Toward the end of the classic Vietnam war film Apocalypse Now, Captain Willard finally found the object of his quest: the mad Colonel Kurtz. Kurtz asked whether Willard agreed with their superiors who believed that Kurtz’s methods were unsound.
Willard replied, “I don’t see any method at all, Sir.”
The government’s response to Omicron over the summer break has had too little method and too much madness.
Before the country went off on summer holidays, things seemed in hand.
On 21 December, the government announced measures to reduce the risk of an outbreak while helping to prepare against the worst. MIQ stays were lengthened to guard against late-onset cases. Travellers would need to present a test result that was no more than 48 hours old, rather than the prior 72-hour limit. And booster vaccinations would be available two months sooner.
The measures made sense. Preventing Covid-positive people from boarding flights to New Zealand was the simplest way of limiting risk to other passengers and to the country more broadly. And boosters substantially reduce the risk that the Omicron variant might send people to hospital.
On the 9th of January, the government changed the pre-departure testing requirements.
Travellers from a long list of countries would be allowed to board flights to New Zealand without a PCR test. A rapid antigen test within 24 hours of departure would suffice.
Australia was on the list of countries despite, or perhaps because of, its substantial Omicron wave.
PCR testing collapsed in Australia for the same reason that it will collapse in New Zealand when our surge hits.
Pooled sampling techniques allow testing labs to multiply their testing capacity. When few people have Covid, the technique allows labs to quickly verify that a group of people do not have Covid. When positivity rates are high, pooled sampling no longer works and testing capacity immediately reduces to a small fraction of what it had been.
Would-be travellers from Australia would have had a harder time sourcing a quick-turnaround PCR test. The testing system was under too great a burden because too many Australians had Covid.
Allowing a rapid antigen test instead of a PCR test meant travellers and returnees from Australia had a simpler way through.
A rapid antigen test, administered at the departure gate immediately prior to travel, would have been an excellent complement to PCR testing requirements. The additional layer of protection would have caught some travellers who only developed Covid after their PCR test.
But a rapid antigen test is a poor substitute for a PCR test.
The New Zealand government banned rapid antigen tests in early 2020 because it viewed them as less accurate than PCR tests and too likely to deliver false negative results. In late 2021, after substantial business pressure, the government grudgingly allowed rapid tests to be used in very specific circumstances.
But less than three weeks after tightening test-to-travel requirements to reduce Omicron’s risk in MIQ, the government allowed travellers to use rapid tests instead of PCR tests for travel from places with Covid caseloads substantial enough to break PCR testing systems.
It is little surprise that Omicron caseloads in MIQ ballooned.
And, given Omicron’s infectiousness, it is little surprise that Omicron then escaped.
But it is difficult to reconcile the tightening up of test-to-travel restrictions, to reduce risk, with the subsequent move to allow rapid antigen tests instead of PCR tests before travel. If the government considered rapid antigen tests to be safe enough because travellers were entering MIQ, why tighten the window for PCR tests in the first place?
As Captain Willard put it, “I don’t see any method at all, Sir.”
More method, or at least some method, will be needed in the months ahead.
Omicron’s burden on health systems abroad is obvious. New Zealand’s vaccination rate will mean far fewer Kiwis wind up in hospital as case numbers surge. But medical staff will catch Covid and will be out sick.
The Los Angeles Times reported, two weeks ago, that almost ten percent of staff at Tufts Medical Center in Boston were out sick with Covid on a single day – and that such cases are not rare. In California, staff shortages in a Covid surge mean asymptomatic Covid-positive medical staff continue working, in protective gear, with Covid patients.
Short of that kind of nightmare scenario, quickly clearing medical staff to return to work safely after self-isolation will matter. Accurate tests able to deliver results within hours, rather than days, would mean fewer critical medical staff in unnecessary isolation when the health system is under strain.
While vaccination sharply reduces Covid hospitalisation, infected people will have elective surgeries deferred because of the risk they pose to others in hospital. Being able to clear them more quickly, so they can access treatment, is also important.
Testing labs will also be under strain in the surge. Contracting now for the capacity that will be needed would avoid the health system’s finding itself caught short.
May the fall bring more method and less madness.