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All COVID-19 requirements removed – Expert Reaction

As of Tuesday 15 August 2023, mandatory seven-day isolation will no longer be required for people with COVID-19, and visitors to healthcare facilities will no longer be required to wear face masks. 

People are advised to take a Rapid Antigen Test for COVID-19 if symptomatic, and if the test is positive, to isolate for five days and stay home until they feel well.

The SMC asked experts to comment.

Professor Michael Baker, Department of Public Health/Te Tari Hauora Tūmatanui, University of Otago, Wellington, comments:

“The removal of the last Covid-19 mandates is understandable. However, it is important to emphasise that this change does not in any way sound the ‘all clear’.  Covid-19 remains New Zealand’s leading cause of death from an infectious disease and an important cause of hospitalisation. Infections and reinfections will continue to add to the burden of long Covid.

“Covid-19 appears to be transitioning from being a pandemic threat to being an endemic respiratory infection that is unfortunately always with us.  We therefore still need to self-isolate when sick and use masks in healthcare settings to limit transmission of this virus. The good news is that these measures limit transmission of all respiratory infections.

“As we mainstream Covid-19 with other respiratory infections it will be important to emphasise these key control measures. Government can reinforce these behaviours in ways that don’t require mandates:

  • Running a media campaign about the need for self-isolation and mask use in health care settings,
  • Developing codes of practice in collaboration with employers, unions, education sector organisations, and hospitality venue operators about how they can support these infection control measures,
  • Reviewing infection control in health care facilities including hospital emergency departments and primary care waiting rooms.

“Aotearoa New Zealand could take this opportunity to develop and implement an integrated respiratory infectious disease surveillance and control strategy that includes Covid-19, influenza, and other respiratory diseases.

“It is important to remember that Government is still supporting our Covid-19 response with widespread free access to vaccines, antivirals, and RAT tests.  The public should take advantage of these measures which can be lifesaving.”

No conflict of interest. 

Associate Professor Amanda Kvalsvig, Epidemiologist at the Department of Public Health, University of Otago Wellington, comments:

“One of the reasons New Zealand’s pandemic response was so effective in 2020 was that New Zealanders were highly motivated to keep themselves and others safe. The Government is now removing all Covid protections, including in healthcare. This is a concerning decision with widespread implications, especially for disabled people, people with long-term health conditions, and those who care about them.

“Many common respiratory infections spread easily in public settings and a key insight from the pandemic is that these infections can be prevented using simple measures like ensuring good indoor air quality, staying at home when there’s a possibility of being infectious, testing before returning to work in the case of a Covid infection, and wearing a face mask when visiting a clinic or hospital. As in food safety and many other spheres, mandating specific health measures protects people who might be under pressure from employers or others to cut corners, helps to keep us all safe in public settings.

“What is needed now is for New Zealanders to hold onto those values of keeping others safe even when Government policy is no longer aligned with those values. We need to make sure that Aotearoa NZ continues to benefit from its hard-won pandemic experience. People with decision-making power, for example employers, can use that power to maintain workplace safety, ensuring that unwell workers are able to stay home and recover without infecting their co-workers. And all of us, however bullet-proof we might feel personally, can continue to make sure that any infection we have stops with us. We can never know who might be further down the chain of infections, and what an infection might mean for them.”

No conflict of interest declared.

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

“As someone still following all the evidence on what this virus does to the human body, this is the news I’ve been dreading. New Zealand was one of the few countries that still had some COVID protections in place; they’ve helped us get through winter with relatively low case numbers and hospitalisations.

“I really don’t understand how we could remove masking from healthcare settings. That’s the one protection it makes perfect sense to keep forever! With hindsight, you wonder why we haven’t used them more in healthcare settings and aged care facilities.

“It’s also worth noting the health advice is still to isolate if you have COVID-19 – though for five days rather than seven. But without isolation being mandated, I wouldn’t be surprised if more employers now start demanding people work when unwell.

“I think we need to be clear about what removing these protections means for New Zealand. We can expect to see higher case numbers, which means more people will develop long Covid (about 1 in 5 people according to a recent study from Australia) and more people will experience damage to their brains, hearts, and other organs that will put them at higher risk of developing everything from neurological diseases to heart attacks and strokes in the years to come. This is bad for all of us, but it is especially bad for our more vulnerable/at-risk colleagues, friends, and whānau. We’ve just thrown them under the bus.

“It’s ironic that as we dismantle these last protections, many experts overseas are pleading for masking to be brought back in healthcare settings to protect the most vulnerable. That’s because Covid case numbers and hospitalisations are on the rise again, thanks to new variants including EG.5.1 (“Eris”)  and “FLIP”. It may be summer in the northern hemisphere but that hasn’t stopped the virus from evolving.

No conflict of interest.

Professor Michael Plank, School of Mathematics and Statistics, University of Canterbury, comments:

“Overall, I think it the decision to end remaining health requirements for Covid-19 at this time is a reasonable one. The government took a relatively cautious approach in April to extend the isolation mandate because of the risk that a winter Covid wave could coincide with the flu season, putting severe strain on our healthcare system. Now, the worst of the flu season is probably behind us and Covid levels have remained low throughout winter.

“Over the longer term, Covid is not going away and there will certainly be further waves. Some will be concerned that lifting the isolation mandate will lead to higher levels of infection. However, keeping the mandate indefinitely does have drawbacks and it is important that these are justified by the benefits. Now that Covid is endemic, the benefit of isolation mandates in reducing infection rates in the long term is probably quite marginal. Many people infected with the virus do not get tested, potentially because they have no or very mild symptoms thanks largely to vaccines. In addition, significant transmission occurs before symptom onset.

