"Eighteen months into this pandemic, despite ongoing warnings, the fragilities of our health system remain glaringly obvious." writes Michael Morrah.
Like the villain and the hero of a Hollywood movie, Delta creates havoc and the health system and its workforce fight back.
But just a week into this outbreak, the cracks in the system were obvious. On August 24, the Director General of Health Dr Ashley Bloomfield acknowledged in his typically measured, reassuring way that the virus had thrown “a few curve balls.”
"Combating Delta in the community is like dealing with a whole new virus," he said.
But this of course is not a new virus, and this outbreak should not surprise anyone. So called “curve balls” are what Delta delivered when it first showed up last December.
For months we’ve watched it spiral out of control - first in India, then Fiji, and more recently in Australia. An outbreak here was inevitable. It was predictable. And for months the public was reassured by officials that we were ready for Delta. But when it hit, it rapidly became clear, we weren’t.
Before this outbreak, I had been asking questions about our contact tracing capacity and what’s known as stress testing.
Stress testing is important as it gives you an indication of how well we’d cope if we suddenly had an outbreak. Think of it like asking staff to contact 300 people in 10 minutes and see how they cope. Contact tracing is about identifying cases quickly, so you get ahead of the virus and anticipate the risks. If it’s done well with adequate resources, it can get us out of lockdowns faster.
On August 13, just three days before this current outbreak, in response to questions about outbreak planning, the Health Ministry told Newshub "scenario planning exercises began in December 2020".
On the same day, Auckland Regional Public Health said it had a "fully staffed" COVID response unit, plus surge staff.
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However, just a few days after the virus began to spread and case numbers grew, officials scrambled to recruit hundreds of extra contact tracers.
Philip Hill is a McAuley Professor of International Health at Otago University and has been advising the government on its response. He told Newshub the current outbreak is not a massive one, but it’s clear officials were taken by surprise.
"If you plan properly for an outbreak like this then one would hope you wouldn’t have to advertise for new staff in the middle of the outbreak."
Three times Professor Hill and a team of experts including Sir Brian Roche have reviewed our response, and three times there have been calls for improvements to contact tracing capacity.
"And I think we are probably seeing relatively limited capacity in this outbreak when you look at the response and what we know so far," Professor Hill told Newshub.
When you look back on New Zealand’s coronavirus experience, limited capacity is a recurring theme.
During the August 2020 outbreak, the COVID response minister said this:
"I can say the contact tracing systems are not only holding up, they are performing as well, if not better than we expected them to."
But Official Information revealed the reality.
Authorities were "too slow" to respond and worked "unsustainable long hours". They couldn’t keep up with a maximum daily workload of just 14 new cases a day.
Fast forward to Auckland’s February outbreak and concerns about “limited resources” were flagged almost immediately. Public health staff were at “risk of burnout” when managing just 12 community cases.
Professor Hill says that’s a significant problem.
"You can't afford to play around with a COVID outbreak. What you want is the staff to be full of energy and enthusiasm and to be confident."
Last August, Hill and his team revealed a problem in our public health system.
"That was a real lightbulb moment for us I think. We found that they'd been battling constantly over their finances."
At that point, Auckland Regional Public Health had been given extra COVID funding - about 7 million dollars. While that might seem like a lot of money, for people in the know, like Hill, it was just a drop in the bucket. A dangerous gamble.
"We couldn't make any sense of it. It was like someone was deciding on behalf of New Zealand to throw a dice and convince themselves and everyone else that it was always going to land on a 1 or a 2 and that we were never going to have a large outbreak," he said.
A further one billion dollars was announced to support testing and contact tracing in December. It's not clear exactly how that money was spent.
The Health Ministry has not responded to questions about the extra funding, and as we know, capacity issues were evident during the February outbreak after this funding had been allocated.
On the frontline of this deadly virus are the doctors and nurses.
Lynne Dowland began a career as a nurse as a 17 year old and has been in the job for 35 years. She's worked in hospitals, in the community as a district nurse and is currently a delegate for the New Zealand Nurses' Organisation. When she first started in the job, she remembered a very different working environment.
"There was a time as a young nurse we had time to talk to our patients. We had time to do the job properly. We had time to make sure our patients were washed, their beds were made," she told Newshub.
Now she says everything is rushed, and every shift is non-stop.
But throw in a Delta outbreak and with chronic low staffing already an issue and she says it’s become dangerous, especially for her hospital colleagues.
"I was at a delegates meeting, on Zoom, the other day and the staff were utterly fatigued, they looked exhausted. One girl was so tired she had driven home and crashed her car into a fence and then said 'and I’ve got to go back to work tomorrow'."
She worries about what would happen if a large number of nurses and doctors suddenly got sick with COVID19.
"If you haven’t got them, what’s going to happen? People are not going to be able to be looked after and I think some people just might die."
A nurse at Wellington Hospital agrees with her colleagues’ assessment of the overburdened workforce.
The nurse, who asked to remain anonymous, said during this outbreak, she also felt unsafe on the job.
Recently, she was sick with COVID-19 symptoms and awaiting a COVID test result, but told Newshub she was told to come to work anyway.
"(It was) upsetting and it didn't make me feel safe in the hands of the DHB (District Health Board)," the nurse told Newshub.
The Government made rule changes mid outbreak allowing health workers to return to work in some instances quicker than people employed in non frontline roles.
But when we asked the Ministry about the scenario with the Wellington Hospital nurse, it’s advice was clear. A spokesperson told Newshub “anyone with symptoms of COVID-19 should get a test and self-isolate until the test result is back".
The nurse said her DHB bosses thought otherwise.
"They told me I was a low risk of having COVID so I should just come into work. I felt like I was obliged to go to work, and yes pressured to go to work," she said.
The nurse also spoke of conflicting advice given to her colleagues by different DHB managers about when they should return to work after being stood down when they’d returned to Wellington from Auckland.
Newshub spoke to two other hospital nurses in Auckland who spoke of similar concerns. Neither were willing to be interviewed fearing repercussions from the DHB.
This outbreak and how we handled it will no doubt need to be reviewed, to once again investigate where we could do better. Once again, faults will be found. But when will we learn from these experiences?
Contact tracing staff appear to have been overwhelmed in the face of a relatively small-scale Delta outbreak, nurses complained of safety issues like they did in early 2020, and vaccinators suddenly closed their clinics in Auckland to support their colleagues at overrun testing sites.
Eighteen months into this pandemic, despite ongoing warnings, the fragilities of our health system remain glaringly obvious.
Will we get out of this outbreak? Professor Hill says yes.
"I’m sure that we can stamp this Delta outbreak out but we’re going to have to put everything we have into it and at alert level 4 it means the whole population needs to do exactly what’s needed."
But when the case numbers and testing queues subside, the Government will need to show New Zealanders exactly how it’s addressing these concerns before Delta strikes again.
Michael Morrah is Newshub’s Investigations Reporter. He won Reporter of the Year at the NZTV Awards in 2020, and Best Coverage of a Major Event for his work on COVID-19 at the 2021 Voyager Media Awards.
