The government has scrapped the Covid-19 Protection Framework, otherwise known as the traffic light system.
Government vaccine mandates and most mask mandates will be removed, and household contacts of Covid cases will no longer be required to isolate. Household contacts will instead be required to take a daily RAT test before going out in public.
Pharmac is more than doubling the eligible population for Covid anti-viral medication, opening it up to all New Zealanders aged 65+, Māori aged 50+, and those who meet other Pharmac requirements.
The SMC asked experts to comment.
Dr Jin Russell, Paediatrician and PhD candidate, University of Auckland
“The end of the traffic light system represents a clear shift away from non-pharmacological interventions such as universal masking in all but health and aged care settings, to a greater reliance on pharmacological interventions to manage covid. This is a proportionate change to the current situation and reflects the efficacy of vaccinations and antiviral treatments in reducing the risk of serious illness to New Zealanders.
“I am seeing a lot of concern for the immunocompromised and disabled community, and for good reason. There is firm evidence for relatively higher risk of serious illness among these groups.
“However, it is important to note that the greatest risk factor for covid hospitalisation and death, by a long way, remains age. According to US data, relative to 18-29y olds, the rate of hospitalisation increases significantly to reach 10x higher in 85y+ group. The risk of death increases with age to a whopping 330x higher in the 85y+ group. You can see the same gradient of increasing risk with older age occurring in real world NZ data.
“The government’s current covid response makes good use of these pharmacological tools to significantly reduce the risk of serious illness for elderly and immunocompromised New Zealanders.
“Three doses of the vaccine provide significant protection against hospitalisation and death for older age groups (see University of Melbourne vaccine report, p4).
“The current covid vaccine programme offers additional primary and booster vaccine doses for immunocompromised people over the age of 5 years. These additional vaccine doses can be expected to provide significant protection.
“Clearly, there remains some residual risk for the elderly, and immunocompromised groups, however, the government’s pharmacological response has followed the science and “closed” a large part of the gap between immunocompromised peoples and their immunocompetent peers.
“The decision to widen access to paxlovid to all over 65 years of age and for all Māori over 50y, is aligned with the very latest evidence. A new study, based on real world Israeli data of paxlovid efficacy during the omicron wave, found paxlovid very significantly reduced the risk of hospitalisation for over 65 year olds. No clear benefit was seen for adults younger than 65y, and this aligns with the New Zealand government’s move.
“A remaining area of uncertainty is the expected burden of long covid across the population. The interpretation of long covid research studies to the New Zealand population has been tricky because the successful elimination strategy meant NZ skipped the ancestral strain, alpha, and mostly the delta variant as well. The first omicron wave went through a very highly vaccinated population. The evidence base for long covid is tricky to interpret, due to considerable variations in definitions, and different methodologies used.
“A recent UK study found that the odds of long covid were reduced during the omicron period compared with the delta period. 10.8% of people with delta infections reported long covid (defined as 4 or more weeks of symptoms), versus 4.5% of people with omicron infections. An illness pyramid should be expected, with the majority of people meeting the definition of long covid experiencing some degree of persisting symptoms, and a smaller proportion of people with more severe symptoms. A large number of New Zealanders may be affected, and it is crucial to ensure health and social supports for this group.
“I think there is genuine uncertainty about the burden and risk of long covid to the population. While I don’t want more illness and disability, I recognise it’s difficult to mandate policy in uncertainty, especially when some non-pharmaceutical interventions such as universal masking may now be less effective to slow spread at a population level. This is due to the high transmissibility of omicron which can make it difficult to bring the Reff below 1. Wearing a well fitted, high quality mask can still provide a degree of protection against infection at an individual level.
“Overall, the government has used the available pharmaceutical tools effectively to significantly reduce the risk of serious illness to the population. The winding down of non-pharmacological measures is appropriate. But some critical areas remain.
“If we are to achieve a good public health response, we need to ensure equity in access to boosters and antivirals. Since antivirals have to be taken early in an infection, ensuring equitable access for rural and disadvantaged communities will be a vital goal. We must continue to educate the public around the value of ventilation, which has numerous health benefits (not just reducing risk of covid), and also clearly state the uncertainties around long covid, so the public can determine their own risk. We should ensure access to rapid testing and adequate sick leave and encourage the good habit of staying home when unwell.”
