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Alert Level 2 revised due to Delta variant – Expert Reaction

With the exception of Auckland, New Zealand will drop down to Alert Level 2 tomorrow night. The Alert Level 2 settings have been significantly revised in response to the more transmissible Delta variant.

Under the revised Alert Level 2 settings, people will be required to wear masks and scan QR codes in most indoor public spaces, and indoor gatherings will be capped at 50 people.

The SMC asked experts to comment on the announcement.

Dr Amanda Kvalsvig, Epidemiologist, Department of Public Health, University of Otago Wellington, comments:

“It’s great news that masks are recommended in schools. When stepping down Alert Levels it’s important to retain a high level of protection for a limited time to ensure that no cases have been missed.

“It’s good to see an increasing commitment from Government to protect children given rising concerns about the impacts of Covid-19 on children. Our children are still largely unvaccinated and extremely vulnerable to ongoing outbreaks.

“The current outbreak has included a large number of children from multiple schools, with thousands in quarantine after being identified as close contacts. Outbreaks in the community are extremely disruptive for children and they perpetuate our poor record of inequities in infectious diseases in children.

“What I hope we’ll hear about in the coming days is practical advice for schools to support them in implementing mask use in an appropriate and child-centered way, and clear messaging for children to encourage them to wear a mask to protect others. I also hope that we’ll hear much more about improving ventilation in classrooms, a key measure that works alongside masks to prevent viral spread. While structural changes to school buildings will take time, simple measures like opening windows whenever feasible will help to prevent spread of a number of respiratory infections and will also improve children’s learning and concentration. This messaging needs to get out to New Zealand schools and the public right away.

“It’s good to see that the response is adapting to evolving changes in the pandemic, with a ‘Delta 2’ that’s stronger than the previous Alert Level 2 settings. However, Delta is just the latest in a series of highly infectious variants of concern in the pandemic. The next major variant may already be circulating, and the response will need to keep ahead of any new characteristics that appear. We need a much more flexible Alert Level system that can react swiftly to new challenges in the pandemic, with closer calibration to the level of risk in the community.”

No conflict of interest.

Professor Michael Plank, Te Pūnaha Matatini and University of Canterbury, comments:

“From Wednesday, New Zealand outside Auckland will move to a new ‘Delta Alert Level 2,’ which includes some extra safeguards compared to Alert Level 2 in the past. These include mandatory mask use, record-keeping and 2 m distancing in most public venues, and a gathering limit of 50 people inside and 100 people outside. These additional measures make it harder for the virus to spread and reduce the risk of superspreading events.

“These safeguards are important because the movement of essential workers and goods poses a risk that a case could leak out of Auckland. No boundary is watertight and just because most regions have remained Covid-free up to now doesn’t guarantee a case won’t pop up in future. If this does happen, Alert Level 2 conditions mean the virus will be able to spread more easily. Preventing superspreading events, which were a big factor in the size of Auckland’s outbreak, is key to avoiding a similar outbreak happening elsewhere. The other key factor in detecting any outbreak early is high testing rates. So, it’s crucial for everyone with any symptoms to get tested immediately no matter whereabouts you are.

“The recent downward trend in cases is promising. If we keep doing what we’re doing, we have an excellent chance of eliminating this outbreak. But there is work still to be done and, as experience in Australia shows, if we give Delta an inch it will take a mile. In the next phase of this outbreak, the biggest danger is relaxing too soon. So, we need to get this right the first time because with Delta we might not get a second chance.”

Conflict of interest statement: I am partly funded by MBIE for research on mathematical modelling of COVID-19.

Lesley Gray, Senior Lecturer, Department of Primary Health Care & General Practice, University of Otago, comments:

“Today’s announcement that boundaries to the north and south of Auckland will move to Alert Level 2+ is a welcome outcome for many and reflects what we have seen in case numbers, community cases and wastewater testing in the last few weeks. The South Island has produced no positive wastewater results and by geography is able to isolate from parts of New Zealand that have current cases and ongoing contact tracing and places of interest. A key issue will be how and whether what will occur between and through the Auckland region while in different alert levels. Mandatory mask advice and record keeping for indoor venues is very important due to the way that the Covid-19 virus is transmitted.

“While at this point as our lockdown has tighter restrictions much quicker at this point compared to Australia’s lockdown, we cannot be complacent with the numbers lower these last few days. You only have to look at some of the Australian case numbers to see that when, for example, Victoria’s case numbers reduced right down at the start of August, Victorians could be forgiven for thinking they were on top of that outbreak, but within two weeks of low numbers, the cases started creeping up and by the end of August case numbers were up as high as an average of 145 a day. In NSW, they were averaging 20 cases a day towards the end of June and last week their daily average was over 1,300. Of course, our aim is that through a tight lockdown we all have as short a lockdown as possible. However, what is clear is that without stringent measures, the Delta variant is far more transmittable, very quickly and would so easily be out of control had we not had a fast and firm lockdown and if we become complacent. We can also learn that our best chance was for a hard and fast lockdown. NSW is still dealing with increasing positive cases on a daily basis.

“4750 COVID-19 tests were processed in the last 24 hours and 2000 people were tested in Auckland yesterday. This does sound like a lot of tests, but this is actually a very low level of testing compared even to last week’s numbers (over 13,000). Anyone with cold, flu or Covid-like symptoms should arrange to get a test.  We know this virus transmits very quickly. I am pleased to hear the Government will introduce saliva-based surveillance testing in the community in the next few weeks. This will be especially helpful in locations where more frequent testing due to outbreaks is required in addition to those workers requiring more frequent routine testing.

