What will it mean to live with COVID-19?

Regular viewers of Victoria and New South Wales’ daily COVID press conferences will have noticed concessions from both state premiers that ‘donut days’ are likely a relic of the past.
 
But rather than see this as defeat, Professor Catherine Bennett, Chair in Epidemiology at Deakin University, believes it is actually an ‘important step’ towards Australia learning to live with the virus. 
 
‘The plan was that we will get ourselves to a level of resilience, if you like,’ she told newsGP. 
 
‘It’s all about preparedness: vaccination rates, having a well-geared up public health response that can manage COVID on an ongoing basis without needing blanket restrictions, and so on.’
 
In July the Federal Government released its national transition plan, based on modelling by the Doherty Institute. It aims to fully vaccinate 80% of the population aged 16 and older prior to loosening restrictions and managing COVID-19 like other notifiable communicable diseases.
 
Current uptake figures suggest that target could be reached by December; however, Professor Bennett is concerned about inconsistencies in vaccine uptake across states and communities.
 
As a result, she says public health measures are likely to continue well into 2022 and require more localised responses.
 
‘Masks indoors will be the last precaution to go, and large gatherings the last banned activity to return, although large events will no doubt happen sooner if we go the way of adopting vaccine passports as have other countries,’ Professor Bennett wrote in a recently released paper.
 
The epidemiologist believes planning ‘a pathway forward for life beyond lockdown’ is well overdue, but writes that it must be guided by ‘discussions on our tolerance for serious illness, and hospital and intensive care unit capacity’.
 
In particular, Professor Bennett highlighted states that are continuing to take a COVID-zero approach, such as Western Australia and Queensland, whose chief health officer was left visibly shaken when questioned by media about the level of death she would be comfortable with to see the state’s borders open up.
 
‘Can you please remember who I am?’ Dr Jeannette Young said. ‘I went into medicine to save lives. I’m not comfortable with any deaths that are preventable.’
 
Professor Bennett says trying to maintain a low death rate is a ‘normal public health measure’. But she says suggesting that states can keep the virus out forever is not only a ‘false promise’ but can also lead to a lack of motivation to get vaccinated.
 
‘You want to be using this time to actually make sure every population in Australia, no matter how small or large, is as prepared as we can be so that the virus – which inevitably will find its way through the entire population at some point – is going to have the least impact,’ she said.
 
‘[That does not mean] locking up entire states because you might have a low number of deaths. We don’t do that for other diseases, and it doesn’t make sense to just single COVID out, because we should be having a level of control with our current vaccines.’

Professor Catherine Bennett, Chair in Epidemiology at Deakin University planning for ‘life beyond lockdown’ is well overdue.
 
As vaccination rates increase, Professor Bennett says the focus will need to turn to serious illness to control the impact on the health system, ensuring there isn’t a surge before borders open.
 
‘This is all about control,’ she said. ‘It’s a bit more like Denmark than the UK; we’re switching over to different controls and trying to hold our case numbers or exacting them down.’
 
As such, one (and the only) upside of the current outbreaks in NSW and Victoria, according to Professor Bennett, is that it is testing systems that have been established to mitigate viral spread, so they can be refined as vaccination rates increase to support contact tracing efforts, and in time, decrease hospitalisation rates and death.
 
‘In New South Wales, we’re seeing those early signs of … some levelling out now,’ she said.
 
‘The reproductive number is starting to come down [and] we might even be seeing the same thing in Victoria, where the reproductive number’s been sitting even higher.
 
‘Our hospitalisation rates are high, but they’re still not as high as they would be if we hadn’t had the vaccine protection we’ve got. By the time we get to 80%, we will be in a much better level of control than we are now.’
 
And even if cases continue to escalate, she says test, trace and isolate models will ‘no longer need to find every case’.
 
‘It’ll be pulling it back to saying majority are vaccinated, your risk of acquiring the virus is now two-thirds less, and so we can actually be more focused in the way you respond to local outbreaks,’ she said.
 
‘You still want to keep it under control, but it doesn’t mean that you hear about a case in the community and panic because it means you could go into lockdown.
 
‘In fact, you probably won’t even hear about another case in the community. It’ll be happening and we will manage it.’
 
Rapid antigen tests, which are currently being trialled, could also play a role in allowing business to reopen and large-scale events to return.
 
However, Professor Bennett says their use will likely depend on viral prevalence in the community, as low infection rates can impact the reliability of results.
 
‘It might be something we step in,’ she said.
 
‘So we’re probably going to see a time where your dial some things up, like everyone masks back on in public transport and small stores, and if the amber lights are flashing if you work in these industries, we’re switching back on the testing.’
 
What is clear is that even with high vaccine coverage and other mitigation strategies, the fight against COVID is not over. The possibility of another variant of concern emerging is very real, and could make it harder to control infections.  
 
But current vaccines are likely to buy Australia time, Professor Bennett said. 
 
‘The thing that’s important to remember is we’re already talking about our next generation vaccines, which are a better fit to Delta,’ she said.
 
‘We don’t have to go through quite the same trials … and you can adapt the vaccine much faster, particularly the mRNAs, which is why there’s so much interest in them.
 
‘But if we can actually reduce the levels of transmission around the world, that will also slow down the mutation clock.’
 
If New South Wales and Victoria can demonstrate the ability to bring their outbreaks under control, while taking small steps out lockdown, Dr Bennett says it will set a standard for other states. 
 
‘So if the rest of Australia gets to levels that are safe, and we’ve got the virus in the country, the international borders become less important,’ she said.
 
‘You want to monitor and survey what’s going on … have outbreak investigations if we have areas of vulnerability with low vaccination rates. But we’re going to be open to the rest of the world.
 
‘It’s not about National Cabinet dictating the time, the virus is doing this for us now and it’s really [about] using that to get people ready faster.’
  
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