No conflicts of interest declared
Dr Amanda Kvalsvig, epidemiologist, University of Otago, Wellington, comments:
“It was good to hear about additional measures to support the wellbeing of New Zealanders, including expanded eligibility of antiviral medication, and programmes to address mental distress and promote mental wellbeing. Stepping down vaccine mandates in most settings is a reasonable recognition of variant escape and fading immunity, even though vaccines are still very effective.
“But some very important elements were missing from the announcements today:
“Fairness: Government has a duty to ensure that all New Zealanders can safely access work, education, health, and social settings. Covid-19 is still circulating and still causing deaths every day. Reduced measures mean that disabled and immune-compromised people will now be sharing public spaces with unmasked people who could be a household contact of a case and actively infectious. As masks and other protections are removed, the need for excellent indoor air quality steps up. Indoor ventilation and air filtration are now urgent public health priorities for New Zealand and the good news is, they really work. But without safe access to public spaces many disabled people will have to make choices no-one should have to make, between a lockdown – but this time, a private one with no endpoint – or taking on the risk of a life-changing or life-limiting infection.
“The science: There is now extensive evidence about longer-term illness and disability from Covid. Damage from Covid-19 can be seen in every organ system including the heart and brain. Very few New Zealanders can afford to be long-term ill and unable to work or study. New Zealanders should be advised to avoid getting Covid-19 and to avoid getting reinfected, and should be given the information and tools to do so.
“Realism: New Zealanders are being promised a Covid-free summer, but that lovely outcome is not in the power of any Government to promise. We have a high level of certainty that new variants will appear with capability to evade immunity from infection or vaccines. We don’t know when they will appear or how serious they’ll be. A far more reassuring message would be for the NZ Government to demonstrate that it‘s aware of the challenges and is actively preparing for both expected and unexpected threats to public health. That reassurance would include a much more realistic and absolutely achievable aim of having systems in place to ensure that people can enjoy summer even if it coincides with the arrival of the next variant outbreak.
“Future-proofing: We’ve had an extremely effective pandemic response and we can do so again. We need to use the breathing space we have now to embed protections into the background of our lives, keeping us connected and safe. This is a promise that Government both can and should be making to the NZ public right now. In practical terms that will mean not less action, but more. We need further investment in infrastructure and protections for the variants, epidemics, and pandemics to come. To organise all of this activity Aotearoa New Zealand needs a new pandemic plan that is effective and upholds Te Tiriti and now is the time to formulate it and co-design it with experts and the public.”
No conflicts of interest declared
Dr Emily Harvey, COVID-19 Modelling Aotearoa:
“COVID-19 is a dangerous virus that can have serious acute consequences, as well as long term consequences that we are still learning about. Vaccines help to reduce, but not prevent, these serious consequences. Unfortunately, until we can develop vaccines that effectively block transmission, COVID-19 is here to stay.
“Due to the immense numbers of infections in the two Omicron waves this year, we are now shifting into a period with the lowest rates of infection since the start of this year, and probably the lowest rates of infection that we will see for the next year as well. It makes sense at this time to shift from a reactive, emergency response phase into a phase with transmission reduction policies that are sustainable long term.
“We have the opportunity to invest in making systematic changes that will make future COVID-19 waves smaller, as well as reducing the rates of other respiratory infectious diseases like influenza and RSV.
“Since COVID-19 emerged in early 2020, we have learned a lot about how it spreads; specifically that it is spread through the air and overwhelmingly in closed spaces (indoors and poorly ventilated), crowded places, and close contact settings. In these higher-risk settings we know that masks (especially N95 or similar) have a large impact on reducing transmission.
“Removing masks before we have made indoor settings safer by improving ventilation and air cleaning, just because case numbers are low now, is like removing the tarpaulin over the leaky roof, just because it is not raining now, rather than waiting until the roof has been repaired.
“Furthermore, removing mask requirements before making indoor spaces safer means that members of our community who have health conditions that put them at higher risk, are now not able to participate in society, or even go to the supermarket, safely.
