This report is a pre-print. It has been subject to internal peer review.

Embargoed until 3pm, 11th April 2023, NZ time.

Modelling the effect of changes to the COVID-19 case

isolation policy
Samik Datta, James Gilmour, Emily Harvey, Oliver J. Maclaren, Dion R.J. O'Neale,
Frankie Patten-Elliott, Michael J. Plank, Ella Priest-Forsyth, Steven Turnbull, Giorgia
Vattiato, David Wu. (Author list alphabetical.)

Provided to NZ Ministry of Health: 22 March 2023; This version updated 27 Mar 2023 following
internal peer review.

Executive Summary
● We used a mathematical model to investigate the potential impact of ending
mandatory COVID-19 case isolation requirements on the number of infections,
hospital admissions, and deaths over the next 6 months.
● In the model, ending mandatory case isolation caused a wave of infections in the
subsequent 1-2 months, although after 4-6 months infections settled to a level
that was only slightly higher than if mandatory isolation was maintained.
● Under our best estimate, ending mandatory case isolation led to a 13-25%
increase in the total number of COVID-19 admissions and deaths in the
subsequent 6 months.
● However, there is a lot of uncertainty about the exact impact of ending
mandatory isolation, because firstly the current behaviour of people with
COVID-19 is not well known and secondly the change in behaviour in response to
the policy change is difficult to predict. Not everyone follows the current
requirements, while others will continue to follow isolation guidelines even if they
are no longer mandatory.
● To account for some of this uncertainty, we ran alternative model scenarios. In a
scenario with a smaller transmission increase, which could occur if many people
continue to test and isolate voluntarily, the increase in hospital admissions and
deaths could be as small as 6%. In a scenario with a larger transmission increase
where more people leave their dwelling while infectious, the increase in
admissions and deaths could be over 35%.
● The model results only relate to total national numbers. It is likely that groups at
higher risk of severe COVID-19, including Māori and Pacific people, and shielding
individuals will be disproportionately affected by an increase in transmission.
● The model results suggest that, beyond the 4-6 months following a policy change,
long-term outcomes are relatively insensitive to the timing of any decision to end
mandatory isolation.
● Irrespective of legal requirements, staying at home when sick is an important
public health message for reducing disease transmission.

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This report is a pre-print. It has been subject to internal peer review.
Embargoed until 3pm, 11th April 2023, NZ time.

Background
We have previously modelled the dynamics of SARS-CoV-2 in New Zealand using a
compartment-based ordinary differential equation (ODE) model (Lustig et al., 2023;
Vattiato et al., 2023). This age-structured model includes waning of vaccine-derived and
infection-derived immunity, immune evasion of new Omicron sub-variants,
age-dependent hospitalisation and death rates, and changes in transmission resulting
from behavioural and policy changes. The model is calibrated to data on COVID-19
cases, hospitalisations and deaths using an approximate Bayesian computation (ABC)
method.

Anyone testing positive for COVID-19 in New Zealand is currently legally required to
self-isolate until 7 days after their positive test result or onset of COVID-19 symptoms,
whichever is earlier (Parliamentary Counsel Office, 2022). Previous work from COVID-19
Modelling Aotearoa has estimated the effect of different isolation periods on
transmission risk (Harvey et al. 2022a). This report presents results from the ODE model
(Lustig et al., 2023) to support the 16 March 2023 Public Health Risk Assessment (PHRA)
to assess whether the current public health risk of COVID-19 justifies retaining mandatory
isolation. The Ministry of Health is providing information to the PHRA related to risk of
reinfections, long covid, and key surveillance trends showing the current impact/risk
profile of COVID-19.

Model scenarios
We ran a baseline version of the model fitted to data up to 25 February 2023. We then
compared this baseline model against three scenarios in which there is an instantaneous
increase in the effective reproduction number on 21 March 2023 of 5%, 10% and 15%. This
can equivalently be thought of as a 5%, 10% or 15% increase in the average number of
contacts during an individual’s infectious period. The 10% increase in transmission is our
central estimate of the impact of ending mandatory COVID-19 isolation requirements
and shifting to guidance only, with the 5% and 15% scenarios capturing some of the
uncertainty about the effect size. We present results showing the change in the number
of SARS-CoV-2 infections, COVID-19 hospitalisations and COVID-19 deaths in each of
these scenarios. We do not explicitly show results for cases because the effect of a
policy change on testing and reporting rates is unknown.

