Cabinet is to decide today on the future of the country's Covid-19 protection measures, including the use of vaccine passes and mandates.
A top Covid-19 expert warns while there is a case to scale them back once the Omicron peak passes, the Government needs to continue its cautious approach given the long tail of the outbreak, with smaller waves of cases and new variants on the horizon.
Royal New Zealand College of General Practitioners president Dr Bryan Betty said the country needed to reset, start to remove the mandates and look ahead.
At the moment GPs were slammed dealing with the Omicron outbreak, he told AM.
The best thing that could happen would be seeing the number of Omicron cases decrease to free up space for GPs to do all their other business and provide routine care.
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Betty said there was no doubt over winter they would probably see small peaks and surges of Omicron, they there would also be flu and possibly whooping cough and RSV. "It's going to become a very mixed picture and we need to free up the system."
Epidemiologist professor Rod Jackson said if you were double vaccinated then you were much less likely to transmit or get the virus. He thought New Zealand was probably at the peak of the Omicron pandemic and it was two to four weeks too early to reduce any public health measures including mandates that help stop infections and the speed of which the virus spreads.
Any move in traffic light settings had to be countrywide because people were moving around all over, he said. "We need to keep it simple. In two to four weeks when this current outbreak is over we can do something different."
In fact at this stage in the outbreak, he wanted boosters added to vaccine passes. "We are right on the border of losing control." He said all public health measures needed to stay in place until it was over the outbreak.
People who were unvaccinated were more than three times likely to transmit the virus, more than two times likely to have it and five times likely to be in hospital, Jackson said. "Lets not take our eye off the ball."
In terms of reducing isolation period, Betty said at some point they needed to come down. "I think there's a strong argument for that." The problem in general practices and hospitals was that so many staff were off work and at home isolating.
The health section was only just coping, they both said.
Prime Minister Jacinda Ardern has said all Covid-19 protection measures, including QR scanning and the traffic light framework, are being reviewed by Cabinet as the Omicron wave starts to plateau.
Ardern said two major factors would play into Cabinet's decision-making.
The Prime Minister told RNZ the traffic light system shouldn't be any more restrictive than it needed to be to deal with inevitable further waves of Omicron.
She said vaccine mandates and vaccine passes should also be removed when it was safe to do so.
Mask mandates were likely to remain in place while the country still had a large number of cases.
Those measures were regularly reviewed, however Ardern has said some major decisions around them are imminent and will be announced on Wednesday.
Ardern says they'd be keeping some Covid-19 management tools like vaccine passes and the traffic light system in their back pocket should there be a need for them in the future.
"We are not getting rid of everything that could help us in the future because we don't know what is yet to come."
Ardern told TVNZ's Breakfast that New Zealand is expected to see another wave of the virus variant in winter.
"The reason we need to do that and keep the framework is because this is our first wave and we'll likely have others, particularly over winter, but we just want to make sure we are using the least number of settings possible that still give us protection during those moments," she said.
She said they were getting the balance right between opening New Zealand back up and keeping Kiwis safe.
"That's not to say we will be one of those countries that will shed everything immediately, we won't and that's not what you can expect from us on Wednesday."
"We are still going to be cautious but we are going to try make life feel as normal as it can while we keep going."
She stood by using vaccine mandates.
"They kept us safe at a critical time, they helped us drive up vaccines and they've helped our health system which is stretched and stressed now."
She said the booster shot was not optional for people who wanted full protection from Omicron.
"Boosters are making a difference and you can see the disproportionate over-representation of people in hospital who have not been vaccinated or not been boosted."
MIQ was still being used to safely support people coming into New Zealand if they did not have alternative accommodation and for Omicron cases who needed accommodation support.
Last week a large group from Afghanistan stayed in MIQ, said Ardern.
MIQ would also be one of the tools they keep in their back pocket she said.
Ardern told AM the Government had already given a strong indication that once the outbreak was "coming down the peak" it would look at easing vaccine passes and mandates.
While the tools might not have a use right now, there were questions about whether they would have a use in the future so they were prepared. It was also important to keep the Covid protection framework as it was likely New Zealand would experience another wave over winter, she said.
The big reason for the change was that now the first big Omicron wave had come through, it meant the people who hadn't been vaccinated may now have had Covid. New Zealand also had a highly vaccinated population.
There would still be some circumstances where mandates would still be used such as where there were highly vulnerable individuals. "But we will be discussing today exactly how far that use is."
"It doesn't mean that everything goes out the window. There are ways that we can actually reduce down the restrictions as much as possible while still continuing to protect the highly vulnerable. We can still do both and that is what our ambition has been all the way through."
