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We probably can’t eliminate COVID in Australia forever. As we vaccinate, we should move to a more sustainable strategy

Introduction by Croakey: Sydney’s lockdown has been extended for another week, with New South Wales authorities struggling to contain an outbreak of the Delta COVID-19 strain which Premier Gladys Berejiklian says “is a game-changer…extremely transmissible and more contagious than any other form of the virus that we’ve seen”.

With particular concern for areas in Sydney’s south-west, Berejiklian also flagged that authorities might apply stricter lock-down measures to the local government areas of Fairfield, Canterbury-Bankstown and Liverpool, with the Premier urging residents in those areas to limit their movements and avoid visiting family, a decision that would raise both equity and efficacy concerns.

But the New South Wales Government may be considering a high stakes game-changer of its own, with Health Minister Brad Hazzard saying “at some point we’re going to move to a stage where we’re going to have to accept that the virus has a life which will continue in the community”.

The comment, made towards the end of a long news conference, came amid reports in The Australian that the state’s Treasurer was vehemently opposed to going into lockdown at all.

Hazzard’s comment is “extraordinary” and represents “an enormous threat” and “a huge change in policy”, according to Adjunct Professor Bill Bowtell from the Kirby Institute for Infection and Immunity. He told Channel 10’s The Project that there is no modelling to estimate the number of cases, hospitalisations and deaths that might follow.

Bowtell, who has called for a White Paper to make public all the goals, assumptions, modelling, advice and arguments behind Australia’s four-phase plan to emerge from COVID, said a shift away from Australia’s “zero COVID” strategy would put NSW into the same “radical” position that English is now heading towards.

The big difference, of course is the UK’s high vaccination figures compared to Australia’s (more than 50 percent versus less than 10 percent), but even then UK health experts are deeply worried about the UK’s “uncharted territory” of living with the virus.

The article below, by academics Maximilian de Courten and Rosemary Calder, originally published at The Conversation, looks to a time when we can live with COVID.

But it says to do so our health system should “move rapidly to reduce fear, improve vaccination rates, improve treatments and reduce complications as it does with other diseases we cannot eliminate or fully protect against”.

England has committed to lifting its COVID-19 restrictions by 19 July, even as cases are on course to surpass 50,000 in the next week or so and with global public health leaders expressing fears that the European Football Championships will be a COVID “seeding event” for the rest of Europe, with tens of thousands of people from all over Europe visiting London in a few days.

The warning came in a statement from the Public Health Leadership Coalition urging against complacency.

The Coalition, launched earlier this year by the World Federation of Public Health Associations, said its recent meeting “heard that political imperatives are driving harmful policies in some countries, such as reopening and hosting big gatherings, and that the pandemic is being prolonged by global inequities in access to COVID vaccines as well as vaccine hesitancy in many countries”.

The statement critiques the performance of leaders and health systems in a number of countries, including Canada, Colombia, Brazil and Chile, and warns that the lack of global action on “vaccine inequities and wider inequities is stopping recovery for everyone”.


Maximilian de Courten and Rosemary Calder write:

Nearly half of Australia’s population was in lockdown last week, as parts of New South Wales, Western Australia, the Northern Territory and Queensland enacted strict coronavirus restrictions.

But this angst-driven reaction of locking down with low community transmission of COVID is not a viable long-term strategy. This is because the coronavirus is increasingly likely to become endemic, meaning it will settle into the human population.

Vaccination markedly reduces your chance of getting severely ill and dying from COVID. Vaccination also reduces transmission to some extent. As vaccination rates start to climb, we need to start moving to a calmer, more planned and balanced strategy to help us all learn to live with the virus.

That needs a simultaneous focus on achieving high vaccination rates as fast as possible, while continuing with a consistent strategy of test, trace and isolate. Instead of daily announcements of new cases at press conferences, we should start reporting on vaccination rates and on severe outcomes like hospitalisations and deaths.

Last month Singapore announced its long-term strategy to prepare the country for life with COVID as a recurring, controllable disease. And last week, Prime Minister Scott Morrison announced a similar four-phase plan for Australia.

COVID is likely to become a regular part of life

There’s a theory that viruses often become more transmissible over time. SARS-CoV-2 might be heading that way.

One of the newer variants of the virus, Delta, is estimated to be significantly more transmissible than the Alpha variant, which is more infectious than the original strain of the virus discovered in Wuhan.

Though it’s not guaranteed, the coronavirus might also become less harmful to the population over time, as more people build up immunity.

Research in Nature found the majority of the 119 scientists it surveyed believed the coronavirus would become endemic, meaning it settles into the population, becoming a part of our environment like the flu.

We can’t continue an elimination strategy forever

When the pandemic was first taking hold, Australian health authorities aimed to “flatten the curve” by reducing new cases to a manageable level. In July 2020, the federal government’s own Deputy Chief Medical Officer declared eliminating COVID-19 a “false hope”.

But then Australia (and New Zealand) achieved success in not only suppressing the virus but reducing community spread to zero using lockdowns, social distancing measures and severe restrictions on incoming travellers. Elimination then became the new goal for many chief health officers around Australia, and many public health experts declared it the optimal strategy.

However, the high costs of the repeated elimination attempts over time are evident in the economy, in people’s livelihoods and businesses, and people’s broader health and well-being.

While we continue to debate whether the huge costs of lockdown are worth it, the costs of not having lockdowns in an unvaccinated population would be far higher. However, it’s likely the benefits of lockdowns will greatly diminish once we have rising vaccination rates and treatments for COVID continue to become more successful.

