Some academics suggest rapid relaxation back to Covid Level 2 restrictions

While the Government and the Ministry of Health seem to be still taking a cautious approach to relaxing Covid-19 Level 4 restrictions on movements, business and schools and universities, some academics are suggesting a quick return to Level 2 which would allow business and schools to start to return to as near normal as is possible in the current situation.

The official line could change as the situation keeps evolving quickly, more data is gathered and a better understanding of the risks emerges.

There are risks with seeing the success in limiting spread and deaths so far as meaning restrictions were too stringent and relaxing things too quickly. Whatever changes are made to restrictions things will need to be carefully monitored.

Looking at different expert views is important in informing the decision makers.

Stuff: Lockdown rules should be relaxed, health experts say

A group of public health experts has broken ranks on the Government’s lockdown strategy, calling for a return to near-normal life in two weeks.

As the number of new coronavirus cases continue to drop, the group of academics told Stuff the Government’s lockdown plan is out of proportion with the health risks posed by the virus.

The group said that from 22 April, when the current lockdown period is due to end, New Zealand should drop to “level two” alert.

This would leave Kiwis free to return to work, most schools and universities and businesses would re-open, and leisure activities and domestic travel would resume.

Restrictions on overseas travel restrictions and gathering on more than 100 people would remain under their plan, titled “plan b”.

Jacinda Ardern has advised the Government will be announcing a revision of Level 4 and Level 3 rules and guidelines on Thursday (sounds a bit like a revised plan ‘a’ at least if not Plan B), and will announce if we will drop from Level 4 next Monday. She and the MoH will be (or at least should be) informed by a range of expert opinions, so this is the time to be discussing the options.

In response to the the group’s proposed plan, a Government spokesman said “the Prime Minister has been clear the best way to protect New Zealanders’ health and economy is to stamp out the virus.

“Modelling undertaken in NZ and the evidence we see daily in the news from overseas tells us that significant loosening of restrictions before the virus is under control, as suggested by this group, can lead to our health system being completely overrun, many people dying and doing even greater damage to our economy.

“Those countries that have followed the sort of prescription set out by this group have generally seen surges in cases and enormous pressure placed on their health systems as well as a far greater number of deaths. In contrast our strategy is seeing a reduction in cases.

The early success of the lockdown should not be used as a reason to move too quickly.”

It sounds like a cautious approach is still favoured but Ardern said they were delaying decisions as long as possible to get as much information as possible to base their decisions on. This should include consideration of a variety of opinions.

The alternative plan was developed by Auckland University’s Senior Lecturer of Epidemiology Simon Thornley.

Others to back the plan include Grant Schofield, Professor of Public Health at AUT, Gerhard Sundborn, senior lecturer of population and pacific health at Victoria University, Grant Morris, Associate Professor of Law, Victoria University,  Ananish Chaudhuri, Professor of experimental economics, University of Auckland, and Michael Jackson, postdoctoral researcher in biostatistics and biodiscovery, Victoria University.

Thornley said the evidence thus far showed eradication of the virus in New Zealand, the Government’s stated aim, was not necessary.

“Lockdown was appropriate when there was so little data…but the data is now clear, this is not the disaster we feared and prepared for.

I don’t know how he can state that with any certainty. In part at least we haven’t suffered the disaster ‘we feared and planned for’ because of the level of actions taken. If nothing was done to prevent the spread of Covid-19 it almost certainly would have been a major disaster, as Italy, Spain, Belgium, New York and other places found the hard way.

Elimination of this virus is likely not achievable and is not necessary.”

Elimination probably isn’t achievable, especially as borders open again, but we should be able to stay near to no spread for some time.

I think it’s still debatable whether virtual elimination is a goal worth targeting or not.

Thornley said the risk to most working people was low and likened it, for most people, to a seasonal influenza virus.

That’s right, and fortunate for most people, although some younger (under 70) victims have become very sick here (and for example Boris Johnson who could easily have died without the best possible hospital care).

He said the plan was developed amid concern the Government’s strategy was over-the-top and likely to “substantially harm the nation’s long term health and well being, social fabric, economy and education”.

Thornley had already said it wasn’t over the top. The debate now is what to do from here, and obviously economic and social health are important considerations.

No deaths had occurred in New Zealanders under 70 and much of the modelling related to the mortality associated with Covid-19 was overestimated, the group said in a statement.

The real threat posed by the virus was it would overwhelm the health system but New Zealand’s risk was lower than in other countries with higher population density, and our health system currently has spare capacity.

That capacity is only due to cutting back on normal health care, and that will have to ramp back up again.

“Data shows a large majority of Covid-19 fatalities have occurred in people due to their comorbidities rather than directly from the virus. Even in Italy only 12 per cent of cases were directly due to Covid.

Many illnesses become more serious due to comorbidities, that’s normal.

“If you catch Covid-19 your likelihood of dying is the same as your average likelihood of dying that year anyway. It has been described as squeezing your years mortality risk into two weeks.”

This looks a bit callous. The difference between dying some time in the next 12 months versus substantially raising the risk of dying within the next 2 weeks is going to be a big deal for nearly everyone of given the choice.

But it may be an indirect choice – what all of us do and are allowed to do can affect the risks for the most vulnerable age and comorbidity group.

The group’s plan would see the majority of schools and universities reopen, most businesses continue to operate, and allow domestic travel to resume.

Other parts of the plan would include people over 60 or with medical conditions continuing to self-isolate and receive state funded support and priority care.

There’s some merit in these suggestions but I don’t think it’s that simple. Freeing things up for people under 60 and accepting some persistence and ongoing spread of Covid-19  will be quite difficult to keep separate from those over 60, whose isolation from the virus would become even harder – and riskier – than it is now.

Thornley et al raise some important alternative considerations, but their proposals could be relaxing restrictions too quick too soon for the decision makers – and possible for people over 60 too. I wonder which way Winston Peters would want things to go?