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New Alert System And Possible Community Transmission – Expert Reaction

The Prime Minister has announced a new COVID-19 alert system, while two cases are being investigated for possible community transmission.

The Prime Minister says we are currently on alert level two - reduce contact - which means limiting domestic travel, and encouraging over-70s and those with compromised immune systems to stay at home as much as possible.

Director-General of Health Dr Ashley Bloomfield says most of the 52 confirmed cases in the country are travel-related but they cannot rule out the risk of community transmission for two cases - one in Auckland and one in Wairarapa.

The SMC asked experts to comment on the news.

Dr Sarb Johal, psychologist, comments:

"The structure offered by the launch of this alert system will be comforting for many.

"The fact that we have a series of actions that is definitively tied to an alert level helps us to feel reassured that likely impacts are being weighed up.

"We will clearly know how we can play a part in stopping and slowing the spread of the virus through our own actions to protect ourselves and each others.

"Of course, this is also a stark message too - the risk of wide and rapid virus transmission is very real, and will provoke some anxious reactions concerning what this means for the future.

"However, as this system rolls into action, for most people, the structure and action framework that is offered will be helpful.

"For the longer term, I think the message implicit here is that this is highly unlikely to be done within a few weeks. We are more likely to see a scaling up and down of the alert level according to what is happening in the community.

"Again, there are two sides to this. For some, it’s a very clear message that if they thought this was likely to have no consequences for them, then that is unlikely to be true. For others, it’s the structure and clear message that this will have a lasting impact.

"This is not going to be easy, but there is the world we are are in, and the world as we wish it was. Right now, although it’s difficult, this is our reality.

"Some people will need assistance to adjust to that, including psychosocial supports. This especially true for those people asked to stay at home because they are over 70 and / or have underlying health conditions.

"Many of these people rely on work to support their incomes. There is an urgent need to ensure that incomes are protected in some way so that people in this group do not expose themselves and others to further risk. Both employers and workers have an urgent part to play in getting this right."

No conflict of interest declared.

Joint comment from:
- Associate Professor James Ussher, Department of Microbiology and Immunology, University of Otago
- Gary McAuliffe, Medical Director, Labtests
- Dr Joshua Freeman, Clinical Director Microbiology and Virology and Acting Clinical Director Infection Prevention and Control, Canterbury District Health Board:

"There is a possibility COVID-19 community transmission has taken place in New Zealand, however we need to consider carefully who we test.

"It is very important that only symptomatic contacts are tested, not asymptomatic ones. Testing of asymptomatic contacts does not alter their need to be isolated for 14 days.

"Diagnostic labs are really struggling to maintain testing capacity due to supply chain issues, which will be ongoing, as they are worldwide.

"In an ideal world we would test all people with influenza-like symptoms even if they had no known contact with a case or travel, in order to prove there is no undetected community transmission. However this is impossible given current supply chain issues.

"The influx of test requests outside the current case definition is currently threatening to overwhelm our capacity to test at all. Labs are working extremely hard to increase testing capacity, but there are many pinch points and issues to be addressed and it is not a straight-forward exercise for testing labs to scale up their operations.

"Messaging to the public about testing is very important. The Ministry of Health is doing the best it can under the circumstances, but the testing labs are in crisis."

No conflict of interest declared.

Dr Christopher Gale, Senior Lecturer, Department of Psychological Medicine, University of Otago, comments:

"Right now, we have a number of cases in New Zealand and we have been contact tracing them. There have been local periods of isolation and people who may have had COVID-19 are self-isolating.

"We are not sure if there is community transmission, or if so, how much. If there is a little community transmission – that is people developing COVID-19 who have not been overseas, we may still be able to contain it with contact tracing and self isolation.

"COVID-19 is affecting the health care system. In mental health, there are people who need daily pickup of medications, and that will become more and more difficult.

"There is a limit to how much training can be done for medical and nursing students without working alongside doctors and nurses in wards and clinics.

"I am aware that the specialist colleges are cancelling oral qualification examinations, and cancelling medical conferences.

"The district health boards are planning to deal with the minority of people who will be very sick with COVID-19 if it is throughout the community, and the mild and moderately ill – who do not need high tech support at this time – will probably be managed at home.

"At this point, the advice for everyone is to hand-wash, keep distances, and minimise spread.

"The borders are closed, and there are restrictions on the size of meetings which has functionally closed most churches, mosques, temples, sports fields, gyms, theatres and concert halls.

"There will a sense of isolation and fear. In my view, these feelings are normal: a little bit of fear and anxiety will motivate us to make changes we would need to cope with living in a smaller area.

"If we move to more restrictive rules – such as asking everyone to stay home and closing most places of work – it may be better in that situation to isolate as families when possible.

"It will be important to have routines, and use the tasks of the day – working from home, caring for children, making meals – to allow us to have a sense of control.

"The more active and involved we can be with each other, with our work, hobbies and interests, and with helping the most vulnerable in our neighbourhoods, the better.

"There is a place for calmness and relaxation. But the best way to manage these fears is behavioural: have a plan, and act through it."

No conflict of interest.

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