Last year, Covid-19 was attributed to 664 reported deaths – its ongoing toll now stands at more than 4500 – along with more than 9000 hospitalisations.
Last year, Covid-19 was attributed to 664 reported deaths – its ongoing toll now stands at more than 4500 – along with more than 9000 hospitalisations.
More than 2.7 million confirmed national cases of Covid-19 have been logged since our very first was announced on February 28, 2020.
While Covid-19 is killing and hospitalising fewer Kiwis than in 2022, it remains our most impactful infectious disease, ‘well ahead’ of influenza.
Experts tell Jamie Morton how New Zealand still isn’t doing enough to tackle the compounding health problem that is Long Covid - and question whether we’re ready for the next catastrophe
What does the ongoing burden of Covid-19 look like?
Covid case number one – a traveller fresh off the plane from Tehran, via Bali – brought the country to a standstill when the news broke on February 28, 2020.
Five years later, few of us would have batted an eyelid as officials logged confirmed case number 2,719,346.
Our collective perception of the coronavirus has shifted from an emergency public health threat to another viral nasty we must all now live with.
Auckland's Queen Street on March 26, 2020 - the first day of Level 4 lockdown, just over five years ago. Photo / Brett Phibbs
But having grown more familiar with it hasn’t removed the burden it continues to have in our homes and hospitals.
Last year, Covid-19 was attributed to 664 reported deaths – its ongoing toll now stands at more than 4500, and more than 9000 hospitalisations.
Those rates have been falling over time: 2024’s total deaths and hospitalisations were 76% and 60% lower than those recorded throughout 2022’s national tsunami of infections.
Still, Otago University epidemiologist Professor Michael Baker said, the coronavirus remained “well ahead” of influenza as our most impactful infectious disease.
University of Otago epidemiologist Professor Michael Baker.
Our most vulnerable – from low-income families to our elderly and those with underlying chronic illnesses - were still being hit hardest.
And each week, Kiwis were getting sick with the virus when basic measures such as free tests might have prevented it, Baker said.
“People are also going to hospital where they are catching Covid-19 - and are sometimes becoming very ill and dying as a result.”
Will scientists ever get to the root of Long Covid?
If the pandemic is likely to leave one legacy above all, that might well prove the quietly compounding health problem that is Long Covid.
It’s known to affect nearly every organ system in our bodies, leaving its previously healthy sufferers with ruined lives and livelihoods.
Several cohort studies have suggested its constellation of lingering symptoms can accompany 4% to 14% of infections, while analyses have placed its annual economic toll for New Zealand as high as $2 billion.
Yet scientists remain troublingly far from fully unravelling its root causes.
Fundamental questions remain unanswered: why do some develop it while others don’t?
What’s the deciding factor that causes chronic illness instead of recovery?
“Despite extensive research documenting multi-system disruption, the core mechanisms remain elusive,” University of Auckland immunologist and Long Covid researcher Dr Anna Brooks said.
“Understanding these will be the gateway to improving prevention strategies and developing targeted treatments.”
While multiple infections raised the risk of health impacts, she pointed out that severe, life-altering symptoms could occur after a single infection.
“The long-term health effects are still unfolding.”
Brooks said the condition’s emergence had brought into sharper focus the strongly linked – and long-neglected - Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.
University of Auckland immunologist Dr Anna Brooks.
In 2023, researchers launched a Long Covid Registry to build a clearer picture of its impact in New Zealand and recently made two dozen recommendations to better address the issue.
But advocates like Brooks remain worried that we’re still not tracking and measuring Long Covid – nor are we doing enough to safeguard people or support those now suffering it.
“Mitigations, prevention, and vaccinations all play their role, but until we sink efforts into the common thread - that many infections are capable of health harms - we are no better prepared than we were in 2020,” Brooks said.
“The lack of adequate funding for urgent, targeted research, coupled with insufficient support for those affected, is deeply alarming.
“We could be so much closer to solutions, to improvements in lives, to prevention of increasing burden.
“This isn’t just a medical issue; it’s a societal one that demands urgent attention and resources.”
Will Covid-19 go seasonal?
If you’ve become used to hearing more about Covid-19 every six months, rather than each winter as we do with influenza, it’s because it’s followed a very different pattern.
Of seven waves over the past three years, just three have coincided with the normal winter flu season.
Our roughly six-monthly flare-ups have been driven more by the emergence of new Omicron offshoots – from early 2022’s BA.2 to last winter’s so-called “FLiRT” variants – meeting waned population immunity.
Covid-19 modeller Professor Michael Plank said the virus continued to evolve, but the impact of new variants appeared to have lessened over time.
“This suggests that the virus has picked most of the low hanging evolutionary fruit, and it’s getting harder for it to find mutations that enable it to rapidly infect or reinfect a lot of people.”
Because Covid-19 was intrinsically more transmissible than influenza, he suspected it might continue to be more of a “year-round virus” with less of a marked difference between winter and summer.
“On the other hand, if we do get a winter wave without a notable new variant, it could indicate that the virus is settling into a more seasonal pattern,” he said.