“I am pleased to see that case isolation requirements have been retained. We know that isolating confirmed cases of COVID-19 while they are infectious is a crucial piece of public health policy, that prevents a large amount of onward transmission, while only causing disruption to the (now much smaller) number of people who are confirmed infections. In terms of largest reduction in transmission for the least disruption, this is the most important policy to keep. Keeping the leave support scheme is also good news, but it would be good to see changes such as extended sick leave provisions, to enable all people to safely isolate without losing their income for that week.
“Omicron is incredibly infectious. We know from case data that unfortunately the majority of household contacts who have not previously been infected, will become infected, with 20% of these household contact infections being detected after the existing 7 day isolation period. Although the legal requirement for household contacts to isolate has been replaced with daily RAT testing requirements, these people still pose the largest transmission risk after cases, and we know RATs will miss the first 1-2 days of the infectious period. In addition to daily RATs, it will be important that businesses and events consider developing their own guidelines for e.g. whether household contacts should work from home while they have an infectious household contact, in order to meet Health & Safety requirements for providing a safe workplace.
“Keeping case isolation requirements, requiring daily testing for household contacts, and giving clear guidance for people to stay home when they are sick, even if they haven’t tested positive on a RAT (yet), will do a lot to reduce transmission. However, what we are missing is a clear strategy around improving ventilation and making indoor air safer.
“With community cases heading to the lowest levels all year, the cases coming across the border become a significant factor in propagating cases in the community. The current RAT requirements for those coming into the country are detecting a large number of incoming cases, mostly on day 0/1, thus preventing onward transmission. PCR testing of these cases also gives us variable genomic information about potential new variants. With the removal of the requirement to test, I would hope that tests are still being provided and encouraged.”
Conflict of interest statement: “Dr Harvey’s employer receives funding from the DPMC to provide modelling and analysis to govt officials on Aotearoa’s COVID response, and from the NZ Health Research Council for a project on modelling and equity for COVID-19 in Aotearoa.”
Dr David Welch, Centre of Computational Evolution, School of Computer Science, University of Auckland, comments:
“A relaxation in measures is reasonable due to low and still falling case numbers. But Covid still remains a significant threat to our health and we use this time to prepare for the next wave and the longer term impacts of this virus.
“Throughout the pandemic we have seen new waves being driven primarily by new variants. These variants have so far all come in across the border, so it is disappointing to see the compulsory RAT tests for arrivals being removed. Detecting new variants early gives us warning of a coming wave before we are in the midst of it. Dropping compulsory RAT tests means we will detect new variants later than we otherwise would.
“Case numbers are still falling although the rate of decline is slowing. Some of the decline in case numbers may be down to lower reporting of cases, but all indicators are falling in tandem – case numbers, wastewater levels, hospitalisations and deaths are all showing a declining trend. It is hard to forecast exactly how low they will go be could well fall below 1000 reported cases per day.
“With a reduced focus on Covid in the community, it is likely that case reporting will drop off, giving us less insight into the progress of the pandemic. To counter this, the long-awaited regular prevalence survey – which the government announced but have still not implemented – should begin.
“Measures like free RAT tests and case isolation remain sensible and effective, and it is good to see they are being maintained.
“Two measures that were not mentioned in the announcement are improved ventilation, and maintaining population immunity by a regular programme of vaccination with vaccines targeting recent variants. Both of these are crucial to reducing the predictable impacts of Covid and, in the case of ventilation, other respiratory viruses.
“Overall, a broader strategy for countering covid harms should be developed to allow us to focus on the long-term and embed best practice across all sectors.”
Conflict of interest statement: “I receive funding from ESR for modelling Covid genomics.”
Dr Dion O’Neale, Project Lead, COVID Modelling Aotearoa; and Senior Lecturer, Physics Department, University of Auckland, comments:
“The COVID-19 situation in Aotearoa is currently quite different from what it was when the COVID Protection Framework was first announced. The immunity landscape in particular is now very different, with a highly vaccinated population and with many people having possibly also acquired some immunity from a recent infection. The retirement of the CPF acknowledges that the COVID-19 situation and the tools available, such as Rapid Antigen Tests (RATs), have changed since the introduction of the CPF.
