How COVID health advice and modelling has been opaque, slow to change and politicised in Australia


William Bowtell, UNSWIn a recent article, The Australian’s health reporter asked: “has any modelling put forward by scientific institutes throughout the pandemic ever proved accurate?”

It’s a good question but the answer lies in understanding the truth about modelling — it cannot predict the future.

Rather, it’s a process that identifies variables most likely to shape the course of, say, a pandemic and to quantify their impacts over time.

Politicians commission modellers to assess the present state of things then consider what might happen if various policy settings were to be adjusted.

By providing assessments of the costs, benefits and impacts of proposed policies, good modelling provides governments with a firm foundation for deciding which policies will have what effects.

Politicians know invoking “health modelling” generates public support for their policies.

This week, federal Treasurer Josh Frydenberg claimed his decision to scrap COVID support payments at 80% double-dosed vaccination coverage accorded with the National Plan as informed by the Doherty Institute modelling.

But in neither the plan nor the modelling is any connection drawn between ending support payments at any level of vaccination coverage.

Nor was any modelling apparently commissioned on the likely impact of removing financial support for the most vulnerable when infection rates are high – as in Sydney – and rising alarmingly as in Melbourne.




Read more:
Scientific modelling is steering our response to coronavirus. But what is scientific modelling?


The power of ‘health advice’

Since the beginning of the COVID pandemic, politicians have justified the many difficult decisions they’ve had to make as being based on “health advice”.

As it should be, “health advice” provided to politicians by chief health officers is informed by modelling commissioned from a range of well-respected and credentialed scientific research institutes.

The public draws a strong causal link between health modelling inputs and policy outcomes.

They are more likely to accept policies buttressed by modelling and health advice than not.

Modelling is therefore a powerful political tool.

In a pandemic, political decisions have human and economic impacts that are irrevocable, significant and for many a matter of life and death.

Even more reason, therefore, for the scientific integrity of modelling that informs those decisions to be beyond reproach.

The brief given to the modellers is critically important in setting parameters and assumptions and selecting the variables that will be assessed and measured.

Transparency is essential

The key to building public trust in modelling is full transparency.

But in Australia, these briefs and processes are often shrouded and opaque. Secrecy and a lack of transparency has greatly affected the quality of Australia’s response to COVID.

At the beginning of the pandemic, the federal government’s Emergency Response Plan for Novel Coronavirus did not canvass the cessation of international travel and closure of borders, domestic lockdowns and the use of masks as possible or desirable responses to the pandemic.

Yet within weeks of this advice being published, the modelling had been overtaken by events.

Travel from some but not all countries was stopped, international and domestic borders closed from late March 2020, and lockdowns implemented across Australia.

In the initial planning and options, lockdowns, cessation of travel and masks were not among the assumptions. The entire response was based on a paradigm of influenza rather than the facts of coronavirus and need for rapid, preventive responses.

The assumptions informing the initial modelling should have been published, interrogated and debated before, and not after, the initial and ineffectual policy settings were adopted.




Read more:
Australia’s COVID plan was designed before we knew how Delta would hit us. We need more flexibility


Separating science from politics

Over the course of the pandemic, the assumptions of modelling commissioned by governments should have been published, scrutinised and debated before, not after, the modelling was undertaken.

Modelling ought to have been commissioned from a range of Australia’s excellent scientific institutions.

Open debate might have meant aerosol transmission of first Alpha and then Delta would have been factored into projections and policy-making about the efficacy of hotel quarantine and border protection far earlier than it was.

This unnecessary addiction to secrecy has eroded the trust and confidence that should exist between governments and the people.

Politics and science each have their separate and distinct roles to play in the managing the pandemic and reducing to the lowest possible levels the damage it causes to lives and livelihoods.

In the response to HIV/AIDS, the politicians of the day ensured scientific advice was provided independently of governments and published as it became available.

The advice became the foundation of the political decision-making process.

Now, as then, Australians expect a similar standard of open and independent scientific advice, information and assessment about the present and likely impact of the pandemic.

Whether commissioned by governments or acting independently, Australia’s pandemic modellers have lived up to their responsibilities to science and the Australian people.

They have applied their expertise to quantifying COVID and the costs and benefits of policy options.

But the critical decisions on assumptions, debate, contestability and transparency are made by politicians, not modellers.

As much as some politicians may wish to deny it, they alone are responsible and accountable to the Australian people for the decisions that have created Australia’s COVID response and will shape its future.

Modelling is integral to building the most robust, sustainable and well-supported response to the increasingly complex challenges of the pandemic.

The Australian people will be best served by separating science from politics.




Read more:
Explainer: do the states have to obey the COVID national plan?


The Conversation


William Bowtell, Adjunct professor, Kirby Institute for Infection and Immunity, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Worksafe’s hotel quarantine breach penalties are a warning for other employers to keep workers safe from COVID


Alex Collie, Monash UniversityVictoria’s occupational health and safety regulator, Worksafe, has charged the state’s health department with 58 breaches for failing to provide hotel quarantine staff with a safe workplace.

The breaches occurred between March and July 2020, and at up to A$1.64 million per breach, could amount to fines of $95 million.

This should serve as a warning to all employers to start assessing their workers’ safety against COVID and how they can mitigate these risks, ahead of the nation reopening.




Read more:
Here’s the proof we need. Many more health workers than we ever thought are catching COVID-19 on the job


Remind me, what is Worksafe?

States and territories have responsibility for enforcing laws designed to keep people safe at work: occupational health and safety (OHS) laws.

Worksafe Victoria is responsible for and regulates OHS in Victoria. It’s responsible for making sure employers and workers comply with OHS laws; and it provides information, advice and support.

Victoria’s parliament has given Worksafe the power to prosecute employers if they breach OHS laws. In 2018-19, it commenced 157 prosecutions which resulted in nearly A$7 million in fines.

Unlike some other state OHS regulators, Worksafe also manages the Victorian workers’ compensation system.

Why did Worksafe charge the health department?

Worksafe charged Victoria’s Department of Health with 58 breaches of sections 21 and 23 of the Victorian Occupational Health and Safety Act.

The Act requires employers to maintain a working environment that is “safe and without risks to health” of employees. These obligations extend to independent contractors or people employed by those contractors.

