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NZ Moves To Red As Omicron Cases Spread - Expert Reaction

The country will shift to the Red setting of the traffic light system at midnight tonight, after nine cases of the Omicron Covid-19 variant were detected in the Nelson/Marlborough region.

Some of the cases attended a wedding in Auckland. Prime Minister Jacinda Ardern said she expects to see more Covid cases in the coming months than the country has seen in the past two years of the pandemic.

The SMC asked experts to comment.

Associate Professor James Ussher, Department of Microbiology and Immunology, University of Otago, comments:

"Given the amount of Omicron circulating overseas and presenting at the border, this was inevitable. It is unlikely that we will be able to stamp this out. Ultimately, we will need to accept endemic SARS-CoV-2 circulation in New Zealand.

"However, thanks to our excellent vaccination rates we are in a good position to minimise the impact of Omicron on the health of New Zealanders, but we need to get our booster rates up as soon as possible. For those who are unvaccinated, it is not too late to get vaccinated and they should do so ASAP.

"A move to red is sensible and will help slow transmission of Omicron, enabling administration of boosters and primary vaccination courses and reducing the impact on our health system."

Conflict of interest statement: Associate Professor Ussher is Science Director of the Government-funded Vaccine Alliance Aotearoa New Zealand – Ohu Kaupare Huaketo, a partnership between the University of Otago, the Malaghan Institute and Victoria University of Wellington. He is also on the Government's COVID-19 Vaccine Science and Technical Advisory Group.

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

"It is obviously distressing to hear that Omicron is now in the community in New Zealand, but we knew it was only a matter of time given how widespread this variant is around the world. We know that the traffic light system was really good at reducing the transmission of Delta but we have yet to see how effective it will be against Omicron. The Omicron variant is more infectious and better able to infect people who have been vaccinated, especially if they have only received two doses. I firmly believe we need to do everything we can to reduce the transmission of Omicron. It is important to remember that this virus is spread through the air and that people can be infectious before they realise they are infected. This means that wearing a mask is really important - one that fits well and covers your mouth and nose. If you are only wearing a fabric mask, consider upgrading to one that includes a PM2.5 filter or wearing one over a surgical mask. FFP2, Kn95, or KF94 masks are good options but beware of where you buy these from as there are many counterfeit masks on the market. Masks can be reused, so try to have one for each day of the week, and store in a paper bag between uses. Replace if they become wet or soiled, or the straps loosen so they don't fit as well.

"Transmission through the air does mean some environments are higher risk than others - especially indoor environments where people are not wearing masks. This is why I am concerned about hospitality and other similar venues. It doesn't matter if groups of people are seated one metre away from each other, if they are indoors, especially if the place is badly ventilated, then the risk of transmission is high and we've seen lots of examples of Omicron spreading in these types of settings overseas. Improving ventilation and introducing air-purifiers are ways to reduce this risk.

"Recent studies have shown that three doses of the Pfizer vaccine provide really good protection against serious disease from Omicron so I urge people to get boosted as soon as they are eligible. I also urge all parents to vaccinate their children. For those who haven't yet been vaccinated, Omicron has the potential to be a very serious disease and those who are unvaccinated are much more likely to be hospitalised."

No conflict of interest.

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

"An outbreak of the Omicron variant has been getting increasingly likely, but it still comes as a shock to learn that Omicron is in the community and has likely spread to a significant number people in different parts of the country. Moving to the Red setting is not a lockdown but it is a clear signal that extra caution is needed to reduce transmission. That means things like masks and social distancing in public places. The government has indicated that, while cases are less than around 1000 per day, testing and contact tracing will continue to operate as in the past to try and stamp out chains of transmission. That means get tested if you fell at all unwell and follow public health advice if you’ve been at a location if interest.

"When we start to get several thousand cases per day, there will be a shift towards greater use of rapid antigen tests and possibly a shortening of the isolation period. It’s likely to take 2-3 weeks at least to reach this stage. These kinds of case numbers will sound daunting, but we should remember that if you are up to date with your vaccinations the individual risk is very low. New Zealand is in a good position to manage the impacts of Omicron. We have high vaccination rates which drastically reduce the risk of severe illness, our efforts in controlling Delta mean the number of Covid patients currently in hospital is very low, and we have a head start on the booster rollout in some of our most vulnerable groups.

