By leaving isolation decisions up to each close contact, Phase 3 will see the poor spread the virus while the rich stay home, Marc Daalder writes
Analysis: As New Zealand moves to Phase 3 of its Omicron response and everyone starts to come in contact with Covid-19 or know people who have, few will have a crystal clear idea of the rules after Thursday’s press conference.
The Government’s crisp communications over the past two years have been highlighted again and again, but the arrival of Omicron in the community appears to have flagged an end to that. The rules are changing so often and have so many exceptions and permutations that even Labour Party MPs are mucking it up.
On Wednesday, Northcote MP Shanan Halbert admitted he had been getting regular Covid-19 tests despite not being symptomatic as a way to make sure he wouldn’t accidentally infect vulnerable constituents. Last year, that had been the norm for MPs frequently travelling in and out of Auckland – Halbert clearly hadn’t realised the rules had changed.
Prime Minister Jacinda Ardern was chagrined enough by the mistake to speak to Halbert that evening. She clearly sees that the understandable error highlights the deeper issue of muddled messaging, which potentially puts strain on resources like testing and tracing and could damage the health response.
The announcement of new isolation rules on Thursday suffered from the same issue. In theory, the restrictions are simple: Covid-19 cases isolate for 10 days, their household contacts isolate for the same period with a rapid antigen test (RAT) on Day 3 and Day 10 and all other contacts are free to go about their lives while keeping an eye on symptoms.
“We are trying to make it as simple as possible. We don’t want confusion about who needs to isolate,” Covid-19 Response Minister Chris Hipkins said. “We have worked hard over the last few weeks to make sure it is as clear as possible so people understand whether they need to isolate or not.”
Mere seconds later, he contradicted himself.
“It’s important to note, this is who is required by law to isolate. That doesn’t mean people who feel they have been exposed shouldn’t isolate if they are in a position to do that. This is who is required to isolate.”
So, what should people actually do?
“We are encouraging everybody whether they are required to or not to just be thoughtful about the risk they may pose to others and take appropriate cautions,” Director-General of Health Ashley Bloomfield chimed in a few minutes later.
“Everyone should act as we did earlier in the pandemic. You will remember the specific call, act as if you might have Covid and behave accordingly to protect others, including using masks et cetera.”
Of course, Bloomfield doesn’t actually mean everyone should act as if they had Covid-19. That would be a call for everyone (and their household members) to stay home.
A balancing act
The jumbled comms here flags the delicate balance the Government is trying to strike between public health and the economy. If every non-household close contact of a Covid-19 case stayed home for the full 10 days – remembering that there will be more than 10,000 daily cases within a few days – the entire country would grind to a halt.
New Zealand’s famous “two degrees of separation” is a weakness in the fight against Omicron, with a wave of cases threatening to cripple the economy via contact isolation rules.
On the flipside, if every non-household close contact decided not to isolate and went about their day, the outbreak would probably be needlessly accelerated, threatening to overwhelm the healthcare system.
Dion O’Neale, a disease modeller at Te Pūnaha Matatini, thinks the Government’s close contact exemption scheme should be enough to keep the economy standing and the changes to close contact rules aren’t needed.
“Reducing self-isolation requirements to only confirmed cases and their household contacts increases the risk of onward transmission from any other contacts of confirmed cases that would previously have been classified as ‘close’ until today,” he said.
“The change in the close contact definition and isolation requirements have the potential to increase transmission risk without strong evidence being presented that staffing of critical roles can’t be managed under the close contact exemption scheme.”
The Government has chosen to walk the middle ground, hoping some close contacts stay home so as not to overwhelm the health system while also hoping enough return to work so that businesses can keep operating.
An individualised and inequitable response
By leaving it up to each contact, the Government is individualising the response – placing the burden of calculating risks and deciding what’s safe or responsible onto each person’s shoulders. This is new. Prior to Omicron, ministers felt the Government’s role was to determine what was safe, require people to do that and then enforce it. Now, we’re each responsible for our own public health advice.
The obvious drawback of individualising the response is that it leads to people doing unpredictable things. While people are still freely able to go to bars and restaurants, many are choosing not to in a time of record-high case numbers. It’s hardly fair for the Government to turn around now and complain that people aren’t going out, given it has delegated the task of keeping people safe to those individual people.
The mixed messages on isolation for close contacts are an effort to rein in that unpredictability, signalling to those inclined to stay home that they should while flagging those who want to return to work that they can do that too. But this approach risks entrenching inequities which have already been highlighted by the failed effort to eliminate Delta.
In reality, those who can afford to work from home or take time off work are more likely to isolate. The minimum wage service workers, on the other hand, won’t have a choice to stay home even if they truly want to.
“The pattern of who is disproportionately affected by Covid around the world is well established – people with disabilities, indigenous populations, people of colour, and people on lower incomes or in precarious work bear the brunt of infections,” O’Neale said.
“The move in Aotearoa of people being expected to look after themselves as best they can will mean we move further down that path of driving infections towards the most vulnerable populations.”
RATs hard to get
This inequity is made worse by the Government’s approach to supplying rapid antigen tests.
In the United Kingdom, each person can get 14 free test kits a week. In Scotland, they’re each advised to take two a week to monitor for undetected spread and also to take one before attending large gatherings or visiting high-risk people, like the elderly.
While RATs don’t catch all infections, they’re nearly as good as traditional PCR tests at detecting when someone is infectious – meaning they’re perfectly suited to clearing people prior to social events.
In New Zealand, you can still only get a RAT if you have symptoms or are a close contact. They’ll become more widely available in March, but through private sales at pharmacies and supermarkets. Price gouging is likely, but even the Government’s idea of a fair price – Bloomfield thinks $8 to $10 for a single test – is steep for low-income people hoping to get together.
Without the widespread availability and accessibility of rapid tests to allow people to make informed decisions about their health and their risk of contracting or spreading Covid-19, they’ll have to make uninformed decisions instead. That means people could easily be overcautious and stay home when well, or over-reckless and spread the virus to vulnerable loved ones.
Despite its effort to tread the middle ground, the Government is instead forcing people into different camps – those on unnecessary self-imposed lockdown and those pretending a respiratory virus isn’t spreading like wildfire in the community, having already infected one in every 93 Aucklanders.
As it turns out, the Government can’t have its cake and eat it too. Bloomfield and Hipkins will at some stage have to decide whether they want to put more effort into limiting transmission or more effort into freeing up businesses to operate – just leaving it up to everyday New Zealanders will mean neither gets done well.