Christchurch man Daniel Freeman has Long Covid. He has had to move back in with his parents so they can help care for him. Photo / George Heard
New Zealand spent the first two years of the pandemic trying to keep out Covid-19, and the third trying to blunt its blow. Now that we’re well and truly living with the coronavirus, what will
be the ongoing human cost? Jamie Morton reports.
Daniel Freeman did everything right.
He got his three doses of Pfizer. He seldom took his mask off.
And when coronavirus finally found him in June 2022, the 43-year-old medical technician isolated in the apartment he’d bought three years earlier.
The apartment’s gone now, as is his independence, with debilitating health problems forcing him to sell up and move in with his parents for daily support.
Someone who enjoyed yoga classes, working out and walking an equivalent 8km most days, Freeman now struggles to haul himself out of bed.
“The dreams and goals I had for my future are now uncertain,” he says.
“There isn’t a single aspect of my life that hasn’t been impacted by the illness.”
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His boss is keeping his job open for him, but it’s been months since he was last able to work.
Instead, his daily routine consists of a morning round of medications; an exhausting shower; perhaps another appointment; a long sleep after lunch; and then evenings spent doing online research.
He figures he’s seen mates four or five times since mid-winter.
Instead, he’s more likely to be catching up with his GP, physiotherapist and counsellor.
Unlike plenty of others left with long Covid, Freeman’s lucky to have clinicians who take him seriously and acknowledge his symptoms, of which there are almost too many to list.
There’s fatigue, a racing heart and shortness of breath.
Appetite loss that saw him shed 16kg.
Dizziness and vertigo that once left him vomiting on his parents’ living room floor, before he collapsed and his dad called an ambulance.
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He’s often forgotten his phone number and own age because of constant brain fog; other times, he writes sentences that make no sense when read back.
Sleeping pills and hypnosis haven’t helped his insomnia; neither has the tinnitus that leaves his ears ringing loudest when he’s lying down.
He suspects a prolonged inflammation response is what sometimes makes his body feel like it’s on fire, and why he’s developed an itchy scalp condition that has made him scratch so much that chunks of hair have tumbled out.
Eventually, he shaved his head.
Then, there’s severe anxiety that he describes as terror striking from nowhere.
“On my final day at work, I was trembling with each patient I saw and had to go to the bathroom several times to throw up,” he said.
“At this stage, I hadn’t connected my other symptoms with being long Covid. I thought that everything going on was ‘in my head’ and that I was having a mental breakdown.”
To the trolls and anti-vaxxers he encounters online, Freeman is either a liar or victim of the vaccine.
To Dr Anna Brooks, however, his case represents one of the most worrying legacies of the Covid-19 pandemic.
“It’s important to understand that long Covid can impact people at any age, including those previously healthy,” the University of Auckland immunologist explains.
“We continue to hear stories of athletes succumbing to long Covid and failing to recover.”
She’s spent much of the last three years trying to unravel the complex causes of a multi-system illness capable of affecting nearly every organ, with no treatment or cure in sight.
There’s a range of hypotheses. Most involve the immune system going haywire and leaving people with a frighteningly wide spectrum of ongoing symptoms.
“We know that it can cause damage to our blood vessels, disrupts our clotting pathways, and impairs our immune system – yet the trajectory of a ‘return to a healthy baseline’ is not yet known,” Brooks says.
“Research is uncovering that our ability to fight off infections, or our general immune control, may be disrupted following Covid-19, even when mild.”
It’s possible that infection can also re-awaken dormant viruses within us that we normally control with a healthy immune system.
And any reinfection is a long Covid gamble.
For long-haulers like Freeman, another bout can worsen lingering symptoms – as shown among eight in 10 such cases in one landmark US study – or cause fresh flare-ups in people recovering.
All the while, a rampant Omicron, with its ever-growing tree of tricky subvariants, is finding new ways to side-step what immunity we have to put in its path.
“We might be finished with the pandemic,” Otago University epidemiologist Professor Michael Baker says, “but the pandemic isn’t finished with us.”
Our year with Omicron
Within just 10 months, Covid-19 has claimed a place alongside lung cancer and stroke as one of our leading causes of death, taking six times’ more lives than lost on our roads in 2021.
As at mid-December, more than 2250 Kiwis had died from the virus – four times the flu’s annual toll – while some 22,600 had been hospitalised with it.
