By Public Health Expert 16/09/2021


Prof Nick Wilson, Dr Julie Bennett, Dr Leah Grout, Dr Jin Russell, Dr Jennifer Summers, Prof Michael Baker

 

Despite some good progress, the persisting Covid-19 outbreak in Auckland still poses risks to health, social wellbeing and the economy. There is a need for accelerated efforts to ensure more rapid elimination of community transmission. In this blog we look at five critical measures to implement immediately, along with a range of other Covid-19 control measures that will help Auckland and the whole country sustain elimination in the medium term. 

It is critical that Aotearoa NZ continues with its elimination strategy and successfully ends the current outbreak in Auckland. The impact of failure can be seen in New South Wales and Victoria in Australia where there are mounting cases, hospitalisations and deaths from Covid-19. Furthermore, these Australian states will probably need to maintain intense restrictions for some months so that these outbreaks don’t completely overwhelm healthcare systems. Also, there is growing concern that conditions such as “long Covid” have potentially very long-term impacts. One commentator suggests a best assumption of 2-3% of those who get Covid-19 will have a crippling “long Covid” similar to chronic fatigue syndrome [1].

Five critical measures to regain Covid-19 elimination status in NZ

1. Enhance surveillance for Covid-19 infections. There are recent efforts to enhance focused community testing in suburbs of Auckland where undetected community transmission may be occurring. These efforts are very welcome but need to be further expanded to include the widespread testing of essential workers in large workplaces, testing of people visiting supermarkets, and testing of all attendees and visitors to hospitals on entry or weekly for regular visitors. There is also a need to expand wastewater testing to more suburbs in Auckland – so that case finding can be more focused (as per the successful approach to identify cases in Warkworth a few weeks ago [2] and to respond to a recent positive result for wastewater from Pukekohe [3]).

2. Accelerate vaccination of the Auckland population, particularly essential workers, Māori and Pasifika. The recent progress with vaccination delivery in Auckland has been impressive – particularly with drive-in clinics; walk-in clinics; pop-up clinics in places such as churches and marae; and the just-announced mobile clinics. But we would like to see an even stronger focus on reaching out to essential workers eg, with 24-hour drop-in clinics (as used in the UK), and taking mobile vaccination services to large workplaces, and requiring vaccination for any essential workers travelling outside of Auckland. More generally, there is probably a need for more funding and workforce support for Māori and Pasifika initiatives to provide ready access for vaccinating these priority populations (as recently argued for by a Māori health leader [4]).

3. Consider further reducing essential worker activity in Auckland (both total numbers and per workplace). There are many workplaces operating in Auckland at Alert Level 4 that are not critical in terms of food provision, healthcare provision, or keeping essential services running (transportation, electricity, sewerage, etc). That is, there are factories producing goods for other sectors of the economy (building supplies, etc) and for export. Where these workplaces are in suburbs in Auckland where there might be persisting community transmission – they could be closed until Alert Level 4 ends. Appropriate economic compensation from the Government would be required for the workers and employers involved. The recently revised Auckland District Health Board policy reducing visitor numbers to their hospitals, in-line with the highly restricted policies used by other DHBs, illustrates the opportunities available to minimise movement and mixing of people at Alert Level 4.

4. Expand Alert Level 4 mask requirements. To maximise effectiveness and simplicity of implementation – masks should be mandatory at all indoor settings outside the home at Alert Levels 3 and 4. This requirement would ensure that all essential office and factory workers are better protected.

5. Enhance economic support for citizens in Alert Levels 3 and 4. Economic support is vital to mitigating household hardship associated with lockdowns. Supplying households with adequate income enables compliance with restrictions to increase. An urgent boost to income support for people receiving benefits is highly recommended, to take effect as soon as possible. This could look like immediately bringing forward the increases to core benefits that are promised in April 2022. Hardship assistance should be easy to access on a high trust model similar to the wage-subsidy model, not requiring overly burdensome proof, and should be in the form of monetary grants which increase the agency of families to meet their own financial needs, rather than in the form of loans or food parcels. Increases to the Working for Families Tax Credit would help all low-income families with children, whether or not they had paid work.

Five additional measures for preventing future outbreaks in Auckland and NZ

1. Substantially decrease numbers of Covid-19 positive travellers arriving in NZ. Options include the introduction of additional pre-departure rapid antigen testing at the overseas airport, requirements to be fully-vaccinated before travel, and putting caps on numbers from the highest risk countries. Rapid antigen testing could also be considered on arrival so that infected travellers could be transported directly to specialised MIQ facilities with enhanced containment capacity (see below).

