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Image: Tina Tiller
Image: Tina Tiller

ScienceDecember 21, 2021

For many New Zealanders, Covid-19 will be a lifelong disease

Contributing writer
Image: Tina Tiller
Image: Tina Tiller

Research into long Covid is in its infancy, but early indications suggest thousands of people will be unable to work months after contracting the virus.

“Now we have to talk about your quality of life.” I was 21 years old, sitting in a doctor’s office for the 13th time in 12 weeks, and I was being diagnosed with post-viral chronic pain and fatigue syndrome. What had started as an innocent sinus infection had turned into pain that never went away and the kind of fatigue that had me hallucinating on a daily basis, even though I slept for upwards of 12 hours a day. 

I almost laughed out loud. Quality of life was a term used in hospices, wasn’t it? It felt ridiculously out of place. It felt like I had opened someone else’s mail. This wasn’t supposed to be happening to me. 

Six years later and I still have fibromyalgia. I also feel like I’m staring down a wave of chronic illness that is hitting millions of people across the world and is about to hit us here. When the delta strain of Covid-19 finally broke through the barriers we had spent 18 months building up, I couldn’t stop thinking about long Covid in New Zealand.    

I work for an actuarial consulting company, which basically means we help insurance companies manage risk. Covid-19 is something that health insurers, life insurers and those who provide income replacement policies have to think about. With this in mind, I suggested we look into how long Covid would play out in Australia and New Zealand in the near future. This is what we found.

Case numbers

As a starting point for our analysis, we took the case numbers from Te Pūnaha Matatini, a research institute that has informed the New Zealand government’s response to the pandemic.

They projected infections over the next year under a range of scenarios which differ on:

–          The proportion of people vaccinated.

–          How effective the vaccine is.

–          The level of public health measures in place (e.g. restrictions on large gatherings).

–          How well the test, trace, isolate and quarantine (TTIQ) systems are functioning.

When New Zealand moved to the traffic light system on December 3, 86% of the eligible population was fully vaccinated.

For our analysis, we decided to go with the 90% vaccinated scenario from Te Pūnaha Matatini, along with central vaccine effectiveness – meaning neither the most pessimistic nor optimistic estimates – and baseline public health measures. 

While the government is insistent that contact tracing is able to keep up with demand and home isolation is working well, other signs point to a system that is struggling. A report from the Covid-19 Independent Continuous Review, Improvement and Advice Group (IAG) stated that the capacity of contact tracers would begin to diminish during a prolonged period of 100-200 cases per day. Given that case numbers have sat in this range for many weeks at a time, we chose the limited TTIQ scenario.

Under the selected scenario, Te Pūnaha Matatini projects 972,073 Covid-19 infections in a 12-month period. This includes asymptomatic and undetected infections. Based on international projections of asymptomatic versus symptomatic infections, we believe that this would result in approximately 220,000 symptomatic infections being detected in New Zealand.

Of these, we believe that about 105,000 will be vaccinated and 115,000 will be unvaccinated. This means that 2.7% of the vaccinated population will contract Covid, while 9.6% of those who are unvaccinated (or under 12 and ineligible) will catch it. 

Hospitalisations

Hospitalisation not only adds pressure to the healthcare system, it also has a strong impact on the projections of long Covid. The more severe your infection, the likelier you are to experience long Covid.

Based on current national rates and international evidence on the difference in hospitalisation rates between vaccinated and unvaccinated individuals, we project that 4.7% of all symptomatic cases will be hospitalised. For those who are vaccinated, the estimated rate of hospitalisation is 1.4%, while for those who are unvaccinated, it is 7.8%. Children under the age of 12 are included in the unvaccinated figures, and kids are much less likely to be hospitalised than adults. So for unvaccinated adults, the risk is higher than this number suggests.

Of the 220,000 symptomatic cases, we project that 10,500 will end up in hospital, and 1,300 will end up in the ICU. Taking the average cost of a night in hospital and ICU in New Zealand, and the length of time that someone with Covid tends to be hospitalised for, we expect that this will cost the public healthcare system about $158 million in the next year.

While almost half of Covid infections are expected to occur in those who have been vaccinated, we expect that only 14% of hospitalisations and 19% of ICU admissions will be for vaccinated individuals.

