We all engage in predictions. Put simply they are what someone thinks will happen in the future. But a robust prediction is more than an opinion; it is an informed opinion.
This is where epidemiologists come in. They are medical specialists in epidemiology which is the study (scientific, systematic, and data-driven) of the distribution (frequency, pattern) and determinants (causes, risk factors) of health-related states and events (not just diseases) in specified populations (local, provincial, country and global).
That’s quite a mouthful so let’s condense epidemiology to: “the branch of medicine which deals with the incidence, distribution, and possible control of diseases and other factors relating to health.”
Epidemiology and prediction
Epidemiologists eat, sleep and drink many things such as data, patterns and causes (even pedantry a leader in the field once advised me). Among this rich menu is predictions. By their very nature predictions can be inexact, especially in the field of epidemiology, and even more so with an unprecedented virus pandemic with so many extraordinarily variable variants.
Having said this, to the best of my knowledge, epidemiologists failed to predict the election of Donald Trump to the United States presidency. Instead it was the Simpsons (however, the Simpsons got it wrong unfortunately in predicting that Lisa Simpson would be Trump’s successor.
Despite this Trump failing, in Aotearoa New Zealand we have good reason to be grateful to epidemiologists (certainly the Government has good reason as much its decision-making that has led to the country having one of the lowest mortality rates, better performing economies and highest vaccination rates has been based on their predictive advice).
Now, one of these ‘pedantry-prone’ epidemiologists, Professor Michael Baker, has done us all a great service with an interview in the NZ Herald (paywalled) with its science reporter Jamie Morton offering three predictions about the highly transmissible Omicron variant of Covid-19. Professor Baker’s predictions.
Prediction 1: More waves, more variants
Omicron’s sudden rise to be the “pandemic’s public enemy number-one” given how deadly the Delta variant was surprised epidemiologists and other scientists. But, having observed its spread globally and its dramatically changing nature, Baker’s first prediction is that there won’t be just one wave of Omicron; unfortunately there will be more (possibly several) and, worse still, more variants to follow.
In the medium-term New Zealand may suffer waves of re-infection with Omicron now that we already have two markedly different sub-variants (the original BA.1 and the ascendant BA.2).
A new variant probably won’t compete with Omicron on transmissibility, But it might do so on immune escape. We should not assume that another variant will cause less severe illness. As worrying as this is it is better to be aware of it than not and it enables us to plan better.
Prediction 2: Smarter technology
On the more positive side, however, Professor Baker’s second prediction is that virus-fighting technology will get “smarter” as it has since to the beginning of the pandemic in early 2020.
He notes approvingly how the manufacture of sophisticated mRNA vaccines has provided adaptability to new variants of Covid-19, at least up until and including Delta. But the effectiveness of this “impressive protection” reduced with the arrival of Omicron.
While work is underway to produce an Omicron-targeted booster more effective than current boosters, this might not happen until after the next variant arrives (our Pfizer booster still helps though).
But Baker does expect vaccine-makers to make “giant strides” against the virus this year. This might be by getting close to producing achieving a pan-coronavirus shot (what he calls a “holy grail” or ‘super-vaccine”). Alternatively, it might be as simple as providing less-intrusive ways of boosting.
In asserting both these prospects Baker refers to encouraging research and early trials in the United States and Canada. He envisages a near future when New Zealanders receiving their annual flu shot also take a Covid-19 vaccine shot which might be topped up with inhaled boosters during the year.
Another development Baker anticipates is much more progress with antivirals. These are medications that help the body fight off certain viruses that can cause disease. They can also be preventive. This includes against Omicron. Potentially a person with cold or flu symptoms who tests positive using a rapid antigen test could then take some antivirals for a few days to protect themselves.
Prediction 3: a long-term strategy
Michael Baker notes that had Aotearoa suffered the mortality rates of other countries on a per capita basis, we might have had 19,900 (United States), 13,700 (United Kingdom), 9,470 (Sweden), or 5,530 (Denmark) pandemic deaths.
