‘We’re all going to get COVID’: What living with the virus may look like

Jolyon Attwooll

5/11/2021 4:48:55 PM

newsGP considers the implications of ‘living with COVID’.

People dressed in COVID-safe way at an airport.
Many people are likely to travel to see loved ones in different states in the next few months.

This week, the borders between New South Wales, ACT and Victoria officially opened to each other.
For the first time in many months, residents of the two Australian states most impacted by the pandemic can now travel freely – as long as they are fully vaccinated – over the Murray River, setting the scene for the first Christmas many families will have shared since 2019.
As the national double-dose vaccination rate for the over-16s pushes 80%, it is a fundamental step towards living with a disease that has dominated the world for almost two years.
Other states will follow suit at different times, with the Premier of Western Australia confirming on Friday that the state borders there will open when 90% of over-12s are fully vaccinated – a timeline likely to stretch well into next year.
No matter what the different stages across the country, the shift to ‘living with COVID’ is now well underway. So, what shape do virologists and infectious disease experts believe it is likely to take?
Perhaps the most obvious change will be the presence of the virus. Vaccination rates may have dampened its spread for now, particularly in New South Wales, but the range of SARS-CoV-2 can only expand in a country that has largely gotten used to its absence.
The high chance of encountering the virus in Australia, which has so far likely infected less than 1% of the population the population, is something that has only recently started to be more widely acknowledged.
In October, Dr Norman Swan told the ABC’s Coronacast program that everyone is likely to get the virus at some stage.
‘The fact of the matter is that we are all going to get infected with COVID-19 at some point, even though we’ve been immunised,’ he said, adding that most people would only experience a mild illness.
While using a more cautious turn of phrase, Professor Dale Godfrey, Immunology Theme Leader at the Doherty Institute, echoed the sense that COVID-19 will become a feature of everyday life.
‘It’s likely that everyone will eventually encounter the SARS-CoV-2 virus, much like most people encounter influenza and other respiratory viruses,’ he told newsGP. ‘That’s what I expect as people are increasingly circulating and mingling.’
Like Dr Swan, he says few will have severe symptoms and that some are likely to be unaware of being infected altogether.
‘The people who are vaccinated and have sufficient protection may not even know if they encounter the virus and get infected,’ Professor Godfrey said. ‘Some vaccinated people might get mild symptoms and a much smaller proportion will still get more severe disease and some of these will die.
‘The people who will be at greatest risk are the people who have opted to not be vaccinated or who are unable to be vaccinated. They will be vulnerable to the full risks associated with COVID that we have seen in the pre-vaccination period.’
University of Queensland virologist Associate Professor Ian Mackay has also publicly said people are likely to get COVID not just once, but ‘multiple times in their lifespan’.

Changing behaviour
Professor Bruce Thompson, the Dean of the School of Health Sciences at Swinburne University, agrees that everyone will get the virus, but says Australia’s high vaccination rates mean this should make it more manageable than in many other countries.
However, he does believe people will need to keep adapting the way they act to reduce the risks and points to previous situations where there have been successful, lasting behavioural changes due to a health crisis.
‘As a society, whether we like it or not, we definitely will have to socially adapt. We’ve done it before, numerous times, not so long ago,’ he told newsGP.
‘We did for HIV. We socially adapted in terms of sexual health, hugely. [It was a] fundamental change.’
The prospect of mask use and social distancing is also around to stay for a while yet, he believes, with frequent testing likely to figure much more widely.
‘Rapid antigen testing will probably become part of our life,’ Professor Thompson said.
‘We will be socially adapting in terms of wearing masks, spreading ourselves out a little bit more in general, [and] potentially getting ourselves tested for this particular virus frequently.’
Dr Lara Herrero, a virologist and infectious disease researcher at Griffith University, also told the ABC that protective measures will be needed to shield more vulnerable people.
‘People without immunity being exposed to the virus is the thing we really need to slow down,’ she said. ‘We need to look at this on a community level and say it’s not just about me, it’s about my community.’
Managing the burden of disease
Much of the planning for living with COVID is designed around reducing the burden of disease, with GPs set to play a key role in that process, from the vaccination rollout to GP-led respiratory clinics, as well as in the expanded use of telehealth.
Professor Thompson says the new phase of living with COVID will continue to hit the country’s hospitals hard.
‘It fundamentally challenges our healthcare network, because it’s probably going to increase the number of hospitalisations by 5–10%,’ he said. ‘The change to the healthcare system is going to be significant.’
However, he believes new advances are eventually likely to have a bearing on how COVID is managed within the community here.
‘I think they’ve got every real chance of having long lasting vaccines, like we have for MMR,’ he said.
Another treatment that may become part of the general practice toolkit against COVID-19 is the Merck antiviral drug, molnupiravir. On Friday, the UK became the first country in the world to approve its use.
The Federal Government has 300,000 doses on order subject to its approval here, alongside 500,000 of Pfizer’s oral antiviral treatment.
Some also have the sense that the real pressure on healthcare resources will not arrive for several months yet. The living with COVID era is only in its infancy – or not even begun for many in Australia – with many people likely to spend more time outdoors over summer, where the risk of infection is lower.
Both Professor Godfrey and infectious diseases physician Professor Peter Collignon have suggested the real pinchpoint for infections in Australia could be next winter, a seasonal reflection of the current surge of cases in Europe.
Whenever and wherever the inevitable rise in cases occurs, vaccination is likely to remain at the heart of the response, whether for a primary course or booster rollout in adults, or even doses for younger children.
Associate Professor Mackay suggested as much on social media when discussing the prospect of his home state of Queensland opening up.
‘Get vaccinated as soon as you can so that your first meeting with this virus is as safe as it can be,’ he said.
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Dr Suresh Gareth Khirwadkar   6/11/2021 7:24:18 AM

And yet some states are still insisting on quarantining for 2 weeks. What is the point when everyone has it? Huge damage to the economy and people's livelihoods by not being able to earn any money for 2 weeks, to then come out of quarantine and probably go straight back in because they walked past someone who has covid.

Dr Jane Laloma   6/11/2021 9:50:59 AM

Timely perspective. Professionalism and team work will be crucial. Government resourcing will be most effective if it supports these qualities for the long term.

A.Prof Christopher David Hogan   8/11/2021 12:16:43 AM

There is more than merely living with Covid.
Covid is a different virus & its vaccines are different. There is no Herd Immunity- the unimmunised cannot be shielded by the vaccinated & although at a slow rate among the vaccinated, the virus will keep circulating - everyone will be infected- possibly more than once.
If it keeps circulating, it will continue to mutate.
When flu virus mutates, it has the good grace to usually lessen in severity & fade until the next outbreak. Covid is not so helpful.
* Other zoonotic viruses may emerge & lead to coincident infection
* Better viral diagnostics & therapeutics will keep emerging

We must not ignore the impact on so many of our systems . I can think of some easily
-our medical systems, our economy, our education systems, our technology, the decentralization of our populations, the lessening of peak hour, the decreased use of mass transport systems, the attrition of our unskilled & manual workforce.
There are others.