Shane Reti: Are Covid deaths the sole measure of pandemic effectiveness?

Does the fact we have had 53 deaths really reflect the breadth of the impact of Covid? Photo / Getty Images

FROM PARLIAMENT

With the impending two-year anniversary of Covid in New Zealand, people are reflecting on our Covid performance over the past two years.

An often quoted measure is the fact that to date we have had 53 deaths over two years. On a per capita basis, even though every death is a tragedy, the stand-alone figure is good compared to other countries. A question to ask, then, is whether this figure covers the breadth of the impact of Covid. I would say it does not.

A recent article in the British Medical Journal observes that "Missed care for conditions such as diabetes, cardiovascular disease, cancer, and mental health, for example, has short- and long-term implications for morbidity and mortality. Measuring the pandemic's effects only in terms of deaths due to Covid-19 fails to accommodate these important outcomes". The same article proposes that instead of Covid deaths, "excess deaths", (deaths above what was expected) are a better measure.

One particularly time-sensitive measure is cancer management during Covid. The WHO recently reported its Global Pulse Survey assessing the continuity of essential services during Covid. The commentary especially noted cancer, observing that in the early stages of the alpha strain pandemic in 2020 the diagnosis of cancer fell by 44 per cent in Belgium and 34 per cent in Spain. Screening for bowel cancer fell by 46 per cent in Italy.
How does NZ compare?

I will first preface that there are always challenges comparing apples with apples for health measures across countries, but New Zealand's cancer control agency Te Aho o Te Kahu reported in April 2020 that cancer registrations in New Zealand had fallen by 47 per cent, diagnostic gastroenterology endoscopy (bowel telescope) and diagnostic bronchoscopy (lung telescope) had fallen a stunning 79 per cent and 75 per cent respectively. Diagnostic services particularly took a hammering. This is the raw price of lockdowns, social distancing and an underprepared health system.

The last Te Aho cancer report in 2020 concluded the alpha strain pandemic and in October showed that mostly surgery, diagnosis and the treatment of cancer had caught up over the year. This is a good thing, although bronchoscopy for Maori did remain an outlier of some concern.

What these figures don't show, however, is a wider range of medical and social impacts. For example, in how many people was a cancer diagnosis delayed, resulting in more aggressive treatment or a shortened life? How do we assess the mental health impacts around worrying for delayed surgery, endoscopy or specialist assessment ?

The Delta outbreak in August 2021 again put cancer management under stress. Even though the Delta outbreak some 15 months later was not as severe on cancer management as the 2020 Alpha outbreak, it was still significant, with Te Aho reporting August 2021 figures showing a nine per cent decrease in cancer registration and again diagnostic services particularly impacted with GI endoscopy down 34 per cent and bronchoscopy down 44 per cent.

In conclusion, the Covid death rate per capita for New Zealand to date compares favourably with other countries but many other measures need to be taken into account before we do a victory lap. These other measures may better take into account the broad effect of lockdowns, social distancing and an underprepared health system.