Is Dominic Perrottet the Premier for NSW or for Sydney? It’s a question that arises when considering his determination to open up at speed, despite the clear risk to many regional areas.
“Regional NSW not only has the fastest growth in COVID cases, it also has the lowest vaccination rates,” observes Professor Kathy Eagar, Director of the Australian Health Services Research Institute at the University of Wollongong, in her latest column.
Kathy Eagar writes:
“The randomness of illness is far too frightening for many to contemplate – so they rely on a fiction they’re special and can control their bodies. From crackpot COVID theorists to antivaxxers, hubris and fear haunt the wellness community.”
The quote of the work comes from Guardian Australia writer Brigid Delaney.
The word of the week is plandemic, or the inability to plan or make plans due to a pandemic and all of the accompanying restrictions.
“What’s the program for the coming week? Not much really on account of the plandemic”.
Australian COVID at a glance
Here is a summary of the COVID state of the nation yesterday.
The major outbreaks of concern continue to be in NSW and Victoria but they are heading in separate directions.
NSW peaked more than two weeks ago and cases are now down to about a third of what they were at the peak. Victoria is yet to peak and has today recorded the worse day ever – 1,838 cases in one day.
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 Prof Adrian Esterman for his daily calculation of the Reff.
ACT: 40 cases today. 5-day moving average 34 (15.0 last week), Reff 0.86 (0.81 last week) – ACT has fluctuated all week and is not out of the woods yet.
NSW: 646 cases today. 5-day moving average 591 (1,007 last week), Reff 0.75 (0.85 last week) – the Reff and cases are decreasing nicely. The move out of lockdown puts that at risk.
Vic: 1,838 cases today. 5-day moving average 1,599 (657 last week) Reff 1.21 (1.27 last week) – cases are still increasing with each 100 people infecting about 121 more. COVID is now spreading throughout the whole of Victoria thanks to Covidiot protesters and football fanatics
Qld, SA, Tas, WA, NT: moving average 0, Reff 0
A state average does not tell the full story
As well as trends in NSW and Victoria going in opposite directions, we are now also seeing different trends within both NSW and Victoria. Thanks to Juliette O’Brien (covid19data.com.au) for these figures.
NSW
South West and Western Sydney: 259 cases yesterday making 5,782 cases in the last two weeks. This is a 48 percent reduction on the fortnight before.
Rest of Sydney: 87 cases yesterday making 2,158 cases in the last two weeks. This is a 45 percent reduction on the fortnight before.
Regional NSW: 183 cases yesterday making 3,073 cases in the last two weeks. This is a 74 percent increase on the fortnight before.
Here is more detailed breakdown by NSW district.
Victoria
Northern and Western Melbourne: a 94 percent increase compared with the fortnight before (but the growth rate is slowing).
Rest of Melbourne: a 344 percent increase in cases compared to the previous fortnight (growth rate is stable).
Regional Victoria: a 489 percent increase in cases compared to the previous fortnight (growth is speeding up).
While it all looks pretty miserable for Victoria, there is some good news according to Professor Adrian Esterman. Hospitalisation typically occurs about seven days after diagnosis.
This chart tracks cases each day with hospitalisation one week later. We are now seeing a disconnect, with cases rising much faster than hospitalisations. What we are looking at in this graph appears to be a real vaccine effect.
Also see COVID cases numbers by LGA for regional NSW, Greater Sydney, and for Victoria.
Swiss Cheese model of public health
As states, territories and the Commonwealth prepare to open up our communities, our economy and our borders, it is important to keep in mind that the virus is not going away.
A politician lifting a lockdown does not make the country safer. And just because we are all tired of being locked up and want to get our lives back, it doesn’t mean that life will be getting back to ‘old normal’ anytime soon.
The question for each of us now is about the way we want to live in the new COVID normal. There isn’t a right answer to that. We each have a different tolerance for risk. Some of us want to hide under the doona, others think they are bullet proof. And we are each at different levels of risk.
The Swiss Cheese model is a helpful way to think about how we manage our way out of lockdown and manage living with COVID beyond that.
