Changes in Covid-19 policy settings always invoke mixed reactions, and the national cabinet decision to stop isolation requirements for most people is one of the more substantial announcements since the opening of international borders, and the end to supervised quarantine.
Some of us have felt protected by rules, others frustrated by them, while the majority probably sit somewhere in the middle – being reassured that they were there when needed, and relieved when we can ease them safely.
This is not about “giving up”, or “letting it rip”, it is about handing over to sustainable measures that will take us forward.
It was right to be cautious as we have taken a different path to many countries with most of the population having vaccine-induced immunity by the time we opened our borders, rather than immunity through infection.
Omicron was a late curveball landing just as Australia took those steps. We also had two years of more strict controls in place, especially in states affected more frequently by outbreaks, and with that some serious anxiety-raising messaging to stress how important these measures were.
Now we have to be sure the message is clear about what has changed, and why it is we can now be safe to take these steps to ensure that people don’t feel more anxious or vulnerable than the situation warrants.
The positive news behind this is that we have been tested by Omicron, but we have also progressively become more resilient to Sars-CoV-2 in the process. In the meantime, we keep current measures for another two weeks, and they transition as ongoing requirements for high-risk settings in health, age and disability, and morph into standing policies and practices for infection prevention and control.
Safety information and advice now must also be embedded into occupational safety and wellbeing guidance so that employers know how to manage infection risk to protect their staff and their businesses. Bringing otherwise well workers who are infectious back on to a workplace knowingly, when all that might achieve is more staff off next week if too unwell to work, is a false economy.
We have taken smaller steps than other countries, and this has allowed us to test the waters incrementally, as well learn from other countries who took larger steps sooner. Developed countries have not all come through to this point in the pandemic nearly as well as Australia. Sadly, we have lost just over 15,000 lives.
Yet if we had the overall death rates that the UK, US and Italy experienced, we would have lost 80,000 Australians to Covid-19 by today. We have half the death rate of Canada and Denmark, one quarter the death rate per million experienced by France and Sweden, and one-third of that of Germany.
Many of these lives were lost pre-vaccination of course, and so too were many of the infections experienced in these countries. Infection in someone not vaccinated, or before the primary course of two doses of Covid-19 vaccines was completed, is a higher risk factor for long Covid also.
Severe acute Covid-19 disease is also a risk factor that is also more likely in someone not yet vaccinated, and infection with an earlier pre-Omicron variant. Staving off widespread community transmission through our control measures in 2020 and 2021 was incredibly important in saving lives, as was our high vaccine uptake, both of which will have reduced the risk and burden of long Covid in Australia.
The virus has also evolved of course, and the pandemic continues to change in nature. In 2022, waves of infection are driven by the more infectious Omicron immune-escape variants, characterised by high rates of reinfection. We now face variants that cannot be controlled in the ways of the past as they are more infectious, and incubation periods are shorter, so the spread happens faster, disarming our aggressive transmission suppression approaches.
Yet, despite that, we are seeing a reduction in the death rates associated with successive waves of Omicron. This is the effect of the ever-broadening immunity being built after vaccine and infection and, for many both, the so-called hybrid immunity.
If we revisit those overseas countries that had the highest pre-Omicron rates of infection and number of deaths, we find that the deaths per million experienced in the latest Omicron BA.5 wave was much lower than seen for BA.1 in December to January. Reported deaths in those same countries mentioned above were on average three times lower for BA.5 compared with BA.1.
In countries like Australia that had shielded from infection previously, we had similar rates for both waves (in Australia 3.37 per million for BA.1 and 3.75 for BA.5), or higher in countries where borders opened later (eg. New Zealand 2.59 per million for BA.1 and 4.04 for BA.5). Taiwan had the largest reversal from very few Covid-19 deaths until Omicron arrived, and then a daily death rate of 8.83 per million at the peak of their BA.5 wave.
The difference is the added protection that some level of hybrid immunity in the population offers. After nine months of Omicron, Australia is now in a better immunological space. We also lost fewer lives to get to this position, and we got here before viral evolution stripped away completely the effectiveness of the measures we employed previously to hold the virus back until we had access to vaccines.
While hybrid immunity reduces risk of more of serious disease in the short and longer term, those most vulnerable still have measurable risk, and it is these groups that were identified as the priority at the national cabinet media conference.
What was perhaps the most reassuring message was how outbreaks in residential aged care facilities have turned around, with the number of facilities affected down to one sixth of the number at the start of August, with outbreaks being identified and controlled quickly.
As our background rates of infection decline, so too does the exposure risk for our vulnerable whether in supported accommodation or at home. But we are a long way off having such low exposure risk that we can stop contemplating wearing a mask in higher risk indoor settings or transport, or of testing if symptomatic, especially for those who are eligible for antivirals that remain a critically important backstop for reducing risk of serious illness.
Some argue that you cannot turn back once you make these calls as if an argument to keep measures in place.
I would suggest the reverse – we need to preserve these important measures should the situation change, and we need to consider more coordinated emergency approaches once again, whether for a future Covid-19 variant, or some other pathogen.
We saw stringent measures not work as well against Delta in Victoria in 2021 compared with New South Wales, likely due in part to a realisation of fatigue and diminishing adherence. This is a reminder that these measures are not infinite resources, and we need to employ them judiciously.
Covid-19 is not “over”, but nor is it fixable or containable.
It is here to stay as an important human pathogen that we must now contend with. Pursuing short term fixes indefinitely is not the answer. As humans, we have lived alongside viruses throughout our evolution, and we have to take the long view on this, using what we have learned from Covid-19 about our vulnerabilities to shape evidence-based, sustainable and equitable ways of managing infectious diseases for the long haul.
