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COVID SNAPS: as we ‘test to stay’ and acclaim our vaccination successes, beware the signs from Europe

Introduction by Croakey: Impressive increases in COVID vaccination rates in some NSW regions –  increases of 38 percent in the Hunter Valley and 36 percent in Coffs Harbour, in just five weeks – set a precedent for other states and territories to follow, says Professor Kathy Eagar, Director of the Australian Health Services Research Institute at the University of Wollongong.

“If they can do it, the rest of Australia can too,” she writes in her latest column, below.

But escalating case numbers in Europe, where 1.8 million new infections and some 24,000 deaths have been recorded in just one week, are a reminder of the need for continuing vigilance.

“As the experience in Europe and elsewhere illustrates, COVID isn’t finished with us,” says Eagar. “Just because we are all over it, we ignore it at our peril. The next wave is never far away.”


Kathy Eagar writes:

The quote of the week comes from David Astle:

Out and about, observing covoidance to dodge covidiots, sidestepping maskholes and scofflaw moronas, evading any Karen or Darrren practising toxic maskulinity, we wondered if the day was Blursday or Satallday, Winesday or Deepfryday, the Gregorian calendar out of whack, our biorhythms on the fritz.”

The word of the week is ‘covoidance’: The act of politely, but awkwardly, greeting someone from a minimum of two metres distance to avoid risk of contracting COVID.

Phase of the week is ‘test to stay’, the latest jargon phase to master.

‘Test to stay’ has recently been recommended by the Doherty Institute in their final report. The goal is to keep schools open even if children at the school catch COVID. All children exposed to a COVID case are given daily rapid antigen tests (RATS). Students are only excluded from school or sent home if they test positive on the RAT. Otherwise they stay at school.

‘Test to stay’ is already common practice in parts of the USA and elsewhere. The Doherty team reported that ‘test to stay’ is as effective for preventing outbreaks in schools as a full 14-day quarantine and ‘dramatically reduces days of missed face to face learning’.

Under the ‘test to stay’ model being discussed, schools will distribute RAT packs to families. If a classmate tests positive for COVID-19, students are screened with a RAT at home before school.

Imagine the daily excitement for parents as they wait for the RAT results to determine how their day will go. I think we should call it RAT roulette.

Australian COVID at a glance

Here is a summary of the COVID state of the nation. Case numbers have been more or less stable for the last week and are now in the 1,200-1,600 range most days.  We have 10 to 15 deaths most days and this death toll is relatively stable as well.

The good news is that hospitalisations are slowly decreasing. Hospitalisations are a good proxy for severity. If hospitalisations continue to decline, deaths will decline about two weeks later.

To use the jargon, cases and hospitalisations are being ‘de-coupled’, which is exactly what we want. You can see it clearly in this graph from covid19data.com.au.

Reff round up

The Effective Reproduction number or the Reff or the RO tells you how quickly the virus is spreading. When the Reff is greater than 1.0, cases are increasing. When the Reff is less than 1.0, cases are decreasing. Thanks Professor Adrian Esterman for his daily calculation of the Reff.

NSW: 286 cases and 2 deaths yesterday. The 7-day moving average is 233 (204 last week), Reff 1.03 (0.93 last week) – with a Reff of 1.03, each 100 cases is infecting another 103 people. So case numbers are quite stable (and not increasing at anywhere like the rate predicted). Cases numbers could stay like this now right through to Christmas and beyond.

Victoria: 1,115 cases and 9 deaths yesterday. The 7-day moving average is 1,138 (1,184 last week) and the Reff is 1.01 (0.82 last week) – with a Reff of 0.99, each 100 cases is infecting another 101 people. Victoria’s previous improvements have been offset by a small Melbourne Cup effect. As with NSW, Victorian case numbers could remain at this level for months.

ACT: still managing very low numbers.

Qld, SA, Tas, WA, NT: moving average 0, Reff 0

Vaccination round up

Brilliant work ACT, what a five-star effort.

Incredibly, 99 percent of all ACT children aged 12 to 15 years have had one dose and 91 percent have had two.

If anyone thinks that Australians want to ‘live with COVID’, look no further than the ACT for evidence that this is not the case.

Australian parents overwhelmingly want to be vaccinated themselves and want their children vaccinated too.

Here are the same figures for NSW and Victoria. All other states are well behind these.

All of which goes to demonstrate that the more cases of COVID in a community, the more people get vaccinated.

The challenge now will be to bring the rest of the country up to these levels without them having to experience major outbreaks too.

Magic double vaccination rates

Here is the latest update on vaccination rates for NSW statistical areas. Regions are listed in order.