Worksafe is alleging that in operating the Victorian COVID-19 quarantine hotels between March and July 2020, the Department of Health failed to maintain a working environment that was safe and limited risks to health, both to its own employees and to other people working in the hotels.

Essentially Worksafe is stating that through a series of failures, the department placed government employees and other workers at risk of serious illness or death through contracting COVID-19 at work.

Worksafe alleges the Victorian health department failed to:

  • appoint people with expertise in infection control to work at the quarantine hotels
  • provide sufficient infection prevention and control training to security guards working in the hotels, as evidence shows training can improve employees’ safety practices
  • provide instructions, at least initially, on how to use personal protective equipment, and later did not update instructions on mask wearing in some of the quarantine hotels.

Worksafe undertook a 15-month long investigation, beginning in about July 2020. It’s possible the trigger for this investigation was a referral from the Coate inquiry into hotel quarantine, but that has not been stated.

Is it unusual for a government regulator to fine a government department?

It’s not that unusual. Government departments are subject to the same OHS laws as other employers in the state, and so Worksafe’s powers extend to them as well.

In the past few years, Worksafe has successfully prosecuted the Department of Justice, Parks Victoria and the Department of Health, resulting in fines and convictions.

In 2018, for example, Worksafe prosecuted Corrections Victoria (part of the Department of Justice) after a riot at the Metropolitan Remand Centre in 2015 that put the health and safety of staff at risk.

The riot occurred after the introduction of a smoking ban in prisons. Worksafe considered prisoner unrest was predictable and its impact on staff could have been reduced by having additional security in place in the days leading up to the smoking ban.

In that case the Department of Justice pleaded guilty and was convicted and fined A$300,000 plus legal costs.

What does this mean for other employers?

This case highlights that employers have obligations to provide safe working environments for their staff, and other people in their workplaces. This extends to reducing risks of COVID-19 infection.

These obligations don’t just apply to government departments. They apply to every employer in the state.

Employers should ensure they have appropriate systems and policies in place to reduce COVID-19 infection risk to their staff. This includes, where appropriate, physical distancing, working from home, wearing personal protective equipment (PPE), good hygiene practices, workplace ventilation, and so on.

Employers should consider the risks unique to their environment and address them appropriately, in advance of the nation reopening when we reach high levels of COVID vaccination coverage.

Some employers in high-risk settings – such as health care, retail and hospitality – will need to do more to protect their workers than others.

What happens next for the Vic health department?

The case has been filed in the Magistrates court, with an initial hearing date set for October 22. It will progress through the court system from there. Most prosecutions are heard in the Magistrates Court although some proceed to the County Court.

If the Department of Health pleads guilty, the courts will determine if a fine should be paid and how much. The court may also determine if a conviction is recorded.




Read more:
Soon you’ll need to be vaccinated to enjoy shops, cafes and events — but what about the staff there?


The Conversation


Alex Collie, Professor and ARC Future Fellow, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Relying only on vaccination in NSW from December 1 isn’t enough – here’s what we need for sustained freedom


Dan Himbrechts/AAP

C Raina MacIntyre, UNSW; Anne Kavanagh, The University of Melbourne; Eva Segelov, Monash University, and Lisa Jackson Pulver, University of SydneyThe latest New South Wales roadmap to recovery outlines a range of freedoms for fully vaccinated people in the state when 80% of those aged 16 and over are vaccinated.

Unvaccinated people will remain restricted, but will have the same freedoms by December 1, when 90% of adults are expected to be vaccinated.

The relaxing of restrictions will occur in three stages, at the 70%, 80% and 90% vaccination mark, with many restrictions dropped by December 1.

This includes relaxing the 4 square metre density rule to 2 square metres in most indoor venues; and no indoor mask mandates in most venues except public transport, airports and for front-of-house hospitality staff.

The problem is, other countries such as Israel already tried relying mostly on vaccines to relax restrictions – and failed, albeit at lower vaccination levels than NSW is aiming for.

Vaccines alone may not enough to protect against the highly contagious Delta variant.

So who is most vulnerable under the current plan, and how should the NSW reopening plan change to protect these groups and the wider population?




Read more:
NSW risks a second larger COVID peak by Christmas if it eases restrictions too quickly


Vulnerable group 1: children

About 20% of the population is under 16 years. The 80% adult target corresponds to less than 70% of the whole population, leaving plenty of room for Delta to spread.

One in three children aged 12 to 15 have had a single dose of vaccine, but it may be next year before this age group is fully vaccinated.

Another 1.2 million NSW children under 12 will remain unvaccinated. This is the largest unvaccinated group. With no requirements for unvaccinated primary school children to wear masks, and no plan to ventilate classrooms, outbreaks will almost certainly occur.

Children sit in a classroom, raising their hands.
Children generally get a mild infection from COVID but a small proportion need care in hospital.
Shutterstock

In the US, counties with school mask mandates had much lower rates of COVID in children than counties that did not mandate masks. One unvaccinated teacher who took off her mask to read to a primary school class resulted in 26 people becoming infected.

While children get mild infection compared to adults, around 2% of children who get Delta are hospitalised. Of these, some will require ICU care and a proportion will die. This becomes more apparent when there is high community transmission, and high case numbers in unvaccinated children.

The Doherty report estimates 276,000 Australian children will be infected in the first six months after reopening in the most likely scenario, with 2,400 hospitalisations, 206 ICU admissions and 57 child deaths in that time.

Vulnerable group 2: Aboriginal people

Aboriginal communities in NSW are especially vulnerable to epidemics, contracting COVID and getting severe disease.

There are relatively more children in the under 12 age category in Aboriginal communities, which leaves a much higher proportion of the community unvaccinated.

We saw in the Wilcannia outbreak that a high proportion of cases were in children.




Read more:
COVID in Wilcannia: a national disgrace we all saw coming


Despite this, vaccination rates for Aboriginal communities continue to lag about 20% behind the rest of NSW.

Allowing unrestrained travel into these communities before vaccination rates are high enough to afford protection may be disastrous.

Vulnerable group 3: regional NSW

Remote and regional communities are also vulnerable, because of fewer health services and difficulties with access to care.

An outbreak would disproportionately affect regional NSW.

Vulnerable group 4: people with disability

People with disability, many of whom have significant health conditions, are also at high risk.

Vaccination rates for NSW participants in Australia’s National Disability Insurance Scheme lag state rates by about 14% despite being prioritised in the national rollout.

