By Dr Bob Kass, Public Health Physician, MBBS MRCP MScMCH DCH FAFPHM
September 7 2021
It’s been a long haul over the last 18 months and I’m sure, like me, you are fed up with the constant barrage of COVID advice in the media; in particular rhetoric from experts on how we can beat this virus and live happily in a COVID free world. Even now these same experts are telling us that lockdowns might have worked better in Victoria if they had locked down harder after the first case. These people live in fairy land. Lockdowns are an important means to slow up transmission, in other words to “flatten the curve” but real world experience tells us it’s not “if" but "when” you get COVID-19.
We are all going to be exposed to COVID at some time in the future. You can reduce your risk of exposure to some extent but in the end, you too WILL be exposed. This is the nature of a novel infectious disease. It may not be in the next few months or even years but at some time you will contract COVID. People respond to the virus in different ways - some will have few if any symptoms while others will end up on a ventilator in an intensive care unit. Multiple research studies have shown it is more serious in older people, particularly those with pre-existing medical issues such as diabetes or obesity and less so in younger people. The case fatality rate ranges from over 20% in people over 75 years to less than .1% under 30 years (USA data). Deaths do occur in young people and many more young people have been seriously unwell with the Delta strain of COVID. Long COVID can be very debilitating.
I have worked for many years looking after travellers heading overseas. I have also treated many exotic health issues in returned travellers. On one occasion more than 20 years ago, I was asked to review a person who had a very high fever and rash. He had just returned from Thailand and was very concerned he had an exotic disease. Examination revealed multiple posterior cervical lymph nodes consistent with a diagnosis of Rubella (German Measles). Blood was taken and this confirmed the diagnosis. Ten days later I developed similar symptoms but worse. I had developed a nasty arthritis seen with adult Rubella. I was in my 40’s. How could this have happened to me? Was I sloppy in my examination technique. Should I have taken more precautions when examining him? Rubella was a “growing up disease” in the 50’s and 60’s and it wasn’t until 1971 that the Rubella vaccination was offered in the community. First to young girls in primary school and then in 1989 as Measles, Mumps Rubella (MMR) to all children aged 12 months. Vaccination was undertaken to reduce the risk of Congenital Rubella Syndrome in babies born to women infected with Rubella during pregnancy. I just presumed I was naturally immune to Rubella but the reality was that despite working as a paediatrician for a number of years and undertaking extensive travel and work in less developed countries I had actually never been exposed! It still found me out in the end. In the same way it is likely that Covid-19 will find you, and me!
Herd Immunity
Australia has been declared free of Rubella since 2018. The virus is locked out by our high rate of immunisation – 47 years in the making! We do see the occasional imported case in Australia but local transmission is unlikely. It can be similarly said for Measles. Australia was declared free of Measles in 2012 – 44 years to achieve!
So is the same thing possible for Covid-19? Can we lock it out? It took over 40 years for Rubella and Measles to locked out, so Covid-19 being locked out any time soon is quite unlikely.
Once Covid-19 becomes endemic, what can I do to protect myself, and others?
We can all reduce our risk of hospitalisation through vaccination. To put it simply, the likely difference between you experiencing a “cold like experience” and a visit to intensive care is vaccination. This has been well shown in well-vaccinated populations in the UK, USA and Israel. While the vaccines do not stop you from infecting another person, and Covid-19 deaths cannot be fully eliminated even among fully vaccinated, the fatality rate will be greatly reduced in a largely vaccinated population and there is evidence that you will infect fewer people once fully vaccinated.
Because you can’t hide amongst vaccinated people as with Rubella or Measles, it is up to you to protect yourself from Covid-19 and the best way is through vaccination. We don’t have to look too far afield to find the evidence that vaccination makes a difference. NSW is experiencing a major outbreak of COVID-19. More than 23,000 cases and 107 deaths have been reported since June 16th this year. (September 2, 2021). Surveillance data to August 7th show the majority of ICU admissions to be either unvaccinated or partially vaccinated with most of the deaths occurring in those who would have had ample opportunity to be vaccinated. A few would not have been given the opportunity to receive any vaccine and this is very unfortunate.
The next few months are very important in the vaccine roll out. Supplies of the vaccine are increasing and individuals should be able to have a first dose. It is important to undertake this as soon as possible as a major outbreak can happen at any time.
Dr Bob Kass Public Health Physician
Port Noarlunga SA