While there are demands from right wing commentators for a Royal Commission into Australia’s mishandling of the “essentially innocuous” SARS-Cov-2 virus, in reality Australians continue to die from infection while the distressing and prevalent morbidity associated with infection is becoming clearer and clearer.
As we look back at the history to date of the pandemic in Australia the mistakes we did make can be best characterised as under, not overreaction to the challenge. For example we did not place orders for emergent vaccines fast enough, probably because of overconfidence in the availability and suitability of the locally produced AZ vaccine. We did not handle the vaccination program for aged care residents well and made a mistake in keeping those infected in their residence rather than sending them to hospital.
Another and unfortunately current mistake involves the government’s decision to reduce isolation time for those infected to 5 days when it is clearer from many studies that most people infected are infectious for at least 10 days.
We could discuss hospital unpreparedness, poor training of personnel transporting overseas arrivals, problems with vaccine distribution and a few others but my major wish here is to emphasise that the seriousness of the problem warranted the public health initiatives including the mandating of some requirements.
It is true that the majority of those infected, especially children experience short lived symptoms and recover completely. It was always important however to recognise that while infected one is infectious and thus a potential danger to another who might be more vulnerable.
It also became clear in the first year of the pandemic that episodes of infection, be they mild or not, were associated with rapid virus multiplication that served the virus in two ways. Propagation of the infecting virus and the wonderful opportunity to experiment with the benefits or otherwise of changing its structure. The latter aimed at producing ‘variants’ that might better evade the infected’s immune response. Isolation during one’s infectious period always made sense and still does of course.
Given all the publicity it should be common knowledge that as a series of new formulations of the virus settled here it became obvious that first generation vaccines were less effective in providing protection and that the illness associated with infection, even for the young, were more debilitating. Indeed this winter the Australian work force has been and continues to be severely impacted by the absence of workers exposed to or sick with Covid-19. The shortage of front line hospital staff has, and is, causing major problems for our hospitals.
In the last few days a new Omicron variant has been discovered. When you consider the distressing and dangerous inequality associated with the global vaccination program. This is hardly surprising and the phenomenon is certain to continue.
The latest figures show huge inequalities in vaccination rates around the world, with just one in seven people in low-income countries fully vaccinated. e.g, only 11% of the 200 million people in Nigeria are vaccinated.
World wide their is a call for a renewed push to increase vaccine take-up globally to slow the spread of the virus and prevent future variants. The call comes as the WHO reports this week that Covid infections in Europe tripled and hospitalisations doubled in the past six weeks, with deaths totalling 3,000 a week. This pandemic is far from tamed
“Unless we achieve equitable action in addressing this pandemic, it will always remain with us in the world,” said Kavengo Matundu, Africa coordinator for Global Call to Action Against Poverty. “It has shown that it is capable of mutating into anything, and can become something more dangerous than the original.”
Right wing commentators, in arguing that Covid-19 is no ‘big deal’, note that the more than 14,000 deaths attributed to Covid-19 in Australia mainly occurred in the elderly who already had a host of medical issues. That may be the case but the actual cause of the loss of life in these Australians was an infection that in most cases was preventable. Surely we as a society are not saying that the old and frail don’t deserve our best efforts to help them live as long as possible?
And let’s not kid ourselves that we have adequately vaccinated Australia. Of those eligible for vaccination some 95% of us have had two injections. However if that is all you have had, after 9 months or so, you have no significant retained protection from those shots. Worryingly only 72% of those eligible have had a third shot. But even that is not enough. We need, as the virus continues to circulate in our midst in a more potent form, to have 95% of us having had a fourth shot. That figure languishes around 40%!
To minimise further the infection rate we need to include children older than 6 months However the Government is restricting vaccinations in children aged 6 months to 4 years to those children who have a number of existing medical conditions. This is a mistake and I hope a universal approach to vaccination similar to our influenza program for all children over 6 months of age evolves rapidly.
New Covid-19 infections are almost certainly under-reported as many with a positive RAT test are not alerting health authorities of their infection, but offical figure report more than 6000 new cases a week and while too many Australians continue to die from the infection (nursing home deaths remain a major problem), it is not the mortality rate but rather the distressing long term morbidity associated with infection which is becoming so problematic.
The serious illness complex known as ‘Long Covid’ is now known to effect 7-15% of individuals who have experienced a Covid-19 infection. While less common in children they certainly can be effected. While time lines vary considerably, Long Covid symptoms usually develop four or more weeks after an acute infection.
Symptoms can last for weeks or sometimes months, and commonly include extreme fatigue, shortness of breath, heart palpitations, chest pain or tightness, problems with memory and concentration, changes to taste and smell, and joint and muscle pain. As more cases are studied many additional symptoms are being attributed this phenomenon. For many effected work and normal activities are impossible.
More than 10 million Australians have experienced Covid-19 so it is likely that between 4 and 500,000 Australians have or are experiencing Long Covid. Certainly Primary Care and Mental Health facilities are finding it difficult to cope with the numbers needing help.
The cause of the condition is unknown and, as you can imagine, is being subjected to intense world-wide research. It appears most likely that in susceptible individuals the immune response to infection involves an attack on the SARS virus that is not targeted narrowly enough resulting in “innocent bystander’ tissue damage— ‘auto-immunity’. This theory is strengthened by new data reporting a return of Long Covid symptoms in those who had recovered but then experienced a second infection with the virus.
Given the above it is probably not surprising though certainly unfortunate, that vaccination, while reducing serious illness and deaths from the acute infection, appears to offer little protection from ‘Long Covid’.
There are some important conclusions from all the above. We need to intensify our efforts to increase the number of us who are fully vaccinated. Vaccination does not prevent one from becoming infected but does markedly reduce our infectiousness. This is important as reducing the suffering from Long Covid will only occur when fewer Australians are exposed to the virus.
More than 500 of us develop symptoms of this serious condition each week. How shortsighted has been our very premature retreat from crucial public health measures that reduce transmission. No masks required on planes or public transport? Isolation if infected for only 5 days? All this as a new more infectious variant (BA4.6) is racing around the world.
Professor John Dwyer is an Emeritus Professor of Medicine at UNSW and the founder of the Australian Healthcare Reform Alliance.
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