Playing the BLAME GAME
Data shows older people and those with underlying medical conditions are more likely to be affected by Covid-19. But as more of the world’s population succumbs to the disease, young people are falling ill and even dying. New Zealand’s lockdown isn’t just about saving the vulnerable, experts say. If we muck this up, we’re all at risk. Katie Kenny reports.
Tension between Boomers and Millennials has only escalated as a result of Covid19.
TikTok, Twitter and other social media all have memes referring to the novel coronavirus as a ‘‘boomer remover’’. The deeply unkind moniker highlights the deepseated anger many young people feel towards older generations about their politics and other generational differences.
International data suggests older adults and those with serious underlying medical conditions are at higher risk of severe respiratory illness and death from the virus, while children and younger people are likely to experience only mild symptoms. About 80 per cent of Covid-19 deaths in China were among those aged over 60.
Government modelling released this week suggests that, if the virus is not contained, New Zealand will see a similar age distribution of fatal cases.
Unfortunately, that’s led to some younger people continuing to socialise as normal, putting their communities at risk.
World Health Organisation director-general Tedros Adhanom Ghebreyesus has warned that young people are not immune to the disease, and the choices they make could be ‘‘the difference between life and death for someone else’’.
Prime Minister Jacinda Ardern echoed that message when talking to reporters on Wednesday: ‘‘They may think that this won’t affect them much – that they’ll be mild to moderate. They are our vector for transmission. They are the ones that pass it on.’’
If New Zealand experiences widespread outbreaks, it’ll be clear who’s to blame.
Meanwhile, young people are complaining about ageing relatives being cavalier about the virus, and going about life as normally as possible.
In response, Ardern made a heartfelt plea to the elderly to stay at home: ‘‘Anyone out there who is over 70, or has underlying conditions, and is not listening to their children, please listen to me.’’
While it appears true that individual risk associated with Covid-19 increases with age, if New Zealand experiences a pandemic that overloads its health system, experts say, we’re all in trouble.
In bubbles across the country, generations are banding together to keep each other safe.
In Nelson, Gabrielle Matthews is in a bubble with her retired parents and her 92-yearold grandmother, who has a lung condition. As much as possible, they’ve limited their contact with the outside world.
The 31-year-old is employed by a local technology company and is able to continue working from her mother’s music room.
After Matthews finishes work at 5pm, she walks two minutes up the road to her grandmother’s house to provide her daily physiotherapy.
‘‘Normally a helper comes once a day, but about a week before the country went into lockdown, I went into selfisolation and took on that role.
‘‘We decided there was no point having people come and go, we may as well eliminate that risk.’’
Her father is the family’s designated grocery shopper, while her mother takes care of the cooking. Having two houses in the bubble provides extra space and a change of scenery.
‘‘We’ve got all these different roles. It’s going really well, actually. We each have our own space, and come together at dinner time. Nan comes over for some meals, and for a cup of coffee sometimes.’’
Have we underplayed the risk of Covid-19 to young people?
Officials have emphasised it’s still too early to tell whether the country’s lockdown measures have been successful. And it’s still unclear, owing to limited testing, the extent to which the novel coronavirus is already in communities. But at this stage, 80 per cent of New Zealand’s 708 reported Covid-19 cases are under the age of 60.
A quarter of all cases are among those aged 20-29, making them the most affected age group. Given the strong link between New Zealand’s cases and overseas travel, that makes sense.
As the virus spreads around the world, more young, otherwise healthy people are being admitted to hospital and even dying. Medical professionals caring for patients are a particularly vulnerable group, says Otago University epidemiologist Michael Baker.
‘‘The immune system of younger people is more nimble, but you can overwhelm your immune system if you have a large, initial infectious dose.
‘‘That’s one reason why healthcare workers, even though they’re often younger and healthy, are at greater risk.’’
However, there’s been little research on how the amount of virus, also known as the ‘‘viral load’’, influences prognosis.
One recent study reports the virus load tends to be higher in older patients, which fits with the increased pathology of Covid-19 among that cohort, says University of Auckland virology lecturer Dr John Taylor.
‘‘In short I think it’s too soon to make conclusive interpretations from this study. More conclusive studies will certainly follow.’’
