More than 1300 of New Zealand’s total 3645 virus-attributed deaths occurred last year - nearly four times the number of lives lost on our roads – while around 12,000 people were treated in hospital. Photo / WHO
Covid-19 claimed roughly four times as many Kiwi lives as were lost on our roads in 2023. What does another year of living with the virus mean? Science reporter Jamie Morton looks at four key questions.
Last April, Professor Michael Baker offered the rather bleak prediction that some 1000 Kiwis could die from Covid-19 in 2023, while 10,000 could be hospitalised with the virus.
The Otago University epidemiologist’s estimate was, ultimately, an undercount.
More than 1300 of New Zealand’s total 3645 virus-attributed deaths occurred last year - nearly four times the number of lives lost on our roads – while around 12,000 people were treated in hospital.
This will be New Zealand’s third year of the virus spreading freely in our communities, with most Kiwis now having had both multiple vaccinations and Covid-19 itself.
Baker said fewer deaths might be expected this year, if only because widespread transmission had reduced the pool of at-risk people.
“Mortality has been displaced or brought forward by exposure to this virus, and it means that many frail elderly people have died already and that vulnerable population has got smaller,” he said.
“That’s obviously not a good thing: it means less time with your grandparents, or your parents.
“It also means that life expectancy might drop in New Zealand, as Covid continues to reduce lifespans. We haven’t seen that happen here yet, but we have around the world.”
The scale of our current fifth wave – likely to cause hundreds more hospitalisations and thousands more infections before the end of summer - had caused him to reassess what might play out in 2024.
“This wave appears to have been more intense than our fourth, around last April, which makes me think that maybe last year is what things will look like in the future.”
Public Health Agency deputy-director general Dr Andrew Old said picking the timing, size and duration of future waves was difficult.
“However, we expect waves to be of a similar magnitude and frequency to those in 2023, with two to three waves throughout the year depending on a range of factors, such as the emergence of new variants and uptake of vaccinations.”
Baker pointed to the fact that a highly mutated new subvariant – JN.1 – emerged at a time a wave was already building on the back of waning population immunity last year.
“It’s been an interesting wave, because it’s the first time we’ve seen a single variant sweep through and take over since BA.5 back in July 2022,” said Covid-19 modeller Professor Michael Plank, who expected it’d take weeks longer for the wave to subside.
“What’s likely to happen now is that we’ll see a whole load of off-shoots from JN.1, and we might get another soup of variants before another evolutionary leap at some point in the next year.”
The latest generation of Covid-19 boosters, targeting the XBB1.5 variant that’s been widespread here for months, is already being used in Australia, the United States and the United Kingdom.
Yet it’s not likely to be rolled out here until later this year, ahead of the winter season.
“We understand people are interested in who will have access to the Covid-19 XBB.1.5 vaccine when it’s available,” Pharmac pharmaceuticals director Geraldine MacGibbon said.
“There are no changes to eligibility at present.”
The latest wave has brought a five to six-fold jump in people seeking boosters, which are freely available to everyone aged over 30, and those aged 16 and over who were pregnant, and those aged 12 to 29 who were at higher risk of severe illness.
Immunisation Advisory Centre medical director Dr Nikki Turner said that, while the US continued to offer boosters population-wide, other Western countries were taking a more targeted approach.
“After you’ve been vaccinated, immunity does wane – but it does wane quicker for [protection against] mild disease than for severe disease,” she said.
“So, if you’ve had a booster, you’re still well protected for at least six months against severe disease and ending up in hospital.”
As Covid-19 hadn’t yet fallen into a seasonal pattern like other respiratory diseases, Turner said the current strategy remained focused on recommending boosting for at-risk people every six months.
“There are huge rates of Covid-19 around at the moment, so if you’re at high risk, you shouldn’t be delaying and waiting for the next vaccine because the current one is still working well.”
Baker said that, while Covid-19 deaths might be falling over time, “the bad news is this virus has a very high burden of disability that appears to be long term for some people”.
