What we should expect next from COVID-19
15 April 2020
Opinion: The nature of this coronavirus means that we need to steel ourselves for more tough news in the coming weeks. That should only firm our resolve, writes Associate Professor Siouxsie Wiles.
This Easter weekend has seen the number of deaths due to COVID-19 here in Aotearoa New Zealand go from one to four people*. My thoughts go out to their families and friends, and to the people who cared for them during their illness. The sad reality is that we should prepare ourselves for more news like this in the coming weeks. Here’s why.
*New Zealand is now at nine total deaths from COVID-19, as announced by the Ministry of Health.
As I write this there are just over 1,300 confirmed and probable cases of COVID-19 in New Zealand. Fifteen people are currently in hospital. Our “go hard, go early” approach, including the alert level four lockdown that we’re living in now, means that the number of new cases announced each day has stopped growing exponentially. The number of “active cases” has levelled off. This is in stark contrast to many other countries. It means we are on the right track.
We’re still seeing new cases announced, though. As noted in an earlier post, this is because of the “lag”. What we see happening today is a reflection of what happened one or two weeks ago. The virus has an incubation period that means people can go many days before showing the symptoms of COVID-19. And that’s why it taken a few weeks for the lockdown to start showing its effect. It’s also why we need to keep following the rules and not come out of lockdown too early. Any people who may have the virus and not know it could start off more chains of transmission and then we are back where we started.
Sadly, the “lag” is also true for hospitalisations and deaths from COVID-19. The current best information we have for what to expect comes from the joint World Health Organisation/China mission back in February.
The mission reported that about 80% of people with COVID-19 had mild to moderate disease and recovered in about two weeks. Of the rest, about 15% had severe disease and 5% were classed as critical. These patients got sicker about a week after their symptoms started and took about three to six weeks to recover. This fits with other studies like this one that showed people were hospitalised somewhere between three and ten days after symptoms started. For most of the patients that lost their lives, this happened between two and eight weeks after they became sick.
What does this mean for New Zealand?
According to Ministry of Health data, the last 10 days has seen about 500 new people with COVID-19. So, at any point as many as 100 of those people could end up needing hospital treatment. The average fatality rate for COVID-19 is currently estimated at around 5.5%. Just taking those 500 new cases that would be 27 people potentially dying right here in New Zealand in the coming weeks or months.
But – and it’s a big but – there are some important things to know about the fatality rate.
The first is that it varies by country.
Current estimates put that rate somewhere between 1% and 5% for China, Canada, Germany and Switzerland, rising to around 10% for Italy, Spain, UK, France, and the Netherlands. These differences are partly a reflection of how much testing different countries do to identify everyone who might have COVID-19. But they will also reflect the state of a country’s health system and whether the number of people falling ill is overwhelming the ability to care for them all.
The second thing is that the fatality rate is a crude measure that doesn’t reflect the fact that not everyone is as vulnerable to having a severe infection.
The thing the WHO/China report and many other studies have confirmed is that those who are over the age of 70 and those who have underlying health issues are more likely to die of COVID-19. More than half of the reported cases in New Zealand involve people under 40. Sadly, however, one of our clusters is associated with a rest home. In the last 10 days, the Ministry of Health data has reported that there are 40 new people over the age of 70 with COVID-19.
My point is that we could never have expected to stay at one death from COVID-19, and we should prepare ourselves for more. This doesn’t mean that lockdown isn’t working. In fact, staying in our bubbles for the next two weeks is stopping many more potential deaths.
All my thoughts are with everyone who has contracted this virus. The next weeks and months are going to be difficult for many of them and their families and I really hope that they all recover. Together we should send them our support and best wishes. Together we should stay the course.
Associate Professor Siouxsie Wiles is a microbiologist from the Department of Molecular Medicine and Pathology in the Faculty of Medical and Health Sciences' School of Medical Sciences.
This article reflects the opinion of the author and not necessarily the views of the University of Auckland.
Used with permission from The Spinoff, Siouxsie Wiles & Toby Morris: What we should expect next from COVID-19, 6 April 2020
Gilbert Wong | Research Communications Manager
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