This is a question on everyone’s mind – so the RNZ asks experts how and when the level 4 limits might be lifted.
Covid-19 researchers in New Zealand are optimistic that level 4 restrictions can be lifted at least in some areas within a few weeks – but warned that New Zealanders must prepare to do things differently for up to 18 months.
The initial level 4 period will end on April 23, although Prime Minister Jacinda Ardern said the effects of closure will not begin to become apparent until this weekend – when enough time will pass for anyone who has been infected to have the symptoms indicated.
With businesses, workers and parents of school-age children who want to get out of the 4th level thumb, RNZ asks experts when that might happen – and what it looks like.
Is four weeks long enough?
Together with fellow researchers at Te Pūnaha Matatini – a research group studying complex systems – Shaun Hendy has worked on new models of the deployment of Covid-19 in New Zealand that can better predict short-term outcomes.
He felt optimistic. Since March 26 – the first day of level 4 – daily cases have soared, reaching as high as 89 new cases and as low as 54, but no longer show an upward trend that is different from before locking. Yesterday, for the first time, recovery exceeds new cases – means the total number of cases currently actually dipped.
Hendy said the lack of exponential growth in cases showed the lockdown was worth it – but it could feel counterintuitive. “I am pretty sure now that we will not see many cases during this lockdown period. So it seems like nothing happened – but actually this locking stops the balloons that are happening … we actually hold [the numbers] in check. “
So will the case explode if we lift the lock now?
The magic number is something called R0 – the number of new cases created by each existing case. When R0 falls below 1, the total number of cases starts to fall, because new cases no longer follow recovery. Only then can the state think of easing restrictions, Hendy said.
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He said R0 was highly dependent on everyone’s behavior during the locking period that remained – the more stringent each person obeyed the rules, the fewer new cases were made. “There is a very optimistic scenario where we can go to level 3 and still eliminate,” he said. “If we’re as good as the Chinese, you can think of getting out [the strictest level]. “
Or, there is a scenario that the team has modeled where four weeks is not enough: “We might need to extend it longer – it could change to six or eight weeks.”
The worst result is if people – seeing the number of cases begin to stop – begin to relax, he said. “If we are all a little sluggish … then there is actually a scenario where we won’t be able to lock ourselves up for a very long time.”
Otago University infectious disease specialist Ayesha Verrall feels positive about how to track cases. “I see no reason why we cannot complete the lock in four weeks if we follow the plan we have made and if we improve contact tracing and improve our surveillance.”
Even so, that’s a big problem.
Over the weekend, the Ministry of Health brought up the fact that the new National Contact Close Service has tracked 700 contacts in one day. With the lock in place, each new case only has three to five contacts – meaning this service tracks contacts of about 200 cases per day.
Dr Verrall believes that New Zealand needs the ability to track 1,000 cases per day, so that he can move forward even from major outbreaks. Health Director General Ashley Bloomfield said there was still a lot of capacity that had yet to be utilized, but yesterday announced that Verrall would be brought in to audit the contact tracking process.
Dr. Verrall based his opinion on a paper published in a medical journal Lancet a month ago, which modeled how carefully and quickly contact tracing was needed to bring the Covid-19 outbreak under control.
“It says, and I think this makes sense, contact tracing doesn’t have to be completely complete. The paper says that if we can track 80 percent we can still achieve control,” said Dr. Verrall.
“But what we cannot compromise is speed. We must move from cases to illness, to their diagnoses, results are returned and reported, public health services are notified and contacts are informed and put into isolation.”
All this must happen within four days to stay ahead of the spread, he said.
Initially, turn-around testing was slower than in some cases. However, the Department of Health said that the average Covid-19 test was now reversed within a day, with contact tracing beginning as soon as positive results were confirmed. The ministry could not provide an average time frame for the entire process – from diagnosis to isolation of contacts – other than to say it “varies greatly depending on the situation”.
Can we go back to locking level four?
Hendy said that when the initial lockout period ended, our 4 day level was very unlikely to end.
The most likely scenario is easing restrictions – returning to level 3 or even level 2 – but with aggressive contact tracing and testing to rule out new cases. If the new cluster is on, level 4 can be brought back as a backup.