In the UK, 58% of COVID deaths in the United Kingdom were among people who had a disability. People with intellectual disability were eight times more likely to die of COVID than the general population.

Vulnerable group 5: people with cancer and other conditions

Adults and children living with cancer and other conditions that suppress the immune system may have a poorer response to COVID vaccines, and may need a third dose.




Read more:
Why is a third COVID-19 vaccine dose important for people who are immunocompromised?


The need for third dose boosters in susceptible people is recognised and programs to deliver these are underway in many countries.

Some are vaccinating specific groups: the United States and United Kingdom are providing boosters to all people 65 and 50 years and over respectively.

Others, such as Israel and many European nations, are starting with older adults and immunosuppressed people, and later including the rest of the population.

Australia is yet to formulate such a plan.

Older person's arm with a bandaid after being vaccinated.
Some countries have already started giving boosters.
Shutterstock

Children under 12 years with cancer (not yet eligible for vaccination), also deserve to be protected, by vaccines and/or other measures to stop the spread of COVID in the community.

The consequences of overwhelmed health systems on timely diagnoses and treatment of cancer and other serious illness is already being seen in NSW.

A layered plan for a safer reopening

Currently available vaccines alone will not be enough to control Delta. We will need layered protection including safe indoor air, testing, tracing and masks to continue our lives freely when lockdowns lift.

Here’s what we propose:

1. Implement vaccine targets for at-risk groups

We need to make sure no disadvantaged group is left behind, and that vaccine targets are met for all these groups.

For Aboriginal people, we recommend 85-90% targets be met.

For other groups such as people with disability, particularly those living in congregate settings, higher vaccine targets should also be considered.




Read more:
Vaccinations need to reach 90% of First Nations adults and teens to protect vulnerable communities


2. Make indoor air safer

NSW needs a plan to address indoor ventilation, because the virus is airborne.

This has already occurred in Victorian schools, and should be an important part of lifting restrictions in NSW.




Read more:
From vaccination to ventilation: 5 ways to keep kids safe from COVID when schools reopen


The plan should ensure homes, businesses, schools and other public venues have safe indoor air, and that the community is as well informed on safe air as it is on handwashing, so that people are empowered to mitigate risk in their own homes.

3. Maintain high rates of testing and tracing

We must maintain high testing capacity, make rapid antigen testing widely available, and improve contact tracing capacity.

Suggestions of stopping QR code scanning and thereby reducing contact tracing capacity are misguided, and will result in a resurgence of infection.

We do contact tracing routinely for all serious infections such as TB, meningitis and measles, and need to continue this for COVID-19.

4. Plan for booster doses

We also need to address waning immunity from vaccines and be pro-active about booster doses, particularly for those with reduced immunity or who are immunocompromised, and for health care workers.

For the rest of the population, there is enough real-world evidence protection starts to wane as early as five to six months after vaccination.

It is urgent we address this for health workers and other priority groups such as aged care residents, who were mostly vaccinated six months ago or longer. This is not only for their own safety but to prevent health system collapse from under-staffing due to illness or burnout.

Let’s avoid future lockdowns

In the post-lock down world, NSW will likely face a Delta resurgence if multiple restrictions are simultaneously relaxed, as we have seen in countries overseas.

Dropping most restrictions is also likely to result in repeated stop-start lockdown cycles, prompted by health system strain when cases surge.

Only layered, combined protections will provide a chance of safer and sustainable re-opening until we await the promise of second generation vaccines, boosters and smarter vaccine strategies.The Conversation

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW; Anne Kavanagh, Professor of Disability and Health, Melbourne School of Population and Global Health, The University of Melbourne; Eva Segelov, Professor of Oncology, Monash University, and Lisa Jackson Pulver, Deputy Vice-Chancellor, Professor of Public Health and Epidemiology, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How contagious is Delta? How long are you infectious? Is it more deadly? A quick guide to the latest science


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Lara Herrero, Griffith UniversityDelta was recognised as a SARS-CoV-2 variant of concern in May 2021 and has proved extremely difficult to control in unvaccinated populations.

Delta has managed to out-compete other variants, including Alpha. Variants are classified as “of concern” because they’re either more contagious than the original, cause more hospitalisations and deaths, or are better at evading vaccines and therapies. Or all of the above.

So how does Delta fare on these measures? And what have we learnt since Delta was first listed as a variant of concern?




Read more:
Is Delta defeating us? Here’s why the variant makes contact tracing so much harder


How contagious is Delta?

The R0 tells us how many other people, on average, one infected person will pass the virus on to.

Delta has an R0 of 5-8, meaning one infected person passes it onto five to eight others, on average.

This compares with an R0 of 1.5-3 for the original strain.

So Delta is twice to five times as contagious as the virus that circulated in 2020.



The Conversation, CC BY-ND

What happens when you’re exposed to Delta?

SARS-CoV-2 is the virus that causes COVID-19. SARS-CoV-2 is transmitted through droplets an infected person releases when they breathe, cough or sneeze.

In some circumstances, transmission also occurs when a person touches a contaminated object, then touches their face.

Four Turkish men walk across an open town space.
One person infected with Delta infects, on average, five to eight others.
Shutterstock

Once SARS-CoV-2 enters your body – usually through your nose or mouth – it starts to replicate.

The period from exposure to the virus being detectable by a PCR test is called the latent period. For Delta, one study suggests this is an average of four days (with a range of three to five days).

That’s two days faster than the original strain, which took roughly six days (with a range of five to eight days).



The Conversation, CC BY-ND

The virus then continues to replicate. Although often there are no symptoms yet, the person has become infectious.

People with COVID-19 appear to be most infectious two days before to three days after symptoms start, though it’s unclear whether this differs with Delta.

The time from virus exposure to symptoms is called the incubation period. But there is often a gap between when a person becomes infectious to others to when they show symptoms.

As the virus replicates, the viral load increases. For Delta, the viral load is up to roughly 1,200 times higher than the original strain.

With faster replication and higher viral loads it is easy to see why Delta is challenging contact tracers and spreading so rapidly.

What are the possible complications?

Like the original strain, the Delta variant can affect many of the body’s organs including the lungs, heart and kidneys.

Complications include blood clots, which at their most severe can result in strokes or heart attacks.

