A column by Professor Kathy Eagar

COVID SNAPS: the urgency of childhood vaccination, hopes for herd immunity and forging lifelong bonds

Melissa Sweet
Kathy Eagar
Monday, November 1, 2021

COVID-19, COVID SNAPS, Education, Child health, Pregnancy and childbirth, Public health, Vaccination

With predictions that 40 percent of Australia’s unvaccinated population will soon be children under five, childcare is set to become the next COVID frontline amid increasing urgency to roll out childhood vaccination, writes Professor Kathy Eagar, Director of the Australian Health Services Research Institute at the University of Wollongong, in her latest column.

“I am optimistically assuming it will be possible for all 5-12 year olds to be offered the vaccine in time for school Term 1 in 2022. If we can achieve that, we have every chance of achieving close to herd immunity levels in 2022,” she says.

Kathy Eagar writes:

Our quote of the week (anonymous) is: “I find it very suspicious that COVID seems to be only targeting people who didn’t get that ridiculous vaccine. Has anybody else noticed this? Why is the virus only killing those who stand up to the government jab all of a sudden?”

Word of the week is”quaranteam”.

Your quaranteam is the small group of people you spent time with during quarantine and lockdown. For better or for worse, you and your quaranteam now have a lifelong bond.

Australian COVID at a glance

Here is a summary of the COVID state of the nation on 28 October.

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: 234 cases and 8 deaths on 29 October. 5-day moving average 277 (301 last week), Reff 0.83 (0.87 last week) – cases have more or less plateaued this week. It could stay like this for some time now because improving vaccination rates are being offset by easing out of lockdown.

Victoria: 1,656 cases and 10 deaths on 29 October. 5-day moving average has dropped to 1,589 (1,965 last week) and the Reff is 0.86 (0.98 last week) – Victoria continues to hover below its peak. With lockdown now ending, it could plateau at this level for quite a while.

ACT is now down to very low numbers and a Reff below 0.5.

Queensland, SA, Tasmania, WA, Qld, SA, NT: moving average 0, Reff 0.

Below is a nice summary of the role of vaccine in reducing transmission. It comes from an article by Christopher Baker and Andrew Robinson in The Conversation. It is on my recommended reading list.

Vaccination round up

Here is a summary of vaccination rates by state and territory. The columns to look at are the 0+ columns. These are the percentage of the whole population vaccinated, not just those over 15.

In total, 62.5 percent of the whole Australian population is fully vaccinated (blue ink) and 73.5 percent has had one jab (black ink). ACT heads the list with 75.6 percent of the ACT population fully vaccinated and 83.5 percent of the population having had one jab.

WA and NT are still well behind, with just under half of their population fully vaccinated.

Celebrating a decoupling

First, a quick refresher. Coronavirus is a virus that spreads through the air and that gets into your body, largely via your nose or mouth. COVID is the disease caused by the SARS-CoV-2 coronavirus. Vaccine does not target coronavirus. Vaccine targets COVID.

A national vaccination strategy aims to:

1. Reduce the number of people who get infected. Coronavirus can still be circulating but the aim of the vaccine is to help your body fight the coronavirus and stop you developing the COVID disease. Infection is measured by case numbers.

2. Reduce the severity of the disease in those who, in spite of being vaccinated, do become infected. Severity is measured by hospitalisations and by deaths.

Here is a graph showing cases, hospitalisations and ICU admissions during 2020.

There is typically a one to two week lag between cases and hospitalisations. When cases go up, hospitalisations follow about two weeks later. When cases go down, hospitalisations follow about two weeks later.

When vaccine is doing its job, hospitalisations stop following cases and they go their separate ways. Hospitalisations (and deaths) become ‘decoupled’ from cases.

You can see evidence of decoupling in the graph below. The decoupling of cases and hospitalisations began around the last week of August. Cases (the broken black line) continued to increase at a fast rate from August. But the rate of hospitalisations (the blue line) and ICU admissions (the yellow line) did not neatly follow two weeks later.

