Introduction by Croakey: Australia can expect to pass another COVID milestone next week when the 2,000th pandemic death is likely to occur. Looking at how the pandemic is playing out around the world, it seems we will have many more grim milestones to come.
In her latest column, Professor Kathy Eagar, Director of the Australian Health Services Research Institute at the University of Wollongong, sounds the alarm about the New South Wales Government’s “extraordinary” decision to further ease public health measures at a risky time.
And she urges our political leaders to implement three measures to help prevent us following the European experience of surging cases: third dose vaccinations for adults; the rollout of a vaccination program for young children; and the maintenance of basic public health measures.
“Sadly I don’t think our politicians are hearing this message,” she says.
Kathy Eagar writes:
If you’re able to get vaccinated, and you choose not to, discrimination is the wrong word. You have freedom to make the choice but if you make a choice, those choices have consequences.
Being held accountable for your own actions isn’t called discrimination, it’s called being, you wouldn’t believe it, a goddamn bloody adult.”
The quote of the week comes from Senator Jacqui Lambie (watch the full speech).
Word of the week: Epiphany quitter.
An epiphany quitter is a person who quits their job after re-evaluating their life while in COVID lockdown. The decision to quit comes after a “pandemic epiphany” of life changing insights.
“When individuals are close to death or illness, we tend to take a step back and take stock of our own lives. We ask ourselves: am I living life the way I want to live it? Lockdown gave people a lot of time to reflect and plan if they wanted to do something different with their career.” Professor Anthony Klotz (SMH, paywall).
Australian COVID at a glance
Here is a summary of the COVID state of the nation. We had a major milestone this week when we passed 200,000 cases. We will have another milestone next week when we pass 2,000 deaths.
But the overall national picture has not changed much since last week. We still have about 1,200 cases most days. And we still have around 10 deaths most days.
The major difference this week is a really worrying outbreak in the Northern Territory with cases spreading through a number of remote Aboriginal communities.
NT is on a knife edge. We also had our first cases in South Australia yesterday, just a day after South Australia opened its interstate borders.
The good news is that de-coupling is still going well. But there has been a slight upturn in hospitalisations with 52 NT residents now in hospital.
Thanks covid19data.com.au for this daily update.
The not so good news is that infants, kids and teens now represent 33 percent of all COVID cases in NSW. Infants, kids and teens are just 24 percent of the population so they are really over-represented in the COVID numbers in NSW.
The situation is no different in Victoria. I haven’t seen case data from NT so far.
When I look at the NSW profile I cannot believe that Australia is still strolling toward vaccinating 5 to 11 year olds. For me, it’s now our top priority.
The USA, Canada, Israel, Hong Kong and other countries are now vaccinating children. If it’s safe for their kids, it’s safe for our kids.
I have a growing suspicion that, once again, someone forgot to order the vaccine until very recently. I am hearing it may arrive at the end of January. Expect this to be spun into a ‘good news’ story some time in December.
Here is the national ‘common operating picture’ for last week. This is issued each week by the Commonwealth to ‘provide a weekly traffic light report of the coronavirus (COVID-19) situation across Australia’. While I look at it every week, I don’t normally post it in my email as I find it too busy.
Reff round up
NSW: 261 cases and no deaths. The 7-day moving average is 212 (215 last week), Reff 1.05 (0.95 last week) – Case numbers wobble around a bit each day but are more or less stable.
Victoria: 1,362 cases and 7 deaths. The 7-day moving average is 1,153 (1,001 last week) and the Reff is 1.08 (0.95 last week) – Victorian case numbers increased slightly this week, offsetting declines in NSW earlier in the week.
Vaccination round up
Here is a table showing vaccination rates by state and territory.
While politicians and the media are busy proclaiming that more than 85 percent of Australians are ‘fully vaccinated’, the true situation is that 72.1 percent of the Australians are double vaccinated. 
We are about to open up our domestic and international borders at a time when less than three-quarters of us are double vaccinated and less than 400,000 people have had a third jab so far. Add waning immunity and Christmas social events and we are starting to look a bit risky.
The one thing we don’t want is to repeat the pattern already seen in Europe (see below). Even 85 percent double vaccinated will not protect us from a new wave.
