Preparing for a Covid summer – Expert Reaction

The country is preparing for another major shift in how it manages COVID-19, with Auckland able to interact with the rest of the country in a week’s time.

What might it look like when Auckland’s domestic boundary lifts next week and – given what we know now – how prepared are we for this change?

The SMC asked experts to comment on the upcoming shift, as well as provide practical tips for navigating the new landscape.

Dr Dion O’Neale, Principal Investigator, Te Pūnaha Matatini; and Lecturer, Physics Department, University of Auckland, comments:

“Removing regional travel boundaries will mean that we would expect to see cases distributed much more around the rest of Aotearoa. It’s possible to learn a lot about the number of trips that people make to and from Auckland using data on electronic transactions from past years. During a typical (pre-COVID) week, we would expect to see about 150,000 trips per week into Auckland and about 200,000 trips per week originating in Auckland and travelling outside the region. These numbers decreased a bit once COVID reached Aotearoa in 2020, but during periods where the country was at Alert Level 1, we still saw over 100,000 trips per week to, and 200,000 trips from Auckland. This is without accounting for the summer holiday surge in travel when trips outside of Auckland typically double.

“Requiring people to be vaccinated, or to test negative for COVID in the 72 hours prior to travel, can be expected to slightly reduce the chance of further cases spreading outside the Auckland region. However, there are a number of reasons why these measures might not be as effective as we would hope.

“In the current outbreak, about 24% of cases have been in children who are too young to be vaccinated and who aren’t required to have a negative test.

“Related to this, although vaccination significantly reduces the chance that you will be infected (and reduces the chance that you will transmit COVID further if you have a breakthrough infection), it does not remove that risk. Similarly, a negative test in the three days before travel is not going to mean that adults are still non-infectious when they travel.

“And while vaccination is great at preventing transmission in general, it can make it trickier to prevent spread outside of a region since it can reduce the symptom severity of breakthrough infections sufficiently that people may not realise that they are infectious when travelling. There is a role here for easily accessible and affordable Rapid Antigen Tests which can help to quickly detect infections in people during the period when they are most infectious.

“One factor that is in our favour at the moment is the relatively low daily cases numbers we are seeing in Auckland. However even a period of only 100 daily detected cases means that there will be around 1500 active known cases.

“In terms of where Aucklanders typically travel to, Waikato, Northland, and Wellington are the most significant destinations in a typical week. With the removal of the travel boundary coming close to the summer holidays, it is possible that Aucklanders’ movements might look more like their typical patterns over the Christmas and New Year period where Northland, Thames-Coromandel, and Tauranga-Bay of Plenty see big spikes in incoming trips. The population of Thames-Coromandel, for example, more than doubled over past holiday periods.

“Because many of the regions that Aucklanders like to travel to for holidays have lower vaccination rates, we hope that a good number of people make the choice to stay in town for the holiday period, possibly delaying their trip until vaccination rates in other areas have caught up with those in the major cities.”

Conflict of interest statement: “I, along with others from Te Pūnaha Matatini, are funded by Department of Prime Minister and Cabinet to provide advice on the COVID response and from a Health Research Council grant to look at equity related to COVID in Aotearoa.”

Professor Michael Baker, Professor of Public Health, University of Otago, Wellington, comments:

“The opening of the Auckland boundary on 15 December is probably the single most consequential Covid-19 response change before the end of 2021.

“This change marks a further shift away from the elimination strategy to a situation where Covid-19 infections may become widespread but hopefully well controlled.

“Under alert level 3 and 4 restrictions, regional travel was highly limited to prevent infected people spreading the infection more widely.

“Under the traffic lights system there are no routine travel restrictions, though temporary restrictions can be imposed (as is the case at present for travel into and out of Auckland).

“Given the relatively high levels of SARS-CoV-2 virus circulating in Auckland, people leaving Auckland in large numbers over the Christmas-New Year period are likely to disseminate the virus widely across New Zealand.

“This process will probably not result in large outbreaks initially, as the measures now in place across New Zealand (relatively high vaccination coverage, continuing testing and contract tracing, and restrictions on indoor gatherings in hospitality venues) will limit the size of outbreaks. However, there will almost certainly be infections and cases of serious illness and deaths, particularly when the virus is introduced into poorly vaccinated families and communities where it will spread easily.

