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Zero COVID has cost New Zealand dearly

Throughout much of the pandemic, proponents of Zero COVID and lockdown have promoted the island nation of New Zealand as a success story. Since the beginning of March 2022, however, this success has turned sour.

If New Zealand case rates continue to grow as they have in the recent past, cumulative per-capita cases will exceed those in the UK and the EU in the coming months.

Early Zero COVID success

  • On 28 February 2020, New Zealand’s public-health authorities identified the nation’s first COVID patient – a traveller from Iran, where a large outbreak of COVID cases was then proceeding.

New Zealanders panicked, stocking up on food, toilet paper and other necessities. Rumours surfaced that the New Zealand government planned to impose lockdowns, including mandatory stay-at-home orders.

On 19 March 2020, Jacinda Ardern, New Zealand’s prime minister, swatted away the rumours, telling people to look only to the government for true information: ‘Unless you hear it from us, it is not the truth.’

Just over a month into New Zealand’s sharp two-month lockdown, COVID cases dropped to zero. On most days throughout 2020 and 2021, New Zealand reported no new COVID cases. While much of the rest of the world suffered through pandemic and lockdown misery in 2020, New Zealand residents proudly posted pictures on social-media sites of normal life. In the New England Journal of Medicine, experts funded by the Health Research Council of New Zealand bragged about how New Zealand’s strategy of lockdown, closed borders, contact tracing, isolation and quarantine had conquered the virus afflicting much of the rest of the world.

Why did New Zealand succeed in those early months in eliminating COVID?

It had two significant advantages that many other countries lacked.

  • First, COVID likely first arrived in New Zealand in early 2020 – midsummer in the southern hemisphere.

Although it can spread out of season, COVID has a seasonal pattern, and winter is its season.

If this highly infectious virus had landed on New Zealand’s shores in its winter, the virus would have spread more readily.

  • Second, New Zealand is an island nation with the majority of international traffic coming in through a single airport in Auckland. Shutting itself off from the rest of the world is possible in New Zealand in a way that is impossible elsewhere.

Intermittent lockdowns and lockdown harms

The Zero COVID success, however, was far from costless or complete. Closed borders meant many ex-pats faced steep hurdles returning home, even to care for sick family members. The two-month-long lockdown at the beginning of the pandemic led many to delay essential health services, subsequently causing overburdened hospital systems and long delays in medical care for tens of thousands of New Zealanders that continue to this day.

  • Despite effectively zero community spread of COVID in 2021, the average of weekly mortality levels was higher than expected, given mortality patterns from before the pandemic.
  • There was economic damage as well during the Zero COVID period.

New Zealand’s typically robust tourist industry collapsed as overseas visitors stopped coming. The New Zealand economy shrank by two per cent in 2020 despite Zero COVID, recovered to grow by 5.6 per cent in 2021, but shrank again in the first quarter of 2022 as Omicron cases spread throughout the nation.

Looming over the citizens of New Zealand throughout its Zero COVID glory days was the threat of another lockdown whenever the public-health authorities found even a single case on the island. After 100 days with no community transmission, in August 2020, the emergence of a few cases led Ardern’s government to impose a stay-at-home order in Auckland and restrictions on gatherings in the rest of the country. This pattern repeated itself over and over during the pandemic, often including sharp restrictions on freedom of movement across the country. During one lockdown in September 2021, two enterprising citizens smuggled contraband Kentucky Fried Chicken into Auckland from outside the city limits and were arrested for the crime.

Delayed vaccination rollout

When the COVID vaccines arrived in December 2020, they offered a way out of the Zero Covid trap that New Zealand found itself in. At great cost, the policy had ‘worked’, but there was no endpoint to it that did not involve isolation from the international community forever. With the advent of the vaccines, New Zealand had a way out.

In fact, the vaccine offered two possible ways out, and New Zealand needed to choose between them. On the one hand, if the vaccine could durably prevent the infection and transmission of the disease, it could be used to effectively protect the island from ever having a sizeable COVID outbreak, as long as a sufficiently large portion of the population were vaccinated. On the other hand, if the vaccine protected against severe disease and death from COVID infection, it could be used to protect high-risk people (the elderly and others). It could be used, in effect, as a tool for the focused protection of the vulnerable, as suggested in the Great Barrington Declaration, which I co-authored back in October 2020. In either case, the vaccine would enable the lifting of the lockdowns.

