Why a Plan B when Plan A is working so well?

Newsroom presents two views from academics on the best way to manage future Covid-19 outbreaks - here Dr Mark Thomas puts the case for what he says has been a successful national approach so far, Plan A. For an alternative view see here.

The pandemic of COVID-19 disease is now approximately 240 days old. New Zealand’s response to the pandemic has differed from that in almost all other nations. We have sought to eliminate community transmission, and thus prevent disease in our population.

Almost every other nation has sought not to eliminate, but instead to slow community transmission. The goal of this suppression strategy has been to limit the spread of infection sufficiently to ensure that people who become infected, and develop severe disease that might benefit from intensive care, do not find that such care is unavailable because their hospitals have become overwhelmed by large numbers of severely unwell patients. In many countries the suppression strategy has clearly failed, and hospitals have been swamped by an onslaught of patients with severe disease.

Our elimination strategy means we have avoided having intensive care units that have become overwhelmed by more patients than they can effectively care for. We have not had bodies stored in refrigerated trucks outside our hospitals and the other ghastly consequences seen in many other nations. We not only eliminated community transmission in New Zealand for more than 100 days, we have also quickly identified the single community outbreak that has occurred despite our strict border controls, and have responded rapidly to terminate that outbreak. We can confidently expect that we continue to learn from our experience, and will again have a prolonged period of zero community transmission.

Meanwhile, developments elsewhere strongly suggest we have taken the correct path. Studies on patients with Covid-19 disease show their immune responses bring the infection under control, and prevent transmission of infection to others, within 14 days of the onset of illness. These immune responses are so effective that second attacks of illness almost never occur in the weeks to months after recovery. Only three people have been identified to have suffered a second episode of infection, and in these people it appears infection was brief and asymptomatic. Studies of Covid-19 vaccines have shown they stimulate immune responses that are at least as strong as those resulting from Covid-19 disease. Administration of an effective Covid-19 vaccine to at least 60 to70 percent of the New Zealand population will dramatically limit transmission in New Zealand.

However, various individuals and groups, most notably the Plan B proponents, continue to suggest we should alter the New Zealand Covid-19 strategy. The Plan B website states that the epidemiologists and others in their team are “refreshing the plan to account for recent developments”. Despite this, the Plan B proponents continue to make some, in my view, strange suggestions.

On a Zoom webinar presented on August 17, overseas experts and other speakers stated that: “we can’t keep it (Covid-19) out”, “it takes 10 years to make a safe vaccine”, and “Covid is affecting those who may otherwise have died from other diseases”.

But the fact is, we did keep it out, and had more than 100 days with zero community transmission of Covid-19, and we can expect to again have long periods without community transmission. Furthermore, while development of vaccines has, in the past, been a slow process, we have benefited from the large amount of research that went into development of vaccines against other closely related coronavirus diseases (SARS and MERS). These vaccines did not progress because SARS disappeared and MERS remained a relatively minor threat. The Russians have already distributed a Covid-19 vaccine, albeit without first demonstrating whether or not it is effective, and a large number of other vaccine manufacturers are likely to be distributing, safe and demonstrably effective, vaccines in the coming months

Covid-19 is affecting elderly people who might otherwise have died from other diseases, but that is the case for many illnesses. We do not decline to treat elderly people who suffer a stroke, or a heart attack, or fracture their hip, because they may die in the coming months from other diseases, so why should we not do all that we reasonably can to protect elderly people from developing Covid-19? Furthermore while elderly people comprise the majority of deaths from this virus, deaths of young people are not inordinately rare.

The messages the Plan B group continues to promote: dismissing the harms that would be caused by the spread of Covid-19, exaggerating the costs of fighting the spread of infection, and exciting fear that vaccines will not be available for the foreseeable future, largely have fallen on deaf ears. Past experience has helped of course. These are the same people who only a few months ago confidently told us that: “a second wave is extremely unlikely”; “a travel bubble between Australia and New Zealand is now safe”; “harsh social distancing measures have little to no effect”(Simon Thornley, June 5 2020), and “the suppression strategy has left us in an international and economic dead end” (Simon Thornley, July 28, 2020).

Mostly, the motivation for the Plan B group to push these messages seems to be that the economic costs of New Zealand’s elimination approach are too great. However, only in the future will we be able to come to some conclusions about whether our approach has actually been the best possible one for our economy. In the meantime, the actions of New Zealanders, who have almost universally followed the Government’s advice about social distancing to slow the spread of the infection, strongly suggests they overwhelmingly agree with the present strategy.

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