‘I don’t think we’ll go back to square one’

How Kiwis can steer through Omicron storm

In early January, three Americans proposed a plan for the ‘‘new normal’’: that is, life with Covid-19. The coronavirus, they wrote, should be seen as another circulating respiratory illness – like influenza or respiratory syncytial virus (RSV).

Eradication or elimination of Covid-19 is impossible given immunity imbued by the current vaccines do not protect against infection in the long-term. Frankly, it means there’s no practical way right now to expel this bothersome newcomer.

Spain’s prime minister Pedro Sanchez has suggested it’s time to treat Covid-19 like the flu. Bill Gates has said similar. Pfizer CEO Albert Bourla has said the coronavirus will circulate for years to come, and thinks this will be the last wave to require restrictions.

South Africa is also pivoting towards a new approach made possible by the fact, as a trio of public health experts write: ‘‘The death rate with [the] Omicron wave in South Africa is on track to be approximately onetenth compared to the Delta wave.’’

In the UK, Labour leader Keir Starmer has outlined a plan to coexist with the virus where people can ‘‘live their lives as normal’’ and never again face ‘‘tough restrictions on our lives, our livelihoods and our liberties’’.

Professor David Heymann of the London School of Hygiene and Tropical Medicine has said the pandemic in the UK may soon be over. The virus, he suggested, will soon be endemic.

You’ll see this word thrown around quite a bit over the coming months; it’s used by different people in different ways. It does not mean the virus is harmless. It just means it reaches an equilibrium of sorts, where it’s somewhat predictable and manageable. This, as some have written, will technically happen when everyone has been vaccinated or has had Covid-19.

Such attitudes have been embraced not because Omicron is the common cold. Yes, Omicron certainly appears less intrinsically severe than Delta, Dr Stephen Kissler, an infectious disease expert from Harvard University told me, but it may well be somewhat comparable to earlier variants that wreaked havoc before mass inoculation.

These attitudes are only possible because of mass vaccination.

Others have taken a much more cautious approach. The World Health Organisation (WHO), for instance, has said it’s much too early to treat Covid-19 like the flu. (Although it suggests the ‘‘emergency’’ may end this year.)

The pandemic is in a somewhat mindbending space. An individual’s risk (assuming they’ve been fully vaccinated) of dying with Covid is the lowest it’s been. As new treatments come online those risks fall even further.

But the extraordinary infectiousness and speed of the Omicron variant has birthed case loads that have ripped at the fabric of societies worldwide. Even in highly vaccinated countries hundreds of thousands of cases all at once will put hospitals, in particular, under intense pressure.

Omicron may well be mild for most, but it’s not a walk in the park for everyone. In New Zealand, for instance, there are plenty of people for whom Covid-19 is still novel; their immune system will have no idea what it’s up against when the virus looks for somewhere to multiply.

In New South Wales, for instance, data suggests the unvaccinated are 13 times more likely to end up in intensive care.

As with any respiratory illness, the immunocompromised and elderly, in particular, face some risk.

After two years, it’s likely been easy for many New Zealanders to look at the rest of the world and think ‘‘we’ll never be that lot with all their Covid’’. Yet Omicron has changed the game and there are unpleasant realities to face. A large outbreak is very likely imminent.

That does not mean New Zealand will have failed; 15,000 cases and 52 deaths in two years is not failure. The almost unimaginable success of the vaccination roll-out means we will thankfully never endure the breadth of suffering seen in comparable countries overseas. That is not defeat.

Unless New Zealand can keep Covid-19 out and is prepared to live forever with border restrictions, becoming, as Immunisation Advisory Centre medical advisor Professor Peter McIntyre puts it, ‘‘the China of the Pacific’’, we’re going to be just another country with a soaring Omicron curve.

So, now what? What happens when and if Omicron hits? The plan at the moment is quite familiar: use border restrictions to buy time to prepare.

It’s certainly not March 2020 all over again and neither is it August 2021. A staggering 93 per cent of the eligible population has had two doses; there’s no reason to expect a booster campaign – rightly focused on the elderly and Ma¯ ori – will languish. Children are now also being inoculated.