Around 10-30% of people with COVID-19 will experience prolonged symptoms, known as long COVID, which can last for months and cause significant impairment, including in people who were previously well.

Woman in a mask waits in hospital waiting room.
Even previously well people can get long COVID.
Shutterstock

Longer-lasting symptoms can include fatigue, shortness of breath, chest pain, heart palpitations, headaches, brain fog, muscle aches, sleep disturbance, depression and the loss of smell and taste.

Is it more deadly?

Evidence the Delta variant makes people sicker than the original virus is growing.

Preliminary studies from Canada and Singapore found people infected with Delta were more likely to require hospitalisation and were at greater risk of dying than those with the original virus.

In the Canadian study, Delta resulted in a 6.1% chance of hospitalisation and a 1.6% chance of ICU admission. This compared with other variants of concern which landed 5.4% of people in hospital and 1.2% in intensive care.

In the Singapore study, patients with Delta had a 49% chance of developing pneumonia and a 28% chance of needing extra oxygen. This compared with a 38% chance of developing pneumonia and 11% needing oxygen with the original strain.

Similarly, a published study from Scotland found Delta doubled the risk of hospitalisation compared to the Alpha variant.

Older man with cold symptoms lays down, wrapped in a blanket, cradling his head, holding a tissue to his nose.
Emerging evidence suggests Delta is more likely to cause severe disease than the original strain.
Shutterstock

How do the vaccines stack up against Delta?

So far, the data show a complete course of the Pfizer, AstraZeneca or Moderna vaccine reduces your chance of severe disease (requiring hospitalisation) by more than 85%.

While protection is lower for Delta than the original strain, studies show good coverage for all vaccines after two doses.

Can you still get COVID after being vaccinated?

Yes. Breakthrough infection occurs when a vaccinated person tests positive for SARS-Cov-2, regardless of whether they have symptoms.

Breakthrough infection appears more common with Delta than the original strains.

Most symptoms of breakthrough infection are mild and don’t last as long.

It’s also possible to get COVID twice, though this isn’t common.

How likely are you to die from COVID-19?

In Australia, over the life of the pandemic, 1.4% of people with COVID-19 have died from it, compared with 1.6% in the United States and 1.8% in the United Kingdom.

Data from the United States shows people who were vaccinated were ten times less likely than those who weren’t to die from the virus.

The Delta variant is currently proving to be a challenge to control on a global scale, but with full vaccination and maintaining our social distancing practices, we reduce the spread.




Read more:
Why is Delta such a worry? It’s more infectious, probably causes more severe disease, and challenges our vaccines


The Conversation


Lara Herrero, Research Leader in Virology and Infectious Disease, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

With a post-lockdown Victoria in sight, the more we can contain transmission now, the easier the road ahead


Catherine Bennett, Deakin University and Hassan Vally, La Trobe UniversityVictoria’s roadmap out of lockdown, released today, marks an important milestone. It’s a clear commitment to delivering on the National Plan, and provides much-needed clarity on where we are heading and what the next few months will look like. It is staged and sensible, striking the balance between opening up and maintaining a level of control over transmission.

The roadmap charts a course of staged reopening as more Victorians become vaccinated. It’s informed by modelling from the Burnet Institute, which makes some sobering predictions on the number of cases and the strain on our health system, no matter what course we take from here.

It steps us through what things will look like as we move from 80% of those aged 16 and older having had at least one dose, to 70% fully vaccinated, through to and 80% and beyond.

The potential risk of easing restrictions will be managed through a continued focus on outdoor activity and leveraging the lower risk of infection and, even more so, hospitalisation, in the growing number who are fully vaccinated.

Having a clear vision for where you are heading can make all the difference, especially when the time horizons are now within weeks. We need this, as it will still be a difficult transition through “the gateway” to living with COVID.

Balancing the risks

The roadmap was only one of five scenarios the Burnet team modelled and is in fact the least cautious. But the decision was taken to balance these risks with the direct and indirect health costs of delaying the easing of restrictions further.

The modelling forecasts twice the peak in case numbers, ICU admissions and deaths under the proposed path compared with staying under lockdown, or the other more restricted scenarios.

But it also shows that maintaining high levels of testing can mitigate some of this additional risk.

We have a road out, and one we can make less costly by testing when symptomatic, and abiding by the public health orders now the end is in reach.

So what does the plan say?

When 80% of Victorians have had a single vaccination dose

At 80% single dose coverage among those aged 16 and over, expected by September 26, the travel limit in Melbourne will extend to 15km.

Outdoor activities such as basketball, golf, tennis will be allowed, subject to the same people limits as picnics: two adults if unvaccinated, or up to five fully vaccinated.

In regional Victoria, final year VCAL (Victorian Certificate of Applied Learning) students will be allowed back to study onsite. Masks will no longer be required for beauty or personal care services.

When 70% of over-16s are double dosed

October heralds the staged return to partial onsite schooling, with further changes once 70% of those 16 and older are fully vaccinated, expected by October 26.

This marks the official ending of what we know as lockdown.

The curfew will also end in metro Melbourne and outdoor hospitality will open to those fully vaccinated.

Weddings and funerals will be allowed outdoors for up to 50.

Students from all years will be able to return to face-to-face learning for at least part of the week in both Melbourne and regional Victoria.

Regional Victoria will also see further easing with up to 30 fully vaccinated patrons allowed indoors in hospitality venues.

When 80% of over 16s are double-dose vaxxed

When we get to 80% double dose coverage, projected for November 5, all of Victoria will share the same more modest restrictions.

Indoor activity will open further for those fully vaccinated, including retail, and caps will lift to 150 for organised indoor events and 500 outdoors.

Private gatherings of up to 30 people outdoors will be allowed, but only ten guests are allowed in the home, the setting deemed the highest risk.

Masks will only be required indoors.*




Read more:
We’ve become used to wearing masks during COVID. But does that mean the habit will stick?


By the end of the year

By year’s end, as we exceed 80% of adults fully vaccinated and aim for 80% including 12- to 15-year-olds, more visitors to the home will be allowed, possibly extending to 30 by Christmas.

International travel might be possible by then too, at least to low-risk countries.

Interstate travel will also be on the cards, although this might be limited to New South Wales and ACT until other states also move to living with the virus.

Why lift restrictions on outdoor activities and for the vaccinated?

