The government has unveiled a staged approach to responding to Omicron that shifts from stopping to slowing its spread.
The self-isolation period for cases will drop from 14 to 10 days, and for contacts from 10 to seven days, during the last two stages of the plan. In the third phase as cases escalate, a shift towards self-care is signalled, reserving clinical support for people with the highest needs. Rapid antigen testing will rise, including to speed up return-to-work for asymptomatic healthcare and critical workers who are close contacts.
The SMC asked experts to comment on the plan.
Professor Michael Plank, Te Pūnaha Matatini and University of Canterbury, comments:
“The plan released today consists of a phased shift away from active case and contact management towards more automated systems and self-management as the number of daily cases grows into the hundreds and thousands. This will allow public health resources to be focused on the highest risk cases. The self-isolation period will eventually be reduced from 14 days to 10 days for cases and from 10 days to 7 days for contacts. Essential workers without symptoms will be able to resume work early by testing negative on a rapid antigen test (RAT).
“The aim of these changes is to keep the majority of cases isolated during their most infectious period, but allow people to resume work as soon as possible. At the peak of the wave, it is likely that a significant proportion of the population could be isolating, so reducing isolation periods is necessary to ensure critical services such as healthcare and supply chains can be maintained. Other countries have reduced isolation periods to less than 7 days. However, there is a risk involved with this because if people return to work while still infectious, they could spread the virus to co-workers, exacerbating the problem.
“It is currently difficult to predict exactly when these phases will be reached. In places like South Australia and Queensland, daily cases grew from single digits to over a thousand in about 2 weeks. However, with case numbers in New Zealand still very low, it is possible that contact tracing efforts will delay the start of the exponential growth phase.
“For most people, if you’re up to date with your vaccines, the risk of getting severely ill with Omicron is very low. However, the small percentage of serious cases still has the potential to overwhelm healthcare systems. This is why, especially once we move into phases 2 and 3, measures such as mask use, gathering limits, and minimising time in crowded indoor places will be crucial to flatten the curve.”
Conflict of interest statement: Michael Plank is partly funded by the Department of Prime Minister and Cabinet for research on mathematical modelling of COVID-19.
Dr Matthew Hobbs, Co-Director, GeoHealth Laboratory, and Senior Lecturer in Public Health, School of Health Sciences, University of Canterbury, comments:
“I welcome the news that a three-stage plan has been compiled and the fact that the government is taking seriously the threat of Omicron. A coherent plan is needed and may need to be adapted for what could be our most challenging phase of our COVID-19 response so far in NZ.
“Over the next few weeks and months we really could see a rapid and steep rise in infections especially given the large gatherings and flights attended by our early cases. While the three-stage plan is welcomed there are still several areas to address.
Broader context
“First, it is important to clarify that while Omicron does appear to be less severe compared to Delta, especially in those vaccinated, it does not mean it should be thought of as mild. Omicron is hospitalising people, it is killing people, and we should take it seriously.
“Second, over the next few months the government and key services will be challenged to appropriately balance the need, for instance, to self-isolate and ensure there are enough staff to work in key healthcare and essential services. Hence the decision perhaps for the isolation periods in phase 2 & 3 for cases and close contacts will drop to 10 and 7 days as cases increase.
“More broadly in New Zealand, we cannot rely on vaccination alone to protect us. Other measures will help reduce the number of daily infections, hospitalisations and deaths. It is important to remember we have a range of public health measures including: boosters, child vaccinations, masks, good hand hygiene, contact tracing and testing, and QR code scanning – which are all available to keep us safe.
What do we need to do?
“Moving forward we need to retain a strong equity focus for the child vaccination and booster rollouts to ensure we protect our most vulnerable communities, and a focus on increasing and monitoring ventilation. We also need to further upgrade our mask use and advice. It is good to see that workers covered by a vaccine mandate will be required to wear a surgical-grade or N95 face mask in their workplace, instead of cloth face masks. However, this is not enough.
“It would have been good to see the wider public supplied with more effective masks such as the N95 or P2. It is disappointing that the factors hindering this distribution were quoted as supply and cost. Higher-quality masks also tend to come with a higher price tag, so equity is of huge concern at the minute. If individuals are stuck with only a basic surgical mask, consider wearing your cloth mask over your surgical mask to ensure any gaps are removed or knotting the loops for a tighter fit may help.
“Finally, the red setting was developed before Omicron emerged, with vaccine effectiveness against infection, from two doses of the Pfizer vaccine, keeping people safe. However, the arrival of Omicron with its much higher immune escape for people who have not had a booster dose of the vaccine significantly changes the sort of outcomes we can expect from the red setting – and it needs updating. Unless the red setting is updated we can expect to see the steep and rapid growth in cases that has occurred in other countries such as Australia.
Border controls
“In terms of the border, it largely depends on just how things evolve over the next few weeks and months. If Omicron is very prevalent in the community, the case for self-isolation at home grows; however, reopening too early may then allow the more severe Delta variant to reseed in the community. Again this will be a tough balance to get right but only time will tell in terms of how things develop and this will need to be revisited accordingly. There may also in the longer term remain a need for some border controls as Omicron will not be the last COVID-19 variant. Just because Omicron was less severe than Delta does not mean we are not going to experience another new, more severe variant, especially given the global inequities in vaccination coverage.
