JACK WATERFORD. The young not the old are the key to beating COVID-19

Apr 7, 2020

Coronavirus not only effects the elderly and cooperation on the part of the young is the key to beating COVID-19. Perhaps we need Grim Reaper ads to highlight the risk to their own.

People of a certain age (including me) must have been bemused by evidence of a certain indifference by younger adults to the fate of their grandparents. That’s if indications of crowds at beaches, pubs and places of entertainment a week or so ago were anything to go by. Until state and territory police and military began patrolling the streets, a good many younger folk seemed to feel that they were themselves at little risk and that their behaviour was no great threat to older Australians. Coercion seemed the only answer.

Or was it that the marketing campaign designed to foster a sense of communal social responsibility, particularly towards senior citizens, and focused on promoting social distance, handwashing and reducing the risk of shedding and spreading Coronavirus was less than the optimal approach to galvanising and changing the behaviour of young people? That’s not necessarily to suggest that the advertising campaigns have been a complete failure, because millions of Australians have heard and are abiding by the messages being sent out by the public health authorities. But it did not seem to get the buy-in from younger people, any more than angry denunciations by the prime minister, or shaming efforts by television broadcasters.

Forty years ago, Australia faced another public health crisis, and again initially with limited “buy-in” by a good many smug Australians. It was the HIV virus, and AIDS – with at that stage only very limited treatment options. A former senior public servant, if one still engaged in public life, spoke to me this week of the problem of getting the public interested and concerned enough to conscientiously change behaviour. Many Australians might have empathised in principle with the victims – mostly homosexuals, intravenous drug users or haemophiliacs – but did not see themselves as being at great risk. They agreed intellectually that lifestyle changes were called for, but lacked a strong emotional response or much in the way of a sense that they needed to change too. Then came the Grim Reaper ads – arresting, shocking, and, on all of the evidence, very effective. Australian public authorities led the world in dealing with AIDS in the population, not least by involving and engaging with Australians who were most at risk.

With COVID-19 and younger people, the relationship between the risk of mild or asymptomatic conditions and the terrible suffering, and high mortality among mostly very elderly Australians seems too remote. A different approach is needed, one which brings the risks home to the people whose behaviour needs to change.

We know now that coronavirus produces acute conditions particularly among people with compromised immune systems.  Most people associated this with age. But there are many younger people in the community with compromised systems.

A young person being casual about the risk of coronavirus infection was a threat to the health of a person, young or old, undergoing chemotherapy for cancer. That might be your best friend or your best friend’s mum. A woman who had suffered from anorexia or bulimia was at enhanced risk. So was anyone with diabetes.  Or any of the autoimmune diseases – such as lupus, multiple sclerosis or rheumatoid arthritis. Smokers and heavy drinkers were at higher risk. But so were people with asthma, eczema, hay fever and people who were allergic to particular foods. Add to that a raft of people with chronic respiratory conditions, including, particularly in children, ear disease, and those with more acute ones, including colds and flu. People who have had recent surgery. And malaria – no longer a major problem in Australia – but often to be seen at our door — and with symptoms, including fever, remarkably like a COVID-19 presentation.

A typical fit Australian woman or man – a very likely candidate for casually picking up the virus from a chance encounter with someone exhibiting no obvious symptoms, or nothing more than a cold, and then not themselves developing any condition might not be in regular attendance at an aged persons home.  There is a very good chance that this person will have been completely unaware of the transfer, which may have come from some surface both had touched. There’s a good chance that this person will not develop any symptoms of having picked up the virus, or will not consider that she has COVID if she gets mild symptoms. If, of course, she suspects the condition, but does not know where she got it, she might present at a testing station and be rejected for actual testing, unless she had recently returned from abroad, or could show she had been exposed to someone already identified as a carrier. And even if she were tested and told she was a carrier, she would be sent home for a fortnight and warned not to associate with others.

But innocently or not, asymptomatic or only mildly suffering, this woman or man is, we think, actively shedding and spreading the coronavirus, whether directly to others by physical contact, or by leaving the virus on surfaces touched by others.  This person may not have much direct contact with the very elderly, but she, or he, is much more likely to be in casual contact with diabetics, smokers or people with multiple sclerosis  — people whose health they could seriously compromise. People they could kill, in fact. It might be around this risk, as much as a more generic threat to grandmother, that one might get a younger generation feeling they had more stake in the outcome.

Alas, it is not only young people who are paying insufficient attention to the risks posed by younger Australians to the health of the entire population. Equally problematic are many of the members of public health committees advising government, the ministers who are relying on their advice, and, frankly, not a few of the medical practitioners already up to their armpits in acute cases who wonder whether we can afford the luxury, the time, or the resources, to investigate the presence of mild or asymptomatic cases in the general population. Or, for that matter, establishing who does not have the condition at all.

Members of the health committees and ministers will piously assure everyone that Australia is doing more mass testing or more mass testing per capita than almost anyone else. They have the figures to prove the number of tests, and, unlike figures pulled out of a hat by Donald Trump, these figures are not made up.

But even if we are doing more tests, we are not mass testing at all. Our tests are rationed. We are only bothering to test people we think will turn up positive. This might once have been justified, up to a point, when there was a shortage of tests available.  That is not now the problem: the issue is the resource cost of extended testing – of testing everyone, perhaps regularly. It is said to be a low priority or a distraction as our focus shifts to increasing intensive care beds, training more health workers and developing extra hospital space.

 In recent days we have slightly widened the testing net – and now also maintain a necessary watch on health practitioners working with acute cases who might have caught the virus.  Testing of suspects is justified in its own right. Doctors with critically ill patients can sometimes push patients into the COVID-19 treatment stream before testing has established that their condition is COVID-19. But since coronavirus is far from the only source of respiratory crisis, it will probably be grudgingly until COVID-19 is demonstrated by serology (proof of an antigen response to coronavirus by the person’s body) or of strands of the Coronavirus genome.

But using tests to stream patients is not a substitute for research into the spread of the virus into the population.  And until we understand that epidemiology, particularly before we get a vaccine, we are doomed to have to slay the hydra over and over again, as fresh victims emerge.

Jack Waterford is a former Editor of The Canberra Times

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