Most people would like to see the back of Covid but its impacts will be felt long-term. Photo / Michael Craig, File
Most people would like to see the back of Covid but its impacts will be felt long-term. Photo / Michael Craig, File
Opinion
OPINION
Before and throughout the pandemic my counterparts around the world regularly shared data and observations to help inform how large public health issues can combine with personal drivers – age, sex, smoking habits, medical information, occupation, and high-risk pastimes – to influence mortality and morbidity.
At the onset ofthe pandemic, we could not predict which way the numbers would go relative to actuarial tables but, coming out of the acute phase, New Zealand and Australia have done well among developed countries from a health standpoint.
We exercised our option to close borders, and leaders generally got widespread buy-in for their decision-making around lockdowns.
As a result, we did not see the excess mortality experienced in many countries. Lengthy periods of lockdowns over two years meant lower-than-usual rates of accidental and workplace deaths and rates of influenza mortality compared with what we typically see each winter.
All this makes New Zealand markedly different from almost every other country in the same period.
As we move beyond the crisis phase of the pandemic and into endemic Covid-19, there are lessons and data emerging which should inform our wider public health approach.
Commuters wearing face masks on a crowded bus during morning rush hour in Beijing. Photo / Andy Wong, AP
We will continue to deal with Covid and political organisation remains key: A stable government will form adaptive yet coherent strategies for pandemic management.
One key element is a country's national health system, as this determines how vaccines, tests and treatments are distributed and funded. The system's resilience and flexibility, or otherwise, are important.
The UK's vaccine roll-out programme was widely considered a success (unlike some other aspects of its pandemic management), and the UK and Singapore were able to mobilise temporary hospitals quickly in unused buildings such as warehouses.
Conversely, New Zealand relied on other defences and did not significantly increase hospital or staffing capacity – and Covid's peak during winter 2022, as other seasonal ailments hit hard for the first time in two years, severely stressed the health workforce.
From an actuarial point of view, our small population size means we often refer to overseas data to predict what will happen here and inform our insurance services.
However, because New Zealand hasn't had the same experience as the markets we usually look at, the longer impact of what has happened over the past few years is harder to define.
We are likely to see a catch-up in mortality after we delayed some deaths with our pandemic response. Over a five-year period, including the last couple of years, the impact will be neutral.
Other countries will probably have a lower death rate from 2022 to 2024, because their more vulnerable populations succumbed in greater numbers during the pandemic.
In terms of long-term Covid management, we are working with a dual advantage of a high national vaccination rate and access to extra boosters and antiviral drugs. If you test positive for Covid and you are at risk with co-morbidity factors (respiratory illnesses such as asthma, other illnesses where immunity is compromised, even old age), you can be treated straight away.
My mother had a mild dose of it at 86, possibly because she was treated with those drugs immediately. This access can keep higher numbers of at-risk people out of intensive care and out of hospital, thus lowering the risk of delayed or interrupted health system access for others seeking care or treatment.
Actuaries project months and years into the future based on a variety of information: historical data in New Zealand, overseas data, population growth projections, everything we know about vaccination rates, smoking rates, accidents and illnesses and much more.
Earlier this year, when considering how quickly the national health system would be able to catch up after lockdowns and delayed surgeries and treatments, we determined that this period would last about three months to June 2022, and then normalise.
What is happening is worse than projected. We dropped mask mandates and became exposed to germs brought in by overseas visitors and it has become evident that we have significant disruption to our health sector; the hospital system is still very broken - the people as well as the infrastructure.
Kate Dron. Photo / Greg Bowker
Workers have not necessarily had the care they need over this period – many are desperately in need of a break – so the public health system is not back to working as it should. It is overloaded and patients are being pushed into the private sector, and those who can't afford private services or don't have private insurance are missing out.
New Zealand deals with crises incredibly well; it's the post-crisis point we struggle with, and that's what is hitting people now.
The other big issue emerging now is people who missed health screenings such as mammograms, cervical smears, and colonoscopies. Many were deferred because of lockdowns, and backlogs take time to clear.
Now, if people feel no urgency to catch up, a problem might be detected six or 12 months later than they otherwise would have been, which can mean disease has progressed to a more difficult stage.
These are the concerns we have now – trying to see what is really going on at the population level and how that will affect New Zealand as a whole and our insurance sector.
• Kate Dron is chief appointed actuary at Partners Life.
