Opinion

Raina MacIntyre
Why Australia’s daily Covid cases are on the rise again

For most of this year, I have decided to not comment further on Covid-19. Given the lack of appetite for truth about the pandemic, I have declined all media requests. There seems to be a dogged determination to pretend everything is okay. Anyone who suggests otherwise is shot down in flames.

We live in silence with Covid, with testing harder to access, the rights of workers to a safe workplace eroded, hospitals chronically overburdened and Covid-19 now in all states and territories. The false premise of the Doherty report – that test and trace would remain intact – is long forgotten, even though it was the basis for opening up and keeping case numbers manageable.

New cases remain about 60,000 a day in Australia, with an upward trend. In states such as New South Wales the numbers are bouncing around but have increased since a low of 4916 daily cases on February 21. In the past week, they have ranged from 17,000 to more than 25,000 a day.

Part of the problem is the lack of testing and the lack of reporting. The message of “live with it” runs counter to the importance of reporting a positive test, if you can afford one. PCR testing remains restricted, so daily case numbers are a substantial underestimate and even the trends may not be accurate.

 

Following trends in hospitalisations is more informative, because it is more reliably reported and tracked. These have been rising during March, with more than 2000 people hospitalised across the country. Our high vaccination rates will mitigate severe illness, but when the volume of infection eclipses past peaks, as the Omicron wave did, the total number of deaths and hospitalisations does too.

At the tail end of the Delta wave in December 2021, where we could reasonably point to the start of the Omicron wave, we had 2006 deaths. The Omicron wave saw close to a 200 per cent increase in deaths compared with all previous waves combined, with 5928 deaths by March 29. This includes six deaths in children under 10, two in people aged 10-19 years, 16 in the group 20-29 and 52 deaths in people 30-39 years old. The largest single age group for deaths was in people 80-89 years, with 2025 deaths. Another 2100 or so deaths were recorded in people aged 40-79 years and the remainder – about 1400 deaths – in people aged 90 years and over.

Of reported Covid-19 cases, the highest numbers are in the 20-29 year age group, with children 10-19 and 0-9 years not far behind. In NSW, rates are highest in 10 to 19-year-olds, with schools severely affected. Some schools report large numbers of students absent every day, and casuals are in short supply to replace sick teachers. Teachers have expressed frustration at the lack of strategy to mitigate the spread in schools.

Victoria is the only state to have addressed safe indoor air and provided HEPA filtered air purifiers to school, but they, too, have dropped mask mandates. Several private schools have reintroduced mask mandates and ventilated classrooms, but public schools are subject to state directives. In response to the chaos in NSW schools, NSW Health “allowed” schools to introduce mask-wearing last week if there was an outbreak. With the more contagious BA.2 Omicron variant on the rise, schools will only have relief with the Easter holidays.

Most of us know someone with Covid-19 right now, usually someone whose school-aged child brought it home, resulting in several family members becoming infected. Only 52 per cent of children 5-11 years have had one dose of vaccine, and only 24 per cent have had a second dose, in stark contrast with the phenomenal 95 per cent vaccination rates for two doses for Australians 16 and over, and 85 per cent for children 12-15 years. Yet two doses barely protects against symptomatic infection, so a booster dose is critical. Who would know? People still hear “double jab” echoing in their heads as the end of the journey. Our booster doses lag at 68 per cent uptake, with no sense of urgency or high-profile campaign to achieve high rates. We know it is possible to achieve it, because Australia has a vaccine-accepting culture, but there has been little push to increase uptake.

For those who have had the third dose, protection wanes after a few months, even against severe outcomes. Many other countries have introduced fourth doses for older adults. The new recommendation for a fourth dose came slowly and again excluded health workers, who have had no respite from a hazardous workplace with repeated exposure to Covid-19. People 65 years and over, Aboriginal or Torres Strait Islander people 50 years and over and a small group of people defined as having severe immunosuppression can now have a fourth dose, but it is not available more broadly.

With no attention to safe indoor air and mask mandates dropped, the fourth dose becomes even more important. I would have liked to see a fourth dose available to anyone over 50, because at 50 the immune system starts to decline in a process called immunosenescence, and it declines exponentially and predictably from then on. This has been well studied for other infections and Covid-19 seems to follow the same pattern. Meanwhile, we must get third-dose rates up to 90 per cent or higher and ensure people in aged-care facilities and other recommended groups get their fourth dose as soon as they are eligible.

