Why Sir David Skegg is ‘cautiously optimistic’ worst of Covid-19 is over

Renowned epidemiologist Professor Sir David Skegg has received the Blake Medal for his decades of leadership in public health. Photo / Supplied

Professor Sir David Skegg is “cautiously optimistic” the worst of the coronavirus crisis is behind us – but warns we should remain ready for some nasty twists.

Our pre-eminent epidemiologist, tonight honoured with this year's Blake Medal, has reflected on a pandemic that's now killed more than 6.5 million people globally - and just driven our third Omicron wave.

Back in the darkest months of 2020, as the country stood at the brink of being overwhelmed by Covid-19, the 74-year-old proved a commanding presence at the highest levels of power, bringing to bear his decades of expertise in public health.

Appearing before Parliament's hastily-formed Epidemic Response Committee, he bluntly told officials it was make-or-break time to stop the virus, and chastised them over everything from tracing and testing to border measures and strategy.

His calls – described by the Herald's Derek Cheng as a "hurricane of fresh air" - and those of colleagues helped cement a bold strategy that likely saved thousands of lives, while buying crucial time to vaccinate the population before Omicron arrived.

"In future years, I believe New Zealanders will look back on our handling of this pandemic as one of our great national achievements," he told the Herald this week.

"This is not to suggest that everything was perfect – or even close to that.

"But we avoided the terrible loss of life and the burden of illness experienced in many comparable nations."

Over the pre-Omicron period, New Zealand had minus 215 excess deaths per million, which equated to around 1103 fewer people dying than in a scenario in which the Covid-19 crisis never happened.

Otago University researchers have calculated that, if we'd experienced a similar per capita excess mortality rate with other jurisdictions, New Zealand may have seen 1856 extra deaths (Japan), or 2127 (Taiwan), 2577 (Australia), 3798 (Singapore) or 5167 (South Korea).

Remarkably, there were only nine jurisdictions on the planet which had recorded negative cumulative excess mortality for that pandemic period - of which New Zealand was the largest.

Professor Sir David Skegg (bottom centre) joins Parliament's Epidemic Response Committee over video conference on March 31, shortly after New Zealand went into lockdown. Image / Supplied

"We also had less social disruption, and our economy remained strong," said Skegg, who formerly served as a consultant to the World Health Organisation, chair of the Health Research Council, president of Royal Society Te Apārangi, and Vice-Chancellor of Otago University.

"By the time the Delta and Omicron variants forced a change in strategy, New Zealand had access to effective vaccines, rapid testing and antiviral drugs."

He thought it a pity our health system wasn't quicker at rolling life-saving drugs like Paxlovid, which may have reduced the number of virus-attributed deaths earlier this year.

Still, he said credit was due to our political leaders who resisted the common instinct to follow larger countries like the UK and US – as we appeared to be doing when considering mitigation or suppression tactics over the pandemic's opening weeks.

"This required a fresh look at the scientific evidence, and willingness to make bold and ambitious decisions under great time pressure," Skegg said.

"Experience elsewhere has shown that delays of only a week or two in implementing measures such as lockdowns could cost thousands of lives.

"Our relative success also depended on widespread public support, which shows that we have an unusually cohesive and caring society – despite some fraying at the edges recently.

"It also required a huge effort by health professionals and by workers in many other walks of life."

That New Zealand entered the crisis unprepared for a pandemic was especially frustrating for Skegg, who'd only just authored a book criticising the state of our public health infrastructure and central leadership.

Had these problems been addressed, we might have been able to avoid costly, disruptive lockdowns, as Taiwan did successfully.

While he hoped our new Public Health Agency (PHA) and national public health service would improve the situation, he saw the need for a Crown entity that could be kept at arm's length from the government of the day.

"This could consult more freely, advocate for public health, and provide independent advice to government and the community," he said.

"It is important to remember that infectious diseases are not the only, or even the main, threat to the health of people in a country like New Zealand."

For Skegg himself, being utterly consumed in a pandemic for well over two years wasn't how he'd planned to spend his early seventies.