The estimates of increase in transmission are based on results of a behavioural survey

(see below) and previous results from COVID-19 Modelling Aotearoa’s network contagion
model and ODE model. A behavioural survey undertaken on behalf of the NZ Ministry of
Health in late 2022 (Horizon Research Limited, 2022) suggests that a large proportion of
survey respondents were still testing if symptomatic and self-isolating if they test
positive and that they intended to continue with such behaviour in the future (see
Supplementary Material). This suggests that self-isolation continues to play a role as

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This report is a pre-print. It has been subject to internal peer review.
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part of transmission-reducing behaviour for a significant fraction of the population and

as such there remains potential for increased transmission if such behaviours were to
end, or significantly reduce, with the end of mandatory self-isolation.

The network contagion model results estimated that the complete removal of case
isolation behaviours could lead to a 15% increase in transmission, relative to a baseline
with no household quarantine and only symptomatic testing but high compliance with
case isolation (Harvey et al., 2022b). There is significant uncertainty in this estimate, in
particular due to the difficulty of estimating the proportion of people currently testing
and following case isolation requirements, the number of people who would follow
“guidance to isolate”, and other unmodelled changes in behaviour that might
accompany such a policy change. If case isolation behaviour has already decreased, or
if people follow the isolation guidance after mandatory isolation has ended, the
modelled increase would be less than 15%. However, model results following the end of
the Covid-19 Protection Framework in September 2022 showed that subsequent
epidemiological data were consistent with a larger than expected increase in
transmission (Vattiato et al., 2023). This was potentially the result of unmodelled
behaviour changes, which could also occur following an end to mandatory Covid-19
isolation.

The impact of shifting to guidance will also depend on what the recommended isolation
guidance is. For example, voluntary test-to-release for when to end isolation would
reduce transmission, but advice to only isolate while symptomatic would increase risk. In
previous work, COVID-19 Modelling Aotearoa (Harvey et al. 2022a) calculated that the
impact of the current 7 day policy of mandatory isolation of confirmed COVID-19 cases
results in an average of 9 hours infectious in the community after release1 and 83 hours
of excess isolation2 per confirmed case. The same report calculated that a
“test-to-release” policy with a 7 day maximum, but with possible early release after day 5
upon returning 1 (respectively 2) negative results on an antigen test would result in only
a small increase in hours infectious in the community after release (12 (resp. 10) hours)
but a large reduction in hours of excess isolation (51 (resp. 57) hours).

Factors that may shift outcomes towards the lower transmission increase scenario
include strong, clear public health messages on the importance of following the
1
An estimated 15% of individuals are still infectious at the end of their mandatory 7 day isolation
period. The average hours infectious in the community is the mean number of hours that
individuals remain infectious for, after the end of mandatory isolation, averaged across the whole
population of confirmed cases including those cases whose infectivity resolves before the end of
mandatory isolation and who contribute zero hours to the mean.
2
The estimated 85% of individuals whose infectious period ends before the end of their
mandatory isolation period will be required to spend some time in isolation in excess of the end of
their infectious period. Average hours of excess isolation is the mean number of hours that
individuals spend in isolation when no longer infectious, averaged across the whole population,
including those cases whose infectivity resolves after the end of their isolation period and who
contribute zero hours to the mean.

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recommended isolation guidelines and what the guidelines are, availability of and access
to rapid antigen tests, and providing financial support for people to isolate.

Results
Table 1 shows the change in infections, hospitalisations and deaths under each scenario,
relative to the baseline model in which there is no policy or behavioural change. The
Table shows results for a 7 week period and for a 26 week period following the policy
change. Figure 1 shows the relative change in cumulative infections, hospitalisations and
deaths over time compared to the baseline model. See Supplementary Material for
additional results broken down by age group.