"There is more work still to be done, but we are in a vastly better position that we were last year before our population was vaccinated. We should be prepared for the likelihood that Omicron will infect large numbers of people, but our actions can make a big difference to reducing that number and relieving pressure on our healthcare system. Right now that means masking up, getting tested and staying home if you’re sick, and above all get boosted as soon as you can."

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.

Dr Amanda Kvalsvig, Epidemiologist and Senior Research Fellow, Department of Public Health, University of Otago, Wellington, comments:

"The plan outlined by the Prime Minister has a number of strong points. Perhaps the most important is that the Government is taking the Omicron variant seriously. The plan as described uses a range of control measures to slow the spread of the virus, with a goal of reducing the severe impacts seen in other countries when community transmission rapidly escalates to a high peak. Overall, the NZ Government’s approach seems highly appropriate and has every chance of working well.

"Some important gaps remain and these gaps need to be addressed very urgently now. The Government needs to move away from its current stance on respirator masks (eg, P2 or N95) which appears to be that the public would not understand how to wear them. This stance would deny New Zealanders one of the most effective protections that they have just now. Respirator masks are standard wear in many countries and there is abundant clear and straightforward advice about their use. Here is an example endorsed by the CDC. Even without instruction, N95-type masks tend to fit better around the face than surgical masks, which typically bunch up at the sides so they have gaps for the virus to enter.

"The Prime Minister has signalled that lockdowns will not be used. If that is the case and New Zealanders will be mixing in public while Omicron is circulating, then people must have access to effective masks. That is particularly true for children who are the least-vaccinated age group. This protection should not be available only to more privileged members of society who are already ordering masks from overseas. The Government should now consider importing enough masks for every New Zealander to have at least one mask, but more usefully a set that they can rotate every 5-7 days. While universal mask access is being arranged, priority should go to supplying effective masks to those most at risk, including essential workers.

"A final point is that we need an upgraded Alert Level system to take us through this outbreak, the coming winter, and the variants yet to come. My colleagues and I have previously proposed several changes to the previous Alert Level system to ensure that it is adaptable to a range of future developments in this pandemic and beyond."

No conflict of interest declared.

Jacqui Maguire, Registered Clinical Psychologist, comments:

"Here we go again, there is community transmission and we are back in Red. Whist as a country we are familiar with this pattern (community detection followed by the implementation of restrictions), this outbreak comes with a higher risk of catching the virus. We have seen first-hand with our Australian neighbours how fast Omicron spreads, which will likely be expedited with widespread holiday travel.

"In this wave of uncertainty as we face our new threat (“when will Omicron land in my community?”, “will I catch Omicron?”, “how will we survive home isolation?”) it is expected many will feel anxious. This is our bodies natural preparatory survival state, kickstarting behaviours that will keep you safe. For those in our community who are vulnerable or trying to protect vulnerable loved ones – and parents of young children ineligible for vaccination – again it is normal for anxiety to be heightened further. These members of our society are exposed to a great threat with no shield. We should not however overlook the feelings of despair, frustration and resignment that will also be experienced by the masses.

"The upside to this wave is that we are familiar with Covid, the sanctioned restrictions and public health behaviour (masks, hand washing, checking-in and displaying vaccine passports). We aren’t having to rapidly learn new ways of living. We also have a level of frontline protection with high vaccination status, which we have not had in previous outbreaks. This knowledge may be enough for some to lower their worry.

"Whatever the emotion, don’t judge it. Just notice it and ’name it to tame it’.

"What else is important in the days and weeks to come:

1. Don’t jump ahead of yourself. There is zero point guessing the unknown. Wait for the briefings to gather your information. Stay informed but not consumed.

2. Focus on what you can control. Wear your mask, stay socially distanced, scan in and get boosted as soon as possible.

3. Follow the rules. This is not about just about avoiding your personal detection of Omicron, but protecting the vulnerable, your wider community and the health system.

