Post-vaccination life ‘is not going to be a pre-COVID experience’

At the beginning of the pandemic, Melbourne GP Dr Lorraine Baker started connecting with other doctors and scientists who found themselves looking on in horror at the scenes unfolding globally.
 
And over the course of the past 18 months, what initially served as a support group has evolved into an action-driven collective.
 
‘What the Australian population is yearning for – and what we’re all yearning for around the world – is a return to a life without COVID,’ Dr Baker told newsGP.
 
‘But you can’t live with COVID, you die with COVID. And so if you’ve got the capacity to not have COVID circulating in your community, you jump on every opportunity to do so.
 
‘We fear we’ve lost that [chance] in New South Wales, but we can do a lot more.’
 
Just last week, the group sent an open letter to the Federal Department of Health – signed by 24 doctors and public health experts – to oppose New South Wales Premier Gladys Berejiklian’s suggestion that restrictions could be eased once 50% of the eligible population is fully vaccinated. The group described it as ‘an erroneous benchmark’ that would put many people, including children, at grave risk.
 
‘We don’t know the consequences yet for that generation – we’ll find out soon from the United States and the United Kingdom,’ she said. ‘But while we don’t know, we have to protect.’
 
And even though the Premier appears to have backtracked on the idea, Dr Baker says the group is still concerned that little is being done to pursue prevention strategies beyond vaccination, such as ventilation, even as cases in NSW and Victoria continue to climb despite stringent public health orders.
 
For example, Australia’s Infection Control Expert Group (ICEG) updated its PPE guidelines in June in acknowledgement of aerosol spread, more than a month after the World Health Organization formally recognised the route of transmission.
 
However, Dr Baker and her group say there is still an urgent need to clearly communicate to the public that SARS-CoV-2 is primarily spread via aerosols.
 
‘Repeating this advice daily maintains understanding that mask-wearing and good ventilation [ie open windows or HEPA filters] will be part of public health advice throughout Australia, ongoing even after immunisation targets are reached if there is continuation of community transmission,’ the open letter states.
 
University of Queensland virologist Associate Professor Ian Mackay was not a co-signatory to the letter but agrees that vaccines alone are not enough.
 
He says the international experience among highly vaccinated populations, such as Israel, suggests that both the vaccinated and unvaccinated people can be hosts of infection. And considering Australia’s targets leave at least 30% unprotected, he believes there is a clear need to take other measures to minimise the risk of transmission.
 
‘That leaves a lot of people in which the virus can still run rampant,’ Associate Professor Mackay told newsGP.
 
‘So we do need to look at other strategies apart from just setting a specific percentage vaccination.
 
‘Those sorts of strategies include filtration of air and better ventilation in rooms, and just a better consideration of wearing masks and what the risks are for us if we don’t do these things.’
 
But for effective action to be taken, both Dr Baker and Associate Professor Mackay say government leadership is required.
 
Germany is among the countries leading the way. In October, the government committed €500 million (AU$805 million) to improve ventilation systems in public buildings, including public offices, museums, universities and schools in the hopes of reducing viral spread.
 
By taking these steps, Associate Professor Mackay says the benefits will extend beyond COVID-19, to curbing illness and death from other viruses, including influenza and respiratory syncytial virus (RSV), extending to less stress on the healthcare system and other economic benefits.
 
‘All that sort of thing is possible if we can get this right now,’ he said. ‘There’s never going to be a better time than a pandemic, due to a respiratory virus, to actually address this and make some changes.
 
‘We need to have already been starting this really. But it is daunting … there’s a lot involved in changing some of our habits and some of our engineering structures to deal with this. So we need to just think about it step by step, bit by bit, [and] start making changes where we can.’


Associate Professor Ian Mackay says Australia needs to consider strategies around air filtration and ventilation. 

Similar to vaccination and social distancing regulations, Dr Baker says governments could start by guiding business owners to undertake an audit of their ventilation system and assess their processes for keeping workers safe.
 
Meanwhile, for healthcare settings, such as general practices, she says it is clear the triage system is not foolproof, especially when it comes to asymptomatic infection.
 
‘They will come into your building, which is why everyone will need to continue to wear a high quality mask and you don’t let them into your practice without a mask on,’ Dr Baker said. ‘We may [also] need to start talking about putting masks on children when they come to see the GP.’
 
Beyond mask-wearing and ventilation, the letter is also calling for best practices identified in each state to be applied nationally, including consistent border controls. The group has also identified the need for a standardised definition of a close contact, to reduce the number of infectious people circulating in the community and facilitate contact tracing.
 
Dr Baker says the long-term plan is partly about setting clear expectations for what a post-vaccinated Australia looks like.
 
‘We have to redefine what freedom looks like and create expectations that match what international experience is telling us,’ she said.
 
‘And that is that masks will probably still be needed, especially if we don’t now suppress the virus in this country, and there will be restrictions on numbers and gatherings and so forth.
 
‘But most importantly, just signalling that post-vaccination Australia is not going to be a pre-COVID experience.’
 
Associate Professor Mackay fears it may already be too late for authorities to make it clear to the public that vaccines work to prevent disease and death, not necessarily transmission or infection. 
 
‘Maybe the scientists have let everybody down by making them think that we were going to be able to come out of this in a year or two years because we had a vaccine, rather than saying “yes, this virus might end up being like one of our common cold viruses, but that’s not going to happen overnight”,’ he said.
 
‘It’s going to take a while and it requires all of us to have some level of immunity, whether it’s from a vaccine or infection, before that’s possible.
 
‘It won’t be an endemic virus until – like with flu, like with RSV, like with rhinoviruses – we all have been exposed to them from birth and grown up with them being exposed over and over again.
 
‘There’s lots of complexity there. [That’s why] we need to think about tackling this in a multi-layered approach.’
 
Dr Baker says public health response going forwards must involve clear communication.
 
‘We embrace vaccination targets … but also contextualise it with preparing the ground for the way we will have to live life until there’s a foolproof treatment for COVID-19, which there isn’t yet,’ she said.
 
‘I’m not catastrophising; I think those things will come. But we have the luxury of protecting our health system at the moment and we don’t want to lose that. The global experience tells us everything.’
 
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