Big Read: Experts explain how NZ can get level 2 right

Shifting to Level 2 offers New Zealand an opportunity to cement its global reputation as a wrangler of Covid-19.

But done badly, public health experts warn, all of the gains won through more than a month of lockdown could be lost.

While the Government hasn't yet indicated when the shift might happen – or precisely what the new rules might look like – level 2 would broadly allow schools and early childhood centres, most businesses and public venues to re-open.

Many strict measures would still apply: gatherings of more than 100 people indoors and 500 people outdoors would be banned, people would still need to keep a metre away from each other and avoid non-essential travel between regions, and those at-risk would be encouraged to stay home.

Experts approached by the Herald say that, before any relaxing of lockdown measures, they'd like "mass masking" in confined, indoor areas; better hygiene practices; digital tracking technology with high uptake among smartphone users; continued control and quarantining at the borders; and higher levels of testing and contact tracing.

"The move from level 3 to level 2 is the perfect opportunity to show the world that we understand risk and we're going to manage it shrewdly," said Otago University epidemiologist Professor Michael Baker.

"Yes, we're going to re-open the economy, but we are going to use every tool available to ensure that we do it as safely as possible."

Keeping it out

If New Zealand succeeded in eliminating Covid-19, the sole remaining avenue for the virus to re-emerge would be through our borders.

Otago University epidemiologist Dr Ayesha Verrall said current border measures – which had effectively shut New Zealand off from the rest of the world, and required anyone arriving to go into quarantine for two weeks – had been greatly improved.

"There are now really clear procedures for people arriving and going into quarantine, so that's good," she said.

"What's important is that the performance of this system to make sure it's monitored going forward – such as transmission of a person in quarantine to a person caring for them."

University of Auckland microbiologist Professor Siouxsie Wiles agreed New Zealand's future border arrangement would need some consideration.

"Depending on how much travel there ends up being, it's not going to be feasible to have everyone in a Government-sanctioned quarantine."

TO READ THE HERALD'S FULL CORONAVIRUS COVERAGE CLICK HERE

There had been suggestions of requiring travellers to undertake tests before flying – but Wiles pointed out that these took days to carry out, and didn't always capture infected people.

"We need to ensure the right test is being done, that it is reliable and that the person isn't a risk - so good border control his absolutely crucial for us."

Baker and colleagues have argued that special new criteria should be set for border management.

They've also argued that if New Zealand succeeded in eliminating Covid-19, but then detected a fresh case as a result of a border control failure, its "elimination" status should be revoked.

Both Prime Minister Jacinda Ardern and Australian Prime Minister Scott Morrison have discussed opening a transtasman bubble – but with the ability to exclude any Australian state caught up in a Covid-19 flare-up.

Baker said: "This is a containable disease – but that's only possible with having extremely organised systems and assuming the worst. Complacency is absolutely the enemy here."

Tracing and testing

Verrall said public health surveillance – namely testing – needed to be operating at a level where any outbreak could be detected rapidly, before ballooning to 30 or 40 cases.

This week, her colleagues suggested that Covid-19 could not be defined as "eliminated" unless there were enough tests were being carried out to ensure no cases were slipping through.

They pointed to Australian modelling that found how testing all patients with coughs and fevers at primary care clinics – capturing some 9000 people per week, per million of population – would stop any cases being missed.

Although New Zealand has one of the highest testing rates in the world, its current rate was lower, at around 6000 people per week, per million of population.

Verrall said rates of contact tracing - the identification and isolation of people who have been exposed to an infectious case, to prevent onward transmission from the contact to others – should also be three to four times it was before New Zealand went into lockdown.

She'd been advised by the Ministry of Health that the country's contact tracing capacity was now at least double what it was, and officials were working through other recommendations in a report she prepared.

"Back in March, the disaster scenario for contact tracing was hearing someone had been to a restaurant, or on a large plane, or a concert – so moving to the relaxed restrictions at level 2 will be very much about making contact tracing more manageable."

Covid-19 in NZ — 18th December

2110

10

new

Total confirmed and probable cases

51

⬆︎8

Active cases

0

In Hospital

0

In ICU

2034

⬆︎2

Recovered

25

Deaths

427

⬆︎10

Border cases

Last updated: Fri 18th December at 12:17 am

Go here to see all our Covid-19 data

Digital dragnet

Today, Jacinda Ardern said the Government wouldn't be making a contact-tracing app contingent on lowering the alert level, describing the measure as an "enhancement" on top of what the World Health Organisation recommended.

