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Two years later, and we’re not out of the woods yet

Introduction by Croakey: Just over two years ago – on 11 March, 2020 – the World Health Organization declared that COVID-19 was a pandemic, the first involving a coronavirus. At that time, 4,291 deaths had been reported globally.

On that day, Director-General Dr Tedros Adhanom Ghebreyesus urged countries to take a whole-of-government, whole-of-society approach, built around a comprehensive strategy to prevent infections, save lives and minimise impact. He stressed the importance of political leadership.

How’s that going Australia?

Below are two separate assessments – by University of Wollongong researcher Professor Kathy Eagar and Croakey editor Alison Barrett – that suggest an uncertain road ahead.


Kathy Eagar writes:

National Cabinet’s decision on 11 March to progressively lift the last remaining protections against COVID-19 comes at a time when Australia is still averaging more than 30,000 cases and more than 150 COVID-19 deaths a week, and more than 1,600 people in hospital each day.

These numbers would have been unbelievable just a year ago.

In this context, it seems ridiculous that Australia’s political leaders have now declared the pandemic effectively ‘over’. The message to the community is that we have all had the opportunity to be vaccinated, Omicron is ‘mild’ and we now need to resume our normal lives while ‘living with COVID’.

There are many reasons why lifting the last restrictions is an attractive idea. The economy has been in a lull, many businesses have closed, mental health problems in children, teens and adults have reportedly increased due to social isolation and there have been considerable social impacts as families and friends have been isolated from each other due to closed borders.

Yet COVID-19 is a long way from being endemic and our vaccination rates are far below anything approaching ‘herd immunity’ levels.  Only 47 percent of us have had three doses of vaccine, the minimum necessary to get reasonable protection from COVID-19.

So how did we get here and where do we go from here?

Two years into the pandemic, our political leaders have made a judgement that the community is ‘over it’ and will no longer cooperate in complying with public health protections.

This has not been helped by the politicisation of public health measures. Masks are a good example but there are others.

Instead of being promoted as a safe, easy and highly effective public health measure, masks have become a symbol of oppression, of the government unnecessarily telling people what to do. A government announcement to end masks is being sold as a government decision to ‘liberate’ electors from repressive government restrictions.

For the Coalition governments in power at a national level as well as New South Wales, South Australia and Tasmania, the removal of final public health protections is consistent with their broader libertarian agendas. They want to attempt to manage future COVID-19 outbreaks through personal responsibility rather than through a public health approach.

In general, the Labor governments in Victoria, Queensland, Western Australia, ACT and the NT have been more comfortable with a public health approach.

Australians locked down over the last two years to protect our most vulnerable citizens. In deciding to progressively walk away from these public health measures in recent months, our Australian governments (federal and state) have been explicitly making choices to reduce protections for these same vulnerable citizens and to increase their risk of dying from COVID-19.

Underpinning the National Cabinet decision at its meeting of 11 March 2022 is a judgement that, with vaccine readily available for all but young children and the immunocompromised, the price of protecting our most vulnerable citizens is now too high. They are now on their own while the rest of us resume our normal lives.

The winners and losers are well known as patterns of COVID-19 outbreaks in 2021 and 2022 have been driven by the usual social determinants of disease. This was not the case in the early days of the pandemic when those who could afford to travel experienced the early outbreaks.

In 2022, children and teens have the highest case rates and the elderly (particularly in residential aged care) have the highest death rates. Socioeconomic status matters, with high socioeconomic groups having low case and death rates.

People of diverse cultural backgrounds, people who do not speak English and Indigenous communities have been particularly hard hit.

The prospects for the next six months are not promising. While we do have high vaccination rates among the eligible population, winter is approaching, we have waning vaccine immunity and it seems almost inevitable that another sub-variant of Omicron will emerge.

It is tempting to think that, as we move forward, governments will again listen to public health experts and follow their advice as they did in the early stages of the pandemic. But there are no indicators at this stage that they will. ‘

Living with COVID’ from this point on will inevitably increase health inequalities. Individuals with the means to do so will ensure that they themselves are well protected. But our most vulnerable citizens will be increasingly put at risk.

Going forward, public health experts have little choice but to continue to give their best advice knowing that most of it will be ignored. Then we wait for the inevitable next wave of the pandemic to hit. Based on the international experience, it won’t take long.

Professor Kathy Eagar is Director of the Australian Health Services Research Institute at the University of Wollongong


Alison Barrett writes:

After two years of COVID-19, it feels this week like we are seeing an awful lot like history repeating.

Granted, things are definitely not the same as they were two years ago.

We now have an amazing smorgasbord of vaccines available to most, but not everyone (more on this later), we have knowledge of airborne transmission (more on this later), and the lockdowns we were heading into two years ago saved many lives.

However, Australian COVID-19 case numbers and hospitalisations have started creeping up in recent weeks, likely due to waning vaccine immunity, the emergence of Omicron sub-variant BA.2 and/or the removal of public health measures, such as mask mandates, in some jurisdictions.