Thanks Juliette O’Brien (https://www.covid19data.com.au) for these splendid graphs.

By the time that cases and hospitalisations got ‘decoupled’ and went their own ways, vaccination rates for the ‘eligible’ population had hit 54 percent in NSW, 44 percent in Victoria and 57 percent in ACT. Hospitalisations in the current wave peaked at around 1,500 per day (compared to 700 at their peak in 2020) and have been steadily declining since then.

What we are seeing in this graph is (hopefully) the pattern we can expect to see going forward. Case numbers will always matter but their importance will diminish over time. What will become more important to monitor is hospitalisations, ICU admissions and deaths.

The goal now is to turn this decoupling into a permanent divorce. As many of us already know, a trial separation is rarely enough.

We now need to keep a close eye on hospitalisations and deaths as well as case numbers. Third booster shots will be essential to address waning immunity otherwise cases will start rising again. And the Australian Technical Advisory Group on Immunisation (ATAGI), the Therapeutic Goods Administration (TGA) and the Government need to get a wriggle on so we can start vaccinating the 5-11 year age group. Eventually babies and preschool children will need to be vaccinated too.

We also need to keep an eye on advances in medical care for critically ill COVID patients. I’ll cover that in a future update.

The national baseline for opening up

As Australia opens up, it will be important to monitor changes in cases, hospitalisations and deaths. Here is a table showing cases and deaths since 25 January 2020 when the first case was diagnosed in Australia until Thursday 28 October 2021.

Since January 2020, we have had a total of 165,904 cases of COVID and 1,696 deaths. The case fatality rate so far has been one percent. No one should believe that this is a trivial disease. One in every hundred cases dying is much higher than any flu.

We had 28,408 cases and 909 deaths in 2020 giving a case fatality rate of 3.2 percent. Three quarters of those deaths were in aged care.

We had a dream run for the first half of 2021 with only 1,883 cases and one death.

Our third wave began in Sydney on 16 June 2021 before spreading through NSW, Victoria and the ACT. This third wave has resulted in 135,613 cases and 786 deaths so far. Our case fatality rate for this wave is 0.58 percent. This lower death rate is largely due to keeping COVID out of aged care homes although some improvement is also due to improving vaccination rates.

This is our baseline to measure our success ‘living with COVID’ from here. If it all goes according to plan, we should expect to see the case numbers fall and the fatality rate significantly reduce. I think it’s realistic to expect the fatality rate to be cut by half. This would reduce our case fatality rate to about 0.25% or 2.5 deaths per 1,000 cases. Nearly all of these will be unvaccinated adults.

The tables below show cases (top table) and deaths (bottom table) by aged group. People under 20 have had more than 45,000 cases and 2 deaths. At the other end of the spectrum, people over 80 have had less than 4,500 cases but 1,024 deaths.

Young people already represent the majority of COVID cases and case numbers in children can be expected to increase from here. With most older people being vaccinated, the coronavirus will concentrate among people who are not vaccinated.

The current prediction is that 40 percent of Australia’s unvaccinated population will soon be kids under five. This will inevitably make childcare the next COVID frontline. This increases the urgency of rolling out childhood vaccination.

Magic vaccination rates

Here is the latest update on vaccination rates for NSW statistical areas. NSW continues to have the highest vaccination rates in the country.

Regions are listed from highest (Baulkham Hills and Hawkesbury) to lowest (Richmond-Tweed). I have also included the 80 percent threshold. These are percentages of people over 16, not the whole population.

In total, 23 areas are at 80 percent or better, up from 17 last week. Five are still to reach the 80 percent threshold. Illawarra has had a 5.6 percent improvement in the last week.

Vaccination and TTS

There was one new case of “Thrombosis with thrombocytopenia syndrome (TTS)” blood clots caused by AstraZeneca vaccine last week.