“The requirement that all people 12-years of age or over are either fully vaccinated or have a negative pre-travel test prior to them leaving Auckland will help to reduce that risk.

“However, these requirements for travel within New Zealand are markedly less that the ones that are applied to travelers flying into New Zealand from overseas. Even under the more relaxed requirements that are proposed for international travelers entering New Zealand starting in January next year, all travelers will need a minimum of full vaccination, a pre-departure test, a test on arrival, 7 days of self-isolation, and a further test at that point.

“There are ways that NZ could reduce the risk of widespread dissemination of Covid-19 outside Auckland after 15 December:

  1. Encourage or require people to get tested in addition to being vaccinated – Families with children under 12 years of age may be particularly vulnerable to taking the virus with them. They should consider getting children tested prior to leaving Auckland. For those flying into New Zealand there is a requirement for testing children down to the age of 2 years.
  2. Encourage Aucklanders to avoid visiting or staying with unvaccinated or vulnerable family and friends – It would be a real family tragedy to take this virus with you, and infect family and friends who are either unvaccinated or particularly vulnerable to infection. Now is the time to have those conversations about vaccination with the people you will be visiting and socialising with. There is still time before Christmas for people to have a vaccine dose or booster if they are eligible.
  3. Ensure the vigorous enforcement of vaccine and testing requirements for those leaving Auckland – It is important that the likelihood and consequences of being found to have left Auckland without meeting vaccination or testing requirements are sufficiently high to act as an effective deterrent.

“Not following these requirements could be seen as comparable to drunk-driving as both of these behaviours have the potential to cause serious harm and death to others. This is not the time to let people off with a warning. The consequences of breaking the law in this situation should include fines and also being required to return to Auckland (until fully vaccinated or tested).

“A vigorous response to limiting transmission of Covid-19 from Auckland would be consistent with the ‘tight suppression’ strategy that New Zealand now appears to have adopted for Covid-19.  We describe this strategy in a recent NZMJ editorial.

“This strategy is consistent with New Zealand efforts to minimise the health harms caused by the pandemic.  It is also supported by the precautionary principle, which expresses the need to take a cautious approach in situations of high uncertainty where decisions have significant impacts.

“Such an approach is likely to provide benefits in the face of a viral threat that is continuing to evolve, notably with the emergence of the Omicron variant of concern.”

No conflict of interest.

Dr Matthew Hobbs, Co-Director, GeoHealth Laboratory, and Senior Lecturer in Public Health, School of Health Sciences, University of Canterbury, and Lukas Marek, researcher and lecturer in Spatial Data Science, University of Canterbury, comment:

Note: These are excerpted comments from Dr Hobbs’ and Dr Marek’s recently published piece in The Conversation.

“As New Zealand gets ready for the festive season under the new traffic light system, the emergence of the Omicron variant is a reminder this pandemic is far from over.

“The new variant of concern is already fuelling a new wave of infections in South Africa and there is some evidence hospitalisations are increasing.

“Omicron has already arrived in Australia and the question now is whether it will get to New Zealand during the summer holiday season and potentially affect plans for border openings.

“So, how prepared is New Zealand?

“In the short term, New Zealand is well placed to deal with Omicron. Our strong border controls, testing and rapid genome sequencing mean that when Omicron arrives at our border, we can respond quickly and prevent community incursion.

“It is unlikely it will be our unwanted guest this Christmas. Despite this, significant challenges lie ahead in the long term, including vaccination inequity and disruptions to routine healthcare.

“In several regions, including Auckland and Canterbury, 90% of the eligible population are now fully vaccinated. High vaccination rates may blunt the extent of future potential waves of infection, but significant inequities in vaccination levels remain.

“We know that vaccinated people transmit COVID-19 less than unvaccinated people, but only 70% of Māori have received both doses.

“Even without COVID-19 spread widely, there is already pressure on hospital capacity and staff with delayed surgeries now more common, be that in Hawke’s Bay, Dunedin or Christchurch.