“Since the beginning of the COVID pandemic in early 2020, isolation of confirmed cases has been one of the proven effective tools at reducing community spread and reducing onwards transmission. It’s good to see isolation of confirmed cases retained in the revised COVID setting. Staying home when you are sick with a contagious disease is, as always, quality public health advice. Replacing the requirement for household contacts of a confirmed case to quarantine with the requirement for daily testing with a RAT is a pragmatic choice. While RATs will not detect new infections in household contacts in the very first days, they are very good at detecting infections by the point of peak infectivity and therefore allow a way for ensuring that the risk of onwards transmission in the community is reduced. The move to use of daily RATs rather than quarantine for household contacts of confirmed cases rather than a short quarantine period for contacts also makes sense because long chains of transmission within a household mean that contacts may not even become infected until after ending their quarantine period.
“Not introducing Test-To-Release (TTR) for ending the isolation period for confirmed cases does, however mean that many confirmed cases will be isolating for longer than necessary, while some cases will be ending isolation while still infectious. A move TTR for case isolation offers the opportunity to both reduce the average isolation time, at a population level, while also reducing the risk of onwards transmission in the community. While TTR may not be a requirement of the new COVID-19 settings, it is still something that people may choose to follow and the continued free availability of RATs makes that more practical than it otherwise would be.
“While current low case numbers mean that the removal of protections, such as masking requirements, is as safe now as it is likely to be in the near future, it would be good to see the removal of individual based protections such as masking requirements be accompanied by a move towards an expectation of widespread systemic protections such as clean air and ventilation requirements.
“It is also important to remember that, as always, government mandated requirements are a minimum level of what can be expected of people, as opposed to what is sufficient to keep everyone safe in all situations. We know that masking works best when everyone in a room is wearing a well fitted mask. With the removal of masking requirements, it will be increasingly important for individuals to choose to mask up in order to protect those who are more vulnerable to COVID and to make sure that others can still safely participate in everyday life.”
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.”
Professor Michael Baker, Professor of Public Health, University of Otago, Wellington, comments:
“I am looking at these changes to our Covid-19 measures announced today based on whether they will give New Zealand the best possible health outcomes through the next stage of the pandemic. Also from the perspective of strengthening our resilience to pandemics more generally. From this perspective I think some of these changes are a missed opportunity to sustain and improve our effective pandemic response.
“In particular we need a framework to replace the ‘traffic lights system.’ Such a framework can provide a simple, meaningful way for describing the level of risk posed by Covid-19 and a proportionate response at each level. We have systems for categorising the risk from fires, storms, and earthquakes so this is a well-established approach to managing threats. We certainly know enough to have a science-based alert-level system for Covid-19 and other respiratory disease pandemics. Based on its behaviour over the last two years, we can expect Covid-19 to continue to evolve and generate future waves of infection that will need a coordinated response.
“It is good that we have retained mask requirements (mandates) for health care and aged care settings. Masks work best when everyone is using them as they provide both source control and personal protection for the wearer. That is why mask mandates are needed to protect people in high-risk situations. We need criteria to identify these high-risk situations, particularly those that are confined, crowded, and close-contact where people are regularly exposed. On that basis, public transports would be an important environment for universal mask use, at least until we have sustained low Covid-19 transmission, which we have not yet reached.
“I am pleased that Government has retained mandatory isolation requirements for cases. It is fundamental to disease control that sick people stay home and don’t go off to work, school, and social events to infect other people. The number of people isolating will drop as Covid-19 cases decline, so this measure will become less of a burden over time. It is good that the duration has been kept to a minimum of 7 days as even at that stage, about a quarter of people are still infectious.
“Removing the vaccine mandate for health care workers is understandable, but again needs to be replaced with measures to ensure universal vaccination of this workforces. There are multiple reasons why vaccination matters for this workforce. It is a basic occupational health and safety requirement for much the same reason we require some groups of first responders to wear protective clothing. Vaccination of health care workers helps to protect their patients. It also helps to maintain this critical workforce, particularly over winter. Vaccination of health care workers is also important for the integrity of the healthcare system – these staff are trained to use scientific evidence and best practice so need to follow their own advice and get vaccinated.