It makes sense to use outdoor settings and individual and population vaccination protection to progress on this road out to manage transmission risk.

Remaining unvaccinated is a greater risk now, even with these rules in place – 204 people in hospital this week, and only 1% of these fully vaccinated.

Vaccine passports won’t be a permanent fixture, but allow us to do more things earlier than otherwise possible.




Read more:
Vaccine passports are coming to Australia. How will they work and what will you need them for?


But it could be worse – or better

It’s important to recognise that the steps along the way may end up looking somewhat different depending on case numbers, perhaps for the better.

Lower case numbers as we start this transition will put us in a better position, as the Doherty modellers reported last week. So the more we contain transmission while in lockdown, the easier the road ahead and lowest impact on hospitals.

The immediate challenge has not changed. We still need to do everything we can to keep case numbers from rising and, if possible, bring them down. We still need to get vaccinated as quickly as possible and push coverage in those over 16 up to 80%, and beyond.

What has changed is that we can see clearly where we are heading and how our hard work to prevent further waves while waiting for the vaccine roll-out now translates into greater freedoms in coming months.

This is a critical transition period that will test us all, and it helps to see vaccination levels that can provide some relief within reach after a gruelling 18 months. With the end of this “pre-vaccine” phase within sight, a final push to control transmission over this last stretch makes this a safer and quicker passage through the gateway to living with the virus.

If we do better than the Burnet modelling assumes by getting tested when symptomatic, vaccinated or not, and abiding by the rules in place, we will come in well under the forecast case and death counts.

Victoria and NSW are watching and learning from each other as each state eases out of lockdown while keeping a level of control over the virus. Success will reassure other states and territories of how this can work, and allow Australia to once again be open for business.




Read more:
NSW risks a second larger COVID peak by Christmas if it eases restrictions too quickly


*Correction: This article originally said masks would only be required outdoors. This has now been corrected.The Conversation

Catherine Bennett, Chair in Epidemiology, Deakin University and Hassan Vally, Associate Professor, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

When COVID patients are intubated in ICU, the trauma can stay with them long after this breathing emergency


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Deb Massey, Southern Cross UniversityThe current wave of COVID cases is leading to more hospital and intensive care (ICU) admissions. Frontline health workers and experts use the term “intubation” for the extra breathing support some patients need in an emergency.

But many people don’t know what this procedure involves and the trauma it can cause.

Patients with COVID-19 who deteriorate and need additional support with their breathing require intubating and ventilating. That means a tube is inserted and a ventilation machine delivers oxygen straight to the lungs.

Inserting the tube

Intubating a patient is a highly skilled procedure and involves inserting a tube through the patient’s mouth and into their airway:

  1. patients are usually sedated, allowing their mouth and airway to relax. They often lie on their back, while the health-care professional stands near the top of the bed, facing the patient’s feet
  2. the patient’s mouth is gently opened. An instrument called a laryngoscope is used to flatten the tongue and illuminate the throat. The tube is steered into the throat and advanced into the airway, pushing apart the vocal chords
  3. a small balloon around the tube is inflated to keep the tube in place and prevent air from escaping. Once this balloon is inflated, the tube must be tied or taped in place at the mouth
  4. successful placement is checked by listening to the lungs with a stethoscope and confirmed via a chest x-ray.
surgical instrument
A laryngoscope is used to guide a tube into the airway.
Shutterstock



Read more:
How are the most serious COVID-19 cases treated, and does the coronavirus cause lasting damage?


Can breathe, can’t speak or swallow

While intubated patients are attached to a ventilator and their breathing is supported, they are unable to talk or swallow food, drink or their saliva.

They often remain sedated to enable them to tolerate the tube. They can’t attend to any of their own needs and disconnection from the ventilator can be catastrophic.

For this reason any patient who is intubated and ventilated is cared for in an intensive care unit with a registered nurse constantly by their bedside.

American lawyer and editor David Latt recalled his experience of being intubated and ventilated following a diagnosis of COVID-19, saying:

When they were giving me anesthesia to put me to sleep so they could put a tube in my mouth that would enable me to breathe, I just remember thinking, ‘I might die.’ Sometimes in the abstract, you think, ‘If it’s my time, it’s my time.’ But when I was on that table […] I just thought, ‘No, I don’t want to go.’

Latt feared he would never see his two-year-old son or his partner again.

Taking the tube out

The length of time a COVID patient requires intubation and ventilation varies and depends on the reasons for it and the response to treatment. However, there are reports of patients being intubated and ventilated for over 100 days.

Once a patient’s respiration improves and they no longer require breathing support, the tube is removed in a procedure called “extubation”. Like intubation, extubation requires highly skilled health-care workers to manage the process. It involves:

  1. a spontaneous breathing trial, which assesses the patient’s capacity to breathe unassisted before extubation to decrease the risk of respiratory failure
  2. an assessment by the treating doctor, intensive care nurse, speech pathologist or physiotherapist of the patient’s ability to cough (so they can effectively clear their own throat and prevent substances entering the lungs)
  3. treatment from a physiotherapist is usually required before and after extubation if the patient has had mechanical ventilation for more than 48 hours. This is to ease the process of weaning the patient off the ventilator and help them learn to breathe independently again.

Once extubated, patients remain in ICU and are closely monitored to ensure they can safely maintain a clear and effective airway. Once they are able to do this and are stable enough to transfer to the ward they are discharged from the ICU.

Intubation, ICU and trauma

Patients with COVID-19 who require intubation and ventilation have witnessed a number of stressful events in the ICU, such as emergency resuscitation procedures and deaths. This may increase the risk of post-traumatic stress disorder, anxiety, and depression.

Although we don’t have definitive long-term data, patients who have been critically ill from COVID often have a long and difficult journey of recovery. They will likely remain dependant on health care services for some time.

Many patients who have been intubated and ventilated recall it as being one of the worst experiences of their lives. Clearly it is something we should try to avoid for as many people as possible.

There are currently 138 patients patients intubated and ventilated in ICUs across Australia. That’s 138 patients who cannot communicate with their loved ones, who are scared, frightened and vulnerable.

Most of these patients have not been vaccinated. The most important thing we can do to reduce the risk of being intubated and ventilated as a result of COVID-19 is get vaccinated.