Similarly, we must increase second-dose vaccination rates for children. The low rates reflect poor planning from government and their committees, with a slow recommendation for vaccination of children, after a concerted campaign against vaccination of children by some experts, and slow procurement of paediatric doses. Instead of having our kids fully vaccinated when schools opened in 2022, we sent them back unvaccinated, and most were not eligible for the second dose until April because the recommended spacing between doses is eight weeks.

As school after school has keeled over with Covid-19 outbreaks, we could have made the second-dose timing for kids more flexible and made epidemic control a priority. Instead, we have just stopped trying.

The “test to stay” strategy that was initially touted as the path back to school has been abandoned. In NSW, kids can attend school even if there is a case in their class, as long as they are asymptomatic. But asymptomatic infections are common in kids, and may comprise 30-50 per cent of infections. These cases are just as infectious as symptomatic cases, so it makes no sense. Not with BA.2 on the rise – which is shown to be more severe in children than any past variant.

To stop the relentless onslaught of cases, absenteeism at school and work, we need to reduce transmission. We could do so with a layered strategy of optimal vaccination, masks and safe indoor air, as well as investment in our testing and tracing system. It does not have to be a binary choice between unmitigated spread and total closure.

We must also take a longer-term view of population health as well. Covid-19 is not a cold or the flu. It was clear early in the pandemic that SARS-CoV-2 can cause chronic health problems. “Long Covid” describes a heterogeneous syndrome that may be caused by any or combinations of immunological, neurological, respiratory or cardiac pathology, for which there is increasing scientific evidence. Sustained abnormalities of the brain, heart, lungs and other organ systems after Covid-19 occur in a significant proportion of survivors, even in people with mild infection.

This matters for children and younger people, who have their whole life ahead of them and the most to lose. We already know Covid-19 increases the risk of diabetes in kids. One study found double the risk of heart attacks, strokes, clots and cardiac arrest at least 12 months after infection in adults. There is enough scientific evidence of long-term effects on health to do our best to avoid mass infection.

The British model is not one to emulate, unless we want to decimate our health system and suffer a massive burden of chronic Covid-related illness. Long Covid is already affecting workforces in many countries. In Britain, 2.4 per cent of the whole population is living with long Covid. It has affected the ability to work for 40 per cent of these people overall, and 51 per cent of people aged 30-49 years. The impact on the workforce has been so great in Britain that since February 2022, infected people no longer need to isolate and can attend work and infect others. It’s a Band-Aid solution that may provide more workers for a few days but ultimately will result in greater losses and is unsustainable.

Like Britain, Sweden chose unmitigated transmission and relied on “personal responsibility”. A recent study in Nature analysed the Swedish approach and found Sweden had a death rate 10 times higher than neighbouring Norway and used mass, involuntary euthanasia of elderly people, giving them morphine instead of oxygen when they got ill. The study found that science and true experts were ignored, with willing lackeys elevated to be the official “experts”, and Covid-19 data obfuscated, manipulated and evaded to make the pandemic appear less severe than it truly was. The public was kept ignorant of basic information such as the transmission of SARS-CoV-2 and that masks reduce transmission.

Britain, too, hides data – such as deaths by age group. It’s difficult to find out how many children in total have died of Covid-19, except for occasional information through freedom of information requests.

Will Australia end up like Britain or Sweden? We do have a much stronger culture of public good and civic mindedness, but we are slow with boosters and numbers are rising without any public health response. The community remains largely unaware of the importance of safe indoor air – something that could be fixed with a media campaign. If you do not fill your glass with water from the toilet bowl, then during this pandemic think of the air you breathe in the same way.

Be aware that shared indoor air is the greatest risk for transmission, and take simple steps to reduce that risk, as we provide in the Australian Scientific Advisory Group for Emergencies (OzSAGE). When no one else is masking, using a P2 or N95 respirator becomes even more important. Masks have been wrongly badged as a “restriction” when in truth they can bring us more freedom. A recent survey showed that more than 60 per cent of people would prefer everyone to be masked in public spaces.

Measuring cases and outcomes is also essential. We should make PCR testing widely accessible and make rapid antigen tests low in cost for the population. Without identifying cases, we cannot affect transmission and we cannot benefit from promising new antivirals that are proved to reduce severe outcomes if taken early. In time, these will become widely available, just like antivirals for influenza are, but without testing, they will be useless. They need to be used early to be effective.

The World Health Organization has called on countries to test, trace, maintain robust public health systems and report on cases and outcomes transparently. Heeding that advice is in the best interests of Australians. 

This article was first published in the print edition of The Saturday Paper on April 2, 2022 as "Living with Covid".

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Raina MacIntyre leads the biosecurity program at the Kirby Institute. She is on the World Health Organization’s technical advisory group on Covid-19 vaccine composition.

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