Covid 19 Omicron outbreak: Derek Cheng – From red to orange; if not now, then when?

ANALYSIS

The Government will today reveal what traffic light setting will be in place over Easter and the school holidays, and there definitely remains a health justification for leaving the country at red.

But having already dangled the prospect of fewer restrictions over Easter, it would cost Jacinda Ardern political capital to push orange even further into the future.

Last week, the Prime Minister said the public health advice was for Auckland to remain in red because hospitalisations were at the high end of the modelled medium transmission scenario.

Those numbers have dropped from a peak of around 600 in Auckland’s three hospitals to 350 last week to 289 yesterday, but they remain at the high end of the medium transmission scenario.

Case numbers are dropping – yesterday’s seven-day rolling average was under 10,000 for the first time in months, and 23 per cent lower than a week ago – and the West Coast is the only DHB that hasn’t peaked.

The caveat is that the number of cases relies on self-reporting. A Health Ministry prevalence survey to have a better picture of country-wide infections is still only planned sometime “over the coming months”.

Ardern also made a plea for people to get a booster shot, adding it was still worth it to wait for booster coverage to be higher. This makes sense, as three doses gives far more protection against severe illness than two.

But only about 1500 boosters are being administered a day, and there are still just shy of a million Kiwis eligible but unboosted. She, and we, can’t wait forever.

She also mentioned the strain on the health workforce. It remains under strain, although with lower case numbers, it’s reasonable to assume there are fewer health workers isolating due to having Covid or looking after someone who has it.

Given these downward trends, if the country isn’t ready for orange now, when will it be?

“We’re not in a massively different situation now to where we were a week ago, but you have to do it [move to orange] at some point,” says Covid-19 modeller Professor Michael Plank.

“It seems like a reasonably good time when cases and hospitalisations have come down significantly in almost all parts of the country. Hospitalisations in Auckland are less than half what it was – a significant drop.

“You also generally expect to see less mixing and less transmission over school holidays, so that’s another advantage.”

Covid hospital admissions also dropped to about 20 a day in the northern region over the weekend.

Otago University epidemiologist Professor Michael Baker says the rolling average for daily fatalities is also going down.

“It’s been dropping for over a week. It was 20 on April 4, so it’s now been declining for eight days, and it’s half what it was at the peak in Auckland.”

Orange means no limits for indoor gatherings, no seated-and-separated requirement, and no masks when eating or drinking – which effectively means no masks.

But the risk of super-spreader events is mitigated by vaccination coverage, natural immunity from up to a third of the country catching Omicron in recent months, and continued caution from those unwilling to attend a gig in case they get infected.

People also have the choice to attend an indoor gathering, but schools, where only 22 per cent of children aged 5 to 11 are double dosed, are another matter.

Ardern said on Monday that schools were able to require masks if they felt they were needed, but Baker points out that not all schools are created equal.

“There are huge differences in the level of resources that parents have in different socio-economic areas, for instance. Are we just going to keep perpetuating these inequalities?”

A better solution, Baker says, would be to mandate and supply masks in schools unless they provided proof of adequate ventilation. The Government has also ordered 5000 air purifiers for schools, but most of them won’t arrive until winter.

Adds Baker: “The other big unknown is Long Covid in children, and the precautionary principle is ‘if you don’t know, then you should minimise that risk’.”

University of Auckland community and developmental paediatrician Dr Jin Russell also wants a mask mandate in schools for orange – and to reassess after winter.

“There are lots of good reasons. Firstly, we have ongoing circulation of Omicron in the community, and we’re seeing spread in lots of contexts – including schools. Secondly, we’re expecting to have quite a tough winter with influenza and RSV, and because we haven’t seen a lot of influenza over the past couple of years, we might expect children to not have as much immunity to that.

“And every winter, our hospitals are stretched. All these layers of protection reduce the risk of spread within classrooms, and actually make our classrooms safer spaces for children who are medically more at risk.”

She adds that mask use in Auckland schools was inconsistent the last time they were recommended, but not mandated.

It will be interesting to see if Ardern is prepared to balance any move to orange with a mask mandate for schools. She has previously cited Russell as providing key advice for ministers’ decisions.

Another factor – and perhaps the most pertinent – is whether Ardern might face blowback if the country stayed in red, having essentially created expectations of orange for Easter.

If that transpired, she would at least look at arm’s length. Covid-19 Response Minister Chris Hipkins is expected to reveal the decision this afternoon.

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