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Proposal to drop most mask mandates in healthcare settings – Expert Reaction

The government has asked for feedback on a proposal to scrap almost all mandates to wear masks in healthcare settings except the most high-risk ones, reports the Otago Daily Times.

According to the report, the Ministry for Disabled People asked disability support providers for feedback on a proposal to “significantly narrow” where masks had to be worn. The requirement for visitors to wear a mask would only extend to primary care, urgent care, hospitals, residential aged care and disability-related residential care.

The SMC asked experts to comment on the news. 

Dr Amanda Kvalsvig, epidemiologist, University of Otago, Wellington, comments:

“It’s good to see case numbers declining and to look for opportunities to reduce pandemic control measures. Removal of mask mandates will be described by many as ‘removing restrictions’. But for people at high risk, these changes will mean exactly the opposite: removal of protections will further restrict the number of places that they can safely access. Framing the setting change as reducing restrictions and creating freedom is ableist and it isn’t a meaningful aim during an active pandemic. Even at lower case numbers, Covid-19 remains a highly infectious pathogen that can cause serious health complications.

“Instead, the controls at any level need to have a clearly articulated aim of ensuring that all New Zealanders can safely access health, education, work, and social settings. The specific protections that are needed will vary depending on the level of risk, and the good news is that we now have a lot of knowledge about how to reduce transmission. Protections like clean indoor air, vaccines, and staying home when unwell are highly effective, and respirator masks provide an additional layer of protection for high-demand settings. This is why health-related settings need to retain universal mask use even during time of relatively low community transmission: these settings must be safe for anyone to access at any time. Another example is public transport where we have documented poor air quality and people are in close contact.

“Finally, while case levels are relatively low, New Zealand must use the time wisely and upgrade the Traffic Light System. It was never designed to be a long-term, sustainable solution. We need a cohesive and forward-looking system that can enable all New Zealanders to participate in society and stay safe. My colleagues and I have previously described how such a system would work. Most of this new system wouldn’t be visible to the public, but it’ll be working in the background to navigate us through and out of the pandemic. We can’t wish the pandemic away but we do have a large amount of control over how well New Zealand can weather the next phase. It’s essential that New Zealand doesn’t waste this opportunity.

No conflicts of interest declared.

Associate Professor Siouxsie Wiles, microbiologist, University of Auckland, comments:

Public health measures like mask-wearing are in place to help reduce the transmission of COVID-19. There are still many people who need to limit their exposure to COVID-19 for health reasons. Some have people like carers coming to their homes and good quality masks are an important layer of protection. Many people also regularly need to access places other than our healthcare facilities, like retail outlets, supermarkets, and libraries.

“If people want to see the end of mask-wearing then we need to replace masks with other public health measures that will protect us. Two important measures immediately spring to mind: improving ventilation/air purification and publicly reporting on air quality so people can see if a space is safe for them to be in, and making better use of rapid antigen tests.

“RATs are a good measure of when people are infectious, providing people understand they need to swab both their throat and their nose. Using RATs before attending events or visiting vulnerable friends and family or healthcare providers will help stop people inadvertently infecting people before they realise they have COVID-19. Similarly, using RATs to test if people are safe to end isolation and providing financial support directly to people who need to isolate will reduce the number of infectious people out and about.

“Much as we all wish COVID-19 was over, it isn’t, and we should be using the time between waves to strengthen our protections. We will reap the benefits in the long run.”

No conflicts of interest.

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

“Firstly, it is very good news that Covid-19 case numbers are coming down steadily, which will reduce all of the negative effects of infection, including illness, hospitalisations, deaths, and long-Covid.  This is therefore the right time to carry out an updated risk assessment and review all of the control settings.

“One immediate problem is that the current Traffic Light System is not helping us consider and discuss the policy options. The Orange and Green levels now only cover mask use policy and present us with only two mask use settings: either a requirement to use masks in some indoor environments (at orange) or no requirements at all (at green).

