NZ edges towards grim milestone of 1000 Covid deaths. Who and where has it hit hardest? – New Zealand Herald

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ANALYSIS:

The number of fatalities in New Zealand linked to Covid-19 is about to tip over 1000.

Who has died and where has mirrored the spread of Omicron, with Aucklanders making up a higher proportion initially, but less and less as the virus became more prevalent further south.

Before the Omicron outbreak, there were only 55 deaths, but the death toll hit 500 on April 11, and has roughly doubled in the last five weeks. Today it stands at 986.

While every death is a tragedy, New Zealand's per capita death rate is still very low compared to other countries. According to one measure, New Zealand still has the world's lowest excess mortality rate - the number of deaths above and beyond what was expected before Covid.

Like Delta before it, Omicron hit Auckland first before spreading more widely.

The seven-day rolling average for Auckland cases peaked on March 4, March 15 for hospitalisations, and April 3 for deaths, according to Otago University epidemiologist Professor Michael Baker.

Almost 40 per cent of the first 500 deaths were across Auckland's three DHB areas.

This dropped to 32 per cent for the 937 people who have died within 28 days of testing positive for Covid-19. This means Aucklanders made up roughly 200 of the first 500 deaths, but only about 100 of the next 500 deaths.

The way Omicron spread south is also shown by the jump in deaths in the Canterbury DHB region, which made up only 6 per cent of first 500 deaths, but today make up 13 per cent of the total number of deaths.

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Almost 90 per cent of the deaths are among those aged 60 and older, with 78 per cent among those 70 or older. This is not unexpected, given how much more susceptible the elderly and the immunocompromised are to severe health consequences if they catch Covid-19.

More than half - 55 per cent - of those who have died are male.

Fifteen per cent of the deaths are among Mori, down from 17 per cent for the first 500 deaths. The trend is the same for Pasifika, who made up 15 per cent of the first 500 deaths, and now make up 12 per cent. Again, this reflects how the virus infected those communities earlier.

Baker adds that care must be taken in interpreting the data.

Mori make up 17 per cent of the population, but it's not correct to say Covid-19 is just as likely to kill Mori as non-Mori because there are several factors at play; for example, the Mori population has a much young age profile than non-Mori, and it's still unclear how many of the deaths were caused by Covid-19.

Research has indicated that Mori are two and a half times more likely to need hospital care than non-Mori, while the risk for Pacific people is three times higher.

The cause is yet to be established for 815 deaths linked to Covid, the Health Ministry says. The number of Covid deaths could well be over-counted, given that a person killed in a car crash would be logged as a Covid-19 death if they'd tested positive within 28 days of the crash.

There are also likely to have been Covid-related deaths where the person had not been tested.

Of the 85 deaths to date where Covid-19 has been identified as the underlying cause, 19 were Mori. The proportion of these deaths is the same - 22 per cent - for Pasifika.

Covid-19 has contributed to 18 deaths, the ministry says, and was not a factor in 23 deaths.

Of the 937 deaths where the ministry has vaccination data, 217 of them were not fully vaccinated, 250 had received two doses, and 470 had received three doses.

The Economist's excess mortality tracker puts New Zealand ahead of the rest of the world.

"New Zealand is at minus 2.6 per cent, or 413 people per million. In terms of lives saved, that's over 2000," Baker says.

"Australia was similar but has gone into the positives now. New Zealand will get into the positives eventually because Omicron is just gnawing away at us. We're still getting 10 to 15 deaths a day.

"That's one of the many differences from influenza, which causes maybe 500 deaths a year but over a few months. Covid-19 doesn't need winter to give it a boost. It'll go all year because it's so infectious."

Baker estimates that the case fatality rate in New Zealand is below 0.1 per cent, or less than one death per 1000 cases.

The number of total infections, however, could be as much as three times the number of reported cases, meaning the infection fatality risk could be 0.03 per cent.

"That's about three in 10,000 people who get it dying from it."

Baker still expected the case fatality rate to increase over winter.

"Auckland cases are 70 per cent higher than four weeks ago, so we are seeing this gentle rise. They're plateauing and starting to rise in most other DHBs. It could accelerate over the next few months.

"Basically, there are more factors favouring the virus than holding it back now. We're not seeing it yet, but we will get more infectious subvariants arriving here. Then there is waning immunity for people, winter conditions, and people relaxing because controls are no longer required, or because of response fatigue."

One factor countering this is the number of people getting infected everyday who will then be more immune, but Baker says people shouldn't try and get infected.

"They're getting immunity, but they're also getting all the risks associated with getting infected. That's the wrong way to get immunity.

"In any one year, over 30,000 people die. If we don't get on top of Omicron, if it's going to kill 10 people a day, that's almost 4000 people a year. It starts to move into causing over 10 per cent of annual deaths if we don't get it under control."

Higher booster uptake and a fourth dose for the elderly and the immunocompromised would help. The Health Ministry is still yet to provide advice on who should be eligible for a fourth dose, and how long it should be after a third dose.

A "winter" dose has already been approved in Australia for those aged 65 or older, those in an aged care or disability care facility, the severely immunocompromised, or Aboriginal people aged 50 and older.

"Flu is about 2 per cent of our deaths. That's already our biggest infectious disease killer. We don't want another thing like the flu, but worse, gnawing away at us," Baker says.

"We shouldn't catastrophise it, but we shouldn't trivialise it either."

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NZ edges towards grim milestone of 1000 Covid deaths. Who and where has it hit hardest? - New Zealand Herald