Analysis: New Zealand has never seen anything like the wave of Covid-19 that is barrelling towards us.
For the two years after the first person tested positive in New Zealand, we have kept deaths, hospitalisations and mass disabling Long Covid at bay. New Zealand enjoys not only some of the best health and mortality statistics in the developed world, but also some of the best economic figures as a result of 18 months of successful elimination.
By eliminating and then vaccinating, we have skipped the most acute stage of the pandemic. Our excess mortality for the past two years is negative – 2500 fewer people have died since January 2020 than would be expected pre-pandemic. If we had the death rates of the United States, we would instead have nearly 20,000 extra deaths.
But elimination is over now. Our vaccine rollout is mostly complete and the booster rollout is rapidly catching up. With the hyper-transmissible and immune-evading Omicron, we’re now entering a new phase of the pandemic.
The Omicron wave brings its own risks, including threats to swamp the healthcare system, the ability to inflict high death counts for a short period of time, the slight chance of debilitating long-term effects, including for vaccinated adults and unvaccinated children, and a psychological toll for a country used to thinking of the pandemic as something that was happening elsewhere.
Pandemic fatigue
We’re adjusting easily – maybe too easily. Each day’s record-high case count shocks us at 1pm. But by the next day, that milestone seems puny compared to the new record figure.
There are now more people in hospital with Covid-19 than at any previous phase of the pandemic and that number continues to skyrocket each day. There’s still no sign that people are tapering down risky behaviour as happened during the lockdowns of 2020 and 2021, with ambulance callouts and emergency department visits unusually high for this time of year.
In Auckland, the epicentre of the outbreak where more than one in 93 people are currently an active Covid-19 case, visits to retail, hospitality and recreation spots have returned to pre-pandemic levels. Across New Zealand, retail and recreation activity is up 2 percent on January 2020’s baseline.
There’s a sense of fatigue after two years of pandemic restrictions, of news blaring the latest case numbers or highlighting the newest variant, of arguments with friends and family about lockdowns and vaccines and mandates. Perhaps understandably, plenty of people are burying their heads in the sand.
People are worried about Omicron, but that is fading even as the virus spreads like wildfire – a recent survey found 66 percent were concerned about the variant, down from 70 percent in late January and 73 percent in December. Less than a quarter of the unvaccinated, who are most at risk from Omicron, say they’re concerned about it.
Among the third of New Zealanders overall who aren’t troubled, fatigue seems to be the guiding reason. Almost 90 percent say they’re not concerned because “the virus will continue to mutate, and we will have to live with it”, followed by 47 percent who are comforted because “the variant is not as deadly as Delta”.
But Omicron still has the potential to sicken New Zealanders, even to kill them. It can weigh on the resources of our already-stretched health system, dragging out response times for ambulances and forcing medical centres to turn away patients. Overseas, Omicron is still killing almost 2000 Americans every single day. That’s the equivalent of the Twin Towers collapsing every other day, and it’s been happening for more than a month.
New Zealand is different from the United States. We can also respond to the virus differently. But an effective response requires first recognising that this is still a potent enemy. It may not be the cataclysmic wild-type virus of 2020, but Omicron still deserves our attention and our focus.
Multiple outbreaks
University of Otago epidemiologist Michael Baker called New Zealand’s outbreak “multi-speed”.
When you sum up all the cases from around New Zealand, our epidemic curve looks like it’s going vertical – the hallmark of an Omicron outbreak.
In reality, that’s just Auckland.
New Zealand is actually undergoing several distinct outbreaks across the country. Every two cases pass the virus on to about five others. Some of these travel to other places, seeding new outbreaks or spurring on existing ones. New Zealand’s outbreaks are interconnected, but they’re still running at different speeds – while places like the West Coast are just getting started, Auckland is about three weeks ahead of everyone else.
To some extent, Auckland will give the rest of New Zealand a hint of what to expect in terms of case numbers and the burden on the health system. Auckland is of course different – it’s more highly vaccinated, for starters, and has dealt with previous outbreaks so has prior experience. But its system is also stretched by those experiences and its people exhausted by them.
Still, roughly, it will be a model for everyone else, Baker said.
“Watching how things go in Auckland will be very helpful for the rest of the country.”
Overall, the majority of projections estimate the national outbreak will peak in mid to late March.
“It’s going to be a shock. We could have several weeks where we’re getting 10 or more deaths a day, and we’re just not used to that,” Baker said.