  • Despite the impetus for ending the Zero COVID policy as rapidly as possible, the New Zealand government dawdled in its vaccine rollout. While many developed countries vaccinated a significant fraction of their elderly populations by April 2021, New Zealand delayed.
  • As late as October 2021, the Ardern government came under fire for its delays in coming to an agreement with vaccine manufacturers to obtain sufficient doses for the whole population. The government organised an ‘election-style’ vaccination drive throughout October to make up for the problem. Nevertheless, when the Delta wave of the virus hit the world, only a small fraction of New Zealand’s population was vaccinated, so the lockdown restrictions continued.

A failed herd-immunity strategy

  • Ultimately, New Zealand chose a strategy of vaccinating its population for herd immunity rather than a strategy that primarily focused on protecting the vulnerable and rapidly lifting restrictions.
  • The New Zealand government set a target of immunising 90 per cent of its population as a precondition for ending restrictions. It enforced its policy by requiring large classes of workers – including police, healthcare workers and some educators – to be vaccinated as a condition of employment. It instituted the ‘NZ COVID Tracer’ application for smartphones that businesses could use to monitor the vaccination status of patrons.

Unfortunately, New Zealand bet wrongly on the vaccine-induced herd-immunity approach.

The problem is that while the vaccine prevents severe disease and death due to COVID, it does not stop the disease from spreading. This fact was impossible to know with certainty in late 2020.

  • By late 2021, country after country with high vaccination levels experienced large waves of COVID cases.
  • The only way this was possible was if the vaccine did not stop people from becoming infected and transmitting the disease onward.

High-quality papers published in top medical journals demonstrated that vaccination protected against infection for only a few months after vaccination. Boosting with additional vaccine doses – especially in the Omicron era – also does not prevent infection.

  • From this evidence, it was clear that New Zealand’s herd-immunity strategy would inevitably fail. When it finally opened up, it could expect a significant wave of COVID cases, which is precisely what happened.

The Omicron wave hit the world in late 2021 and early 2022, with a highly infectious variant capable of evading immunity and infecting both people who were COVID recovered and vaccinated people in high numbers.

By February 2022, like other developed countries, New Zealand had successfully vaccinated a large proportion of its population, elderly and young, vulnerable and non-vulnerable alike. The pressure on the government to relax the lockdowns was immense. Finally, even as a wave of new cases hit New Zealand in late February / early March 2022, PM Ardern jettisoned Zero COVID and adopted a ‘suppression’ policy. In April, Ardern’s government rescinded New Zealand’s vaccine mandates and passport policies. The COVID surge that started in late February continues to today. Zero COVID lockdowns have not returned, though mask mandates remain in place in select venues.

Evaluating New Zealand’s Zero COVID strategy

With two-and-a-half years of hindsight, a tentative evaluation of New Zealand’s lockdown-focused Zero COVID strategy is possible. On the plus side of the ledger is that New Zealand’s strategy delayed the inevitable spread of COVID throughout the population to a time after the development, testing and deployment of a vaccine capable of reducing the burden of severe COVID disease.

  • Despite having experienced more COVID cases per capita throughout the pandemic than the US, New Zealand has a tiny proportion of the US’s COVID-attributable deaths per capita.

On the negative side of the ledger is the tremendous burden on the New Zealand population that has come from being isolated from the rest of the world for such a long time, and from the intermittent lockdowns the government imposed on the population.

All-cause excess deaths – below baseline levels in 2020 – shot up in 2021 and in 2022. Some weeks, recorded death rates were at 32 per cent above the norm.

New Zealand delayed and reduced COVID deaths at the expense of increasing deaths from other causes. And then, of course, there are the enormous economic, psychological and additional health costs of lockdown that the population will pay out for over the coming years.

The strategy itself is also not exportable to other countries.

  • It depended on the good fortune of New Zealand being an isolatable Pacific island in the southern hemisphere.

Suppose COVID had hit during New Zealand’s winter rather than its summer. In that case, it is unlikely that the March / April lockdown (instituted late relative to other countries like China or Italy) would have worked to reduce COVID cases to zero during that first wave. And, of course, not every country is located on an island in the Pacific.

After the vaccine arrived, New Zealand’s decision to use it to free itself from its Zero COVID trap and the ever-looming threat of lockdowns was smart. However, New Zealand failed to vaccinate its population with urgency, exposing its people to a full year of Zero COVID harms even after most developed countries had deployed the vaccine successfully.

If the government had adopted the Great Barrington Declaration strategy of vaccinating for focused protection instead of for herd immunity, and if it had not dawdled in obtaining the vaccine, New Zealand could have been open by mid-spring 2021 rather than mid-spring 2022.

