We face social fatigue and misconceptions about social distancing; irresponsible public behaviour; and a widespread lack of appreciation of the long-term clinical consequences of an encounter with this virus.
Saturday morning at Queen’s Park in Sydney, the venue for a half-dozen or so soccer matches for children of varying ages, finds hundreds of parents and friends in clusters along the sidelines ‘cheek by jowl’. They are yelling encouragement and spraying respiratory secretions into the air– with not a mask in sight.
Sunday afternoon, at an NRL clash, a stadium makes social distancing impossible by allowing far more spectators to cram onto benches than is acceptable. Not a mask in sight.
The vast majority of infected people met the virus while in close proximity to an infectious individual for an extended period of time. Prolonged exposure not only results in a much greater chance of being infected, but it also makes it likely that one will be heavily infected (a ‘high viral load’) – a major factor in determining the severity of any subsequent illness.
Our mitigation strategies are not giving this reality sufficient emphasis. It is crucial that we not only practise social distancing, but also minimise being close to fellow citizens for a prolonged period of time, i.e. the importance of – ‘social brevity’.
Remember how one infected local person attending a wedding reception infected 35 other guests? So think how irresponsible it was to ever contemplate having four thousand protesters, even if masked, gathering for a prolonged period of time, in the area around our town hall for a ‘Black Lives Matter’ rally (no matter how laudable the principle). Giving voice to their concerns would have risked spreading the virus. What irony that a protest about saving lives could be responsible for putting many lives at risk. As we have seen in Melbourne, a single carrier can set off an infective tidal wave.
Prolonged exposure results in ‘clusters’ of infection – as we have seen in meat-packaging plants, nursing homes, restaurants, cramped housing estates and, increasingly, hospital settings. More than 700 of our health professionals have been infected. In the Italian crisis, more than 100 previously healthy and often young Italian doctors died after being constantly in close contact with huge numbers of infected individuals over many weeks.
You might get infected making your way around a crowed supermarket. You might pick up Covid from a solid surface or meet it in air exhaled by a fellow shopper – but the risk is low.
On the other hand, religious services, choirs, funerals, parties, hotels where drinking while standing in groups is allowed, public transport and the normal daily routines in nursing homes are all dangerous situations. Opportunities to work at home are clearly important for safety.
We must pay special attention to the working conditions associated with ‘essential services’. We have had clusters on construction sites and in factories. Industry experts should be working with health authorities to devise the best possible protective gear and arrangements for such workers. Social distancing was not, of course, a consideration when practices and spatial layouts were created to maximise workplace efficiency. Today’s planning must be guided by recognition that our Covid-19 struggle will be lengthy. We must create solutions now which would minimise disruptions before the inevitable next pandemic.
The recurrence in Victoria clearly illustrates how quickly a reassuringly low rate of new infections can explode to produce so many more. Our best efforts at contact tracing are unable to arrest such an exponential increase. NSW is understandably nervous that our currently manageable numbers could suddenly accelerate. Recent NSW cases have emerged from hotels and restaurants etc, which facilitate social longevity, rather than brevity.
We need to consider the evidence for universal mask-wearing as currently required of Victorians. The results of many studies trying to quantitate the value of universal mask-wearing are mixed. This controversy is well presented on the NSW Department of Health’s website. However, there is no doubt that they reduce the likelihood of an infected individual infecting contacts. Of course, individuals with respiratory symptoms should wear a mask while they seek testing and then self-isolate until they have the result. No-one with symptoms should think that a mask makes them harmless when out of their homes.
Respected authorities such as the WHO and America’s CDC both recommend the importance of universal mask-wearing by all in Victoria’s situation. Certainly, the same is true for communities like Florida and Texas where 25% of those tested are infected. But mask-wearing is not the panacea which will terminate the epidemic. Stay at home orders will slow the infection rate but our need to ‘live’ with this virus and restore our economy requires us to adapt our normal social interaction to the longterm epidemiological reality we face. That adaptation must address the need for ‘social brevity’ for the foreseeable future.
While vaccine news features much optimism, which I believe is justified, the actual data is very preliminary. We are learning that natural infection might not bestow long-term immunity. America’s CDC estimates, from US field studies, that the number of diagnosed cases should be multiplied by at least 6 (or even perhaps by 24) to get close to the real number of infections.
