Here's a question that should be asked of Jacinda Ardern and Judith Collins in TVNZ's leaders' debate on Tuesday night but probably will not be:
Given that Covid-19 now has an estimated fatality ratio of less than 1 per cent of infected populations, is it worth the cost to the economy to continue pursuing the goal of elimination?
Before I'm accused of spreading "misinformation" let me say that fatality ratio was based on figures published in the BMJ (British Medical Journal of old) on Wednesday of last week. The journal commissioned a debate on the question, "Should countries aim for elimination in the Covid-19 pandemic?"
Yes, said a British GP and member of the Royal Society of Public Health, Andrew Lee, who advocates an elimination policy for the UK and, indeed, the world. No, said New Zealand epidemiologist Simon Thornley in a piece co-signed by colleagues Arthur J. Morris and Gerhard Sundborn.
Lee explained, "Elimination is usually pursued for diseases that cause serious illness or death such as smallpox, polio, measles and Ebola. The alternative approach is suppression, which attempts to reduce disease incidence to acceptable levels. Against the backdrop of rising unemployment and economic recession, suppression may seem the most economical approach. However, this is a short-term perspective. Societal costs in the long term need to be considered.
"Take influenza, for example," he said. "Each year a billion people are infected with flu and as many as 650,000 die from it. The costs of immunising, treating, and controlling flu are substantial. Furthermore, Covid-19 is not a low-consequence infection. It is more contagious than flu and has high fatality rates, especially among elderly people and those with comorbidities."
Thornley, Morris and Sundborn disagreed. "The estimated infection fatality ratio was high when polymerase chain reaction tests were used to detect cases," they said. "With the development of antibody assays, it's now clear that infection spread is much wider and the fatality ratio estimates now range from 0.02 per cent to 0.86 per cent, with a median of 0.26 per cent."
They also observed, "The age distribution of Covid-19 deaths in New Zealand is similar to that from the same period in 2019. This indicates that Sars Cov-2 is not dramatically shortening life when compared to background survival."
They concluded: "With the virus now widespread globally and vaccines a distant possibility, a more sustainable strategy is for nations to learn to live with it ... Chasing an unrealistic goal comes with an unacceptably high price to our country that will take decades to repay."
The National Party will deny this now but had they been in power this year I have no doubt they would have taken advice from the likes of Thornley, Morris and Sundborn rather than from Professor Michael Baker and his ilk.
Under National we would not have gone "hard and early". We would have been more like Australia, which means we might be Melbourne by now or we might be Sydney and looking forward to hosting Sanzar's Rugby Championship.
We might have lost 7 per cent of GDP rather than 12 per cent in the June quarter.
Instead, both our major parties are committed to the goal of elimination because it's naturally popular. Who wouldn't want to avoid a virus, even a common cold, if you could? The vast majority of New Zealanders, including National voters, are glad to believe they are living in a place that can be sealed from a pandemic.
They have endured lockdowns and found ways to work around them. Wage subsidies and cash flow loans have cushioned most people from business failures and unemployment. For the moment only economists seem to care that the country is in the deepest recession we've seen. Let them worry about the scale of distress in the years ahead, enumerated in the Treasury's pre-election economic and fiscal projections this week.
Election campaigns are supposed to be the epitome of political debate but they often avoid the most important question facing the country at the time. The next four weeks will be a phony war, in which National and Labour will argue over which can be trusted to pursue elimination more rigorously, while maybe opening the border a little for fruit-pickers, skilled labour, international education and rugby.
But once the election is over, we may see a rethink of elimination, no matter who wins.
Some see it happening already. Travel restrictions were removed before Auckland's August outbreak was entirely contained. Hospitals are about to receive more than 100 additional ventilators, with another 200 due by the end of the year. If the Cabinet on Monday moves the rest of the country down to level 1, it will accept the risk that a travelling Aucklander could infect a crowd.
Once the election is over, we will probably get real.