‘Treat flu like Covid’: Experts want new strategy for pandemic’s next phase

New Zealand should treat other serious respiratory infections like Covid-19, says a group of leading scientists and doctors calling for a comprehensive new strategy for the pandemic’s next phase.

Nearly a year on from the country’s last big Covid-19 surge, modellers expect future waves to play out as they have since, with smaller peaks over time.

The coronavirus continues to cause thousands of infections, hundreds of hospitalisations and tens of deaths every week – and this year may claim twice the number of lives the flu annually does.

“While Covid-19 is no longer causing a health emergency, it remains a global pandemic with continuing high health impacts,” Otago University epidemiologist Professor Michael Baker said.

“It is also causing a large, but unmeasured burden of long Covid, which may ultimately be its bigger health impact.”

Flu, too, has been causing a heavy health burden in New Zealand over the past two years – clinics have been dealing with sustained cases since the season began early in April – as have other respiratory nasties such as RSV.

In an editorial in the New Zealand Medical Journal today, Baker and 15 other experts have called for a rethink about how the country manages all respiratory infections.

They propose a new national strategy that includes measures like raising vaccination rates for at-risk people, supporting those who are self-isolated, improving indoor air quality, encouraging masks in crowded and poorly ventilated spaces and continuing infection control across the healthcare sector.

New Zealand ended the last of its Covid-19 health protections in August – and the fact the roll-back didn’t result in a big rebound of cases led some experts to speculate Kiwis had continued to be vigilant and stay home when sick.

Otago epidemiologist Associate Professor Amanda Kvalsvig said adopting the strategy’s approaches would put New Zealand in a “strong position” to manage today’s respiratory illnesses, along with future pandemics.

“We also need better real-time data about respiratory infections to help guide our response,” she said.

“One important step will be to set up sentinel sites in communities around the country to monitor infections and test for viruses in a systematic way.”

ESR ran surveillance of Covid-19 through sampling wastewater and community and hospital virus samples, while monitoring flu, RSV and a host of other viruses and diseases.

But Government plans for regular infection prevalence surveys were repeatedly postponed, then finally shelved this year.

Another co-author, New Zealand College of Public Health Medicine president Sir Collin Tukuitonga said equity needed to be at the heart of a new strategy.

“The pandemic remains a major cause of health inequities, with far higher rates of hospitalisation and death for Māori and Pacific people, even after adjusting for age.”

New Zealand’s response to the pandemic, especially its elimination strategy, has been globally lauded for keeping cumulative excess mortality rates close to zero.

Baker said the response ultimately saved almost 20,000 lives in New Zealand, based on the deaths that would have occurred with the United States’ mortality rate.

“Remarkably, New Zealand has achieved this outcome with a relatively low level of restrictions, with the average stringency of control measures being lower here than in other high-income countries such as Sweden.”

Ahead of this month’s election, parties have signalled differing ways of managing Covid-19 – particularly long Covid.

Labour has asked health agencies to consider a raft of expert recommendations to address long Covid, and the Greens have pledged to introduce new ventilation standards and extending access to the bivalent vaccine to everyone aged under 30 years.

National says it would “work with experts to identify the ongoing health impacts” of Covid-19 then “monitor and manage the conditions, impacts and interventions”. Act supported management of long Covid “through the existing health system”.

Today’s call comes as a new study, led by Otago researcher Dr Jennifer Summers, compared New Zealand’s experience with the Covid-19 pandemic and the influenza pandemic a century before.

While both were driven by respiratory viruses, the influenza wave swept through the country in less than two months, infecting about half the population and killing more than 9000 people, before largely disappearing.

By contrast, the Covid-19 pandemic was still ongoing, with 20 people a week dying from it, and the death toll today standing at more than 3360.

“In the United States, Covid‑19 has now killed 1.13 million people, far more than the 675,000 people who died from the influenza pandemic in 1918-19,” Baker said.

Despite the pandemics being more than 100 years apart, he said, authorities initially had similar measures to draw on, including border management, isolating cases and quarantining contacts.

In 2020, however, we had the benefit of tools like modern testing and tracing, genome sequencing, rapid vaccine development and huge advances in treatment of severely ill people.

Another similarity stood out to the researchers: “Māori in 1918-19 experienced higher rates of chronic disease and discriminatory outbreak management approaches,” said co-author Associate Professor Matire Harwood, of the University of Auckland.

“More than 100 years later, those health inequities from chronic disease still exist.”

Co-author Professor Nick Wilson said the study’s findings showed a need for a pandemic plan that covered a wide range of pandemic organisms and scenarios – along with a systematic approach to tackle health inequities.

“Future plans need to be far more versatile and even include the possibility of engineered pathogens that are used in warfare or escape from laboratories,” he said.

“Our previous plan largely accepted that we would simply let the pandemic wash over us – a mitigation strategy – as we did in 1918.

“Yet, as this analysis shows, we had much better outcomes with an elimination strategy.”