Covid-19 over the holidays – Expert Reaction

Modelling suggests hospitalisations from New Zealand’s current Covid-19 wave will peak this week.

Meanwhile a new variant JN.1 is gaining traction in New Zealand, and stocks of the Paxlovid antiviral are running low.

The SMC asked experts to comment.

Professor Michael Plank, Te Pūnaha Matatini and University of Canterbury, comments:

“After a relatively quiet winter, Covid-19 has been on the rise in New Zealand for the last few months. The good news is that hospital admissions and deaths due to Covid-19 are still well below the levels they were at this time last year. And the start of school holidays may bring a bit of a reprieve as there are fewer opportunities for the virus to spread.

“The bad news is that the JN.1 variant, which is probably the fastest growing variant we’ve seen this year, could prolong or increase the size of the wave. JN.1 is an offshoot of BA.2.86 (Pirola), which is a highly mutated variant that cropped up in countries around the world in August, but didn’t take off at the time. It’s looks as though JN.1 has picked up mutations which allow it to spread rapidly in a wider part of the population than BA.2.86 could.

“JN.1 was responsible for around 10-15% of infections in New Zealand according to the latest sequencing and wastewater data, so we are yet to feel its full impact. But if it grows at a similar rate to other countries, it could become the dominant variant early in the new year. This could cause the wave to continue to rise for longer, or potentially cause a double peak.

“Covid-19 has not yet become seasonal in the way influenza is, but it is settling into a more regular cycle of peaks and troughs. As the current wave progresses, the pool of people who are susceptible to the dominant variant gets depleted. This makes is steadily harder and harder for the virus to find new hosts until eventually the wave peaks and starts to come back down. Then over time immunity wanes, new variants emerge and the cycle eventually begins again.

“The risk of getting severely ill with Covid-19 is now very low for most people. However, it can still be a serious illness for some and there is still a risk of Long Covid (although this is much lower now than earlier in the pandemic). If you’re over 30 and it’s been more than 6 months since your last vaccine, you may be eligible for another booster. Now is a good time to get one to reduce the risk of Covid ruining your summer holidays. And if you don’t feel well, it’s better to stay home than to risk spreading Covid or other nasty viruses, especially if you are seeing elderly relatives over the holiday period.”

No conflict of interest declared.

Professor Nikki Turner, Director, Immunisation Advisory Centre, University of Auckland, comments:

“There is an enormous amount of COVID around at the moment.

“People aren’t reporting their positive results as much anymore, so we need to look at hospitalisation and wastewater rates to get a clearer picture of how much COVID disease there is currently. Rates are now the highest they have been since January this year.

“The latest data is really compelling – the rolling seven-day average rate of hospital admissions has risen in recent weeks; and wastewater rates have climbed significantly in October and November. So that tells us there is a lot of COVID around.

“With Christmas and New Year approaching, everyone is mixing more and going on holiday around the country, so we need to focus on who is at high risk of severe disease and how we can protect them this summer.

“While everyone is at ongoing risk of COVID, not everyone is at the same risk of severe disease. This disease particularly affects elderly and people with significant medical conditions that put them at higher risk.

“Everyone in the high-risk category should get a booster now which is expected to give important protection against severe disease. While the Omicron variants are continuing to evolve, data to date is reassuring that the vaccine remains effective – particularly against severe disease.

“But as well as an individual’s own protection, there is also data showing that boosters do temporarily help to reduce transmission as well – and that reduction is more effective the more recently you have been vaccinated. Vaccination with a booster dose now could go a long way to helping slow the spread of disease over this summer and especially helping to protect those who are immunocompromised/elderly.

“Then there is also other important advice – we need to continue to be very sensitive to those who are at high risk of severe COVID-19. Stay away from others if you’re symptomatic, and wear masks in crowded areas if you’re worried about catching the infection and wish to reduce spread.

“Remember, COVID-19 is still with us. We’re fed up to the back teeth with it, but it’s still here and we need to protect ourselves and those around us.”

No conflict of interest declared.

Dr Lesley Gray, Senior Lecturer, Department of Primary Health Care & General Practice, University of Otago, comments:

“We are reading a lot about COVID-19 numbers rising again with the latest variant. This also coincides with the time when many people are becoming due/overdue for booster vaccinations.

