Currently Australia, or at least New South Wales and Victoria are in the midst of continuous or rolling, recurring lockdowns. For Sydney this is the first real surgery of the COVID-19 pandemic having largely been successful at transmission suppression in the time prior to Easter 2021. The reason is the emergence of the delta variant of COVID-19 just at the point when the Australian vaccination campaign was being implemented. Due to the tyranny of distance vaccine distribution in Australia was delayed whilst Europe and North America received their shots. During that time vaccine hesitancy, or more specifically Astra-Zeneca hesitancy, became common due to the emergence of a low probability but potentially fatal coagulation disruption called VIPIT. Pfizer was not yet available and the medical communicators were equivocating. Meanwhile the delta variant was arriving by plane and evading hotel quarantine. This variant seems more transmissible, possibly due to higher viral load in the infected, and appears to cause more serious illness in younger individuals than earlier variants.

The Australian Government and the NSW Government have indicated lockdowns will not be needed once 70% of the population are fully vaccinated. This should occur, with current vaccination rates, towards the end of October 2021. What is the significance of the 70% target. The United Kingdom is the example to note. At approximately 75% of the population over 16 years of age fully vaccinated the UK is still experience a surge of cases of around 30K per day – roughly half the peak at the start of 2021 and predominantly driven by delta. Most of the cases are unvaccinated or partially vaccinated although some breakthrough cases are occurring. Notably the risk of hospitalisation is reduced and the number dying each day is <100 (counting deaths that occur within 28 days of diagnosis. This is versus a daily death toll that peaked at 1800.

To date the Australian approach seems to have been to pursue freedom through perfection: tight border controls, zero local cases and zero transmission. This has been achieved with snap lockdowns, masking, etc. Even more perfect that Australia has been New Zealand, which is even more remote from the rest of the world.

Australia and New Zealand cannot remain islands unto themselves forever and they can’t stay locked down forever. From a practical perspective it is actually unknown at the current time whether or not the current lockdown settings or any lockdown settings are strong enough to suppress a delta variant outbreak. Based on the current situation in the UK and making a major assumption that the situation won’t deteriorate due to waning immunity or the emergence of a even more virulent and transmissible variant, Australia will need to get used to living with the presence of COVID-19 if it is going to relax lockdown.
Living with endemic COVID-19 means that despite high vaccination rates and herd immunity due to the combination of vaccination and infection/exposure individuals will become infected, most will have milder illness but there will still be, based on the current UK experience, hospitalisations and deaths.

Let’s assume 70% vaccination is by the end of October and true to the word of the politicians the lockdown is lifted and internal borders are opened – then what? Well in 10 WEEKS the Australian healthcare system needs to be able to accomodate a manageable number of hospitalisations and ICU admissions AND be able to conduct as much business as usual activity as possible. If we are unable to re-open the healthcare system then either the lockdowns don’t end or the whole situation needs re-thinking.

The other part of the mindset that will need to change is that we will need to accept that there will be some deaths. Australia is fortunate that there have been no influenza death for 12 months. This is not the norm and in a cyclical fashion Australia regularly has in the order of 1000 deaths per annum. This may be where we land with endemic COVID-19. The current influenza mortality rate is due to a combination of the local measures put in place to fight covid, rigid border control and ongoing vaccination programs. It is implausible that we will reach a state of no deaths from COVID-19 even after herd immunity is achieved so we need to learn to live with some poor outcomes.

Overall, and despite the current surge, Australia has been relatively good at responding to the pandemic. Where Australia has failed is planning adequately for the short and medium term future, implementing some of the plans (like vaccination) and in becoming complacent when things were going well. Now that things aren’t going well it is time once again to move at pace and scale to ensure the resilience of the healthcare system beyond October and to develop effective communications strategies to that the public knows where the ship is sailing to and that sometime we need to change tack.