Photo: Daniel Walker. CC0

Free masks and RATs ahead of the winter Covid-19 peak – Expert Reaction

Rapid Antigen Tests and masks will be free for all, and more people will be able to access antivirals, as the government gears up for a winter Covid-19 peak.

Antiviral medications Paxlovid, molnupiravir, and remdesivir will be funded for a wider group of people (400,000 more Kiwis), and will eventually be made available in pharmacies.

The SMC asked experts to comment. 

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

“Boost, mask, test, ventilate. The message is clear that these are the public health measures that are needed to get us through the current wave. Modelling shows that, because of the combination of the BA.5 variant and the increase in average age of cases, there is the potential for the number of hospitalisations to be higher in this wave than in the first wave. Taking these simple measures will help our healthcare system get through the difficult winter period.

“Deciding whether to wear a mask doesn’t need to be a forever decision. During a wave is the most important time to be taking precautions. So if you’ve got out of the habit, digging your mask out and using it for the next month or so will make a difference.

“Making RATs freely available to everyone is a welcome move. RATs are an excellent tool for people to check whether they are infectious so they don’t unknowingly spread the virus. This also applies to people who’ve had Covid before, because the BA.5 variant is causing an increasing number of reinfections. Doing RATs before large gatherings or before visiting vulnerable relatives is a great way to reduce risk.”

Conflict of interest statement: Michael Plank is partly funded by the Department of Prime Minister and Cabinet for research on mathematical modelling of COVID-19.

Associate Professor Siouxsie Wiles, School of Medical Sciences, Faculty of Medical and Health Sciences, University of Auckland, comments:

“The changes announced today are all sensible and important. Better access to masks, rapid antigen tests, and antiviral medications will help lower the transmission of COVID-19 if people use them. And that’s the big if.

“There is clearly no appetite for mandating masks more widely, and that’s no surprise given the protests earlier this year. But the message is really clear – if you are outside of your home, wear a mask. I hope everyone in New Zealand takes this message on board. I know plenty of people who would happily wear a mask but feel the weight of peer pressure not to because it isn’t a requirement. Worse still are those workplaces that have mask policies that aren’t following the science – it doesn’t matter if you can stay two metres away from others, in a badly ventilated indoor space, that distance is meaningless.

“If you aren’t able to see how well a space is ventilated, then mask up. If we all do this, in our workplaces especially, it will make a difference.

“We need to recapture the spirit we had early in the pandemic – our actions matter. Wearing a mask, taking a test, isolating when positive, opening a window – all these things will protect our lives and our livelihoods and is the least we can do to support our healthcare workers who are trying to care for sick people under the most difficult of circumstances.”

No conflict of interest.

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

“This a very positive set of announcements in terms of reducing the impact of the current Covid-19 pandemic along with lowering transmission of influenza and other respiratory infections. There was a strong acknowledgement of the impact that these infections are having on the health care system. These measures come on a day when the moving average of Covid-19 deaths has hit 20 a day, which has only previous occurred briefly at the start of April.

“The main element missing from this announcement was any expansion in requirements for mask use indoors. The obvious setting where a mask mandate is needed is in schools. Schools have been left to make their own individual decisions about mask use, which means that many children and their teachers are missing out on this protection. There are many benefits in school students learning to use masks effectively. One is that they can take this message home to their whānau.

“Aotearoa New Zealand needs to shift to become a mask using society, at least until we have got through winter. Effective masks need to be used universally in all indoor environments when people are with others who are not members of their usual households.

“We know this behaviour change would save lives. It needs to be supported using every tool we have available, in a similar way to how we approach road safety measures such as mandating the use of safety belts and laws to reduce drunk driving.

No conflict of interest.

Dr Dion O’Neale, Project Lead, COVID Modelling Aotearoa; and Senior Lecturer, Physics Department, University of Auckland, comments:

“Appropriate use of both masks and rapid antigen tests are some of the most effective actions that individuals can take to keep themselves and others safe from COVID-19 and other respiratory illnesses. Making sure that both masks and RATs are effective relies on good access to them and good advice about how to best use them. The announcement today has the potential to improve both of those aspects.

“RATs are very good at providing information about when people with COVID are actively infectious. RATs can miss a day or two at the beginning of someone’s infectious period, but after that the scientific evidence is that RATs closely track infectivity for the remainder of the infectious period, with a lag of only about a day at the tail end of infections.