An increase in transmission typically leads to a wave of infections in the subsequent 2-3

months, with larger transmission increases associated with higher peaks. After a longer
period of time, the differences between scenarios are smaller as infection rates settle
down to similar levels following the initial wave. The model assumes that behavioural
change in response to a policy update occurs immediately. If instead the behavioural
change occurs more gradually, this would tend to reduce the size of the initial peak and
lead to a more gradual transition onto the same long-term trends. Retrospective
analysis of the impact of the September policy change found that epidemiological data
was consistent with the transmission increases being spread over several weeks
(Vattiato et al., 2023). Relative increases in severe health outcomes in the longer-term
tend to be slightly larger than the associated increase in infections (see Table 1). This is
because the additional infections caused by the transmission increase tend to occur
disproportionately in older age groups due to their lower rates of prior infection.

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Table 1. Model results for the short-term and long-term impact of ending mandatory COVID-19 isolation requirements. Differences
in cumulative infections, COVID-19 hospital admissions, and COVID-19 deaths, in the 7 weeks and 26 weeks following the policy change,
and peak hospital occupancy during the 26 weeks following the policy change, under three model scenarios (+5%, +10% and +15% change
in transmission on 21 March 202). All results are relative to the baseline model with no policy change. In each table cell, the first line shows
change in absolute numbers and the second line shows relative (percentage) change compared to baseline. Values in brackets represent
the 95% confidence intervals on these differences.

Short term impact Long term impact Difference in

Difference in cumulative numbers from 0 to 7 weeks Difference in cumulative numbers from 0 to 26 weeks peak hospital
post policy change post policy change occupancy
in the 26 weeks
Hospital Hospital post policy
Infections Deaths Infections Deaths
Scenario admissions admissions change

Lower +83,000 [+32,000, +95,000] +500 [+200, +600] +23 [+12, +40] +81,000 [+59,000, +88,000] +700 [+400, +800] +73 [+63, +135] +103 [+30, +130]
(+5% on +27% [+25%, +29%] +25% [+21%, +26%] +15% [+12%, +16%] +6% [+5%, +9%] +7% [+6%, +11%] +8% [+7%, +13%] +24% [+12%, +26%]
21Mar23)

Central +179,000 [+73,000, +200,000] +1,000 [+400, +1,300] +51 [+27, +88] +164,000 [+117,000, +176,000] +1,400 [+700, +1,500] +148 [+124, +269] +233 [+95, +287]
(+10% on +57% [+52%, +65%] +55% [+48%, +57%] +34% [+26%, +36%] +12% [+11%, +17%] +15% [+13%, +21%] +17% [+15%, +25%] +54% [+37%, +57%]
21Mar23)

Higher +282,000 [+123,000, +308,000] +1,700 [+700, +2,100] +85 [+45, +145] +247,000 [+174,000, +264,000] +2,100 [+1,100, +2,300] +225 [+185, +406] +382 [+179, +463]
(+15% on +91% [+80%, +108%] +90% [+82%, +96%] +56% [+43%, +59%] +18% [+16%, +24%] +23% [+20%, +31%] +25% [+23%, +37%] +88% [+70%, +92%]
21Mar23)

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Figure 1. Model results for the relative (percentage) increase in cumulative infections (left), cumulative COVID-19 hospital admissions
(middle) and cumulative COVID-19 deaths (right), over one year following an increase in transmission of 5% (blue), 10% (green), 15%
(purple) compared to the baseline model (0% change in red). Results are aggregated across all ages. Solid curves show the difference in
best-fit model trajectory with and without the transmission increase, shaded bands contain the difference for paired trajectories (same
set of parameters) with and without the transmission increase for 95% of accepted model realisations.

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This report is a pre-print. It has been subject to internal peer review.
Embargoed until 3pm, 11th April 2023, NZ time.