4. Get prepared. When we ‘do something’ it signals to our body that we are responding to its fight or flight system. It tells our body that we understand the threat, and are attempting to protect ourselves. Buying appropriate medical supplies, having an isolation plan, talking with your employer about how they plan to manage the latest rules will all help to reduce worry.

5. Get off social media. Information bombardment causes anxiety in itself.

6. Ask yourself what has been most helpful for your wellbeing over the last two years. Do more of those activities to boost your wellbeing.

7. Take care, and stay connected. Look after yourself and each other. And if you are struggling reach out, whether that be to someone in your family, a loved one over the phone or a trained professional at the end of a helping."

No conflict of interest.

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

"The Covid Protection Framework (CPF), including the Red setting, was designed in a pre-Omicron environment, with the vaccine effectiveness against infection, from two doses of the Pfizer vaccine, doing much of the heavy lifting to keep people safe. The arrival of Omicron with its much higher immune escape for people who have not had a booster dose of the vaccine significantly changes the sort of outcomes we can expect from the Red CPF setting. Unless the Red CPF setting is updated, we can expect to see the sort of rapid growth in cases that have occurred in Australia and other countries.

"There is hope that individuals and businesses may choose, of their own accord, to do more than the relatively weak measures that are required of them by the Red CPF setting. For example people choosing to limit the number of contacts they have, and making sure that they are wearing good quality, well fitting masks whenever they leave the house. Or businesses facilitating people to work from home as much as possible and requiring masks in the workplace - including in non-public facing roles. Things like these can help to slow the speed of growth in infections, beyond what would be achieved by the CPF Red setting alone. Official requirements and support will, however, remain important as not all businesses will be inclined to do more than the minimum required of them and not all individuals are in the fortunate financial position of being able to do as much as possible.

"It was good to hear that advice for use of masks is being updated. Good quality (certified), well-fitting masks have a huge role to play in preventing transmission of COVID-19. Vaccine efficacy might wane over time, but masks remain just as effective at preventing airborne transmission as they were for Delta and earlier variants.

"However, while the CPF Red setting still allows up to 100 people to eat and drink together indoors, encouraging better mask use isn’t going to have an effect in environments where they aren’t being worn. Indoor dining is one of the key areas where the CPF could stand to be easily strengthened.

"Vaccine booster doses have a huge role to play in both curbing transmission and in mitigating the consequences of infection. The vaccine roll out to date has been slow to immunize Māori, and 5-11 year-olds, leaving many of them either unprotected, or under-protected.

"We want to reduce the number of people with waned immunity but not yet past the four month eligibility period for a booster. It would have been good to see the eligibility period for boosters reduced from 4 to 3 months for adults. Similarly, there are advantages to reducing the inter-dose period for children from the current 8 weeks.

"It has been reported that we currently have good levels of vaccine supplies and it would be ideal to take advantage of that and turn that into increased protection for people as early as possible. Vaccine doses are more effective when they are in people’s arms rather than in a freezer."

Conflict of interest statement: I, along with others from Te Pūnaha Matatini, are funded by 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 Sarb Johal, registered clinical psychologist, comments:

These comments are excerpted from Dr Johal's latest blog post.

"We are moving from a place of what people can call a place of relative safe certainty to, hopefully, a place of safe ‘uncertainty’ again. We know what we can do to remain safer & slow down & reduce the clinical burden on people, the health system & containing outbreaks.

"Understand that you have three systems that govern your reaction: your threat system, your calming system and your drive system.

"To manage your sense of threat, understand and act upon what you can do to reduce your personal, family and community consequence of becoming infected – for example, getting vaccinated and boosted as soon as you are eligible.

"To get into more calm mental states, understand that you can feel tired getting into this red alert state under the traffic light system. Get rested, do things that make you feel calmer.

"Do the things you need to do to make you feel safe – that can help too. It’s not a lockdown, but you need to familiarise yourself with what you can do, with who, where, and under what circumstances.

"Your drive system is important too – and I note that there were some details released recently about setting expectations about what happens after the omicron wave peaks  – what happens next.

