News

Australia must learn to live with coronavirus: Infectious disease expert


Doug Hendrie


5/05/2020 7:30:11 AM

The virus will be part of our lives until an effective vaccine arrives – because elimination is ‘very unlikely’.

Woman in isolation
Some states are preparing to exit lockdown. But what comes next?

That is the view of infectious disease specialist and microbiologist Peter Collignon, a professor at the Australian National University and former World Health Organization (WHO) advisor.
 
‘New Zealand is aiming for elimination and Victoria is trying to emulate that. But I think that’s very unlikely,’ Professor Collignon told newsGP.
 
‘There are so many mild or asymptomatic cases that we can’t find them all. I don’t think we’re going to stop it, but we can keep it to really low numbers.’
 
These comments come as countries around the world plan a staggered return to normality, depending on their infection rates.
 
Professor Collignon has outlined an approach he believes could restore a version of familiarity, as states and territories around Australia look to progressively reopen. These steps include:

  • testing sewage for the virus to get early warnings of a new outbreak
  • using newer testing methods and sentinel testing to find clusters, track contacts and isolate people with the virus
  • maintaining hand hygiene and droplet control, given droplets seem to be the main transmission vector
  • considering the introduction of face shields for all public-facing staff in order to reduce the risks of both passing or receiving the virus.
Learning to live with the coronavirus will be essential, as Australia is likely to enter the ‘long tail’ of the virus with community transmission dampened but clusters still emerging.

The Federal Government’s new COVIDSafe app is intended to enable the progressive reopening of society, by allowing state and territory health departments to more easily track contacts of people with the virus. 
  
‘Elimination is not very likely, but we can achieve low levels of transmission and do that without lockdowns,’ Professor Collignon said. ‘That can mean less isolation and cabin fever.’
 
Though the coming winter’s expected rise in cases could be a challenge, Professor Collignon predicts that any second wave will likely be smaller than the first.
 
‘As our first was due in large part to cruise ships and overseas travellers returning,’ he said.
 
Nations like the Netherlands and France are now employing sewage testing as a way to catch new outbreaks.
 
Sewage testing is a good early warning system to tell us if we need to tighten up restrictions,’ Professor Collignon explained.
 
‘Sixty per cent of people with the virus excrete it, so you can see it rising before there are increased cases in hospitals.
 
‘We may also need to think about face shields in the community for medical workers and anyone who can’t avoid getting close. Face shields have the advantage that if people have droplets [sprayed on them], it goes on the shield. It also reduces the chance of touching your face. And if people are presymptomatic and they cough, it is caught inside the shield.
 
‘You can wear them for hours, whereas masks are uncomfortable and don’t protect your eyes. You can clean them and decontaminate face shields.’

Coronavirus-sewage-test-hero.jpg
University of Queensland and CSIRO researchers recently identified genetic traces of COVID-19 in raw sewage, which has the potential to reveal virus hotspots and approximate the number of people infected.

To date, Professor Collignon believes Australia has done well balancing the economic destruction of the shutdowns against the risks the virus poses to health, by employing a less stringent lockdown than New Zealand while also avoiding the dangers of the Swedish hands-off approach.
 
Sweden’s decision to leave most of the economy open has contributed to a death rate almost 70 times higher than Australia’s on a population basis, with 262.1 deaths per million compared to Australia’s 3.8. However, other nations that entered lockdown also have rates as high or higher than Sweden.  
 
‘I would not recommend the Swedish approach. Their death rate is many times higher than Australia and they haven’t had a large percentage of their population become immune,’ Professor Collignon said.
 
Australia’s decision not to enter a stringent stage four lockdown as New Zealand did – requiring almost everyone to be housebound – has been vindicated by the fact both countries have all but flattened the curve, Professor Collignon said.
 
‘We took a relatively severe approach, with a million people out of work,’ he said. ‘But we haven’t had the same lockdown as New Zealand.
 
‘And I’d argue we don’t have to, because we don’t have uncontrolled spread. A complete lockdown is appropriate when you have no control over the situation, as in the UK or New York.’ 

Professor Bruce Thompson, Dean of Health at Swinburne University told newsGP that the fact Australia was considering re-opening without eliminating the virus meant we would have to live alongside it until an effective vaccine was available. 

‘We have to start working on a society where we have these viruses alongside us, while containing them,’ he said. 

Professor Thompson said living with low levels of coronavirus would mean society would have to change, such as challenging the expectation that it was acceptable for someone with a minor illness or fever to come to work.

University of Adelaide Professor of General Practice Nigel Stocks told newsGP that his sentinel testing network of GPs is preparing to begin testing symptomatic people aged 20–49 as early as next week, pending ethics approval.
 
With more 300 GPs participating around Australia, the Australian Sentinel Practices Research Network (ASPREN) is expanding focus from tracking influenza and other respiratory viruses to begin the hunt for hidden cases of the coronavirus.
 
But Professor Stocks said the effectiveness of social distancing will make broad-scale sentinel testing more challenging.
 
‘The difficulty is that SARS-CoV-2 is now quite a rare virus [in Australia],’ he said. ‘You would expect more cases to be arising if it was common and asymptomatic. Can it hide that well? Or is it gone?
 
‘Unless you have the capacity to ramp up sentinel testing, it’s not as effective for rare illnesses because you just can’t cover everyone or every location.’
 
Log in below to join the conversation.



coronavirus COVID-19 infectious disease public health sentinel testing



Login to comment

Dr Paul Francis Kelly   6/05/2020 9:24:00 AM

Very good commentary. Signals that change in behaviour will limit spread of the virus now and other viruses in the future. Consciousness raising vital. Staying away from work if unwell essential.


Dr Ian Mark Light   6/05/2020 10:38:43 AM

Intuitively being outside in the open air diminishes viral spread .
Some studies have shown this .
Well ventilated rooms with windows that can be partly open might have less spread of virions as they aerated away .
So the Testing Centres are in open air spaces with Some shelter and the health workers have head visors as suggested with masks usually N95 gloves sanitizers and gowns but they do many tests .
Outside work infrastructure projects with distancing still rather than tunnels would be safer then and new model masks both excellent for filtration but also ok for breathing when workers gather for a break is an industry developing .


Dr Jan Leslie Forsten Hanson   25/06/2020 3:42:09 PM

If we expect people to stay home from work with even mild symptoms, we need to be prepared to continue to provide enough sick leave and financial support, especially for casual workers.