  • Finally, New Zealand’s strategy relied entirely on the development and testing of a vaccine outside of its borders. Indeed, the vaccines could never have been tested in 2020 and 2021 within New Zealand because there were insufficient COVID cases to run a meaningful randomised trial.
  • In effect, New Zealand relied on the fact that other countries did not adopt a Zero COVID policy to create conditions that permitted New Zealand to escape from the Zero COVID trap it embraced until spring 2022.

Ultimately, New Zealand’s Zero COVID strategy was immoral, incoherent and a grand failure.

Source: Jay Bhattacharya – spiked

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SARS-2 Surges Only in The Winter, Goes Endemic After Two Waves, Is Impervious to Vaccination, and Has Become Harmless with Omicron

A lot of the Corona data we’re fed is essentially meaningless propaganda, and it has obscured crucial patterns.

Here, I want to look at the only metric that really matters, namely excess mortality, to make some basic points about what has happened to us since 2020, and what is happening now.

  • To date, the pandemicists have counted five or six waves of infection.

If you ignore the case statistics, though, and look at nothing but European excess mortality, you see a totally different picture. Corona only has one deadly season a year, namely the winter, and no European country has seen more than two winter mortality spikes.

Beyond the no-signal countires, which had no excess deaths at all, there are two patterns for Eurozone Corona mortality.

There are the early-outbreak countries, which saw their mortality spike after March 2020; and there are the late-outbreak countries, which skipped this wave and first saw significant Corona deaths in December 2020.

Let’s look first at the smaller, late-outbreak group, because it will clarify the basic dynamics.

Ideally, a Corona mortality wave would substantially exceed the deaths of the rough 2017/18 flu season, but for purposes of illustration we’ll grant my country’s extremely underwhelming experience with SARS-2 a pass here.

  • There was no Spring 2020 wave at all. Corona first started killing Germans in the winter of 2020/21, and it started killing them again, despite the vaccines, in late Fall of 2021, before Omicron caused mortality to collapse in the course of December.

It’s definitely Omicron, and not the vaccines, that stopped the deaths.

The same pattern exists in Austria, which is slightly less heavily vaccinated than Germany; and also in Hungary and Slovenia, which are substantially less vaccinated.

Hungary is interesting, because their winter wave was bipartite. They had a late Fall mortality spike, corresponding to the traditional coronavirus season peak, and then a separate early Spring spike, corresponding to the more traditional influenza peak.

This bipartite season is observed in the case statistics throughout Europe, but beyond Hungary, all-cause deaths tend to have a single wintertime apex centred either earlier in December, or later, towards the end of January. The precise timing of this peak can be important, as we’ll see below.

Now we turn to the much more common case, the early-outbreak countries. Sweden is archetypal here. They have a very similar vaccination rate and trajectory as Germany, but because the pandemic started earlier there, in Spring 2020, their whole experience is shifted one season to the left.

The Swedes had their first wave when nothing was happening in Germany, and they had their second wave when Germany had their first.

And the crucial point is this:

After that second wave, Sweden was done with the pandemic, vaccines or no vaccines. The Swedes went into Fall 2021 just as heavily vaccinated as Germany, but in Germany excess deaths started to rise again, while in Sweden they stayed flat.

  • In Europe, Corona kills people for two seasons, and then it becomes a nothing-burger, no worse than seasonal influenza in a bad year.

You see exactly the same picture in England – two mortality waves, and then it’s over.

And the same in Ireland …

… and in Belgium …

…and in Italy …

… and in Spain.

This leaves a few interesting outliers. Consider, for example, Portugal, which seems to have skipped both the Spring 2020 wave and the incipient pre-Omicron Winter 2021 wave.

  • Do the heavily vaccinated Portuguese have Pfizer/BioNTech and Moderna to thank for their one-wave pandemic?

No, they do not. It’s the seasonality that saved them.

Portugal, like Spain and Ireland, has a later winter mortality peak than other countries, with deaths spiking not in December, but at the end of January. Portugal was set to see their second death wave at the end of January 2022, but by then Omicron had taken all the mortality out of SARS-2. Portugal got lucky.

  • The Netherlands and France are interesting for presenting a kind of intermediate phenomenon. Both had substantial mortality in spring 2020, followed by a distinctly muted winter 2020/21 wave, and so they saw some pre-Omicron spike in deaths.
  • Switzerland is another configuration of the same phenomenon, with a minimal Spring 2020 spike, followed by a Winter 2020 and an incipient Winter 2021 wave.

The pandemic will surely look different in the United States, or in the southern hemisphere.

Particularly countries with extensive use of climatisation – which creates winter-like conditions in the late summer – will see different mortality patterns.

In the Eurozone, though, this is how the Corona pandemic unfolded.