And there’s also COVID-fatigue, complacency and a general desire to put COVID in the past. But, as much as we want it to be over, it is not.

After reaching a peak of 109,210 cases on 13 January 2022, overall cases in Australia steadily decreased to around an average of 22,000 cases per day by the end of February. Since the beginning of March, cases have increased to approximately 30,000 per day.

Due to international and state border closures, stay-at-home orders, other non-pharmacological interventions (NPIs) and good vaccine coverage prior to Omicron, Australia’s death toll has been lower than many other countries.

However, despite Australia’s overall deaths currently trending down, 5,639 Australians have died from COVID-19.

I agree with the sentiments of Ed Yong in his latest piece in The Atlantic – How and when did this many deaths become okay? And, how many more are we willing to accept?

Last week, global deaths from COVID-19 passed six million, which in reality is likely to be far lower than the actual toll.

On 11 March 2022 National Cabinet announced they were discussing ways forward in the pandemic, including changes to PCR testing and requirements for close contacts to change.

Since the end of 2021, Federal and State/Territory leaders have been increasingly placing the onus on us to fend for ourselves, move on and treat COVID-19 like a simple cold (and they have said as much).

For most people, COVID-19 may be ‘just like a cold’, but for many it will be worse than a cold, resulting in moderate-severe symptoms or long-term symptoms, known as long-COVID. As so many warned, ‘living with COVID’ actually means, for some people, ’dying with COVID’.

The transition from public health to personal responsibility has happened without community consultation, especially with priority populations, without a nation-wide public health education program advising best practices in protecting ourselves and without ensuring social networks and support systems are easily accessible to everyone.

Not everyone knows what to do, not everyone has the health literacy required to make healthy choices or behaviours, and not everyone has access to basic support systems to enable them to protect themselves.

There has also been minimal communication about the medium-long plan. For example, how many people are we aiming for to receive three COVID-19 vaccine doses? What is the plan for future variants and waves? And given two doses are not sufficient enough for protection against Omicron, why aren’t vaccine mandates based on three doses instead of two?

Similar sentiments were shared by Professor Marie Bismark at The University of Melbourne,

“I would love to know what the plan is around boosters, because we do know that that many people will be starting to have some waning immunity now,” she told me. ”We’re seeing those rates increase overseas and at a time when we should really be preparing for the next variant…we seem to be lulled into the sense of complacency.”

Many cities in China have recently gone into lockdown In their first COVID-19 surge since the beginning of the pandemic.

Similarly, until recent weeks, Hong Kong had managed to keep COVID-19 mostly at bay. The country has been hit with an increase in Omicron cases and deaths, which is reported to be due to low vaccination rates, particularly among those older than 70 years.

This great thread by Dr Eric Topol explains the situation in more detail.

As highlighted by the situation in Hong Kong, COVID-19 vaccines are incredibly important in protecting people from severe disease outcomes.

However, global vaccine inequities mean variants are likely to continue developing and it is unclear when the pandemic will end.

Acknowledging the pandemic is not over yet, the World Health Organization (WHO) has recently been discussing what criteria is required for them to declare an end to the pandemic.

In addition to vaccines, and as is recommended by the WHO, United States Centers for Disease Prevention and Control, and many other public health experts, NPIs such as physical distancing and wearing masks are valuable tools for minimising risk of infection or transmitting the virus to others.

Indicating mask wearing has become a contentious issue again, I have seen countless arguments arise on Twitter over the past month debating the merits for and against masks.

Bismark shared with me that she was verbally abused after posting the below tweet about wearing a mask, and she wondered “what’s gone wrong with the public health messaging” for this sort of reaction to mask-wearing.

“So I just, you know, had streams of abuse yesterday just for mentioning that I personally have made a decision to wear a mask and so it’s really interesting the extent to which this really basic public health measure has somehow become conflated with this sort of freedom protests for want of a better word,” she said. “And I just think it’s crazy. If there’s a really simple cheap measure you can take to protect yourself. Why wouldn’t you do that?”

Given the evidence is well-established that SARS-CoV-2 is predominantly an airborne transmitted virus, and masks can help prevent transmission (see detailed thread by Professor Trisha Greenhalgh here), it is surprising so many jurisdictions and leaders do not encourage the wearing of them.

In summary, if the past two years has taught us anything, it is that transparent and accessible communication is required, systems must be implemented to appropriately and equitably support individuals, and global vaccine equity must become a priority.


Additional reading

How Families Can Approach ‘The Great Unmasking’, by Elizabeth Stuart, Keri Althoff, Lindsay Smith Rogers at John Hopkins Bloomberg School of Public Health

The Pandemic after the Pandemic, by Katherine J. Wu in The Atlantic

COVID restrictions are lifting – what scientists think, by Chris Stokel-Walker, in Nature

We cannot afford to repeat these four pandemic mistakes, by Abraar Karan, in the British Medical Journal


From Twitter


See Croakey’s archive of stories on health communications.

 

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