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We’re two frontline COVID doctors. Here’s what we see as case numbers rise


The Conversation


Deb Massey, Associate Professor, Faculty of Health, School of Nursing, Southern Cross University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Chief health officers are in the spotlight like never before. Here’s what goes on behind the scenes


Patrick Harris, UNSW; Aryati Yashadhana, UNSW, and Evelyne de Leeuw, UNSWUntil COVID-19, few people knew anything about Australia’s chief medical officer or the state and territories’ chief health officers. Now they are front and centre of the news cycle.

But media coverage misses the nuances of the role. We see people with particular skills and personalities. Yet, each of the offices and officers is embedded in a particular institutional and historical context, which drives their role.

We are involved in an international study to look at their role during the pandemic in Australia, New Zealand, the United Kingdom and Canada. Here’s what we’ve found so far from the Australian data.




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My year as Victoria’s deputy chief health officer: on the pandemic, press conferences and our COVID future


Remind me, who are they?

In Australia, the chief medical officer, Paul Kelly, is the principal medical adviser to the federal health minister and health department. So he has the overarching bureaucratic responsibility for Australia’s federal health response to the pandemic.

For the states and territories, the chief health officers have that overarching responsibility.

COVID-19 has seen all assuming regular slots in press conferences. They are constantly under the microscope of the millions of epidemiologist wannabes.

COVID-19 has shown how contested their roles are. Are they public servants who act on behalf of the government? Or ought they be independent from politics, shaping policy to protect public health? Or must they balance the contradictions that come with being both a health professional and a public servant?




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Their legal powers can help or hinder

Legislation in each jurisdiction gives the chief health officer varying degrees of institutional power. This not only affects their role, but how outbreaks are defined and managed.

In some jurisdictions (New South Wales, Queensland, Tasmania, Western Australia) the chief health officers become public health emergency “controllers” for pandemic management.

Qld gives its chief health officer the most power (possibly the most, even internationally). This is partly due to also serving as deputy director-general (a senior position in the bureaucracy). Qld’s chief health officer is also the final decision-maker on public health restrictions (most notably borders) “in consultation” with the premier. NSW also holds the director-general position but the premier is the final decision-maker.

In comparison, Victoria’s chief health officer has neither the deputy director-general role nor “controller” oversight of emergency procedures.

An inquiry into Victorian hotel quarantine concluded this prevented the chief health officer from fulfilling the “controller” position. As a result, certain infection control details were overlooked, resulting in the outbreak that led to the state’s second wave.

The chief medical officer at the federal level has arguably the least legislative power of all given the jurisdictional autonomy of the states. The power of this role during the pandemic has mainly come through chairing the national committee of state and territory chief health officers.




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They work with politics, policy and evidence

Chief medical and health officers work at the interface of politics, policy and health evidence. They are unelected, yet are accountable to ministers, the premier and parliament. They work with the relevant secretaries and ministerial offices.

Whatever their remit, ultimately the buck stops with them. As we’ve seen under COVID-19, they have the power to “stop the nation”.

However, our analysis provides practical insight about how health evidence during the pandemic intersects with political realities.




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Contrasting NSW and Victoria lockdown coverage reveals much about the politics of COVID – and the media


They must be strategic and media savvy

These officers work within formal pathways to gather and interpret the best available evidence, from say, the Australian Technical Advisory Group on Immunisation.

But communicating evidence is an entirely different matter. More than acting as “honest brokers” of evidence to policy, their use of evidence needs to be strategic if they are to have influence. And this requires political acumen.

Elected politicians need to be seen to be in control. When presenting evidence, not all of which will be popular, chief health and medical officers need to anticipate political responses.

They must also be media savvy. The much-watched daily COVID-19 press conferences (recently disbanded in NSW) are well orchestrated. In times of crisis, clarity of messaging is as important as evidence. Image is too. Displaying collegiality across government is necessary visual messaging despite robust negotiations behind the scenes.




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They must be bureaucrats, networkers

As public servants, chief health officers must be excellent networkers and departmental managers. They delegate authority while holding ultimate responsibility for their legislated role.

In their agencies each has put into place management systems to deal with the complexities of the pandemic. Their networks extend to other sectors and agencies. For example, one chief health officer we interviewed explained having to unexpectedly collaborate closely with the police enforcement of public health restrictions.

Quarantine is under the constitution a federal government responsibility but was agreed to be managed at state level. This source of outbreaks challenged the effectiveness of chief health officers because the mix of public and private involvement compromised effective quarantine management.

Relationships with other chief health officers matter. The virus does not respect state boundaries, however much political leadership claims the contrary.

Collective decisions, often with massive ramifications, must be made. Trust in the skills and decision making of fellow chief health officers in different jurisdictions is fundamental.

Experience helps, demonstrated by those in NSW and Qld who have held the role the longest. But being relatively new brings dynamism. The early goal of zero transmission was championed by a chief health officer with less experience.




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What happens next?

An unprecedented pandemic has thrust previously faceless bureaucrats and their representatives onto our screens and devices in ways unimaginable even two years ago.

Ultimately, chief health officers have shown they need to balance the mix of public servant and health professional with a nuanced approach to politics.

But individuals are never the whole story. Investment in public health (putting hospitals aside) remains inadequate, for instance. New variants of COVID-19 are also testing a coordinated public health response like never before, chief health officers included.The Conversation

Patrick Harris, Senior Research Fellow, Deputy Director, CHETRE, UNSW; Aryati Yashadhana, Research Fellow, UNSW, and Evelyne de Leeuw, Professor, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

No, COVID-19 vaccines don’t affect women’s fertility


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Michelle Wise, University of AucklandSome women are holding off on being vaccinated against COVID-19 because of concerns the jab could affect their fertility, at times taking to social media to voice their concerns.

Anti-vaccination campaigners appear to be fuelling these fears and misleading women into thinking the vaccine may affect their chance of getting pregnant now or in future, or increase their risk of a miscarriage.

But there is no research evidence to support these claims. The science shows COVID vaccines have no effect on fertility, do not impact the chance of a miscarriage, and are safe and effective while pregnant.




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COVID-19, however, can cause severe disease in pregnant women. Currently one in six of the most critically ill COVID patients in the UK are unvaccinated pregnant women.

Where did the fertility myth come from?

Myths about the vaccine affecting fertility can be tracked back to websites in the United States, which highlighted a claim by a European doctor in December 2020, while the vaccine was in Phase 3 trials.