We will need a good dose of common sense (oh dear!) and onging public health measures to end 2021 in a good position.
Magic double vaccination rates
Here are the latest vaccination rates for NSW statistical areas. Thirteen of the 28 areas are now above 95 percent, up from seven last week. A further 10 areas now have more than 90 percent of the eligible population vaccinated.
Only five areas are below 90 percent double vaccinated (Sydney – Inner South West, Richmond – Tweed, Sydney – Inner West, Sydney – Eastern Suburbs and Sydney – City and Inner South). The Illawarra is at 92.6 percent, so I am still hopeful of some further improvement in my own region.
While these are terrific results, look at the percentage changes in the last week. They are really slowing down, with most less than one percent improvement.
We are unlikely to see any more significant improvements from this point until vaccination is approved for everyone over four years of age.
What can Australia learn from international experience?
Being in the southern hemisphere, Australia has the benefit of being able to learn from the northern hemisphere. Because of the timing of our seasons, the northern hemisphere has been six months ahead of us all the way through the pandemic. That won’t change.
This gives us the opportunity to learn from their evidence without having to repeat their mistakes. Wow, how novel. Learning from evidence, not experience.
So the next few sections of today’s update focus on what is happening internationally. If we are smart, we can use the international experience to shape Australia’s response to the next stage of the pandemic.
Global Reff
Every week I include the Reff for the major states and I say the same thing – 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.
While we would all like to think that vaccine and other public health measures will bring the pandemic to an end sometime soon, have a look at this chart.
It shows the international Reff since the beginning of the pandemic. After an initial burst, the Reff globally has oscillated around 1.0 for just about the entire pandemic. There is no evidence that it is decreasing.
Clearly the virus hasn’t been taking much notice of vaccination and public health orders. The virus acts internationally and doesn’t care about our national borders. Every country has been trying to manage it nationally.
We have been quite successful in that, largely because we are an island and we closed our borders. But our borders won’t be closed for much longer. Once our borders reopen, whatever happens internationally will eventually (within six months) happen in Australia.
Here is the same graph. But this time I have added the Australian Reff (the blue line) as well as the Reff for Portugal (the red line).
The reason I selected Portugal is that, among larger countries, it currently has the highest percentage of the population who are double vaccinated – Portugal is at 88 percent double vaccinated compared to 72 percent in Australia. Despite having 16 percent more people vaccinated than us, Portugal’s Reff this week is 1.38. Every 100 cases in Portugal are infecting 138 other people. The Portuguese Reff is up from just 0.47 in February.
The key lesson is obvious – vaccine alone is not enough to bring COVID under control. We need to maintain what OzSage calls a ‘Vaccine Plus’ strategy.
COVID is not over just because we are tired of it or because we are vaccinated.
Now have a look at the graph below showing what is happening right now in Europe. Just because we are over it, COVID isn’t finished with us yet.
Case rates are rising sharply in parts of Europe and various countries are going back into lockdown yet again. Sadly for Europe, winter is approaching just as immunity from double dose vaccination is declining.
It will be equally sad for us in 2022 if we don’t plan ahead. We can expect to see Australia repeat the European pattern as we go into winter 2022.
The three keys to preventing it are third dose vaccinations for adults, the rollout of a vaccination program for young children and the maintenance of basic public health measures.
Sadly I don’t think our politicians are hearing this message.
Misleading narrative
The problem now is that is that Australia has been sold the Freedom Day narrative – an illusory social contract that, if people came forward for vaccines, life will return to normal. In your dreams.
The question is how we turn this around in a way that will keep us safe throughout 2022.
Europe is learning a crucial lesson – vaccines work, but they alone won’t stop COVID now.
“As Western Europe’s vaccination rollout gained strength in the early part of 2021, many of the region’s leaders touted the shots as their immediate route out of the pandemic. Press conferences took on an almost celebratory tone as Presidents, Prime Ministers and Chancellors announced road maps away from Covid-19 restrictions, hailing their country’s uptake rates and speaking colorfully about a return to normalcy.”
Sound familiar? You can read more about it here.
