The lingering pandemic
The past year has been relatively normal in New Zealand. But the pandemic is far from over - and may yet be with us for years to come. Brittney Deguara and Felippe Rodrigues report.
At the end of March, thousands of art and musicloving fans flocked to Wellington’s street festival Cuba Dupa. In April, homegrown band Six60 played to 50,000 cheering fans at Auckland’s Eden Park. And just over a week ago the Crusaders sold out Orangetheory Stadium in Christchurch in their clash against the Blues.
On April 30, there were just 23 active cases in managed isolation, the lowest total in almost 9 months.
This is New Zealand in 2021. Yet, much of the rest of the world is on fire. Covid-19 infections have continuously multiplied and bodies are piling up.
‘‘We should be concerned with the changing global picture of the viral infection, and we cannot afford to drop our guard,’’ says Dr Arindam Basu, an epidemiologist from the University of Canterbury.
Infections, mutated variants ravaging the world
The pandemic, in terms of case numbers, is a vastly different beast now from one year ago.
Now, there are about 845,000 new cases across the world each day.
This represents an increase of about 800 per cent on the same time in 2020, when the equivalent number was 92,000.
The total number of recorded cases now is about 146 million, which accounts for 1.8 per cent of the global population. Compare that to one year ago and the number was 2.7m infections (around 0.03 per cent of the population). This tells us Covid19’s presence across the globe has ballooned by 5160 per cent.
Throughout the world, mutated variants have emerged, threatening efforts to contain or eliminate the virus. The UK variant (B.1.1.7) was found to be more transmissible than earlier variants.
It quickly spread beyond the UK – cases emerged in New Zealand, and it became the dominant strain in the United States. Dangerous variants from South Africa (B.1.351) and Brazil (P.1) were also discovered, as was a variant with a double mutation in India.
Brazil has struggled with an influx of cases linked to a new variant, and India has been hit with what is believed to be the worst Covid-19 surge in the world.
As of April 27, 17.63 million infections and 197,894 deaths have been reported in the country, according to the World Health Organisation (WHO).
India was once seen as a success story, but its health system is now crumbling. There aren’t enough ventilators or hospital beds, and crematoriums are overwhelmed.
By the end of April, the number of global infections had climbed for nine consecutive weeks, and deaths increased for six weeks. To put that into perspective, the number of global cases reported in one week in April were almost on par with cases reported in the first five months of the pandemic.
How the pandemic will end
Vaccination programmes are well under way around the globe. More than 1.13 billion vaccine doses have been dispensed, according to the New York Times tracker. Remember, though, the world’s population is about 7.8b.
There are also major vaccine inequities around the globe, with some countries hoarding more doses than they need and others yet to even receive one vial.
‘‘It’s a very unfair world out there,’’ says Dr Nikki Turner, director of the Immunisation Advisory Centre (IMAC). She describes global vaccination efforts as ‘‘patchy’’ and ‘‘inequitable’’.
‘‘Some countries are doing well and racing ahead, the countries with [the] least resources are missing out and other countries are very out of control [with infections]. It’s really sad and scary out there . . . [There’s] a long way to go.’’
Covid-19 modeller and physicist Professor Shaun Hendy notes that the countries rapidly deploying vaccines are reducing infections and fatalities, but some are distributing vaccines ‘‘far too slowly’’ to significantly affect ongoing outbreaks.
India is a perfect example of this. The country is vaccinating at a rate of 2.2m doses a day, which will only see 30 per cent of the eligible population protected by the year’s end.
Some countries also chose to go back to normal life instead of cautiously walking back while vaccination programmes gained momentum.
‘‘Vaccinations haven’t been given a chance to work,’’ Turner explains. ‘‘All the important public health measures didn’t stay in place.’’
Israel’s approach to reopening the economy while ramping up vaccinations is admirable. This stepby-step approach has resulted in ‘‘really dramatic’’ results, Turner says.
By April 17, over 10.3m doses had been administered, and on April 25 the lowest daily case count in a year was recorded, with 38 new infections. This is what’s called exponential decay – the opposite of the exponential growth we saw throughout the pandemic.
Zoe McLaren, an associate professor from the University of Mayland’s school of public policy, wrote about this in the New York Times.
She explained how every prevented Covid-19 case cuts off transmission chains, reducing the number of infections down the line – so 1000 cases might halve to 500 in one day and then continue to halve as transmission routes are doused. This is already happening in the US, thanks to its widespread vaccination campaign.
McLaren thought balancing vaccination roll-outs and easing restrictions could spell the end of the pandemic if all countries come to the table.
‘‘Every single thing people can do to slow transmission helps – including wearing masks, getting tested and avoiding crowded indoor spaces – especially given concerns about current and future variants, since it could be what gets us past the threshold into exponential decay,’’ she wrote.
