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Image: Toby Morris
Image: Toby Morris

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.

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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!
a yellow image showing a map of New Zealand + a virus + a vaccine = ...
(Image: Tina Tiller)

Covid-19July 6, 2022

How do Aotearoa’s Covid regulations compare to the most up-to-date science?

a yellow image showing a map of New Zealand + a virus + a vaccine = ...
(Image: Tina Tiller)

After nearly three months at the orange light setting, Shanti Mathias asks the experts if our current regulations still fit.

Aotearoa has been at the orange light setting, with widespread community transmission of Covid, since mid-April. In that time, more than half a million people have caught Covid. With Covid hospitalisations the highest they’ve been for months, and the BA.5 variant spreading, The Spinoff talked to microbiologist Siouxsie Wiles and epidemiologist Michael Baker about how the ever-evolving science does and doesn’t align with Aotearoa’s current Covid regulations.

Does two doses mean fully vaccinated?

While vaccine mandates have largely been phased out, except for healthcare workers, there’s widespread uncertainty about how many doses of the vaccine offer full protection. Second boosters for immunocompromised people and those over 50 have been available since June 28. Across the government websites which provide information about Covid, the first two doses of a mRNA Covid vaccine are now referred to as a “primary course” of the vaccine, rather than “fully vaccinated”, although this isn’t entirely consistent

Scientists say that the term ‘fully vaccinated’ needs to be replaced with ‘up to date’. (Image: Getty)

“Your vaccination should be ‘up-to-date with current criteria’,” suggests Baker, as an alternative description of vaccine status. A booster is essential for protection against omicron. Vaccine doses in the future may be tailored to providing maximum protection against particular variants of the virus. 

While 95% of eligible New Zealanders have had two vaccine doses, only 68% of that group have had a third booster dose. False perceptions “that the boosters are optional extras combined with the idea that omicron is mild, which is simply not true” may contribute to a lack of booster uptake, Wiles says. 

Test for reinfection after 29 days

On June 30, the guidance around Covid reinfection was updated, changing from not having any requirement to retest for Covid within 90 days of an infection to 29 days. “The latest evidence shows that getting reinfected with Covid-19 can occur within a short period of time,” says the government’s Covid website. However, household contacts of a case who have had Covid in the previous 90 days still do not need to isolate.

The 90-day regulation may have prevented health agencies from getting accurate data about reinfection – there is very little available data on reinfection in New Zealand – although it made sense when the primary testing method was PCR tests, which are more sensitive to any viral load. The Spinoff spoke to Baker and Wiles before the 90-day reinfection guidance changed.

Rapid antigen tests are an easy way to work out if you have been reinfected with Covid (Image: Ezra Whittaker)

“We don’t know much about reinfection in New Zealand because the advice has been for people to not get tested if they were within three months of having Covid,” says Wiles. “It’s clear now that people can get omicron more than once. If people’s symptoms reappear then it’s important for us to understand if someone has been reinfected or if they might be chronically infected. Because rapid antigen tests basically detect infectious virus, it’s crucial people get tested to help answer that question.”

Baker agrees. A cut-off date for reinfections is arbitrary, but 90 days was too long. “Reinfection is unusual within the month,” he says. “But there are well documented cases of people getting Covid within three weeks. We shouldn’t have any barriers to having something declared as a reinfection because it can happen.” 

Is seven days long enough for isolation? 

Current regulations say that “you can end self isolation seven days after your symptoms started or you tested positive, whichever came first. … You do not need a negative RAT to end self-isolation”. Guidelines also recommend that those with ongoing symptoms stay in isolation until 24 hours after their symptoms resolve. 

The science around infectiousness is complex, and very case-dependent. As many as one in four people can still be infectious seven days after symptom onset, says Wiles. Given this, RATs are a useful tool: “the beauty of using rapid antigen tests is that we have a quick and easy way of telling if someone is likely infectious. We should be using those and making sure people are staying isolated if they are still testing positive,” she says. If someone continues to test positive for several weeks, then they may be chronically infected. 

Wearing a mask after the seven-day isolation period has ended will help to prevent spread of Covid to others (Image: Tina Tiller)

“Seven days is a compromise,” says Baker. In other countries, such as the US, isolation ends after five days, but Covid cases are encouraged to wear a mask while in public to avoid infecting others. While a mix of consistent mask wearing and a “test to release” could prevent still-infectious people from spreading Covid after their isolation ends, Baker says that adding these layers into the Covid regulations would increase the complexity of guidelines and make it more difficult for people to adhere to. 

Why the regulations and science don’t match

“The regulations are a tradeoff between protecting people and the government getting society moving again,” says Baker. He compares Covid regulations to the road toll: while the interventions to prevent people getting killed on roads are well known – slower speeds, road barriers, and so on – the appetite to go places fast means that there is limited social licence to apply these limits to how people move on roads. 

Similarly, the ways to reduce the harms of the pandemic are well established. Increasing vaccination coverage, reducing virus transmission and caring for positive cases are what Baker calls the “three big opportunities” to minimise the impact of Covid. 

Given that Covid hospitalisations are currently the highest they have been since April, it could be time to revisit how Covid guidance limits harm. Baker suggests that employers could be supported to encourage a seven-day isolation period for workers with any respiratory infection, not just Covid. “We’re still in a pandemic stage,” he says. “Covid isn’t endemic yet.” If the current mortality rate of around 10 deaths a day continues all year, it will add 10% to New Zealand’s annual mortality. 

“We’ve got to balance protection against Covid with [limiting] the economic and social consequences [of restrictions],” Baker says. Currently, the mechanics of these trade offs aren’t explicit enough – and those who are most affected are not the people making decisions. Baker says it’s “the old, the vulnerable, and the disabled” who have had to reduce their social interaction due to the danger of Covid. “Their world has shrunk.”  

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