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The move to Phase Two – Expert Reaction

New Zealand will enter Phase Two of its public health response to the Omicron outbreak tomorrow night.

The shift is in response to growing numbers of Covid-19 cases, with 981 new community cases announced today. Today also marked a record high rate of positive tests returned, with 5.6 per cent of the 17,616 swabs returning positive results for Covid-19.

Phase Two reduces the isolation period for Covid-19 cases and close contacts, and encourages self-care for people who test positive, where possible, to ensure support for people with greater needs.

The SMC asked experts to comment on the news.

Lesley Gray, Senior Lecturer, University of Otago, Wellington, comments:

“As we move very close to 1000 cases a day of COVID-19 reported in the community, the Government has signalled we will move to Phase Two tomorrow. Understandably, many people will be confused about the many different phases we have already been through and especially the change in approach that Phase 2 signals, given as a country we have maintained the ‘keep it out’ and ‘stamp it out’ approaches so successfully in the prior two years.

“With so many community cases we cannot continue with the ‘stamp it out’ approach and so requirements will change. These include reduced time for those isolation (10 days for cases and seven days for contacts); changes to how household contacts will be managed and the types of tests that will be available or required – for some this will see the introduction of rapid antigen tests and a close contact exemption scheme for critical workers returning daily negative tests.

“We will also see a shift towards what has been termed a ‘self-service’ approach where, for example, cases will be directed to an online self-investigation tool. These changes will bring about greater uncertainty for many, and people more vulnerable to COVID-19 will no doubt be especially concerned and understandably worried, especially if greater numbers in local communities do not follow guidance regarding physical distancing, correct mask use, or scanning into locations.

“Many agencies already supporting people in the community will be taking extra steps as community hubs to support those needing ongoing care and support for most cases to isolate at home where possible.”

Conflict of interest statement: Lesley Gray is a named investigator on Health Research Council of New Zealand-funded COVID-19 research projects.

Phillip Wilcox, Associate Professor, Department of Mathematics and Statistics, and Affiliate Faculty, Bioethics Centre, University of Otago, comments:

“Overseas research has identified genes that increase the risk of severe Covid-19, demonstrating that severe Covid-19 is heritable. What this means is vulnerability to severe Covid-19 is higher if a close contact is also a close relative. Therefore testing strategies need to account for this elevated probability, as well as the incomplete (i.e., less than 100 per cent) sensitivity of rapid antigen tests. It may be that a more stringent testing regime is required in instances where the close contact of a Covid-19 case is also a close relative.”

No conflict of interest.

Dr Dianne Sika-Paotonu, Immunologist, Associate Dean (Pacific), Head of University of Otago Wellington Pacific Office, and Senior Lecturer, Pathology & Molecular Medicine, University of Otago Wellington, comments:

“Omicron is spreading rapidly across Aotearoa New Zealand with the 981 new community COVID-19 cases reported today representing a sharp jump and highest number ever to be recorded thus far.

“The increasing COVID-19 case numbers will place added pressure on our health and other support systems in Aotearoa New Zealand, with true COVID-19 cases are likely to be much higher than this right now.

“As a matter of urgency it’s important that our children, tamariki and tamaiki (5-11 years) get vaccinated, people get boosted, tested and isolate accordingly, and follow the appropriate public measures.

“Care and caution is needed moving forward as we shift into Phase 2 of the Omicron Response plan, known as the transition phase, as we still remain in the process of protecting vulnerable communities that include our children, tamariki and tamaiki aged 5-11 years, and getting people boosted to protect them from Omicron.

“Inequities with respect to Māori and Pacific peoples, tamariki and tamaiki are again evident in booster and vaccination levels. Of those children aged 5-11 years, 45 per cent of the general population have received their first vaccine dose, while for Māori and Pacific tamariki and tamaiki, vaccination levels for first doses are at 26 per cent and 36 cent respectively.

“It is important to remember that evidence has clearly demonstrated that Māori and Pacific peoples and their whānau, aiaga and kainga remain vulnerable to being disproportionately impacted and affected by COVID-19 and therefore will require focus and prioritisation with respect to COVID-19 vaccination, boosters, testing and prevention efforts.

“An equity focus that reduces barriers and builds trust for people and with the appropriate prioritisation, will help people access the help and services they need at this time and avoid our hospitals becoming overwhelmed as they have become in other countries.

“We need to do everything we can to slow down the spread of Omicron while our children, tamariki and tamaiki (5-11 years) get vaccinated, and for people to get boosted.

“Stay safe and take care – keep others around you safe by getting vaccinated, boosted, tested, following the rules and guidelines, and reaching out to help others do the same.”

No conflicts of interest declared.

Dr Matthew Parry, Senior Lecturer, Dept of Mathematics & Statistics, University of Otago, comments:

“While the test positivity rate was 5.6 per cent today, it does fluctuate significantly over the course of a week. The seven-day rolling average is closer to 2.3 per cent.

“Nevertheless, the test positivity rate is trending up. An increasing positivity rate indicates that the testing and tracing system is starting to struggle to keep up with the new cases and raises the possibility that cases are not being detected.

“Unfortunately, we will meet the capacity limits of the testing and tracing system before the peak in new cases occurs. One way to determine case prevalence in this situation is via survey-based methods.

“Another important rate to consider is the hospitalisation rate. This is the ratio of the people in hospital to the number of active cases. Currently, this is around 0.7 per cent and drifting up. Since hospital admissions tend to lag case numbers by up to a week, we still have to wait see how the surge in Omicron will affect this rate.”

No conflict of interest.

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

“The move to Phase 2 follows a recent acceleration in the growth rate of case numbers, with the doubling time shortening to around three days – similar to what we would expect based on other countries comparable to Aotearoa. With case numbers around 1000 per day, many of the systems and approaches that we have taken until now to limit spread of COVID, will become impractical. The move to Phase 2 is an acknowledgement of the need to change systems and processes to balance different pressures as case numbers increase.