In most countries, the two-wave mortality surge was over by the time the vaccines were rolled out; in central Europe, it was still raging, but it was Omicron and not the vaccines that stopped the deaths.

Source: eugyppius

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Study claims virus thrives in temperate climate band across globe

A study published […] suggested that COVID-19 thrives in cooler, drier weather, the latest volley in an ongoing scientific debate over whether the coronavirus is affected by seasonal changes.

The analysis, published by a team out of the University of Maryland, found that hard-hit cities around the globe were within a band between 30 and 50 degrees North, while 42 other cities that seemed to avoid the worst of the pandemic were to the north or south of them.

“The distribution of substantial community outbreaks of COVID-19 along restricted latitude, temperature, and humidity measurements was consistent with the behavior of a seasonal respiratory virus,” the authors wrote in the study, published online by the Journal of the America Medical Association.

The eight cities examined within the band were Wuhan, China; Tokyo, Japan; Daegu, South Korea; Qom, Iran; Milan, Italy; Paris, France; Seattle, Washington; and Madrid, Spain. All of them had temperatures between 41 to 51 degrees Fahrenheit and relative humidity between 44 and 84 percent when the virus was spreading most rapidly.

“We think the SARS-CoV-2 virus has a more difficult time spreading in conditions with higher temperature and humidity,” study co-author Dr. Mohammad Sajadi told UPI.

He added that researchers could use climate modeling to predict where the virus might break out next, but cautioned that more work needed to be done.

Some experts have suggested that hotter temperatures can affect the spread of the virus, though others say the climate is not a major factor. In Israel, Prime Minister Benjamin Netanyahu has insisted that heat does not affect the virus.

The authors noted in the study that coronaviruses that cause the common cold in humans “have been shown to display strong winter seasonality between December and April and are undetectable in summer months in temperate regions of the northern hemisphere.”

Maps produced by the research team showed a green band of moderate weather across the northern hemisphere that forms a sort of Goldilocks Zone for the virus, and which all eight cities fell into. Israel is just to the south of the zone.

It claimed that cities near virus centers but outside the temperate zone appeared to have fared better than those within it, though the study only includes data up to March 10. Among the cities listed as not having major outbreaks is Jerusalem, though Israel’s worst-hit city saw most of its infections only starting in late March and April.

The model conforms with major outbreaks in several cities in March and April based on the climate data, including London, Berlin, New York and Beijing.

Source: TOI Staff

Notes:

Discussion on Temperature, Humidity, and Latitude Analysis to Estimate Potential Spread and Seasonality of Coronavirus Disease 2019 (COVID-19)

The distribution of the substantial community outbreaks of COVID-19 along restricted latitude, temperature, and humidity measurements were consistent with the behavior of a seasonal respiratory virus.

The association between temperature and humidity in the cities affected by COVID-19 deserves special attention.

There is a similarity in the measures of mean temperature (ie, 5-11 °C) and RH (ie, 44%-84%) in the affected cities and known laboratory conditions that are conducive to coronavirus survival (4 °C and 20%-80% RH).[…]

In the time we have written up these results, new centers of substantial community outbreaks include parts of Germany and England, all of which had seen mean temperatures between 5 and 11 °C in January and February 2020 and were included in either the January to February 2020 map […] or the March to April risk map […].

Temperature and humidity are known factors in SARS-CoV, MERS-CoV, and influenza survival.[…] Furthermore, new outbreaks occurred during prolonged periods at these temperatures, perhaps pointing to increased risk of outbreaks with prolonged conditions in this range.

Besides potentially prolonging half-life and viability of the virus, other potential mechanisms associated with cold temperature and low humidity include stabilization of the droplet, enhanced propagation in nasal mucosa, and impaired localized innate immunity, as has been demonstrated with other respiratory viruses.[…] It is important to note that even colder areas in the more northern latitudes have been relatively free of COVID-19, pointing to a potential minimum range for temperature, which could be because of avoidance of freeze-thaw cycles that could affect virus viability or other factors (given that at least 1 human coronavirus tested is freeze-thaw resistant).

Human coronaviruses (HCoV 229E, HCoV HKU1, HCoV NL63, and HCoV OC43), which usually cause common cold symptoms, have been shown to display strong winter seasonality between December and April and are undetectable in summer months in temperate regions of the northern hemisphere.[…] Some studies have shown that the alphacoronavirus HCoV 229E peaks in the fall, while HCoV OC43 (a betacoronavirus in the same genera as SARS-CoV-2) has a winter predominance.[…] Although it would be even more difficult to make a long-term estimation at this stage, it is possible that COVID-19 will diminish considerably in affected areas (above 30° N) in the coming months and into the summer. However, given that SARS-CoV-2 is only recently introduced to humans, there is presumably no preexisting immunity. In such cases, whether the 2009 H1N1 influenza pandemic or the first whooping cough pandemics documented in Persia and France in the 1400s and 1500s, the initial epidemic acted unpredictably, so in addition to their recognizable seasonal peak, they had additional peaks outside their later seasonal patterns.

