New Zealand has been applauded globally for its apparent success in limiting COVID-19 infections and death. It is true that New Zealanders enjoy liberties in their day-to-day lives that are not available to others around the globe.
But a question remains that is relevant to both this pandemic and the next. At what cost was the success achieved? Available evidence suggests that the costs may have been much higher than anticipated and also higher than any benefits.
This is not to minimize New Zealand’s success or to needlessly question the policy response. It is important to understand that there were always trade-offs involved in mitigating the COVID-19 threat. Any potential benefits of stringent policy measures such as strict lockdowns need to be balanced against the threat of economic slowdown, job losses and other social and economic problems.
The reason why this question is important is that all available evidence indicates that the success achieved by New Zealand was not entirely its own doing and that it could have been achieved with lower social and economic costs.
Early on in 2020 it became clear that the lockdowns had little impact on COVID-19 mortality. This was true if one compared across countries at a point in time, across counties in the United States and within the same country over a span of time. It was also clear early on that the main drivers of COVID-19 mortality1, by country, had little to do with whether or not a country locked down.
New Zealand’s initial severe lockdown was justified as an effort to protect the health system from a flood of COVID-19 patients needing ventilators, supported by dire forecasting.2 We now know that intensive cares in this country were never threatened. The high initial fatality ratio of the virus of 3.4% has now been dialed back considerably to about 0.2%.3 Countries such as Singapore that have applied a rigorous definition to reporting COVID-19 deaths now have astonishingly low fatality rates.4
In addition, hospitals are much better at treating COVID-19 cases than they were earlier in the pandemic. A study in New York5 showed that hospital mortality has reduced by more than two thirds since earlier this year. Since we have recently had community cases without further lockdowns, we support the government’s resolve to handle the virus without resorting to these strict measures.
We know now that lockdowns have devastating unintended consequences for jobs and individual’s mental health. Lockdowns have adverse effects on children’s mental health, with a surge in eating disorders in Melbourne6, and we understand that Starship hospital in Auckland has been affected by a similar surge.
The economy and peoples’ livelihoods in this country have taken a similar hit. The City Mission7 reported demand for food parcels 175% higher during level 3 than the same period the year before. More than 50,000 people are now on the job seeker benefit since the start of the year and many industries are suffering from skill and labour shortages as a result of strict quarantine regulations. Those on the front lines dealing with child poverty8 have noticed increasing hardship.
We now appreciate that the costs of lockdowns9 in this country were about 200 times what Treasury would normally accept for other policies aimed at achieving health gain. The International Monetary Fund predicts that the economic slowdown in New Zealand coupled with the massive expansion in government borrowing will lead to New Zealand’s per capita GDP to be lower in 2025 compared to 2019.
As New Zealand seeks to recover from COVID-19 what should our strategy be?
Will vaccines be the path to freedom? According to a recent BMJ article10 none of the current vaccine candidates may be successful in reducing severe COVID-19 (hospital admission, ICU, or death) or interrupting transmission (person-to-person spread). At least the trials are not designed to test for these primarily due to the extremely compressed time-frame.
We need to be cautious about vaccines since these are aimed at otherwise healthy people, especially as the vast majority of people under the age of 65 years are at very low risk from fatality from the virus. We need remember others’ experience with rushed vaccines such as for swine flu. Narcolepsy cases rose among the vaccinated.11 A British nurse committed suicide12 after she developed narcolepsy following a swine flu vaccine as a condition of her employment. The Pandemrix® narcolepsy affair was described as “a completely avoidable catastrophe” by an Irish politician.13 After much initial alarm about high fatality from swine flu, these figures were later found to be exaggerated, and vaccination unwarranted. This is not to say that the same will happen for COVID-19, however, we need to learn from past mistakes.
Border policy is now the last barrier to returning to normal life. The European CDC14 is now advising against systematic testing and quarantine of travelers in Europe. Authorities overseas are now balancing COVID-19 concerns with other societal goals and are looking to return economic activity to normal. Prime Minister Ardern’s pledge for a travel bubble with Australia and The Cooks are a step in the right direction. It is simply not sustainable for New Zealand’s borders to remain firmly restricted for long periods.
A strong international movement15 has now developed, led by leading medical and epidemiological scholars urging a return to normal for the majority of the population who are very low risk of adverse consequences from infection. Those at raised risk as a result of age or other illness may be voluntarily protected. With about half of COVID-19 fatalities occurring in people who live in residential care, these institutions are an obvious priority for enhanced infection control.
About the authors:
Dr Simon Thornley is a Senior Lecturer of Epidemiology and Biostatistics at the University of Auckland.
Dr Ananish Chaudhuri is a Professor of Experimental Economics at the University of Auckland, and Visiting Professor of Public Policy and Decision Making at Harvard University, Massachusetts, USA.
Dr Grant Schofield is a Professor of Public Health at AUT.
We know now that lockdowns have devastating unintended consequences for jobs and individual’s mental health.