Introduction by Croakey: “COVID cases and deaths have now become so normalised that major milestones hardly rate a mention in the media. When we become de-sensitised to illness and death, we lose perspective on what’s important.”
In her regular COVID SNAPS column, Eagar puts a focus on important concerns ranging from the vaccine equity gap and Long COVID to a lack of clarity with some vaccination data, and the importance of boosting vaccination rates among 16 to 29 year olds.
Kathy Eagar writes:
The quote of the week is from Mohamad Safa: “I don’t know who needs to hear this but polio and smallpox never reached natural herd immunity. They were eradicated by vaccines.”
The word of the week is ‘strollout’. It is also the Australian word of the year as announced by the Australian National Dictionary Centre.
Strollout was coined by ACTU head Sally McManus to describe delays in Australia’s COVID-19 vaccine rollout in May this year.
The word made headlines in Australia and international publications in the United States and New Zealand, apparently beating terms related to the ongoing climate emergency and regional security.
The phase of the week is ‘post-acute sequelae of COVID-19’ (PASC) – the latest jargon phase to master.
AKA ‘long COVID’, PASC has now been formally recognised as a ‘syndrome’ characterised by persistent and prolonged effects after COVID-19. I’ve included more about PASC in a section below on COVID disease staging.
Australian COVID at a glance
Here is a summary of the COVID state of the nation. Case numbers have fallen in the last week in Victoria, reducing the Australian average to about 1,200 most days. We have 10 to 15 deaths most days with the death toll falling more slowly than cases.The good news is that hospitalisations have decreased quite quickly over the week commencing 15 November. You can see it clearly in the graph below from covid19data.com.au.
After a trial separation, cases and hospitalisations have now divorced and each has gone their separate ways. We want them to stay de-coupled and that is exactly what they are doing. This pattern is, of course, driven by NSW and Victoria.
The million dollar question is about what will happen when other states open their borders.
Case numbers in the other states are expected to increase very quickly. What is not clear (at least to me) is what will happen with hospitalisations and deaths. We will know the answer to that question over the next two months.
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.
NSW: 216 cases and 3 deaths. The 7-day moving average is 215 (233 the previous week), Reff 0.95 (1.03 the previous week) – with a Reff of 0.95, each 100 cases is infecting another 95 people. So case numbers are quite stable although perhaps declining slightly. It is looking more likely now that cases are probably stuck at this level right through to Christmas and beyond. The only question is whether they go up again after international borders open and many thousands of families are reunited.
Victoria: 1,273 cases and 8 deaths. The 7-day moving average is down to 1,001 (1,138 last week) and the Reff is down to 0.95 (1.01 last week) – Victorian case numbers are slowly decreasing too. But they could continue to hover in the 800-1,200 a day range for months. As with NSW, I’m expecting Victoria to go into the Christmas period with cases remaining at a similar level.
ACT is still managing very low numbers. ACT had 17 yesterday and the 7-day moving average is up to 14. Despite the highest vaccination rates in the country, the Reff is back up to 1.10.
Vaccination round up
Here is a table showing vaccination rates by age group. The data are starting to get very confusing because data collections don’t seem to be able to distinguish between people getting a second jab and a third jab. Hence you can see more than 100 percent of those enthusiastic 70-89 year olds getting a second jab.
Setting that aside, the percentages with one jab are looking very good as they will largely convert into people who get two jabs.
Well done to parents and young people 12-15 years. Over half have been double vaccinated in only a few months.
The group I am most concerned about are the 16-29 year age group. They are the group who are the most mobile, who socialise the most and who have the lowest vaccination rates.
Not surprisingly, they also represent the highest number of cases of any age group.
The next table shows vaccination rates by state and territory. The columns labelled ‘0+’ are the percentage of the whole population who have had one jab or two, not just those over 15.
In total, 70.5 percent of all Australians are double vaccinated. The rate varies from 81.8 percent in the ACT to 58.4 percent in the NT.
But state and territory averages don’t tell the whole story. There is considerable variability in some jurisdictions and you can see it clearly in this vaccination map (thanks Citizen Science).
Our national goal now needs to be to close the vaccine equity gap. Otherwise it will be a real disaster for vulnerable communities in the months to come.
Magic double vaccination rates
Here is the latest update on vaccination rates for NSW statistical areas.
Seven of the 28 areas are now above 95 percent. That is really impressive. They are followed by 23 areas that now have more than 90 percent of the eligible population vaccinated.
Sydney City and Inner South is still below 80 percent and is the outlier. But that’s probably because their population count hasn’t been adjusted to remove international university students who aren’t there at the moment. I suspect we have a similar issue but on a smaller scale in Wollongong and Newcastle.
This table shows the same information but this time sorted based on the percentage improvement in the last six weeks.
Coffs Harbour-Grafton tops the list with a 40.1 percent increase in the number of people double vaccinated compared to just six weeks before.
At the other end of the spectrum, the Baulkham Hills Hawkesbury area improved the least. But that is just a ‘ceiling effect’. They were already doing well and didn’t have as much room for improvement as other regions.