“There are problems with removing the vaccination requirement for visitors to New Zealand. This population will be an increasing sources of Covid-19 infection in New Zealand, particularly as case numbers fall here. We need an active discussion about how to reduce the impact of visitors to New Zealand as key drivers of our pandemic.”
No conflicts of interest declared
Professor Michael Plank, Te Pūnaha Matatini and University of Canterbury, comments:
With cases, hospitalisations, and deaths at their lowest since February, it is a good time to review which measures we still need, which we can relax, and what we else we could be doing to mitigate the health burden from respiratory illnesses.
Covid-19 is shifting from being an acute threat to an endemic disease. That doesn’t mean it’s harmless or that we can forget about it. But it does mean that that some of the interventions that were crucial to flattening the curve and protecting health system capacity in the acute phase are less effective as we move into the next phase.
Blanket measures such as mask mandates in places like retail, schools and workplaces are likely to have a marginal effect on the number of infections in the long-term. The reason is that, at any given point in time, the large majority of the population will be immune to the virus and so the majority of masks will be having little or no effect. Masks do have downsides and it’s important to weigh those against the benefits they provide. Many countries have lifted mask mandates without experiencing a significant increase in sickness or death as a result.
However, this needs to be balanced against the fact that mask wearing still affords protection to individuals who are at higher risk. It makes sense to target measures to high-risk settings such as healthcare and aged residential care. Mask requirements may also need to be re-introduced for example if a new variant threatens to cause a major wave.
Overall today’s changes look like a reasonable response to the current situation. But we should use this period of relative respite to focus on lasting public health measures like improving indoor air quality, better sick pay entitlement so everyone can afford to stay home when they are sick, and continued investment in vaccine development and delivery. These are sustainable measures that can largely happen unnoticed by the general population but will deliver health benefits more broadly than just for Covid-19.
Conflict of interest statement: “Michael Plank is funded by the Department of Prime Minister and Cabinet for mathematical modelling of Covid-19.”
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:
“Yesterday it was announced that the Covid-19 protection framework, otherwise known as the traffic light system would end. This included dropping vaccine mandates, along with mask wearing requirements except for healthcare and aged care facilities. Improved accessibility to antiviral medications was also proposed.
“Although new reported cases of Covid-19 infections and hospitalisations have dropped recently and is encouraging news, the actual Covid-19 case figures likely remain higher with Omicron continuing to circulate, and still impacting on hospitals, primary and community care and support systems, families, communities, schools, workforces and our most vulnerable, across Aotearoa New Zealand.
“The public health measures that include vaccines/boosters, masks, isolating when sick, proper ventilation and other public health measures, remain important steps to help protect against the severe impact of Covid-19, against reinfection, and also other illnesses still circulating at this time – especially for our most vulnerable.
“Improving accessibility to antiviral medications will be an important step, given the inequitable and disproportionate impact and vulnerability for Māori and Pacific communities especially, and for other groups, as a result of Covid-19.
“Covid-19 related deaths in Aotearoa New Zealand continue to occur daily – with sympathies and condolences respectfully extended to all family, whānau, kāinga, aiga and friends who continue to be impacted and affected.
“The risk of further waves and reinfections with the SARS-CoV-2 virus remain, 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.
“Reinfections have increased substantially when compared with earlier variants of the SARS-CoV-2 virus and there is still work to be done, especially to prepare for the future, and in particular, to protect our most vulnerable.
“The risk of long-term complications and Long Covid-19 development resulting from infection with the SARS-CoV-2 virus, also persists for all.
“Childhood vaccination rates for non-COVID-19 conditions have been impacted by the pandemic which leaves some of our most young and vulnerable unprotected from serious conditions that we currently have vaccines for and there is potential risk of measles or whooping cough outbreaks, for example.
“New variants of the SARS-CoV-2 virus will continue to emerge, develop and spread, while issues with unequal global Covid-19 vaccine coverage, availability, accessibility and distribution persist, and remain unaddressed. Addressing health inequities and current inequities in society will be critical steps moving forward.
“Care and caution is still needed at this time – particularly with respect to our most vulnerable.”
No conflicts of interest declared