She noted that the Government had in any case required hospitality businesses to ensure it could contact-trace people who came in and out of their premises, whether through an app or other ways.

But Baker argued a smartphone app, with high public uptake, should be an essential part of a smart digital strategy that he felt needed to be in place before New Zealand left level 3.

"When we move to level 2, there are all of these requirements for New Zealand businesses to have the ability to track people," he said.

"It would be much more practical to have a single, Government co-ordinated app that is versatile and can meet many of different needs we'll have."

Prime Minister Jacinda Ardern says a contact-tracing app isn't required for New Zealand to move to level 2. Photo / Mark Mitchell

One new Ipsos poll, released today, showed that, of 94 per cent of Kiwis with a smartphone, 62 per cent said they were likely to download a contact tracing app to aid the tracking of virus transmission - significantly higher than in Australia where the level is just 45 per cent.

The 20 per cent of smartphone-using Kiwis who felt they were unlikely to download a tracing app mostly cited privacy concerns, but also worries about accuracy and data usage.

A quarter of those reluctant thought their behaviour would keep them safe from infection anyway.

But Baker said Covid-19 resurgences in South Korea and Singapore had demonstrated how quickly the virus could spread out of control again.

"I don't that's a scenario that we'd want to see here – but it's where having good contact tracing capability is going to be very important," he said.

"I'd be really quite shocked if we dropped down to level 2 without a very clear digital strategy that all of us can buy into, that is going to manage the risk, that Maori and Pasifika can see their role in, and which the Privacy Commissioner can give a big tick."

But Wiles added that an app was only as effective as its accuracy – and how many people used it.

"We need to know whether it actually works, and does so in a way that doesn't invade anyone's privacy – if it does, then lots of people won't use it," she said.

"So I'm relieved that the Government isn't putting all of its eggs in one basket and saying [level 2] is only going to work if you app. It's about strengthening the bits of the system that are already working."

Mass-masking?

The second measure Baker wanted to see under level 2 was widespread use of "mass masking" in crowded or confined spaces like offices, trains and buses.

"Mass-masking is universal in Asia and is being introduced more widely in other countries."

Another Ipsos poll showed the countries where most people had adopted the practice were Vietnam (91 per cent), China (83 per cent), Italy (81 per cent), Japan (77 per cent) and India (76 per cent).

Meanwhile, those in developed nations are least likely to do this – they included United Kingdom (16 per cent), Germany (20 per cent), Australia (21 per cent), Canada (28 per cent) and France (34 per cent).

New Zealand wasn't included in the poll, but Baker said our country would do much better to look to Asia than Europe or North America, "as they've had very unsuccessful responses to the pandemic".

Other Otago University scientists have pointed out that the main way the Sars-CoV-2 virus spread was likely through small droplets – often just via talking – and these could sometimes travel much further than the two metres used in distancing guidelines.

Further, perhaps half or more of people infected never developed any symptoms, so could spread the virus without knowing.

Baker said overseas studies were increasingly showing the value of wearing masks.

One suggested that a non-fitted surgical mask could block up to 100 per cent of droplets containing coronavirus, while another, focused on cotton mask use on infected patients, found viral spread from a cough was cut down by 96 per cent.

"I don't know about you, but I'd feel much more confident in a bus if everyone else had a mask on - that seems like a very small sacrifice to make," Baker said.

Baker felt that mass-masking could encourage those worried about infection not to keep themselves at home, and wanted to see the Government promote the concept and issue advice.

Nonetheless, the benefits of "mass masking" still remain debated among public health experts around the world – with some citing worries about them fuelling false confidence, failing to prevent spread, or people simply not wearing them properly.

Hygiene 101

Beyond that, good hygiene remained crucial.

"Even five or six weeks of lockdown likely still won't be enough to change generations of poor behaviour with hygiene," Baker said.

"The critical thing is not to go to work or any social setting if you've even got a hint of illness."

"Complacency is absolutely the enemy here," Otago University's Professor Michael Baker says. Photo / Supplied

Wiles agreed Kiwis had a culture of coming to work when sick – which, for those who couldn't afford to stay home, was often out of necessity.

"Those other practices for ensuring everybody's health – social distancing and changing how we interact with each other – are also going to very important."

Wiles said for employers who ran open-plan offices, or had workers operating in close proximity, a re-think might be required.

"Every business needs to be thinking, if this is going to happen again, how would they stop stuff?"

• Covid19.govt.nz: The Government's official Covid-19 advisory website