This is extraordinary and comes down to the Government largely following the advice of experts such as him to implement an elimination (zero tolerance) strategy towards community transmission.
But Omicron’s very high transmissibility means that our boundaries have been breached and we have to mitigate rather than eliminate. Consequently Baker calls for a durable long-term strategy for managing the virus.
This would include protective public health measures such as mask-wearing. It would also include requirements for border arrivals to be fully vaccinated plus a pre-travel Covid-19 test, and rapid antigen tested. Of course, there will need to be much more to a strategy than this.
Baker says less on this prediction than he does on his first two. Partly this is the nature of the subject matter compared with his other two predictions.
But partly (I suspect) it is the frustration felt by many epidemiologists and other experts of the failure of government, largely through the Ministry of Health, to actively engage with them. In the early stages of the pandemic the encouragement was more proactive but this waned over time to being narrowly reactive.
There was a noticeable deterioration last September. First there was a failure to engage over the premature decision to lower Auckland’s alert level from 4 to 3 (thereby extending the total period under lockdown).
Second, there was a failure to engage over the Prime Minister’s muddled decision to abandon the elimination strategy for Auckland (but continuing with elimination in the rest of the country).
In both these failures epidemiologists and other scientists were blindsided and confused.
For some time now the form of engagement has been government asking for advice on specific issues it identifies. While Professor Baker’s first two predictions look plausible, the third won’t materialise in a sufficiently meaningful way unless there is a turnaround in how the engagement process is allowed to work – from reactive to both proactive and interactive.
Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion
Where do you start.
Astonishing that people still think we can vaccinate our way out of this.
Nature has figured out what humans couldn’t and resolved the virus for us, once it spreads through the population and we get the far superior natural immunity.
Yet we still get articles like this, more jabs, jabs for everyone, muliple jabs for everyone, all aboard the booster bus, which of course runs alongside the train of doom and fear.
Depressing.
until a new variant arises then ‘natural immunity’ is back to square one too.
@gagarin Natural immunity doesn’t go back to square one otherwise the Spanish Flu from 1918 would still be killing thousands of people like it did after WW1. It’s very apparent that people built up enough immunity that they could cope with new variants of the flu and only get a mild cold. This level of immunity has clearly been passed onto our generation from our parents and grand parents.
It doesn’t take an epidemiologist to work that out but for the life of me I never hear our media or health experts talk about this as the end game – instead they just keep trying to scare us with the threat of future variants, even as other countries are starting to declare that the pandemic is over as nearly 100% of the population have some degree of immunity.
And then those same journalists and health experts wonder why there are so many people who treat them with suspicion.
actually the spanish flu evolved into a form with lower morbidity, people still get it’s descendants every year….so no we don’t have ‘natural immunity’ after 100 yrs of exposure…
“This level of immunity has clearly been passed onto our generation from our parents and grand parents”.
Well Aaron, as always there’s a grain of truth but ‘the flu’ (what variant I don’t know) is still the end for some. Globally, tens of thousands (if not more) I believe. Thousands in NZ annually. But you’re partly right, not the millions as in the Spansih Flu pandemic. Some folk have argued that the mortality rates from influenza is not that different from the Covid-19 virus but not sure if that is the case. Anyways influenza is still lethal for a good many, globally and here in NZ.
To be sure Covid-19 (and its variants) will also continue to be lethal for some. Even with medical breakthroughs, better vaccines, antiviral drugs, there will come a time when the world – and us folk here in NZ – will just have to live with the virus, as with influenza. Mask wearing and physical distancing may linger on, brought into periodic focus by an outbreak. Some will do better than others. Possibly not those with chronic asthma, obesity, heart disease, diabetes, kidney disease, hyptension, the immune compromised – and more. I don’t really know who is more vunerable.
” …as nearly 100% of the population have some degree of immunity”.
The trouble is that until developing countries have “some degree of immunity” we are always going to get new variants, new challenges, a curve ball or two.
@ma. “Nature has figured out what humans couldn’t”
So by your logic humans aren’t ‘natural’. I see.