Key model assumptions, limitations and sources of

uncertainty
● There is significant uncertainty as to the impact of a change in the COVID-19
isolation policy on transmission. This is because the effect of ending legal
isolation requirements depends not only on the effect of isolation on
individual-level transmission risk, but also on the number of people complying
with isolation requirements before the policy change, the number voluntarily
following isolation guidance after the change, what the guidance is, and what
other behavioural changes there are. The scenarios shown represent a central
estimate and a lower and higher estimate of the effect of ending mandatory
case isolation. However, outcomes outside this range (either above or below)
cannot be completely ruled out.
● The model assumes that the increase in transmission following an end to
mandatory isolation occurs uniformly across all age groups. This may not be the
reality, although it is a necessary modelling assumption in the absence of
detailed age-specific data on compliance with isolation requirements.
● The greatest level of uncertainty applies to the magnitude of the short-term
increase in infections following a policy or behavioural change (see
Supplementary Figure S1). Long-term differences between different policy
settings are likely to be smaller due to the role of infection-acquired immunity in
controlling transmission.
● The model assumes that there is no major new variant of SARS-CoV-2, no change
in the intrinsic virulence of the virus, no seasonal variation (e.g. transmission rates
do not increase in winter), and no other behavioural changes affecting
transmission rates over the relevant time period. This means that the baseline
model should not be used as a long-term prediction for the absolute numbers of
infections, admissions or deaths, but rather a scenario of what would be likely to
occur under these specific modelling assumptions. The results for the relative
percentage change in these numbers compared to the baseline model are
expected to be more robust to these unmodelled effects, and are the focus of this
report.
● The model ignores regional and socioeconomic heterogeneities in prevalence,
transmission and isolation behaviour and can only be used to give a national
population-level picture. Isolation procedures are also an important way to shield
vulnerable individuals but this is not included in the model. In particular, the model
does not capture the fact that more vulnerable individuals who may be less able
to follow non-mandated guidance around isolation will tend to be in contact with
others who are also more vulnerable.
● The model does not give any information about how the impact of a policy
change will be distributed across particular communities or demographic groups.
Any groups that become unable to isolate, for example due to financial pressures,

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This report is a pre-print. It has been subject to internal peer review.
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may be exposed to higher risk. The behavioural survey undertaken for NZ

Ministry of Health in late 2022 (Horizon Research Limited, 2022) identified a
significant fraction of New Zealanders who felt that they were unable to isolate or
quarantine because of economic factors. People who reported that they would be
unable to self-isolate if sick with COVID-19 were more likely to be Māori, Pasifika,
or Asian. Māori and Pasifika also have higher risk of severe COVID-19 (Steyn et al.,
2021; MOH, 2022) so are likely to be disproportionately affected by increased
transmission rates.
● We have not modelled any drop in case reporting rates that may follow a policy
change, such as is thought to have occurred in Australia for example. This does
not affect the number of infections, hospitalisations or deaths in the model.
However, in practice it could affect COVID-19 surveillance systems and situational
awareness, as well as access to antiviral medications, which rely on prompt
diagnosis.
● The model currently overestimates the number of daily deaths following a
reduction in the observed case fatality ratio since around September 2022. If this
discrepancy continues, model results for the effect of the policy change may
overestimate its effect on the number of deaths (although results for the relative
percentage change will be more robust).
● The immune landscape in New Zealand has become more complex, with various
combinations of immunity derived from vaccination and prior infection at
different time points. The model necessarily makes simplifying assumptions
about the nature of the immunity landscape and it is possible that results are
sensitive to these assumptions.
● The model does not include the effect of any vaccine doses given after 13
February 2023. This is to avoid the need to make assumptions about future
vaccine uptake. Future updates to the model will continue to account for vaccine
doses given, particularly following the rollout of the bivalent booster vaccine from
April 2023.
● The model does not consider the economic, legal or broader public health (e.g.
mental health) implications of the COVID-19 isolation policy.

Acknowledgements
The authors acknowledge the role of the New Zealand Ministry of Health, StatsNZ, and
the Institute of Environmental Science and Research in supplying data in support of this
work. The authors acknowledge the role of the COVID-19 Modelling Government Steering
Group in designing the modelling questions to support the Public Health Risk
Assessment. The authors are grateful to Nigel French, Amanda Kvalsvig, Markus
Luczak-Roesch, Melissa McLeod, L. Martis, Ben Ritchie, Matt Parry and Patricia Priest for
feedback on an earlier version of this report. This work was funded by the New Zealand
Department of Prime Minister and Cabinet and Ministry of Health.