The Government had focused on both health and the economic response all the way through and had done things to help keep its unemployment low. The cost of living had been a by-product of the pandemic and was having an impact on people and they were hurting, she said.
This is why the Government had dropped 25 cents per litre off fuel last week as the price of petrol rose rapidly due to the war in Ukraine, she said.
"We have done both all the way through, all the way through. We knew we needed to protect lives and livelihoods."
The Government was still trying to manage a pandemic and the Government had not changed its approach. "We are moving with the evidence and the experts."
The Government imposed mandates were rather limited as well as those who had to use vaccine passes, but other businesses had also decided to adopt their own policies.
"We might be debating something that is likely to change."
Ardern said they would be reviewing the settings in red and orange rather than whether New Zealand was ready to change colours.
With the border reopening to vaccinated Australian visitors from April 13, National has been calling for vaccine passes to end on the same day, given the difficulty of enforcing them on international visitors.
A Government spokesman said no decisions on a date for vaccine passes had been made yet.
National leader Christopher Luxon has called for the Government to immediately scrap vaccine passes for all but large, indoor events.
The party also wants to see all scanning requirements dropped immediately along with vaccine mandates for all young people aged under 18.
He also called for a move to a five-day isolation period for Covid-19 cases and their household contacts, down from seven days.
Act has been calling for those and vaccine mandates more broadly to end immediately.
Epidemiologist Professor Michael Baker said as the country got to the low point of the Omicron wave there would be a case to scale back the use of vaccine passes and mandates and other health protection measures.
As at Sunday, New Zealand's rolling seven-day average stood at 17,278 cases – the vast majority of them self-reported from rapid antigen tests – with officials increasingly optimistic the outbreak had peaked in Auckland.
While the Ministry of Health announced another 12,020 community cases - down from the 18,514 reported on Saturday - it warned weekend testing numbers were generally lower.
The ministry said there was a "steady decline" in case numbers across Auckland while cases in other parts of the country continued to fluctuate.
Nine people died, with the total number of publicly-reported Covid related deaths has now reached 175, with a seven-day rolling average of nine.
Hospitalisations remained under 1000, and looked to be plateauing.
Baker said while the peak had likely passed about two weeks ago, given the lag in cases being reported, we were in for a "long tail" with potential for some smaller waves.
These risk factors meant getting rid of all Covid-19 protection measures risked a "yo-yo" in cases and putting extra pressure on an already-stretched health system.
While Australian cases peaked at more than 110,000 cases a day in January, and subsequently dropped to around 25,000 a day in February, numbers had since climbed again to more than 40,000 – partly on the back of the more transmissible BA.2 subtype.
Here, based on the Australian experience, Baker said there could be about 200-300 people in hospital with Covid-19 for the next few months.
"All of this is really a warning for the health system that it's going to be under pressure for many months."
Baker said this meant changes to protection measures needed to be strategic, and continue in areas where there was strong evidence for them to continue.
Alongside this, requirements for vaccine passes needed to be changed to include a booster dose.
While two doses and/or prior infection was shown to be effective at reducing transmissibility of Delta, it was less effective with Omicron.
People who had a booster dose though were less likely to be infected by Omicron and infect others.
A recent model found that, when compared with boosted people, unvaccinated people were 3.1 times more likely to infect others and 2.4 times more likely to be infected.
Baker said given the high-risk environments and interactions with vulnerable people there were arguments to maintain vaccine mandates in healthcare, aged-care and for first responders.
Vaccine passes could continue in some high-risk areas, but responsibility shifted to businesses, employers, such as event organisers, he said.
Meanwhile, in an interview reflecting on two years of the pandemic, Ardern has said she wished the Government could have "brought more people with us" on its response.
"I would have preferred that we would have been able to do that. How, I haven't quite landed on, because again the flipside was probably more generic restrictions affecting more people rather than targeted ones that affected a few.
"But I'll probably think about that for a long time."
Her comments come after a three-week-long protest at Parliament that culminated in some of the most violent confrontations between the public and police in the country's history.
Ardern said on the flipside to the pain and heartache caused by some of the Government's Covid-19 measures - border restrictions, preventing family from attending funerals, and job losses caused by vaccine mandates - were the lives saved.
"One of our critical advisers through this, who's from the science community, mentioned to me the other day that on their calculation, give or take possibly 5000 people have been saved by what we had done.
"So in those moments I think of that. Now those 5000 people, they don't know who they are. They don't know that it was them that has been potentially protected by these measures. But I just keep that in my mind. It's been hard, but the flipside would have been even more painful."
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