IIt is difficult to predict arrival times on a long road trip, especially when you are unsure of the destination or the conditions along the road ahead. In a pandemic, we know that travel is shaped by a dynamic interplay between the virus, the human host and the environment, and this generates unpredictability.
Not good news as the coronavirus has already subjected us to two years of uncertainty, but we are making progress towards exiting the official pandemic period.
A pandemic is declared when a new human pathogen emerges, or with an unexpected increase in the spread or severity of an existing disease that crosses international borders. We can no longer say that the waves of Sars-CoV-2 infections are unexpected after two years of global transmission and four major waves, but the other important aspect of the call for a pandemic is that it signals the need global cooperation and resource mobilization.
This is what keeps us in pandemic mode, with some countries still struggling to access vaccines, to control the waves, or to manage the burden on health systems or the impacts of strict control measures.
Eradicating a new human pathogen is the holy grail, but it’s always been a long time for a coronavirus – we knew we’d be lucky to create a vaccine that could lessen the impact of the virus. The virus has now also moved into animal reservoirs, removing eradication from the table.
As the virus has evolved, so have we. Immunity induced by vaccines and infections, along with our environmental and behavioral changes, have curbed the disease potential of this coronavirus, and higher infection rates are no longer likely to overwhelm our healthcare systems in most regions. of the world. Our progress on this path has only been possible thanks to vaccines, with strong uptake in Australia.
This, combined with new monoclonal antibodies and antiviral treatments, helps keep most infections out of the hospital and enables us to provide optimal care to those who end up there.
The risk of ending up in intensive care if you have an infection is now significantly lower than it was at any other time during the pandemic, but of course more people have infections now that community transmission is on the rise. Australia scale. We have just under half the number of people infected with Covid in ICUs now (133) as we did in October last year (300), although on average we have over 40,000 new cases reported every day, compared to 2,750 new cases per day in 2021. This equates to a 33-fold reduction in the intensive care rate among reported infections in just six months.
Increasing vaccination rates during this period is the most effective preventive measure. Another change concerns the dominant variants, with Omicron often being described as “milder”.
However, Omicron is as virulent as early variants, with a lower hospitalization rate among infections until immunity and treatments preventing disease escalation, and a study in the United States published last week revealed that Omicron was just as virulent as all previous variants when patient characteristics and vaccination status were taken into account. Omicron being “soft” therefore may be less about the virus and more about our success in managing this virus.
With the arrival of Omicron and the easing of restrictions, Australia has one of the highest “reported infection” rates per capita in the world, second only to New Zealand. However, if you look at hospitalization rates or deaths per capita, we are way down the list.
Take the UK, for example. They are further down their BA2 wave, reporting a case rate that is 10% of ours, but double the hospitalization rate. This tells us that it is not possible to directly compare infection rates as some end their testing programs. We are in fact likely to have half the infection rate of the UK today.
But Australia’s infection rates are still 15 times higher than with Delta, and even with a smaller proportion of infections ending up in hospital because of their infection, the number of cases still translates by a higher number of deaths than we have seen before.
There is an urgent need to better understand who becomes seriously ill and if it could have been avoided. Booster doses have been essential in rebuilding protection against severe disease with Omicron, and Israeli data shows that this protection is maintained beyond six months.
GPs can now prescribe antivirals, making them readily available to people at risk of serious illness early in their infection. But there may be factors contributing to poor health outcomes that we can address, including diagnostic delays and the lack of the critical time window where antivirals can be effective.
Infection rates remain high, with a succession of Omicron variants now increasing the risk of reinfection. It is not surprising that sub-variants emerged after massive waves of BA.1 and BA.2 hit the northern and southern hemispheres simultaneously – each infection increases the chance of seeing a new variant and new infections have peaked at more than 3.8 million per day worldwide on January 21. year when the previous waves never reached one million.
We are not off the hook just yet as it may take a few weeks for a new variant to spread enough to be detected. On the positive side, to be successful, the new variants must be even more transmissible than Omicron, which reduces the proportion that will pose a threat.
I believe that we will not know that we have left the pandemic period before the event, when we have entered a period of greater control of the virus and consistency in the variants and our public health responses and, with that, the certainty.
We are on the right track, but in Australia we need to ensure preventable deaths are considered before setting expectations for this disease as we transition out of the pandemic period.
We also need to remember that whatever we each do to avoid contracting the virus or passing it on helps us to speed up this transition.
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