“That’s our worst day for confirmed cases,” Dion O’Neale, the project lead at COVID Modelling Aotearoa, told Newsroom. “Our biggest day for infections will come about a week before that and we won’t know that. Our worst day for hospitalisations will come after that peak.”
It will likely take at least as long to descend from the peak as it took to meet it, meaning we won’t be in the clear until well into April or even May.
Flattening the curve
While some may be hoping for a rapid return to normality, the best way to protect the health system is to squash the peak and extend the most acute part of the outbreak over a longer period of time.
“You’d rather it happen over three months than one month,” Baker said.
The measures the Government has put in place to do this are limited.
Contact tracing is a thing of the past, with the Ministry of Health announcing on Friday it will no longer post locations of interest. Our tracing system could barely keep up with a couple hundred daily cases – more than 10,000 is far beyond the pale.
The booster rollout is flagging, with fewer than 70 percent of those eligible for a third shot having taken up the opportunity. That was considered “low uptake” in recent modelling from COVID Modelling Aotearoa, the successor to Te Pūnaha Matatini’s modelling division.
All else being equal, the difference between 90 and 70 percent booster uptake could mean 100 extra deaths, 50 percent more people in hospital at the peak of the wave and hundreds of thousands more people being infected.
Mask use will be critical to slowing the spread, but the most highly-effective masks are not widely available. While the Government is undertaking work into making N95 or P2-style respirators free for those who need them, there’s no sign this will be finished in time.
The lack of free and accessible rapid antigen tests will also push people into making overly-reckless decisions.
Baker believes the Government needs to have a backstop option of increased restrictions in its toolbox. We may not need them, but better to be prepared and protect the health system than to be caught off guard.
“We’ve just gone straight to the red zone before we really hit much transmission, so you don’t really have anywhere else to go with that framework,” he said
“Most New Zealanders would like the idea that there is another level you can go to, just temporarily, if you’re actually worried about your collective security and the health system is threatened.”
‘Head in the sand’
Instead, as case numbers have skyrocketed, the only thing the Government has done is repeal restrictions. Under the first phase of the Omicron plan, close contacts had to isolate for 10 days after being exposed to a case. Now, they don’t need to isolate at all.
This is part of an effort to keep businesses operating, but risks unnecessarily spreading the virus and speeding up the pace of the outbreak. It’s not at all consistent with flattening the curve.
The Government is following the general population in burying its head in the sand.
“It really is, we’re going to put our head in the sand a little bit,” O’Neale said.
The Government is comfortable with missing a certain number of cases, believing that on a population level, it can weather the outbreak even if some infectious people don’t isolate. That’s cold comfort for the cases themselves, who might unknowingly spread the virus to loved ones, friends and coworkers.
It’s also, O’Neale said, misguided from an outbreak control perspective.
It may well be that Omicron peaks and subsides without unduly burdening the health system. But what if new restrictions really are needed? By the time we start to see our hospitals buckle, it will be too late to impose new restrictions.
“Anything you do now, you only see the effect of that in your case numbers coming through in one week. It’s a week to two weeks to get through,” O’Neale said.
“If we get three quarters of the way up the peak and decide, actually, we’ve hit the worst we can cope with for our hospitalisations, we’re going to full on lockdown. Well, that’s too bad. You’ve already baked in a week’s worth of infections that you don’t know about yet.”
The Government could get a week ahead if it had a solid estimate of how many infections were being missed for each case found. It could do this through testing random people for Covid-19 to establish a baseline for how prevalent the virus is and then match that up to reported case numbers.
“If you know that, then given some cases, you can estimate your infections and so it’s almost like you gain an extra week’s worth of information. Infections being a leading factor for cases and cases leading hospitalisations. You care about the hospitalisations, that’s what you want to plan for. If you can know that two weeks in advance, rather than just one week, that’s really valuable,” O’Neale said.
Director-General of Health Ashley Bloomfield said on Thursday that determining this figure – called the case ascertainment rate – wasn’t all that important. O’Neale said he had presented the case for a background prevalence survey to the Government on multiple occasions. Prior to Omicron, they had felt it wasn’t useful because there wasn’t much Covid-19 in the community. Now they say it’s too late to set one up.
The Government is playing a game of brinkmanship, where it accelerates the outbreak until it reaches the edge of disaster and then pulls back at the last moment. Without that information, however, what it thinks will be the last moment could end up being a week too late.
