Cabinet will be playing "Russian roulette" with the health of New Zealanders if it makes a lockdown decision without first vastly improving rapid contact-tracing and collecting more information about Covid-19 in vulnerable communities.
That was the stark warning this morning from Otago University Professor and epidemiologist Sir David Skegg, who appeared before the Epidemic Response Committee for the third straight week.
Prime Minister Jacinda Ardern has said that Cabinet will make a decision on Monday on whether to lift or extend the nationwide lockdown from next Thursday.
But Skegg said the Health Ministry first needed to make giant strides in rapid contact-tracing, in order to deal with any new fast-spreading clusters, and surveillance testing, which means collecting information to see where coronavirus is present in the population or among certain demographics.
Skegg said New Zealand should be able to trace close contacts for all new cases within two to three days - which is Australia's current capacity - as well as having surveillance testing not only up and running, but completed by the end of this week.
"If the answer to those questions is 'no', I would submit that we're asking the Cabinet to play Russian roulette with the health of New Zealanders," Skegg said.
"I'm concerned the public health authorities have not yet completed the tasks that are needed to ensure we are on a path to elimination."
Skegg said it was foolish to presume a decline in new cases was enough to show the virus was being eliminated, and more testing data was needed to be more confident - especially among more at-risk groups.
Surveillance testing was essential before "we have reached the point where we can take our foot off the brake", and there was still no sign of when that would start taking place in New Zealand.
"This virus must still be circulating today in New Zealand among the many essential workers and others who are leaving heir bubbles everyday.
"As soon as the lockdown is lifted, the epidemic will take off again unless we have the other measures in place."
Earlier, Director General of Health Ashley Bloomfield had not been able to say how many days it was taking in New Zealand to contact-trace.
He added that surveillance testing was still yet to start, even though Health Minister David Clark said the roll-out was imminent on March 18.
Published testing data already showed that more testing was needed in Whanganui and Te Tai Rawhiti, and he said that such testing was now being done.
Ardern and Bloomfield have previously said that an app to enhance contact-tracing did not need to be ready before lockdown might be lifted.
Bloomfield has also pushed back on the need - proposed by infectious diseases specialist
Dr Ayesha Verrall - for close contacts of 1000 cases to be traced in a day. Bloomfield based this on the fact there are fewer than 1000 active cases in New Zealand now.
Skegg said New Zealand was in its third week of lockdown but still was nowhere near where it should be in terms of contact-tracing, which would be key in isolating and containing any new cluster post-lockdown.
Looser lockdown in Australia
Skegg rejected the suggestion that New Zealand should have followed the looser restrictions in Australia to allow for more wheels of the economy to keep turning, while still keeping Covid-19 in check.
"We're right to be ambitious. If we fail, we can slip back to what the Australians are doing, but you can't go the other way.
"I don't think we should apologise for trying to get a better outcome."
He said Australia's restrictions, which allowed for more construction, manufacturing and retail, were also likely to be in place for at least six months, but if New Zealand played its cards right, the lockdown would be over after four weeks.
Earlier the committee heard from Australia's chief medical officer Professor Brendan Murphy, who said New Zealand was lucky that the Ruby Princess cruise ship only made temporary stops in New Zealand.
The cruise ship stopped in Christchurch, Wellington and Hawke's Bay before returning to Sydney on March 19.
The ship is at the centre of multiple Covid-19 deaths across the Tasman.
Seventeen passengers from the Carnival cruise ship had died, and more than 650 people have been infected. They include passengers and other points of contact.
The cruise ship headed to New Zealand for a two-week cruise around the country.
The Ruby Princess berthed at the port in Napier on March 15, its last port of call in New Zealand before heading back to Sydney.
Its docking led to a cluster of Covid-19 cases in Hawke's Bay, including six in Gladys Mary Care Home in Napier.
Murphy told the committee today that Australia had many more cases than New Zealand, though two-thirds of the cases in Australia were from returning travellers and from cruise ships.
There were about 30 to 40 new cases every day. All returned travellers were being quarantined for two weeks, but a significant number of new cases continued to come from overseas arrivals.
He noted that an outbreak in Tasmania was linked to what he called an "illegal dinner party" of health professionals, details that he has not previously confirmed.
Murphy said any clamour to relax the restrictions was still "premature", and there was no right answer to getting out of the pandemic without a vaccine.
Australia, as had New Zealand, had rejected the idea of a controlled outbreak, and Murphy said aggressive suppression was Australia's goal and he doubted "elimination" could be achieved in the long term.
"But if we were pursuing a total elimination strategy, that's the situation where you might go a bit harder for a bit longer - that's a debate we have to have, but at the moment there's no pressure."
But Australia's "social distancing" had been in a "large part" similar to New Zealand's approach.
National leader Simon Bridges, who chairs the committee, said he had been told he needed a haircut, and he couldn't in New Zealand but hairdressers in Australia were allowed to continue to operate.
Murphy said people were told to work from home, but if they couldn't, they were allowed to go to work if they could remain physically distant.
Hairdressers had been allowed to continue as the restrictions were likely to be in place for months, he added.
Retail chains were allowed to stay open, but many had chosen to close, Murphy said.
The Australian Government had not wanted to close schools - but parents had stepped in and stopped sending kids to schools.
Murphy said the last thing Australia wanted was a relaxation of the restrictions leading to further outbreak.
The use of apps to enhance contact tracing was needed before any relaxations, and there also needed to be a good supply chain of test kits, as well as surveillance testing to check wide community transmission, which he said was still some weeks away.
