Beef up the Covid Alert Level system, say researchers – Expert Reaction

New Zealand’s Alert Level system needs an urgent revamp to suit the evolving pandemic, say University of Otago researchers.

In a new paper they say the current alert level system was designed for last year’s pandemic context, and failed to promote equity and uphold the Treaty of Waitangi. They call for an upgraded system that better suits Māori communities, and reflects new health knowledge, such as strengthening measures on face masks and ventilation to prevent virus spread from breathing infected air.

The SMC asked experts to comment on the paper.

Dr Matthew Hobbs, Senior Research Fellow (Adjunct), GeoHealth Laboratory, University of Canterbury, comments:

“Recent modelling has shown that Māori have 2.5 times and Pacific people 3 times greater odds of hospitalisation than non-Māori, non-Pacific people. Persistent inequities mean that Māori and Pacific communities face a much greater health burden from Covid-19 and thus updates that ensure that Te Tiriti is better upheld are necessary.

“More broadly, the emergence of more transmittable variants around the world has changed the nature of this pandemic. The complacency of New Zealanders after more than 100 days without community transmission provide the ideal circumstances for a large outbreak. The revision of the alert level system will help us better respond to such outbreaks. Of particular concern are the emergence of new variants which are more transmissible and may also decrease the effectiveness of some public health measures. For instance, compared to the original alpha variant, the delta variant is 60% more contagious, making it harder to keep up with in terms of contact tracing. According to UK research, it is also twice as likely to lead to hospitalisation.

“A revision of the national Covid-19 alert level system has been warranted for some time now and the paper by Kvalsvig raises several important areas for further consultation and review.”

No conflict of interest.

Associate Professor Collin Tukuitonga, Associate Dean Pacific, Faculty of Medical and Health Sciences, University of Auckland, comments:

“The paper by Kvalsvig and colleagues is a timely reminder that our alert level system needs to evolve with the changing pandemic disease pattern, and allow for what we have learnt since the beginning of the pandemic in February 2020.

“It has become clearer that the pandemic is complex and likely to persist for an extended period. Experiences with Māori communities have also raised weaknesses in our current system, and indigenous values and way of life need to be incorporated into our revised alert system. Adjustments for Māori values will also benefit Pacific people in Aotearoa/New Zealand because they share similar risk profiles.

“The proposed alert system is an expansion of the current system. It is fundamentally sound but this proposal includes more levels to consider when planning implementation and communication with the public.”

No conflict of interest.

Arindam Basu, Associate Professor of Epidemiology and Health Sciences, University of Canterbury, comments:

“The scheme proposed by Kvalsvig and colleagues has several valid arguments – and at the same time, the scheme is also quite complex compared to the present system.

“The authors’ calls for a new alert system based on new knowledge – and clearer, evidence-based regional travel policies – are well-founded.

“Also, the criticisms that Māori knowledge is inadequately accounted for in the current system is undoubtedly important. As the authors say, the current system does seem to be focused on small nuclear families, whereas Māori and Pacific families may be larger. However, the extent of spread of respiratory viruses can be uncertain in both large and small families, and will depend on how the virus transmits. For example, it is known that the SARS class viruses spread in ways where about 10-20% individuals infect the remaining 80-90% individuals. If that is true for future infections as well, then family size may be less relevant.

“However, their proposed system does not seem to explicitly address all of their own concerns and seems quite complex compared to the existing system. First, they do not appear to have accounted for the pattern of spread (where few people spread the virus to most people) and therefore the need for tighter and local/regional control. In fact, this is what NZ Ministry of Health seems to doing better now, so more on this aspect would be useful.

“Second, the authors mentioned the role of ventilation management, but did not build this into their proposed scheme. Recent research has increasingly established that SARS-CoV-2 is mainly about airborne transmission. Third, while their concern about regional travel restriction is understandable, it is not clear what they propose to do differently in these recommendations. The authors do not mention New Zealand’s relationships with the Pacific Islands and this omission is not explained in the commentary. At present, both Australia (NSW) and Fiji are experiencing outbreaks that are of concern, but the relative containment strategies in the two places are different, and so New Zealand’s response to travellers from these two regions in future will need to be decided region-by-region, but this is not discussed in the paper. Use of the term ‘an international outbreak of concern’ should be defined.

“Essentially, these researchers are proposing a four-tiered system (based on Table 2 in the accompanying supplement). All said and done, perhaps a simpler modification of the current alert level system is warranted – somewhere between the current four-tiered alert level, and a simplified six-level alert system.”

No conflict of interest declared.