“So far, New Zealand has been luckier than other countries where concerns are growing about disruptions to routine healthcare. Delays may leave patients with treatable conditions suffering illnesses that can become fatal.

“New Zealand has one of the lowest ICU capacities in the world. While the government has announced $644 million to raise ICU capacity, it will take time to build capacity and train staff.

“Although unlikely, should Omicron breach our border like Delta did, it will have to be tackled against the backdrop of trying to manage the current Delta outbreak.

“Child vaccinations are set to start at the end of January. However, low vaccination levels are often in areas where health provision and hospitals are a long way away. This will need to be incorporated into the rollout strategy to ensure equitable childhood vaccination rates.

“The Auckland border will lift on December 15 and many are bracing themselves for a COVID summer. Calls for staycations have emerged as popular summer holiday spots such as Matai Bay close and iwi are asking people to stay away from some destinations.

“Our analysis by regional tourism areas in the map below supports this. It shows most regional tourism areas have low vaccination rates, especially for Māori and Pacific peoples.

“As New Zealand heads into the holiday season, public health measures such as mask wearing, physical distancing, hand hygiene, contact tracing, case isolation and vaccination will remain essential.”

Conflict of interest statement: “Matthew Hobbs receives funding from New Zealand Health Research Council, A Better Start National Science Challenge, Cure Kids and IStar for this research.” “Lukas Marek has previously received funding from the Ministry of Health.”

Dr Andrew Chen, Research Fellow, Koi Tū – Centre for Informed Futures, University of Auckland, comments:

“As the Auckland boundary lifts and people start to travel around the country more freely, we should expect to see more cases appear in other parts of the country. It is all the more important that people keep track of their own movements, preferably using the NZ COVID Tracer app. This is so that if COVID appears in your community, then you will be better prepared to respond to contact tracers. When COVID is already in a community, contact tracing is a key step to help identify potentially infected persons and stop them from passing the virus onto others.

“If you use the NZ COVID Tracer app, the data stays on your device only and is not transmitted to the government or anyone else unless you voluntarily provide it as part of contact tracing processes. The data is also now legally protected with legislation passed a few weeks ago and cannot be used for any purpose other than contact tracing.”

Conflict of interest statement: I have had interactions with the Ministry of Health around digital contact tracing in an academic capacity but am not employed or paid by them.

Dr Amanda Wallis, Research Lead, Umbrella Wellbeing Ltd, comments:

Note: These are republished comments from 1 Dec.

“The new traffic light system may create uncertainty for people around Aotearoa as we are forced to determine our own comfort levels with mingling with others, travelling and using public spaces. When socialising with loved ones, for example, choosing in the moment whether to mask up, physically distance, and meet inside or outdoors may be cognitively taxing, as well as potentially costly to our own wellbeing. Social norms inform our behaviour to a large extent, and research shows that navigating public health measures may contribute to feelings of social anxiety through fear of norm violation.

“To combat this, people could try to prepare for upcoming events by establishing their intentions and crafting social norms ahead of time. Consider messaging family members or friends a few days prior to the event and let them know you plan on wearing a mask, for example, and create a psychologically safe discussion around how you might keep each other safe. Try to centre the focus of this conversation on COVID-19 as the threat, rather than each other. For example, ‘I know this is new territory for all of us but I’m quite scared about catching COVID-19 – do you mind if we catch-up outside to play it safe?’”

No conflict of interest

Dr Melanie Woodfield, The Werry Centre, Department of Psychological Medicine, University of Auckland, comments:

Note: These are abridged comments from 1 Dec – with a new comment below

“Holding child development in mind can help parents respond effectively this summer, when differing family norms and values will be busily intersecting with public health guidelines at the beach or the campground.

“For example, in terms of moral development, young children tend to determine whether someone is good or bad based solely on whether they follow the rules: for example, ‘Uncle Bob is bad because he’s not wearing his mask.’ As they develop, children increasingly understand that it’s possible to be a good person, and not follow a rule. Subtleties such as intentions come into play – there’s a difference between deliberately not washing your hands, versus carelessly forgetting.