He said, though, that most school outbreaks had been adult-to-adult, and getting schools back and running was on the agenda.
Murphy said some states with bigger outbreaks were considering more business closures, but Australia had gone for a two-person gathering restriction instead.
The public health recommendations were that physical distancing could be in place for several months, which was why major gatherings, pubs and clubs, cinemas and gyms were all shut.
'We would go harder if necessary'
Construction, manufacturing and retail would have followed if the outbreaks had been worse, he said.
"The feeling in the National Cabinet was we would like to keep some of those core activities going, and clearly if things got worse or do get worse, we would go harder."
He would not be drawn on whether New Zealand should allow more construction, manufacturing and retail, saying it depended on New Zealand's circumstances and it was a decision for the New Zealand Government.
"It's a long haul, with measures in place that are pretty significant that you can tweak a bit from time to time, but nothing will really beat having a really broad public health response.
"The evidence that if you go hard late, which the UK has done, you can see what carnage you suffer on the way through. As soon as we saw significant community transmission, we felt we did have to go hard.
"Our 'hard' is very different to someone else's 'hard', but it is very disruptive. We may not have gone as hard as New Zealand, but we will go harder if necessary."
Murphy said until a vaccine was ready, the level of vigilance needed to "be huge" and further outbreaks were always possible.
He said surveillance testing and the use of smartphone technology and physical distancing would continue to be the "new normal", and festivals would likely continue to be banned for the foreseeable future.
He said the TraceTogether app, which is used in Singapore and is being considered by New Zealand to enhance contact-tracing, was also on Australia's radar.
Skegg said Australia was a "bit of an enigma", even though the number of per capita cases in Australia was similar to New Zealand.
"If you look at the harder end points, in terms of recurrence of disease, they have a lot more deaths than we do ... if you look at hospitalisations, Australia had 378 people in hospital. New Zealand has 15."
That amounted to five times as many people in hospitals in Australia, accounting for the differences in population, Skegg said.
Skegg said it was an enigma because, like New Zealand, Australia had a high rate of testing, a high proportion of positive cases linked to comparatively healthy travellers returning from overseas, and was coming out of a summer.
"I can't really explain it."
National MP Paul Goldsmith said Australia had shown that lockdown could be eased and the number of new cases would still be "manageable", and Skegg New Zealand could have similarly looser restrictions but only if it had more rapid contact-tracing in place.
Skegg said Australia would need to hold its own lockdown for at least six months, possibly 18 months.
"The countries that have not succeeded in controlling this disease - in a few months, it will probably be 100 countries - I would be very surprised if we're going to do worse economically because of the measures we're taking in the medium-term."
He said he would love to see "some transparency" about the criteria for coming out of lockdown, and an independent advisory committee including public health experts, academics and business leaders should be set up to advise the Government.
Kiwi health boss on how NZ compares to Oz
Asked about the less severe lockdown in Australia, Bloomfield told the committee there was more "strikingly similar" in the two approaches and Australia was probably at alert level 3.5, depending on the state.
He noted that Australia was prepared to "go harder" if necessary, and New Zealand had decided to go "a little harder to start with", but he was watching Australia to inform the New Zealand Government about how to move forward.
Bloomfield said no decisions had been made on whether to ease restrictions on certain sections of the economy, and things wouldn't be the same at alert level 3 or even 2 because physical distancing measures would "continue to be absolutely essential".
"Whatever level we find ourselves in in four or six weeks, there will be some fundamental things about physical distancing, the ability to contact trace - those will be almost like a new baseline."
He added that the economic activity will likely be eased slowly, with a close eye being kept on how that goes.
Australia had allowed more small food stores to stay open and construction workers to keep hold of their livelihoods, but Bloomfield said the message not to go out except for something essential was the same message in both countries.
Asked about whether New Zealand could have had a looser lockdown and still achieved what Australia had done in suppressing outbreaks, Bloomfield said it was not possible to say.
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"It's different in each country because the pattern is different in each country."
Bloomfield said over 6000 samples can be tested for Covid-19 a day, and he pushed back on the suggestion that comprehensive contact-tracing capacity would not be ready in time for lockdown to be lifted from next Thursday.
He said more than 64,000 tests had now been done and there was a good regional spread of tests.
"That's giving us a very good picture of Covid-19 and/or the spread, where it may be around the country."
Bridges said there were gaps in the Health Ministry's information about the days taken for a test result and the time taken for contact-tracing - key factors in whether the lockdown can be eased.
Bloomfield said the manual system had been upgraded in recent weeks and that information will be available soon.
Next week he would be able to talk about the time taken from when people develop symptoms to when they are tested and how long they've been in self-isolation.
Labour MP Kiri Allan asked about the vulnerabilities around rural communities, including Te Ti Rawhiti, and Bloomfield said restrictions into and out of those areas were being considered.
Bloomfield said the rationale for going harder - and imposing more restrictions than Australia - was to come out of lockdown as quickly as possible.
Asked whether New Zealand was likely to go back into alert level 4 again once the nationwide lockdown was the lifted, Bloomfield said: "I can't say. I'm sorry, I'd love to be able to say that."
Bridges pressed Bloomfield on PPE, noting that there appeared to be a disconnect between reality and the Health Ministry's line that PPE was available for all those who needed it.
"Doesn't that show more progress still is needed?" Bridges said.
Bloomfield said the process was "not perfect" and he was happy to receive correspondence showing where access to PPE was failing.