Don’t expect a green light just yet

As winter adds flu and RSV to the virus mix, the Government is set to stay at orange

T hose hoping for more freedoms with a move from orange to green are likely to be disappointed by the review of the traffic light setting.

The Omicron outbreak has unfolded largely as expected, with a peak firstly in Auckland and then the rest of the country, followed by a flattening of case numbers which have then crept up in the last month.

Reported daily case numbers peaked at about 20,000 in early March, with hospitalisations peaking at about 1000 in late March, and deaths at 18 per day in early April. These fell post-peak to about 7500 cases, 350 hospitalisations, and 10 deaths per day.

But health officials are anticipating a winter peak of up to nearly 2600 hospital beds taken up by Covid, RSV, flu and other respiratory illnesses.

That’s about a third of the total number of resourced hospital ward beds in the country, which leaves not nearly enough of a safety margin to ease the few restrictions that remain.

The winter peak is based on modelling that director general of health Ashley Bloomfield revealed. He presented two scenarios — the lower-transmission one peaked at 500 cases in hospital in September, while the higher-transmission one peaked at just shy of 1300 hospitalisations in mid-August.

Hospitals were planning for the high-transmission scenario, he said.

Add RSV and other respiratory illnesses, including flu, and hospitalisations are modelled to peak this winter at about 2500 beds for a period of six weeks.

Factor in, too, the context of a hospital system that’s usually under pressure in winter, even in pre-Covid times, and how stretched the health system was in March when the hospitalisation peak was lower than the modelled winter peak.

This would make it very surprising if the Government signalled a move to green until winter was well and truly in the rearview mirror.

“Green seems inconceivable at the moment,” University of Otago epidemiologist Professor Michael Baker says.

There remains, as always, much uncertainty. That currently centres around Omicron subvariants BA.4, BA.5, and BA2.12.1, which are becoming more prevalent overseas as they appear to be more infectious than the BA.2 variant, which dominated New Zealand’s first Omicron wave.

Each of those subvariants has been detected at the border in New Zealand, though none are yet to get a grip on community transmission.

BA.4 and BA.5 are behind a recent surge in case numbers in South Africa, and they might also be starting to trigger a new wave in the UK.

There is nothing to suggest that any of them cause more serious illness than BA.2 but there is emerging evidence on how little immunity you might have against them if you’ve already had BA.1 or BA.2.

“The data I’ve seen shows that, if you haven’t been vaccinated, then prior infection with BA.1 or BA.2 doesn’t give you great immunity against BA.4 or BA.5,” says Covid-19 modeller Professor Michael Plank.

“But if you’ve been infected and vaccinated, you’ve got more immunity against getting severely ill.

There are several ways that pressure on hospitals can be eased this winter, including the flu vaccine rollout, and a fourth Covid vaccine dose for the elderly, vulnerable and immunocompromised, which is expected to start in June to maximise winter immunity.

Officials are also somewhat flying blind when it comes to the level of population immunity because the Ministry of Health’s prevalence survey is still only scheduled to be actioned “over the coming months”.

Political decisions on traffic light settings are always a balancing act, and today’s context is a Labour Party that’s been sliding in the polls and a population that is over Covid.

The Australian election result over the weekend also shows how quickly keeping Covid in check for much of 2020 and 2021 can become irrelevant.

The New Zealand Government’s elimination strategy, with an implicit goal to prevent as many Covid deaths as possible, resonated with voters as well as public health experts.

But that’s all changed with Omicron. Now the stated aim of government restrictions is not only to keep the health system from being overwhelmed but to cause the least amount of disruption in people’s lives.

The price of that has been 1000 deaths linked to Omicron.

Almost 90 per cent of those who died were aged 60 and over.

The pivot to fewer government mandates and more personal responsibility has made life harder for the vulnerable and immunocompromised.

Why would the parent of an immunocompromised student send them to a classroom where students don’t have to wear masks?

The implicit question underlying the level of restrictions is: how many deaths are too many?

A party calling for fewer restrictions is essentially saying that the price of keeping the current level of safety is too much.

One calling for more controls is saying too many preventable deaths are happening, and we should all carry the burden of more restrictions.

Based on the current settings, it seems the Government’s answer to how many Covid deaths are tolerable is about 2500 to 3000 a year.