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The daily, grinding tragedy of Covid-19

By unilaterally disarming in the fight against the coronavirus, the Government is exposing New Zealanders to the very serious ongoing health burden of Covid-19, Marc Daalder writes

Analysis:The de facto end of the Covid-19 response lacked the gravitas we’ve come to expect from Jacinda Ardern.

Since the start of the pandemic, the Prime Minister has become famous for her sober, moving speeches on the challenges Covid-19 has posed. Her addresses on the alert level system and the eve of the first lockdown were seen by hundreds of thousands of New Zealanders. She introduced the concept of the team of five million, of the bubble and of so many other recognizable tropes to the public.

On paper, Ardern’s speech on Monday was a victory lap.

“Today, 927 days into this pandemic, we’ve reached a major milestone in our journey with Covid-19. Today, Cabinet has determined that, based on public health advice, we are able to remove the traffic light system – and with that decision, claim back the certainty we have all lost over the last three years,” she began.

Despite the optimistic language, the sermon was delivered halfheartedly.

Maybe it was because so much of the country (and the Press Gallery) appears to have moved on from Covid-19.

Perhaps it was overshadowed by the death of the Queen, restricting how celebratory Ardern could seem.

Maybe it was tempered by the realization that a large minority of the population remains concerned about the pandemic – including some of Ardern’s most loyal constituents.

It certainly didn’t have the sense of triumph one would expect from an address effectively announcing the end of two and a half years of Covid-19 restrictions.

And the announcement was qualified by Ardern’s repeated reiterations that the Government was ready and willing to reinstate mask requirements if the situation required it.

That promise rang hollow, given the scrapping of the traffic light system and therefore any formal mechanism for reintroducing protective measures.

No risk signal

We’ve already seen this song and dance around a range of other measures which were removed from the traffic light system in March with a pledge that they would still be considered if necessitated in the future. When BA.5 reared its head in July, the Government found itself lacking the political will and social license to pull from that toolbox.

In the absence of extra protective measures, case numbers spiked, particularly in older age groups. The weekly all-cause mortality record in New Zealand was broken twice during the BA.5 wave.

The importance of a framework for ratcheting up public health measures was clearly identified by then-Covid-19 Response Minister Chris Hipkins in a late March Cabinet paper.

“I don’t recommend removing the [traffic light] Framework altogether at this stage. It enables quick decisions to shift up Framework colors and scale up restrictions as needed,” he wrote.

“The Framework also plays an important role in signaling the level of risk around Covid-19 that New Zealanders can use in making their own day-to-day decisions about management. Uncertainty about what kind of response any new variants or future Omicron waves might require means that agility within the Covid-19 toolkit is needed in future.”

Now that signal is gone.

With case numbers at their lowest levels in seven months, most agree that we can loosen our protections somewhat. But the lack of any mechanism for returning them when the next wave hits has experts concerned.

“New Zealanders are being promised a Covid-free summer, but that lovely outcome is not in the power of any government to promise. We have a high level of certainty that new variants will appear with capability to evade immunity from infection or vaccines. We don’t know when they will appear or how serious they’ll be,” University of Otago epidemiologist Amanda Kvalsvig said on Monday.

“A far more reassuring message would be for the NZ Government to demonstrate that it’s aware of the challenges and is actively preparing for both expected and unexpected threats to public health. That reassurance would include a much more realistic and absolutely achievable aim of having systems in place to ensure that people can enjoy summer even if it coincides with the arrival of the next variant outbreak.”

Emily Harvey, the co-lead of the Contagion Network modeling program at Covid-19 Modeling Aotearoa, said case numbers now are not only the lowest since the start of the year but also probably the lowest we’ll see in the next year. In other words, this break from the Covid-19 onslaught probably won’t last.

“It makes sense at this time to shift from a reactive, emergency response phase into a phase with transmission reduction policies that are sustainable long term. We have the opportunity to invest in making systematic changes that will make future Covid-19 waves smaller, as well as reducing the rates of other respiratory infectious diseases like influenza and RSV,” she said.

The daily tragedy of Covid-19

Both experts said the decision to remove masks from public spaces without first investing in improvements to air quality was premature. We can move to a new normal where masks are less prevalent, but only when we have better systems for removing the virus from the air – either by ventilation or filtration – in the event of a future surge. And slashing requirements for household contacts to isolate now puts the people most likely to be infectious with Covid-19 back in the community.

“Removing masks before we have made indoor settings safer by improving ventilation and air cleaning, just because case numbers are low now, is like removing the tarpaulin over the leaky roof, just because it is not raining now, rather than waiting until the roof has been repaired,” Harvey said.

The consequence is that healthy young people will feel free to return to a pre-Covid lifestyle, while many older, disabled and immunocompromised New Zealanders will find their freedoms restricted.

“Without safe access to public spaces many disabled people will have to make choices no-one should have to make, between a lockdown – but this time, a private one with no endpoint – or taking on the risk of a life-changing or life -limiting infection,” Kvalsvig said.

Harvey agreed: “Removing mask requirements before making indoor spaces safer means that members of our community who have health conditions that put them at higher risk, are now not able to participate in society, or even go to the supermarket, safely.”

This was the Government’s other lesson from the BA.5 wave – that it could abandon the vulnerable and get away with it. Public health experts and disability advocates pressured the Government to put in place new protections, but it didn’t.

More New Zealanders were killed by BA.5 in a few weeks than die on our roads in an average year, but no one really noticed or cared. Tragedies like the capsized boat in KaikĊura get headlines, but the daily, grinding tragedy of Covid-19 flies under the radar.

Individually, for the families of those who died and for the many thousands more left with Long Covid and for the many tens of thousands more who suffered from illness, the consequences of Government inaction during the BA.5 wave were serious.

Politically, the consequences were palatable.

The BA.5 experience shows the Government is unlikely to reintroduce mask rules in the event of a future wave, so long as the public continues to view Covid-19 as little more than a bad flu. That view will only be reinforced as the daily reporting of Covid-19 case numbers, hospitalizations and deaths moves to a weekly one and the toll of the virus fades out of sight.

We can expect to see a steady further erosion of Covid-19 protections as Ardern’s stated quest for a “new normal” looks more and more like a journey back to the old normal.

We actively manage several serious diseases. Tuberculosis cases, for example, are required to isolate at home. But the Government has taken heed of commentators’ views that Covid-19 should instead be treated like the flu, which is not managed actively outside the health system.

Of course, Covid-19 is much worse than a bad flu. In six months, it has killed four times more people than the flu does in an average year.

It also leaves a sizeable proportion of patients with chronic conditions that can be debilitating.

In the United Kingdom, one in every 50 adults reports Long Covid symptoms are affecting their daily lives.

In Australia, an estimated 31,000 people are unable to work each day due to Long Covid, costing the economy some three million working days since the start of the year, according to a Treasury report.

No similar research has yet been undertaken in New Zealand. Finance Minister Grant Robertson said previously he didn’t think Long Covid was an issue for Treasury to examine.

No one disagrees that we must figure out how to manage endemic Covid-19 sustainably. But that management must be sustainable from a health perspective as well as an economic one. Simply ignoring the very real toll of failing to control Covid-19 transmission isn’t sustainable either.

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