In the United States, the Centers for Disease Control and Prevention is reporting close to 40 per cent of coronavirus
patients hospitalised are between the ages of 20 and 54. Other countries, such as China, and Italy, have reported deaths of young, otherwise healthy people.
This has led to questions around China’s data, and whether it underplayed the risks to younger people.
But that’s unlikely, says Dr Andrew Stapleton, chair of the New Zealand committee of the College of Intensive Care Medicine, and a member of the Australian and New Zealand Society of Intensive Care
Medicine working group.
‘‘The Italian data supports the Chinese data that becoming seriously unwell below 70 is far less likely than when you’re older,’’ he says.
However, when so many people are infected simultaneously, even if a person’s individual chance of getting sick is low, there will still be significant numbers in their demographic.
‘‘In overrun hospitals abroad, the elderly have been very quickly triaged out of [intensive care units] and then hospital care, so the net result is the hospitals are full of the younger people even though as a cohort, there are far fewer of them.’’
Despite Kiwis in their 20s currently being the most affected by Covid-19, ‘‘there’s no reason to expect more of them to be sicker than elsewhere’’.
‘‘If there are differences in patterns it will most likely relate to our early lockdown, compared to other countries.’’
Why New Zealand’s data will be different
Until recently, officials were still talking about ‘‘flattening the curve’’ of the pandemic, to keep it from overwhelming the health system. A similar ‘‘suppression’’ strategy was being employed by other countries, where the focus was on reducing case numbers to low levels through social distancing of the entire population.
But academics and health professionals were frustrated by the lack of strategic clarity and concerned that even limited spread of the disease would overwhelm the health system.
New Zealand’s number of intensive care unit (ICU) spaces is low, relative to other, similar countries. The Australian and New Zealand Intensive Care Society in 2018 estimated there were 5.14 ICU beds per 100,000 people in New Zealand, far fewer than in Australia (8.92), nearly all countries in Europe (average 11.5), and Canada (13.5).
According to the Ministry of Health’s latest count, New Zealand has 153 ICU beds in public hospitals nationally. Accounting for beds that could be adapted to support ventilation, the number rises to 560. Limiting factors are ventilators (there are 520 ventilators spread across all district health boards) and qualified staff.
‘‘There is a difference between physical beds and nursed beds,’’ Stapleton previously told Stuff. ‘‘You need one nurse to one patient at all times in an ICU, so no nurse equals no ventilated patient, no exceptions.’’
A worst-case scenario, modelled by a team at University of Otago Wellington and given to the Government last week, found more than 27,000 New Zealanders could die if efforts to stamp out the virus fail.
The scenario assumes the worst in terms of high transmission rates and the country giving up on severe restrictions after two months. The author, Professor Nick Wilson from the university’s Department of Public Health, gave it about a 5 per cent chance of coming to fruition.
On Tuesday, Director-General of Health Ashley Bloomfield revealed the end goal for the Government was not simply suppression but eradication of the disease.
‘‘We’ve been saying we want to break the chain of infection. Ideally we want to break it and if we stay in this position and are rigorous about enforcing the physical distancing, we will eliminate it,’’ Bloomfield said.
When epidemiologist Michael Baker heard that, he breathed a sigh of relief. The public’s ‘‘strange obsession with exponential curves’’ is unhelpful, he says, because testing isn’t widespread enough to reflect the reality.
‘‘Once you get on that curve, you can’t really get off it. Across Europe, they’re trying to take the edge off so they don’t completely swamp their system. They’re in suppression mode, and that’s no fun. There’s no easy way out.
‘‘The virus is sweeping around the global and will affect up to 60 per cent of the population in coming years. The count that will mean something is the count of people dying from [Covid-19]. And even then, in some low-income countries, they’re not even properly counting those numbers.’’
New Zealand’s point of difference is its decision to pursue an elimination strategy. ‘‘I think the Government should be congratulated on being decisive about that.’’ While it’ll be tough, particularly for those who are losing their livelihoods, the potential benefits are ‘‘huge’’.
The current case tally says very little about which groups are at risk, he continues. ‘‘It’s just telling us who’s travelled and where they’ve come from.
‘‘It says nothing about which groups are at risk.’’