“Lockdown fatigue has been described worldwide as a state of exhaustion relating to the impact and effect of COVID-19 on all aspects of life and the changes it has caused. It is a state experienced when people have had to come to terms with a virus that has affected every aspect of their life, including their freedom, and which has continued for months, sometimes feeling as though there is no end in sight (although with vaccinations we do at least have a way to manage and limit severity). It is understandable for many of us to feel as though we are on a ‘Covid-19 hampster wheel’ where usual business/usual life is upturned and so many plans have to be changed, cancelled, changed again. This can be an extremely emotional and stressful time causing psychological, physical and emotional effects including both mental and physical exhaustion. It is important to recognise what we can and cannot do at this time and accept things that we cannot change individually but take actions to maintain safety such as vaccination, physical distancing, wearing a facemask for those who should. Acknowledging feelings during this time, being kind to yourself, take breaks, accept you may be more tired than usual, may be more irritable, or may struggle trying to be as productive as usual. Remember this is everyone trying to live and work and raise families in an unusual time where ‘usual’ might be more difficult or not possible – there is no ‘business as usual’ right now. Most humans are ‘social’ so connecting with friends, colleagues, family is essential, but harder in lockdown. How can you continue some form of connection with your networks? Possibly using technology if available to you. One thing I have been following on Facebook for example, a local family has been providing garden entertainment by ‘staging’ their teddies in different activities (e.g., Time Team archaeological dig, Teddy bear picnic, gardening) with photos and this has given many locals immense joy to see each day.”

Conflict of interest statement: Note: Lesley has received a Health Research Council grant for this research: “Improving effectiveness and equity in the operation of COVID-19 ‘self-isolation.”

Professor Nick Wilson, Department of Public Health, University of Otago, comments:

“The reduction in the Alert Levels for outside of Auckland is a justifiable move from a public health and social perspective. The new requirements for ‘Delta Alert Level 2’ around masks, QR code scanning/sign-ins, and reduced limits for indoor gatherings (to 50 indoors and 100 outdoors) are very desirable. Unfortunately, it would have been preferable to have an ‘Alert Level 2 plus’ – which we argued would have more comprehensive indoor mask requirements and actually keep high-risk venues closed (i.e., bars, nightclubs, gyms and churches).

“But more attention is also needed to tighten the border around Auckland. There should be a requirement that all essential workers crossing the border are vaccinated. Rapid antigen tests also need to be used at border crossings – with these only taking 15 minutes to produce a result. This approach is much safer than the weekly testing of these workers that the Ministry of Health is currently planning. These measures are now even more important given the even lower Alert Levels that are now in place both north and south of Auckland.

“There is also a still a need to accelerate infection control measures in Auckland. This not only requires high levels of testing in the community of anyone with symptoms – but also an expansion of wastewater testing so that suburbs testing positive can be identified and testing boosted at such localities (as occurred in Warkworth recently). Campaigns to improve ventilation of buildings in Auckland are also urgently needed – with these often being as simple as opening windows.

“Drive-through vaccination centres and walk-in centres with no bookings required are very valuable initiatives being used. Placing these in convenient places for the public to assess is critical. All these approaches should be prioritised in Auckland as part of outbreak control.

“The actions suggested here seem feasible and would help the country regain its valued elimination status as soon as possible.”

No conflict of interest.

Associate Professor Arindam Basu, College of Education, Health & Human Development, University of Canterbury, comments:

“Delta is a fast-spreading variant and masks are for source control. As a result, even a slight leakage can lead to an increased risk of transmission. That said, masks must be worn snugly around the mouth regardless, and the best is to use N95 masks compared with cloth or disposable masks. A quick test if sunglasses or glasses get fogged while one is wearing a mask, this indicates that the mask is not snugly worn.

“Second, when one wears a mask, one is best not to take it off when one speaks as it defeats the purpose of wearing a mask. Interestingly, it is common to see people take off masks when they speak, yet viruses have a high risk of spread when an infectious person speaks or shouts, and masks are best suited for ‘source control’. Third, while wearing a mask, it is best not to touch the mask.

“The importance of wearing masks cannot be over-emphasised. A mask is perhaps the only device in the hands of an individual that helps to protect both oneself and others.”

No conflict of interest.

Dr Paula O’Kane, Senior Lecturer in Human Resource Management (HRM), University of Otago Business School, comments:

“The results from the Work Futures Otago ‘Working from Home during Lockdown’ survey of over 2,000 New Zealanders demonstrate several key issues that impact employees. First, we see two key cohorts of respondents. The first is working parents who are having difficulty parenting and working effectively, with some feeling supported but many others feeling very overwhelmed and guilty about both work and children. Those parents outside Auckland will be breathing a huge sigh of relieve that schools return on Thursday, but for those in Auckland employers need to be mindful of the impact of the lockdown on their ability to have space to work, and the knock-on impacts on stress strongly evident in our study.

“The second cohort is, in some ways, experiencing the opposite. These respondents are employees living alone who feel not only isolated but also that their loneliness is being ignored by their workplaces. Many commented that the difficulty of parenting is recognised but not the experience of loneliness. For those in Auckland, the alert level changes in the rest of New Zealand are likely to intensify these feelings. We see respondents finding benefits in daily communication with their teams, especially informal interactions. These need to be made available to support mental wellbeing. Overall, we see people feeling fatigued because of the quick lockdown and lack of time given to prepare for working from home, coupled with the uncertain lockdown length. This uncertainty means people are not sure the best way to approach their working from home plan. While today’s announcement gives those outside Auckland a roadmap, we know that this is not definitive, and that uncertainty will continue both for Aucklanders and New Zealanders. This needs to be recognised and supported.”

No conflict of interest