'Way beyond time for an overhaul' - Health experts propose 7 level Covid-19 alert system

Source: 1News

A group of Covid-19 public health experts have sent a proposal to the Government, recommending urgent action over the way the Covid-19 alert level system is managed.

AUCKLAND, NEW ZEALAND - SEPTEMBER 07: A sign encourages masks and social  distancing in Newmarket on September 07, 2020 in Auckland, New Zealand. Face coverings are now compulsory for all New Zealanders over the age of 12 on public transport or planes under current Alert Level restrictions in place across the country. Auckland is currently at Alert Level 2.5 while the rest of New Zealand is at Alert Level 2. (Photo by Fiona Goodall/Getty Images)

In 2020, a group of colleagues in the Department of Public Health at the University of Otago, Wellington formed a Covid-19 research collaborative, called Co-Search. It’s directed by epidemiologist, Professor Michael Baker and his lead research colleague, Dr Amanda Kvalsvig.

In March this year, the group led by Kvalsvig, sent the Government a report on revising the alert levels.

“The current alert level system worked very well for us a year ago and it’s been an excellent policy that has supported clear communication and effective pandemic control. But both the pandemic and our response to it have evolved since then and it’s clear that the system urgently needs an overhaul,” Kvalsvig told 1 NEWS.

“It’s obvious that having only four levels is too broad for good outbreak control, we all agree on that. We need to avoid arguments about what to call the levels – it’s distracting and we can’t afford distraction just now.

“I and colleagues have recommended that to work optimally the system needs seven levels (six control levels plus a Level 0 for when the pandemic ends). But non-specialists will never have to memorise those levels. In our system, the new levels are organised into three risk zones – green, amber, red – that send a clear message to the public about the level of risk and what they’re expected to do. The finer points will be communicated to the public in terms of actions: for example, what to do about mass gatherings,” Kvalsvig explains.

“In essence, the virus spreads when people are sharing air. So the highest risk is in closed indoor settings, especially with certain breathing patterns, eg, when people are exercising, singing, or coughing, and where people are spending long periods crowded together in one space.

“Ventilation is key,” Kvalsvig says. “Experts are estimating that in an average room you want 4 to 6 air changes per hour, either by circulating outdoor air into the room, or by filtering air that is recirculated.

“Mask wearing is effective in reducing risk, and so is reducing the number of people in a room or the amount of time they spend in the room. Opening a window or stepping outside are effective too. These measures can be used in a variety of settings including homes, schools, and workplaces, and they’ll protect us not only from SARS-CoV-2 but from multiple other infectious diseases. We must all do better with ventilation, from Government down to each one of us.”

Professor Baker says the need for a response was becoming urgent in the wake of events across the Asia Pacific region, where several countries are “now working hard to contain outbreaks of more infectious Covid-19 variants”.

The epidemiologist says the length of time between Case A and B being infected means there is likely another case which has been missed.

“The New Zealand response has often been characterised as rapid, decisive and nimble. In keeping with that tradition, I think that now is the time to act to upgrade our alert level system to keep ahead of the virus. Personally I think that it would help to switch to this upgraded way of presenting the alert levels and numbering them to signal a clear advance in our approach,” Baker says.

Kvalsvig says the two major problems to current alert levels are - “firstly that it doesn’t reflect current best evidence about effective Covid-19 control, and secondly that it no longer matches the way we manage outbreaks. In addition, it needs to be more equitable and forward-looking, and it’s too focused on managing just one infectious disease”.

She adds that the system is a “great communication tool.

“People know what they need to do. Levels 3 and 4 work very well as circuit-breakers to gather information and get on top of a new outbreak."

Recommended changes from the report:

Kvalsvig says proposed changes include strengthening the lower levels, more fine-tuning of controls as we go into and come out of outbreaks, recognition of Māori as Treaty partners and ensuring that the alert levels uphold Treaty principles.

She says the system should be used to align risk assessment with other countries as New Zealand extends travel bubbles and developing the system into legacy infrastructure that can protect New Zealand from other endemic, epidemic, and pandemic infections.

“In particular now that travel bubbles are in operation and outbreak risk is so high, the lower alert levels urgently need to be strengthened to stop outbreaks before they start.

"That means providing good indoor air quality everywhere people gather and wearing masks in travel and healthcare settings. It also means ensuring that in the event of illness or an outbreak, people can do what they’re being asked to do. Everyone needs a safe home and access to necessities including meals, health services, income protection, remote learning, and other types of support.

"These measures need to be built into the alert levels so that as the alert levels go up, so does the support.

“Looking further ahead there’s tremendous potential to use this system to reduce the huge burden of infectious disease in New Zealand and protect us from future infectious disease threats – we shouldn’t allow it to become increasingly irrelevant and eventually fade away. We need the system to stay up-to-date and working effectively for population health.

“Crucially, the populations most at risk including Māori and Pasifika must have a voice and leadership in these decisions. These populations were largely excluded from pandemic response decision-making early on and that must change,” Kvalsvig says.

She says “It’s hard for a government to move faster than an infectious disease outbreak”.

"The timescale is challenging for policymakers. That’s why having an effective and up-to-date alert levels system is so important. The scientific evidence can be worked out in detail and then embedded in the levels, so the country can respond quickly to a new threat.

“But that means that the system must be constantly evaluated and upgraded. It’s way beyond time for that overhaul. We need action on a very short timeframe - this week, next week, the week after - to build protections against a large community outbreak in New Zealand.”

The co-authors of the proposal sent to Government were: Dr Amanda Kvalsvig, Prof Nick Wilson, Cheryl Davies (Ngāti Raukawa, Ngāti Mutunga ki te Wharekauri, Ngāti Pikiao), Carmen Timu-Parata (Ngāti Kahungunu), Dr Virginia Signal, Prof Michael Baker.