In a blog post which has since been deleted, he hypothesised there were proteins in the placenta which have similarities with the spike protein in the virus. He thought antibodies in the vaccines that block the spike protein might also attach to the placenta.

But the viral and placental proteins are not similar enough that we would expect this to happen; studies have now confirmed this.




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Pregnant or worried about infertility? Get vaccinated against COVID-19


What else does the science say?

Since the vaccine rollout began, six billion doses of COVID vaccines have been administered around the world, including Pfizer and Moderna, the recommended vaccines in Australia for under-60s, including pregnant women. Pfizer is the only vaccine offered in New Zealand.

There has not been a concurrent epidemic of infertility nor miscarriage.

Young woman in mask, outside in the sun, smiling.
No fertility-related safety issues have been detected.
Shutterstock

Several populations of women have been followed up after vaccination. Women who have received COVID vaccinations have no difference in markers of ovarian follicle (egg) quality compared to unvaccinated women.

Studies have demonstrated no difference in embryo implantation rate for women who had received vaccination against COVID prior to having in vitro fertilisation (IVF) compared to unvaccinated women.

Studies have also looked for an effect of the vaccine on male fertility. These have demonstrated no change in sperm volume, concentration, motility (the ability to swim the right way) and total motile sperm count when comparing samples taken before and after COVID vaccination.




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COVID-19 could cause male infertility and sexual dysfunction – but vaccines do not


What about in pregnancy?

Studies have also looked specifically at miscarriage. If antibodies against the spike did cause problems for the placenta, we would expect to see miscarriages. This is not the case.

The science is also clear the vaccine is safe in pregnancy. In studies of pregnant women in Canada and the United States who received the vaccine, minor side effects were similar to non-pregnant adults, and pregnancy complications and baby outcomes were similar to the background rate.

Pregnant woman in mask sits on bedroom floor, looking at laptop.
Pregnant women experience the same minor side effects as the rest of the population.
Shutterstock

Research has shown there’s additional benefit of vaccination in pregnancy, with the baby gaining some protection against COVID. Antibodies have been found in cord blood and in breastmilk, suggesting temporary protection for babies (called passive immunity).

Getting vaccinated at any stage of pregnancy will provide this additional benefit.

What about future fertility?

The COVID vaccine – like every other vaccine you received during childhood, and like the flu vaccine that you get every flu season – induces your body to create an immune response. The components of the vaccine itself are broken down by the body within hours.

In other words, COVID vaccines don’t stay in your body. After vaccination, you are left with antibodies ready to act in case you get exposed to the COVID virus in the future. There is no link with infertility or miscarriage.




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No, COVID vaccines don’t stay in your body for years


Women who are pregnant, planning a pregnancy or are concerned about their future fertility might still have concerns or questions about getting a COVID vaccination. If this is you, talk to your own doctor or midwife who can discuss the science with you and answer any questions in a non-judgemental way.

Dr Erena Browne, Registrar in O&G at Auckland District Health Board, co-authored this article.The Conversation

Michelle Wise, Senior Lecturer, Department of Obstetrics and Gynaecology, University of Auckland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Home rapid antigen testing is on its way. But we need to make sure everyone has access


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Lesley Russell, University of SydneyAs Australia opens up and we learn to live with COVID-19, rapid antigen tests are likely to play an increasingly important role in limiting the spread of the virus.

So we can expect growing demand for these tests, which can give a result in minutes, and are already used in other countries, including the United Kingdom.

Airline travel, accommodation, entry to ticketed events and school attendance may depend on this type of testing. Large-scale family gatherings and community events will also want to ensure the safety of all attendees, especially if some, for whatever reason, are unvaccinated.




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What are rapid antigen tests?

Rapid antigen tests have many advantages over the polymerase chain reaction (PCR) tests used at public testing centres. They are cheaper,
can be used anywhere at any time, and results are available within minutes. But they are also less reliable than PCR tests.

The Therapeutic Goods Administration (TGA) has approved dozens of these rapid antigen tests. But these are only available for use in health care, aged care, schools and workplaces.

These tests are not commercially available for home use, although this is on its way. Health Minister Greg Hunt expects home tests will be available from November 1.

Between now and then, here are four issues we need to consider if individuals and families are expected to use these tests and if rapid antigen testing is to be an effective and equitable gateway to activities and services.

1. Do they work?

The TGA will need to ensure the tests, many of which were developed more than a year ago, perform well with the Delta variant.

A Cochrane review recommends evaluations of the tests in the settings where they are intended to be used to fully establish how well they work in practice. It is not clear if this research is being done in Australia.

Tests from different manufacturers vary in accuracy and are less accurate in people without symptoms and/or with low viral loads – when they will most likely be used.




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Many home tests advise testing twice over a three-day period, with at least 36 hours between tests; they work best when testing is done regularly.

Appropriate consumer information material needs to be included with the tests to ensure people are using and interpreting them correctly at home.

There also needs to be a back-up service (such as a telephone hotline) for people who are confused, get unexpected results, and for those who test positive and need PCR testing to confirm their status.

Person at home dropping reagent into a rapid antigen test
People need adequate instructions to use these tests correctly.
Shutterstock

2. Do we have enough tests?

There are already signs supply of these tests could be a problem.

The biggest Australian manufacturer of rapid antigen tests has a large government supply contract with the United States, where supply of such tests cannot keep pace with demand.

India has also recently acted to restrict export of rapid antigen tests.

There are indications the federal government has supplies for distribution to aged-care facilities and local government areas as needed. However, the extent of the stockpile – and whether tests might be released from the stockpile for home use – is unknown.

3. What will they cost?

Once approved for use at home, people will most likely be able to buy these tests in pharmacies. However, there’s been no suggestion these will be subsidised or their price controlled.

There are different international approaches. In the UK, people can order two packs of seven tests free from a government website and can pick them up from places including pharmacies and libraries.

In Germany, people can buy tests in supermarkets for about €25 (about AU$39) for a pack of five.

In the US, there are huge price variations with each test costing US$5-30 (about AU$6.80-$40.90).

In Australia, worksites in Sydney can buy tests direct from suppliers for AU$8.50-$12.50 (depending on quantity). But they also need to employ a health-care professional to oversee their use.

Companies providing rapid antigen tests are reportedly contacting schools, saying they can supply tests at A$15 each (with additional costs for a nurse and administration).