“Making RATs more accessible will help people to use them to determine when they are more likely to infect others and need to change their behaviour (i.e. staying home, not being indoors in poorly ventilated places with others). They will also allow people who might be completely asymptomatic to test themselves before going to higher risk settings like social gatherings where people may be unmasked while eating or drinking.

“There are details around disease progression of COVID in a highly vaccinated population that it is worth keeping in mind with using RATs for confirmatory testing. Some people can develop symptoms a couple of days before they become infectious. Most people will also become infectious before they are likely to test positive on a RAT. This is another reason to remind ourselves of what we all know: we should be staying home and keep testing if we have symptoms of a respiratory illness, even if we initially test negative for COVID.

“Making high quality masks available can also help to prevent transmission of respiratory disease, such as COVID. It’s important to remember that a mask is only as good as its fit. If a mask isn’t covering your nose, or if air is easily able to escape around the edges of it, then it’s not providing as much safety to you and others as it could be.”

Conflict of interest statement: I, along with others from COVID Modelling Aotearoa, 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 Amanda Kvalsvig, Epidemiologist and Senior Research Fellow, Department of Public Health, University of Otago, Wellington, comments:

“The changes announced today are welcome and they’ll certainly help to reduce the spread of Covid-19, influenza, and other respiratory infections. It will come as a relief to many to see decisive action and clear communication from the Government. But the situation we’re in now with rising cases and deaths raises some important questions about the performance of the traffic light system. The arrival of new Omicron subvariants and the return of flu were predicted well in advance, and winter shouldn’t have come as a surprise to anyone. The fact that it has taken so long to get to this point indicates that the traffic light system isn’t delivering the flexible and proportionate pandemic response that New Zealand needs to get us through winter 2022 and emerging outbreaks.

“Today’s announcements emphasised that New Zealand isn’t moving to the red setting, but it doesn’t make a difference which traffic light setting NZ is at: this system was never designed to be forward-looking, which is why the settings have to be changed in an ad hoc way. To give the NZ public certainty and confidence, NZ needs an upgraded and revised Alert Level system. Compared with the beginning of the pandemic we now have a comprehensive toolkit that can enable us to prevent Covid-19 spread without needing to use lockdowns. We need to build on that capability.

“An upgraded Alert Level system would deliver the integrated and forward-looking response that New Zealand needs now. That means having a system that works in an organised way to suppress transmission of multiple infectious disease threats whether they’re predictable ones like seasonal flu, or unexpected ones like monkeypox.

“Put together with a world-class disease surveillance system and a range of health and social protections for those who experience the highest impacts, a well-designed Alert Level System would ensure that each public health threat is identified and actively managed long before it becomes a crisis.”

No conflict of interest declared.

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 continuing to cause nationwide disruption for all, putting hospitals, support systems, primary care and community care under immense strain and pressure – which they’ve been dealing with for a while now.

“Wastewater testing results have been indicating much higher Covid-19 infections levels in the community than reflected by reported figures, driving further concern people who may be unwell aren’t testing or isolating, and therefore continuing to spread Covid-19. Concern about the under-reporting of Covid-19 case figures has been a long standing issue, and it is estimated that the actual Covid-19 cases are double those being reported right now.

“Newer Omicron subvariants have also been causing problems with higher transmissibility, and Omicron reinfections being more of an issue than with previous variants of the SARS-CoV-2 virus. Ongoing work will be needed to understand more about whether re-infections for Omicron and all its subvariants end up being more or less severe, when compared to a primary infection.

“Masks, Covid-19 vaccines and proper ventilation within the education setting remain important for protection, particularly for children, tamariki and tamaiki aged 5-11 years and those still needing to be vaccinated against Covid-19.

“In general, antiviral medicines reduce and limit the severity of symptoms that someone might experience with a viral infection, lessen the duration of the viral illness and shortens the length of time that someone stays unwell for, and reduces viral transmission. Antivirals need to reach those who require them quickly in order to prevent severe illness and hospitalisation – and can help protect our hospitals and support systems, primary and community care.

“There has been significant global demand for antiviral medications during the Covid-19 pandemic and countries have been challenged in trying to get access to some medications – it is welcome news to have an additional supply of antiviral medications at this time.

“It is important to remember however that antivirals are not a substitute for Covid-19 vaccines and boosters – these are still much needed at this time.”

No conflict of interest declared.