“At least one scenario that we have seen, we can manage it with a lock that is much shorter than this one,” Hendy said. “If you do enough work in the beginning then your ramp-up back to level 4 can be a little fail-safe, and it might not have to be long and strong as this one. You have used this initial period to slow the disease down and then you can use that switch back to level 4 to break the waves that hit you again. “
Level 4 can also be applied more precisely, he said.
The effect of the initial lockdown is to localize the spread of the virus – the cluster has largely been contained in their home region.
“We might be able to see parts of the country that haven’t had a case for a long time and have the level of confidence that we can [lower] level there, “Hendy said.” That might also be useful for us, useful for the government, in understanding how people will react at that transition point. “
Can we hack the lock for longer?
Prime Minister Jacinda Ardern praised the public for how well everyone has obeyed the limits so far. However, as time goes by and cases fail to skyrocket, Hendy said the locking might become more difficult for some people.
Countries such as Italy and France, which have been locked up for more than a month already have plans to extend them to a far more dire situation. “Overseas people actually do it; they make their locks effective, but the qualification for that is that the disease is far more prevalent and the situation they are facing is more frightening.”
University of Victoria clinical psychologist Dougal Sutherland says the acceptance of longer lockouts here depends on how and when the government makes a decision.
“If level 4 is to be extended to some or all of us, the decision must be made as soon as possible to enable people to adjust their expectations and reduce feelings of disappointment and anger that might occur naturally,” he said. “Having a bored and angry population who lose motivation is a situation the government wants to avoid.”
How will things change in the medium term?
The end of level 4 is not returning to normal life, Hendy said. “Once everything relaxes, everyone will want to go out and do a lot of things that they can’t do at level 4.”
If everyone rushes to fulfill their locking desires, that “can actually be very bad,” he said. “This will be the key to how the government manages the transition and ensures that we don’t all go a little crazy and destroy all the good work we have done at level 4.”
Ayesha Verrall said the locking was needed to buy time, but she wanted to see a more nuanced policy developed so that the level of restrictions need not be so blunt. “We have better tools than when we entered. So if we have more sophisticated surveillance, we can apply locking by region. If we have more power in tracing our contacts, we can have a higher threshold for the number of cases. in any region before applying lock. “
New Zealand can also learn from countries like Hong Kong that have experienced previous outbreaks such as SARS. “They have more distance social devices than we have and they use other options more creatively than we do.”
That could include changes in the way the education system works, said Verrall. “At present our framework has an open school, and the school is closed. You can have a school where children do not have a public lunch hour, which will reduce mixing; you can have much better processes around hygiene when entering and leaving school You can have guidelines for school seating that will hopefully reduce the number of contacts. “
Similar behavior can develop in business. “Some things like physical distance – two meters in all your store lines – we can apply them when stores are open … In some cases, the number of people in the store at one time.”
When all this will end?
Both Hendy and Verrall agree that the end of the real game of upheaval created by Covid-19 is a vaccine.
“If you pursue a elimination strategy so that you avoid tens of thousands of deaths, then you need to manage the risk of an outbreak until you get a vaccine or treatment – and that’s maybe 18 months away,” Verrall said.
Even countries like Italy which have suffered many fatalities do not have immunity, Hendy said. “Even though it seems certain that it peaked there, it was the lock that forced that peak … they could have exactly the same thing happening to them [again] in a few months. “
He said there were some promising treatments antibody test being developed, but it’s still a few months away at best and won’t be available for everyone. “So we all have to wait – all countries, no matter how we travel in the next few moments – have to wait on the vaccine. It will be the same here. We will have to live with some of these steps for quite a long time. . “
The spread of Covid-19 abroad means that long after New Zealand is able to lift restrictions on daily life, the border will remain closed, Hendy said. “Border control will be with us the longest. Testing, tracking, self-isolation – it will be there for a while too.”
Visiting friends and family in New Zealand and returning to work and school will not be far away, he hoped. “Hopefully physical distance is something that – if we can get rid of it – then we can start relaxing some of that, which means many of us can get back to our work and have a little more social life.”
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