OPINION:
"We should be doing what New Zealand is doing" I told my husband in the early days of the worldwide Covid-19 pandemic.
New Zealand was coming out of a successful lockdown, and I had just received an email pitch recruiting me to take a job as a forensic pathologist in the capital city.
From my vantage point from the autopsy suite of a California coroner's morgue in May 2020, I could already see that New Zealand's response was far superior to what was happening — or, really, what was not happening — in the United States.
A forensic pathologist is a doctor who examines, among other things, diseases and injuries that stop people in their tracks and prevent them from getting to the hospital for diagnosis and treatment. And Covid doesn't only kill patients in the hospital, after weeks of ICU care. It also kills suddenly and unexpectedly.
The SARS-CoV-2 virus has a predilection to attack endothelial cells, the pavers of the blood vessel highways that feed all your organs. In the same way that damaged roads cause traffic backups and crashes, damaged endothelial cells cause blood clots, which then cause strokes and heart attacks.
We've always known that Covid-19 attacks the lungs and heart, but we're now also learning that the virus targeting blood vessels is causing long-term, irreversible damage to the whole body.
Pathologists like me see it as blood clots and fatal damage in the organs of patients who have died after having recovered from Covid. When we put their brain tissue under the microscope, we find inflammatory cells surrounding blood vessels, and the dead nerve cells that result.
There are sickly pale white scars in the heart muscle, which interrupt signal delivery in its electrical system. In the lungs, tissue that should be empty spaces ready to fill with air are incompletely repaired.
A recent Nature study of the brains of people with "mild" Covid show visible radiologic changes long after they have recovered from the disease's outward symptoms. Covid may cause permanent damage.
Up until a few weeks ago, I was seeing few deaths in Wellington from the novel coronavirus. I credit the government's successful public health strategy to stop it at the borders, and our "Swiss cheese" model of layered protections: lockdowns, managed isolation, testing, and contact tracing.
I also credit the remarkable dedication I have seen from Kiwis in wanting to protect each other — not just themselves, but the entire community — from the spread of infection.
When the Delta variant of Covid-19 finally infiltrated our defences in late 2021, New Zealand was already highly vaccinated, and public masking and vaccine passport mandates were in place. The per capita death rate has remained extremely low compared to other countries, despite the spike in infections and hospitalisations with the ongoing Omicron wave. New Zealand's response as of a few months ago was still being hailed as one of the best in the world.
However, excess death data is already showing us that overall mortality has been increasing in countries with rampant spread of Covid-19, and with the reopening of the New Zealand borders to tourism in July we will be inviting in new variants, more virulent and more capable of evading our vaccine protection, that have evolved elsewhere.
There is also data emerging that Covid damage to the brain causes cognitive decline, and that the harm Covid does to the cardiovascular system increases risk of sudden death from strokes and heart attacks within a year of a patient's infection.
It's still unclear what the consequences of repeated infections will be. What does this mean to us at a time when global travel is set to reopen?
I don't know — so I'm doing everything I can personally to limit repeated exposure to this virus. I am vaccinated and double boosted, and I have vaccinated my children. I'm masking up. I only use N95 masks and I haven't eaten indoors with strangers in months, getting takeaway or patronising restaurants with outdoor seating, no matter how cold it gets. I avoid travel as much as possible and limit my interactions to a small bubble of family, friends, and work colleagues.
Is there anything else we, collectively, could be doing? Here's what this doctor who investigates death would like to see happen to keep everyone safe as borders reopen:
• Masking with N95 or KN95 masks, the standard used in hospitals. These are much more effective against new Covid variants than standard surgical or cloth masks are. I'd like to see proper fit-test training and free distribution of these masks in schools and crowded indoor venues.
• Improved, monitored ventilation in schools and businesses, and government guidelines to set air exchange standards that might allow us to go mask-free indoors with less risk.
• Encourage and facilitate outdoor dining and activities.
• Continued education through public health campaigns — and yes, even the 1pm conferences — to counteract misinformation campaigns.
• Getting everyone boosted, and having a system in place to continue updating our vaccines to combat emerging variants, and to maintain a steady stream of anti-viral medicines.
New Zealand must stay resilient and nimble ahead of the coronavirus — because this virus is still evolving. If we succeed, we can be healthy and make sure the next generation of Kiwis avoid excess death and lifelong disability.
We have the invaluable advantage of a tight-knit, caring culture. My neighbours, friends, and colleagues in this country have taught me about manaakitanga: that we care for one another. Two years on, I am trying to practice manaakitanga, and am proud to see it in action.
Dr. Judy Melinek is an American forensic pathologist and the CEO of PathologyExpert Inc. She is currently working as a contract pathologist in Wellington, New Zealand. She is the co-author with her husband, writer T.J. Mitchell, of the New York Times bestselling memoir Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner, and two novels, First Cut and Aftershock, in the Jessie Teska forensic detective series. You can follow her on Twitter @drjudymelinek and Facebook/DrJudyMelinekMD.
