We all engage in predictions. Simply put, they are what someone thinks will happen in the future. But a robust prediction is more than an opinion; it is an informed opinion.
This is where epidemiologists come in. They are medical specialists in epidemiology, i.e. the study (scientific, systematic and based on data) of the distribution (frequency, pattern) and determinants (causes, risk factors) of states and events health related. (not just diseases) in specific populations (local, provincial, national and global).
That’s long enough, so let’s condense epidemiology to: “the branch of medicine that deals with the incidence, distribution, and eventual control of disease and other health-related factors.”
Epidemiology and prediction
Epidemiologists eat, sleep, and drink a lot of things like data, patterns, and causes (even the pedantry that a leader in the field once advised me). Among this rich menu are predictions. By their very nature, predictions can be inaccurate, especially in the field of epidemiology, and even more so with an unprecedented virus pandemic with so many extraordinarily variable variants.
That said, to my knowledge, epidemiologists have not predicted the election of Donald Trump as President of the United States. Instead, it was the The Simpsons (However, the Simpsons were sadly mistaken in predicting that Lisa Simpson would be Trump’s successor.
“The Simpsons” predicted well
Despite this failure by Trump, in Aotearoa New Zealand we have good reason to be grateful to epidemiologists (the government certainly has good reason as much for its decision-making that led to the country having one of the highest death rates lowest, best performing savings and highest vaccination rates were based on their predictive advice).
Now one of those “pedantic” epidemiologists, Professor Michael Baker, has done us all a big favor with an interview in the New Zealand Herald (paywalled) with his science journalist Jamie Morton offering three predictions about the highly transmissible Omicron variant of Covid-19. Professor Baker’s predictions.
Professor Michael Baker makes valuable predictions Omicron
Prediction 1: More waves, more variations
Omicron’s sudden rise to “public enemy number one of the pandemic” given the mortality of the Delta variant has surprised epidemiologists and other scientists. But, after watching its global spread and radically changing nature, Baker’s first prediction is that there won’t be just one wave of Omicron; unfortunately, there will be more (maybe several) and, even worse, more variants to follow.
In the medium term, New Zealand may experience waves of Omicron re-infection now that we already have two distinctly different sub-variants (the original BA.1 and the ascendant BA.2).
A new variant probably won’t compete with Omicron on transmissibility, but it might on immune evasion. We should not assume that another variant will cause less severe disease. As worrying as it is, it is better to be aware of it than not and it allows us to plan better.
Prediction 2: Smarter Technology
On the brighter side, however, Professor Baker’s second prediction is that virus-fighting technology will become ‘smarter’ as it has since the start of the pandemic in early 2020.
He notes with approval how the manufacture of sophisticated mRNA vaccines provided adaptability to new variants of Covid-19, at least up to and including Delta. But the effectiveness of this “impressive protection” has been reduced with the arrival of Omicron.
Although work is underway to produce a targeted Omicron booster that is more effective than current boosters, this may not happen until the next variant arrives (our Pfizer booster always helps).
But Baker expects vaccine makers to make “leaps and bounds” against the virus this year. That could be by getting closer to achieving a pan-coronavirus vaccine (what he calls a “holy grail” or “super-vaccine”). Alternatively, it could be as simple as providing less intrusive means of boosting.
In affirming these two perspectives, Baker is referring to the encouragement of research and early trials in the United States and Canada. He envisions a near future where New Zealanders receiving their annual flu shot will also take a Covid-19 shot which could be supplemented with inhaled boosters during the year.
Another development that Baker anticipates is much more progress with antivirals. These are drugs that help the body fight off certain viruses that can cause disease. They can also be preventive. This includes against Omicron. Potentially, someone with cold or flu symptoms who tests positive using a rapid antigen test could then take antivirals for a few days to protect themselves.
Prediction 3: a long-term strategy
Michael Baker notes that if Aotearoa had suffered other countries’ death rates per capita, we could have had 19,900 (US), 13,700 (UK), 9,470 (Sweden) or 5,530 (Denmark) pandemic death.
This is extraordinary and falls to the government largely following the advice of experts like him to implement a strategy of elimination (zero tolerance) towards community transmission.
But Omicron’s very high transmissibility means our limits have been crossed and we need to mitigate rather than eliminate. Therefore, Baker calls for a long-term sustainable strategy to manage the virus.
This would include public health protection measures such as wearing a mask. It would also include requirements for border arrivals to be fully vaccinated, plus a pre-travel Covid-19 test and a rapid antigen test. Of course, it will take a lot more than that in a strategy.
Baker says less about this prediction than his first two. This is partly the nature of the subject in relation to his other two predictions.
But partly (I guess) it’s the frustration felt by many epidemiologists and other experts at the failure of the government, largely through the Department of Health, to actively engage with them. In the early stages of the pandemic, the encouragement was more proactive, but it has diminished over time to become narrowly reactive.
There was a noticeable deterioration last September. First, there was a failure to commit to the premature decision to lower Auckland’s alert level from 4 to 3 (thereby extending the total lockdown period).
Second, there was a failure to commit to the Prime Minister’s confused decision to abandon the elimination strategy for Auckland (but continuing with elimination in the rest of the country).
In both of these failures, epidemiologists and other scientists were caught off guard and confused.
For some time now, the form of engagement has been for the government to seek advice on specific issues it identifies. While Professor Baker’s first two predictions seem plausible, the third will not materialize significantly enough unless there is a shift in the way the engagement process is allowed to operate – from reactive to both proactive and interactive.
Ian Powell was executive director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years until December 2019. He is now a health systems commentator , labor market and political living in the small river estuary community of Otaihanga (the place by the tide). First published at Second opinion of Otaihanga