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Author contributions
● SD: prepared document, including model output manipulation and visualisations;
contributed to ODE model.
● JG: contributed to the design and building of the interaction network that the
Network Contagion Model runs on.
● EH: design, building, and running the Network Contagion Model which feeds
parameters into the ODE model, contributed to ODE model design, assisted in
writing the document.
● DO: led design and building of the Network Contagion Model which feeds
parameters into the ODE model, contributed to ODE model design, assisted in
writing the document.
● FPE: involved in running the Network Contagion Model which feeds parameters
into the ODE model, and interpreting results.
● EPF: involved in running the Network Contagion Model which feeds parameters
into the ODE model, and interpreting results, assisted in writing the document.
● MP: prepared document, involved in building the ODE model.
● OM: contributed to the design of the contagion code for the Network Contagion
Model, involved in building the ODE model, developed/implemented the
fitting/credible band construction methods, assisted in writing the document.
● ST: contributed to the design and building of the interaction network that the
Network Contagion Model runs on.
● GV: prepared document, involved in building the ODE model, ran model
simulations presented.
● DW: developed the contagion code codebase for the Network Contagion Model.

References
1. Harvey, E.P., Looker, J., O’Neale, D.R.J., Plank, M.J., Priest Forsyth, E., Trent, J.
(2022a). Quantifying the impact of isolation period and the use of rapid antigen
tests for confirmed COVID-19 cases. COVID-19 Modelling Aotearoa pre-print,
available at:
https://www.covid19modelling.ac.nz/quantifying-the-impact-of-isolation-period/
2. Harvey, E.P., O’Neale, D.R.J., Patten-Elliot, F., and Priest Forsyth, E. (2022b).
Estimating the effect of changes in case isolation on the effective reproduction
number of COVID-19 in Aotearoa. Advice sent to the COVID-19 Modelling
Government Steering Group 15/09/2022.
3. Horizon Research Limited (2022). Behavioural surveillance 2 survey, November
2022 Report. Prepared for: Evaluation and Behavioural Science, Intelligence,

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Embargoed until 3pm, 11th April 2023, NZ time.

Surveillance and Knowledge, Public Health Agency, Manatū Hauora - Ministry of

Health.
4. Lustig, A., Vattiato, G., Maclaren, O., Watson, L.M., Datta, S., & Plank, M.J. (2023).
Modelling the impact of the Omicron BA. 5 subvariant in New Zealand. Journal of
the Royal Society Interface, 20(199), 20220698.
5. Ministry of Health (2022). COVID-19 Trends and Insights Report 23 December
2022. Available at:
https://www.health.govt.nz/system/files/documents/pages/trends_and_insights
_report_-_23_december_2022.pdf
6. Parliamentary Counsel Office (2022). COVID-19 Public Health Response
(Self-isolation Requirements) Order 2022. New Zealand Legislation SL 2022/46
(Version as at 19 December 2022). Available at:
https://www.legislation.govt.nz/regulation/public/2022/0046/latest/LMS647648.h
tml
7. Steyn, N., Binny, R.N., Hannah, K., Hendy, S.C., James, A. Lustig, A., Ridings, A.,
Plank, M.J., Sporle, A. (2021). Māori and Pacific people in New Zealand have a
higher risk of hospitalisation for COVID-19. New Zealand Medical Journal
134(1538): 28-43.
8. Vattiato, G., Datta, S., Maclaren, O.J., Lustig, A. and Plank, M.J. (2023). Modelling
COVID-19 dynamics in New Zealand August 2022 to February 2023. COVID-19
Modelling Aotearoa. Available at: https://www.covid19modelling.ac.nz/reports/

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This report is a pre-print. It has been subject to internal peer review.
Embargoed until 3pm, 11th April 2023, NZ time.