Elimination also requires really tight control of our borders. Very limited numbers of travellers (mostly returning Australians) are allowed through our quarantine system. This creation of “fortress Australia” ignores thousands of Australian citizens stranded overseas and prohibits overseas travel for almost all residents.

Despite this, our system continues to leak the virus into the community and to spark snap lockdowns. Australia currently experiences about one to two outbreaks per month from hotel quarantine.

Australia needs a more mature COVID approach for the long-term

Three Singaporean ministers, writing in The Straits Times, sum it up perfectly:

The bad news is that COVID-19 may never go away. The good news is that it is possible to live normally with it in our midst.

Moving away from an elimination approach to a long-term management strategy requires us to rapidly vaccinate most, if not all, of the population, as vaccination significantly reduces severe outcomes from COVID.

We need vaccine development to keep pace with the emergence of variants of the virus, as these seem to reduce the efficacy of vaccines to some extent. This will require booster vaccinations and continued research and development of new vaccines.

Developing effective treatments for COVID is also crucial. As we find effective treatments, these will make COVID a “milder” disease, lowering the risk of hospitals and intensive care units becoming overwhelmed.

Although we don’t yet have a gold-standard treatment, methods to treat the disease are rapidly improving. Steroid treatment dexamethasone is one example, which cuts the risk of death by one third for patients on ventilators. Antibody therapy is another.

The federal government’s four-phase plan doesn’t mention treatment at all. But we should accelerate support for ongoing research into COVID treatments.

Read more: Stopping, blocking and dampening – how Aussie drugs in the pipeline could treat COVID-19

We need to learn to live with yet another viral disease among us

Given COVID is likely to become endemic, the national cabinet decision to commit to a four-phase plan is a welcome recognition that Australia needs to begin treating COVID-19 “like the flu” in a long term approach.

Read more: Australia has a new four-phase plan for a return to normality. Here’s what we know so far

This transition of Australia’s approach should be based less on anxiety-inducing reports of daily new cases and where they might have strolled near you.

Instead it should focus more on how many people are partially and fully vaccinated, as well as how many people become very ill from the coronavirus and other health outcome measures.

This will give a consistent set of messages aimed at encouraging much stronger vaccination take-up. This looks to be included in “phase 3” of the federal government’s transition timeline and therefore we estimate this isn’t likely to occur until well into next year.

We’d argue this phase should begin much earlier, in tandem with the move from phase 1 to 2 and paired with sustainable public health measures to reduce exposure to infection. Public health measures should focus on community awareness, knowledge and engagement and on restoring community calm, economic livelihoods, health and well-being.

Masks, rapid and routine COVID testing, and tracing and isolation of contacts will be important when cluster infections occur.

What’s more, there should be particular engagement and protective measures for highly vulnerable people, such as the elderly, those who are disadvantaged, minority groups and people living with mental ill-health and with a disability.

We need to learn to live with yet another viral disease among us. Our health system should move rapidly to reduce fear, improve vaccination rates, improve treatments and reduce complications as it does with other diseases we cannot eliminate or fully protect against.

Maximilian de Courten is Professor in Global Public Health and Director of the Mitchell Institute, Victoria University.

Rosemary Calder is Professor of Health Policy at the Mitchell Institute, Victoria University and leads the Australian Health Policy Collaboration, (AHPC)


See our previous coverage of global health.

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diabetes
digital technology
disabilities
e-health
emergency departments and care
Equally Well
euthanasia
evidence-based issues
general practice
genetics
health & medical marketing
health and medical education
health and medical research
Health Care Homes
health ethics
health financing and costs
health reform
health regulation
health workforce
HIV/AIDS
hospitals
HRT
infectious diseases
influenza
international medical graduates
journal articles
LGBTIQ
medical marijuana
Medicare Locals
men's health
mental health
MyHospitals website
National Commission of Audit 2014
National Health Performance Authority
naturopathy
NDIS
NHMRC
non communicable diseases
nurses and nursing
oral health
organ transplants
out of pocket costs
pain
palliative care
paramedics
pathology
Pharmaceutical Benefits Scheme
pharmaceutical industry
pharmacy
Pregnancy and childbirth
primary health care
Primary Health Networks
private health insurance
quality and safety of health care
rural and remote health
screening
sexual health
social media and healthcare
suicide
surgery
swine flu
telehealth
tests
TGA
trauma
women's health
youth health
Indigenous health
#CTG10
#NTRC
Acknowledgement
cultural safety
Indigenous education
Lowitja Institute
NT Intervention
social and emotional wellbeing
Uluru Statement
WA community closures
News about Croakey
PIJ Commissions 2021
Public health and population health
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
air pollution
alcohol
consumer health matters
COVIDwrap
environmental health
Fetal Alcohol Spectrum Disorders (FASD)
food and nutrition
gambling
Government 2.0
gun control
health communications
health impact assessment
Health in All Policies
health inequalities
health literacy
human rights
illicit drugs
injuries
legal issues
marriage equality
Media Doctor Australia
media-related issues
nanny state
National Preventive Health Agency
obesity
occupational health
physical activity
plain packaging
prevention
public health
public interest journalism
road safety
sport
sugar tax
tobacco control
transport
vaccination
violence
Web 2.0
weight loss products
Royal Commission
Social determinants of health
discrimination
education
justice
Justice Reinvestment
NBN
Newstart
poverty
racism
social policy
Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017