Friends and colleagues have suggested that, as an epidemiologist and public health medicine specialist, I must be excited by the Covid-19 pandemic. But I can honestly say that my main reaction has been fear and anger.
Yet, while most New Zealanders have reacted to the recent bungled isolation of two visitors from the UK with fear and anger, my reaction was one of relief and even elation.
I backed the Government's strict lockdown and cautious reopening strategy and cringed every time I heard criticism of the approach. After 40 years in public health, I know that our greatest successes are invisible – nothing happens – and that most New Zealanders were unaware of the health catastrophe we averted by our restrictive Covid elimination strategy.
But most New Zealanders have felt the economic pain. So, the public outrage in response to revelations about our lax isolation procedures at the border demonstrated that most New Zealanders now realise what we have to lose if we don't remain Covid-free.
Not surprisingly, New Zealanders are probably less worried that the border bungle could lead to loss of life (although they should be) and more worried they will lose their newly regained freedom. The freedom to see friends and family, colleagues and customers, to watch their kids play weekend sport with hundreds of other parents and grandparents, or watch a game of rugby surrounded by thousands.
However, I'm not concerned about the exact reason for the public's current outrage, I'm just happy about its impact. There is now almost universal public support to make isolation procedures at our borders more stringent. No more court cases will be brought against the Ministry of Health to force them to make exemptions on compassionate grounds. There will be no more sniping from the sidelines about our elimination strategy.
Indeed, the lax implementation of our isolation policies is one of the first opportunities for the strategy's opponents to say something constructive. Front-line staff will now have the backing to enforce isolation and those going into isolation will have much greater clarity about the rules.
We are one of few countries where you can now go out and enjoy yourself in the company of thousands, without the fear of catching a disease that will kill one of 100 people within four weeks of being infected.
I have spent much of the last few months trying to work out this elusive number, known as the infection fatality proportion, and there is increasing convergence of expert opinion
worldwide that the one in 100 number is about right.
It's more than 10 times worse than the seasonal flu, perhaps closer to 20 times worse, so I watch with trepidation as countries that still have unexplained community transmission are opening up without first ensuring they have sufficient testing, contract tracing and supervised isolation capacity. It can only end badly.
I hope we get an effective vaccine. I hope the virus becomes less virulent. I hope we get effective treatments. But hope is not a strategy and the odds are not great that any immunity gained from infection or a vaccine will be sustained or that effective treatments will be found.
Moreover, most cost-benefit analyses of an elimination strategy have hugely undervalued the freedom to leave your home without the fear of catching a disease that will kill one in 100 in less than one month.
As New Zealanders, we have now experienced the value of this post-Covid freedom and don't want to lose it again.
The world needs to realise that an elimination strategy is the only viable option, however difficult that will be for some countries. A surprisingly large number of countries are getting close. There are many ways to achieve elimination that we have learnt about over the past six months.
Trusted leadership, good communication and evidence-based strategies are essential ingredients. But Covid-19's one saving grace is the approximate five-day window between being infected and becoming infectious – it's only two days for seasonal flu.
This window is sufficiently long to make elimination a viable strategy, not a hope, and sadly, there is no viable plan B.
• Rod Jackson is a Professor of Epidemiology with the School of Population Health at the University of Auckland.