"And though that’s too early to say, don’t underestimate how important this will be for helping people prepare for what comes next & perhaps moving to a more sustainable way of living in these times, or if the virus becomes a serious threat less than a pandemic, but still a genuine concern."

No conflict of interest declared.

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

"It is especially important for us to use the tools we have available to move quickly to respond to Omicron and keep the number of cases down. Collecting your own data about where you have been and when can help contact tracers in the event they need to identify you quickly.

"After reaching an all-time high level of participation before Christmas (almost 4 million QR codes scanned on 1pm-1pm 23-24 December, from 1.45 million people, with 2.4 million devices participating in Bluetooth Tracing), we have seen a bit of a drop in QR code scanning over January after Christmas and New Years (now averaging 2.5 million QR code scans a day, from approximately 1.1 million people). This is the opposite trend to what we observed over the same period in 2021, when we saw scanning return to pre-Christmas levels by mid-January.

"We now expect the participation rate to stay relatively steady, as it is currently comparable to levels of participation in October and November 2021 when most of New Zealand was at Alert Level 2 with some areas in Alert Level 3. Based on the population-level mobility data, we still expect that there are hundreds of thousands of people who should be scanning in who are choosing not to. Bluetooth Tracing is not a replacement for scanning QR codes, and we need both to give ourselves the best chance of responding.

"It is important for people to be scanning QR codes when they enter venues and have Bluetooth Tracing on because it could make the difference between contact tracers having enough information to act on quickly, and leaving the virus out in the community spreading for longer. Digital contact tracing is one tool in our toolkit, including wearing well-fitted masks to reduce virus transmission, testing when symptomatic to identify cases, and getting vaccinated to reduce the severity of the disease to reduce the impact on our health system."

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.

 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:

"A large number of Omicron cases had been accumulating at our borders in Aotearoa New Zealand, and it was only a matter of time before Omicron entered our communities – we are also still dealing with Delta in the community in Aotearoa New Zealand.

"The Omicron variant has much higher transmissibility and has been spreading globally, now detected in more than 80 countries. It was indicated today that Omicron will be circulating in the Auckland Region and likely to be circulating in the Nelson/Marlborough Region.

"The staged response to Omicron announced today involves 3 phases, where we are currently positioned in the initial phase of stamping Omicron out, involving steps such as sustained contact tracing, isolation measures, testing with PCR test primarily being the mainstay for the time being – with a focus on more rapid antigen testing to follow later.

"Although vaccination levels have increased across the country which has been important, vigilance is still needed since areas remain in Aotearoa New Zealand where there is lower vaccination coverage still. In addition, our communities are also still in the process of getting their boosters and our 5-11 year old children, tamariki and tamaiki have had access to their paediatric Pfizer COVID-19 vaccine since last Monday so will have had less time than others across Aotearoa New Zealand to get their COVID-19 vaccine.

"The high demand for the paediatric COVID-19 vaccine for children, tamariki and tamaiki aged 5-11 years has been encouraging and it was announced today, that the timeframe between COVID-19 vaccine doses for children, tamariki and tamaiki aged 5- 11 years will be reconsidered given Omicron is now in the community in Aotearoa New Zealand.

"Evidence indicates that Māori and Pacific peoples 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 will help people get the help and services they need at this time – we have seen equity in action with our Māori and Pacific teams working tirelessly to drive up vaccination levels and protect their communities, whānau and kāinga.

"The Pfizer COVID-19 vaccine booster gives strong immune protection against Omicron and must continue to be rolled out as quickly as possible with the appropriate prioritisation and delivery that takes into account our most vulnerable.

"There remains work for us all to do in Aotearoa New Zealand if we want to keep everyone safe and protected from COVID-19 - we must avoid our hospitals becoming overwhelmed as they have become in Australia and other countries.

"Be prepared for the possibility of isolation in the home setting with a plan, a medical kit and a buddy for support - just in case.

"Please stay safe and keep others around you safe as well – by getting vaccinated, boosted, tested, following the rules, reaching out to help others do the same."

No conflict of interest declared.

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