Haven’t we done well?

Dear Editor,

This rhetorical question is heard all too frequently in regard to WA’s approach to COVID. We have done well but what was the cost of our approach? In medicine we must always make assessments of any intervention critically.

Nicholas McLernon, MBBS (Hons) FRACGP

The next pandemic may occur in a few months or in a hundred years. It is likely that in the next year or three the usual non-SARS-COV2 respiratory viruses will return to our state with a vengeance. If we do not assess our approach with a skeptical eye, we will fail to learn lessons for the future. 

The prolonged border closure was a popular measure but that does not mean that it was without long side effects that may yet emerge. Was there a subtle rise in xenophobia? Did key workers go elsewhere? Will the non-mining economy recover? Without doubt, for a small portion of the population, the separation from family was very difficult.

Many children and parents were kept apart for two years, missing important life events. For some, the travel system was difficult to negotiate in the absence of high income, flexible work arrangements and physical/psychological ability to cope with quarantine. Even if one’s conclusion is that the border closure was appropriate, to ignore those who suffered is callous.

I am grateful to live in Western Australia. All my family is here, and I had no need to leave the state. However, on a weekly basis I would sit with tearful patients who did need to leave. If they shared their grief with friends, they risked public shaming. Preference falsification can lead to unforeseen consequences and may be a sign of an unhealthy democracy.

As the months wore on and we remained COVID naïve, it became absolutely clear that the virus would cross the border at some point. What has been our state’s contribution to the world’s understanding of COVID-19? Why did we not set up random surveillance testing, RCTs of ‘control’ measures such as masking, trials of different vaccine schedules by age and so on? 

Such studies could not be conducted anywhere else in the world (given their hybridised immunity from infection as well as vaccination). I am not aware of any such studies being in place. I hope they are. 

Unfortunately, the political situation was so charged no one wanted to touch some areas of COVID research with a barge pole. To question our response may have been seen as heresy. Other places conducted vaccine effectiveness RCTs (which could not be conducted in a COVID-free place), so we benefited from their COVID infections.

Through good management and good luck, we have had a soft landing. WA doctors are increasing their confidence in the management of COVID and some of the unnecessary fear that was extant even in late 2021 has evaporated. The time has come to remove all measures that do not have a very high level of evidence (looking at you, vaccine mandates, tents outside of hospital entrances and hospital visitor restrictions). 

I have great respect for our public health physicians who had to make difficult calls over the past two years. I have great admiration for the many people who worked long hours in vaccine clinics, quarantine centres and so many jobs made harder over that time. 

Even so, to view our response over the past two years with rose-coloured glasses disrespects those that were collateral damage and misses an opportunity to refine future pandemic responses. 

Nicholas McLernon, MBBS (Hons) FRACGP

ED: Dr McLernon is a GP in private practice. He declares these are his own views, with no conflicts of interest to declare and no affiliations with any political party or politician.

A heavy hand

Dear Editor,

In 2019 the WHO published a pandemic plan. Non-pharmaceutical interventions (NPIs) were proportionate to the threat: measured; flexible; and tailored to different population risk.

Dr Harvey Smith

The remit was to keep modern society functioning. No threat imaginable could justify contact tracing, the quarantine of exposed individuals, entry/exit screening and international border closures. 

In less than a year, most countries ditched this approach, often in the absence of cost benefit analysis let alone public debate. 

NPIs were applied in a one-size-fits-all, including those counselled against in 2019. The impacts are now clear.

The substitution of distance learning for schools has reduced maths and English skills, particularly for the least advantaged in society.

In Japan, no alteration in community spread was found in closing schools. The closure of US public primary schools has been estimated to reduce life expectancy for students by almost a year. 

Households in low to middle-income countries experienced a nearly a 70% drop of income. The health of children in these households will be adversely impacted long term. 

The WHO in 2019 did not envisage that shelter-in-place would be mandated. Nations who kept SIPs as advisory rather than mandatory did no better or worse in terms of COVID spread and excess mortality than those who used police coercion.

NPIs have impacted justice with criminals and victims waiting longer. In the UK serious sexual offence trials that were delayed for longer than a year increased over 400%. 

Pandemic alcohol-related deaths in the US increased by 25%, with opioid overdose deaths increasing 38%. Only a small proportion of these listed COVID as a complicating factor.

The mental health of young people has been impacted by restrictive NPIs to the extent that one group of authors regarded it as causing a ‘wellbeing crisis’.

The new plan resulted in many health systems being reorientated as COVID services. The excess deaths from neglected screening for cardiovascular and cancer are clearly documented. 

Many governments stoked fear of COVID as a nudge to ‘do the right thing’. Red-flag patients avoided hospital contributing to 8% of excess non-COVID deaths in one population. 

I would encourage readers to reflect on the link between health and economics. When this happens again, I would just make one plea. If we cannot become Florida, could we at least be a little more Swedish? Skol! 

ED: Dr Harvey Smith is a Perth dermatologist.