Just because it's allowed doesn't mean it's safe. New Zealanders now have to make their own evaluations of what activities are worth the risk under the traffic light system, Marc Daalder reports
Analysis: The guidance on how to keep yourself and your community safe at the start of the pandemic was clear: Stay home, save lives.
Now, as daily case numbers rocket to record levels and Covid-19 Minister Chris Hipkins warns "the next phase could well be more challenging than anything that we've dealt with in our Covid-19 response to date", New Zealanders are being left to their own devices to determine what social activities are safe for them to engage in.
The broad, one-size-fits-all rules of the alert level system only permitted activities that were not only safe on an individual level but safe for society and the health system as well. Under the traffic light system, a far greater range of activities are allowed but some vulnerable people might be better advised to skip them, experts say.
"Just like the initial settings of the Covid protection framework, there is a difference between what is permitted and what is safe: not wearing a mask in an indoor setting, such as a workplace, school, or other indoor venues like restaurants still has high transmission risk," Te Pūnaha Matatini principal investigator and disease modeller Dion O'Neale said.
Even those who don't consider themselves vulnerable will have to take into account the risk status of those around them as case numbers rise.
Keeping safe
The Government's elimination approach over the first 18 months of the pandemic meant that harsh restrictions were used to combat any community spread of Covid-19. These restrictions were probably overkill on an individual basis - during the 2020 Auckland August outbreak, in which there were fewer than 200 cases, more than a million people were put into Level 3 and limited social contact to just their bubble or maybe one other.
If some of those people had socialised more widely, their risk of being infected would still be minute. But the broad brush measures were needed to ensure the virus was eliminated and we could return to the freedoms of Level 1 once again.
Now, with Covid-19 spreading in the community, the Government's goal is much less ambitious: Merely to ensure the number of cases needing hospital treatment doesn't overwhelm the health system.
Government-imposed restrictions aren't geared towards eliminating the risk of spread but merely towards reducing it. The virus will continue to infect people, including at venues like restaurants and movie theatres and pubs which remain open (albeit capped at 100 patrons) under the red setting. If you as an individual want to reduce your risk of being infected below the Government's low bar of "keeping the health system standing", you may have to take matters into your own hands, University of Auckland microbiologist Siouxsie Wiles said.
"[The Government's] focus now is, 'How do we ensure that we have a functioning society for most people and a hospital system that isn't overwhelmed?' Individuals are making the decision, 'Do I want to risk being a case and if I don't, what are the things that I can do to help that?'"
Sarb Johal, a clinical psychologist and commentator on aspects of the Covid-19 response, told Newsroom people now have to manage their personal safety in an environment of uncertainty - a step change from the certainty that existed under the elimination strategy. What's comfortable or risky for each person will be different and people will have to figure out how to apply broad health guidance to their personal circumstances.
"There are a lot of moving parts and it's rapidly changing, so I think people won't be able to receive bespoke guidance that's going to fit their circumstances. They are going to have to kind of pick out the principles and apply it to their own lives," he said.
"I do think that perhaps I'm seeing a little less in terms of fresh guidance but I think there's a lot of guidance that's already out there. It's the way that people are going to be able to apply, decipher and use that guidance and I think that's what's going to feel overwhelming."
Wiles has a small checklist of things to keep in mind when evaluating Covid-19 risk, but caveats that there's no risk elimination here and everyone's circumstances are different.
"I think it's unhelpful when people say it's safe to do this thing. It depends on who you are, actually, it might not be safe for you. It's really important that people understand: Who are you? What is your situation? What is it about that that would make you safe or unsafe?" she said. "It's complicated. And that's one of the difficulties is that everybody wants really clear guidance, but it's more complicated than that, unfortunately."
That said, there are five key things that can help determine what's safe for you: The vaccination status of yourself and those you're meeting with, the health status of yourself and those in your lives (remembering that the vaccines are often less effective for immunocompromised people), whether the event is indoors or outdoors (and whether you can wear a mask in the case of the former), how close you'll be to other people and how long you'll be there.
