seen a large secondary outbreak of Covid-19 in migrant worker communities, where people lived in crowded dormitories – with sometimes up to 20 people in one room – and had poor access to testing.
"There are reasons to expect that the disease will spread very differently under these conditions than it might in more well-off districts in Singapore," he said.
"This shows how important it is to capture the different living conditions and access to healthcare that different communities have in modelling Covid-19."
In New Zealand, statistics showed that Māori and Pacific people had less access to
healthcare and were much more likely to have unmet health needs.
"This not only puts Māori and Pacific people at higher risk if they do get infected, it means that they may not be able to get a test if they need one," Hendy explained.
"If the Government wants to avoid a secondary outbreak then it needs to ensure that the health needs of all communities in New Zealand are having their health needs met equitably.
"Singapore has already shown us that inequities in healthcare can lead to Covid-19 outbreaks that grow very quickly before being detected."
The modelling looked at a scenario where a population was split into two groups, both of which had the same amount of sub-clinical levels of Covid-19, but differing access to healthcare.
It suggested that, in the group with good access, 75 per cent of cases would be detected – but in the other group, with poorer access, just 5 per cent of cases – or only the most severe ones - would be picked up.
Another big risk factor was communities with limited ability to self-isolate or practice social distancing.
"Remote populations, including for example rural Māori communities, are particularly high-risk, especially given they tend to have relatively older populations," Hendy said.
"The overcrowding and economic insecurity that affects Pacific communities in our urban centres also put them at risk.
"There is a danger that undetected outbreaks could grow quite rapidly so it is important to provide access to community testing facilities for these communities."
Covid-19 and kids
Meanwhile, the modelling also looked to fast-emerging evidence indicating that Covid-19 was a very different disease in children than in adults.
"Our model showed that because children don't tend to spread the disease as much or get severely ill, reopening schools is unlikely to result in more cases in an outbreak," Hendy said.
"However, it also showed that if adult interaction increases, for example through parents at the school gate, then an outbreak is more likely."
Overall, data suggested there were very few cases detected in children and they were less severe, although there have been some tragic cases worldwide.
Just as important, Hendy added, was that children were less likely to spread the disease – and studies of multiple family clusters had revealed children were unlikely to be the first case in a family.
"One of our biggest clusters was named the Marist College cluster because the first case was a teacher at the school, but it's worth remembering the majority of cases in that cluster were not children."
Hendy said the main takeaway from the latest data was that inequity made societies much more vulnerable to the virus.
"To stop the spread of Covid-19 you've got to ensure that the healthcare system delivers equitable outcomes for everyone," he said.
"Ideally this would have been addressed before the current crisis, but it would be a real weakness now if we let these issues persist. It could see us have to go into lockdown again and it could prevent us from reopening our borders in the future."
The group's work has suggested that, although there's a possibility New Zealand has stamped out community transmission through its bold lockdowns, it's possible the virus might still be silently circulating.
"If it is still out there then we will likely see a bounce back at alert level 2 in the coming weeks," Hendy said.
"If that happens then our testing and contact tracing, which has improved a lot since March, will be crucial at containing any new outbreak and preventing us from having to go back into alert level 4 again."
Today, director general of health Dr Ashley Bloomfield said a sole new case reported today – a "weak positive" that had carried over through lockdown - reinforced the "long tail" of the coronavirus outbreak.
"While we do not consider this case to be infectious, it does demonstrate once again that we must stay vigilant," he said.
"Covid-19 will continue to linger, so we need to keep consistently doing the things which will help keep all New Zealanders safe and allow us to continue to relax restrictions."
New Zealand's case tally stood at 1498 cases, of which 1148 were confirmed and just 56 were active.