“Many other countries including Australia have already removed isolation mandates. That’s not to say New Zealand should blindly follow what others are doing – our pandemic response has only been as effective as it has because we weren’t afraid to do something different. But in this case, there’s no evidence that there was a surge in numbers after isolation requirements were lifted.

“Importantly, ending the mandate does not mean it’s a good idea to go out and about when you’re sick. The Ministry of Health continue to recommend that people stay home if they’re unwell or have tested positive for Covid. This applies not just to Covid but to other infectious diseases that we have to manage in the community. A good way to ensure people are able to stay home when sick would be to have better universal sick pay entitlement. And the best way to minimise the health burden from Covid is to redouble efforts to improve vaccine coverage in vulnerable groups.”

Conflict of interest statement: “I receive funding from the Department of Prime Minister and Cabinet and the Ministry of Health for mathematical modelling of Covid-19.”

Dr Dion O’Neale, Programme Co-Lead, COVID-19 Modelling Aotearoa, comments:

“Staying home when you are sick, in particular when you are infectious and can make other people sick, remains one of the key public health tools to reduce the spread of airborne respiratory diseases like COVID-19. However, having a legal requirement that people must stay at home when they have a confirmed COVID-19 infection is only effective if people are first finding out that they are a confirmed case and are then inclined to, or able to, follow a mandated requirement to stay home.

“Mandated case isolation may have been playing a part in helping some people to stay home and do the right thing. However at this point in the pandemic, other factors such as sick-leave provisions, access to easy to use rapid antigen tests, and social support for people who need to stay home because they are ill or are caring for someone who is sick are potentially better ways to support people in reducing onwards transmission of COVID-19 and other respiratory diseases.

“Without support for people who are sick with COVID, the removal of mandated case isolation may make it more difficult for people who are more vulnerable to stay home when they, or younger children in their household, need to. This can be due to factors such as precarious employment, lack of sick-leave provisions, or financial pressures. If employers want to prevent the spread of respiratory disease in their workplaces, they will need to make sure that employees are supported to stay home when sick, rather than coming in and potentially infecting their co-workers.

“Even though it is no longer mandated, the advice from the Ministry of Health is still to stay home for 5 days after testing positive for COVID-19. For most people, their isolation period would have previously started from the date of first symptoms, which occurs, on average a couple of days prior to testing positive, according to reported case data. A consequence of this is that the effective recommended isolation period is about the same.”

Conflict of interest statement: “I, along with others from COVID Modelling Aotearoa, am funded by the Ministry of Health to provide advice on the COVID response and from a Health Research Council grant to look at equity related to COVID in Aotearoa.”

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:

“It was announced yesterday that the last remaining Covid-19 restrictions in Aotearoa New Zealand would be removed and end at midnight. It was also reported that the Covid-19 risk was deemed low due to the recent reduction in cases, hospitalisations and wastewater testing levels.

“Still, into the winter months here in Aotearoa New Zealand, added burden remains for hospitals, support systems, primary and community care, all continuing to experience significant pressure at this time.

“These systems were overloaded prior to the start of the global pandemic, and with this year’s seasonal illnesses, workforce issues and Covid-19 still causing complications, there has been additional stress and strain.

“As the SARS-CoV-2 virus continues to change and circulate, a new Omicron subvariant EG.5 has been identified in Aotearoa New Zealand and has now been classified by the WHO as a “variant of interest”.

“Nicknamed “Eris” (after the Greek goddess of discord, strife and chaos) and spreading quickly in the US, it is now the dominant strain and will be monitored given that Covid-19 cases, hospitalisations and ER presentations in the US have also been rising recently.

“As of 7 August 2023, EG.5 has been detected in 51 different countries including Korea, Japan, Canada, Australia, Singapore, the UK, France, Portugal and Spain. Eris contains an additional mutation in the spike protein at position 465, and although appearing to have growth advantages and potential immune escape characteristics, no changes in disease severity caused by EG.5 have yet been identified.”

“Continued surveillance will be important particularly with schools and tertiary institutions in the US and Europe recommencing soon.

“In the meantime, major health inequities persist in Aotearoa New Zealand, with timely accessibility to appropriate healthcare problematic for some. Efforts that support and include equity based approaches (unlike “one-size fits-all” models), will help address inequities and healthcare barriers effectively and efficiently moving forward.

“Accessibility to Covid-19 antivirals will still be needed for people in Aotearoa New Zealand to reach those who require them quickly, within 5 days of symptoms, and prevent severe illness and hospitalisation.”

No conflict of interest declared

Dr Hiran Thabrew, Senior Lecturer, Medical Psychological Medicine, comments:

“Although face masks have been invaluable during the bulk of the pandemic, and they may have helped health workers be more present during the most recent winter period, the removal of remaining COVID-19 restrictions is likely to be welcomed by the majority of people and is in keeping with the rest of the world.

“As COVID-19 and other winter illnesses remain in existence and a threat to those who are elderly and immunologically compromised, some people will still be anxious about this change and need time to readjust to a life without mask-wearing. It would be great to see us continue to practice kindness by accommodating differences in attitude toward the Government’s announcement and by using masks to prevent the spread of colds as has long been the case in some Asian countries.”

No conflict of interest declared