Covid-19 may have been the sixth leading cause of death in New Zealand last year, justifying an ongoing cautious approach to the virus through winter, Marc Daalder reports
Analysis: There was a sense of déjà vu in the Beehive Theaterette on Tuesday afternoon, as Chris Hipkins announced current Covid-19 isolation settings would remain but the Government would look into a test-to-release option to shorten the timeframe in the next two months.
It was familiar because we'd heard it before: In August, Ayesha Verrall said the Government would look into test-to-release to get healthy people out of isolation while keeping contagious people at home. Just a few weeks after that, a study confirmed that test-to-release could both reduce the average time spent in isolation and the risk of ongoing transmission.
Still, more than a year after experts first raised the option, we're not really any closer to seeing a test-to-release scheme formally implemented. It's not clear why the Government would make a different decision now than it did in the past, but modellers are hopeful.
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"It's good to hear that the Prime Minister has got the Cabinet looking at this again," Emily Harvey of Covid-19 Modelling Aotearoa said. She authored the August study on test-to-release.
Harvey's modelling showed that if the minimum isolation period dropped to five days, with two negative tests needed to be released and a maximum time of 10 days, the number of cases still infectious when released reduces by 40 percent and the time spent in isolation on average decreases by 8 percent.
"We know that seven days' blanket isolation period will keep some people in isolation for longer than they are infectious and, on the flip side, there will be some people who are still infectious after that infectious period," she said.
A range of briefings released to Newsroom under the Official Information Act show health officials repeatedly pushed back against test-to-release. At times, they said it would be too confusing for people to implement. On one occasion, officials worried about people knowing they were still infectious.
"We have already accepted the risk of some cases still being infectious at release, however that is different to the person themselves knowing that they may still be infectious at release (due to a positive RAT)," they wrote.
Verrall said isolation continues to be effective at reducing the spread of Covid-19.
"We know isolation for Covid-19 cases is the best way to break the chain of transmission to make sure people aren’t passing on the virus and getting other people sick."
Modelling that informed the decision to keep the current settings was also released on Tuesday. It shows removing isolation could be expected to spark a new wave of cases over the next month or two, leading to an additional 23 to 85 deaths and 500 to 1700 hospitalisations.
In the long term, cases, hospitalisations and deaths would be slightly higher than otherwise, but not significantly (8 to 25 percent).
While the current rules are expected to stay for now, the Government is facing pressure from businesses and the media to change that.
Hipkins said removing the isolation mandate could have unintended consequences for workforce availability. Sure, some people would return to work earlier, he said, but they would be more likely to infect their co-workers and businesses might lose more staff hours to sickness than beforehand.
New Zealand's rules are on the more restrictive end of isolation requirements globally, but our unique way of counting days makes comparisons hard. Isolation here is seven days from the onset of symptoms or the first positive test. Elsewhere, the count starts just from the positive test.
Since most people develop symptoms a couple of days before they test positive on a RAT, New Zealand's rules correspond more closely to a five-day period when comparing with other jurisdictions. That puts us on par with California, Italy and some of Germany, and shorter than South Korea where the period is seven days.
Australia, the United Kingdom and United States (at a federal level) have no legal isolation requirement.
After the announcement, Hipkins said he envisaged the isolation mandate dropping away at some stage after winter, as Covid-19 begins to be managed as "normal".
But what "normal" looks like is in the eye of the beholder.
Some diseases in New Zealand are managed more harshly than Covid-19. Tuberculosis cases can be directed to isolate for up to six months, for example. Seasonal influenza, on the other hand, isn't subject to any central government mandates or requirements.
People will differ in their views of where Covid-19 sits on that spectrum.
It is clearly worse than influenza at a population level, at least at the moment.
In 2022, at least 1388 people died with Covid-19 listed as the underlying (main) cause of death. If mortality trends from before the pandemic hold over into 2022, that would make it the sixth leading cause of death - behind ischaemic heart disease and lung cancer, for example, but ahead of diabetes, stroke, Alzheimer's, prostate cancer, breast cancer and a host of other illnesses.
An RNZ analysis last year found Covid-19 killed three times more people than flu does in a normal year.
Covid-19 also leaves at least 2 percent of cases with long-term symptoms, which in some cases can be debilitating. With millions of cases last year and hundreds of thousands expected this year, that's a lot of Long Covid.
Whether all of that necessitates centrally-mandated isolation will be a matter of personal opinion.
In the end, the opinion that matters most is that of Chris Hipkins.
When winter ends, he'll be the one deciding what 'Covid normal' looks like.