Yes, the vaccines are much less effective at stopping transmission (that’s not to say they’re entirely bypassed, by the way) but they do, most importantly, hold up very well against serious illness and death. And fortunately, Omicron is less severe.

‘‘The risk that we face from Covid-19, with an Omicron infection, once you’re vaccinated and boosted is really now much more in line with the risk from other infectious diseases that we’re already familiar with, and sort of tolerate in our societies,’’ Kissler said.

What will likely be disconcerting is that both our major Covid acts had endpoints – a time when things went back to ‘‘normal’’.

In early 2020, with its entire population facing a novel virus, New Zealand eliminated Covid-19. Last year the Delta incursion was suppressed until mass vaccination was achieved.

Unless we enact the tightest restrictions (and people follow the rules), there’s no reason to expect we’ll avoid comparable case numbers to those seen overseas.

What about those severe restrictions then? New Zealand’s Covid response has been made possible by border closures and lockdowns. If the borders are breached, why not go to the other tool?

The Government has said, given the vaccination rates, it would not use lockdowns this time around.

Just for some context, the Netherlands went into lockdown in mid-December. While it’s managed to control Omicron much better than most of its neighbours, it’s still seeing more than 30,000 cases a day. And now as cases continue to go up, some restrictions are being lifted.

New Zealand will, instead, use the red light setting to essentially do what it can to limit spread or flatten the Omicron curve. Think of this as ‘‘mitigation’’, it will likely mean success is gauged not via case numbers but by whether the hospitals are swamped or not.

It might look a little like Ireland – a very well boosted country, which placed tight limits on hospitality and limited mass gatherings. Ireland has seen 284,000 Covid cases in the Omicron wave (and 67 deaths, although that number will go up given infected people don’t die for some time).

Keep in mind, flattening the curve simply spreads out the caseload over a longer period to stop that all-at-once onslaught that has pushed medical systems beyond breaking point overseas.

This means New Zealand will still see a lot of cases. Yes, the virus won’t reach everyone, but the wave will not subside until Omicron has run out of people to infect.

How we behave also plays a part here. UK mobility data suggests the lack of a formal lockdown didn’t necessarily mean the whole country just got on with their regular life. Many, it appears, did stay at home as Omicron spread. This would have deprived the virus of hosts to grab on to.

There is another advantage to ‘‘curveflattening’’, as Professor Michael Plank explained. What goes up must go down and because the wave peaks at a lower point, there are fewer people infected following the crest.

Where does this all leave us? Ultimately, it means there will be hospitalisations, there will still be deaths and those numbers will almost certainly supersede anything we’ve seen thus far in the pandemic here in Aotearoa.

But it is not March 2020. Then, we were entirely exposed, now we’re not. Without the vaccines this would be exceedingly awful.

How the Government responds to the onslaught would ultimately, McIntyre also said, be based on politics, not just public health. Let’s go back to that word ‘‘endemic’’ for a moment. For many the coronavirus becomes endemic, not when it lines up perfectly to a textbook definition, but when society deems the risks acceptable.

New Zealand has by and large supported a cautious Covid strategy. There have been disagreements (‘‘Don’t travel for summer!’’ ‘‘Travel for summer is fine!’’), but these have been underpinned by a collective acceptance that Covid-19 is a serious illness, so we should do something. Will that now change?

In a piece titled: Why More Americans Are Saying They’re ‘Vaxxed and Done’, US publication The Atlantic speaks of a divide between the ‘‘vaxxed and done’’ (people, who after two years, have done everything they’ve been asked to do and are content to take the risks) and the ‘‘vaxxed and cautious’’ (people who very much believe ongoing restrictions are necessary).

This divergence is much more nuanced and understandable given the risk dynamic in highly vaccinated countries has changed. As the author Derek Thompson writes: ‘‘The risk of death from Omicron for boosted, healthy adults under 50 seems to be somewhere between that of riding a bike and going on an airplane.’’

It’s based on, as Leana Wall, a public health expert wrote in The Washington Post, a widespread belief that it’s ‘‘unreasonable to ask vaccinated people to refrain from prepandemic activities’’.

Australian columnist Brigid Delaney also touched on this in the midst of the NSW outbreak. In a recent column she wrote: ‘‘Even among groups of friends, there are cracks appearing between those comfortable being in the community and those who are essentially going back into lockdown this summer.’’