This brings the total number of cases of TTS to 157 (79 men and 78 women; 86 confirmed and 71 probable cases) from 12.9 million doses of AstraZeneca vaccine:

140 discharged
8 in hospital
8 deaths (6 women, 2 men).

The TTS rate is 157 cases from 12.9 million doses of the AstraZeneca vaccine or 1 case per 82,165 doses. The death rate is one death per 1.61 million doses. The case fatality rate (the chance of dying from TTS if you get it) is 8 deaths from 157 cases or five percent.

School is back but hundreds are closed

Schools are back in NSW but over 100 schools have already been closed because of COVID cases. Here is to a great resource by a team who are mapping school closures. They are aiming to map school closures nationally but are rightly focused on NSW and Victoria at this stage.

I find it quite bizarre that this information is not available on every Department of Education website in the country.

Surely parents and the general community have the right to know what schools are open and what schools are closed? We can hardly expect the community to pull together to manage community transmission in a climate of secrecy.

Vaccinating children

A long awaited Pfizer trial testing the COVID vaccine for 5-12 years old has now reported. The trial found that young children were able to tolerate the vaccine well and they produced a strong immune response.

The 2,268 children aged 5 to 11 years in the trial received doses a third the size of an adult vaccine dose, spaced 21 days apart.

The USA Food and Drug Administration determined recently that the Pfizer vaccine is safe and effective for children ages 5 to 11 and it is now expected that Pfizer vaccine will be authorised for US schoolchildren within the next two weeks.

Pfizer reported that the vaccine is more than 90 percent effective at protecting school-age children from serious illness or hospitalisation. This is similar to the level of protection it provides in adults.

While the USA will likely approve vaccination for 5-11 year olds within a fortnight, we will need to wait a little longer.

Our approval processes (ATAGI, TGA, and then a political announcement) will inevitably drag on before we get approval too. I suspect that our inefficient approval processes will not be fast enough to make it in time for school year 2021.

But I am optimistically assuming it will be possible for all 5-12 year olds to be offered the vaccine in time for school Term 1 in 2022. If we can achieve that, we have every chance of achieving close to herd immunity levels in 2022.

Pregnancy and vaccination

There has been a lot of commentary on social media claiming that vaccine interferes with fertility and pregnancy. Just to set the record right, it does not.

The latest report on this topic has just been published in The Lancet, one of the most highly regarded medical journals in the world. It reports on a randomised control study on both fertility rates and birth outcomes after AstraZeneca vaccine. Fertility was unaffected by vaccination, there was no increased risk of miscarriage and no increased risk of stillbirth in women vaccinated before pregnancy.

This adds to a significant body of evidence that vaccination is safe for both mother and baby. There is also a significant body of evidence that COVID infection is dangerous for both mother and baby. The key message is that the best way a mother can protect her newborn is to be vaccinated before or during her pregnancy.

Vaccine hesitancy is old news

‘Vaccine hesitancy’ has all but collapsed in Australia. The latest opinion poll has found that only four percent of respondents are ‘not at all likely’ to get vaccinated and a further two percent say that it is ‘not very likely’.

You can see the trend over time in the graph below and read all about it in the SMH article in the recomended reading list below.

There is nothing like a major outbreak of COVID in combination with the promise of reopening to increase the popularity of vaccination.

Australians are generally very supportive of vaccination and we have extremely high rates of vaccination for other infectious diseases. With vaccine hesitancy all but gone, we now have every chance of (eventually) reaching 95 percent double vaccination, a rate adequate for herd immunity.

For your viewing pleasure

Not ready to venture out into the new normal COVID world? I recommend you enrol in a course at The Institute for Reopening.

For those still not confident about venturing out, I have attached a quiz the whole family will enjoy. Up to 10 answers are allowable. The first family to complete all ten answers wins a prize.

A date for your diary

Third vaccination shots have now been approved and will become available from November 8.

The third dose will be Pfizer for now and eventually Moderna as well. AstraZeneca is being phased out and will not be used.

As I flagged last week, you will be eligible six months after your second jab. So lock a booking into your diary.

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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