Is the worst of Covid-19 yet to come?
The most recent wave of Covid19 is, I suspect, much more significant than the headlines so far would suggest. This phase started in Europe, has been very evident in South America, and is now apparent in Asia (eg Philippines, India, and now Japan.) Further, Covid19 is starting to take hold again in the United States, especially in Michigan, and the urban northeastern cities (eg New York) most associated with the initial wave in America. And Ontario, Canada, is now moving to a new lockdown, as young people are getting seriously ill.
In South America, the countries of greatest concern are Uruguay, Chile and Argentina; Brazil's high recent death statistics notwithstanding.
Uruguay is of particular concern, because – like New Zealand – it had very few cases in 2020. On 4 April it reported 1,100 cases per million people, equivalent to 5,500 cases in one day in New Zealand. That's seven times the case rate (for that day) of Brazil, and three times the case rate for Chile. That's more than one in a thousand Uruguayans reporting positive in a single day!
Two other countries had worse 'new case' incidences that day: Curaçao, and Bermuda. In the overall (historical statistics), in the world (as of 7 April) Uruguay is 151st in cases per capita, and 81st in deaths. Curaçao is 40th in cases per capita, and 83rd in deaths. Bermuda is 86th in cases per capita, and 101st in deaths. In all three of these countries, more than half of all reported cases have been since 1 March 2021. And all three have been countries which, in 2020, performed substantially better than their neighbours (eg Aruba for Curaçao, and Bahamas for Bermuda).
Uruguay is looking like it might be a victim of its own success. So is Chile, which is now getting more than twice as many new cases per capita than is the oft-reported Brazil. Chile is one of the most vaccinated countries in the world for Covid19; and indeed the mainly older people who have been vaccinated there are doing much better than in 2020. It's the younger people who are now of most concern in Chile. The same pattern is clearly emerging in the urban northeast of the USA, the places which were first to emerge from the pandemic in the USA, the 'Democratic states' which were generally most accepting of lockdowns and mask use.
New Zealand in 2020 had significantly negative numbers of 'excess deaths', thanks in the main to a dramatic reduction in deaths arising from influenza. The lockdowns and physical distancing prevented the transmission of seasonal influenza. Presumably, the Covid19 restrictions also substantially reduced the incidence of winter colds.
The mandatory use of masks on public transport in New Zealand is irrelevant to Covid19, and almost certainly counterproductive overall; facemasks have only been mandated in the summer months so far. Further, over the summer, the voluntary use of facemasks in other settings has been practically nil. To the best of my knowledge only one or two cases of Covid19 in New Zealand have ever been conclusively linked to public transport; these were on one Auckland bus – the number 22 bus – on the morning prior to the August lockdown.
Other countries that performed well in 2020 also did so because of mandated emergency restrictions to substantially minimise the risk of transmission, with that risk being at its maximum in indoor settings in which physical distancing is difficult. (In some cases, like Chile and New York, lockdowns were belated but eventually effective. In other countries – such as New Zealand – restrictions came about in time, and effective track and trace capacity was possible, further helping these countries to keep on top of Covid19.) All of these successful countries will have had very low exposures to common seasonal viruses, a byproduct of restricting Covid19.
Probably too little exposure to the 'common cold'.
Common Cold exposure may be, in effect, a partially effective Covid19 vaccine.
On 23 March, the BBC ran a story Coronavirus: How the common cold can boot out Covid. Wikipedia suggests that about 15 percent of common cold cases are due to attenuated human coronaviruses. The majority of common cold viruses are rhinoviruses. And in the entry on Coronavirus, Wikipedia says "Four human coronaviruses produce symptoms that are generally mild, even though it is contended they might have been more aggressive in the past". Of particular note, the 'Russian Flu' of 1889-90 may have the more lethal form of one of the four present day 'common cold' coronaviruses (Human coronavirus OC43). The 'Russian Flu' is estimated to have killed one million people, at a time when the world population was one-sixth of what it is today. (World deaths from Covid19 are now approaching three million, and will probably end up being close to six million.)
The BBC story suggests that exposure to rhinoviruses can provide a significant degree of immunity protection from Covid19. Presumably, exposure to the human coronaviruses that cause 15 percent of colds would provide at least as much protection as rhinovirus exposure.
It seems very likely that the dangerous recent outbreaks of Covid19 in places such as Uruguay, Chile and Michigan are happening because young and middle-age people in those countries have had minimal exposure to these common and generally mild seasonal viruses. (It seems likely, to me, that the new strains of Covid19 are not necessary more lethal than earlier strains; rather, younger people are less protected from common cold exposure in 2021 than they were in 2020.) Further, these viruses are difficult to produce vaccines for, because they mutate rapidly; indeed, influenza vaccines have to be renewed every year for this reason.
Clearly, in future years, a substantial majority of the world's adult population is going to need a coronavirus and an influenza vaccination at least once a year; a massive but necessary logistical challenge.
