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Minimising harms from COVID-19 and other respiratory infections – University of Otago

Aotearoa New Zealand should implement a comprehensive respiratory infectious disease mitigation strategy to manage the next phase of COVID-19, as well as influenza and other serious respiratory infections.

In a viewpoint article published in this week’s New Zealand Medical Journal, 16 leading New Zealand scientists and doctors who worked on the COVID-19 pandemic response outline an optimal ongoing response strategy.

While the pandemic virus looks likely to result in waves of infection with peaks that diminish over time, there are still thousands of infections, scores of hospitalisations and tens of deaths caused by COVID-19 each week.

Lead author Professor Michael Baker, of the University of Otago, Wellington, Department of Public Health, says developing a respiratory infectious disease mitigation strategy is an effective and efficient way to simultaneously manage COVID-19 and other respiratory infections.

“While COVID-19 is no longer causing a health emergency, it remains a global pandemic with continuing high health impacts,” he says.

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

Other respiratory infections also severely impact the lives of New Zealanders, yet rates of influenza infection decreased during the first two years of the pandemic when public health measures were in place.

“We should treat other serious respiratory infections more like COVID-19. The disease burden of influenza is not inevitable and public health measures can alter the annual epidemic patterns.”

The proposed mitigation strategy contains many of these measures, including raising vaccination rates for at-risk people and supporting those who are self-isolating.

Other recommendations are improving indoor air quality, wearing masks in crowded and poorly ventilated indoor areas, and continuing innovative infection control across the healthcare sector.

Co-author Associate Professor Amanda Kvalsvig, of the Department of Public Health, says this strategy will enhance public health, equity, and health security. “Adopting these effective approaches to reduce the spread of airborne infections will put Aotearoa in a strong position to manage current respiratory illnesses and future pandemics,” she says.

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

“This system would be a vital resource to improve our understanding of how respiratory infections spread and to provide early warning of new outbreaks and epidemics.”

Co-author Sir Collin Tukuitonga, President of the New Zealand College of Public Health Medicine, says equity needs to be at the heart of the 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.”

Strong Māori and Pacific leadership should be included at all levels of decision-making and delivery, so they have the opportunity and resources to lead a response that meets the needs of their communities, Sir Collin says.

New Zealand’s response to the pandemic, especially its elimination strategy, has been deemed among the best in the world and kept cumulative excess mortality rates close to zero.

Professor Baker says this response has saved almost 20,000 lives in New Zealand, based on the deaths we would have seen if we had the same mortality rate as the United States.

“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.” Excess mortality only increased in New Zealand at the start of 2022 with the arrival and widespread infection from the Omicron subvariant. There was no association of excess mortality with control measures which were introduced in 2020 or vaccination which was highest in 2021. Professor Baker says a priority now is to focus on preventing the next major pandemic. “We encourage the Royal Commission of Inquiry to document these successes and identify how New Zealand can build on its world-leading COVID-19 response and contribute to regional and global preparedness for severe future pandemics.”