Will we all get COVID eventually? Burnet Institute’s Margaret Hellard answers readers’ questions

That’s a really good question. There are some people who hold the view that eventually everybody will be infected with COVID and there are others that disagree with that view. I think it is unknown, and the reason it’s unknown is that things are uncertain and unpredictable. This time last year we didn’t know there was a Delta variant coming in 2021. And in March 2020, if someone said we’d have vaccines by 2021 that were as good as they are, I would have said you’re being overly optimistic.

Burnet Institute epidemiologist Professor Margaret Hellard.

There are good things and bad things that happen along this journey, that we don’t get to control or easily predict. If we have a situation in Australia where we manage to keep up our vaccination levels well over 90 per cent, people get boosters that address waning immunity, and we manage not to have variants coming in all the time that avoid those vaccines, then we might achieve something that is equivalent to herd immunity. But if those scenarios don’t play out, then it may be true that we’ll all eventually get infected.

Question from Damian: How do you manage the stresses on the team of creating modelling that the government depends upon for their road map, that has very real impacts on ordinary people, both in terms of risk of infection, and the deprivations of lockdowns? I assume this creates a degree of worry amongst members of the team?

Damian’s absolutely right. It is for some people a very stressful thing to be doing work which is in the public eye, particularly when you are trying to say to people “there are caveats around this, these are assumptions”. We as modellers don’t like people grabbing onto one number. People don’t understand there are a range of numbers in the modelling, and that one number for example is just the median. It can be stressful because, to be honest, the media have struggled to understand it, so a lot of the conversation is around you “constantly getting it wrong” and you feel you’re being defensive.

Often we are not actually getting it wrong, the situation we forecast in the model changes; for example the government introduces an intervention or restriction to slow virus transmission (often informed by a scenario we have suggested) so what happens is different to the initial forecast. Secondly, the models take time to run and people are asking “can I have it tomorrow?” so managing expectations is stressful. The hours have been wickedly huge.

Question from Stephanie: My two daughters have chronic allergies and asthma. They both will be fully vaccinated by mid-December. But as a parent, I still have ongoing worries and concerns especially that things are opening up. What would be the best management strategy so that we can safely participate in activities?

With the caution of answering questions for individuals whose health issues I’m not fully aware of, the simple things that one can do is, firstly, is to get vaccinated (like they have). Secondly, when a booster dose becomes available, make sure that that happens. Third, you’re less likely to be exposed to COVID if the people you are engaging with are vaccinated. In terms of activities, it can be difficult, but outside is better than inside when with large numbers of people. Wearing masks indoors is better.

Question from Marcia: How often will we need booster shots in the future?

Put simply, nobody knows the answer to that. I think we should expect that we will need regular boosters or regular vaccination for some time. Whether that’s every six months or it becomes annually, it is not known yet.

Question from Anne: Do you factor in the possibility of the virus mutating when doing modelling around future numbers?

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For the COVASIM model (used for Victorian and NSW modelling) we don’t factor it in variants. We are very mindful variants, but for the COVASIM models we look at the scenario currently underway. However the model is designed so it can quickly adapt to include different variants – whether the variant is more transmissible, or causes more disease and makes people sicker, the model is designed to be able to build those changes in.

Anonymous question: Do we have any chance of avoiding that December peak? (Modelling conducted by the Burnet Institute to inform Victoria’s road map suggests the state could see another larger peak of cases around Christmas)

Yes. There’s always a chance of avoiding something. And this gets back to us understanding that we, the people, the community, have some level of control over this. The outcome will be better if more people get vaccinated, if people get tested. Even though restrictions are being removed, if we are still mindful and thoughtful that there’s disease in the community, and we think about our actions, how we mix and continue to wear masks, all the little one percenters add up. There are very few things that are predicted to happen in the future that can’t be changed if we do something about it, that’s the whole idea.

Question from Antonio: Why are we still counting cases? I know it makes a great news headline. If we expect vaccination to be working shouldn’t we be focusing on hospital/ICU admissions?

I think we should count all those things. My view is, for us to understand what is happening in terms of the pandemic, we need to as modellers be counting the number of infections and then asking how is this translating to hospitalisation, ICU admissions and deaths? It’s critically important because if we get waning immunity or get a new variant, you might see something different. To say “oh we only count one thing and not another” is like going into a fight with one arm tied behind your back.

Question from David: What concerns do you have about future variant strains that may arise and our ability in the current political appetite to deal with them?

Hubris concerns me always; that we think we know more than we do, and we think we understand what’s coming, and we have it under control. We have to be prepared to say that that may not be the case. We have to be ready to adapt and be nimble. The truth of the matter is if you asked me in March last year whether masks could be as effective as they were, I would have said “oh there’s no evidence for masks”. Now there’s clear evidence for masks. You have to keep your mind open to the evidence in front of you.

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