Ashley Bloomfield grabs a selfie with Dakta Green, cannabis legalisation campaigner, after spotting a likeness on the activist's T-shirt. Photo / Mike Scott
When will the pandemic end? Dr Ashley Bloomfield, director-general of health, has no idea.
In an interview with the Herald, Bloomfield said there was no clearly foreseeable end point to the pandemic that has thrown the world into turmoil, and likened its impact on society to the decades-long Cold War.
Asked if there was a "pandemic horizon", Bloomfield said: "I can't say anything with any expert insights, no more than anyone else can, to be honest."
He acknowledged SARS‑CoV‑2 - the virus that causes the Covid-19 disease - had created an environment of "uncertainty" that was "incredibly unsettling for everybody".
Bloomfield said there was stability to be found in asking "what are the things that we can control and provide certainty around".
From a national perspective, he said the country had proved adept at "being able to mount successful responses to incursions of the virus".
"While that still leaves a high degree of uncertainty about the horizon, it gives us a much greater sense of certainty about the near-future and that creates more options for us, which is a good thing."
The interview followed an invitation by Bloomfield to share impressions gained through the Herald's The Road Ahead project after a chance meeting outside Parliament during the road trip.
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During the interview, he talked of normalising the use of masks at alert level 1, how that level setting was not normal life and that reshaping society to live with the virus touches on changes needed for other great challenges facing humanity, such as global warming.
Bloomfield said a safe vaccine that was effective would be "a fundamental turning point" to allow the world to "determine what the medium and longer-term future is with this virus".
"But there are many unknowns," he said, among which was the tendency of viruses to mutate over time and a tendency for that change to make the health impact less severe although not less infectious.
"So it may well be that the impact of the virus over time - if we have to live with it, even with a successful vaccine - is that it doesn't create the degree of illness and death that it has at the start of the pandemic."
"The way I think about it is more that the virus will be a significant influence … of our future in the next five to 10 years and some of the things that we have done as part of normal lives.
"We are very adaptable, of course, as humans. Think back to our own younger years - childhood and teenage years - and the things that were so stark and a reality there that shaped our context and our lives like the Iron Curtain, the Cold War."
The Cold War is estimated to have spanned four decades until the fall of the Soviet Union in 1991, shaping the world over that time and since.
"Those things were writ large and they shaped our society." He said it could well be the same with the pandemic and society would adjust to it, as it was rapidly doing so.
Bloomfield agreed life in our pandemic world would lead to discussions about how society functioned, from working practices to cities structured around large commercial hubs.
It was a discussion for the whole of government and society, he said, with the health bureaucracy having an "important role to play, as we do right through the pandemic", through advice.
"We've got plenty of good ideas about some of these things, because from a public health perspective it also provides an opportunity for us and others to talk a bit and reimagine our future when we think about some of those other huge global challenges, like global warming."
As an example, he said there were issues to confront about the potential impact of global warming on mosquito-borne diseases.
"Health and public health needs to be a really key part of that discussion about what future society might look like.
"And there are many other things, you know, around the future of work and so on. So it's a really good opportunity for us to reignite those discussions with a sense of real focus."
In more than 100 interviews across the country carried out between lockdowns, the Herald found no one person who thought we would remain virus-free. In those interviews, people also spoke enthusiastically about a return to normal life.
Bloomfield said those 100 days without the virus might have felt normal. "We knew in the back of our minds there was this pandemic raging away offshore."
It was a "tricky virus", he said, and in the weeks before the new outbreak was detected there had been efforts to talk to the community about preventative measures. "It was a matter of when, not if, we would see another infection.
"So in a way, it's reassuring to hear that people had picked up that message, that we weren't out of the woods on this, that we couldn't expect to go virus-free until a vaccine arrived.
"I think as we aim to move back down to alert level 1 across the country, I would like to think that people will maintain a sort of higher degree of vigilance - and I guess that applies to all of us - and a less complacent sort of view, especially because the pandemic continues to accelerate overseas. It's not slowing down."
Bloomfield - without indicating any change in alert level - said: "It's important to remember that level 1 is not level zero."
Borders remained closed to all but New Zealanders and all - with few exceptions on medical and rare grounds - had to undergo 14 days of managed isolation. It also meant a focus on "basic public health measures, particularly hygiene measures".
"One of the things we've been thinking about is whether there are some other things that we should normalise within alert level 1. And one of the obvious things that there's a lot of interest in is mask use."
He said World Health Organisation advice on mask use had changed and it was recommended as helping when there was community transmission.
"The key point being made by some, and, you know, this is what I'm thoughtful about, is normalising mask use.
"And I think it's been interesting to see how quickly people have accepted and got used to using masks on public transport and on flights."
Bloomfield said there was also an expectation people would continue to use the Covid-19 app to scan QR codes, record visits, and maintain accurate contact details, as more than half the population now had.
"So I think alert level 1 will have additional aspects to it that we didn't have … last time."
Bloomfield described the second outbreak as a "real wake-up call" in our communities. "I can also understand why people felt - well, why we all felt - that life was sort of quite normal at alert level 1.
"On the one hand, people felt safe because we were saying we've stamped out community transmission, or eliminated the transmission of the virus, but by the same token, we want you to go and have a test.
"And, you know, people rightly had difficulty reconciling those two things. I think now, as we go back into alert level 1, people will also understand the need for us to continue that pretty reasonable level of baseline testing partly because we now know that there is a higher degree of asymptomatic … infection than we initially thought at the outset. And also it just means that we get that early warning, much earlier than we otherwise would. So I think that will be another feature of alert level 1."
There was some criticism - although not from many - that apparent gaps in the system showed some in the health system were letting down the national effort.
Hearing that was, for Bloomfield, frustrating but "not surprising".
"I think one of the things we know from the health system is that mistakes and errors will happen in just about every situation. They're not the fault of an individual."
He said it had been shown that pinning fault to individuals had a counterproductive impact, in that it left staff afraid to carry out the actions, and make the decisions, their job required of them.
A similar culture shift around blame had happened in other industries, with Bloomfield pointing to the airline industry and the idea that pilot error was "the cause of everything".
Bloomfield said it was almost always a systemic issue where a range of adverse factors had lined up to create an issue.
"We have to keep it in perspective when there are things that don't go a hundred per cent perfectly, that we're prepared to say 'that didn't go well, let's review it and let's improve', and we don't call every single one of these things a failure because that's a word I think just gets bandied around way too much.
"I think we do have a tendency - not just the media, as a society - to label anything that doesn't go perfectly as a failure which - in medicine and the health sector - is known to create an environment where the people are afraid of making a mistake and you see a pattern or practice of behaviour that can emerge that is actually counterproductive.
"There are a couple of things I always keep in mind. This is a first for everybody. No one, I think as the Prime Minister says, no one has a playbook on this.
"We just need to be realistic that we won't get it right first time, every time. As long as we keep learning."
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