Adam Schwab: When will Australia learn to live with COVID?

living with COVID

Two men walking outside during Victoria's stage four lockdown. Source: James Ross/AAP.

It is scientifically questionable whether it really is darkest just before dawn, but let’s use some licence because it’s certainly dark in Victoria and NSW right now. But as Sydney and Melbourne endure their strictest lockdowns since the pandemic began, the larger battle of when Australia will start ‘living with COVID’ continues to rage.

Delta’s fast incubation period and high transmissibility has killed the dream of COVID-zero and herd immunity. This has meant that COVID-zero adherents have had to come up with another reason to delay opening up. Their latest missive: opening with a high number of existing infections wasn’t part of the deal.

James McCaw, who was one of the authors of the Doherty Report (but not the primary author, who was Jodie McVernon), and who holds an honoury role at the Doherty Institute, claimed that even with 70-80% of adults vaccinated (56-64% of all people), NSW wouldn’t be able to ‘open up’ with high case numbers.

McCaw’s view was echoed by Daniel Andrews and Steven Miles in recent days, with Andrews warning that “if you don’t actively suppress this virus then when you do open up, we will have scenes the likes of which none of us have ever experienced in our hospital.”

McCaw claimed that “NSW needs to work to continue to reduce those case numbers and get the outbreak under control. There is a very, very clear and coherent relationship between the targets Doherty puts forward and the response required by NSW to help us get there.”

But McCaw was quickly contradicted by Australia’s Chief Medical Officer, Professor Paul Kelly, who noted “the model itself remains the same, it’s a tweak to the assumptions”.

The McCaw/Andrews/Miles view doesn’t make a huge amount of sense given the transmissibility of the Delta strain. If Australia lifted restrictions at even 80% adult vaccination levels, there will inevitably a rapid spike in infections — potentially upwards of 20,000 per day — regardless of the starting number. When we open borders, even to lower risk countries, infections will inevitably be imported.

But there are two significant mitigating factors here.

First, vaccinations are more effective at preventing serious illness and death than infections, so we would inevitably see more mild cases, but not hospitalisations or deaths. We have seen a practice run in the past fortnight in NSW, where daily infections have increased by 300%, but ICU patients have increased by a more modest 41%, and this is with only 31% of adults in NSW fully vaccinated.

Second, vaccinations have been targeted towards the older and the at-risk (in NSW, 87% of the high-risk 70+ group have had at least one dose), which means the case fatality rate will drop significantly. In the UK, which followed a similar targeted vaccination campaign, the CFR has fallen from 2% in January to around 0.3% now.

While the Doherty modelling appears to have understated infection levels after re-opening, the vaccination targets appear defensible given the countries which reached 64% vaccination levels (like Canada and Iceland) were able to re-open with very low death rates (Israel, currently experiencing a third wave, has not yet even reached Doherty’s Phase C target yet).

The arguments are becoming increasingly hostile as we move from the theoretical to the actual. Australia’s vaccination rate has morphed from slowest in the OECD to the world’s fastest rate (NSW is currently vaccinating people at a higher rate than even the UK were able to achieve).

By the end of October, Australia will likely have completed 38 million vaccinations, or 76% of the total population. At that level, no Western country could keep their borders or their businesses closed.

It is not without irony that while Australians turn out in record numbers to get vaccinated, state premiers are trying come up with new ways to ensure that they remain under lock and key.

Adam Schwab is a SmartCompany and Crikey contributor, company founder, angel investor and author.

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