Extended 'mask mandates' are most likely aggravating the problem, by removing these 'natural vaccines' from circulation. Certainly, mandated mask use indoors serves as an important break on the transmission of Covid19 during a substantial outbreak of that disease; that is, an outbreak severe enough to justify what we in New Zealand would call a Level 3 or Level 4 lockdown. Beyond that, it is not desirable to interfere with the transmission of the seasonal viruses which protect us from much more serious infectious disease. Individuals of course should always be able to choose to wear facemasks, and to protect themselves through the use of, for example, Vitamin C supplements.
One of the most significant epochs in global demographic history was the European conquest of the Americas, and the subsequent collapse of the native American populations. It was pathogens, not guns, that did most of the damage. Eurasia and Africa are a single landmass that had a much greater history of acquired immunity than did the Americas. As a case of double-jeopardy, this human population die-off in the Americas helped to fuel the 'white' European superiority-complex. Europeans, conveniently for them, both utilised and ignored this supremacist interpretation of the American conquest, when considering the 'black' African population that was quite well-adapted to both European and tropical diseases.
The native American population was simply overwhelmed by novel pathogens, which they had no immunity to. Indeed, the Covid19 disproportionate tragedy in Brazil's Amazon region is probably due in large part to people there getting less exposure to common cold viruses. Indigenous populations in Oceania suffered the same fate, by and large.
When viral disease types do not circulate widely for decades, then populations regain a degree of viral virginity. This is one of the reasons why it seems likely that the 'Russian flu' was, in 1889, a novel coronavirus much like the SARS-Cov2 virus that causes Covid19.
In the 25 years before 1918, humankind seems to have lost a degree of natural protection from influenza. As a result the 1918 flu pandemic was more severe than subsequent flu pandemics in 1957, 1968 and 2009.
Of further interest is the fact that the 1918 H1N1 'Spanish Flu' – better known as the 'Black Flu' – came in three waves, with the second (November 1918) wave being the most lethal. With better understanding than we had then, it is now believed that exposure to the less lethal (but nevertheless nasty) first wave of the disease gave protection from the second wave. Whereas the pattern of mortality and morbidity in the first wave was more like the usual pattern for influenza – that is the patterns of 1957 and 1968, in which the elderly suffered most – the lethal second wave of the Black Flu most affected younger adults, and (in New Zealand) Māori communities which had largely missed out on the first wave. In the United States in 1818, and probably elsewhere, 'sickly' urban young men entering the army were significantly better protected from the Black Flu than were 'vigorous' young men from rural counties. City youth had had much more exposure to attenuated circulating viruses.
My concern is that, globally, the Covid19 is just entering the first wave of its more lethal second phase; a phase which will disproportionately kill unvaccinated younger people. And that the major single reason why this will happen is the loss of partial immunity previously conferred through common colds and the like.
New Zealand Exceptionalism
Like many countries, New Zealand has an 'exceptionalist' view of itself. (I contributed a New Zealand chapter to the 2016 book about Australian exceptionalism, Only in Australia.)
New Zealand's exceptionalism is about both insecurity and superiority. We are desperate to be noticed, and to be liked – indeed loved – by the rest of the world. We once believed we supplied the best soldiers to the British Empire; not only did we have 'better whites' than the rest of the 'anglosphere', we though, but we also had 'better blacks'.
Today we love to revel in the image that we broadcast to the world: the images of inventiveness, improvisation, incorruptibility, sporting prowess, enlightened race relations, inclusiveness, clean greenness, ideal climate for food production, landscapes, safety (despite big volcanoes, earthquake faultlines and adventure tourism), and compassionate stoicism. (We used to promote ourselves as egalitarian, and that is an image that is still widely believed overseas!) And we love our present government, because it convincingly conveys those optics to the wider world.
New Zealand thinks it's immune from the tragedy that's now unfolding in Uruguay, and elsewhere. It's not.
New Zealanders are supremely proud of their record on Covid19, and just love it when overseas people – indeed overseas intellectuals – praise us for our superior management of 'the pandemic'. If we are to continue to be able to present this image to the world, we do not want to suffer a Uruguay moment. (While Uruguay was – and still is – largely underneath the world's covid radar, New Zealand has conspicuously displayed its covid success to the world. It was even news on Al Jazeera when a single case drove New Zealand into Covid19 lockdown in February. And last year, New Zealand's August outbreak made world news, to the extent that Donald Trump would imply that our situation had become as bad as, if not worse than, the situation in the United States.)
Our leaders understand this; hence the need for an ultra-cautious approach about human reengagement with the rest of the world. Thus, given our diminishing natural immunity to respiratory viruses, the success of the covid vaccination program – as a program of annual repeat vaccinations – is critical to our re-entry into the world of human intercourse.
As insurance, however, while at Covid19 emergency Level 1, our leaders should now be encouraging our working-age adults to return to normal social engagement. New Zealanders need to get more common colds – not less – this autumn and winter.
Keith Rankin, trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.