If these claims are accurate then in Florida and Texas – where for many months at least 20% of tests have been positive – one would by now expect to see signs of ‘herd immunity’ and a decrease in transmission rates. We are not. We will need to diligently apply a cocktail of evidence- based strategies to live – and work – despite this virus.
Accumulating data also warn us that Covid infections globally are causing more and more serious and long-term sicknesses for young people. Too often we hear that Covid is only a problem for ‘oldies’. Young people have been urged to practise avoidance techniques to minimise any chance that they might infect people who are more vulnerable. We should also be advising them on the importance of protecting themselves.
President Trump stubbornly gives priority to maintaining the US’s economic recovery rather than protecting the health of Americans. In his tweets he is using the Melbourne recurrence to argue against employing, in America’s South-West, the Victorian restrictions. What’s the use, he argues. Australia shut down months ago, thought they had the epidemic under control and yet look what has happened. How happy would Texans feel were they facing the Melbourne statistics rather than their 10,000 new cases daily? It’s literally tragic that the US politicisation of the epidemic makes it impossible to implement the Melbourne approach – the only way they could hope to reign in the continuing current disaster that continues to claim about 100 lives per day.
This week, the US demonstrated an extraordinary example of a problem increasingly common throughout the western world. Scientific and technological expertise has never been more important. It is available, but all too often dangerously disrespected. The media often grant anything but expert views undeserved credibility. For example…
Last week, based on numerous well-conducted trials, Dr Anthony Fauci, Americas’s most respected infectious disease expert, told fellow Americans that hydroxychloroquine does not help infected people. This matter has been controversial since President Trump declared, months ago, that it was a “game-changer”. He ordered his administration to purchase huge quantities. It can, however, have dangerous side-effects. The WHO has warned the world not to use it for Covid-19 infections.
On the same day that Dr Fauci provided evidence-based advice, one Dr Stella Immanuel, leader of a church ‘Fire Power Ministries’ which she had established, stood on the steps of the Capitol in Washington, surrounded by a half-dozen or so doctors, and screamed (literally) that she had cured 350 patients with hydroxychloroquine. She also asserted that there was no benefit from wearing masks.
Immanuel, who obtained a medical degree in Nigeria and who currently practises as a GP in Houston, also enlightened her listeners with other ‘truths’: American scientists have isolated brain DNA responsible for allowing people to be ‘religious’ and are developing a vaccine to de-activate the responsible genes. Many illnesses experienced by women occur after they have received ‘demon sperm’ from evil spirits during sexual dreams. She gave the example of endometriosis, a serious condition when uterine tissue grows outside the uterus. Laughable, but sad.
However, a delighted President Trump, seizing on her claims re hydroxychloroquine, declared her to be a remarkable woman and sent the video of her proclamations to his 60 million followers. His son, Don Jr, sent it to his followers as a “must see”. The next day, a Republican Senator diagnosed with Covid infection, announced that he would be taking hydroxychloroquine!
While polls show that a majority of Americans have confidence in health advice given by Dr Fauci rather than by the President, dedicated Trump supporters say the opposite. Little wonder that there is increasing concern for the mental health of the self-declared “stable genius.”
In Brazil, Trump’s clone, President Bolsonaro, who has steadfastly refused to listen to expert advice, presides over a disastrous epidemic which will, by the next day or so, have killed 100,000 Brazilians. His health minister resigned in disgust; the country’s doctors are furious that Bolsonaro will not listen to advice. He continues to reassure his countrymen that hydroxychloroquine cures the disease. Despite the death of a thousand people daily, Bolsonaro’s approval rating remains high. The severity of the Swedish epidemic can be blamed on the government’s refusal to follow expert advice on the need for containment. The wisdom of Covid-19 in picking a target so capable of self-delusion and harm is obvious.
Australians are being provided with an abundance of expert evidence based advice that justifies the restrictions introduced. The next few weeks will tell us if that advise has educated and motivated. If so we will have regained control of a perilous situation.
Editorial assistance from Dr Peter Arnold is appreciated.