“The nature of the long-term annual pattern, and whether we will get another major new variant, is probably one of the biggest unknowns.”
Since the Omicron variant emerged in late 2021, helping bring the pandemic’s crisis period to an end, it’s sprouted more than 300 lineages – the latest being KP.3.
Omicron variant KP.3 - denoted in light purple - currently makes up a third of sequenced Covid-19 cases. Source / ESR
Each has packed mutations that help the virus to evade our immunity and spread faster, but they’ve also lacked the severity that made predecessors like Delta so deadly.
For virologists like the University of Otago’s Professor Jemma Geoghegan, the biggest question remains whether the virus will take another dramatic evolutionary leap, potentially up-ending much of the immunity we’ve built to it so far.
“Omicron subvariants are clearly getting better and better at infecting us and transmitting between us, even with our increased immune protection from past infections and vaccines,” she said.
“For a dramatic shift to occur away from Omicron at this stage, I think it would be possible if another zoonosis [animal spill-over] event occurred, similar to when new subtypes of influenza virus emerge.”
With time, Geoghegan said, we might also start seeing Covid-19’s pattern of infection change.
“This will likely have evolutionary consequences, because we might see fewer changes in subvariant types throughout the year, with fewer infections in summer months.”
Yet, with the United States having already moved to a newer formulation aimed at KP.3, we again find ourselves lagging other countries.
Did that matter?
Given how closely related the two targeted variants are, there wasn’t likely to be a huge difference between the two vaccines’ effectiveness.
University of Auckland vaccinologist Associate Professor Helen Petousis-Harris said the more important measure was between getting the Covid-19 vaccine – which roughly halved the risk of severe disease – or not.
By now, most Kiwis would have a degree of “hybrid immunity” built up from prior vaccination and infection, providing stronger and broader protection against severe sickness than they would have had in 2022.
Last month, New Zealand began rolling out an updated Pfizer vaccine - freely available to everyone over 30 - targeting the JN.1 strain.
But Petousis-Harris pointed out that protection from the vaccine still waned over six months and immunocompromised people continued to be at higher risk.
“Getting the latest booster before the virus season hits will substantially reduce your chances of a bad Covid-19 infection.”
The vaccine was especially recommended for those aged 65 and older; Māori and Pacific people aged 50; severely immunocompromised people; and those aged 12 and over who have a medical condition putting them at risk of severe illness from Covid-19.
Just beyond the horizon lay new classes of vaccines, such as self-amplifying mRNA shots and nasal sprays, with the potential to target a broader range of variants for longer.
But that was coming amid experts’ concerns about rising vaccine hesitancy – and troubling new moves in the US to ban or restrict mRNA vaccines, despite being considered safe and effective by world health regulators.
Having claimed more than seven million lives, the pandemic takes its grim place as humankind’s fifth deadliest.
Baker thought it a positive that the experience had “fundamentally” changed our knowledge and approach to pandemic diseases and respiratory infections.
When Covid-19 hit, New Zealand’s hospitals lacked training, equipment, and capacity, while our flu-focused pandemic plan was quickly found unfit for purpose – as were our leadership structures.
“We now have the tools to potentially exclude severe new pandemics at our borders for a period of time, while we obtain vaccines and refine other prevention measures,” Baker said.
“We know that masks are effective, even if [people] don’t always wear them in high-risk settings like public transport and healthcare facilities.”
The pandemic has driven science advances across multiple areas, from vaccine development and disease modelling to whole genome sequencing and wastewater testing.
But even as the next global crisis could lie just around the corner – there are concerns H5N1 bird flu may be silently spreading among humans – experts fear the world has sunk back into complacency.
In one recent paper published in the New Zealand Medical Journal, leading figures Sir Ashley Bloomfield and Professor David Murdoch described a sense of “collective global amnesia”.
They warned global investment in prevention, preparedness, and response was “nowhere near the scale or speed necessary” to deal with the next “inevitable” event.
“The risk is that we are falling into what has been dubbed ‘the cycle of panic and neglect’.”
Former Director-General of Health Sir Ashley Bloomfield. Photo / Getty Images
At home, the Ministry of Health recently updated the country’s pandemic plan, while some other agencies were moving ahead with implementing recommendations from the Royal Commission of Inquiry’s first report.
Bloomfield and Murdoch set out their own, such as considering pandemics as security threats, and updating plans every year, with exercises to run officials through different scenarios.
Earlier, infectious diseases research platform Te Niwha released a report pinpointing what would be critical for a successful response: namely building more capacity in areas like surveillance, testing, and vaccines.
And Baker and Otago University colleagues have called for a new centre for disease control, along with an agreement with Australia that would lock in shared pandemic supplies and protocols for safe transtasman trade and travel.
With multiple assessments pointing to a rising risk of pandemic, Baker saw no benefit in delaying such work.
“Pandemics are like earthquakes – they can come at any moment, you can’t predict exactly where and when – so we do have to be constantly prepared."
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.
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