"But it was a privilege to be able to lend a hand in a global crisis."

Aotearoa in the Omicron era

With most Kiwis now having caught the virus – and measures like lockdowns, vaccine mandates and intensive contact tracing efforts well behind us – our Covid-19 landscape has dramatically changed from the elimination era.

That’s not to say the burden of Covid-19 is diminished: the more than 2000 deaths New Zealand has recorded this year is about six times last year’s national road toll, making the virus one of our leading causes of mortality.

That impact, he added, had been substantially higher among Māori and Pacific peoples, which, according to one recent analysis, respectively faced risks of death 3.7 and 2.9 times higher in people younger than 60.

"Those deaths mean many grieving families, and much loss of human potential," he said.

"Clearly, deaths from Covid-19 will continue, although I hope we will not return to the high numbers experienced a few months ago."

We also didn't know nearly enough about the ever-present risk of Long Covid, and he feared a significant number of people would be left suffering long-term effects.

"In future years, I believe New Zealanders will look back on our handling of this pandemic as one of our great national achievements," Professor Sir David Skegg says. Photo / Mark Mitchell

"There are some quite worrying, although inconclusive, studies suggesting higher risks of cardiovascular disease, dementia, and so on," he said.

"Hence, we should continue to try to minimise the risk of infection, because reinfections can also cause Long Covid."

Beyond health, Skegg also saw lasting consequences for every other aspect of social, political and economic life.

"Already, in New Zealand as in other countries, we can see some of these adverse impacts, such as interference with the educational achievement of young people, a rise in the spread of disinformation - especially through social media - and diminished trust in politicians and experts," he said.

"It might be tempting to attribute some of these effects to various aspects of our pandemic response, but the fact is that we have been battling a novel virus that proved to be more than a match for humanity."

Nor was this virus finished with us.

A major International Science Council report Skegg worked on alongside Kiwi counterparts Professor Sir Peter Gluckman and Dr Anne Bardsley warned the pandemic's echoes were likely to ring on for years longer because governments had failed to tackle it together.

Its most likely scenario for 2027 was that the virus had become endemic and was still driving seasonal surges requiring updated boosters, with large numbers of unvaccinated people in low-income states where health systems could risk collapse.

At home, and in the immediate term, Skegg said relaxed health measures, waned immunity and new subvariants would mean more infections – and more deaths.

"I would encourage anyone who is eligible for a booster shot to take up the opportunity without delay," he said.

"But it is important to note that New Zealand is still using other public health measures, including widespread testing and the requirement for infected people to self-isolate for seven days.

"Without these measures, we would have a greater burden of disease and more pressure on our overstretched health services."

Like many epidemiologists, he'd liked to have seen the country keep some other core measures: namely masking on flights and public transport.

"But governments need to assess whether particular measures will have public support at each phase of an epidemic," he said.

"In general, I think the measures being taken in New Zealand are sensible and proportionate."

Generally, he was quietly optimistic that we'd seen the worst of Covid-19, "yet we need to be prepared for nasty surprises".

"The virus continues to replicate millions of times every day around the world, and it is entirely possible that a completely new variant will emerge," he said.

"This could be either more or less challenging. The failure of rich countries to get vaccines distributed equitably puts everyone at risk."

Skegg's medal – presented this evening at a black-tie dinner in Auckland by Blake (formerly the Sir Peter Blake Trust) - recognised not just his contribution to the pandemic response, but to other global issues including HIV/Aids, Mad Cow Disease and reproductive health in developing nations.

"Sir David's extraordinary leadership over multiple decades stems from his consistent dedication to the betterment of human knowledge and public health," Blake chief executive James Gibson said.

Blake leader awards were also presented to sustainable business entrepreneur Brianne West; GNS Science paleoclimatologist and glacial scientist Dr Richard Levy; University of Auckland earth systems scientist Mātauranga Māori lecturer Dr Dan Hikuroa; former rugby league player and sustainable nutrition advocate Carlos Hotene; Potiki Poi founder Georgia Latu; and naturalist and “Bugman” Ruud Kleinpaste.