"Still, with all of those things in place, there are still activities that are going to be high risk. Those are activities where you are not wearing a mask, where you are in the company of others and if you can't do them outside or in well-ventilated areas, they are still a risk," she said.
"That's when people are going to be saying, 'Well, can I afford the consequences if I become unwell? If I can't, then I won't do that activity.' Some of those activities are optional activities, like dining out."
Behaviour change
The impact of behaviour change on the hospitality industry has been well-traversed over the past few weeks. Although the red setting still allows people to go into the office and to patronise restaurants, cafes and bars, many people are choosing to act more cautiously and staying home instead.
"Your customers don't want to get sick and that's why they're staying home." – Dr Siouxsie Wiles
Pleas from ministers and the insistence of Director-General of Health Ashley Bloomfield that the activities allowed under the red setting are perfectly safe hasn't moved the dial, even as case numbers are now doubling every few days. Wiles says this is something that has happened overseas and shouldn't be surprising in New Zealand, either.
"What the hospitality industry and others seem surprised by is that people will make individual choices about going out. This is something I've been talking about since the very beginning. People will make choices, people will change their behaviour," she said. She added there was a certain irony in businesses that had pushed for a laxer approach to Covid-19 now complaining about the consequences.
"Now we're doing exactly what those people wanted, and they're going, 'Where's our customers?' It's like, your customers don't want to get sick and that's why they're staying home."
The other issue is that behaviour change happens inequitably, Wiles said. Not everyone has the choice to work from home - and those less likely to have that option are also more likely to be high risk or have family members who are high risk.
"There are people who can choose to do their own personal Level 3.5 because the jobs they do and the resources they have enable that, and there are others for whom that is absolutely impossible. And I'm particularly concerned for those who are at increased risk and they are not able to make those decisions, often for financial reasons," she said.
"It furthers inequities and it's a very ableist response."
Johal said there were two rough categories of people with different approaches to personal risk as we move into the next phase of the pandemic. There are the "vaxxed and done" who have "had two shots, they've had a booster, they're lucky enough to have no other concerns in their lives or their family or their community.
"They're being sensible about other precautions but to a large extent they've automatised their behaviour now. They've done what they can do to contribute to collective good outcomes, they're still trying to exercise good judgment but at the same time they want to continue on with the lives that they've been living."
Then there are the "vaxxed and cautious", who "may have a more complicated health picture. Maybe they've got personal vulnerabilities or underlying conditions or their family members do. They'll be much more cautious about engaging in society and being out and about than the 'vaxxed and done'."
"We need to minimise transmission and there are things that we collectively are not doing that would help." – Dr Siouxsie Wiles
There's another reason people may decide to limit social contact or skip a night out, even if they themselves are relatively low risk and their loved ones are too. That's a sense of civic duty that by reducing our personal chances of catching and spreading Covid-19, we can help the health system when it's in need.
Wiles said: "While I understand the reasons why our approach has changed, for me, the most important strategy is how do we minimise transmission? We need to protect individuals and we do that with our individual layers of armour. But we need to minimise transmission and there are things that we collectively are not doing that would help."
That includes an expansion of mask-wearing and the distribution of high quality, N95- or P2-standard masks and making greater use of ventilation.
Johal said that again people may choose to reduce social contact or not based on how much they think they should sacrifice for others. He thought those choosing to stay home to protect the health system would probably fit into the "vaxxed and cautious" category.
"They're the people who are saying, 'Look, there's still more I can do here'. It's really also about where do people see their individual level of contribution? Everybody's going to vary on that - to the point that some people aren't going to get vaccinated at all," he pointed out.
These questions are only going to become more common as case numbers rise, though Johal is hopeful that by the time we come out the other end of the Omicron wave, businesses, the Government and individuals will all have developed robust systems for answering them.
"As we have moved forward through the pandemic and people's situations have changed in terms of where their balance of risk lies - depending upon their vaccination status but also the accumulating risks of being in lockdowns for extended periods of time or having their economic activity impacted - I think that this is a shared responsibility model that is going to persist in the future," he said.
"I think that this is quite a big posture change that reflects what society might look like later this year."