The emergence of new variants has made containment more difficult. Vaccination campaigns are not able to keep up with the rapid spread of these new variants, essentially paving the way for new waves.
‘‘Until around 70 per cent to 80 per cent of us are vaccinated, we remain vulnerable to further waves,’’ Hendy explains. ‘‘These variants have made the second and third waves that many countries faced – or are facing – more deadly and more difficult to manage.’’
There are concerns that mutated variants will escape vaccine cover, but researchers are already working to develop second-generation vaccines to fill this potential gap. Hendy says there may be a need for annual vaccination campaigns in future, to keep up with these mutations.
According to McLaren, infections could begin to taper off when herd immunity is reached. Herd immunity is when a large enough portion of a community (the herd) becomes immune to a disease, making the spread less likely. It could be reached through mass vaccination.
That said, there’s still a lot of uncertainty around how vaccines will change things in the long term, says Professor Nick Wilson, a public health expert from the University of Otago. He highlights two potential outcomes that may eventuate:
■ Green travel zones, with tight border controls, expand when countries reach elimination. New countries are added one by one, eventually resulting in global eradication.
■ The global community decides that eradication, through vaccinations and border controls, isn’t feasible, so only when a country
vaccinates a significant portion of its population do borders reopen. Any occasional outbreaks in unvaccinated populations will be controlled, much like how measles outbreaks are handled.
Hendy thinks future measures may involve continued travel restrictions for certain countries, rapid tests on arrival, or vaccination proof for travellers.
New Zealand not out of trouble yet
New Zealand’s Covid-free status isn’t guaranteed. Things change and there have been 15 border control failures since June last year.
Until vaccines have a chance to diminish the global threat, cases will continue to pop up at the border, and short, sharp lockdowns will remain a priority if infections leak into the community, Hendy says.
‘‘Until we have sufficient vaccine coverage here – and we won’t get close to that until the end of the year – we will remain vulnerable to future outbreaks.’’
The border has been one of the key factors in protecting the country from the worst of the pandemic. Hendy thinks it will remain ‘‘crucial’’ for most of 2021, at least. Turner agrees and says we need to keep on top of the borders.
Can more be done? Wilson suggests three main areas to strengthen:
■ MIQ should be completed in purpose-built facilities outside city centres, especially for travellers from red zone countries. Australia’s Howard Springs facility in the Northern Territory is a good facility to imitate.
■ Workers at the border and returnees in MIQ should undergo mandatory daily saliva tests.
■ Returnees in MIQ facilities must stay in their rooms for two weeks with no shared spaces for exercise or smoking. This is already happening in Australia.
There are also new measures that could be introduced – pre-flight quarantine in a supervised airport hotel, arrival limitations, compulsory use of the contact tracing app for green-flight travellers, and even a vaccine passport.
Any border control changes will depend on how well the rest of the world is handling the virus, Hendy says.
A Ministry of Health spokesperson says numerous government agencies are regularly reviewing and improving the border response.
‘‘New Zealand’s overall Covid-19 response is based on a system that’s allowed us to adapt, as we’ve
continued to learn more about the way the virus is transmitted and the best methods of protection against it.’’
The spokesperson said the ideas Wilson floats have been considered, and some even adopted where appropriate – like saliva testing.
There are no plans to establish MIQ facilities in any other locations, a spokesperson from the Ministry for Business, Innovation and Employment says. Wilson’s third suggestion wasn’t specifically addressed.
While no extensive studies have been performed, Basu believes complacency is in the air in Aoteaora. ‘‘It does seem to me that many people tend to take for granted that we are ‘lucky’ in New Zealand that we do not have Covid-19.’’
The measures that have lapsed over time – face mask use and scanning QR codes for contact tracing, for example – are the same measures that have allowed Kiwis the freedoms they enjoy today.
Wilson does not see public complacency as a big issue; his concerns rest with the Government. ‘‘They are not doing enough to improve the safeguards at the border and in [managed isolation and quarantine] facilities, the vaccination roll-out is too slow, the Alert Level system is overdue for an upgrade, and there is slow progress on getting travel bubbles with Pacific Islands.’’
Hendy says: ‘‘The best-case scenario is that we will reach good levels of vaccine coverage across the globe sometime in 2022. We may be able to put the pandemic behind us in 2022.’’
At the current vaccination rate, however, global completion isn’t likely until 2023 or 2024. The longer it takes to immunise the masses, the more likely altered booster shots will be needed.
‘‘If global vaccine distribution remains slow and inequitable . . . then Covid-19 may be with us for many decades ahead.’’
‘‘Every single thing people can do to slow transmission helps ... ’’