It’s 15 months since COVID-19 first raised its ugly head and academic physician and cardiologist Dr Paul Langton has been tracking its course.
This is an attempt to plot the COVID-19 pandemic – my view of where we have been, what we have learnt and where next.
Initial Response
December 2019 saw reports of COVID-19 from Wuhan. By February, international cases exploded and Italian hospitals were overwhelmed. WA needed to close down to give us time to prepare, and we saw rapid planning, increased potential beds and ICU capacity. Thankfully, aggressive lobbying by many (led by AMA WA) prompted a border closure on March 16.
We were all anxious, initially. Luckily, we had time to prepare and respond. After that initial response, however, ongoing promotion of ‘fear’ was Machiavellian (“a leader should be both feared and loved”, “but such emotions are difficult to simultaneously inspire. If you need to choose one, choose fear”). In part, ongoing border closures reflect the failure to upscale our control measures.
Transmission and PPE
“Watch what they do” was more reliable than “Listen to what we say”. Wuhan used full gown, glove, KN95 and goggles. They knew it was airborne transmission. Like SARS, spread is mostly droplets +/- surface but we saw early examples of aerosol super-spreading (such as singing).
Ideally you use N95/FFP2 masks especially in high-risk scenarios such as COVID wards, aerosol procedures, and hotel quarantine. Surgical masks are probably adequate for use outside of these high-risk scenarios – noting eye protection should also be used. Pending vaccination, the best PPE should be available to all high-risk workers but shortages have not been fully resolved.
Lockdown in retrospect
We saw businesses pivot to work from home and private schools moved to virtual classrooms. Low-income manual workers were those most affected by retrenchments.
Education Minister Sue Ellery did a great job by implementing distance learning in public schools.
Dr Kempton Cowan led the JHC response to 81 infected Artania passengers, with no transmission
to healthcare workers.
Dr Robyn Lawrence successfully led hotel quarantine of more than 38,000 individuals, with only one worker infected and no community transmission.
COVID-19 indirect effects
Health: we have daily numbers but lack metrics of community consequences. Lockdowns and anxiety led to less health care, and telehealth is a partial substitute. Blood pressure monitors sold out as quickly as toilet paper. There’s no substitute for a physical examination.
Locally, we’ve seen a reduction in influenza, but it will be years before we know how many more mental health, cancer, and cardiovascular deaths we face. In contrast, systems such as EuroMOMO reliably track and quantify ‘any cause’ excess deaths.
Vaccines & borders
With early control measures, life in WA quickly returned to a new-normal. Most healthcare workers will be vaccinated in phase 1b (due March 22, pending the implementation plan). Extra groups are agitating to be in 1a, but it is hard to justify.
Many are speculating that one vaccine is more effective than another. Individual trials were done in different populations and times (recent trials have included COVID-19 variants) and cannot be easily compared. Without head-to-head data this is just speculation. To date, all vaccines prevent serious disease and death.
To help global equity, CSIRO is manufacturing the ChAdOx (Astra Zeneca) vaccine in our region. But until we have a global roll-out, new dangerous variants will arise in un(der)-vaccinated communities. In the medium term, will vaccination passports be sufficient for politicians to allow travel?
New variants may be just ‘scariants’. The ‘abundance of caution’ response dissolves with experience. New variants can be controlled by existing measures but the effective implementation of these measures is a greater question.
- B.1.1.7 (UK) is outrunning others in Europe and USA. It remains vaccine-responsive, is more serious and about 50% more transmissible.
- B.1.351 (SA), P.1 (Brazil) & B.1.526 (NY) are partial immune evaders, hence 30-40% reduction in vaccine response, and risk of
re-infections.
Politics of fear
We elect politicians to make political decisions, but they have been misusing ‘best medical advice’ (which is always qualified) for political gain. In most cases, prolonged state border closures have not been well justified. NSW has shown that COVID-19 can be managed with the combination of hotel quarantine for returned travellers, hygiene, social distancing and well implemented test, track and trace. Victoria was the opposite end of the spectrum (hotel quarantine outbreaks, prolonged lockdown and 89% of Australia’s deaths); and WA was mid-range.
Scientific bullying
Finally, thoughts on the scientific process. Science evolves, in this case in a rapidly changing landscape. Individuals will struggle to keep on top of all the new information. And we can all have slightly different interpretations of studies and personal views.
Some will be speaking for organisations, others influenced by political bias. But an overriding consideration is that we should be able to have mature debate of the issues.
However, recently some people have been bullied about their perspectives on COVID-19. We don’t have to necessarily agree with their views, but we should absolutely oppose any non-scientific debate. Please be mindful of this, particularly on social media.