“Many of the changes that will come into effect with Phase 2, such as shortening home isolation periods (or allowing exemptions to isolation for some critical workers who are close contacts) and prioritising contact tracing resources on high risk cases, are less restrictive than the settings during Phase 1. This is not because the risk of transmission has reduced — the opposite is true — but because with higher case numbers it is possible that there will be resource constraints if changes to the COVID settings are not made.

“Just like the initial settings of the COVID protection framework, there is a difference between what is permitted and what is safe: not wearing a mask in an indoor setting, such as a workplace, school, or other indoor venues like restaurants still has high transmission risk. And people who are able to continue to isolate for the original, longer periods, can still reduce risk to those around them by doing so.

“Similarly, with official contact tracing systems becoming further strained, people who are identified as positive cases or close contacts can help to reduce possible onwards transmission by quickly notifying the people they have recently been in contact with, rather than waiting for official contact tracers. The use of newly introduced online contact tracing tools will hopefully help with this.

“It is important to remember that observed new cases lag behind new, but as yet undetected, infections. This means that, while case numbers are still increasing, the number of potentially infectious people in the community at any point is going to be higher than the number of confirmed cases. This is not necessarily because we are detecting a smaller fraction of infections (though case ascertainment rates are likely to fall somewhat as prevalence gets higher), but is simply a consequence of the lag between people becoming infected and returning a positive test result.

“If it takes three to four days after infection before someone develops symptoms and gets tested, and another day or two for their test result to be returned, then with a doubling time of around three days, the number of new infections could have increased by almost a factor of four by the time that infection is recorded as a confirmed case.”

Conflict of interest statement: “I, along with others from Te Pūnaha Matatini, am funded by the 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.”

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

“At the end of January, the government clearly signalled that it would be reducing contact tracing, no longer publishing locations of interest or using Bluetooth Tracing once we get to Phase 3. It reflects us entering the next phase of Omicron – when we have thousands or tens of thousands of cases a day, we have to move from looking for pockets of cases to managing the impacts of the virus on our population as a whole. We have to treat everyone as being high-risk and adjust our behaviours accordingly. Our digital contact tracing tools have had a positive impact on our efforts so far, with approximately 127,000 location alerts (based on scanning QR codes) being generated, and about 1,300 Bluetooth Tracing alerts being generated on smartphones. But the utility of these tools changes when the virus is spreading much faster.

“The Ministry of Health is rolling out tools to help people self-report their testing results and self-manage their contacts – we individually will have to take on some of the workload because it simply won’t be possible to do it centrally as we have expected in the past. This will also mean that anonymous contacts (i.e., contacts that are not known to the case) are less likely to be found. A Privacy Impact Assessment for the self-reporting Contact Tracing Form has been released by the Ministry of Health, which contains more details about what information will be collected. There will also be mechanisms to support individuals who can’t fill out a digital form.

“While we may stop using locations of interest or Bluetooth Tracing in Phase 3, it is important to note that we may be called to use these tools again when we get to the other side of the Omicron wave, when we return to stamping out pockets of cases to bring infections to an end. It is a lot easier to maintain a behaviour than to stop and restart the behaviour. So if you can, leave Bluetooth Tracing on (it’s passive and you don’t need to do anything to leave it on). If you are scanning QR codes now, keep doing it because it can still help you with your own contact tracing, and we can keep the habit up. Of course, if it is too difficult or too stressful to keep scanning QR codes, it is more important to get vaccinated, to wear good masks, to wash your hands, to prefer ventilated environments – these actions reduce the likelihood of infection in the first place even though there are no silver bullets.”

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.

Associate Professor Bernard Walker, College of Business & Law, University of Canterbury, comments:

“New Zealand employers will have to get up to speed fast on what this means. The warning signs have been there for a long time as we’ve seen what happened in Australia where large scale staff absences crippled businesses.

“It affects businesses on four levels. The first is managing your own staff. Having multiple staff infected is not something most businesses have handled on this scale before, so employers will have to do some reading about isolation and rapid antigen tests.

“The second is business continuity. It will need contingency plans for how businesses can keep operating. Some larger organisations have created teams what work separately, to provide back-ups.

“The third is supply chains. They can be fragile and if it’s a long chain there’s a lot that can go wrong. It seems they were one of the weak points in Australia.

“The final one is understanding your customers. New Zealand businesses haven’t had to make the same changes as other countries, where the move to online and alternative service-provision has taken off. The companies that do well in this new setting will be those who think about their customers and adapt with online and contactless services.”

No conflict of interest.

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

“Changes to the self-isolation rules will bring little relief for non-critical small businesses. Combinations of waiting for test results, self-isolating as a close contact and self-isolation because of infection will cripple already strained small businesses throughout New Zealand, in relation to both availability of staff and to customer numbers.

“As has already been seen in Queenstown and Auckland, many small businesses cannot operate bubbles, and will have to close their business altogether should one person become infected, or even be a close contact. The government needs to prioritise the provision and rollout of Rapid Antigen Tests (RATs) to all businesses, and even individuals as we have seen elsewhere in the world, which can enable small businesses to immediately know if a person is infected, instead of having to wait for results, avoiding this aspect of self-isolation.

“Additionally, instead of self-isolation of close contacts daily RAT tests could enable businesses to operate. Although there is some financial support for isolating, this doesn’t cover all the additional costs of doing business, the very reason the resurgence payment was introduced. This needs to be prioritised again. Supporting small businesses through this is key to future economic growth for New Zealand.”

Conflict of interest statement: Paula O’Kane is a co-owner of a hospitality business.