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COVID SNAPS: be careful what you wish for

Professor Kathy Eagar, Director of the Australian Health Services Research Institute at the University of Wollongong, emails a regular COVID update to her networks, combining a mixture of evidence, observation and pithy humour.

In a new, semi-regular column, Croakey will publish excerpts from these emails as “COVID SNAPS”.


Kathy Eagar writes:

Quote of the week:

Sloganising ‘hindsight heroes’ by foresight failures and procrastinating precautionary principle deniers.

The right course was to contract for maximum supply, conditional upon pre-delivery certification”.

Twitter response after PM Scott Morrison described everyone criticising Australia’s vaccine procurement strategy as ‘hindsight heroes’.

Equity matters

It’s important to look at COVID through an equity lens. We need to make sure that we protect our most vulnerable citizens.

The table below shows the number of Indigenous people in NSW infected with COVID in the last three months. In total, 1,717 people have been infected.

About 40 percent come from western and far west NSW, 40 percent from western Sydney and 20 percent from the rest of the state.

This was so predictable and so preventable.

Are things getting better or worse?

But first, a reminder about the Effective Reproduction number or the Reff or the RO. It’s the most important number in a pandemic. It tells you how quickly the virus is spreading.

When the Reff=1.0, 1 infected person is infecting 1 other person and 10 infected people are infecting 10 other person. When the Reff=2.0, each infected person is infecting 2 other people and 10 infected people are infecting 20 others.

When the Reff is 0.5, 10 infected people are infecting 5 others. When the Reff is less than 1.0, case numbers gradually decrease until they get to zero.

The natural Reff of the Delta variant in Australia is more than 5. In other words, if we didn’t have public health measures like masks, social distancing and lockdowns, each infected person would infect at least 5 other people.

The natural Reff of COVID in 2020 was about 2.5. So last year each person was infecting an average of 2.5 other people.

The Delta variant in 2021 is twice as infectious as the variants in 2020.

The moving average is the average in the last five days (that’s why it keeps ‘moving’). Cases can go up and down every day.

The moving average smooths them out and is a better measure of how case numbers are really going.

So if you want to know if things are getting better or worse, you need to track both the moving average and the Reff.

Reff round up

ACT: 5-day moving average 19 (17.8 last week), Reff 1.12 (1.01 last week) – in essence, no change

NSW: 5-day moving average 1,241 (1,365 last week), Reff 0.89 (1.01 last week) – I’m quietly optimistic NSW may have peaked

Vic: 5-day moving average 467 (241 last week) Reff 1.20 (1.38 last week) – cases are still increasing with each 100 people infecting about 120 more

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

Public health measures are working in every state, including in Victoria. If they weren’t working, Victoria would have a Reff of about 5.0. With a Reff of 1.20, Victoria has a way to go.

After three months, the NSW Reff has finally dropped below 1.0, the first time since this outbreak began. Cases have actually fallen a little in NSW and it is possible that cases in NSW have now peaked. We will know for sure over the next week or two.

But there is reason for caution. The Reff is falling faster in the 12 Local Government Areas that have had severe restrictions than it is in the rest of NSW and this is good evidence that hard lockdowns work. In contrast, the Reff is going up in some parts of NSW where we have had ‘lockdown light’ (including in the Illawarra).

You can see it quite clearly in these two graphs from the Burnet Institute.

In summary, NSW is looking promising but is not out of the woods yet. NSW has to achieve a continuing fall in cases in the 12 hotspot LGAs as well as reverse the upward trend in the rest of NSW. Doing one without the other won’t work. Watch this space.

This is what the projection is looking like for the next few months. Brilliant work by Chris Billington and I love the colour scheme too.

Daily numbers (the maroon line) are up until 16 September. The blue shading is the Reff. The blue shade is the actual Reff up until 16 September and then the projected Reff beyond that. The other background colours show when each of the lockdown measures kicked in.

The projection is that NSW will get the Reff down to 0.5 and the daily case number to less than 100 in early November.

