Responding to Omicron

University of Otago epidemiologist Dr Amanda Kvalsvig​ has done Aotearoa New Zealand a favour by advocating in the mainstream media (11 January) that all schools, including early childhood facilities, should delay reopening after the summer break until “basic protections” against the omicron variant of Covid-19 were in place: https://www.stuff.co.nz/national/health/coronavirus/127467336/epidemiologist-calls-for-delay-in-school-reopening-due-to-omicron-but-paediatricians-disagree.

Her argument was that more time was needed to vaccinate 5-11 year olds (nearly half a million), give booster shots to older students and education staff, ensure carbon dioxide monitors and air filters were installed in classrooms, and for high-grade N95 masks and rapid antigen testing to be available in schools.

Dr Amanda Kvalsvig has encouraged a healthy debate

Based on information from overseas she feared omicron triggering “an avalanche of child cases, at higher rates than previously seen in this pandemic”. High infection rates were hard to manage in schools and hospitals and there were rising concerns about lasting effects in children, including ‘long Covid’ and autoimmune problems such as diabetes.

Healthy debate

Kvalsvig’s comments prompted healthy debate. Some paediatricians disagreed with delaying school reopening given there was no community outbreak of omicron and relatively low cases of the delta variant. They were concerned that prolonged school closures can be harmful for children’s wellbeing and development.

Professor Peter McIntyre, a paediatrician specialising in infectious disease at Otago University, described delaying reopening schools as an “overreaction” because of the harm to children would be much higher than any benefit in disease prevention.

Professor Peter McIntyre warns of overreaction

So who is right? The epidemiologist or paediatricians? The answer is both. The two approaches are not necessarily in conflict. It completely depends on how things unfold with omicron.

Describing omicron as a dilemma for schools, Cherie Taylor-Patel as President of the Principals’ Federation summed it up well. While schools want to reopen smoothy without delays after the disruption of last year, they were also concerned about virus spread. She was hoping for at least two-thirds of 5-11-year olds to be vaccinated before going back to school.

In Taylor-Patel’s own words: “What happens in the next two weeks is critical.” In other words, government has to make and action the right decisions by the end of January. Australia provides realistic context for decision-making.

Across the Tasman

On 7 January Australia had 91 Covid-19 deaths per million people. By 18 January this rate had increased dramatically to 108. Over the preceding seven days there were 285 deaths representing a mortality rate per million of 11.

In other words over this seven day period there were more deaths per million than the total rate in New Zealand since the pandemic arrived in early 2020 (9 per million).

This is devastating especially as it is now across most Australian states including those who had been successful in their response to the delta variant by using the elimination of community transmission strategy.

While our Labour government erred in lowering Auckland’s alert levels too early and abandoning elimination there, it is clear that elimination won’t stop omicron once it gets into the community.

This will instead require a mitigation strategy designed to first control and then suppress omicron, recognising the need to significantly increase vaccination rates (even though high by international standards) and implement boosters to the already vaccinated.

A must read blog

Fortunately the University of Otago’s Public Health Expert (17 January) have published timely advice which the Government would be foolish to disregard: https://blogs.otago.ac.nz/pubhealthexpert/preparing-for-omicron-a-proactive-government-response-is-urgently-needed-to-minimise-harms/.

The blog is a collaborative piece by five experienced experts, one of whom is Dr Kvalswig. The others are Professor Michael Baker, Dr Jennifer Summers, Dr Matire Harwood and Professor Nick Wilson.

It begins by noting that the delta variant is now under control as evidenced by declining daily infection cases and hospitalisations. But it then describes the contrasting omicron outbreak threat by identifying the dramatic increase in the seven day average of infections detected at the border since late December.

In summary, the blog advises that based on omicron’s around two months experience, compared with the delta variant, it is much more transmissible and less severe (especially for the vaccinated) but is not a mild infection.

Therefore the authors assess that “…a poorly controlled Omicron outbreak in NZ risks overwhelming the health care system, increasing inequities, and disrupting essential services as is being seen overseas.” What Australia is presently experiencing provides the best example of what Aotearoa should expect.

Urgent actions

Consequently they recommend urgent actions in order to minimise omicron harm beginning with delaying its entry to the country. This should be much more than the Government has recently announced including immediately further reducing infected travellers arriving, tightening pre-departure testing requirements, and further delaying border reopening beyond February.

Other recommended measures (expanded in the blog) include:

  • continuing to suppress and ideally eliminate the delta outbreak;
  • continuing to boost immunity (including 5-11 year olds) to both omicron and delta;
  • shifting from minimising the number of infections to a ‘flatten the curve’ goal;
  • introducing an upgraded alert system to include briefer more localised periods of controls (recognising that the traffic lights system is largely orientated towards achieving an indoor vaccine mandate);
  • a more developed mask strategy to support the effective use of high-quality masks in all settings where they will make a meaningful difference;
  • supporting schools, workplaces and essential services to prepare for omicron (such as adequate sick leave and ventilation);
  • uprading Covid-19 testing capacity; and
  • measures to protect the healthcare system and improve support for home care.

Looking ahead

The blog then identifies longer-term measures to reduce the risk from new variants which may be more rather than less virulent. Some involve New Zealand building its capacity for high-quality risk assessment and management so that it can adapt its response strategy to changes in the pandemic. Some require improved global health leadership and equity to delivery vaccines and other interventions.

This advice from Drs Baker, Kvalsvig, Summers, Harwood and Wilso is based on experience and expertise. Further, unlike the advice of less experienced and less expert business consultants the Government is following in restructuring our health system, it is free and absent of self-interest. It deserves to be followed.

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