Auckland health authorities have flagged a need for continued border and public health controls over the coming year if hospitals are to cope with an expected surge of Covid patients, even if ambitious targets to vaccinate 90 per cent of the eligible population are reached.
Detailed scenario planning prepared last month for the Auckland, Counties-Manukau, Waitematā and Northern Region district health boards obtained under the Official Information Act also reveal how disproportionately the death toll of the pandemic is expected to fall on Auckland's Māori and Pacific communities as the outbreak grows.
The author of the plans, Counties-Manukau director of population health Gary Jackson, said the document was prepared on September 16 with the "optimistic" assumption the current outbreak could be controlled, and had a warning for Aucklanders about developments since.
"No country has switched from being completely naive to having Covid circulating without having a horrible surge and lots of deaths," he said.
"You'll either get vaccinated or catch it over the next year. It's that simple."
His report concluded: "In the best case, this sees a manageable volume of cases, hospitalisations and deaths for the Northern Region, but a range of control measures will be needed for some time to ensure this. In the worst case, our controls may be somewhat illusory and the virus could sweep through the population."
Yesterday saw another grim record with 125 new cases of Covid-19 in the community, including a case in an Auckland retirement village. Thirty-nine people are in hospital and four of those in ICU.
Jackson stressed to the Weekend Herald that his study was not a forecast. "This is what it could look like. It's not a projection and it's going to be wrong. The whole point of the document was to allow hospitals to plan."
The optimistic scenario conceived Covid deaths in the region at 160 per year, similar to annual fatalities from the flu. But this was based on regional cases stabilising at 590 cases a week - fewer than the rising numbers seen over the past few weeks.
Other scenarios showed the effect of loosening border and public restrictions on both total case numbers and the increasingly disproportionate cost to disadvantaged communities.
The worst case planned for, with weekly cases stabilising at 5400 a week, was expected to result in 1000 deaths in the region each year.
Jackson said Counties-Manukau had a population that skewed younger, and children under 12 were at presently not able to be vaccinated, meaning even if 90 per cent of the eligible population received two doses more than a quarter of that population would be unprotected.
"That creates a large pool for virus to circulate, unless you try getting some control over it: probably for a year or two at least," he said.
Jackson said his population catchment was 38 per cent Māori and Pacific, but were presently accounting for 90 per cent of his DHB's cases in the current outbreak and models suggested they would bear nearly two-thirds of the death toll.
"It's a large chunk of our population and at immense risk," Jackson said.
University of Auckland epidemiologist Rod Jackson said while the vaccine offered strong protection against the virus with a widespread outbreak, it became an unmanageable numbers game as it found its way into unvaccinated pockets.
"In this current outbreak, one in 10 - more than that - have been admitted to hospital. But that's mainly because this has got into our most deprived communities. Even if the vaccine reduced that to one in 100, or one in 200, if you multiply that by a large enough bunch of people you're in serious trouble," he said.
"This is why Covid is the biggest public health crisis in 100 years."
National Party covid spokesman Chris Bishop could foresee the need for ongoing, albeit targeted, restrictions and said the near future was unlikely to resemble the recent past.
"No one wants to do nationwide lockdowns again, but you can always keep in the toolbox more regional-focused restrictions. Life is New Zealand in 2022 is not going to be what life was like in 2019, no doubt: We've got a global pandemic going on," he said.
Shaun Hendy, whose modelling at Te Pūnaha Matatini underpinned the scenario planning by Auckland health authorities, had a similar warning about 2022.
"We have been insulated, because we've had a lot of alert level 1 life - very few countries have had anything like that over the past 18 months. This will be a bit of a shock for people next year," he said.