Today’s covid update has NZ Twitter feeling wild. The traffic light system ends. There is a clear shift from using non-pharmacological interventions, to reliance on pharmacological interventions to manage covid.
To judge this decision, we need to ask four questions.
A thread🧵/1 The four questions are these:
1/ Who remains at (greatest) risk?
2/ How effective are vaccines for those at risk?
3/ How effective is paxlovid for those at risk?
4/ What is the risk (to the population) of long covid?
I can’t see that these 4 ques were addressed at the standup, /2

Our primary school kept masks compulsory through winter for Y4 upwards when we moved into Orange. That decision has paid off tremendously. Just received email from Principal saying that unlike neighbouring schools, we’ve had no year group closures due to staff illness/outbreak /1 My boys have been able to enjoy two full school terms of uninterrupted learning. The rhythm and consistency has been amazing for their wellbeing, esp with our youngest starting school this year. We’ve also avoided catching covid as a family - I’ve made it to my second booster. /2

I’m encouraged that mainstream media are increasingly interested in how the pandemic has affected children, going beyond case counts and covid complications.

Here’s me with @nzherald. We are parenting the pandemic generation - go easy, breathe 🙂/1 nzherald.co.nz/lifestyle/one-… All around the world, incl here in Aotearoa, we are seeing the impacts of the pandemic on children and young people - disruption, anxiety, financial stress, educational gaps, and more. The TL;DR is, we need to pay attention to these impacts so we can support our young people /2

The Royal Children’s Hospital in Melbourne is recording a surge in hospital presentations from influenza, RSV, Covid-19, parainfluenza, enteroviruses etc.

NZ parents, schools, and other settings can act now to help reduce the risk this winter to kids /1
smh.com.au/national/surge… It is well worth it for NZ parents to read the article in full, because NZ infection patterns tend to follow those in Australia. /2

#Budget2022. A missed opportunity to reduce child poverty. The major investment in healthcare services needed to go hand in hand with efforts to reduce poverty.

Poverty is a major determinant of child health. Investing in one without the other is ambulance at the bottom stuff Child health is exquisitely sensitive to child poverty. We can’t achieve child health and well-being without tackling child poverty. /2

https://twitter.com/drjinrussell/status/1526128801822158848

Cabinet is going to possibly announce changes to the traffic light settings in Ao/NZ on Thursday. A shift to orange could mean masks are no longer mandated for Y4+ in schools.

Here are five reasons why I think we should keep wearing masks in schools through this winter /1 First, masks are about source control - protecting each other. They are a simple and effective way to reduce the risk of transmission of Covid-19, and are an important layer of protection in schools during the pandemic. /1

The week after we learnt that the Director-General, Dr Ashley Bloomfield is leaving, alongside top public health physicians Dr Caroline McElnay and Dr Niki Stefanogiannis.

Shall we talk about healthcare workforce burnout now? nzherald.co.nz/nz/public-heal… It takes 6 years of medical school, then a Master of Public Health alongside at least four years of specialty training with the NZ College of Public Health Medicine.

Every public health consultant we lost represents 10y+ of training invested. They are not easily replaced /2

Hey parents, do check whether the kids are all up to date w their routine immunisations! Ask your friends too. S.pneumoniae causes pneumonia, blood infection, & meningitis in little ones, the risk can be reduced a lot by vaccines. This is happening right now in our community: /1

https://twitter.com/prasmao/status/1506894217515192321

More info on streptococcus pneumoniae infections and the routine immunisations that protect children, here immune.org.nz/sites/default/…

These graphs, showing vaccine efficacy against symptomatic infection and hospitalisation, over time, for 2 doses, partly help explain the government’s decisions to lift mandatory vaccines. A v important message is that vaccines matter immensely, even if mandates are repealed /1 As you can see, the efficacy of two doses against the risk of breakthrough infection from omicron wanes, while protection against severe illness/hospitalisation remain high.

Here are the same graphs but for three doses of Pfizer/Moderna: /2

Great thread. Looking at latest polling, it’s possible that many New Zealanders are not aware of just how well NZ managed Covid-19 - this may be because kiwis compare our present situation to elimination Level 1, when the comparison should be how other populations fared.

https://twitter.com/danielgoyal/status/1501854039277023233

That is not to say it wasn’t hard work, and there was no room for improvement - there was/is! But we need to keep perspective. Facing Omicron rather than delta, with a (mostly) highly vaccinated population, was one of the best scenarios we could have been in. /2

For the record, this Dr Jin has clearly and repeatedly said that protective measures in schools should be *optimised* and *strengthened* in light of omicron. There is no room for blasé. This is not a “let it rip” strategy. Please don’t use my name to cover this. (Exits)

https://twitter.com/tzemingdynasty/status/1501101186145198080

If you’re holding choir practice inside, if you’re sending kids in camping trips, don’t put my name to this.