Sydney City and Inner South is the only area below 80 percent. But that is probably just a data problem as the denominator (the population living in each area) appears to include university students who normally live in those suburbs.

Of the 28 areas, 21 now have more than 90 percent of the eligible population vaccinated. This includes the Illawarra. A fantastic achievement.

Have a look at the increases in just five weeks. They really are impressive. A 38 percent increase in the Hunter Valley and 36 percent in Coffs Harbour in just five weeks. If they can do it, the rest of Australia can too.

Keep in mind that these are the percentage of people over 16, not the whole population.

In total, 79.5 percent of the whole NSW population (including children) has now had one dose and 76.2 percent has had two. We need to get to around 95 percent to achieve herd immunity.

Vaccinating 5 to 11 year olds

The USA has wasted no time and has already started to roll out a national vaccination program for 5 to 11 year olds. Over 300,000 American children have apparently have already been vaccinated and approximately 900,000 are booked to receive a first dose this week. It seems that they understand it’s a race.

Things have already started to progress quite quickly in other countries as well. Based on the American CDC decision and the trial results, Argentina, Austria, Cambodia, Chile, China, Cuba, Ecuador, El Salvador, India, Indonesia, Japan, Malaysia, Saudi Arabia, Singapore, Slovakia and UAE (to name just a few) are all at various stages of approval and the EU medicines regulator has the approval process underway.

It never occurred to me that Australia would move with speed. After all, why start now?

But I did feel optimistic last week that our approval process would be fast enough to allow all 5-12 year olds to be offered the vaccine in time for school Term 1 in 2022. That is still possible. But I’m less optimistic about that this week.

The Australian Technical Advisory Group on Immunisation (ATAGI) has indicated that it wants to review more American data first. ATAGI advises the Minister for Health on immunisation and the Government would be reluctant to move without sign-off from ATAGI. The ATAGI is specifically concerned that the USA trials were not large enough to determine the risk of very rare complications.

The rare condition of most concern is myocarditis (an inflammation of the heart muscle). Vaccine myocarditis is a rare side effect of both Comirnaty (Pfizer) and Spikevax (Moderna). It is usually very mild and temporary. Treatment is ibuprofen for a few days. The TGA is reporting myocarditis in about one in of every 100,000 people who receive Comirnaty (Pfizer), although it is more common in young men and teenage boys after the second dose (3–7 cases per 100,000 doses).

While cases of vaccine myocarditis have been reported in older children, there were no cases of myocarditis in the Pfizer vaccine trial with 5-11 year olds.  ATAGI expects to have the American data on the vaccine roll out within a month.

Myocarditis is also a relatively common complication of COVID-19. In those cases, it is much more serious with potential long-term consequences.

No one is seriously suggesting that approval will be denied in Australia. I have no doubt it will happen. But it does make approval before Christmas look less likely.

However, a potentially bigger issue is that it is very unclear whether Australia has actually placed an ordered for the vaccine. Oh dear, not again?  Oh yes, I forgot. It’s not a race.

Mind you, while the processes in Australia have been less than ideal, they are positively brilliant compared to the UK. An article from the Financial Times called ‘UK dithering over Covid jabs for young must not happen again’ explains why and is on my recommended reading list for the weekend.

In the meantime, below is an excellent resource for parents by Dr Ruth Ann Crystal (The Coronavirus Technical Handbook). It’s written for American parents.

Luckily Australian children are physically the same as American children so this is a great resource for Australian parents too. I am looking forward to seeing the same approach in Australia (eventually!).

Read more here.

COVID has important social impacts

We all understand that COVID has had important social consequences and has hit the most disadvantaged in our community much harder than people who are better off. What is less clear is how these issues have been handled by different governments.

The Menzies Centre for Health Governance has been looking at this issue and has just delivered its report card on Australian COVID-19 policy responses. It assessed policy responses in relation to employment, income support and housing.

Here is how the Commonwealth and the states and territories performed. No jurisdiction scored an A and there were only a few B’s.

Hmm… not bad given we are living through a pandemic. But there is a lot of room for improvement.

(Read more in this previous Croakey article by Marie McInerney).

Europe is back at the epicenter of the pandemic

New cases across Europe have risen 55 percent in the past four weeks. The World Health Organization (WHO) European Director Hans Kluge has recently reported that there have been “1.8 million new infections and some 24,000 deaths in the European region in the past week alone”.

WHO is projecting is that, if Europe stays on this trajectory, there will be another half a million COVID-19 deaths in Europe and Central Asia by February 2022.