Supplementary Material

Summary of behavioural survey results relevant to self-isolation

Results from a behavioural survey undertaken for the Ministry of Health in late 2022
(Horizon Research Limited, 2022) show that, in the two weeks prior to the survey:
- 63% of respondents with COVID-19 symptoms took at least one RAT.
- 78% of respondents who tested positive self-isolated.
- 90% of those who tested positive reported symptoms.
- Only 8% of respondents who tested positive did not report any of their test results
from the prior two weeks on My COVID Record.
When asked about future intentions:
- over 75% of respondents said they were “likely” or “very likely” to “have a RAT if
[they have] COVID-19 symptoms in the future”.
- over 80% said that they were “likely” or “very likely” to “self-isolate for the
required 7-day period if [they have] a positive RAT result in the future”3.
In terms of results relating to the level of adherence to the guidelines for household
contacts of confirmed cases once mandatory quarantine was removed, the behavioural
survey found that, in the two weeks prior to the survey
- 71% of household contacts of a confirmed case took at least one RAT.
- 33% of household contacts of a confirmed case quarantined (self-isolated).

These results suggest that there are reasonably high levels of compliance with current
case isolation requirements. This also shows that although household contact quarantine
requirements were replaced with guidance in September, in November there were a
reasonable number of household contacts following the guidance. This is evidence that
there is still a significant proportion of the public who are currently taking actions
including symptomatic testing, case isolation and household contact quarantine to
reduce transmission. And therefore there is potential for an increase in transmission if
case isolation requirements are removed, and if behaviours changed around testing and
staying home if sick, or if a household contact.

ODE model summary

The ODE model is based on numerous parameter assumptions: some of these values
are fixed, others are fitted using a naive ABC (approximate Bayesian computation)
method (see Lustig et al., 2023 for details). Using this method, the model picks random
combinations of parameter values from their 'prior' distributions (results presented here

3
In the survey, of the people who indicated that they would have difficulty self-isolating, 18% said
it was because they “don’t have space to self-isolate away from others at home”. This indicates a
potential misinterpretation of “self-isolation”, and suggests that some of those who hadn’t (or
wouldn’t) self-isolate, may still stay home, they just may not be able to stay away from their
household contacts.

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are from 15,000 independent draws from the prior distribution), then outputs a sample
from an approximate posterior distribution of accepted values. The accepted values are
those resulting in the 1% best fitting trajectories (i.e. those that give the smallest value for
a distance function that measures the difference between a simulated trajectory and
observed data). The distance function is based on the number of new daily infections in
a routinely tested cohort of border workers (up to July 2022), total and age-stratified
daily reported cases of COVID-19, total and age-stratified daily hospital admissions for
COVID-19, and total daily COVID-19 deaths (excluding deaths that are classified as “Not
COVID-related”. The age-stratified daily cases and hospital admissions are included for
each age group as a proportion of the total. The accepted model runs are then used to
plot a 'best fit' line and a 95% confidence interval.

It is worth noting that multiple different combinations of parameter choices can result in
simulations that give an equally good fit to empirical data, including combinations of
parameters that may conflict with other parameter combinations. It is therefore
important to consider modelling results as an ensemble of plausible trajectories, subject
to the constraints and assumptions of the model.

Supplementary results

The results shown here are for scenarios with a specified increase in transmission on 21
March 2023, representing the potential impact of a reduction in the number of infected
individuals effectively isolating during their infectious period, as described in the Main
Text. The model was run with an increase in transmission of: 0% (henceforth referred to
as the 'baseline' model), 5%, 10% and 15%.

Figure S1 shows model results in the four scenarios for the number of daily infections,
reported cases, new daily Covid-19 hospital admissions, hospital occupancy, and daily
Covid-19 deaths. Note that for the results on cases, the model assumes that the case
ascertainment rate (i.e. proportion of infections that are reported as cases) is not
affected by any policy change. In reality, it is likely that ending mandatory
reporting/isolation will lead to a drop in the case ascertainment rate, as is thought to
have occurred in Australia for example. This means that the model may significantly
overestimate the number of reported cases following a policy change, but we note that
this does not affect the number of infections, hospitalisations or deaths in the model.