It will not be sustainable to ask parents of schoolchildren and university students to pay such costs on an ongoing basis.




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4. How do we ensure equity?

US survey results indicate Americans’ willingness to regularly use home testing is price sensitive. That surely is also the case in Australia.

To date, all the signs are the federal government is taking a hands-off approach to the introduction of rapid antigen testing for home use. But it’s essential we have effective distribution mechanisms to cover all of Australia. We also need a regulated price structure and/or subsidies to make the cost of these tests affordable.

Failure to ensure availability and affordability of home testing will further disadvantage Australians already disproportionately affected by the pandemic.




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As lockdowns ease, vaccination disparities risk further entrenching disadvantage


The Conversation


Lesley Russell, Adjunct Associate Professor, Menzies Centre for Health Policy, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why Sydney’s COVID numbers didn’t get as bad as the modelling suggested


Jamie Triccas, University of Sydney and Megan Steain, University of SydneyLast Monday, Sydney emerged from a lockdown of more than 100 days after reaching the milestone of having 70% of the over-16 population fully vaccinated.

Modelling predicted New South Wales would “open up” with around 1,900 daily cases when this target was reached.

However, the state recorded just 496 new local cases on that day. And the current seven-day average for NSW is 488 cases, with numbers trending downwards.

What’s more, other modelling suggested COVID-19 hospitalisations would peak between 2,200 and 4,000 in greater Sydney in late September.

On September 21, peak COVID hospital occupancy for all of NSW was 1,268 patients. There are currently 711 COVID patients hospitalised in NSW, as of October 14.

We propose there are two main factors which might account for these discrepancies.

Vaccine effectiveness underestimated

Firstly, predictions of vaccine impact have typically used estimates of effectiveness against the Delta variant based on the UK Scientific Advisory Group for Emergencies (SAGE) roadmap, published in June. This suggested an effectiveness against hospitalisation of 87% for Pfizer and 86% for AstraZeneca.

However, more recent data across numerous countries has shown effectiveness against severe infection and hospitalisation is somewhat greater. A different UK study suggested 95% protection against hospitalisation for both Pfizer and AstraZeneca. And a study from the Netherlands found 96% and 94% protection against hospitalisation for Pfizer and AstraZeneca, respectively.

This difference may account for the disparity between the actual NSW hospitalisation numbers and those predicted based on the current vaccine rollout.

Real-time protection

The second reason for the current NSW situation could be a concept we’ve termed “protection in real-time”.

The rapid pace of vaccine uptake during NSW’s Delta wave ensured there was a large proportion of recent vaccines within the population.

This may offset the impact of waning vaccine immunity.

Optimal immunity after vaccination occurs at about two weeks after getting the second dose. But a partial protective effect of vaccination with Pfizer was apparent in clinical trials as early as 12 days after the first dose.

In addition, protection against severe infection may only require a lower level of immune response after vaccination.




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How has this played out overseas?

The protection in real-time concept can be used to explain the impact of vaccination in other countries, which may provide a “real world” perspective of the future of the pandemic in Australia.

Denmark reached 25% vaccination of the total population before the arrival of the Delta variant. During the Delta wave there were reduced hospitalisations and deaths compared to previous waves and a dissociation between case numbers and deaths.

You can see the black line (cases) starts to separate from the green line (hospitalisations) and the red line (deaths) as the vaccine rollout progresses.
Data from ourworldindata.org/covid-vaccinations and covidlive.com.au, Author provided

NSW’s achievement of reaching the 70% threshold last week actually equates to around 56% of the total population of NSW. At the peak of its Delta wave in July, Denmark reached 50% vaccination coverage of the entire population.

The restrictions in place at this time in Denmark were requiring proof of vaccination, past infection or a recent negative COVID test to enter certain indoor settings, such as restaurants and cinemas.

With a population size similar to greater Sydney, the coming months in Denmark may serve as an important comparison as to how the pandemic may unfold in Australia.

 

Similarly in Singapore, vaccination rates are high, at around 80% of the total population, and the pace of the vaccine rollout is very similar to Denmark.

Singapore has seen a recent spike in cases since the relaxation of restrictions, with case numbers at their highest. However, 98% of these cases are mild or asymptomatic. This suggests vaccines are having a major impact on lessening the severity of COVID, but a less pronounced ability to completely interrupt disease transmission.

 

Another example of the impact of real-time protection is the situation in Israel. Israel is often used as as the benchmark of vaccine effectiveness. Its vaccine program involved a rapid rollout of mRNA vaccines, predominately Pfizer’s. Initial studies in the country found the vaccine had high effectiveness against symptomatic COVID-19 and hospitalisation.

However, the arrival of Delta in Israel resulted in a large increase in COVID-19 cases with accompanying spikes in hospitalisations and deaths.

While this may provide some insight into the impact of Delta in Australia, there are key differences.

 
Israel experienced a large increase in COVID cases, hospitalisations and deaths after the arrival of the Delta variant.
Data from ourworldindata.org/covid-vaccinations and covidlive.com.au, Author provided

Why did hospitalisations rise in Israel? And what are the lessons for Australia?

Israel saw a large proportion of the eligible population vaccinated quickly. Around 50% of the total population was fully vaccinated by mid-March. But after this, there was a marked slow-down in uptake.

 
The NSW and Australian populations have been vaccinated much more recently than Israel’s.
Data from ourworldindata.org/covid-vaccinations and covidlive.com.au, Author provided

Thus, a combination of waning immunity and a large unvaccinated population may have exposed Israel to Delta.

While the Pfizer vaccine demonstrates excellent effectiveness against severe COVID-19, recent evidence from Israel suggests some waning of protection against severe disease over time, which prompted the introduction of the country’s booster program in July. A third dose was initially offered to over-60s, before being extended to everyone aged 12 and over.

In Australia, the widespread rollout of booster shots in the near future would be premature. The priority now is to get everyone eligible fully vaccinated, and consider boosters for targeted groups.

The federal government announced last week booster shots would be available to Australians who are “severely immunocompromised” from this week.

Governments should also consider a “mix and match” approach of booster shots. This strategy is being pursued in the UK, based on evidence that combining different vaccines may lead to stronger immunity.

 

The Conversation

Jamie Triccas, Professor of Medical Microbiology, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney and Megan Steain, Lecturer, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.