As many as eight in 10 of us may have been exposed to it, knowingly or not.
“You’d have to go all the way back to the Second World War to find something that’s had an impact like this,” Baker says.
“This is going to add perhaps 2500 deaths – which is an equivalent 6 or 7 per cent – to our annual mortality. That’s quite a big increment and will push down life expectancy in New Zealand.”
Had we not largely succeeded at keeping the virus at bay for the pandemic’s first two years, thousands more would have died. A US or UK experience would have translated, per capita, to 19,900 and 13,700 Kiwi deaths respectively.
Instead, we confronted Omicron as one of the most vaccinated populations on the planet, armed with emergency treatments and all of the lessons we’d been able to learn from afar.
While still fighting a rear-guard action against Delta, Omicron hit us like a sledgehammer, causing a nationwide deluge of cases that pushed our total tally past 100,000 within weeks.
As daily numbers topped 20,000 in that first big wave, a quarter of Auckland City Hospital’s staff was put out of action.
Then came the winter “twindemic” – our worst flu season in years, followed by another Omicron surge powered by second-generation subvariants BA.4 and BA.5.
Patients arriving at Whangārei Hospital were confronted with the sight of outdoor tents and sick people being treated in corridors.
New Zealand Nurses Organisation kaiwhakahaere Kerri Nuku says it’s been an “incredibly tough” year for frontline workers who’ve had to grapple with a health crisis and the net effect of years of under-resourcing.
Long Covid is something the nursing community has only recently begun discussing.
“There’s certainly a lot of health professionals I know that have been crippled by long Covid, and some of my friends are still needing specialist care and support.”
With the Ministry of Health developing a new workforce strategy, ongoing exposure to Covid-19 is a huge worry.
“It’s a real concern and something we have to protect ourselves against.”
That anxiety is shared by education unions.
“It’s fair to say that everyone is a little concerned about the effects of the pandemic as it enters its fourth year,” NZEI president Liam Rutherford says.
Over 2022, the education system was “stretched towards breaking”, as teachers and schools were forced to adapt to community transmission.
Inevitably, many couldn’t avoid it. By August, sick leave among teaching staff had ballooned by 80 per cent.
Figures provided to the Herald by the Ministry of Education (MoE) showed that, over 2022, there’d been 215,704 recorded teacher absences in the Auckland region – double that of the year before the pandemic, with similar differences elsewhere.
Post Primary Teachers’ Association president Melanie Webber is aware of hundreds of teachers who’ve exhausted their sick leave because of long Covid – and the union could only point them to provisions in their collective contracts that didn’t seem to fit the problem.
Victoria University epidemiologist Dr Mona Jeffreys, who’s been running one of the country’s first long Covid studies, says teachers are at higher risk.
That’s not just because of spending their days among children, but also down to the physical and mental demands of the job.
“Coming back to work, which teachers may feel they have to do following their isolation, may not be appropriate if they have not fully recovered.”
As research now tells us, not allowing enough time to rest boosts the risk of long Covid.
“I can’t afford to get sick again; I can’t afford to have a relapse,” one such teacher, who burned through five years of built-up leave in a few months, told the Herald this year.
Others spoke of not being able to climb stairs, having to head home after lunch for long sleeps, or needing directions to their own classrooms.
After what she described as the worst year of the pandemic, Webber says the union has “serious concerns” about what little support there was for teachers.
“This situation is exacerbated by the shortage of relief teachers, so teachers are giving up their non-contact time to fill in for their colleagues, which adds to teachers’ stress and pressure levels.”
While schools had been able to draw on a special Government relief fund this year to cover staff absences and pay relievers, it wasn’t clear what support there’d be for them over the long term.
MoE operations and integration leader Sean Teddy says schools have their own plans to protect staff and students against the virus, and measures like good ventilation can make a difference.
Whether our classrooms can be truly made safe against transmission – especially in the colder months – remains to be seen.
For children, Brooks says there appears to be a lower risk of long Covid, “but certainly not no risk”.
“The stories of children having their life on pause due to not recovering are truly heart-breaking.”
An unequal burden
If health planners knew schools and hospitals would fare badly this year, they would’ve also foreseen the unequal suffering of our Māori and Pacific communities.
Combined, these two groups account for nearly a third of hospitalisations to date, along with four in 10 cases requiring intensive care – not to mention a heavily disproportionate rate of deaths among younger adult age groups.
