Covid-19

What a regional lockdown would look like

The Prime Minister has signalled New Zealand could resort to regional lockdowns to avert a second wave, but what would that look like in practice? Marc Daalder reports

On April 15, on the far end of New Zealand's Covid-19 curve, Cabinet was presented with a question: Assuming the promising trend of declining case numbers continued (it would), how should we move out of lockdown?

Inherent in the question were logistical and legal issues around transitioning out of a state of emergency and defining the parameters of the lower alert levels. Further complicating the issue was the geographical difference in the way Covid-19 had hit New Zealand.

Already, several regions had gone two or more weeks without a confirmed case. If the virus surged in Auckland or Christchurch, would it really be fair to hold West Coast or Taranaki in lockdown while they were, for all intents and purposes, virus-free?

And if Cabinet did decide, in the end, to move some parts of the country down to Level 3 ahead of the rest of New Zealand, what would that look like? How would travel work between two regions at different levels? How would the legal frameworks be enacted?

A 16-page paper provided to the Cabinet by the National Crisis Management Centre (NCMC) laid out in detail how the process would work, before recommending against a regional step-down. Ultimately, Cabinet agreed and the country as a whole descended through the alert levels until reaching Level 1 on June 9.

Now, however, as second waves of the virus surge through Australia and the United States, the Government has signalled a new willingness to apply alert level changes regionally. Here's what that might look like.

Stopping inter-regional travel

The fundamental principle of a regional alert level change is that some regions are virus-free and some are not. Those that don't have Covid-19 should be allowed to continue on with business-as-usual - but this only works if those regions remain virus-free.

Therefore, stopping travel between regions on different alert levels is one of the key measures.

"There would need to be strict limits on movement between areas that are Alert Level 4, and de-escalated regions, so as to prevent the spread of Covid-19 from areas of the country where it is relatively contained, to areas where it is not," the NCMC paper stated.

Those limits would essentially stop all but a small number of people from crossing between regions at different alert levels. Freight, essential workers performing essential work, emergency staff, officials giving effect to court orders, foreign nationals leaving New Zealand, people returning from overseas and individuals with compassionate exemptions would be the only people allowed to travel both ways between alert levels.

In addition, people relocating a home or business could cross the boundaries, but only from a place with a lower alert level to a place with a higher one.

"No travel between these regions would be permitted for anyone with or displaying symptoms of Covid-19, or their close contacts."

The paper recommended using the 16 civil defence regions as the basis for regional borders, which largely align with regional council boundaries, and identified 84 road crossings or other "control points" that connect the regions. Were each point to be manned 24/7 by a capable team, it would require 12 to 15 full-time staff per crossing or 1008 to 1260 staff nationwide.

Of course, that only applies in a scenario where every single region is closed off from every other region. A more likely scenario is a handful of adjacent regions moving up or down alert levels while the rest of the country operates as one whole. In that circumstance, the situation is more manageable, although some regions would still pose a large burden on manpower - Waikato, for example, accounts for 26 of the 84 control points.

Barriers to regional differentiation

In the end, the NCMC paper indicated a nationwide step-down was preferable. This was largely motivated by the logistical complexity of the operation.

"The complexities of having different alert levels and the limits on resourcing needed to effectively enforce boundaries suggest that geographic differentiation [...] should only be used for a small number of regions at any one time (i.e. most regions, or alternatively only a few regions, should be at Alert Level 3; it would be more difficult to implement such a 'half-half' approach); should be seen as a transition measure with the aim of getting all parts of the country at the same alert level; and would be best used in those areas where there are not significant issues of regular cross-boundary travel for work or school," the paper stated.

"The boundary between Auckland and Waikato and the boundary between Wellington and Manawatu-Whanganui are the most challenging (but not impossible) in this respect."

The NCMC paper raised another crucial reason not to step-down regionally - it could erode the narrative of the team of five million.

"The other key risk is that a geographically differentiated approach to step-down could undermine the social licence on which our wider COVID strategy is dependent. Allowing some regions to step down sooner may detract from the 'all in this together' narrative and compromise efforts at public acceptability for more stringent control measures," it noted.

This same risk was homed in on by the Ministry of Health, which the NCMC authors approached for comment.

"The Ministry of Health does not support different regional alert levels in the first instance," health officials replied.

"We consider it would undermine public cooperation and compliance with the public health requirements, if people see neighbouring regions treated differently. We are also concerned about the likely enforcement measures required, e.g. roadblocks."

However, the ministry did leave open the door for regional differentiation in future scenarios.

"As information about regional incidence becomes clearer and more publicly available in the coming weeks, we consider there is likely to be a better case for regional de-escalation or escalation where justified by public health risk," health officials wrote.

Moving up levels regionally today

Last week, Jacinda Ardern said the country was prepared for any potential second wave of Covid-19 and mentioned regional alert level changes were in her arsenal.

In a scenario where there is a large cluster of cases, connected to a particular event or location, within a broader geographic region, the country could remain at Level 1 while the entire region was put into a higher alert level.

"Here, a significant increase in testing would be the priority. We would look to undertake much wider community testing, on top of testing any contacts or potential contacts of those with the virus. This could look like it did in Victoria where health staff went door to door to test people in affected areas," she said.

"We would also take steps to stop the spread to other parts of the country so a regional shift in alert level would likely be applied that restricted travel. This would mean travel in or out of the city, town or region could be stopped, people in that place asked to work from home, and local restrictions on gatherings implemented."

Michael Baker, a professor at Otago University's Department of Public Health and an expert on infectious diseases, told Newsroom a regional approach could ensure the rest of the country didn't need to suffer the economic and social disruption of a second lockdown unnecessarily. However, he had two recommendations for what needs to change to ensure such an approach functions most effectively.

First, Baker wants to see mask-wearing written in to the parameters of Level 2.

"We've been talking about masks for about two months because we've seen that the New Zealand position has been out of step with the evidence or behind the evidence," he said.

In order to prepare for mass masking, the Government needs to begin embarking now on a communications campaign explaining why masks work and how to wear them properly. New Zealanders should all have a supply of surgical masks or homemade, fabric masks that can be washed and reused, he said.

"We could have an outbreak detected this afternoon. If we wanted to have a localised response to transmission, masks are not going to be part of that because people are not familiar with using them, don't have a supply at home. We would struggle to implement something like that quickly and obviously time is of the essence in that situation," Baker said.

Baker's second recommendation is the creation of intermediate alert levels. While the alert level system has operated well so far, Baker thinks there is room for a bit more nuance and fine-tuning of the rules and regulations.

He points to the staggered step-down from Level 3 to Level 2, in which public gathering limits were slowly inched upwards and bars and restaurants were initially closed. Something similar could be applied nationwide in the event of an outbreak in a particular region - while that area moves up to Level 2 or higher as needed, the country moves to Level 1.5.

In particular, this would see the closure of extremely high-risk settings - bars, concert venues and other indoor spaces where large numbers of people gather in close quarters. After officials could be sure that the virus had not spread out of the region in question before the escalation of the alert level, those nationwide restrictions could be allowed to lapse once again.

"We're probably overdue to revisit the structure of the system. It's very sound - the principles are sound. But the fact that it's now about managing resurgences and therefore we want it to be more useful at a regional level, I think there's just a more effective way of administering it," Baker said.

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