In the face of record high autumn deaths and the prospect of another surge in sickness, the Government appears to have no strategy for handling Covid-19, Marc Daalder writes
Comment: Chris Hipkins says the pandemic isn't over, but he's acting like it is.
At every stage of the Omicron outbreak, the Government has weakened or removed restrictions. Isolation rules were eased as cases spiked, the traffic light system was gutted while they peaked, mandates were repealed as hospitalisations rose to record levels and the country moved to Orange while a dozen virus cases were dying each day.
Two weeks after the country moved to the Orange setting, a steady decline in case numbers has turned into a plateau. An average of 13 people are dying every day with Covid-19, virtually unchanged for nearly 20 days.
While some of those deaths may have been incidental, or people who would have died even without Covid-19, 539 more New Zealanders died in the first 13 weeks of this year than in the first 13 weeks of 2021. Hundreds of people are dying who would not have, if not for Covid-19.
It's about to get worse.
As we head into winter, experts are certain that Covid-19 cases - and therefore hospitalisations and deaths - will rise once again. It may not be the same sharp peak as we saw in March, but it could be sustained for a longer period, sickening even more in a second wave than were affected by the first. That will coincide with the reintroduction of influenza, which could cause far more than its usual 500 annual deaths given we've gone two years without it.
Our chronically under-resourced health system has just been squeezed like never before and is now staring down a second, potentially worse period of pressure.
In the face of record high autumn deaths and the prospect of another surge in sickness, the Government appears to have no strategy whatsoever. Ministers have given up on handling Covid-19 and seem content just to plug their ears and pretend it isn't happening.
"From appearances, it would appear that there isn't much of a strategy," Wellington urgent care doctor Kelvin Ward told Newsroom. Ward organised an open letter to the Government calling on it to return to a mitigation strategy, relying on a combination of vaccines, widespread mask use, ventilation, interventions targeted at schools and clear public communications. More than 150 scientists and doctors, including big names like Michael Baker and Siouxsie Wiles, have put their name to the plea.
"It would appear that they have decided that vaccination is enough and that the vaccinations are going to mitigate, sufficiently, the long-term risks of infection. And that they don't have a significant commitment to suppressing infection and that they seem to be comfortable with high levels of infection."
Hipkins declined an interview with Newsroom, but responded in a written statement to questions about the current approach. "We keep our response to the current community outbreak of Covid-19 under constant review and will adapt it as the outbreak and pandemic evolve and as part of our resurgence planning," he said.
Excess deaths
On April 13, Hipkins announced that New Zealand would move to Orange and that 16 people died with Covid-19.
Then as now, an average of 13 Covid-19 cases were dying each day. Was that an acceptable level of death?
"There’s no such thing as an acceptable rate of death when you’re dealing with an infectious disease," Hipkins told Newsroom at the time. "We do everything that we can to lower the death rate to as close to zero as we can possibly get it - but acknowledging that getting to absolutely zero is impossible."
Of course, that's not true. If the Government was doing everything it could to lower the death rate, it wouldn't have been moving to Orange when 13 people were dying every day.
Hipkins conceded that and described the issue as "a very sensitive topic". He went on to say that while mortality in New Zealand was above usual levels, it wasn't "a massive increase on what we would normally see". Would an acceptable level of infection be when Covid-19 deaths are no longer driving all-cause mortality above expected levels - because the deaths are all incidental or of people who were likely to die of something else in the same timeframe?
"That's certainly what we'd be aiming for, yes."
There's a long way to go. The Ministry of Health and Statistics New Zealand has been closely tracking excess mortality in New Zealand over the course of the Omicron outbreak. That data isn't ready for release yet, but another source shows New Zealand is seeing a record number of deaths for the autumn period.
The global Human Mortality Database has tracked the number of deaths in New Zealand each week since late 2010. That data reveals 8789 people died in the first 13 weeks of the year - the highest level on record. Each week since the end of January, more people have died than in any previous year in the Human Mortality Database.
University of Otago epidemiologist Amanda Kvalsvig, one of the lead signatories of the open letter for a new strategy, told Newsroom that the Government's goal of "no excess deaths" is both unambitious and unlikely to be achieved under current settings.
"'No excess deaths' would be a decidedly underwhelming ambition for New Zealand, considering the outstanding achievements of earlier phases of the pandemic. But even that low-level aim is going to be difficult to deliver given how infectious the SARS-CoV-2 virus has become, with the potential to cause a large number of infections and reinfections."
Others agree. Dion O'Neale is a lecturer at the University of Auckland and is the co-lead of Covid Modelling Aotearoa. He said the Orange setting won't get us to Hipkins' goal.
"It's doing more than if we didn't have it. I guess you could say that. But it's not going to do anything like get deaths down towards zero."
In his statement, Hipkins didn't answer Newsroom's questions about whether the Government's current approach was likely to lead to no excess deaths.
