Covid 19 Delta outbreak: Derek Cheng - Why Jacinda Ardern is easing restrictions as cases rise - again

ANALYSIS

The Delta tightrope that Prime Minister Jacinda Ardern has been inching along since the start of the outbreak won't get any easier if she lets Auckland open up more next week.

But the fact she has signalled more freedoms - which can only mean Aucklanders will be more likely to catch Delta - shows how her decision-making has changed in recent months.

Step 2 of level 3 means retail shops, museums and libraries can open with no limit on numbers, and outdoor gatherings can be held for up to 25 people.

If that seems reckless for a city in the grip of rising cases numbers, then Ardern's counterpoints are fear of lockdown fatigue, and vaccination coverage.

The former appeared on Saturday when a protest of up to 5000 people marched through Auckland.

It's hardly a large proportion of people in a city of 1.7 million, but it only takes a small number to break the rules in a way that could see the virus spread far more widely.

With the Opposition piling on the pressure for a Freedom Day in Auckland, Ardern is acutely aware of the ongoing need for social cohesion, which means continuing to show Aucklanders a way out of lockdown.

The cost-benefit equation is how to allow more freedoms while keeping health services from being overwhelmed.

This is where vaccination coverage matters; only three of the 260 cases who have been hospitalised were fully immunised, meaning they had their second dose at least 14 days before testing positive.

Double dose coverage in Auckland DHB is estimated to hit 90 per cent coverage of the eligible population in about 10 days, in Waitemata DHB a week after that, and in Counties-Manukau DHB by the end of the month.

These are the trends that have fed modelling by Counties-Manukau director of public health Dr Gary Jackson, which showed case numbers peaking at about 200 a day by mid-November.

By the end of November, 150 people a week would be admitted to hospital, 11 needing ICU care. Covid-19 patients would take up 106 hospital beds, including 20 ICU beds.

The health system and contact tracing capacity should be able to cope with this, with most of the active cases in home isolation.

These are the estimates for the model's median projection, which more or less aligns with the outbreak at the moment.

The upper projection is for 300 cases a day by the end of November and still trending up, but Ardern said that hospitals would still cope with this scenario.

Modelling showing the upper and median projections for daily case numbers as vaccination coverage increases.

But does the modelling assume upcoming looser restrictions?

Waikato moves to step 2 of level 3 tomorrow, even though there are 100,000 eligible people who are less than fully vaccinated, and the virus is circulating in marginalised communities that are much harder to engage.

In Auckland, the 90 per cent double-dose targets are unlikely to be met by Monday next week, when Cabinet will meet to confirm the Auckland move to step 2.

By then, there will still be at least 200,000 eligible Aucklanders who are less than fully vaccinated, 100,000-odd who are not vaccinated at all, and 300,000 who are too young to be eligible.

There will also be some 50,000 eligible Māori, who make up a far greater proportion of cases than any other ethnicity - who will be less than fully vaccinated.

Asked if further easing restrictions as case numbers continued to grow would throw Māori under the bus, Ardern said opening retail stores wouldn't do that.

But it's not only about retail shops. We know Aucklanders are exceptionally interconnected, and there are thousands of ways the virus could hop from one suburb to the next.

The health advice, Ardern said, was that level 3 step 2 in Auckland wouldn't see a marked increase in case numbers.

Added director-general of health Dr Ashley Bloomfield: "Step 2 won't add a whole lot of additional risk."

This perfectly encapsulates how Ardern's tightrope has changed.

Cabinet used to ask Bloomfield for the best way to keep the most New Zealanders safe.

Now he is asked what freedoms can be restored that will clearly be risky, just not too risky - or so we all hope.