NZ's failure to prepare for Omicron means there's a shambles to come

Dr Eric Crampton
The Dominion Post
24 January, 2022

February weather forecasting on the Canadian prairies was relatively simple. Southerlies brought warmth. Northerlies brought cold. And if a Colorado Low were on the way, it was time to prepare. A Colorado Low meant severe blizzards later in the week.

New Zealand has had a glorious summer. The weather has been spectacular. August’s Covid outbreak has almost been extinguished. But Omicron looms like a Colorado Low stalled somewhere over the Dakotas.

This week’s Sunday Star-Times made for grim reading.

Andrea Vance tallied the failures to prepare the health system and to improve testing.

Tracy Watkins reminded readers that effective therapeutics like Paxlovid remain stalled in Medsafe’s processes.

The American Food and Drug Administration authorised Paxlovid before Christmas, Great Britain on the last day of 2021, and Canada approved it last week. It is increasingly difficult to see what Medsafe provides Kiwis other than delayed access to medications and vaccines.

And Ellen O’Dwyer explained that local General Practitioners will be overwhelmed, so stocking up on at-home treatments for common ailments is a rather good idea.

When the weather forecast says a Colorado Low is a week away, there is time to prepare. But fewer options are left the day before the blizzard.

The country’s Covid testing system is likely to fall apart, quickly, when case numbers rise. Testing labs can bundle five to ten samples together for testing. If none are positive, all is fine. If the pooled sample is positive, individual samples need separate re-testing. When positivity rates are low, the system works well. But when positivity rates are high, pooled sampling stops working. Testing capacity drops to a small fraction of what it had been, just when it is most needed.

Headline figures on testing capacity may be more than a little optimistic. Contracting now for greater capacity, focusing on the saliva-based PCR testing that catches Omicron cases earlier, matters.

Hopefully it is not too late. Rapid Antigen Tests will not save us.

Less sensitive RATs could have been very useful as part of testing systems in 2020 and 2021. Daily rapid tests between weekly or twice-weekly PCR tests would have let more essential workplaces keep operating safely during lockdowns.

Rapid tests have proven less successful so far with Omicron, returning too many false negative results while people are infectious. They will not be as useful for keeping infectious people out of workplaces and public spaces.

RATs may still be helpful in confirming positive cases among those who are sick at home. Therapeutics like Paxlovid, once available, work best if started early. If the PCR testing system fails under the load, a positive RAT result could confirm whether therapeutics are needed. But making sick and infectious people go to a pharmacy for testing while sick and infectious would be a terrible mistake. Policy will need to change.

Greater support for sick leave will also matter. In 2020, Covid-leave schemes provided compensation when workers needed to isolate themselves. Similar schemes will be needed this year if the government expects most infectious people to stay home to help flatten the curve. Sick workers will need to self-isolate. The burden for parents will be greater.

Omicron has been ripping through schools abroad. Kiwi kids are at greater risk than children abroad because New Zealand was slow to start vaccinating under-12s. Parents staying home to care for sick kids will likely also catch it. Sick leave entitlements will be burned through.

Making schools safer means hastening vaccination of children and allowing under-18s to receive vaccine boosters.

Better ventilation in schools, and air filtration in harder-to-ventilate places, also matter.

Late last year, the government announced air filtration units were being ordered, along with carbon dioxide monitors that help track whether a room has sufficient ventilation. No progress has been reported.

Preparation at schools is bad enough that epidemiologist Amanda Kvalsvig recommended that the start of school be delayed.

Waiting for the government to get its act together may lead to disappointment. Parents could move faster in schools that are less well prepared.

Carbon dioxide monitors are not hard to find online. Buy one for some in-class experiments, after talking with your child’s teacher. What is the carbon dioxide level at the start of the day, as children start filing in? By how much does it increase when the students have been in the room together for a while? Does opening windows help much?

A simple student experiment could help the school identify problem areas with poor air circulation.

If there are ventilation problems in your child’s classroom, a second classroom project might help. Homemade air filtration units, called Corsi-Rosenthal boxes, are easy for older students to build and can help clear the air. Plans are easily found online, though parts can be harder to source.

The blizzard is coming. We had best prepare ourselves.

New Zealand moved into Red after this column was filed. The government has confirmed that Covid leave support will be available. 

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