Covid exit strategy?

It seems we have painted ourselves into a corner here in Australia. We have been so successful at suppressing the virus and so successful at terrifying our population that we now find ourselves unable to come to terms with the virus as the rest of the the world has been forced to do. This leaves us in a position of having to accept rolling lockdowns, travel restrictions within the country and even within individual states, closed international borders, with Australians unable to travel overseas without a special exemption and quarantining.

Australians are truly a nation of migrants and we find ourseleves unable to visit our families, our homelands, just holiday for pleasure or travel for business. The government, while congratulating itself on what a fine job they have done in "keeping us safe", seem unable to articulate any exit strategy. No case of coronavirus seems to be acceptable. Every new positive test is treated as a mortal danger to the community. The population as a whole appear very happy with this state of affairs judging by the results of recent state elections.

Vaccines have been touted as the way out of this mess, though recent data from Israel, which shows that 50% of new covid cases are in fully vaccinated individuals, gives the lie to this. In the UK 43% of recent deaths have been fully vaccinated people. This doesn't mean that the vaccine doesn't work. It just means that nearly all vulnerable people in the UK have been vaccinated and that vaccines cannot eliminate Covid.

The public satisfaction with the elimination strategy appears to be becuase the public grossly overestimates the dangers of the virus. This may be due to poor mathematical skills, an inability to understand simple statistics or simply exposure to constant media messaging about this "beast" of a virus. Most Australians would probably be unaware that only a small portion of the population are actually at risk of serious illness or death. Those people are easily identified. They are generally old (over seventy) with comorbidities. The main people at serious risk are nursing home residents who in the first wave in April 2020 had an approximate 30% death rate if they caught the virus.

The reality is in Australia, we currently have 337 cases with 58 people in hospitals with only 2 in ICU. I suspect many of these hospitalised are not desperately ill but are there because they live in shared accomodation with other vulnerable individuals such as in nursing homes. To get this in perspective, we have over 62,000 public hospital beds in Australia.

Of the 30,528 Australian Covid cases, 910 have died, 685 (75%) of which were nursing home residents. From this data we can quickly see who is vulnerable. The old and infirm. The young and healthy have little to fear from this virus, though it is they who are asked to pay the heftiest price with serious disruptions to education, international travel and destruction of industries that traditionally employ young people.

So what is the possible exit strategy if vaccination alone will not do the job?

Firstly, we need to decrease the level of fear so the Australian people will support whatever measures are taken. This means providing accurate information to the public that demonstrates the real risks they face. I am sceptical that most Australians understand basic maths. For example for people aged 20-29 years we have identified 6,705 cases with only 1 death. This means a death rate for that age group of 0.00015 or 0.015%. How many Australians understand that 0.015% means 1 death for every 6705 people? Yet understanding the risks associated with this virus requires that this message gets across.

I propose a major education campaign with TV and radio advertising in simple language with numbers that can be understood by ordinary people that focusses only on the things that matter: risk of hospitalisation and risk of death. And most importantly differential risk for different groups. For instance, nursing home residents – high risk; school children – almost zero risk; obese with diabetes and heart disease – high risk; lean and fit with good health – low risk. When Australians realise the real risks they face from this virus they will be more willing to take that risk and less willing to sacrifice their freedoms for the illusion of protection.

Secondly, we need to focus heavily on early treatment. If people are treated early then the vast majority of infections can be succesfully treated without need for hospitalisation. If treatment is left until the person is so sick that they require hospitalisation then the prognosis is poor. As such, early treatment is vital. This early treatment has multiple benefits.

If the viral load in the patient is low they are less likely to pass the disease to others. If they are kept out of hospital they are less likely to pass it to other vulnerable people. If they are kept out of hospital they will not be placing the hospital system under strain or healthcare workers at risk. If their illness is treated in the early stages, they will not get so sick and hence they are less likely to suffer long term effects. Additionally, prophylactic treatment can also be used for those who are vulnerable and those who are caring for the sick. Despite the obvious benefits of early treatment, there appears to be little attention being paid to this area. In fact, anyone who suggests that effective early treatments exist runs the risk of being cancelled by the major tech firms who have become the all powerful arbiters of truth in today's Covid world. When Australians understand that there are effective early treatments available, they will be much more willing to allow the virus to circulate within the community.

Thirdly, continue the vaccination roll out. While not a silver bullet, vaccinations have an important role in decreasing the severity of illness in the vulnerable groups. Compulsory vaccinations are simply not required. The vast majority who are vulnerable to either hospitalisation or death will happily take the vaccine. Even if this doesn't prevent them from catching the virus, it will vastly reduce their chance of dying or of being hospitalised, the effects of which we have seen in the UK. For those who are not vulnerable, it simply does not matter if they are vaccinated or not. Most will eventually catch the virus and recover and enjoy relatively long term natural immunity.