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ScienceJuly 13, 2022

Siouxsie Wiles & Toby Morris: How we can hold back the new omicron wave

Image: Toby Morris
Image: Toby Morris

We’re all tired of Covid, but there’s no avoiding the fact that case numbers and hospitalisations are rising, and the worst is yet to come. Siouxsie Wiles explains what could be done to ease the impact, and how you can prepare.

I went to the hairdresser last week. It had been about six weeks since I last went and the difference between the two appointments couldn’t have been starker. QR code? Gone. Official “Unite against Covid-19” signage reminding people to mask up? Gone. Box of surgical masks on the counter for those who’d forgotten their mask? Gone.

It’s like I’d stepped into some other timeline where Covid-19 doesn’t exist.

This lack of pandemic signalling made a difference. Six weeks ago, almost everyone in the salon was wearing a mask. Last week, it was just me, one other client, and the staff. I’m guessing the only reason many of the staff were wearing a mask is because at the orange setting of the government’s Covid Protection Framework, hairdressers are required to. The rules are also clear that masks should cover a person’s mouth and nose. But that didn’t stop some of the staff from wearing their mask under their nose or on their chin. In other words, mask theatre.

I get why. We’re all tired and wish the pandemic hadn’t happened. Wasn’t still happening. I was told that Covid-19 rampaged through the salon staff a couple of months ago, so they’re probably feeling like they’re not at risk of another infection so soon. That’s wrong but not surprising given the official guidance has only just caught up with the changing evidence. Even if you were infected as recently as three weeks ago, you are at risk of getting Covid-19 again. And with each infection, you roll the dice that could lead to long Covid, disability, and long-term health issues.

As well as the lack of masks, all the salon’s windows were closed. Seems the message about the importance of fresh air hadn’t got through either. I nearly had a panic attack and wished I’d had my CO2 monitor with me to measure how much potentially contaminated air everyone was sharing. I kept my mask on and crossed my fingers that it would be enough to protect me if one of the staff or other clients was infectious.

A new wave means you’re more at risk of getting Covid

The reality is that your chances of encountering someone infectious with Covid-19 now are higher than they were six weeks ago, and they’ll continue to increase. Just look at the seven-day rolling average of daily cases. It’s doubled in the last few weeks and we’re almost halfway to the peak of our first omicron wave.

Newsroom’s Marc Daalder has pulled together a nice interactive visualisation of data from Dr Kit Yates, an author and mathematical biologist at the University of Bath. It shows how the chances of sharing a space with someone with Covid-19 increases as the number of people in a space increases and the population prevalence – the amount of Covid-19 around – increases.

We aren’t alone in experiencing this latest wave, which is thanks to the latest omicron variant, BA.5, and immunity from having been infected and/or vaccinated fading over time. Check out the explainer from Toby Morris and me about that here. Cases and hospitalisations are rising in lots of countries, including Australia, Japan, the UK, the US, and across Europe. So, all this “the rest of the world has moved on” bullshit is just people being dangerously in denial of reality. It does look as though we might be punching above our weight in terms of per capita confirmed daily cases, though Dr Jin Russell and I have written about how hard it’s getting to interpret the Covid-19 data coming from lots of different countries.

Hospitalisations are on the rise – and that’s bad news

What’s really worrying for New Zealand is our rising hospitalisations, up from 417 two weeks ago to over 700 now. They peaked at 1,016 during the first omicron wave but there is real concern they’re going to get even higher this time around. That’s partly because of the age demographics of the current cases. The rolling seven-day average of daily cases for the over-70s is already twice as high as it was at the peak of our first omicron wave.

Dr Matire Harwood, a clinical researcher and a GP on the frontline, spoke to Q&A’s Jack Tame recently about the impact Covid-19 is having on her practice. The combination of staff shortages and sickness, with increasing sickness in the community, means many people are struggling to get to see their GP in time. That means some people won’t be getting the care they need and may well end up needing to be hospitalised. That is only going to get worse as the wave continues.

One reason it’s important for older and high-risk people to be able to see a GP or other health provider promptly if they have Covid is to get access to Paxlovid. That’s the oral medicine designed to block the virus from replicating in our cells. Clinical trials have shown Paxlovid is very effective at preventing hospitalisation and death in high-risk patients if given within the first few days of them developing symptoms. 

In the US it seems like anyone can get a prescription if they can afford it. That’s asking for trouble as it’s not clear if the benefits of making Paxlovid so accessible outweigh the very real possibility of resistance emerging.

But I wonder if we’ve got the balance right in New Zealand. Here, Paxlovid can only be prescribed if a patient meets certain criteria. Pharmac has a handy tool for clinicians to see if their patients qualify. If you are severely immunocompromised, you automatically qualify, but for almost everyone else, it depends on several factors, including your age and whether you are vaccinated. For example, if you are under 50 and vaccinated, you’ll also need to have four to five high-risk medical conditions to get a Paxlovid prescription.

Paxlovid is very effective at preventing hospitalisation and death in high-risk patients (Photo: Getty Images)

Preparing ourselves for the wave

So, as we brace for this next omicron wave, what can we do?

First, I’d encourage everyone to watch this video from the John Snow Project that explains how the Covid-19 virus spreads through the air. (You might want to watch with the sound off – the voiceover is quite something.) The John Snow project is named not after the Game of Thrones character, but after a doctor considered one of the founders of epidemiology for his work on cholera. During an outbreak in London’s Soho in 1854, he plotted the cholera cases on a map and found they clustered around a public water pump on Broad Street.​ His map was enough to persuade the local authorities to disable the pump by removing its handle, which was credited with helping stop the outbreak.

OK, once you’ve watched that, go and check out this great piece by RNZ data journalist Farah Hancock. She took a portable CO2 monitor around with her basically measuring how much of the air she was breathing had been exhaled by someone else. 

Time to revamp the traffic light system

For a while, I’ve been struggling to understand who or what the Covid Protection Framework is protecting. As I write this, we are at the orange setting and the government seems to have ruled out moving to red. Probably the most important thing about the red setting is mandating the use of masks. Covid-19 is an airborne disease, and we need to be using all the protections we can to reduce airborne transmission.

It’s well past time for the Covid Protection Framework to be revamped so that it focuses on ways we know we can reduce the spread of Covid-19 through the air. That means mandating high-quality respirator-type masks, not surgical masks, and making them free or at least massively subsiding them. It means helping individuals and businesses get their heads around how to make indoor spaces safer through ventilation and air filtration and introducing a “scores on the door” air quality rating system. It also means ensuring people have the sick leave they need to stay home when unwell. And why aren’t we making more use of rapid antigen tests to ensure that people aren’t attending gatherings and events while infectious?

We have the tools, we just aren’t applying them.

In the meantime, it’s up to all of us to do our bit. We need to rekindle the collective spirit we had at the beginning of the pandemic and focus on protecting each other.

Let’s make it so that popping on a mask becomes as natural as clicking in your seatbelt.

All the exhausted people working in our healthcare system are depending on us.

Keep going!