A Research New Zealand analysis several weeks into the Auckland lockdown found 70 per cent supported the use of a lockdown to eliminate Covid-19, but most of that support only existed until the vaccination targets were reached. Only 23 per cent supported lockdowns to eliminate Covid until it was ‘‘no longer a threat’’.

Given the high vaccination rates, and the fact parents can now vaccinate their children, New Zealanders (Aucklanders in particular) may well be done with the toughest restrictions, Emanuel Kalafatelis, the firm’s managing partner, said. But we simply don’t know yet.

‘‘Appropriately anxious’’ is how Dr Dougal Sutherland, clinical psychologist at Victoria University, described New Zealanders’ response to Covid.

And given that anxiety, he believed the population will be comfortable with restrictions for some time yet, particularly in the context of large case numbers.

‘‘I think if we look at how everyone has responded so far, I think the likelihood is that we’ll see people hunker down, initially, and we may get to a time when we kind of get over it [that anxiety] ... Maybe it’ll be a little different for Auckland.’’

It may also be that poorer people, living in packed homes, assess their risk differently, National Ma¯ ori Pandemic Group member and Ma¯ ori health provider Ha¯ pai te Hauora chief executive Selah Hart told me.

And what happens after Omicron? Let’s just put it this way. One of the experts I spoke to for this piece was humble enough to proactively tell me how often they’d been wrong about Covid.

We still don’t know precisely what happens when an Omicron wave recedes. As psychologist Dr Sarb Johal said, New Zealand will yearn for something definite that is likely not yet possible. The one thing we can expect with some certainty is that the sheer number of infections will almost certainly provide another layer of protection against future serious illness, but how long does that last? We’re still not sure what will happen to Delta, which is still doing the rounds. What about long Covid? Will the vulnerable need annual boosters? Will we all? Will better vaccines emerge?

There’s also the issue of a next Greek alphabet letter to go up in lights.

In a series of tweets last week, Adam Kucharski, an associate professor in infectious disease epidemiology in London, explained that Omicron didn’t emerge from the Delta family and Delta did not emerge from the Alpha clan.

‘‘And this is in quite a contrast to what we see with the seasonal viruses that have settled into a more predictable dynamic like influenza,’’ he told me subsequently.

This suggests the future of Covid-19 is fuzzy.

Of course, it’s rather unlikely a new variant will emerge that entirely evades our immune response, but a new iteration that is as infectious as Omicron and more severe is certainly plausible. This virus is a fairly simple beast – it just wants to make more of itself, and it doesn’t really care if it kills people.

‘‘I don’t think we’ll go back to a square one scenario, but we aren’t necessarily going in a nicer direction,’’ Kucharski said.

We cannot assume Covid-19 grows old gracefully. It may become a painful crank.

In that context, the Government will need to make decisions on a viable long-term strategy to manage Covid-19. How will it stay nimble to deal with mutations? Will it invest more in hospitals? Will it support people who need to isolate? Will it invest heavily in ventilation? Will it ensure there are enough anti-viral treatments and high-quality masks?

And if Covid becomes endemic, alongside other respiratory illness, what else can be done to ease the overall health burden? How, for instance, could we better subdue flu and diabetes without unreasonably impinging on the entire population’s lives?

Worryingly, as a number of public health experts have told me, once the panic ends, attention typically drifts elsewhere. Bureaucrats and politicians simply move onto the next big headline-grabbing thing.

Y‘‘I think if we look at how everyone has responded so far, I think the likelihood is that we’ll see people hunker down, initially, and we may get to a time when we kind of get over it [that anxiety] ... Maybe it’ll be a little different for Auckland.’’ Dougal Sutherland Clinical psychologist at Victoria University

ou might remember earlier, I mentioned three Americans have suggested it’s time to treat Covid like other respiratory illnesses. You may well have winced at that. ‘‘They want to do what?’’

They’re not cranks, by the way, who just want it to be 2019 all over again. They certainly don’t want to ‘‘let it rip’’.

No, they’re highly respected public health experts, advocating for a realistic and imperfect solution to a problem none of us wanted. They simply believe, as many others do, that the perpetual state of emergency cannot go on like this.