"The hard work and sacrifices of New Zealanders supported the Government’s strategy and delivered the lowest numbers of cases and deaths in the OECD, and of course our aim remains to minimise deaths from Covid-19," he said instead.
No strategy
The key problem in Kvalsvig's view is that the Government appears to have no strategy for Covid-19 at all. The move from the alert level system to the traffic lights already weakened the country's toolkit. When almost everything other than masks (at Orange and Red) and gathering caps (at Red) was stripped out of the traffic light system in March, that left the Government with little more than vaccinations to slow the spread of the virus.
"It’s hard to say exactly what New Zealand’s strategy is right now, what the key aims are, and how we’ll know if it’s working. We’ve not had clear communication to the New Zealand public about strategy since late 2021 and it’s become even more opaque since the Omicron outbreak arrived," Kvalsvig said.
"Instead of a strategy, the post-elimination focus was on vaccination which isn’t a strategy, it’s a control measure. That might seem like a pedantic distinction, but if all you have to offer is vaccines and the virus is mutating to evade them, and vaccination rates are static, where do you go? A strategy is amongst other things a way of coordinating a wide array of policies and protections so that you don’t have all your pandemic control eggs in one basket."
When asked how he would describe New Zealand's current Covid-19 strategy, Hipkins effectively said it was only vaccination.
"The strategy focuses on vaccinations as the best protection people can give themselves and their whānau from Covid-19, as well as extra measures such as wearing masks," he said in the written response.
"The ongoing management of the response is important for ensuring we protect vulnerable populations, encourage vaccination and promote messages and public health measures that allow people to protect themselves and their loved ones, and includes having isolation measures in place, so people stay home from work or school when they are sick."
Kvalsvig believes this isn't enough.
"From observation the New Zealand Government is making a conscious shift from a public health approach to an individualised one, and from an approach that centred population health to one that is much more politicised and aimed at making popular choices," she said.
"In the past few months that’s led to a situation where New Zealand is trying to solve a massive public health threat by encouraging people to do their own risk assessments and take action accordingly, with predictably uneven results and with an increasing trend of focusing all of the risk onto children and people with underlying health conditions. The most vulnerable are effectively being excluded from participating in society as they can’t afford the risk of learning, socialising, and working in public spaces when the chance of encountering an infectious person is so high."
O'Neale agreed the Government is making political decisions, though says this is to some extent unavoidable.
"Certainly, the Government's strategy to me looks like one that is balancing multiple different factors and making those difficult political choices. The current strategy is not the strategy that would minimise the number of infections. Absolutely, we could have those lower."
Looking ahead
With the Government failing to take the current level of cases, hospitalisations and deaths seriously, experts have little hope it will be prepared for what's to come.
"Now that the border protections are coming away, we’re likely to see the return of more familiar infectious diseases such as influenza that used to cause acute and delayed deaths each year. We’ve had a two-year reprieve from those conditions, with greatly reduced illness and death," Kvalsvig said.
"But without preventive action those common causes of mortality will very likely be back this year, potentially as soon as this winter. One very concerning possibility is that the effect on New Zealanders’ mortality risk won’t simply be additive - Covid-19 deaths plus deaths from other infections - but multiplicative, with Covid-19 causing underlying conditions that in turn make people vulnerable to other infections - and vice versa - so all of these airborne infections, if allowed to spread by the removal of Covid protections, could potentially amplify one another."
We know that the pandemic isn't over. The current period of stabilised cases - even with a weekly death toll that exceeds anything seen in the past decade - is actually a period of reprieve compared to what's to come.
Hipkins insists the Government knows this and is trying to communicate that warning.
"The pandemic is not over. We can’t take our foot off the pedal as we head into winter," he said.
"Public campaigns have played a vital role as part of a sustained and wide effort to communicate good health behaviour and measures. These have been incredibly successful and they will continue. As with any sustained communications strategy, the public can tune out over time, but we remain committed to the challenge of effectively promoting public awareness of Covid-19 and good public health behaviour."
But that message isn't filtering through to the public, the signatories of the open letter worry.
"I think the public perception is that you get it once, it's a one and done type situation, it's mostly going to be mild and then you'll be over it and once we're through this wave, the country will be over it and go back to normal," Ward told Newsroom.
"Looking at what's happened around the world and knowing about reinfections and waning immunity, I don't think that's the reality. It seems to me that we've got this sort of parochial exceptionalism about what's happening overseas - some countries are on their fourth, fifth, sixth waves - and it almost feels like there's a public sentiment that it's not going to happen here. Or at least there's no expression of fear that it's going to happen here."
Covid-19 is here to stay. That doesn't mean we can forget about it. If it does become endemic - reaching a natural equilibrium without excessive outbreaks - it could still be deeply harmful. Smallpox was endemic, too. It also killed millions of people every year.
The Government's current approach to Covid-19 is purely wishful thinking - that if it looks away, then the virus won't spread. So the Government has looked away, but Covid-19 is still spreading.
If we keep ignoring it, then its next resurgence will be much worse than it has to be.
