Coronavirus – more nimble than politicians
Omicron
Just when the nation and the states thought they had a pathway to opening their borders and living with Covid-19 as an endemic condition, Omicron has mugged policymakers.
At this stage we know that it’s more easily transmitted than the presently dominant Delta variant, that it can make its way past two doses of vaccination, and that a third dose can restore a reasonably high level of protection against acquiring Covid-19 and therefore transmitting it. We don’t know how deadly it is: because there are lags between outbreaks, hospitalisation, ICU treatment and deaths, we won’t know much about its virulence for a few weeks.
So far in Australia policymakers are taking a “don’t panic” public approach to Omicron, while trying to slow its introduction and pulling forward eligibility for a third dose. That approach may suffice for another week, until Christmas, or perhaps another two weeks, until New Year. Governments are not wavering in their plans to open borders and to lift restrictions on the unvaccinated, but as in other countries they will almost certainly have to make some tough , leading once again to disruptions to people’s lives.
There are at least five areas where some policy response will be needed.
First, if Omicron is indeed significantly less virulent and produces a large proportion of asymptomatic cases, then the test, trace, isolate, quarantine (TTIQ) approach is going to be less effective in holding back its spread and may have to be reviewed.
Second there is the problem of vaccination. Because the Commonwealth failed to order vaccines when they were available, and was tardy and negligent in distributing vaccines, there are many people who still have to wait some time for a third dose. Many public health experts suggest that the interval should be reduced even further from its present five months, as has happened in at least one European country, but even so, because vaccination has proceeded slowly in states and territories where the virus has been kept out (10 million people or 40 percent of our population), there will be some difficult trade-offs to be managed. For example, if third doses are brought forward, will their effectiveness be waning a few months on as colder weather approaches?
A related problem is that for 2.3 million children aged 5 to 11 vaccination won’t be available until around January 10, and there is some evidence that children may be particularly susceptible to Omicron, even if they don’t become particularly ill. Also in Queensland, South Australia, Western Australia and the Northern Territory, all of which have reached at least a 68 percent vaccination level, there are many remote communities, mainly of indigenous Australians, where vaccination levels are much lower. Writing in The Conversation Claire Smith and Jasmine Willika call for the Northern Territory to keep its border shut: Why the NT must delay opening its border to protect First Nations people.
Third, there is the problem of testing capacity. For now, apart from travel between New South Wales, ACT and Victoria, most people crossing state borders require two PCR tests and some require quarantining. As holiday travel picks up this will place additional stress on already-stressed testing centres, on top of any demands associated with Omicron.
Fourth, there are the petulant demands from some so-called business lobbies, demanding an easing of restrictions and a guarantee that there will be no new ones. They are oblivious to the economic consequences of failing to implement mild restrictions early and having to implement harsher ones down the line, and are oblivious to what is happening in other countries, even in countries such as Denmark which has achieved a high rate of vaccination. It is unimaginable, for example, that in the presence of Omicron any responsible government would go on allowing superspreading establishments such as crowded nightclubs to go on operating: there are plenty of other options for people to get together with their friends.
Even among business lobbies with a more rational understanding of the dynamics of epidemics and the public reaction, there is a belief that Coronavirus can be allowed to spread up to the point where the health care system can just cope, and that public policy should be directed to the tricky task of keeping the virus’s reproduction rate R at around 1.0 from then on. It’s a view that sees health care as a servant to the corporate sector, rather than as a community service.
Fifth, there is the political sensitivity, particularly in the Coalition, towards hard-right anti-vaxxers. Although their numbers nationally are small, they seem to have a presence in non-metropolitan Queensland, where the Morrison government is trying to hold seats won at the 2019 election. The Morrison government finds it convenient to give tacit support to those who believe they have a human right to subject others to danger.
Contrasting with this attitude, in Israel holders of vaccine passports must get a third dose of vaccine within six months of their second dose, or lose the freedoms conferred by their passports. Similarly in France, the third dose will soon be a requirement for the vaccine passport to retain its validity. Notably these requirements pre-date the emergence of Omicron. Morrison’s carping about getting the government to butt out of our lives, as if “government” is some oppressive imposition rather than the means by which citizens make collective choices, is yet another of his silly shibboleths.
State premiers have told us not to be too concerned by Covid-19 numbers, but that’s like telling a child not to look outside the car window. The exponential growth in New South Wales, shown in the graph below, is too obvious to be ignored and infection is growing strongly in Victoria.
So far in New South Wales and Victoria there has been no increase in deaths, and only a small rise in hospitalisations, but unless this variant is very different to others, and is very much less dangerous than Delta, hospitalisations and deaths will follow. The best guess so far is that its higher rate of infection will outweigh its more modest reduction in deadliness, leading to a lower rate of hospitalisation per case but a higher number of hospitalisations overall, and unless its rate of infection (R) is constrained with whatever suite of measures is available, hospital systems could soon be overwhelmed.
Those who want to see how Covid-19 is tracking in Australia and in selected other countries, would do well to follow the data-rich website maintained by Juliette O’Brien and her colleagues, Covid-19 in Australia, particularly the section “Monitoring countries with Omicron”. You can hear O’Brien explaining the difference between New South Wales and Victoria and suggesting how the virus will progress in other states on ABC Breakfast: Up and up? Charting COVID case numbers. (8 minutes)
Vaccination
So far policymakers have been concerned with first and second-dose vaccination. Nationally we have achieved 75 percent two-dose vaccination, and 79 percent have received their first dose. [1] Of more relevance for now is that in New South Wales, the ACT and Victoria, where the virus has been spreading, two-dose vaccination is 78 percent, while it is 70 percent in the rest of Australia.
It is a reasonable guess that the rest of Australia will achieve a level the same as in New South Wales, the ACT and Victoria, but a rate around 78 percent may be the limit for now (until children 5-11 are vaccinated). It is notable that the rate of vaccination in New South Wales and Victoria has slowed; at the present rate of vaccination a rough extrapolation, based on first-dose vaccination, and assuming all will go on to second dose, suggests it would take at least a year to vaccinate all remaining unvaccinated adults, and that’s before considering third doses.
A national level of 78 percent seems to be impressive: it’s well ahead of some large European countries (Germany 69 percent, UK 69 percent, France 71 percent, Italy 73 percent) and the USA (61 percent). If we think western Europe has vaccination problems we might spend 7 minutes watching Deutsche Welle’s coverage of eastern Europe: “people who get vaccinated get some kind of a chip inserted”.
Before we congratulate ourselves, however, we should note that there are several countries with vaccination rates well above 80 percent, including Portugal (89 percent), Singapore (88 percent), Chile (85 percent), Iceland (82 percent) and Spain (81 percent). [2] Our media seems to have a bias to over-reporting what is happening in the UK.
Our vaccination progress over the last two months is shown in the two diagrams below. Younger people, who also happen to be the most mobile in the community, are less vaccinated than older people, and their rate of vaccination is slowing. The same data is presented in different format in an article by Mary Ward in the Sydney Morning Herald – Why hasn’t the NSW double vaccination rate hit 95 per cent? – revealing that there are many people, mainly younger people, who have had their first dose and are not coming back for their second. The New South Wales Government hasn’t helped its own people or the rest of the nation in relaxing restrictions on the unvaccinated last Wednesday, 15 December, even though it had not met its vaccination targets.
[1] The Commonwealth is likely to talk about 90 percent two-dose vaccination and 93 percent first-dose, but these figures refer only to the 16+ population. ↩
[2] Vaccination percentages from Our World in Data.↩