I wonder what a person affected by polio and now living in an iron lung might think of your simplistic and frankly dangerous logic?
“Astonishing that people still think we can vaccinate our way out of this.”
Maybe we can, maybe we can’t, maybe (probably) it’s just one important part of a multi faceted approach.
The fact remains that at the moment vaccination remains the most effective medical intervention available against death from the disease.
More depressing is your defeatism.
“More depressing is your defeatism.”
To clarify; my comment was made in reply to “ma”.
Epidemiologists can only predict on the data at hand they don’t understand the nuances of biological virology, for that you need a virologist but that doesn’t mean they can predict much better they just have a deeper understanding of the history of virology and make a hypothesis’s. Sioxsie Wiles is really good!
“This is extraordinary and comes down to the Government largely following the advice of experts such as him to implement an elimination (zero tolerance) strategy towards community transmission.”
No.
It came about largely because we live on a couple of remote islands in the South Pacific and because most of us don’t live in apartment blocks. This enabled the MoH to eliminate the first wave while the Americans developed their vaccine.
A key advantage of living in the antipodes that many overlook was that when the virus first got out of the lab in Wuhan, our Chinese students were heading home for the long Christmas break, whereas in the north they returned before the lockdowns were imposed. For example the US had over 400,000 arrivals from China before they shut down. In Italy and Iran, tens of thousands of contract workers arrived from China even after the Chinese had locked down internally, preventing travel between regions.
Andrew Australia is an island, just a really big one. Your Chinese student theory would apply there too. I think we compare favourably to Australia ( who are also pretty good)There is no denying luck plays some role in any response but you won’t be accused of being a Labour supporter for just saying we have got SOME things right.
I’d go further and say Western Australia = NZ, very remote, its further away from Sydney than Auckland by 1000km. Vast area sparsely populated. And its held up just as well maybe even better.
NSW got the arrival of a plague ship – the Ruby Princess – to kick things off there.
Being a couple of remote islands wouldn’t have achieved anything if the government strategy was to delay early border closures or worse, adopt an open border strategy and management policy rather than elimination – as was advocated by several self-ordained leaders of our business community at the outbreak of the pandemic. You know, Andrew, the people that you adore so much.
Actually yes, our good record was “down to the Government largely following the advice of experts such as him to implement an elimination (zero tolerance) strategy towards community transmission.” It essentially kept the virus out of the country for 18 months. Govt. policy in this matter was the decisive factor.
Actually the left in NZ were calling Trump a racist for shutting the border at that time.
Trump wanted to do more than close the border – he wanted a massive wall spreading over 1000’s of kilometres to stop poor (“Brown”) migrants/refugees from entering the US – quite different don’t you think?!
what were the reasons for the respective border closures andy? that’s right covid in our case and ‘AYYEEE DUN’T REAKON NONE TO DARKIES’ on the trumpanista side.
To suggest either of you (Ian or Mick) are useful idiots is understating the obvious
go on then andy ‘mention vaccine harm’
preferably as a percentage of confirmed deaths from reactions as related to the total number of doses given….
Excellent Post @ I.P.
I have a prediction. Epidemiologists will continue predicting doom and gloom in order to continue basking in the sun and governments keen to bring out their inner Mao will heed those calls.
Another prediction is it will all stop at the next election or when a so called world leader from any country catches a bullet because people are sick of their petty tyranny.
I would suggest Trudeau is in 1st spot for this honor with Adern a respectable 2nd, albeit not in the home straight yet.
Jay, the USA, Britain, Denmark and other European countries have already moved to “its over, just learn to live with it”, mitigation now abandoned.
And guess what? Case surging, hospitals filling up again. Another wave of BA2 – a nasty variant.
Who gives a fuck?
If saving lives comes at a cost of freedom, then the lives aren’t worth saving.
Anyone that holds truly liberal views understands that. If you are willing to abandon your principles because you are scared, then they’re not principles they are hobbies.
Is there any ocassion in a liberal democracy that individual rights can be over-ridden for the public good? Just asking Jays. For a short time perhaps. Not for decades.