Long Covid

Long Covid is becoming more relevant as we realise just how many people seem to experience some degree of symptoms for months after the initial infection. Research into long Covid is in its infancy and we don’t know how long these symptoms will continue, in part because enough time hasn’t gone by. Anyone looking at our projections should bear in mind the uncertainty that exists in this area. However, we do have some initial indications of what to expect.

Research suggests that 27% of those with a symptomatic infection and 50% of those who are hospitalised will have a post-Covid condition at 30 days. This means that they are still experiencing some symptoms a month on, most commonly pain, breathing difficulties, hyperlipidaemia (high cholesterol) or fatigue. We can combine this with evidence that of those people who are experiencing symptoms at 30 days, 45% will be working reduced hours seven months down the road due to long Covid, while an additional 22% will not be working at all.

Vaccination does seem to cut the risk of long Covid in half, along with reducing the risk of catching Covid in the first place and reducing the risk of hospitalisation.

We expect that 22,000 people in New Zealand will have long Covid such that they would need to work reduced hours seven months after the acute infection, and an additional 10,700 would need to stop working completely.

These numbers include people who are not working (e.g. children, students, stay at home parents, unemployed and retired people), so could be more accurately thought of as moderate and severe impairment due to long Covid. Our projections indicate that 6.3% of vaccinated cases and 13.2% of unvaccinated cases will experience moderate impairment, and 3.1% of vaccinated cases and 6.5% of unvaccinated cases will experience severe impairment seven months after infection.

Among the working age population (aged 18-65) we expect that 13,700 New Zealanders will be moderately impaired and 6,800 will be severely impaired due to long Covid, seven months after they initially caught the virus. In both cases, unvaccinated individuals make up just over 60% of all long Covid cases, despite being only 10% of the adult population. 

Conclusion

Until now, the health impacts of Covid-19 on New Zealand have been much more limited than in other countries. That is changing, and for some, this will not be a short-term acute infection that is completely resolved after a few weeks.

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Many of us who have conditions that are similar to long Covid hope that more research, better treatment and an awareness of chronic illness will come out of this pandemic. We also know how difficult things are about to get for those people who develop long Covid.

So how is my quality of life now? Probably better than that doctor expected. I manage my condition through a combination of medication, exercise, and having the kind of sleep schedule that most 20-somethings would laugh at. I don’t hallucinate because of fatigue anymore, and I have some pain-free days. But put it this way: if I could only change one thing about my life, this reality would be it.

Since the pandemic began, I’ve been significantly less worried about the acute illness that Covid can cause, and much more worried about the long-term impacts of getting sick. The risk might be small, but when we roll that dice hundreds of thousands of times, you don’t need to be an actuary to know that thousands of people will lose. So I am asking you to give yourself the best odds, get vaccinated, wear a high quality mask, and take any other precautions you can to protect yourself.

Keep going!
A queue at a vaccination hub at Chelsea FC’s Stamford Bridge stadium in London on December 18. The UK delivered record numbers of booster shots over the weekend as omicron continued its spread (Photo: Wiktor Szymanowicz/Future Publishing via Getty Images
A queue at a vaccination hub at Chelsea FC’s Stamford Bridge stadium in London on December 18. The UK delivered record numbers of booster shots over the weekend as omicron continued its spread (Photo: Wiktor Szymanowicz/Future Publishing via Getty Images

ScienceDecember 20, 2021

Siouxsie Wiles on the worrying rise of omicron

Contributing writer
A queue at a vaccination hub at Chelsea FC’s Stamford Bridge stadium in London on December 18. The UK delivered record numbers of booster shots over the weekend as omicron continued its spread (Photo: Wiktor Szymanowicz/Future Publishing via Getty Images
A queue at a vaccination hub at Chelsea FC’s Stamford Bridge stadium in London on December 18. The UK delivered record numbers of booster shots over the weekend as omicron continued its spread (Photo: Wiktor Szymanowicz/Future Publishing via Getty Images

In less than a month, the new Covid variant has made it around the world – including to New Zealand. Siouxsie Wiles breaks down what you need to know about the rapid spread of omicron.

It’s hard to believe that it’s been only a few weeks since we first heard about the omicron variant. Since then it’s spread all around the world, including to Aotearoa. 

So, what do we now know about omicron?

It’s very transmissible, and cases are rising really fast

Dr Ridhwaan Suliman posted this graph on Twitter that compares cases in Gauteng, South Africa for each of their Covid waves. The red line is omicron. The rise in cases compared to the previous waves is astonishing. 