NSW “Roadmap to Freedom”

The NSW “Roadmap to Freedom” is based on restrictions easing when 70 percent and then 80 percent of the ‘eligible’ population are fully vaccinated.

While the age cut-off to be vaccinated has been reduced to 12 years, the ‘eligible’ population is still defined as 16 years and older. Sneaky.

There are 8.3 million people in NSW and the plan is to reduce restrictions once 5.8 million people (70 percent) are vaccinated. At that point there will be 3.5 million unvaccinated people – 1.7 million children and 1.8 million adults.

I wonder if those applauding the ‘Roadmap to Freedom’ realise the implications of 3.5 million people being unvaccinated when restrictions ease?

Here are some baseline measures on how the NSW health system is coping now. All but two NSW rural districts are classified already as being at the Red risk level.

Look at these numbers – and this is before restrictions ease. I will be watching how this dashboard moves each week from here to assess the impact of restrictions being progressively lifted.

Working in the NSW health system is a health hazard at the moment and Victoria is not much different.

A big shout out to health workers everywhere. Thank you for protecting the rest of us, putting yourself at risk in the process.

Be careful what you wish for

We all want lockdowns across Australia to end as soon as possible. But be careful what you wish for and don’t plan your Christmas lunch with the extended family just yet.

Here is a link to an excellent article by Professor Raina MacIntyre explaining the risks if the lockdown restrictions are relaxed without enough people being vaccinated.

Can you believe it?

That sneaky COVID is planning a new outbreak that will peak Christmas week and that will overwhelm our hospitals (if they aren’t overwhelmed already) if we aren’t smart about how we open up.

While the modelling led by the Doherty Institute has had a lot of coverage, it is important to recognise that not everyone agrees with the Doherty model.

All models start with a set of assumptions and that includes the Doherty model. Many other experts are developing alternative models with different assumptions and coming to different conclusions.

A group to keep an eye on is OzSage. OzSage is a recently formed group of experts in epidemiology, health and economics who have come together to offer independent expert advice on how best to implement an exit strategy while achieving the best possible health, social and economic outcomes. They are all experts in their fields and they have important things to say. You can follow them here.

OzSage modelling is projecting a much higher level of hospitalisation and death than the Doherty model results suggests.  You can read about it here.

Given that everyone else has developed a model, I thought I would ask my friend John to develop a model too. I asked John to develop a model that politicians can understand as many of them are clearly struggling with the models developed to date. John is very clever and designed it in ways that we can all understand. Great job John, I think this prototype will be a real hit with the politicians.

Brilliant work New Zealand

Recently I congratulated Bali on its vaccination rollout. This week I really want to congratulate New Zealand on the way it is managing its most recent COVID wave.

A New Zealand outbreak started toward the end of August and the reproduction number (Reff) was over 4. So one infected person was infecting 4 more. Straight into Level 4 lockdown, no mucking around.

The Reff is now down to 0.8. So 10 infected people are infecting 8 more. If they can keep this up for just a little longer, they will get it to zero again. Fingers crossed.

What a difference when you go fast and go hard and when there is one clear message that everyone gets behind.

Look at that lovely pink curve of cases and the blue wave showing the Reff (thanks Chris Billington). NZ is not out of the woods yet. But it is close.

Australia could learn a lot from New Zealand but it doesn’t look like we want to. I wonder if we could ask New Zealand to invade us and take us over?  We could all help 🙂

Vaccination and TTS

There have now been approximately 22.8 million vaccine doses given in Australia – 14 million first doses and 8.8 million second doses. Of the 22.8 m doses, 10.8 m have been AstraZeneca (now renamed as ‘Vaxzevria’). There have been 9 reported vaccine-related deaths, 8 from “Thrombosis with thrombocytopenia syndrome (TTS)” and one from another rare condition called immune thrombocytopenia (ITP).

