A transition from elimination to suppression was likely to come at some point, but it would be better it happened next year, and under different circumstances. We now face a new set of challenges, writes Siouxsie Wiles.
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Like so many in Aotearoa New Zealand, I’ve spent the last week or so watching our new Covid-19 cases slowly grow. By global standards, our daily cases are minuscule. But every new case that wasn’t part of a household already in isolation signalled the possibility of transmission chains we didn’t know about. After keeping the pandemic at bay for nearly 20 months it began to feel like delta was settling in. Was this the end of elimination for us? I spent much of the last week randomly bursting into tears at the thought of what this means.
Aotearoa’s elimination strategy has required two really important things: restrictions that would have seemed completely unthinkable just two years ago, and the social licence to put those restrictions in place. I remember waking up for our first day at alert level four last year. The street was eerily quiet. Most of us stayed home while our essential workers kept the supermarkets stocked and the power on. They kept the hospitals functioning. They removed our rubbish. So many of them not even earning a living wage. Yet their work and the rest of the country staying home, some of us juggling our work with our children’s online learning, saved lives and our economy.
Meanwhile efforts to live with the virus overseas led to mass graves and refrigerated trucks parked outside of overwhelmed hospitals. To cancelled surgeries and delayed cancer diagnoses that in some countries haven’t been caught up. The Economist estimates that the pandemic is responsible for between 9.9 to 18.5 million deaths so far. A health system overwhelmed by Covid-19 patients can’t also look after people having a heart attack or a stroke or any of the other things that happen to people every day.
Here in New Zealand a force of thousands worked hard to keep the virus at bay at our border. Because of their enormous efforts we’ve spent very little of the pandemic living under restrictions. Our children have spent most of the last two years in school. We’ve had concerts and festivals and sports games and indoor dining. And we’ve been able to do all those things safely.
Our elimination strategy also bought us time. Time to learn from the mistakes of others and time for vaccines and treatments to be added to our toolkit. Who would have thought we’d have more than one safe and effective vaccine in widespread use within just 12 to 18 months of Covid-19 appearing? But the dark cloud hanging over that success story is their limited supply which has led to a humanitarian disaster that should not have been allowed to happen. It is an absolute travesty that some countries are rolling out boosters while others haven’t even been able to vaccinate those most at risk of dying.
To the countries who can get them, vaccines are saving lives every day. Covid-19 is becoming a disease of the unvaccinated. But as the virus has become more transmissible, both the modelling and real-world experience is showing that nearly everyone over the age of five will need to be vaccinated to protect those who can’t be vaccinated or who are vaccinated but haven’t made had a good enough immune response. Like people with some forms of cancer.
Because we don’t yet have a vaccine approved for the under-12s no country is able to protect everyone. That’s why the UK’s so-called Freedom Day was anything but for thousands and thousands of people. Those who can stay home have to weigh up the damage caused by indefinite isolation with the risk of getting seriously ill or dying if they venture out of their homes. Those who aren’t privileged enough to stay home take their lives in their hands. Children who can’t be vaccinated have gone back to school only to be infected by their unvaccinated, unmasked teachers. They then take the virus home with them and infect their families.
I was gutted when the prime minister announced on Monday her roadmap out of our current restrictions. To me it signalled a pragmatic transition from the elimination strategy to one of suppression, where we use vaccination and vaccine passports, masks, improved ventilation, rapid-testing, and other tools to minimise transmission, together with testing, contact-tracing, and isolation to control transmission chains and clusters as they emerge. It is clear we have to keep cases as low as possible or we risk overwhelming our healthcare system, especially at the moment while over half of New Zealanders are not fully vaccinated.
Let me be clear. There is nothing intrinsically wrong with moving from elimination to suppression as a strategy. But the safest time to make that transition would have been next year, when vaccines are likely to become available to our under-12s, and at a moment when Covid-19 was not in our community. That it is happening with an active delta outbreak means it is dangerous to grant any part of New Zealand the freedoms of living at alert level one that we’ve all enjoyed for so much of this pandemic. We have ample evidence that the border around Auckland is not impenetrable, so level one freedoms mean the chance of a super-spreader event are too high.
Transitioning to a suppression strategy means we all need to mentally and physically prepare ourselves for what life with Covid-19 in our communities is going to be like. To keep cases as low as possible will require changes to the way we’ve lived through the pandemic so far. As we’ve seen overseas, it will require vaccine passports and mandates. It will require wearing a mask in certain settings, even if you are fully vaccinated. It will likely require regular testing. We’ll need to up our game on ventilation. But the saddest part is that for some people it will require weighing up whether it is safe for them to do things that they would have been able to do in the past.
It probably sounds a bit weird, but I feel like I’ve started a process of grieving for what we are losing. The pandemic has changed our world forever, and that is going to take some getting used to. My worry is that we will see what we have seen in so many countries, and indeed in New Zealand during this outbreak – that the burden of Covid-19 will continue to fall on people and communities inequitably. We will have failed if our transition from elimination to suppression does not actively work to stop this happening.