“After more than two years of managing the pandemic, we need a better framework to help us guide these important decisions and communicate them. At the very least, we need a system that is more nuanced, potentially with a couple of graduations in each of the orange and green levels.

“There is also a need for well understood and agreed criteria for moving between levels (preferably in an upgraded version of the Traffic Light System). One important criterion of course is what we are seeing at present, which is a decline in case incidence and the number of active cases. Similarly, we need criteria that identify situations where case numbers are going up, or are threatening to if we see new more infectious and/or virulent variants.

“There are obvious criteria that could be useful to guide decision-making about the response level and the kinds of controls that operate at each, notably mask requirements. Such criteria could, for example, prioritise:

  • Environments where infectious people are more likely to congregate, like doctors waiting rooms, hospital emergency departments, and pharmacies;
  • Environments where older and more vulnerable people are living, like aged-care and disability-related residential care;
  • Environments that are poorly ventilated where large numbers of people are required to spend time in contained, crowded, and close contact conditions. Public transport is an obvious example.

“There is a very important feature of mask use that distinguishes it from many other controls. That is that it appears more effective at preventing spread from infected people (source control) than from protecting the wearer (personal protection). That is one reason why mask use needs to be mandated in some indoor environments, in the same way that society now prohibits people from lighting up a cigarette in a bar or restaurant.”

No conflicts of interest.

Associate Professor Dianne Sika-Paotonu, Immunologist, Associate Dean (Pacific), Head of University of Otago Wellington Pacific Office, and Associate Professor, Dean’s Department, University of Otago Wellington, comments:

“Public health measures that include vaccines/boosters, masks, isolating when sick, proper ventilation, etc., all remain important steps to help protect against Covid-19, against reinfection, and also other winter illnesses that are still circulating – especially for our most vulnerable.

“Although the new reported cases of Covid-19 infections may have dropped recently, Omicron remains in circulation, and its spread continues to impact on hospitals, primary and community care and support systems, families, communities, our most vulnerable, schools, workforces across Aotearoa New Zealand.

“Even with more people having now been exposed to the SARS-CoV-2 virus, and with the emergence of the Omicron variant and subvariants, reinfections are increasing in a way not seen with earlier variants.

“The actual Covid-19 community case figures are still likely much higher than those being reported currently, with Covid-19 related deaths continuing to be reported each day – sympathies and condolences respectfully extended to all family, whānau, kāinga, aiga and friends impacted and affected at this time.

“The risk of reinfection with the SARS-CoV-2 virus remains, especially for vulnerable communities and groups who still require careful consideration and prioritisation. Waning immunity, Omicron’s higher transmissibility and ability to evade immune protection are all contributing factors. It is still important that those who may have already had a Covid-19 infection, strengthen their immunity with vaccination as well.

“There is still work to be done to address immunity gaps, where masks, Covid-19 vaccines/boosters, proper ventilation, isolating when sick and other public health measures remain important for protection, especially for our more vulnerable communities and groups – the risk of further waves of Covid-19 remains.

“During the Covid-19 pandemic, there has been limited exposure to other viruses such as the influenza virus here in Aotearoa New Zealand, and there is still potential risk of influenza outbreaks. We now have more of the Influenza vaccines here in Aotearoa New Zealand being made available for people – these are still important.

“Regular childhood vaccine schedules (non- Covid-19) for children, tamariki and tamaiki in Aotearoa New Zealand have also been affected by the Covid-19 pandemic. As a result, there is potential risk of outbreaks for whooping cough, measles and other illnesses that could be prevented. A resurgence of influenza and the respiratory syncytial virus (RSV) could also possibly occur.

“Medical masks and RAT tests were recently made more freely available and accessible in Aotearoa New Zealand, as the COVID-19 pandemic has and continues to cause disruption for all.

“There is still work to be done, particularly to protect our most vulnerable.”

No conflicts of interest declared.