2. Commit to having MIQ facilities (for infected people and travellers from high-risk countries) that are outside of cities as soon as possible to minimise the risk of future Covid-19 outbreaks. This improvement is because MIQ facilities in re-purposed hotels are generally not fit-for-purpose (as per a study covering ones in both Australia and NZ [6]). Facilities need to be built outside of cities (eg, on a military base such as Ōhakea [7] that can house live-in staff and is close to Palmerston North Hospital). Nevertheless, re-purposed hotels in cities could perhaps still be used for travellers from low risk countries who test negative at the airport on arrival.

3. Expand testing options, including more saliva PCR testing and rapid antigen testing for specific situations (we will shortly publish a blog on the latter). In the present outbreak, rapid antigen testing would be particularly useful for essential workers travelling out of Auckland (but in the future, such testing could be used to regularly test all essential workers). As the latter test can take up to 30 minutes to get a result – people could be tested but then be able to travel – but with the requirement to immediately return if sent a message about having had a positive test result.

4. Upgrade the Alert Level system as we have previously outlined in a journal article [5] and in a recent blog. Such a revision would also ensure that there is a new Alert Level 1 that it is fit-for-purpose in the Delta variant environment. A key element of the upgrade is to build in universal masking in indoor environments where and when needed. Active work is needed to better support universal masking including mask quality, supply, equity, and user knowledge and practise. Considerable thought will need to be given to ensure gatherings shift outside and to set tight maximum numbers for indoor events along with universal mask requirements. At some high Alert Levels, consideration could be given to mandating that essential workers use digital tools to facilitate contact tracing (albeit tools that are improvements on the current ones).

5. Improve ventilation for all indoor settings. Despite the importance of improved ventilation in many settings (see our recent blog on the topic and for ventilation in schools), the NZ Government is relatively quiet on this topic. It should consider a campaign to promote improved ventilation in all settings (often as simple as opening windows), along with economic support to enhance ventilation and HEPA filtration in offices and factories with essential workers operating in Alert Level 4. After an Auckland-focused campaign, there could be a national campaign to improve ventilation.

* Author details: Dr Jin Russell is a PhD student at the School of Population Health, University of Auckland and consultant developmental paediatrician in Auckland. All other authors are at the Department of Public Health, University of Otago, Wellington.

 

References

  1. Pueyo T. The Most Alarming Problem about Long COVID: It’s Probably Chronic Fatigue Syndrome. September 2021; https://unchartedterritories.tomaspueyo.com/p/long-covid-chronic-fatigue-syndrome.
  2. Williams C. Covid-19: Warkworth residents asked to get tested after virus found in wastewater. Stuff 2021;(21 August). https://www.stuff.co.nz/national/health/coronavirus/300388198/covid19-warkworth-residents-asked-to-get-tested-after-virus-found-in-wastewate.
  3. Ministry of Health. 15 community cases of COVID-19; two border cases in managed isolation. (Media Release) 2021;14 September. https://www.health.govt.nz/news-media/media-releases/15-community-cases-covid-19-two-border-cases-managed-isolation.
  4. Quinn R. Auckland vaccine programme director hopes for record-breaking week. Radio New Zealand 2021;(14 September). https://www.rnz.co.nz/news/national/451418/auckland-vaccine-programme-director-hopes-for-record-breaking-week.
  5. Kvalsvig A, Wilson N, Davies C, Timu-Parata C, Signal V, Baker MG. Expansion of a national Covid-19 alert level system to improve population health and uphold the values of Indigenous peoples. Lancet Reg Health West Pac. 2021;12:100206.
  6. Grout L, Katar A, Ait Ouakrim D, Summers JA, Kvalsvig A, Baker MG, et al. Failures of quarantine systems for preventing COVID-19 outbreaks in Australia and New Zealand. Med J Aust. 2021.
  7. Wilson N, Baker M. Shifting all Isolation/Quarantine Facilities to a Single Air Force Base: The Need for a Critical Analysis. Public Health Expert 2020;(14 September). https://blogs.otago.ac.nz/pubhealthexpert/2020/09/14/shifting-all-isolation-quarantine-facilities-to-a-single-air-force-base-the-need-for-a-critical-analysis/.