Don’t forget the Swiss cheese
The surge of cases across Western Europe is being driven by the season and by waning double dose immunity.
But there are at least three other factors:
- Just like Australia, increasing numbers of school-related surges due to the failure to vaccinate children and keep schools safe (ventilation and air purification, masks, social distancing regular testing and mandated vaccination for adults entering the school grounds).
- The premature easing of lockdowns and other restrictions (exactly what NSW announced yesterday).
- Over-reliance on vaccines and a lack of multi-layered strategies. Can’t remember the Swiss cheese public health model I described a few months ago? Not to worry, you are not alone. Most of the European countries forgot about it too.
United Kingdom
Extraordinary to believe but COVID is now the third leading cause of death in England and Wales. The figure below (available here) shows leading causes of death in October 2021.
COVID accounted for 5.6 percent of all deaths in England and 9.5 percent of all deaths in Wales.
Here is a comparison of Australia and the UK on key COVID measures.
If you want to find a case study in how not to manage COVID, look no further than the UK. Australia has had 76 deaths for every one million people so far. The UK has had 2,110.
The UK death rate is 28 times higher than the Australian death rate. Their case rate is 19 times higher than Australia.
Yet I have a deep suspicion that the Premier of NSW and other politicians are keen to follow the UK path. Oh dear.
Ireland
Ireland has done well by European standards, ranking 35th out of 47 European deaths in terms of deaths per million. But its rate is still 15 times higher than Australia.
“The countdown to the end of the year has begun in Ireland. Christmas lights have been switched on and people are hopefully preparing for a better December than last year. For the vaccinated, the doors of pubs, restaurants and night clubs are open. For those who have not yet opted to get jabbed, it’s too late for Christmas as they will not be fully immunised in time, unless they can avail of a single dose vaccine – or have immunity because they caught the virus.”
Six COVID factors that will decide what kind of Christmas lies ahead.
Singapore
Our northern neighbour Singapore has had six times more cases than Australia but only one third more deaths. I included Singapore in an earlier update when everything was going well. But Singapore has had another major surge since then. We should learn from their experience.
Australia might be on its coronavirus ‘honeymoon’. Singapore shows what could happen next.
South Korea
Australia and South Korea have a lot in common and you can see it in this comparison table. At the start of the pandemic, both countries pursued a zero-COVID policy.
We have both done very well by international standards.
Find out how South Korea did it – there are many similarities between our two approaches. It involved ‘mass testing, tracing contacts, and supporting isolation to ensure chains of transmission were broken. This was supported by strict travel restrictions to prevent new cases being imported, and strong messaging to the public about wearing masks in public spaces, and the dangers of a new infectious disease’.
This article describes the South Korean approach by saying that “The government worked to protect its people (not to enrich its own interests) and the response was pre-emptive, organised like clockwork, and efficiently delivered.” Hmmm… I wonder if anyone will ever write that about Australia?
What the UK can learn from South Korea’s COVID response.
USA
Look at the table below comparing Australia and the USA. Where to start? It’s a mess.
COVID cases are surging in Europe. America is in denial about what lies in store for it. The US thinks it will be ‘immune’ to what is happening in Europe. That’s wishful thinking.
Israel
“When it comes to Covid-19, it seems where Israel leads, the rest of the world follows. For almost a year, the country has offered other nations a glimpse into the pandemic’s future. Israel has been at the forefront of vaccination rollouts for adults and teenagers, pioneered a vaccine passport and, in recent months, has spearheaded the use of booster shots.”
But the news from Israel is not all good.
Though case numbers have fallen since the booster shot program, the decline has plateaued. And the Reff is back above 1, a sign that the virus is spreading again. One probable reason is that almost 1.5 million people who have had two doses of the vaccine did not go back for their third shot.
But the other major reason is the lack of vaccination of young children – about 50 percent of Israel’s daily infections are occurring in children below 11 years of age.
Israel has recently announced approval for the national rollout of paediatric vaccination for the 5 to 11 year age group. We should do the same thing.
What the world could learn from Israel’s Covid-19 vaccine booster rollout.
NSW residents are very special
The people of NSW must be very special, at least in the eyes of the Premier of NSW.