There were 5 new cases of TTS this past week. There were no deaths and 3 cases previously reported as probable or confirmed TTS have been reclassified following further review which ruled out a causal link with the vaccine.

This takes the total Australian TTS cases following AstraZeneca to 134 cases (75 confirmed, 59 probable) from approximately 10.8 million vaccine doses. Of the 134 cases, 63 are men and 71 are women. 123 cases have occurred after a first dose and 11 have now occurred after a second dose:

  • 116 discharged
  • 10 in hospital
  • 8 deaths.

The TTS rate is 132 cases from 10.8 million doses of the AstraZeneca vaccine or 1 case per 81,818 doses. The death rate is 1 death per 1.35 million doses. The case fatality rate (the chance of dying from TTS if you get it) is 8 deaths from 134 cases or 6.0%.

I am not expecting the TTS rates to change. I’ll keep monitoring the numbers but the evidence is quite clear. Your biggest risk in getting AZ vaccine is having an accident getting to or from the clinic.

Case fatality rate

No one should believe that COVID is a trivial infection. The Delta variant of COVID is 10 times more lethal than influenza. We have now had ~20 deaths in people under 40 and multiple fit young people are hospitalised fighting for their life.

However, the good news is that the COVID death rate remains significantly lower than last year. The NSW case fatality rate for the current outbreak is just 0.5% (as at 16 September, just 210 deaths from 42,511 cases). The case fatality rate in 2020 was 3%.

The lower fatality rate this year is due to reduced cases in aged care homes, a higher proportion of young people being infected and more effective treatment methods for those who become seriously unwell. I can’t see any vaccine effect at this stage but hopefully that should be visible soon.

French ex-health minister charged

Good grief, a Health Minister in France has been charged for failing to protect the community from COVID.  That is certainly not how we do things around here.

Where are the social marketers when you need them?

People in lockdown are not in prison waiting for ‘freedom’ day. Setting aside the small minority of covidiots, the significant majority of the community locked ourselves down by choice and we did it to protect ourselves, our loved ones and our communities.

We haven’t been locked in with a key and, as much as we’d all like lockdown to end, we aren’t all sitting waiting for the principal to give us an early mark.

I really like the Queensland approach which has emphasised that public health measures are about caring for each other and our communities.

And it is paying off. Queensland has had very strict lockdowns (including quite rigid border closures) and has achieved extraordinarily low case numbers. And they have done so while enjoying enormous public support.

We have done a good job in the past marketing public health measures as something that benefits us all – think seat belts and drink driving. We need to do it again.

Recommended reading

Here is a link to an interesting article reporting that people with high confidence in their government are more willing to receive the vaccine.  On that basis it’s extraordinary that we have anyone vaccinated at present.

If interested in NSW, you can check out latest case numbers and vaccination rates by postcode.

Here’s how to talk to a vaccine-hesitant person about getting a COVID-19 jab, and what not to say.

To read the OzSage response to the “NSW Roadmap to freedom for the fully vaccinated” click here.

Here is yet another opportunity for Australia to learn from international experience before we repeat it. Despite 72% of the 12+ population being fully vaccinated, Alberta Canada has declared a health emergency and is launching a proof-of-vaccination program.

To read an excellent analysis by the Australia Institute of the Doherty Report and the Government response click here.

Read the latest evidence that fully-vaccinated people have a 96% lower likelihood of being admitted to hospital if they do get infected with COVID (compared to people who are not vaccinated).

Here is a report of another study that contains reassuring information about kids and long COVID: long COVID in children and adolescents is less common than previously feared.

Read an international perspective on what the next six months of the pandemic may bring.

If you are still unsure about vaccination, ponder this. It brings an essential existential perspective to the issue.

I used my networks to obtain a confidential copy of the government plan to reopen the economy post COVID. Don’t tell anyone, but in confidence


Professor Kathy Eagar is Director Australian Health Services Research Institute (AHSRI) at the University of Wollongong. On Twitter, follow @k_eagar


See our archive of stories on COVID-19.

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