Next variant is around the corner
“NZ needs to and can step up at the global level. The root of this problem, which encourages more variants to emerge, is that the world isn’t doing enough to stop the spread of COVID-19. Booster after booster in a small number of countries will not end a pandemic while billions remain completely unprotected. More needs to be done here.”
No conflict of interest.
Dr Clive Aspin, Senior Lecturer, School of Health, Te Herenga Waka – Victoria University of Wellington, comments:
“It is good to see that RAT kits are at the centre of this strategy.
“I am writing this from Sydney, NSW, on Invasion Day (aka Australia Day) where Omicron is out of control and RATs are like hen’s teeth because the government refuses to make them widely available, and especially to vulnerable populations. I have heard cases of them being sold for $100 a kit.
“Also, people’s levels of anxiety and concern are through the roof.
“Access to RATs and PCR testing is highly problematic and now there seems to be an overreliance on reaching peak levels of Omicron as a way of dispelling people’s anxieties.”
No conflict of interest.
Dr Dianne Sika-Paotonu, Immunologist, Associate Dean (Pacific), Head of University of Otago Wellington Pacific Office, and Senior Lecturer, Pathology & Molecular Medicine, University of Otago Wellington, comments:
Omicron outbreak
“With Omicron being detected in new areas of the country, there are growing numbers of locations of interest, and it was reported earlier that a total of 56 cases of Omicron are now across the country. Due to Omicron’s higher transmissibility, this variant of the SARS-CoV-2 virus will spread rapidly, with the increasing COVID-19 case numbers placing pressure on our health and other support systems.
“As a matter of urgency and to help slow down the spread of Omicron in our communities, it’s important that people get tested and isolate accordingly and follow the appropriate public measures. A number of large events have now been cancelled and many others unlikely to take place due to the Omicron threat. This is the right move as these events will provide super-spreader environments for Omicron that will accelerate spread and exacerbate this outbreak.
“Workforce issues remain a serious concern given Omicron’s rapid spread and high transmissibility and it is critical we do everything we possibly can to slow down the spread of Omicron, while still get people boosted and our children, tamariki and tamaiki vaccinated – we must also protect and prevent our hospitals from becoming overwhelmed.
Three-phase plan
“A three-phased response to the emerging Omicron outbreak was first announced at the start of this week. We are currently operating in the initial Omicron response phase and taking steps and actions to stamp out Omicron, before we get to 1000 cases.
“Phase 1 of this response involves focusing on steps such as sustained contact tracing, strong isolation measures, testing with PCR test primarily being the mainstay for the time being – with Rapid Antigen Testing (RAT) to feature more strongly later – along with other public health measures needed to fight against Omicron and slow down the spread in our communities. Cases will isolate for 14 days, and contacts for 10.
“Changes to mask mandates that come into effect in 9 days’ time were announced yesterday with the Ministry of Health providing further guidance on the appropriate use of approved masks. In preparation for Omicron, PCR testing capability has been increased with the ability to reach 78,000 tests per day sustained over a 7 day period. Rapid Antigen Testing will also be used to help support the fight against OMICRON and will feature heavily in supporting the “Test to Return to Work” approach with a total of 40 million RATS being made available over a 5 month period.
“Phase 2 is being described as a “Transition Phase” where cases have spread further in the community with higher numbers, and a need to minimise and slow further spread while assisting vulnerable communities. The added support of digital technologies will be utilised during Phase 2 as more cases grow and will enable associated communications for those impacted to occur via text, mobile phone and information via email. Support will also be offered for those who are not digitally enabled. Cases will isolate for 10 days, and contacts for seven, with PCR testing still preferred.
“Phase 3 will be initiated when there are thousands of cases per day, where most people will self-manage while health and social services focus on families and communities that have the highest needs. RATs will feature more strongly in this phase of the Omicron response. Cases will isolate for 10 days, and contacts for seven.
Vaccination needs
“This Omicron outbreak is occurring against the backdrop of high COVID-19 vaccination rates, however evidence indicates that a booster shot is still needed to protect against Omicron – it is important to remember also that there remain areas still where vaccination levels are lower than for others.
“Although about 60% of the eligible population in Aotearoa New Zealand have received boosters already, many will not be eligible for their boosters until February 2022 as result of the original planning for the COVID-19 vaccination roll-out in 2021 which meant less time was given for Māori and Pacific peoples to get vaccinated before Delta arrived in the community. Our COVID-19 boosters must continue to be rolled out as quickly as possible with the appropriate prioritisation and delivery taking into account our most vulnerable now that Omicron is here.
“Our 5-11 year old children, tamariki and tamaiki in Aotearoa New Zealand have had the shortest time of any groups to access their paediatric Pfizer COVID-19 vaccine and we will need to help and support them as best we can to get vaccinated quickly and to ensure that no-one is being left behind. It was encouraging to hear about 20% have now been vaccinated.
“An equity focus that reduces barriers and builds trust for people and with the appropriate prioritisation, will help people access the help and services they need at this time and avoid our hospitals becoming overwhelmed as they have become in other countries.”
No conflict of interest declared.