Yesterday NSW announced its revised “roadmap for easing restrictions after the State reaches the 95% double vaccination target or 15 December, whichever comes first”.
In summary, the official NSW policy is now something like this:
Here is the media release. It is really extraordinary.
Ignoring all of the international evidence and disregarding the national roadmap and expert advice, masks will only be required in very limited circumstances. Wearing a mask where you cannot socially distance is encouraged but not required. COVID Safe plans for business will become optional and QR check-ins largely abandoned.
Announcing these plans, the NSW Premier said that the easing of restrictions is possible because NSW is “among the highest vaccinated populations in the world”.
This is where NSW sits. Is your cup half full?
All of the available evidence suggests that we require at least 95 percent of the total population to be vaccinated to achieve any level of herd immunity.
As we stand today, 86 percent of the Australian population over 16 are double vaccinated (92 percent in NSW). But 92 percent of people over 16 in NSW is only 78 percent of the whole NSW population. And 95 percent of the eligible population double vaccinated will still leave about 20 percent of the NSW population unvaccinated. The virus doesn’t ask for your birth certificate first before it infects you.
From my perspective, NSW has made a decision to send NSW children under 12 to the frontline without any protection. What happened to our duty of care to vulnerable people including children?
My view is that we should not be easing these restrictions until every person over four years of age has the opportunity to be at least double vaccinated. But it is too late now.
The NSW Premier is clearly optimistic in believing that the people of NSW are immune to the massive surge of cases and deaths we are now seeing internationally. Boris Johnson has the same view about the UK. I am afraid I do not share their optimism.
This is particularly the case as the abolition of basic public health protections in NSW will be occurring at the same time as we open our international borders.
Keep in mind also that yesterday’s announcement coincided with the identification in South Africa of a new, and potentially more dangerous, variant called B.1.1.529. This new variant has a spike protein that is dramatically different to the coronavirus variant that vaccines were based on. I will include a comment on it in next week’s update, at which point we will have more information.
In the meantime, the best way to continue to protect yourself and your loved ones is to assume that everywhere you go you are at risk of being exposed to coronavirus in the air. So:
The Conversation/ABC News: Will Australia follow Europe into a fourth COVID wave? Boosters, ventilation and masks may help us avoid it? Professor Raina MacIntyre offering excellent advice as usual. But clearly the NSW Premier must have missed it
Croakey: “Freedom” is the message promoted on all sides, but we need a different conversation. One person’s freedom is another person’s risk. We have been sold the Freedom Day narrative – that, if people came forward for vaccines, life would return to normal. In your dreams.
BBC: COVID vaccine ‘waning immunity’: How worried should I be? Think of your body’s defences like Bamburgh Castle – with the walls offering different types of protection.
SMH (paywall): Workers are empowered’: The four factors driving America’s ‘great resignation’
The Conversation: No, vaccinated people are not ‘just as infectious’ as unvaccinated people if they get COVID
The Monthly: The needle and the damage done. An essay in which Richard Denniss argues that the federal government’s handling of the pandemic has been the worst public policy screw-up in Australian history. Wow, that’s a big call considering how many other Federal Government screw-ups we’ve had! Spoilt for choice or what?
Common Dreams: ‘Obscene’: Pfizer, BioNTech, and Moderna Are Raking in $3.9 Million in Profits Per Hour. “Just a few companies are making millions of dollars in profit every single hour, while just two percent of people in low-income countries have been fully vaccinated against coronavirus.”
ABC News: Coronavirus cases are spiking in Europe as temperatures drop and vaccine immunity wanes. Is the future of COVID-19 seasonal? When all else fails, blame the weather
Monthly mortality analysis, England and Wales: October 2021
Recommended viewing and listening
‘False sense of security’ around COVID vaccines: WHO. “In many countries and communities, we are concerned about a false sense of security that vaccines have ended the pandemic, and that people who are vaccinated do not need to take any other precautions,” WHO Director General Tedros Adhanom Ghebreyesus. The NSW Premier must have missed this one too.
Focus on things within our control.
The Sound of Music COVID-style. A sing along for the whole family, the ultimate Christmas tradition
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.