Likewise, one of Germany’s top virologists has warned that a further 100,000 people will die from COVID if nothing is done to halt an aggressive fourth wave. Case numbers have soared and Germany on Wednesday registered its highest rate of infection since the pandemic began, with almost 40,000 cases in a day.

I’ve included links to some reports on Europe in my recommended reading list.

We may be all over it, but COVID isn’t finished with us yet

As the experience in Europe and elsewhere illustrates, COVID isn’t finished with us. Just because we are all over it, we ignore it at our peril. The next wave is never far away. After a snail pace start, our vaccination rates are now looking good. But we are not even close to achieving herd immunity.

So what will 2022 and beyond look like if we are to keep COVID under control?

Vaccination
Based on our current rates, we can realistically expect more than 95 percent of the eligible population to be fully vaccinated by 2022.

Everyone will need three shots. Maybe more. Immunity wanes within six months of getting the second shot. New waves of outbreaks in Israel, Europe and elsewhere are being attributed to declining immunity. We are yet to find out about immunity after a third shot.

Children over five will need to be immunised.

Pregnant women need to be vaccinated to provide immunity to their newborn babies.

It is possible that COVID vaccine might be included in the standard vaccination schedule for babies and pre-schoolers. But the earliest this could happen would be in the second half of 2022 or into 2023. Children 0 to 4 will need to be protected by everyone else till then.

New “immunity tests” will likely become available in 2022 to screen for people who need further boosters. These tests don’t currently exist but are under development

New vaccine technology is under development and will become progressively available. These include nose sprays and needle-free patches to replace injections. Just as well, as the world is starting to run short of syringes and needles.

Clean air and ventilation

Clean air and ventilation are essential in controlling a disease that we now know spreads mostly by airborne transmission. Living with COVID means better management of risky indoor settings including public transport and schools.

Monitoring air quality, installing air purifying systems and regulating crowd numbers will need to become routine. So will wearing a mask in every crowded space.

TTIQ – test, trace, isolate and quarantine – needs to continue

Current systems will need to continue but are likely to be scaled down. They will be supplemented by more rapid antigen testing (I am nominating 2022 as the Year of the DIY RAT 🐀). We can also expect to see more electronic surveillance to replace hotel quarantine.

‘Test to stay’ (AKA as Rat Roulette) will become the norm but school closures will also keep occurring periodically during peak outbreaks.

New and better treatments

While all the focus has been on vaccine technology, there has also been an enormous investment in developing effective treatments. These include treatments to prevent a mild case of COVID from becoming severe and therapies for those who develop severe illness.

In the long run these are likely to become as important as vaccine. But treatment is not a substitute for prevention. I’ll do an update on treatments in the next few weeks

The bigger picture

The coronavirus can only mutate when spreading from one person to another. It cannot mutate on its own. It is therefore not surprising that most variants emerge in low income countries. Low income countries have less capacity to control the spread of the virus and this gives the virus more opportunities to spread and mutate.

Australia and other high income countries need to be doing a lot more to help vaccinate low income countries. We need to be doing this to protect the people in those countries.

And we need to be doing it to better protect ourselves. We will be living with COVID-19 as a pandemic disease until everyone in low income countries has the opportunity to be fully vaccinated. Only then will it be possible for COVID to move from being a pandemic to becoming endemic.

Recommended reading

SMH: Australia to wait for data from US children before clearing vaccine here. This article explains why ATAGI wants to see more data before recommending the vaccination of 5-11 year old children.

CNN: Nearly 1 million kids ages 5 to 11 expected to receive first Covid vaccine dose by end of Wednesday

Financial Times: UK dithering over Covid jabs for young must not happen again. Decision-making in a pandemic can never be perfect, but it can be timely

RegNet: Australian COVID-19 policy responses. A health equity report card

WHO: Europe is again at epicenter of pandemic

Financial Times: Rising Covid infections in Europe spark fears of new wave.

BBC: Germany coronavirus: Record rise prompts warning of 100,000 deaths

For your viewing pleasure

I recently attended this webinar on “Unlocking Fortress Australia” hosted by UOW and OzSage.  Highly recommended.

Meanwhile…

Thinking about going out this weekend but aren’t sure what you want to do?

Try this. Count the people you see going back to their car walking like this. Enormous fun.


Planning instead to stay home and doing a bit of gardening? Here is my suggestion on what to grow this year.


Croakey thanks and acknowledges Professor Kathy Eagar for this column, which is based upon a regular COVID update that she emails her networks, combining a mixture of evidence, observation and pithy humour. On Twitter, follow @k_eagar

Bookmark this link to follow the series.

 

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