A house divided against itself cannot tame the pandemic

Sep 15, 2021
Covid virus feature
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St Matthew tells us that Jesus was at pains to teach his disciples that, “A house divided against itself cannot stand”. The truism comes to mind as one looks in vain for the United States of Australia, an entity essential for our taming of the Covid pandemic.

It’s infuriating, foolish and certainly counterproductive not to have a national plan to help us emerge from our Covid crisis that is agreed to and championed by all our governments. In general Australians are a remarkably homogeneous lot. We are not like the United States where states are not united and where Texas and Texans are very different from New York and New Yorkers. However at the moment division rather than mutual cooperation characterises our interstate relations.

The truth is that with the exception of a vaccination target with which all agree, there would seem to be little appreciation of the urgent need to have nationwide uniformity in the development and application of the non-vaccination strategies that will be essential for us to live, together, more enjoyable and productive lives despite the continuous presence of the SARS-CoV-2 virus.

We deserve better than to have state premiers bickering with each other and the prime minister, who some argue is politicising the distribution of vaccines. Controversy is swirling as documents obtained by Labor suggest that the Morrison government neglected an opportunity for Australians to benefit from the Pfizer vaccine before the end of 2020. History may well report that the offer from Pfizer was not pursued because of confidence of an abundant supply of the AstraZeneca vaccine which was far cheaper than the Pfizer and could be manufactured here by our CSL. The rare but serious side effects of the AZ vaccine were not appreciated at that time.

Real world modelling

We are awash with modelling from universities and Institutions all with somewhat different imperatives for shaking off the yoke of the Covid pandemic. For us at this moment, far more important than these learned predictions are the actual happenings in the rest of the world where a number of countries have actually reached 70 to 80 per cent vaccination rates.

The message for us is very clear, unless vaccination success is complemented by continuing adherence to a range of public health initiatives, then the incidence of COVID-19 can still surge among the unvaccinated and 10 to 15 per cent of those who are vaccinated.

The UK, with almost 70 per cent of the population vaccinated, declared “freedom” from restrictions in July and today hospitals are under siege. With around 35,000 new infections per day hospitals are admitting more than 1000 Covid patients a day and a seven-day average of more than 130 deaths a day.

Singapore was living with Covid comfortably as vaccinations and restrictions had seemingly tamed their epidemic. A secure Covid bubblewas proposed with Germany. Such plans have been abandoned just this week as with the easing of restrictions a new wave of delta infections is again sweeping the country.

Other countries with high vaccination rates such as Canada and Israel are experiencing surges in new cases and appreciating the need for a long term partnership between vaccination and measures to facilitate the need to keep away from each other.

So what will acceptable co-existence with the coronavirus look like? The steady state we seek will feature numbers of new infections that our contact tracers can contain and the capacity to provide hospital and intensive care for those who need it without compromising our capacity to provide the same necessary care for non-Covid illnesses. Indeed the integrity of our hospital services must be the bottom line imperative for living with Covid.

There are three major elements to achieving these goals. Two are within our control, the maintenance of high vaccination rates and high levels of immunity among the vaccinated and community acceptance of long term crucial public health restrictions. The third requires the taming of global infections as we have no choice but to engage with the international community.

Vaccination

Our experience with the available vaccines tells us that about 90 per cent of those vaccinated will be protected from serious illness and death from COVID-19, that immunity wanes about six months after vaccination, booster doses six to eight months after a second dose will be required, so-called break through infections among the vaccinated are to be expected and vaccination reduces the carriage of virus in one’s respiratory tract but still allows for many vaccinated to be infectious.

These facts need to be considered as plans for vaccination passports are developed. My passport may not be as reassuring as your passport if my immunity is waning. The vaccinated who are carriers of virus can infect the vaccinated who are not.

There is general agreement that vaccination of 80 per cent of Australians over 16 will not achieve herd immunity. Twenty-five per cent of new infections in NSW are in children who are far more likely to become seriously ill now that the delta variant is predominant. As soon as possible (probably March/April 2022) we must vaccinate children from five years of age to protect them, better protect the rest of us and deny the virus a cohort for the development of viral mutations.

The SARS-CoV-2 virus has been hard at work seeking model improvements that increase its chances of long-term survival. Enter mu. In the last few weeks scientists have watched a new variant, labelled Mu, pop up in Columbia and take of on its travels. It has so far been detected in 40 countries and 49 of the states in the US. The World Health Organization (WHO) regards it as a variant of interest along with eta, iota, kappa and lambda variants. There are no data suggesting that any of these will displace delta but all need to be monitored carefully.

Noting these developments it is important to again emphasise that the gross inequity associated with the distribution of Covid vaccines is not just abetting the ravaging of the poor by COVID-19 but is also perpetuating the conditions for unfettered experimentation by the SARS virus. Less than 0.2 per cent of vaccine doses have been delivered in our poorest countries.

Things may improve if recent developments see the removal of the intellectual property rights vis a vis vaccines currently protected by manufacturers. It was gratifying to see Australia join more than 100 other countries signing onto the WHO’s campaign for this to happen.

Nationwide preparation for the restrictions that must complement vaccination

While we continue our vaccination program, with wiser and united leadership Australia would now, with a sense of urgency, be investing in a myriad of non-vaccination imperatives to maintain, and in the case off NSW, Victoria and the ACT, return to a cautious but acceptable lifestyle.

Productive, enjoyable, economically imperative freedom of movement around our nation will require all people in all states and territories to metaphorically sign a social contract wherein adherence to evidence based restrictions will maintain that freedom. Masks when one uses public transport, physical distancing indoors, spacing in public arenas, etc. The restrictions the NSW government plans to maintain after we have 70 per cent of the adult population fully vaccinated will, I believe, need to be maintained even if we have 80 per cent of adults vaccinated. But to move freely and safely around our country, the entire country must accept and maintain those restrictions.

There is some good news re better controlling this virus. Better vaccines are being developed and particularly interesting is progress with the development of vaccines that can be administered as a nasal spray. These would produce antibodies in our respiratory secretions that should stop the vaccinated from spreading the disease. Good progress is being made in the search for drugs that if given soon after infection would stop disease progression.

Our government should now be planning an economic stimulus package to address inadequate ventilation in schools and offices, a major issue for cross infection with the SARS virus. Similarly we need to plan for the near future, distribution of rapid antigen testing kits to households so that respiratory symptoms could be quickly assessed for SARS causation. This is already happening in Singapore.

Our prime minister is insisting that with 80 per cent of people over 16 vaccinated we are opening up. If that is a come what may figure we will be sentenced to the same unacceptable outcomes experienced by other countries who tried to do the same. The percentage is only important if it delivers the desired product ie our ability to control this Covid epidemic.

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