We wrote our thinking out so carefully and clearly, right here. Omicron means *strengthen* mitigations in schools.

theconversation.com/despite-omicro…

Thank you Dr Bloomfield for emphasising at the presser today that the vast majority of cases of Covid-19 seen in children <12 are transmitted to children within households, not schools.

School mitigations are working, while we plan to turbocharge them for winter. And also remember that we should expect that a greater *proportion* of Covid-19 cases will be seen in children <12y, as older age groups are increasingly vaccinated. thespinoff.co.nz/society/26-10-…

What do we make of the anticipated timing of paediatric vaccine rollout? /2

I listened to Luxon’s speech w an open mind. But the line “growing our economy and raising productivity are the single biggest things we can do” gave me chills. This led to ineffectual Covid-19 responses abroad, deaths. And cos this doesn’t deliver equity or true wellbeing /1 I felt like I was going back in time listening to it. The internet tells me the phrase “a rising tide lifts all boats” is attributed to JFK in 1963, and I’m slightly more uncomfortable now. /2

Prime Minister Ardern is revealing that NZ's reopening is a patchwork of restrictions - regions enter different levels of the traffic light depending on vax levels & other factors. This is the opposite of a Freedom Day "set and forget". It's active, continual pandemic management As countries in Europe reimpose restrictions, Aotearoa NZ's new Covid-19 Protection Framework allows shift between three different levels of restrictions as outbreak dynamics change. The Covid-19 Alert Level system remains a backup for any overwhelming future variants.

This is a Covid-19 thread especially for kids, written by Dr @JulieSeraSpray and me!
Dr Julie did the pictures.

Kia Ora kids! We wrote this for you (1/10) (2/10)

A mini thread on why NZ needs to quickly up our game on rapid antigen testing and why we can learn from Singapore (and other jurisdictions, but today Singapore). Rapid antigen testing could improve our response, and make the traffic light system more ethical. /1 I like to track Singapore’s pandemic response for lessons, because it’s a world leader in science and healthcare, similar size population to Ao/NZ, gov led evidence-based response w highly immune pop from vaccines (not infection). They have innovated all the way thru pandemic /2

Nice write up here in the Guardian by paeds experts about Oz's vaccination progress for 5 to 11 year olds:
"Pfizer supplied initial data on the vaccine for five to 11-year-olds to Australia’s Therapeutic Goods Administration (TGA) on 26 October..." theguardian.com/commentisfree/… /1 "...During the health minister’s press conference the next day, the head of the TGA, Professor John Skerritt, said “it will take a few weeks [for approval of the vaccine for 5-11-year-olds] but I would hope that we get there by the end of November”. /2

I am still tracking Victoria's gold standard plan for reopening schools. Victoria has invested $125 million into Samsung portable air purifiers with HEPA filters for classrooms, the units that have arrived first are going into high risk areas like staff tea rooms and sick bays /1 A further $60 million investment is for the creation of outdoor learning areas by using shade sails. premier.vic.gov.au/following-thre…

But wait, there's more /2

Kia Ora to the overseas folk. Christchurch has 2 new Covid-19 cases. A testimony to the success of the elimination strategy, these are the first cases the city has had in over ONE YEAR. And vax rates in the region? 89% of eligibles at first dose /1 theguardian.com/world/2021/oct… Almost 70% of eligible people are fully vaccinated in the region. While Christchurch is on notice (but not in lockdown), what is clear is that elimination has purchased these protections. Don’t ever let anyone tell you that NZ has been in eternal lockdown /2

Just testing something. Like this tweet if you never knew community and developmental paediatricians like me existed until 2021 🙂

https://twitter.com/drnicktwit/status/1453317693558378505

Okay - likes rolling in, so I will do a quick explainer. In Australia and NZ, Community Child Health is a subspecialty of paediatrics. After 6 years of med school, 1 yr as an intern, and at least 3 years (usually longer) of general paediatric training, /1

National’s Paul “bite the bullet” Goldsmith demonstrating a disappointing lack of understanding of (a)transmission dynamics in school & to households, (b)mitigation measures for keeping schools safe and open take time. Just all haste, no detail, no plan ☹️ nzherald.co.nz/nz/auckland-sc… The pause is well worth it because (a) better planning and preparation gives the best chance that schools will reopen safely, preventing rolling school outbreaks and students isolating, (b) gives crucial time for unvaccinated to reconcile themselves to new mandates and get vaxed