Figures S2-S7 show the increase in infections, hospital admissions and deaths in the
scenarios with an increase in transmission, compared to the baselines model. In each
graph, solid curves show the difference in the cumulative number of outcomes over time
in the best-fit model between the baseline (no change) model and the scenario with the
specified increase in transmission (5%, 10% or 15%). Shaded bands represent a 95%
confidence interval (under model assumptions) for the difference in the cumulative
number of outcomes as a result of the transmission increase.

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Graphs are shown both for absolute increase and for relative increase compared to
baseline. We do not plot cases here as the effect of any policy change on testing and
reporting behaviour is unknown and not included in the model (see also Main Text). Each
set of graphs shows results split into 10-year age groups and for the aggregated totals
(bottom-right plot in yellow box).

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Figure S1. Model results for new daily infections (per 100,000 people), cumulative
infections since 1 January 2023, daily reported cases, new daily Covid-19 hospital
admissions, hospital occupancy and daily Covid-19 deaths for the four model scenarios
(red = baseline, blue = 5% increase, green = 10% increase, purple = 15% increase in
transmission on 21 March 2023). Solid curves show the best-fit model trajectory, shaded
bands contain 95% of accepted model realisations, red points show observed data. Note
the model assumes that there is no major new variant of SARS-CoV-2, no change in the
intrinsic virulence of the virus, no seasonality or other changes affecting transmission
rates over the relevant time period. This means that the baseline model should not be
used as a long-term prediction for the absolute numbers of infections, admissions or
deaths, but rather a scenario of what would be likely to occur under these specific
modelling assumptions.

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Figure S2. Model results for the change in cumulative infections following an increase in
transmission of 5% (blue), 10% (green), 15% (purple) compared to the baseline model.
Results are shown split into 10-year age bands, and aggregated across all ages (bottom
right graph). Solid curves show the difference in best-fit model trajectory with and
without the transmission increase, shaded bands contain the difference in trajectories
with and without the transmission increase for 95% of accepted model realisations.

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Figure S3. Model results for the percentage increase in cumulative infections following an
increase in transmission of 5% (blue), 10% (green), 15% (purple) compared to the baseline
model. Results are shown split into 10-year age bands, and aggregated across all ages
(bottom right graph). Solid curves show the difference in best-fit model trajectory with
and without the transmission increase, shaded bands contain the difference in
trajectories with and without the transmission increase for 95% of accepted model
realisations.

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This report is a pre-print. It has been subject to internal peer review.
Embargoed until 3pm, 11th April 2023, NZ time.

Figure S4. Model results for the change in cumulative Covid-19 hospital admissions
following an increase in transmission of 5% (blue), 10% (green), 15% (purple) compared
to the baseline model. Results are shown split into 10-year age bands, and aggregated
across all ages (bottom right graph). Solid curves show the difference in best-fit model
trajectory with and without the transmission increase, shaded bands contain the
difference in trajectories with and without the transmission increase for 95% of accepted
model realisations.

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This report is a pre-print. It has been subject to internal peer review.
Embargoed until 3pm, 11th April 2023, NZ time.

Figure S5. Model results for the percentage increase in cumulative Covid-19 hospital
admissions following an increase in transmission of 5% (blue), 10% (green), 15% (purple)
compared to the baseline model. Results are shown split into 10-year age bands, and
aggregated across all ages (bottom right graph). Solid curves show the difference in
best-fit model trajectory with and without the transmission increase, shaded bands
contain the difference in trajectories with and without the transmission increase for 95%
of accepted model realisations.

18
This report is a pre-print. It has been subject to internal peer review.
Embargoed until 3pm, 11th April 2023, NZ time.

Figure S6. Model results for the change in cumulative Covid-19 deaths following an
increase in transmission of 5% (blue), 10% (green), 15% (purple) compared to the baseline
model. Results are shown split into 10-year age bands, and aggregated across all ages
(bottom right graph). Solid curves show the difference in best-fit model trajectory with
and without the transmission increase, shaded bands contain the difference in
trajectories with and without the transmission increase for 95% of accepted model
realisations.

