New antivirals, more research on long Covid and, hopefully, treatments: Experts say we’re now in a ‘totally different era’
Six-hour queues for PCR tests in 30C heat, Western Australia shut off behind a hard border and rapid antigen tests at $60 a packet – Christmas 2021 was a confusing and difficult time for many as large parts of the country eased border restrictions and ended lockdowns in time for the holidays, even as case numbers surged.
In a repeat of the lead-up to Christmas last year, Australia is approaching the new year amid a Covid surge, this time with a mix of Omicron variants responsible for infections.
Yet despite daily case numbers now being about 10 times higher compared with December 2021 (Australia had an average 15,000 cases a day in the first week of December 2022) – official messaging is much different. People are being discouraged from getting PCR tests unless they are at high risk and people wearing masks are becoming a minority in shopping centres and on public transport.
Despite this easing, the director of the Doherty Institute and infectious diseases physician, Prof Sharon Lewin, said she understands why some people might still be anxious about cases and finding it difficult to shift their mentality regarding Covid.
The expectations to limit movement, wear masks and take strong hygiene measures were much stronger a year ago, despite a fraction of the cases.
But she wants to reassure Australians: “We’re in a totally different situation to where we were 12 months ago.
“Back then, Omicron was new. Most of the general population hadn’t had their boosters at that time. We didn’t have widespread availability of antiviral drugs to treat severe cases.”
Of those aged 16 and above, 96% have now had two vaccine doses and 72% have had their third booster shot. Just 78% of people 16 and up had received two doses by mid-December 2021 and boosters were only just being rolled out to the general population.
There are now much higher levels of community immunity through people having been infected, vaccinated or both, Lewin said. It means most of those now infected would be experiencing much milder symptoms than those infected a year earlier, and those susceptible to severe disease are much more likely to be successfully treated.
“Yes, we have a lot of infections at the moment, but we’re seeing much lower levels of disease from those infections than we would have had one year ago,” she said. “Covid has not gone away. But our strategy now is very different.”
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That strategy, the federal health minister, Mark Butler, announced on Tuesday, is to roll-back PCR testing for low-risk, healthy people and to shift measures towards better protecting those at high risk of severe disease and death. Among the most vulnerable are those in aged care homes, which are still suffering high death rates. Since January Covid-19 has caused 5.8% of all deaths among permanent residents of aged care facilities. The latest data shows there were 63 Covid-19 aged care deaths in the first eight days of December.
Lewin said a greater focus on protecting those at high risk was crucial. Her own work is focused on new antivirals to prevent and treat Covid. While vaccine development has been rapid, there has been less progress on antivirals to treat those at most risk.
“We’ve now got variants that have knocked out a few of the therapies we had for Covid,” Lewin said. “So for example, using infusions of monoclonal antibodies is a therapy we can no longer use against the Omicron variants we now have.”
She and her colleagues are examining whether genome-engineering can be used to target and destroy the genetic material of the virus that causes Covid-19, Sars-CoV-2, with the hope the technology can be adapted to target new variants that may emerge.
“The technology is useful as we face Covid-19 emerging variants of concern because of the ability to re-engineer the therapy to synchronise changes in the Sars-CoV-2 genome,” Lewin said.
Other “big research questions” that will be a focus in the year ahead will be the impact of long Covid, cross-immunity from vaccination combined with Omicron infection and the durability of vaccine-induced immunity against variants, she said.
In the meantime, Lewin said travel during the holiday period and large Christmas gatherings were less of a concern this year given the likelihood of becoming seriously unwell with Covid for most people is so low.
“The most important thing now is making sure that people are up to date with their vaccinations including third doses, and additional doses if they’re vulnerable.
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“We need to make sure those at high-risk have an antiviral plan ahead of time and know they should get tested and access the antivirals as soon as they get symptoms. Those targeted measures are going to get us fewer hospitalisations and fewer deaths.”
The chair of epidemiology at Deakin University, Prof Catherine Bennett, said there was an “understandable spike in anxiety each time there is a Covid surge”, but people should feel more confident returning to normal activities, even as the holidays approach.
Many more cases now are reinfections, whereas last Christmas many of those infected would have been experiencing Covid for the first time with more pronounced symptoms.
“Healthy people must still be aware of others, and if they see someone else wearing a mask, they should assume that person is high risk and put a mask on as well.
“We need to move away from the highly emotive narrative that we don’t care about the vulnerable and that we have decided to let the virus rip, and start tailoring behaviour to certain situations.”
Now that it is clear that Covid-19 will be “a perpetual problem” there also needs to be better surveillance of cases with more detailed data, Bennett said. “It’s like the way we report pollen counts,” she said.
“People use that data to help them make decisions about when to take antihistamines, when to wear a mask if they go outside, or when to close the windows or use air filters.
“We need the pollen-count equivalent for Covid. We need to help people understand their risk, which can vary between metro and regional areas, and between suburbs. Maybe some variants will be more likely to put people into hospital and will be more prevalent in certain areas. That will be useful information for people to know. So we need a nationally consistent surveillance system in place.
“That national system is still being worked out, and that’s not good enough at this point of the pandemic.”
Dr Lexi Frydenberg, who works in the public and private system in Victoria, said the social impact of the last three years needed to be appreciated . The mental health and social effects doctors were seeing now were staggering, she said.
“Mental illnesses such as eating disorders were on the rise before Covid, but particularly in Victoria lockdowns have had a significant effect on eating disorder rates and anxiety rates among young people,” Frydenberg said.
“Kids like structure, routine and control. Everything was taken out of their control for about two years. They couldn’t go to school, they couldn’t do sport. They couldn’t see their friends. The only thing they could control was their food and their intake. They also spent a massive amount of time at home and on social media and we can’t underestimate that influence.
“And the anxiety we are seeing is huge, with kids coming and presenting to us with anxiety symptoms, much, much younger.”
Lewin said it was important to encourage a far more normal way of living “which is safe to do now”. She added that people should be comforted by the medical advances already made, and the ongoing research to understand the virus and how to prevent and treat it.
“We’re in a totally different era,” Lewin said.