The spread of the SARS-CoV-2 virus in the upcoming years could follow different patterns; it could prevail at low levels or cause several seasonal peaks in tropical regions like influenza,[…] cause outbreaks in the southern hemisphere at the same time, and begin to rise again in late fall and winter in temperate regions in the upcoming year. Another possibility is that, combined with intensive public health efforts, it will not be able to sustain itself in the summer in the tropics and southern hemisphere and disappear, just as SARS-CoV did in 2003; however, the ever-increasing number of cases worldwide make this increasingly less likely. MERS-CoV has been pointed to as a betacoronavirus that can spread in all seasons. However, it should be remembered that most cases of MERS-CoV were in the Arabian Peninsula and that influenza infection there does not follow the same pattern as in more temperate climates.[…] In the upcoming summer months in the northern hemisphere, surveillance efforts for SARS-CoV-2 in currently affected areas will be important to determine whether there is a viral reservoir (eg, prolonged stool shedding). Similarly, surveillance efforts in the tropics as well as in New Zealand, Australia, South Africa, Argentina, and Chile between the months of June and September may be of value in determining its establishment in the human population.

An avenue for further research involves the use of integrated or coupled epidemiological-earth-human systems models, which can incorporate climate and weather processes and variables (eg, dynamics of temperature, humidity) and their spatiotemporal changes as well as simulate scenarios of human interactions (eg, travel, transmission due to population density). Such models can assimilate data currently being collected to accelerate the improvements of model estimations on short time scales (ie, daily to seasonally). This approach would allow researchers to explore questions such as which population centers are most at risk and for how long; where to intensify large-scale surveillance and tighten control measures to prevent spreading; how to better understand limiting factors for virus spreading in the southern hemisphere; and how to make estimations for the 2021 to 2022 virus season. A better understanding of the cause of seasonality for coronaviruses and other respiratory viruses would undoubtedly aid in better treatments and/or prevention and be useful in determining which areas need heightened surveillance.

Limitations

This study has limitations. The reported data for number of cases and mortality are invariably different in different countries, owing to differences in availability of testing, the sensitivity and specificity of each test, and reporting. Other potential factors that influence transmission (eg, other climate factors, public health interventions, travel, population density, air pollution, population demographic characteristics, viral factors) were not included in this study.

Conclusions

In this study, the distribution of substantial community outbreaks along restricted latitude, temperature, and humidity measurements were consistent with the behavior of a seasonal respiratory virus. Additionally, we have proposed a simplified model that shows a zone that may be at increased risk for COVID-19 spread. Using weather modeling, it may be possible to estimate the regions most likely to be at higher risk of substantial community spread of COVID-19 in the upcoming weeks and months, allowing for a concentration of public health efforts on surveillance and containment.

Comment:

Daylight May Drive Seasonal Variation in SARS-CoV-2 Infectivity

  • Andy Goren, MD | Clinical Hospital Center Sestre Milosrdnice Zagreb, Croatia

SARS-CoV-2 infectivity is dependent on proteolysis of its spike protein by the TMPRSS2 enzyme expressed on the surface of type II pneumocytes (…).

In humans, the only known promoter of the TMPRSS2 gene is an androgen response element; therefore, androgen receptor expression is likely to determine COVID-19 disease severity (…).

In support of the androgen driven COVID-19 hypothesis, a recent study from Italy (…) demonstrated a significant protective effect of androgen depravation therapy in COVID-19 prostate cancer patients OR 4.05 (95% CI: 1.55-10.59). Androgen receptor expression is mediated by the period circadian protein homolog 1 (Per1). Per1 overexpression inhibits the transactivation of the androgen receptor(…). Per1 expression follows a circadian cycle determined by the length of the daylight. Rats exposed to a longer photoperiod (16 hours light and 8 hours darkness) exhibit higher expression of Per1 compared to rats exposed to a shorter photoperiod (8 hours light and 16 hours darkness) (…).

In conclusion, during the fall and the winter months when daylight is short, TMPRSS2 expression is likely to be increased which may lead to increased SARS-CoV-2 infectivity.

Header: A map showing the temperate zone, highlighted in red, where the virus had climate conditions to thrive, according to a study published June 11, 2020. (CC-BY Sajadi MM et al. JAMA Network Open)