It also takes a decent vaccine and contact tracer with the ability to prevent small outbreaks from swelling into future third and fourth waves. There are big questions about who exactly plans to take us back to the promised land and which path we will take.
There is strong evidence that masks are protective, but will we wear them? Will we conduct regular, reliable tests with quick results and use new technology to restore confidence and, as a result, the economy?
One of the most controversial questions is whether our early success with our low case numbers will make us more vulnerable in the long run.
The experts are divided.
For Professor Shitij Kapur, dean of Melbourne University Medical School, Australia’s low infection rate only becomes a risk if there is no vaccine.
“It is reasonable to assume that there will be a vaccine that will ensure herd immunity, and that will create a less restrictive new normal. In the meantime, aggressive repression is still the dominant option. But if a vaccine doesn’t arrive, Australia’s leadership could become a liability, “he says.
“Should vaccines fail in the next 12 to 18 months, we may need to change the game and consider more organic ways to achieve herd immunity and selectively shield and protect it.
“For thousands of years, the only approach to overcoming epidemics and pandemics has been to let the infection naturally seep through the community.”
So should we allow infiltration while waiting for a vaccine that may not arrive or be only partially effective? Many fear that a continued strategy of aggressive repression could leave the country behind if the rest of the world moves on.
“The biggest potential downside for us is that after the winter in the northern hemisphere, most of the world is on the verge of herd immunity and is interested in getting on with life,” says Emma McBryde, professor of infectious disease modeling and epidemiology in Australia Institute of Tropical Health and Medicine, James Cook University, Townsville.
“But Australia and our fellow bubble countries will still be paralyzed because they fear bringing the virus to our region. This could mean widespread travel restrictions and persistent shutdowns of industry, retail and tourism. ”
McBryde says it is time for the country to consider herd immunity in a careful and planned manner.
Destroy general measures
In the beginning Australia did well when it closed its national borders and aimed at “suppression”, but this had mixed results.
Today, most jurisdictions have achieved “elimination” while NSW and Victoria continue to circulate viruses.
“I worry about the imposition of general measures that can destroy the soul and think that life should continue with sensible measures,” says McBryde. “In order to continue, we need an excellent health infrastructure in every state that is able to respond specifically to known clusters.”
Also needed is a community commitment to interact differently, a plethora of rapid tests, relentless contact tracing, and better coordination between states.
With that in mind, McBryde says, we might consider moving to a more thoughtful version of “mitigation,” with relaxation to allow for controlled infection – in other words, to achieve herd immunity.
“Carefully done, this can minimize the loss of life while allowing most of the population to return to a near-normal life. Herd immunity has become a dirty word due to the math used at the beginning of the pandemic. People were told that the virus would be allowed until 60 percent of the population was infected, “says McBryde.
People at risk – sick and old – would almost have to be fenced in to ensure that they do not come into contact with infected people.
– – Professor Emma McBryde, James Cook University
“With an infection mortality rate of 1 percent, that meant 0.6 percent of the population would die, with most deaths among those in need of protection. However, with adequate and careful protection of vulnerable people, the modeling shows that the number of deaths could be reduced by 75 percent. And we’re looking for models that can reduce this even further while achieving herd immunity.
“In order to achieve this and at the same time minimize the damage, vulnerable people – the sick and the elderly – have to be almost fenced in to ensure that they do not come into contact with infected people.
“Just like some doctors and nurses who work on COVID wards sleep in hotels instead of going home at night and putting their families at risk, action can be taken for elderly care workers. One option is to employ people who have already had COVID and therefore may be at least partially immune to re-infection. ”
Age or health advice
And until herd immunity is achieved – with or without a vaccine – McBryde says precautions can be taken for the elderly in public. But would this lead to serious ageism if people over 60 weren’t allowed to regularly sit in a football stadium?
“No,” she says. “It’s not discrimination, it’s health advice – like the advice of an 80-year-old not to climb Everest.”
McBryde says there are many caveats, the most important of which is the strength and durability of immunity after infection.
„But even if immunity lasts for a few months, a selective infection strategy can use herd immunity effects to protect those at risk, resulting in a much lower mortality rate than random measures. ”
Their proposals echo those in Great Barrington’s statement that people at minimal risk live normally and build immunity through natural infections, while those at high risk are protected.
The statement, written by three public health experts from Harvard, Stanford and Oxford Universities, called this “targeted protection”. They encourage governments to lift lockdown restrictions on young and healthy people while focusing protective measures on the elderly.
The idea of herd immunity is a dangerous and ethically irresponsible fallacy.
– – Adam Kamradt-Scott, Global Health Expert
However, they have met with strong opposition, with opponents declaring herd immunity to be unethical and saying it was a “mass murder”. One of the many objections was that younger people are at risk of “long-term COVID” – long-term side effects of infection. This needs to be weighed against the adverse effects of lockdowns and shutdowns in economies.
Adam Kamradt-Scott, a global health expert and associate at the University of Sydney, is strongly against the herd immunity demand.
“There is evidence that previous exposure to the virus and its recovery may not provide long-term immunity. On this basis, the idea of herd immunity is a dangerous and ethically irresponsible fallacy. ”
He advocates containment, saying if the virus isn’t contained, the economy suffers in both cases – from lost productivity for people who get sick and die, and from the added burden on the health system.
“Our greatest hope remains in preventive measures until a vaccine becomes available. We also need to mentally prepare for the reality that a vaccine may be years away or, worse, not arrive at all. ”
Just a temporary fix
The 1918 Spanish flu pandemic shows what happens without a vaccine. With around a third of the world’s infected population, the pandemic ended with herd immunity. But in some places it didn’t end until 1921.
Despite the tremendous technological advances in healthcare over the past century, we still rely on the same measures – quarantine, social isolation, masks, and sanitation – that were in place in 1918.
But even with a vaccine, the prevailing view is that the pandemic will go with us for years, says Professor Lyn Gilbert, lead researcher at the Marie Bashir Institute on Emerging Infections and Biosecurity and the University of Sydney’s Sydney Health Ethics.
Like an infection, a vaccine can only provide temporary, not solid, immunity to the disease, she says. It is also likely that older people will not respond as well to a vaccine as healthy younger people and may not be as well protected.
“It is a myth to believe that we have solid herd immunity that protects the entire population. But after two, three, or four years of various waves of COVID-19, with people becoming infected year after year, some level of immunity is likely to build up, “she says. “There’s just too much we don’t know to predict whether herd immunity will be enough to halt the spread in the long term or just to halt current episodes of COVID-19.”
Gilbert believes Australia’s good performance will not be negative, but it could take years to develop sufficient population immunity to get back to what we were in 2019.
“It would condemn them not to mingle with their younger, less vulnerable relatives and friends – unless they too are willing to stay in a COVID-19 bubble.
“These people could not go to the theater, to concerts, to the movies, to the beach or to the swimming pool – activities that are often enjoyed and financially supported by the elderly and many other people considered at risk.
“It is difficult to imagine how a situation that withholds social interaction, entertainment and movement from a group of people can be viewed as ethical or even sustainable.”
Professor Peter Collignon, an infectious disease doctor at the Australian National University, says that aside from the obvious social and economic costs of Australia’s early success in fighting COVID-19, the significant medical consequences of the restrictions cannot be ignored.
The fact that many people did not have access to cancer services or sought advice about chronic diseases such as diabetes can have long consequences.
“Some of our restrictions and bans were more difficult than necessary to achieve the same results. Victoria may have achieved the same result with the third tier lockdown. ”
In the meantime, according to Collignon, it is important to achieve the correct restriction balance. So when the third, fourth, and fifth waves hit, they can be kept small.
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