“It can help parents to stay calm and effective if a child development lens is applied where possible –‘she’s just little, and didn’t know’ versus ‘how can she think that?’ or ‘she’s unkind’ if a child asserts that their cousin is naughty for not washing hands. Or the child seems confused that their lovely best friend (who is ‘good’) is not following the rules (which is ‘bad’). Steer clear of who is right, and emphasise that different people make different choices, and some people have fewer choices available to them. An opportunity to seed ideas that’ll serve them well as they grow – how to be respectful, while staying true to their own values. How to like someone, yet disagree with their decisions.

NEW “It could be useful to model the decision-making process aloud to young children. ‘On one hand we’re … but the downside is… what’s really important to me is… there’s probably not a perfect solution here, but I think we’ll…’. While being clear to children that adults make – and are responsible for the consequences of – the big decisions, such as whether to travel. Hierarchies are helpful in families. Parents are the executive board of the company, and children the stakeholders. Stakeholders are consulted or invited to express their views, but the ultimate decision is made by the board. And the board deals with the repercussions.

“Talking aloud about your own emotions (within reason) can be both validating and educational for children, especially if there’s some sort of ‘resolution’, or illustration of how the wave of emotion subsided. ‘I was worried about driving out of Auckland, and I guess that makes sense since it’s been so long, but it was actually OK. Once I put my music on, I started to relax a bit.’

“If children need a Covid test prior to travel, it’s often helpful to avoid blanket reasssurance ‘It’s fine! Easy!’ and instead aim for age-appropriate honesty: ‘it doesn’t hurt, but it does feel a bit uncomfortable for about 10 seconds, and it makes your eyes water a bit, but that stops pretty quickly too.’

“And just a reminder for parents that you don’t need to have a perfectly worded response to every curly question that – Murphy’s Law – will be posed by your child at an inopportune time. In fact, little snippets of information and validation are often best for small children, rather than one big sit-down discussion. And it’s absolutely possible to re-visit things ‘I was thinking about what we talked about before, and realised that I wanted to explain it a different way.’

“Also, children take their cues as to how to ‘be’ in a situation as much from what you say, as how it’s said. So, aim for a calm tone, slower speech, and convey a sense that things are going to be OK. Often easier said, than done. But worth keeping in mind.”

Conflict of interest statement: Dr Melanie Woodfield is employed part-time as a Clinical Psychologist in government-funded Child and Adolescent Mental Health Services. She receives research funding from the Health Research Council of New Zealand.

Dr Kirsty Ross, Senior Clinical Psychologist and Senior Lecturer in Clinical Psychology, Massey University, comments:

Note: These are abridged comments from 1 Dec.

“This summer will have felt like a long time coming for many people; a chance to reconnect and have some normality after another period where things have felt quite unpredictable and uncertain. We will have to navigate a new set of rules and guidelines, which will take some getting used to. People may also be feeling a bit nervous about how to manage situations that may arise, such as when people around you are not socially distancing, wearing a mask or scanning in – all public health measures we know are important in keeping the SARS-CoV-2 virus at bay.

“Assertive communication is the boundary where you can take care of yourself and your needs, and care for others in the situation as well. When we sit back passively, we can often feel frustrated (and sometimes even guilty) that we haven’t spoken up, and anxious about the consequences of not doing so. When we speak too aggressively, this can harm the relationship we have with the person we are talking to, and may even mean getting into an argument, or having our message and needs lost as the other person defends their position as they feel under attack.

“Being assertive takes practice and often a good place to start is to place the relationship first. For example, if you are with your family and another group of friends, and someone is not wearing a mask, start by saying how much you enjoy their company, and that you are glad you are finally getting to spend some time together. Then move on to speaking about what is concerning you and what you would like to change: ‘I’m so glad we can finally meet up again as we have really missed seeing you and we have been looking forward to catching up. But when you are not wearing your mask, I feel uncomfortable and worried, as I really want to make sure that we keep well and safe. So, while I respect your right to make your own choices, when we are out together as a group, I would really appreciate it if you could wear your mask around me and my family. Then I will be able to relax and really enjoy myself.’”

No conflict of interest.