Their experience sadly proved what modellers calculated early in the pandemic: that Māori and Pacific people were two and a half and three times more likely respectively to need hospital care, owing to a complex mix of factors.
These communities are more likely to have underlying health conditions, larger households and poorer access to testing and healthcare – the result of decades of systemic inequity.
It’s now “almost a given” they’ll see a heavier toll with long Covid, GP and Waikato University health researcher Dr Rawiri Keenan says, making it all the more crucial that New Zealand puts a strong strategy in place.
“Even if this is something that affects a fraction of people who’ve had Covid, you just consider millions of infections within a couple of years’ time,” he says.
“You can see how all of the dominoes line up to have a really bad effect for the country, and for Māori, Pacific and other marginalised groups in particular.”
Following a vaccine rollout widely criticised as inequitable, the Government put more focus on outreach services, pop-up clinics in places like marae and places of worship, and whānau-centred vaccination efforts.
Antiviral medicines, used in the early stages of infection, continue to be targeted at those over 65, Māori and Pacific people older than 50, or anyone else who meets Pharmac’s requirements.
Still, experts have spoken out about the many frustrating barriers to accessing these life-saving medications – and that many eligible people don’t appear to be aware of them.
As for our single most important intervention, it’s not clear just how – or for who – vaccination will be used over the long-term.
Officials are gathering advice as to whether an annual Covid-19 immunisation programme targeted beyond our most vulnerable is needed.
While the Government is soon likely to roll out new “bivalent” boosters that targets the newer BA.5 subvariant, fewer than half of eligible Kiwis over 50 have bothered to get a second dose of the one available to them now.
University of Auckland vaccinologist Associate Professor Helen Petousis-Harris says studies have shown how virus-fighting neutralising antibodies wane in the months after booster jabs, and the benefits of receiving continual doses aren’t yet understood.
The bulk of the population who’ve received three doses of vaccine, however, would’ve gained some immune memory – namely in the form of T and B cell responses – that will help cut the risk of severe infection.
“There’s definitely still a role for vaccines over the long term – we just need to keep on top of this evolving situation so we can decide how best to use them.”
Rather than trying to chase the virus with subvariant-targeted vaccines, she says a better approach may be annual combination shots that also cover flu; vaccines that can be inhaled; or the ultimate dream prospect of a “pan-coronavirus” jab.
“Besides vaccines, we do have a number of tools, and we probably need to consider using all of them.”
Public health experts have continually called for more action in obvious areas: namely ventilation standards and reporting in our buildings, and more masking in crowded public places like trains and buses.
With few safeguards left in place, Brooks expects there’ll be few workplaces unaffected by sickness.
“I’m sure we’re already on track to experience a summer break with disruptions to travel plans, hospitality and health care, due to staff shortages.”
What will the long-term cost of Covid-19 look like in dollar figures?
Although that sustained impact wouldn’t be as sharp as the economic hit New Zealand took with hard lockdowns and shut-out tourists, workers and students, Professor Nick Wilson says it will be significant nonetheless.
The single biggest drain may well prove long Covid, he says, but right now, we don’t understand what its toll looks like.
We now do elsewhere.
In the US, where as many as one in 13 people are estimated to have had long Covid symptoms, Harvard University researchers calculate the economic blow at US$3.7 trillion ($5.7 trillion).
In the UK, long Covid has been estimated to cost workers £1.5 billion ($2.8b) each month in lost earnings, with some 2 million sufferers reported as at mid-2022.
Across the Tasman, where up to half a million Australians may already be dealing with ongoing symptoms, economic forecasts have been put at an equivalent A$3.6b ($3.8b) in lost output.
“Employers need to understand about long Covid so that they can support employees with managing it and recovering from it,” Wilson says.
For business owners, there are big questions for the Government to answer, says the Employers and Manufacturers Association’s Alan McDonald.
“Businesses have gone to the wall and continue to do so, exacerbated by Covid,” he says.
“They’ve been losing key staff over the crucial period when they’ve been gearing back up, and they can’t fill the shortfall.
“Covid is here, and it’s here to stay, so how do we manage it?”
An uncertain future
Alpha, Beta, Gamma, Delta, Omicron.
