The NSW outbreak of delta infections is worse after six weeks of lockdown. As I am sure is true for many readers, I am frustrated today by the obvious loopholes in our current “lockdown”.
We are currently bombarded with so much Covid information and misinformation that Covid ‘fatigue’ is a real phenomenon here and in many other countries. Complacency on the one hand, and quite militant revolt against imposed restrictions on the other, are both dangerous consequences. In many countries vaccination rates stubbornly plateau, yet public health measures are nonetheless abandoned prematurely. We can see the consequences and must not allow this to happen here.
Vaccines – strengths and weaknesses
This American summer, despite having only 50% of the population fully vaccinated against the SARS-COV-2 virus, related restrictions were eased prematurely. On Cape Cod hundreds of holiday makers crowded into the popular area and the virus had a field day. Most alarmingly, 74% of the infections occurred in fully vaccinated individuals. Most experienced only minor symptoms and none died, but they were carrying very high viral loads and were, of course, infectious.
We have known for many months that vaccination does not stop one from carrying viruses in one’s respiratory secretions. But this event finally persuaded the American CDC to call for the vaccinated to wear masks when indoors and not able to maintain social distancing.
Just when many Americans thought vaccination would provide freedom from the Covid scourge they were once again told to wear masks and practice social distancing. Incredibly some Governors decided this was intolerable and actually banned mandatory mask wearing.
Immunologists expected this situation. While the vaccines we use do reduce by about 50% the carriage of virus in our respiratory secretions, none produce what is called ‘sterilising immunity’, a state where the immune system will not allow viruses to reside in those secretions.
We have a purpose evolved mucosal immune system with special skills to protect our ‘inner skin’, the mucous membranes that line noses, throats, intestines etc. This system is poorly activated by vaccines injected into the body. Hence injected vaccines only effectively protect our vital internal organs and thankfully they do that very well. Dozens of laboratories are hard at work trying to produce vaccines that can be administered by nasal sprays or taking a tablet.
The possible presence of virus in the secretions of the vaccinated limits the usefulness of ‘Vaccine Passports’. This is particularly so if vaccination rates are low. Some countries such as France are focussing on events just for the vaccinated. Attendees at such events are protected but some participants carrying virus could pass delta onto others attending who are vaccinated but not infected. They in turn could become a silent spreader in the broader community.
Australia’s masterplan
At the moment, Australians are studying the government’s four stage plan to end our Covid suffering. Enormous emphasis is being given to some definitive figure for vaccination uptake that will set us free. Various models suggest 70-90% vaccination rates will be required. Truth is that we will only know the true figure when that day arrives and the smouldering embers of the pandemic can readily be dowsed by our contact tracers for the few cases we will encounter.
That figure is certainly a very high one. My point in discussing the carrier status of the vaccinated is to make it clear that for much of 2022, even with the majority of us vaccinated, mask wearing and social distancing will still be required by all of us to avoid ‘lockdowns’ and protect the unvaccinated. Surely Australians would not accept the appalling proposition from a number of social commentators in the UK who argue that we and our government have no duty of care to those who refuse vaccination.
While it’s crucial that transparency prepares Australians for likely scenarios, talking about 80% vaccination rates when we are just nudging 20% may seem premature. In a review in May 11% of Australians said they would never accept vaccination and another 24% expressed doubts. Reaching needed goals of 80- 90% of all Australians immunised is going to be a real challenge.
All sorts of inducements are being discussed, from cash payments to lottery tickets. But Australia should be following the example of many countries that are mandating vaccination for various occupations. With vaccination an essential criteria, you are free to accept or reject a position. We have a surprising number of health professionals working in our health system who have had to be deployed away from the ‘front line’ as they will not be vaccinated!
The government’s plan suggests that with 80% of Australians over 16 vaccinated (Stage C), we could safely employ only highly targeted lockdowns, have no caps on returning vaccinated Australians and lift all restrictions on outbound travel for vaccinated Australians. Further we could extend the travel bubble for unrestricted travel to new candidate countries, allow a gradual reopening of inward and outward international travel with safe countries and employ only proportionate quarantine with reduced requirements for fully vaccinated inbound travellers.