“Covid-19, like many viruses, will continue to develop into new variants. The JN.1 variant is a descendant from an earlier variant of Omicron (the Pirola variant). There is some concern that it might be more transmittable than earlier variants. Symptoms seem to be commonly a raised temperature, runny nose, headache, loss of sense of smell, and some people might get diarrhoea/stomach cramps with it. Extreme fatigue may also occur.

“When in groups, do consider wearing a facemask, especially indoors as we know that masking up helps reduce the transmission of the COVID-19 virus. Luckily for us in Aotearoa NZ, Christmas and New Year are also our summertime, so we are more likely to be meeting outside if the weather settles, which hopefully will help keep a lid on this new variant.

“If you are eligible and haven’t had your COVID-19 vaccination or booster yet, pop it on your Christmas list and get your free jab.”

No conflict of interest declared.

Professor Michael Baker, Department of Public Health, University of Otago, Wellington, comments:

“Covid-19 is causing a large fifth pandemic wave in November-December 2023, as indicated by results of wastewater testing and hospitalisations. This wave is larger than the fourth wave early in 2023 suggesting that the pandemic threat is continuing to evolve in unpredictable ways. The cumulative effect is likely to be approximately 1,000 deaths, 12,000 hospitalisations, and thousands of people disabled from long Covid during 2023 in addition to the those affected in previous years.

“The factors driving these pandemic waves are likely to include a mix of waning immunity, continuing Covid-19 virus evolution, and changing human behaviour (including relaxation of protective measures and some degree of response fatigue and complacency).  This virus can still surprise us with the emergence of highly divergent lineages. That was the case with BA.2.86 (‘Pirola’) which was first detected in August 2023 and has now spread globally. A further evolved version, JN.1, has high immune evasion potential.  It is increasing in frequency worldwide and is now also showing a modest increase in NZ.

“This pattern of recurring large waves of Covid-19 infection is a wake-up call for the NZ Government about the importance of a vigorous national strategy and programme to protect us from Covid-19 and other serious respiratory infections. This programme should include an updated Covid-19 vaccine, support for self-isolation, and a communication plan to maintain awareness about how to stay safe.

“Heading into Christmas, people can protect themselves and others by taking precautions such as vaccination, self-isolation when sick, organising well-ventilated gatherings, and using masks in crowded indoor spaces.”

Professor Baker has also co-authored an opinion piece for the Public Health Communication Centre.

No conflict of interest declared.

Dr Anna Brooks, Senior Lecturer Biological Sciences, University of Auckland, comments:

“As we head into the summer break, we, like the rest of the world, are starting to face the emergence of a new COVID-19 “variant of interest”, as declared by the WHO today (20th December), JN.1, a descendant of Pirola. However, the landscape we face now is much different. The narrative that “COVID is over” coupled with the drop of national messaging surrounding risks, means that only those of us still invested in keeping “covid safe” – or indeed those of embedded in the research – remain engaged on what continues to unfold.

“The risk of developing Long COVID should be front and center as we continue to face waves of infection as variants evolve. Alarmingly, the risks are instead more often downplayed, despite the substantial and growing body of evidence that each infection, regardless of vaccine or infection history, carries a risk of on-going health harms, including but not limited to Long COVID.

“The immune or immunity landscape here in Aotearoa New Zealand is somewhat unique, both based on our vaccination schedule/uptake and number of waves experienced. Will our “immunity wall” continue to follow a similar trend to the previous smaller waves and will cases peak soon? Or will we see a wave that continues to grow due to waning/insufficient population immunity? Only time will tell, so the best we can do is heed the warning expressed by Maria Van Kerkhove from the WHO: “respiratory diseases are seriously on the rise and we have tools that prevent infections, severe disease and death. We need all countries to use capacities expanded during COVID-19 to tackle this NOW”.

“The question is though, are we using all the tools? As at 18th December, Paxlovid supply is low and the updated monovalent vaccines are still yet to be approved for use here. Why are we still waiting? Although the vaccines we have available currently provide adequate protection against severe disease, immune protection will likely wane faster and breakthrough or reinfections may be more common. Hence boosting against the most recent variants should be a priority. Now it seems that, as well as our immunity, access to the best tools is also waning.

“Of course, the first line of defense is to take measures to prevent infection in the first place: ventilate indoor spaces, use face masks when in crowded indoor spaces, and stay home when sick. Awareness and information dissemination remain critical if we are to strive to minimise avoidable harm from infections. COVID is far from over, and right now, based on what is unfolding in other countries, we don’t really know what impacts current and future variants might have. What is undeniable is that Long COVID devastates lives, and therefore infection prevention and health messaging should be a priority.”

