“If every country does what Australia did, then you wouldn’t be calling [the next outbreak] a pandemic,” health philanthropist and Microsoft co-founder, Bill Gates, was recently quoted as saying.
This largely speaks to Australia, and especially, Western Australia’s ability to use science and data in its delivery of some of the best health and economic outcomes throughout the pandemic.
However, as we navigate peak COVID, there are increasingly polarised views about how we move forward. Unfortunately, it is easy to take a binary, zero-sum view.
Some of the more controversial topics are noted below and how, I believe, we need to take the middle, balanced ground over the coming months.
Cases or hospitalisations: early in the pandemic the key metric was measuring the number of cases as this was closely correlated with outcomes - especially death and long COVID. However, the remarkable impact of vaccinations has offset the increased transmissibility of Omicron, leading to lower rates of death and long COVID. The increasing use of RATs, which can be administered quicker and more frequently than the standard PCR, makes reporting cases different to before they were available.
Death from COVID vs death with COVID: the difference between “deaths from COVID” vs “deaths with COVID” is a major talking point. Denmark, which is seen as a bellwether for this, is making efforts to differentiate between deaths that are directly attributable to COVID, as opposed to deaths in which the patient had COVID at the time of death but passed away due to non-COVID-related causes. It has been suggested that COVID is being disproportionately blamed for deaths due to it simply being widespread in our community as opposed to being the cause. On the other hand, many are questioning the excess mortality rate (year-on-year) as an indicator that COVID is directly leading to excess deaths. Making things difficult is easily distinguishing if someone passed away directly from COVID or was simply carrying it at the time.
The impact of COVID on children: as a father of three, including two under five who aren’t yet eligible for vaccination, this is of particular concern to me and has been the basis of some very strong opinions on both sides. It is generally established that children are impacted less by COVID-19, both through transmission and illness. However, there remains a small risk of major illness and possibly long COVID for our kids. The risk of transmission in schools is hotly debated. Many experts are indicating that the risk of contracting COVID in the home is higher than school, while others and many parents (rightly so) are anxious about their children contracting COVID at school. In some states, there is a push to reduce the use of masks, while here in WA they are now mandatory for children in grade three and above.
So how can we unpack these contrasting points for WA? Our extremely high rate of vaccination should give us confidence moving forward by allowing us to focus more on hospitalisation rates than cases. However, it is important to note that monitoring case growth is important as it indicates the likely impact on our hospital system. It can help businesses anticipate the impact on workforces and customers (who may be unwell or isolating).
In respect to death from, or with COVID, the best action is to simply minimise the amount of overall COVID irrespectively. Even if many patients die due to other reasons, should they contract COVID, this may exacerbate the underlying condition as well as consume much greater medical resources when a patient has COVID. This results in a diversion from other important areas, such as cancer screening and prevention, which only leads to worse long-term outcomes.
At an economic level, uncontrolled case growth and high rates of death cause consumers to naturally adapt their behaviour, in effect having a negative impact on the economy. By reducing death and disease people will have more confidence to go about their daily lives, in turn staying healthier and contributing more to the economy.
In respect to kids, fortunately we have the world-class Telethon Kids Institute here in Perth, whose guidance indicates that mask wearing for kids helps reduce transmission (amongst a range of other measures). Given kids under five have no protection from vaccines, asking our older kids to mask up, alongside adults continuing to take precautions, such as mask-wearing, is a small price to pay for the long-term benefit of our children, their education and the wider community.
Finally, one thing that is sure is that the pandemic will continue to present contrasting and challenging situations. It’s vital we avoid being ignorant and face the challenge head-on, listen to the science and find the best way through this. These positive actions will see us continue to lead the world in both health outcomes and economic growth.