Don’t forget that these are the percentage of people over 16, not the whole population. In total, 79.7 percent of the whole NSW population (including children) has now had one dose and 77.2 percent has had two.
We need to get to around 95 percent of everyone being fully vaccinated to achieve herd immunity. ‘Fully vaccinated’ means at least three jabs not two.
Public health measures actually work
At least 72 studies have been undertaken so far to determine which public health measures actually work in preventing COVID. I take my hat off to the research team who systematically reviewed them all so that the rest of us don’t have to read each study.
The key findings are that physical distancing reduces your risk of catching COVID by 25 percent. Mask wearing is twice as effective as social distancing, reducing your risk by 53 percent. Handwashing also reduces your risk by 53 percent.
The handwashing finding is a bit surprising given that we now know that COVID spreads by aerosol rather than by droplet. But a possible explanation is that people who are good at handwashing are also good at avoiding crowds, distancing, and mask wearing. If so, it would be difficult to tease out the impact of handwashing on its own. As every statistician will tell you, correlation is not causation.
Be that as it may, this is a good news story. Public health measures actually work and will continue to do so even as the virus keeps mutating. Vaccination is now a frontline measure and there is no doubt that it works. But it isn’t 100 percent effective. Adding public health measures to vaccination really keeps you safe.
The study that reviewed these 72 studies was just published in the BMJ on 18 November, and it is included in my suggested readings for this week.
But for those who have better things to do, here is the BMJ ‘Visual Abstract’. I love this new format. If all journals adopt something similar, I’ll never have to plow through a full paper ever again.
COVID disease staging
Consistent with the way that we think about and treat other diseases, COVID-19 is now being classified and managed in stages. The UK National Institute for Health and Care Excellence (NICE) (https://www.nice.org.uk/) defines three stages:
Signs and symptoms of COVID-19 for up to four weeks.
Ongoing symptomatic COVID-19
Signs and symptoms of COVID-19 from four to 12 weeks.
Post-acute sequelae of COVID-19 (PASC)
Signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis. PASC is also known as ‘long COVID’.
The table below summarises the current evidence about symptoms reported by patients at each of these stages.
Many patients remain completely asymptomatic but others go on to develop quite severe PASC. This table is a lay summary only, not a systematic review of all of the available evidence and the purpose is a high level scan rather than an in-depth analysis.
The major conclusion for me from this summary is that no one can sensibly claim that COVID is a mild disease that we should all just learn to live with.
COVID can be mild, particularly in people who are vaccinated. But COVID has now killed more than five million people internationally, including nearly 2,000 in Australia.
It is too early to know the long term and lifetime consequences of long COVID.
But we do know something about the consequences of previous pandemics. For example, there was a massive increase in Parkinson’s Disease in the years during and immediately following the 1918 Spanish Flu (influenza) pandemic. In that case, people born during the time of the Spanish flu outbreak had two to three times higher risk of Parkinson’s Disease than those born prior to 1888 or after 1924.
If that could happen with the Spanish flu, we would be kidding ourselves to think that something similar couldn’t happen after COVID.
Only time will tell. In the meantime, prevention is definitely better than cure. Early and effective treatment is the next best thing. All of which reinforces the need for vaccination and for early testing, even if vaccinated.
Pathology testing for COVID is big business
A total of 41.5 million COVID PCR tests have been performed in Australia. Private companies that process the tests are paid a Medicare rebate of A$85 per test, up from A$28.65 at the start of the pandemic in March 2020.
In the 2020-21 financial year, one of the pathology giants, Sonic Healthcare, reported a net profit growth of 149 percent, to A$1.3 billion, with a significant proportion of that from COVID testing.
While many of us are delighted with the introduction of DIY RAT (rapid antigen tests), not everyone will be equally thrilled I suspect.
Working Parkinson Connections Congress blog: The flu and you: how viruses influence the risk of Parkinson’s.
ABC: Experts from Singapore, Canada, the UK and the US give Australia ‘living with COVID’ advice. If we are really smart we will learn from international evidence, not from experience.
The New Statesman: How the UK sleepwalked into another COVID disaster. By failing to prevent the rapid spread of coronavirus in schools, Boris Johnson has thrown children and adults to the wolves. This is an excellent analysis about how not to keep children safe. The once great NHS has really fallen on hard times and made some terrible decisions. Well worth a read as a group of influential paediatricians in Australia want to take the same approach.
The Conversation: Why did Sydney’s COVID case numbers fall faster than Melbourne’s? Climate may offer clues.How come NSW’s cases dropped so much quicker and further than Victoria’s? The easy answer is that it’s all just luck, good or bad. But if we look hard enough, we can usually find reasons that are likely to provide at least some of the explanation.
The MJA: On entering Australia’s third year with COVID‐19. We cannot let complacency encumber how we live with the virus: vigilance and a planned recovery are essential.
The Conversation: COVID tests have made pathology companies big profits, but rapid tests are set to shake up the market.
BMJ: Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis.
For your viewing pleasure
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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