New Zealand Covid-19 resurgence - A timeline of events. Video / NZ Herald
Opinion
OPINION
Thanks to the efforts of Aucklanders and our public health units, the Auckland Covid-19 cluster is contained, showing that the strategy of increasing alert levels when a threat arises works.
It is almost guaranteed that New Zealand will have to stamp out further outbreaks. When the time comes, we will also have to respond to a loud minority of dissenters.
The small group of so-called "Plan B" academics argue for looser restrictions, for allowing community transmission, shielding of older people and the vulnerable, and against lockdowns.
When alert levels rise, it is costly to everyone, and it is superficially appealing to think there might be an easier way forwards.
But Plan B is fundamentally flawed and impracticable; compounding existing health inequities, and carries a high risk of overwhelming hospitals and long-term health consequences.
Six months into the pandemic, Plan B is still hopelessly lacking in detail or modelling for our unique New Zealand situation.
Plan B is built upon the premise that the severity of the virus has been overblown.
Jin Russell. Photo / Supplied
The mortality risk for an infectious disease can be estimated by calculating the infection fatality rate (IFR) – that is, the number of Covid-19 deaths as a proportion of all those infected.
Plan B epidemiologist, Dr Simon Thornley, when interviewed by Jack Tame, cited a single IFR estimate of 0.27 per cent based on a meta-analysis by epidemiologist John Ioannides.
But another meta-analysis by Meyerowitz-Katz and Merone estimated that the IFR is higher - between 0.53 and 0.82 per cent; closer to the WHO's working estimate of 0.5–1.0 per cent.
A difference of half a percentage can mean thousands of lives.
Despite Thornley's claims to the contrary, Professors Michael Baker, Nick Wilson and Rod Jackson told the Australian Associated Press Factchecker that several studies have shown that Covid-19 is substantially more deadly than influenza – seven to 18 times more deadly, depending on which IFR estimate is used.
A good plan would acknowledge the existence of higher IFR estimates, and that more New Zealanders may very well die than Plan B is letting on.
But where Plan B really crumbles, is that it is simply not feasible.
Plan B necessitates that people over 60 years old self-isolate and physically distance.
According to 2018 census data, this would be more than 975,000 New Zealanders staying home indefinitely – one in four NZ Europeans.
Veronica Playle. Photo / Supplied
Shielding loved ones is difficult because our lives are intertwined. For families with older relatives who care for children enabling parents to work, multi-generational households, and families caring for elders, Plan B poses an impossible and dangerous conundrum.
Pacific health researcher Jacinta Fa'alili-Fidow aptly said, "Plan B assumes that our elderly play no role in our country's economy".
Additionally, Plan B requires people with conditions such as diabetes, cardiovascular disease or cancer to self-isolate as they are at increased risk of death from Covid-19. This includes a large number of working age people.
Among 45- to 64-year-olds, one in five Pacific people and one in six Māori have diabetes, compared with one in 20 NZ Europeans, according to a 2013 NZ Medical Journal study.
The numbers are lower, but ethnic patterns similar, for cardiovascular and respiratory diseases.
Asking this many working-age Māori and Pacific people to stay home is incomprehensibly unjust and unworkable.
Māori, Pacific and disadvantaged communities who have a higher burden of comorbidities would be disproportionately impacted, both by shielding and disease. A recent paper by Steyn and colleagues in the NZ Medical Journal estimated that the IFR for Māori would be 50 per cent higher than for non-Māori.
Low paid workers, who may also be essential workers, may not be able to afford to stay home. Public Health England data in September from people under 40 has shown that spread is highest in the most deprived areas.
Many will try to shield, but won't be able to. There will be inequitable hospitalisations and deaths.
Plan B provides scant detail on how our already stretched health system would cope.
A recent paper in the NZ Medical Journal reported that NZ has only four critical care beds per 100,000 people – approximately 200 beds – a very low figure within OECD countries.
Long Covid-19 hospital admissions, averaging two to four weeks, clog up hospitals.
Rapidly increasing beds to meet surge demand requires drastic reconfiguration of health services – makeshift ICU wards, postponing elective surgeries and planned admissions causing delays in treatment, and redeploying staff to care for Covid-19 patients.
Francisco Espana, 60, looks at the Mediterranean from a promenade after 52 days in intensive care at the Hospital del Mar in Barcelona, Spain. AP Photo / Emilio Morenatti
Our health workforce is lean. Isolating contacts when health workers become infected could jeopardise entire medical departments. The risk of overwhelmed hospitals is real.
Finally, Plan B does not acknowledge the growing body of research on the longer-term health effects of Covid-19.
One in 10 infected people experience symptoms for more than three weeks, and a smaller number for months, according to a British Medical Journal paper by Greenhalgh and colleagues.
Breathlessness, unshakable fatigue, and cognitive impairment – described as "brain fog" - are frequently reported, even among young adults who had mild illnesses. Long-term consequences remain unknown.
We agree scientific debate is essential but it should be robust. Plan B is unworkable, inequitable and risky. For it to be worthy of public attention, more rigour is required.
• Dr Jin Russell is a developmental paediatrician and PhD candidate in life course epidemiology at the University of Auckland. Dr Veronica Playle is an infectious diseases physician and microbiologist, and PhD candidate in genomic sequencing of infectious diseases at the University of Auckland.