Conflict of interest statement: “I am a member of the Executive Advisory Long Covid World Health Network (WHN) Group.”

Associate Professor Dianne Sika-Paotonu, Immunologist; Associate Dean (Pacific); and Head of Pacific Office, University of Otago Wellington, comments:

“Although we are now into summer, Covid-19 remains an unwelcome presence in Aotearoa New Zealand. Wastewater testing results have been indicating higher Covid-19 infection levels in the community than reflected by reported figures.

“Higher Covid-19 case and hospitalisation figures also show Aotearoa New Zealand is experiencing its 5th wave of Covid-19, with waning immunity and Omicron’s higher transmissibility as contributing factors.

“Even with more people having now been exposed to the SARS-CoV-2 virus, and with various Omicron subvariants in circulation, Covid-19 vaccine boosters are still important for people.

“As has been seen previously, many remain at higher risk of ending up with more severe consequences of Covid-19. Sadly, deaths associated with Covid-19 continue to be reported each week and will continue to occur into the future.

“Within the past week, public health officials here in Aotearoa New Zealand have recommended some at-risk groups get a booster vaccine, including Māori and Pacific peoples aged 50 years and over, and those aged 65 years and older.

“Given that the Covid-19 pandemic has exacerbated pre-existing inequities in health for different groups, the equitable availability and accessibility of Covid-19 vaccines and boosters, RAT tests, masks and antivirals will be crucial for dealing with Covid-19 waves sweeping across Aotearoa New Zealand. It is important to remember also that there can be barriers for people when seeking to access to help and healthcare in Aotearoa New Zealand, and that cost remains a significant barrier for many.

“One of the new Omicron variants known as JN.1, is currently in Aotearoa New Zealand. JN.1 is almost identical to the highly mutated “Pirola” variant (BA.2.86).

“As with Pirola, JN.1 also carries a very high number of mutations on the spike protein, which is how the virus gets into our cells. According to the US’s Centers for Disease Control and Prevention (CDC), there is only a single change in the spike protein between JN.1 and Pirola.

“The CDC also previously noted that the high degree of change that occurred in the virus that eventually led to the Pirola variant, was similar to the difference between the Delta variant, and the initial Omicron variant.

“JN.1 is currently responsible for growing infections in Aotearoa New Zealand and overseas, with its impact on disease severity yet to be determined.

“Antiviral medicines are used to treat people who’ve already been infected, and they interfere with viral replication and mechanisms.

“In general, antivirals reduce and limit the severity of symptoms that someone might experience with a viral infection, lessen the duration of the viral illness and shortens the length of time that someone stays unwell for, and reduces viral transmission.

“To ensure people get access to antivirals at the time they need them and improve their accessibility and availability.

“Antivirals need to reach those who require them quickly in order to prevent severe illness and hospitalisation – and can help protect our hospitals and support systems, primary and community care.”

No conflict of interest declared.

Professor Graham Le Gros, Director, Malaghan Institute of Medical Research, comments:

“Vaccination remains one of the best tools to protect yourself from the worst effects of COVID. As we work hard to make better, longer-lasting COVID vaccines, the single biggest favour you can do yourself and loved ones this Christmas is to get a COVID vaccine or booster.

“The immunity generated by the vaccine will ensure that any COVID infection you pick up while on holiday will be mild and reduce the chances you will pass the virus on to others.

“If you do become infected be aware that the virus can be excreted for some days after the symptoms have gone and you do not want to pass it on.

“We still do not know the full range of long term effects resulting from COVID19 infection so it is better to play safe and keep your immunity at good levels by vaccination.”

No conflict of interest declared.

Associate Professor Arindam Basu, Faculty of Health, University of Canterbury, comments:

“As we write, there is a fifth wave under way and the number of covid cases are likely to rise around Christmas going through the beginning of the new year, partly due to the indoor gatherings in poorly ventilated places, and holiday travels before they will drop.

“The new variant JN.1 (with L455S mutation) is known to have the property of evading mutations and increased binding to ACE2 receptors; on this basis, infections are likely to last longer and this variant has immune evading properties.

“Vaccinations, masking, RAT tests and where possible, avoiding mass gatherings are still our best bets.”

No conflict of interest declared.