New Zealand stands on the brink of the Covid precipice. Why arent we moving to red? – The Guardian

Last week cabinet made a baffling decision. As winter illnesses spike and another wave of Covid-19 threatens to overwhelm emergency departments, the government held the country at the orange traffic light setting.

Large gatherings can still take place, masks are optional in most settings, and schools and workplaces can open without restrictions. In other words, all the rules that struggled to contain the first outbreak are still in force. This, as daily cases pass the 10,000 mark and experts predict that the BA.5 variant could easily push case numbers above 25,000 before the month is out. With many hospitals already operating at 100% capacity, a more than doubling in case numbers could risk the mass cancellation of procedures, ward closures, and other measures to preserve the health systems capacity.

Thats a disastrous scenario. Hospitals are already operating at the very edge. Last week the Association of General Surgeons wrote to the health minister, Andrew Little, outlining how a staffing shortfall is profoundly reducing doctors ability to deliver care.

Cancelling procedures and closing wards helps make that staffing shortage manageable, allowing hospital executives to redirect staff and resources to Covid-19 care, but then the health care burden only shifts to primary care. Yet general practitioners of whom there is a desperate shortage and urgent care clinics are already reporting impossible numbers. One clinic in Hamilton recorded double the number of patients compared with the same time last year. With the entire system operating at the edge it seems like wishful thinking to hold the country at orange.

To the governments credit, it is taking action to help people protect themselves. Last week the Covid-19 response minister, Dr Ayesha Verrall, announced that the government would supply schools with 50 child-sized face masks for each student in years 4 to 8.

More than two years into the pandemic, we know that masking is one of the simple and effective measures individuals can take to reduce their risk of infection. A study published in the Proceedings of the National Academy of Sciences estimates that, when a sick person and someone nearby both wear N95-style masks rather than surgical or cloth masks, the risk of Covid-19 transmission can be reduced up to 75-fold. This effectiveness probably takes a hit against the more virulent BA.5, but masking remains one of the best forms of protection an individual has and, as a result, one of the best forms of insurance the health system has against a collapse.

But the trouble with holding the country at orange and emphasising personal responsibility is that it flips New Zealands successful pandemic script on its head. In 2020 the governments elimination strategy led the world, successfully reducing the countrys case numbers to zero within a few months.

Lockdowns and crystal clear public messaging helped New Zealanders undertake a collective effort to stop the spread and stamp it out. Advertisements encouraged people to scan in, and the government provided the contact tracing infrastructure to make it effective. Ministers encouraged people to social distance and advertisements communicated the epidemiological benefits of staying at least 2 metres apart. Wage subsidies and other forms of support were made available to ensure that people had the financial means to weather lockdowns and a new form of public life.

Yet Omicron put paid to that intensive government effort. Instead, its up to individuals to take protective actions themselves and hope that enough people in the community do likewise to make that individual effort worthwhile (you could mask up on the bus, for example, but if no one else does then your level of protection is dramatically reduced). The orange setting comes with very few rules and very little government encouragement. The public campaign communicating the benefits of masking, social distancing and self-isolation is over. This seems outrageous when the threat of Covid-19 is at its highest level, ever, in this country.

Of course, the case numbers which are bad and likely to get worse tell only half of the story. Covid-19 works along a chain, with every new infection disrupting a household, a workplace, and a community. When hospital staff fall ill, capacity takes a hit. When teachers fall ill, schools take a hit. When workers fall ill, businesses take a hit.

As the virus moves along that chain there are opportunities to cut it off at each link. In schools, mandatory masking and ventilation can help slow the spread. In businesses, social distancing and ventilation can similarly help slow the spread. None of this is difficult to comprehend. Covid-19 spreads in particles that escape from an infected persons mouth or nose, but the risk of catching that infection is reduced dramatically with masking and air ventilation (or purification). Add to these measures masking and ventilation a test-to-release policy and the virus would find it increasingly difficult to spread.

And yet the government is apparently considering none of this. There are no mandatory ventilation or purification rules, or funding mechanisms to make this possible for businesses and other organisations. Masking is voluntary in most settings and there is little in the way of government support to help in enforcement. Under the current rules people with Covid-19 can exit isolation after seven days. But the seven-day rule owes more to politics than it does to epidemiology. Under a test-to-release policy an infected person would not exit isolation until returning a negative test. Thats a better guarantee of stoping the spread than an arbitrary seven days, but the government appears committed to its week-long rule.

New Zealand led the world with its elimination strategy. The government could lead the world again if it committed wholly to suppression. With increasing evidence that Covid-19 can burrow in your organs, causing long term and irreversible damage, there is an increasingly strong argument that the suppression efforts must be stepped up for the sake of public health. In the absence of action were stuck on a rollercoaster of unplanned labour shortages, disability (long Covid), and death.

In the long term our best shot at suppression is making good-quality masks freely available, supporting businesses and other organisations with funding to improve ventilation, and changing self-isolation policy to better reflect scientific understanding. But in the short term our best shot at suppression is a move to the red setting.

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New Zealand stands on the brink of the Covid precipice. Why arent we moving to red? - The Guardian