But I feel what you are really getting at is that, in this case, the very notion of the ‘public good’ has been simply constructed out of unwarranted fear. There’s a grain of truth in that perhaps. Not fear I would hold but compassion. There’s a difference.
Compassion is essentially concern for the wellbeing of others in times of uncertainty. Although there was nothing uncertain about the Covid-19 virus in the early days, if the experience of a good many countries are to be believed. Call it ‘kindness’ if you like. Compassion / kindness, much the same. Anyways, that’s what a good many folk here in litte ol’ NewZuld would call it and these folk would only be too happy to kick your sorry arse down the road.
quote from andy above, jays–
regardless of “percentages”. Humans are not just stats
Experts still fixated only with death rate and hospitalization rates
Still no one talking about the reality anyone who catches this virus ends up with some kind of organ damage, no matter how vaxxed or how mild/asymtomatic their infection. And with each successive infection more damage.
Why the silence from EVEFRYONE!? Is it just to horrific to face, too much like a sci fi horror movie scenario?
Front page of NZHerald online this avo:
“15,540 new community cases; Auckland numbers steady as primary schools hit hard” – NZ Herald
So much for “covid does not affect children”. That is a whole lot of unvaxxed little ones getting soaked in an extremely destructive virus.
Are these children going to be in a rinse and repeat cycle of variant waves? Each time more and more brain, lung, heart, and God knows what else, damage.
Hipkins noted Omicron infected children are showing a new symptom – gastrointestinal pain. Here’s latest research on covid in the intestines:
“COVID-19: Abdominal and Bowel Damage
Evidence keeps increasing for the number of places in the body and the length after COVID-19 infection the virus continues to cause damage.
The presence of COVID-19 virus was confirmed in intestinal tissue 6 months after the patients stopped testing positive via nasopharyngeal PCR tests which suggests latent/hidden infection”
https://twitter.com/jeffgilchrist/status/1499709449518395394
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01905-3
NZ cardio expert who to the NZHerald’s credit got front page coverage but whose nightmarish warning barely lasted a news cycle and mostly met with silence:
https://www.nzherald.co.nz/nz/covid-19-omicron-outbreak-cardiologist-warns-of-tidal-wave-of-heart-disease-linked-to-long-covid/ZYMK3ZEV2J62UAI2VQ4DTHYIOY/
“Heart-disease risk soars after COVID — even with a mild case
Massive study shows a long-term, substantial rise in risk of cardiovascular disease, including heart attack and stroke, after a SARS-CoV-2 infection.”
https://www.nature.com/articles/d41586-022-00403-0
Scotland BA2 surge is out of control;
“BA2, Covid, Scotland: the surge is so out of control people have been warned NOT TO GO TO HOSPITAL—I repeat THE SURGE IS SO OUT OF CONTROL THEY ARE BEGGING PEOPLE NOT TO GO ALA MARCH 2020 LOCKDOWN.”
https://twitter.com/EnemyInAState/status/1503502828240838671
“Has anyone checked Scotland because everyone I know has Covid this week it’s went absolutely bananas. All high fevers, rigors, neurological symptoms, bedbound. Even teenagers bedbound. Something going on, it’s changed since start of the year.’
https://twitter.com/clara_neuro/status/1503526409309929475
New South Wales facing a resurgence – health professionals want mitigation protocols reintroduced but pollies pretending pandemic is over/mild – even shutting down pandemic data gathering so problem magically disappears!
Prof Kerryn Phelps AM
@drkerrynphelp
“Some truths about #covid19. It may not be what you want to hear, but it is what you NEED to hear.”
https://twitter.com/drkerrynphelps/status/1503235200557334529
mooni Why study or refer to scientific papers from a university like Oxford of Stanford when you can base your decisions on TWITTER. Another useful idiot parroting the narrative which is so far from reality and is the basis of al the division we have here in NZ today. Truth doesn’t seem to matter anymore. IF big pharma say 5 doses will do the trick what could possibly co wrong
are you doubting ‘the youtube university of applied virology’? for shame ross, for shame
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