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