19
This report is a pre-print. It has been subject to internal peer review.
Embargoed until 3pm, 11th April 2023, NZ time.

Figure S7. Model results for the percentage increase in cumulative Covid-19 deaths
following an increase in transmission of 5% (blue), 10% (green), 15% (purple) compared
to the baseline model. Results are shown split into 10-year age bands, and aggregated
across all ages (bottom right graph). Solid curves show the difference in best-fit model
trajectory with and without the transmission increase, shaded bands contain the
difference in trajectories with and without the transmission increase for 95% of accepted
model realisations.

After 7 weeks (2 May 2023)

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This report is a pre-print. It has been subject to internal peer review.
Embargoed until 3pm, 11th April 2023, NZ time.

Infections

Scenario Cumulative Range Increase Increase % % increase

infections range increase range

0% 312,000 129,000 - - - - -
379,000

5% 395,000 161,000 - 83,000 32,000 - 26.7 24.9 - 29

474,000 95,000

10% 490,000 202,000 - 179,000 73,000 - 57.3 52.1 - 65

579,000 200,000

15% 594,000 252,000 - 282,000 123,000 - 90.5 80.4 - 108.3

687,000 308,000

Covid-19 hospital admissions

Scenario Cumulative Range Increase Increase % % increase

admissions range increase range

0% 1,900 800 - - - - -
2,500

5% 2,300 1,000 - 500 200 - 600 24.8 21.2 - 25.7

3,100

10% 2,900 1,300 - 1,000 400 - 1,300 54.8 48 - 57.1

3,800

15% 3,500 1,600 - 1,700 700 - 2,100 89.5 81.5 - 95.6

4,500

Covid-19 deaths

Scenario Cumulative Range Increase Increase % % increase

deaths range increase range

0% 151 96 - 257 - - - -

5% 174 108 - 297 23 12 - 40 15.2 11.6 - 15.9

10% 202 123 - 345 51 27 - 88 33.8 25.8 - 35.5

15% 236 141 - 402 85 45 - 145 56.1 43.1 - 58.9

After 26 weeks (19 September 2023)

Infections

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This report is a pre-print. It has been subject to internal peer review.
Embargoed until 3pm, 11th April 2023, NZ time.

Scenario Cumulative Range Increase Increase % % increase

infections range increase range

0% 1,384,000 750,000 - - - - -
1,515,000

5% 1,465,000 816,000 - 81,000 59,000 - 5.9 5.3 - 8.8

1,602,000 88,000

10% 1,548,000 875,000 - 164,000 117,000 - 11.9 10.6 - 16.7

1,690,000 176,000

15% 1,631,000 930,000 - 247,000 174,000 - 17.9 16.1 - 24

1,777,000 264,000

Covid-19 hospital admissions

Scenario Cumulative Range Increase Increase % % increase

admissions range increase range

0% 9,100 5,100 - - - - -
11,200

5% 9,800 5,500 - 700 400 - 800 7.4 6.4 - 10.9

12,000

10% 10,500 5,900 - 1,400 700 - 1,500 14.9 12.9 - 21

12,700

15% 11,200 6,300 - 2,100 1,100 - 2,300 22.7 19.6 - 30.7

13,500

Covid-19 deaths

Scenario Cumulative Range Increas Increase % % increase

deaths e range increase range

0% 891 630 - 1,534 - - - -

5% 965 697 - 1,666 73 63 - 135 8.2 7.3 - 12.8

10% 1,039 760 - 1,797 148 124 - 269 16.6 14.8 - 24.9

15% 1,116 822 - 1,932 225 185 - 406 25.2 22.5 - 36.6

Peak hospital occupancy

Scenario Maximum Range Increase Increase % % increase

occupancy range increase range

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This report is a pre-print. It has been subject to internal peer review.
Embargoed until 3pm, 11th April 2023, NZ time.

0% 435 234 - 562 - - - -

5% 538 268 - 684 103 30 - 130 23.6 11.7 - 25.9

10% 668 331 - 839 233 95 - 287 53.5 36.7 - 56.9

15% 817 413 - 1015 382 179 - 463 87.7 69.8 - 92.1

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