Covid isn’t over, it’s just getting started

A century ago, one in five people who died in New Zealand were killed by an infectious disease.

Infectious diseases, as a group, took more lives in 1922 than heart disease. Twice as many people were killed by communicable viruses or bacteria as died of all forms of cancer combined.

These days, heart disease and cancer make up nearly three in five deaths each year. Mass mortality from infectious disease is considered a relic of the past or an unfortunate struggle for developing countries.

But it wasn’t that long ago that New Zealand, too, grappled with that same threat. Endemic diseases caused severe long-term complications (polio paralysis) or significant numbers of deaths (smallpox and tuberculosis).

Covid-19 could push us some of the way back to that older era, when infectious diseases were common enough to worry about regularly and posed a serious threat to the health system. The virus that causes Covid-19 continues to evade our immunological defences, raising the spectre of a permanent, endemic, but far from harmless illness.

There is no reason, experts say, why Covid-19 wouldn’t continue to kill five to 10 New Zealanders a day for years to come. And that’s outside of the context of major seasonal surges, which remain on the cards.

Government policy and public attitudes since the peak of the Omicron wave seem to have been undergirded by an assumption that Covid-19 is over. The pandemic has hit us, swept through us, killed a few hundred people, and moved on.

Nothing could be farther from the truth.

The virus is likely to become endemic in New Zealand, as in the rest of the world. But that doesn’t mean it will be harmless.

A permanent presence from Covid-19 means we are now in a long-term war with the virus. Reinfections will become the norm – a never-ending battle against an ever-evolving foe.

The only determinants of how many people will be sickened, disabled or killed by the virus are its own evolutionary leaps and our actions to shape its environment.

Hundreds of excess deaths

For weeks, the number of daily Covid-19 cases, deaths and hospitalisations has remained relatively flat. It looks increasingly like we’ve found our baseline for the virus, outside of the context of surges.

“The effective reproduction number is hovering about one in New Zealand because things are flatlining, so the cumulative impact of everything we’re doing is reaching this new equilibrium,” University of Otago epidemiologist Michael Baker told Newsroom.

The health burden of that new normal is higher than many people might have expected. Dozens of deaths are reported each week by the Ministry of Health. A small number of these end up being unrelated to Covid-19, but 80 percent are either caused directly by the disease or list it as a contributing factor.

Based on that, it’s been nearly three months since we last had an average “true” Covid-19 death count below eight a day. The daily average since then has been closer to 11, after accounting for unrelated deaths. Over a year, that would lead to more than 4000 deaths – eight times worse than the seasonal flu.

Covid-19 is also showing up in all-cause mortality statistics. Between the start of March and mid-May, 831 more people have died than would have been expected to, based on mortality trends from 2020 and 2021. That shows we’re already erasing the gains from the first two pandemic years with a 10 percent bump in mortality. Even against the pre-pandemic baseline, we have seen 446 excess deaths in that time period. By any standard, the wave of death sweeping New Zealand is more than just unusual.

Cases and hospitalisations have also stayed elevated, with the number of patients in hospital fluctuating between 350 and 400 a day and the number of new daily admissions barely dropping below 100. Director-General of Health Ashley Bloomfield said on Tuesday that current Covid-19 prevalence is twice as high as the Government’s modelling anticipated.

Clearly, we will not eliminate Covid-19. It also won’t go away through infection- or vaccine-acquired herd immunity.

When Omicron took hold in the United Kingdom, about one in every 10 new cases was a reinfected person. Now, as new Omicron sub-variants spread around the country, reinfections make up 16 percent of all new cases. Reinfections are expected to become commonplace. Mass infection isn’t the route out of the pandemic.

“It’s going to get to a point where not having some protection is going to be very rare,” University of Otago evolutionary virologist Jemma Geoghegan said. “So the population is forever changing and the virus is finding new avenues to explore to combat that protection. Reinfections are going to become more common as immunity wanes.”

Getting Covid-19 once doesn’t mean you’re safe for good. The aim now is to get infected as few times as you can, because the effects of multiple exposures are still poorly understood. Despite this, experts overseas say the average person will catch Covid-19 every three years or so.

“Barring some intervention that really changes the landscape, we will all get SARS-CoV-2 multiple times in our life,” University of Michigan epidemiologist Aubree Gordon told The Atlantic in May.

There has been an implicit assumption in the public mind, as well as in Government policymaking and the declining media coverage of the ongoing pandemic, that Covid-19 is bound to become harmless or simply vanish.

The blindness to the continuing illness and death, let alone any lack of looking forward, calls to mind former US President Donald Trump’s ridiculous assertion in February 2020: “It’s going to disappear. One day – it’s like a miracle – it will disappear.”

As Mediawatch reported recently, an all-hands email to Stuff – the country’s largest employer of journalists – said “our audience have actively moved on from Covid content and the company needs to stay ahead of that trend”.

And it’s not just the media.

The Government insists the pandemic isn’t over but isn’t acting like it, health experts say. It’s even planning to scrap the Covid-19 legislation which gives it the tools to fight the virus.

“There’s no biological reason why the three main consequences of Covid-19 [hospitalisations, deaths and Long Covid] will settle at any particular point. There’s nothing that says that Covid will somehow drop below that threshold and become like the four coronaviruses that cause the common cold,” Baker said.

Endemic isn’t harmless

Instead of attenuating until it is no worse than the flu or – like a miracle – disappearing, Covid-19 is here to stay. It will join the roster of infectious diseases that we grapple with on a regular basis, like measles, RSV and influenza. But the threat it poses to the health system and its ability to kill and cause Long Covid put it somewhat closer to those older diseases we have since put behind us.

“There’s a fair chance it’s going to sit in this tricky space where it is more serious than the flu but it’s not the existential threat that it was in 2020,” University of Canterbury mathematician and Covid-19 modeller Michael Plank said.

For more than two years, people have looked forward to Covid-19 exiting a pandemic state and becoming endemic, as if that marks the end of our struggle with the virus. In truth, this is just the beginning. Continue reading

Additional reading

News category: Analysis and Comment, Palmerston.