“We don’t yet have the data to show how big this impact is, but it’s looking large.”
As at last month, more than 2000 people had registered as having Long Covid, with another 1200 having signed up to join New Zealand’s official registry – but that was likely just the tip of the iceberg.
A constellation of persisting symptoms thought to accompany 10 to 20 per cent of infections, Long Covid is known to affect nearly every organ system in our bodies – and there remains no universally established treatment or cure.
That’s despite efforts by scientists around the world to unravel its root causes.
University of Auckland immunologist Dr Anna Brooks said the current wave meant New Zealand was in one of its highest risk periods for Long Covid.
“There are a lot of people getting infected right now, and what we do know is that every single infection carries a risk of going on to Long Covid, and that repeated infections can increase your risk,” she said.
“As far as telling what the burden is, that’s going to be very difficult without wide-scale data collection on this.”
Brooks remained concerned that New Zealand still didn’t have adequate clinical pathways in place to manage Long Covid, and wanted to see more communication from health authorities about the risk.
“If you just look at [what] Victoria Health in Australia is doing here, that’s what we need: their video on Long Covid Awareness received over a million views globally.”
The Ministry of Health’s chief allied health professions officer, Martin Chadwick, said the ministry had released guidelines for health professionals, individuals and people caring for those with Long Covid, along with clinical codes.
“The clinical codes will allow for classification of an individual’s diagnosis and over time this will allow us to build a clearer picture of the impact of the condition in New Zealand,” Chadwick said.
“The Ministry of Health expects to begin reporting on Long Covid conditions in 2024, once there is regular use of the code allowing this information to be tracked.”
A year and a half ago, Wellington urgent care physician Dr Kelvin Ward and 150 experts called for a national plan that didn’t rely on vaccines alone to manage Covid-19.
Today, there are even fewer measures in place than then, yet the virus hasn’t gone anywhere.
“In my 20-plus years of urgent care experience, 2023 was the busiest year for respiratory illness both total volume and percentage of overall presentations,” Ward said.
Respiratory infections consistently accounted for 35 to 40 per cent of daily presentations over winter and spring.
“For the first 10 days of 2024, 24 per cent of presentations have been for respiratory illness - and this is mid-summer.”
Ward said it was short-sighted to assume we could continue to accept repeated reinfections without significantly adding to the health burden.
“It’s pretty simple, we need to get serious about reducing transmission until there is a valid exit strategy like a sterilising vaccine.”
Otago University epidemiologist Associate Professor Amanda Kvalsvig said a logical first step was to focus on schools and workplaces, with measures like better air quality.
“With healthy environments in work and education, sickness rates should show a rapid and measurable improvement,” she said.
“This is an arena where New Zealand as a small, agile country can show international leadership.”
Presently, Old said New Zealand’s approach to Covid-19 was similar to the UK, US and Australia, with the virus being managed alongside other respiratory diseases, rather than having a separate focus.
Mask mandates in some settings had been replaced by guidance and recommendations, or by health and safety policies in places like hospitals and aged care facilities.
“As certain aspects of the national response are due to end soon, such as free RAT tests and masks, it will remain important to ensure that there is still a targeted response to help protect vulnerable and at-risk populations,” Old said.
“As the virus continues to evolve, we also monitor for new variants of the virus, using wastewater and whole genome sequencing.”
Like his fellow experts, however, Baker feared New Zealand had simply resigned itself to shouldering a burden of ongoing reinfections, death and long-term disability.
“If we think about the road toll, it peaked at more than 800 in the early 1970s before people began to think, actually, that’s not acceptable, and then started to systematically reduce it,” Baker said.
“While the risk of Covid is probably now over-lapping with flu, the danger is that we’ve moved onto this road of complacency and decided it’s just something to put up with.”
Jamie Morton is a specialist in science and environmental reporting. He joined the Herald in 2011 and writes about everything from conservation and climate change to natural hazards and new technology.
The new free open-air saltwater pool is already proving popular.