Similar rises are being seen all over the world, from Denmark and Germany to the UK and US. Cases are doubling every two to three days. A few days ago, 72% of positive PCR tests in London looked to be omicron. The UK was already experiencing a surge in delta cases, but that’s been swamped by omicron, which has become the dominant strain. Closer to home, New South Wales just announced they’d had 2,566 cases in the last 24 hours. A week ago, they were averaging about 500 cases a day.  

A couple of new lab studies give one potential reason for the increased transmissibility of omicron. In one, researchers from the LKS Faculty of Medicine at The University of Hong Kong looked at the ability of omicron and delta to infect and replicate in human lung and bronchial tissues. These tissues come from people who are having surgery or other medical procedures and would normally be discarded, but these researchers can keep them alive for a few hours to use them in experiments. 

The researchers found that omicron was 70 times better than delta at infecting and replicating in bronchial tissues and 10 times worse at infecting and replicating in lung tissue. The bronchi are the two large tubes that carry air from your windpipe to your lungs. What this means is that the omicron variant probably replicates better in the upper airways, so people may well be breathing out more virus particles. It remains to be seen whether replicating less in the lungs means the omicron variant will cause less severe disease. 

Meanwhile researchers from the US, Germany and South Africa showed that fake viruses (known as pseudoviruses) made to look like omicron were twice as infectious as delta in their lab-based experiments. All the data is pointing the same way.

Omicron and vaccines

Both that study using omicron pseudoviruses and a heap more lab-based studies have shown that the antibodies people make either after they’ve been infected with an earlier version of the virus or if they’ve received two doses of the Pfizer or other vaccines aren’t able to neutralise the omicron variant well, if at all. The picture looks better if you’ve had a booster. 

The numbers vary, but they all suggest that double-vaccinated people will be at much greater risk of catching omicron than they are of catching delta. Of course, there is lots more to our immune system than just antibodies, so these experiments can’t tell how well being vaccinated will protect against serious disease for those people who do test positive.

The findings of those lab studies are certainly playing out in the real world, with lots and lots of vaccinated people testing positive for omicron. Arrivals into our managed isolation system all have to be double-vaccinated and we’re already into double digits for omicron cases in just a few days. The virus also spread across the hall between two vaccinated people in a hotel managed quarantine facility in Hong Kong. There have also been some extraordinary super-spreader events including a party held at a restaurant in Oslo, Norway. As of a week or so ago, around 70 of the 120 party goers had tested positive. So had another 50 people who were at the restaurant at the same time. It sounds like all were vaccinated. 

Meanwhile, data from the UK is suggesting that two shots of the Pfizer vaccine is about 30-40% effective against omicron and a third dose boosts that to 70-80%.

Is disease with omicron milder?

It’s too soon to tell. Hospitalisations and deaths normally lag cases by several weeks as it takes time for people to get very sick, and sometimes they can be in intensive care for weeks to months before they die. 

There are two things we really need to know. How well do the vaccines protect against serious illness and death from omicron, and what happens to people who aren’t vaccinated who get omicron? Here in New Zealand, the overwhelming majority of our eligible population have had two doses of the Pfizer vaccine. But we do have some people who aren’t vaccinated. Or course, we also have all of our under 12s unvaccinated at the moment. The paediatric Pfizer vaccine has just got provisional approval from Medsafe, so hopefully will start being rolled out soon. But it will take time to get them all vaccinated. 

Here’s another graph tweeted by Dr Suliman showing hospitalisations are now on the rise in Gauteng. We’ll be watching to see what happens in other places.

Over the weekend, Imperial College London released an interim analysis of omicron cases in the UK. The study concluded there were at most limited changes in severity of disease between omicron and delta. But even if does turn out that omicron causes a milder illness for most people, that won’t be the case for everyone. And because of the sheer volume of people catching omicron, hospitals are still likely to be overwhelmed. Remember “flatten the curve“? Even a disease that is relatively mild for lots of people can still bring healthcare systems – especially those already battered by waves of Covid-19 – to their knees. We also don’t yet know whether those who have a mild illness from omicron will go on to develop long covid and be impacted for life. 

Let’s hope the incredible efforts of everyone working at our border will keep omicron out of the community for as long as possible, at least till we can get our children vaccinated and everyone else a third dose.