It recognises that no single intervention is perfect at preventing coronavirus spreading. No intervention is 100 percent, every intervention has holes. Multiple layers of protection help limit the spread of the virus. Each layer has holes and the risk of infection increases when the holes align.
The more layers you have in place around you, the more you are protected. If only our governments were having sensible conversations with the public about our appetite for risk going forward and about how all the layers fit together. Oh well, I can always dream.
Dr James Reason, introduced the “Swiss Cheese Model” in 1990 and this meme was made by Dr Ian Mackay from University of Queensland.
NSW and the magic 70 percent double vaccination rate
The brand NSW Premier has spent the last few days proclaiming how great it is that we have achieved 70 percent and announcing various easing of restrictions. The next bar will be when 80 percent of the eligible population is double vaccinated.
Below is a table showing current vaccination rates based on NSW statistical areas. They are listed from highest (Baulkham Hills and Hawkesbury) to lowest (Richmond-Tweed). Far West Orana is the only part of regional NSW that has hit 70 percent.
Regional NSW not only has the fastest growth in COVID cases, it also has the lowest vaccination rates. Hmmm … a cheeky friend suggested that we need a government for the whole of NSW, not just for Sydney. Ouch!
Booster shots
There is increasing international evidence that COVID vaccination booster shots will be required. This is based on evidence that efficacy of the vaccine declines over time. Some countries have already implemented third dose booster programs. One of the first was Israel.
Third dose booster shots present an ethical challenge. How can high income countries roll out third doses when many many millions of people in low income countries are waiting for their first dose?
This is the position adopted by the World Health Organization (WHO), who argue that countries should not introduce third shot booster programs until all people in low income countries have been offered vaccine.
Be that as it may, the Australian Technical Advisory Group on Immunisation (ATAGI) has today issued its national recommendations on a third dose.
ATAGI is only recommending a third dose at this stage to individuals who are severely immunocompromised. ATAGI is not recommending (yet) a third dose for everyone – but in my view that is inevitable.
See the ATAGI list of who should get a third dose.
Crackpot COVID theorists, antivaxxers and fitness fanatics
My quote of the day is from Brigid Delaney and her excellent article on crackpot theories, the wellness industry and COVID.
I really liked this article because it helped me understand why some otherwise sensible people have been so vaccine resistant.
The randomness of illness is far too frightening for many to contemplate – so they rely on a fiction they’re special and can control their bodies. This leads to a belief that a powerful natural immune system is the best defence against COVID, not a vaccine.
Some of this same thinking – that we have the ability to determine our own health status through lifestyle choices – can be seen in organised health promotion programs.
The common wisdom in public health for decades now (supported by good evidence) is that communicable diseases are a thing of the past. In a high income country like Australia, that was certainly the case – until COVID.
Non-communicable diseases (NCD) – heart disease, diabetes, cancers, mental illnesses etc – have been the major causes of ill health for decades and the focus has been on healthy lifestyles as the main tool to control NCDs and to limit demand on the health system.
But the sad reality is that, regardless of how healthy our lifestyle is, we will all die. And sometimes illness and death is just random.
That is a very scary thought in a society that is increasingly death denying and that promotes a belief that we are each in charge of our own destinies.
Recommended reading
My article in the SMH today: Take freedom slowly or the cycle of lockdowns will start all over again.
The White House has announced $1 billion to purchase rapid, at-home coronavirus tests. So now we will have RATS in the White House. Come on Australia, hurry up.
Why anti-vaxxers, conspiracy theorists and the far-right have come together over COVID-19: The far-right, anti-vaxxers, and conspiracy theorists appear to have found fertile ground, particularly among men who feel alienated, fearful about employment and who spend a lot of time scrolling social media and encrypted messaging apps.
Buy a llama not a dog. Llama antibodies have ‘significant potential’ as covid treatment – study.
‘Miasma’ was on my short list for the word of the day: The 2,000-year-old airborne disease theory that blinded COVID experts.
From next week those of us who live in NSW can welcome visitors into our homes again. Here is a great idea.
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
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