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Covid19 Death Semantics

Last year the Government was careful to count anybody who died with a Covid19-positive status as a Covid19 death. Now we keep hearing about such deaths which the government is saying will need to be referred to the coroner before we can establish what they died of. This is looking suspiciously like a slippery slope towards the politically expedient adoption of a narrow definition as to what constitutes a covid death.

So, lets work out the semantics now.

  • In principle, anyone who dies having been infected by the SARS-Cov2 virus in the previous six-months can be classed as having died with Covid19. A subset of these will be people who are known to have had Covid19, and this subset will be the official tally of Covid19 deaths.
  • To have died of Covid19, it will need to have been established by a medical or coronial person that a person would not have died when they did (or within a short subsequent time) if they did not have Covid19. Consider a person who arrives in a hospital in a critical condition without covid, but gets covid in the hospital, and subsequently dies. That person would have died with Covid19 but not of Covid19.
  • A person dies from Covid19 if their death would not have happened if Covid19 had not happened. Thus, such a person may be a covid casualty whatever their immediate cause of death. This is not a concept that can be listed on a person's death certificate; unless, that is, they also died of or with Covid19. But it is an important demographic and statistical concept; and is essential to historical analysis of the pandemic. This is also a 'net' concept, because some people who would otherwise have died are alive today because Covid19 happened when it did. Unambiguously, public health measures saved lives in the short run, though they may well constitute a large part of future mortality from Covid19. A tally of persons dying from Covid19 can be established through an analysis of excess deaths; that is death numbers above (or below) a properly calculated projection of what death numbers would otherwise have been. At present, the New Zealand tally of people dying from Covid19 is negative; indeed, it is about minus 5,000. (Globally, deaths from Covid19 are, at present, between ten and twenty million.)

The most critical determinant of New Zealand's eventual tolls – of, with and from Covid19 – will be the efficiency of the coming revaccination programme.

For Goodness Sake! Don't be Anti-Revaxxers

The scientific message we are getting from overseas is that the coronavirus immunity status of a 'fully-vaccinated' person whose last vaccine was six months ago is similar to the immunity status of an 'undervaccinated' person who has had just one dose of Covid19 vaccine; thus, they too are undervaccinated. And we are hearing that, after about eight months, a person's immunity status is comparable with an unvaccinated person.

RNZ this morning ran a significant discussion ("We need covid boosters now" - health professionals) about the dismay of New Zealand's health professionals about their inability to have a conversation with the Ministry of Health (or the Minister of Health) about the critical need to revaccinate New Zealand's priority vaccinees; these vaccinees include many people whose second vaccine was in March, April or May. I am hearing that the Health bureaucracy has been planning a one-off revaccination 'rollout' for about February 2022.

It defies belief that these bureaucrats might not know what is happening in Europe just now, and about how effective (albeit late) Israel's revaccination program was. It also defies belief that they might not be aware that the two most vulnerable periods for an overwhelming Covid19 wave in Aotearoa New Zealand are the periods when people remingle (Christmas, summer holidays, and back to primary/secondary/tertiary school), and winter.

This means that – urgently – vulnerable people (eg grandparents) and health professionals should be revaccinated before 4 December (three weeks before Christmas) or as soon as they reach six months after their second vaccination. (We should apply this schedule to all priority 3 and 4 people.) And, these people who revaccinate before Christmas should all have their second revaccination by June 2022, ahead of the winter respiratory virus season. In order to have their second revaccination in time, they must have their first revaccination in time.

Additionally, all people involved with secondary and tertiary education – plus primary school teachers – should be revaccinated in January or February, or as soon as they reach six months since their second vaccination. January revaccinations will allow for July revaccinations, ahead of tertiary semester two. (Does the Ministry of Health budget extend sufficiently to provide staff with calendars?)

The consequences of failure in this regard will be substantial and unnecessary deaths, of, with or from Covid19.

I am confident that the Government will heed this message. But why on earth are they doing their very best to appear to us as intransigent anti-revaxxers willing to 'die in a ditch' over some point of principle that nobody else gets. Don't be a bunch of wallies (with apologies to anybody whose name is Wally)!

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Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

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