A coronavirus that emerged from the wet markets of Wuhan and went on to infect well over half the planet’s population – killing perhaps 15 million people in three years – just keeps evolving.
If its current pattern holds, Baker says it’s possible humanity will reach “a more predictable equilibrium” with Covid-19.
We’ll ride continual but smaller waves, driven by mixes of new subvariants packing modest genetic advantages over their predecessors.
Baker and other leading experts expect Omicron, now an ugly conglomeration of hundreds of lineages, has plenty more room to grow and continue its cat-and-mouse game with our changing patchwork of immunity.
“It now seems likely that we’re going to be dealing with Omicron and its descendants from here on,” University of Auckland computational biologist Dr David Welch says.
“But that’s not to say that we’re not going to get some sort of evolutionary saltation, or the kind of big leap we saw with Alpha and Omicron.”
Amid optimism that the virus effectively hit its evolutionary ceiling with BA.5, nasty twists still might come with sudden antigenic shifts, or the virus moving in and out of animal reservoirs to attack us anew.
“These things are really unpredictable.”
For disease modellers like Dr Dion O’Neale, how frequently fresh variants will emerge remains one of the most important unknowns.
“With flu, we see a batch of new variants come around about once a year,” says O’Neale, of Covid-19 Modelling Aotearoa.
“With Covid, it looks like this happens more often – so maybe we’ll see more spikes each year.”
Barring the arrival of a game-changing vaccine, O’Neale suspects the trough of infections that New Zealand reported in mid-spring, when daily cases dipped under 1000, may be the lowest ebb we see in a long time.
In the face of this threat, Baker questions why New Zealand no longer appears to have a single, coherent strategy to manage the virus – not least more measures in place to reduce the risk of long Covid.
“This is something critical to our wider social system because, as reinfection can mean running the gauntlet with long Covid, this is going to produce a huge burden of people with significant disabilities.”
The Herald asked Covid-19 Response Minister Dr Ayesha Verrall what the Government’s long-term strategy is to deal with the virus, what scenarios it is preparing for and if any measures will be brought back.
It also asked whether the Government is taking the risk as seriously as it did earlier in the pandemic – Baker and several other leading health experts suggest it isn’t – and what’s being done to address the growing burden of long Covid.
Verrall says that, with a highly vaccinated population, the risk is “less” and the justification for restrictive public health measures reduced.
She also contends New Zealand’s response has “always” been based on strong scientific and public health advice.
“Our protections remain stronger than many other countries and we have kept things in place such as seven-day mandatory isolation for positive cases.”
Over the longer term, she expects the virus will continue to evolve, and New Zealand stands ready with a variant plan developed over 2022.
“The plan focuses on preparedness and maintaining the capabilities to respond on a range of possible scenarios.”
She acknowledges long Covid is a “very real concern”, and something the ministry has been working to address.
A ministry spokesperson says officials are continuing to track evidence around long Covid, and has introduced new codes and guidelines to help clinicians diagnose the condition.
“As there is no known cure for long Covid, the focus on the guidelines is identification, assessment, diagnosis, interventions, supports and care pathways for rehabilitation of individuals with the condition,” a spokesperson says.
“This guidance is currently being updated.”
To Brooks – among 150 health experts who’ve called for stronger measures to protect people – this isn’t good enough.
“Just because there are guidelines and pathways, doesn’t mean that all healthcare providers are engaging with them, adhering to them, or indeed whether people can afford to access healthcare in the first place,” she said.
“This is on top of the debilitating illnesses they are enduring. Many are too ill to seek adequate help, and some are still not being believed, or indeed are being given harmful, outdated health advice.”
Why isn’t New Zealand providing better workplace policies or access to financial support, or ensuring all teachers and children have properly ventilated classrooms?
Why don’t we yet have infection prevalence surveys in place, and why aren’t we funding enough long Covid research of our own, or at least doing enough to warn Kiwis about the dangers of reinfection?
Brooks could go on.
“In short, no, we are not doing enough.”
Daniel Freeman just wants the misery to end.
It’s now been half a year since he was assured that his age, previous good health and vaccination status would see him fully recover.
“Just knowing that I am not alone and that my experiences are real and valid has helped me keep my sanity,” he said.
“I’ve been in touch with some incredible people both here in New Zealand and around the world, many of whom have been sick since 2020.
“I want there to be a treatment or cure that works for all of us. We need our lives back.”