A new realism entered the public debate about the current Covid outbreak yesterday.

In a way, it has been brewing all week as Covid Response Minister Chris Hipkins, in particular, has speculated about alternatives to the elimination strategy while he has also suggested semi-permanent arrangements for Managed Isolation and Quarantine.

And now the Prime Minister is – albeit obliquely — joining the debate.

Simply the question is becoming how do we live with Covid.

That doesn’t mean how do we live with the virus rampant in our communities, but rather, how do we live with the constant potential for it to become so.

How we are answering that question is the difference between the New Zealand and Australian responses.

The impetus for the debate has come from the Otago epidemiologist, Professor Sir David Skegg, in his role as chair of the Covid Strategy Advisory Committee.

The committee includes clinicians and a business representative, former Air New Zealand CEO Rob Fyfe.

Skegg’s grim prognosis yesterday appearing before Parliament’s Health Select Committee was that the Covid-19 virus was not going away.

“Unfortunately, we’re going to be in a war with this virus for years,” he said.

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It is the realisation that there is no quick fix; that once as many people as possible are vaccinated, things may not necessarily go back to “normal” that seems to be slowly sinking into politicians.

Skegg even suggested that this year might be as good as it gets.

“When we reopen the border, things are going to get tough,” he said.

“I keep saying to my friends; this is the golden year.

“We’ve had a wonderful time the last six months.

“We’re almost the only country on earth just living a normal life.”

Skegg’s pessimism derives from the way the Delta variant behaves and the knowledge that, almost inevitably, there will be more variants down the track.

He said the evidence from China showed that the Delta variant was not only much more transmissible than the earlier variants of the virus but also that the period of time from when someone got exposed to an infected person and then became infectious themselves was about two days shorter.

 “And that makes controlling outbreaks caused by the Delta variant more difficult to control by testing and contact tracing alone,” he said.

“So I think that does make us less optimistic that next year we’ll be able to continue the elimination of outbreaks by testing and contact tracing alone.

“The task has just got harder; the virus has evolved in a way that makes it more difficult to control.”

Complicating the picture is evidence from Israel of “waning immunity” from vaccinations.

The Wall Street Journal has reported that an Israeli Health Ministry study published in July found those who had two shots were just 39% protected against infection between June 20 and July 17 amid an outbreak of the Delta variant in the country.

Data shared later with medical experts advising Israel’s government showed that protection against severe illness for vaccinated people aged 60 and up had dropped to 81% from 97% in mid-April. 

Dr Nikki Turner, Professor of General Practice at the University of Auckland and Director of the Immunisation Advisory Centre, the organisation that advises the New Zealand Medical profession and the New Zealand government on immunisation policy, said she was watching the si6tuation closely.

“I will assume that in the not too distant future, particularly immunocompromised people first will likely need a booster eventually, probably others,” she said.

“And the data is accumulating rapidly.”

It is in the face of these challenges that Skegg has been asked about the future of the elimination strategy.

“We don’t think elimination is a very good word,” he said.

“It confuses people; it doesn’t mean eradication, but I’m sure that the strategy will have to be revised.

“But that can only really be done closer to the time when we know what variants we’re dealing with, when we know more about the issues about the vaccine, some of which have been brought up this afternoon about, for example, waning of immunity, the extent to which the vaccines prevent transmission of infection as opposed to preventing severe admission and death, which we know they’re extremely good.

“And we’ll have new tests.

“We may even have antiviral treatment on the horizon, and that could really change our approach to this disease.

“And also, I hope that in the future, we may have better vaccines.”

Ardern defended the current policy yesterday.

If it weren’t for lockdowns, I’m sure we would have seen cases spread further,” she said.

But the lockdown is costing.

The ASB’s Chief economist, Nick Tuffley, said on Monday that the bank’s estimates were that during a nationwide Level Four lockdown, “we forego activity worth around 0.5-0.6% of annual GDP ($1.9 billion) per week. “

The Prime Minister also addressed the future of the strategy yesterday.

“Right now, the experts are telling us to take on Delta differently, but they’ve also told us to stick with the elimination strategy for now,” she said.

“In their view, it’s not only possible, but it also remains the best strategy.

“And I totally agree.

“Elimination means continuing to stamp out covid wherever it emerges and all the while ramping up our vaccine program and ensuring every eligible New Zealander takes up the opportunity to be protected.”

Ardern said that previously when we didn’t have vaccines, we relied on turning our borders into our protection and when there was a chink in that barricade using lockdowns to get an outbreak under control again.

Ardern confirmed that the Government wanted to end this approach, but that would depend on vaccination rates.

“Our collective goal is to move away from having to use these measures in that way,” she said.

“And vaccines help us do that.

“No one wants to use lockdowns forever.

“And I can tell you now that is not our intention as we have new tools for managing covid and we will use them.

“But for now, while we vaccinate, elimination is the goal, and we can do it.”

On August 12, launching the  “Reconnecting with the World” strategy, Ardern said the elimination strategy would stay in place for the next six months, presumably because it would take that long to get as many people vaccinated as possible.

But Skegg was more cautious about when it might be possible to relax the strategy.

“If we have another outbreak of the Delta variant in the coming months, I think it’s inevitable that we would have another lockdown,” he said.

And even a high rate of vaccination might not mean New Zealand could relax its borders.

“It’s quite clear from modelling in New Zealand and around the world that with this pesky virus, you don’t reach some magical stage of herd immunity where you can just rely on vaccination,” he said.

“So, however high the vaccination coverage, we are going to have to take other precautions at the border to make sure we don’t have lots of people coming in carrying the virus and also public health and social measures within the country.”

Sir David stressed that the role of his group was to offer advice from a health perspective.

“We accept that the government is going to have to consider all the other considerations, social, economic and so on,” he said.

“If you asked us what’s the safest thing we could do for New Zealand’s health, I would say keep the borders completely closed.

“But we are assuming that New Zealand is going to reopen.

“We cannot stay cut off from the world indefinitely.

“So we are acting on the assumption that once everyone has had a chance to be vaccinated, the government is going to start reopening the border in a staged way.”

Ardern also recognises that there is still a long way to go.

“I know that the battle with covid is not over,” she said.

“It won’t be for some time to come.

“And that’s why we will keep changing up our strategy with those three things in mind people’s lives, their livelihoods and their ability to feel as normal as possible.”