This modelling is seriously flawed. Australians over 16 comprise just 65% of the population, a figure that will certainly be too low to achieve the goals set for the crucial ‘Stage C’ of the plan. With 35% of the population unvaccinated and many who are still silent carriers of the virus, these goals can not be achieved. All expert epidemiologists argue that Stage C will require us to vaccinate all our children over the age of 2 years and we need to prepare for this effort now.
This will require a major education program to reassure parents it’s safe to vaccinate their children. Vaccine efficacy and safety has been demonstrated for children aged 12-16 years. The Moderna vaccine has been safe and effective in children as young as two years. Other trials for the 2-12 year olds are advanced and we should not expect any problems.
Explosions of delta infections in other countries warn us that our children are in danger. They are more readily infected with this strain. Vaccinating children is necessary to protect them as well as the community. Infected children may also be a “laboratory” for the SARS virus to develop new variants.
In the US, 36,000 children have been admitted to hospital with Covid-19 and nearly 400 have died. Most recover, but many are left with a long struggle to regain full health. About 10% find that in the weeks and months following infection they are experiencing a myriad of debilitating symptoms; the so called “Long Covid syndrome” that troubles many adults as well.
New Information
The schedule for giving two doses of vaccine has been subjected to much study of late. We now have strong evidence that optimal protection from two doses is provided when the second dose is delayed. This is true for the Pfizer vaccine as well as AstraZenica. Indeed with Pfizer, the strongest response occurs with a second dose given 6 weeks after the first. When the infection rate is very high in a community however, public health experts are advising shorter intervals as second doses after shorter intervals do provide a useful boost to the response from the first injection.
Most vaccine manufacturers are now recommending a third ‘booster’ dose six months after the first. The initial advice that the Johnson and Johnson vaccine would only require one injection has been changed. These developments will put greater pressure than ever on the amount of vaccine the world needs.
People who have experienced COVID-19 and survived have antibodies to the virus, but vaccination produces a much more effective response and these people are also being urged to get vaccinated.
We are now confident that it is safe to immunise pregnant women. This is important as clear evidence has emerged of the increased risk of pre-eclampsia, one of the major complications of pregnancy, in pregnant women infected with the SARS virus. Women planning a pregnancy are being advised to get vaccinated.
An enormous amount of research is being directed to finding a drug to treat COVID-19. Recent studies in which those with a recent onset of the disease were given a combination of two monoclonal antibodies produced very encouraging results.
Frustrations here and now
As I write the NSW outbreak of delta infections is worse after six weeks of lockdown. As I am sure is true for many readers, I am frustrated today by the obvious loopholes in our current “lockdown”. Victoria and other jurisdictions have demonstrated the importance of the “Maximum pain for maximum gain” approach. There are still too many businesses operating. Why was my local car wash doing a roaring trade this past weekend? Essential business?
Other states have been prescriptive and ordered outdoor exercise to be limited to one hour a day. Not so in NSW. We have thousands of Sydneysiders enjoying hours of ‘exercise’ outside strolling up and down esplanades etc not wearing masks or social distancing when we know the delta virus can readily jump from one person to another as they pass each other.
Not good enough, Premier.
See also Ross Gittins in SMH today.
Ross Gittins
I’ve yet to see any of the perpetrators – Liberal tribal mythmakers, industry lobby groups and business media cheer squad – admit to their part in the humbling of that ‘‘gold standard’’ virus fighter, NSW Premier Gladys Berejiklian (a woman I quite like).
All those business people feeling the pain of NSW’s protracted lockdown have no one to blame but the short-sighted, self-centred urgers on their own side.
See this link: When a quick buck is more important than your freedom.
Professor John Dwyer is an Emeritus Professor of Medicine at UNSW and the founder of the Australian Healthcare Reform Alliance.
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