Problems not over when we get to 80pc

People line up outside the Melbourne Exhibition Centre vaccine hub on Wednesday. Picture: Getty Images

This week may be a real turning point in the politics and management of Covid in Australia. For the first time, the desire to reclaim the normal freedoms of life began to compete seriously against the desire to avoid disease and death by Covid. For the first time Scott Morrison seemed to apply a bit of pressure to the opposition and even to the states.

Opposition to lockdowns and a desire for an instant return to the full freedoms of pre-Covid life have always been there on the fringe. But this week it became mainstream.

This is for two reasons. Lockdowns have gone on so long that the damage they inflict has become more intense and widely recognised. More important, the late but rapid uptake of vaccination offers a real chance “to live with” Covid.

However, here are two unassailable facts and one fearless prediction. Nobody knows how this is going to play out, medically or politically. But it will certainly involve a lot of death, more than we are accustomed to dealing with.

And here’s the fearless prediction: every single prediction you hear or read (except this one?) will turn out to be wrong or radically incomplete.

No one will get everything they want. Very few Covid polemicists acknowledge facts inconvenient to their case. Thus, the love of liberty is a righteous sentiment. But you must never break a valid law, you must be governed by common sense and you must recognise that liberties conflict. Thus it is a liberty that no one be forced to take a vaccine. But it is also a liberty that workers are able to go to workplaces that don’t place their health at unnecessary risk. That might mean their employer requiring everyone to be vaccinated.

Living with the virus is a slippery concept. If we had decided last year to live with the virus we would have had Covid mortality rates comparable with other OECD countries.

According to federal Health Minister Greg Hunt, at the OECD average that would be 30,000 dead Australians. US or British death rates would have been nearer to 45,000.

Because we are an island we had the option of isolating and keeping deaths very low. But you cannot live like that forever. And the Delta variant is so much more contagious than the original virus that we can longer maintain that isolation.

Now vaccines give us a way of moving out of that phase in relative safety by international standards. But that safety is extremely relative and is safety only by international standards. NSW Premier Gladys Berejiklian has long proposed that lockdowns can end definitively when we get to 80 per cent of eligible adults vaccinated. It will be really hard work to get to 80 per cent, but it’s a good figure and should be achievable in a nation with as much education, health infrastructure and native good sense as Australia.

But don’t think our problems are over when we get to 80 per cent. That 80 per cent of eligible adults equates to only 62 per cent of the total population. There are about 26 million Australians, so 62 per cent is a touch over 16 million. That leaves 10 million Australians who will be unvac­cinated even if we reach 80 per cent.

Nobody could respect the Doherty Institute more than I do, but its modelling, which is actually pretty cautious, necessarily based on all kinds of assumptions about things we cannot forecast, and also requires near perfect public health management by federal and state authorities, says opening up then might be safe.

But you know, that modelling could turn out to be as mistaken as every other prediction about this virus. We could easily face a devastating pandemic of the unvaccinated, as in the US.

Don’t get me wrong. I certainly support more or less full opening up when we get to that vaccination level because lockdowns cannot go on forever. Premiers who continue to imply that we can live forever with almost no Covid deaths are dishonest or foolish or irresponsible or all three.

But opening up, even with 80 per cent of adults vaccinated, could be tough and tragic, and could involve a lot of death – far, far more than even the worst flu season. Nothing has been sillier through the entire course of the pandemic than the idea that Covid is just like a bad flu. The Economist magazine updated its estimate of global Covid deaths, based on calculations of excess mortality reports and some other inputs. Its estimate is that nine million to 18 million people have died worldwide from Covid. Nobody knows how many people died from the Spanish flu a century ago, but consensus estimates range from 25 million to 50 million.

Given that Covid has years to run, it is approaching the same league as the Spanish flu and, in numerical if not proportionate terms, may well turn out to have a bigger death toll.

Nor do we know how the virus will continue to mutate. The high school orthodox version of mutation is that a disease becomes more contagious but less deadly so that it doesn’t kill off its hosts and has more bodies to inhabit. However, like many high school orthodoxies, it just ain’t so. Smallpox killed a third of the people it infected and it lasted for thousands of years without ever becoming mild.

The Delta variant is a little more deadly, a little more able to evade vaccines and natural immunities, and a little more likely to hit young people, than the other variants. But its biggest evolutionary innovation is that it is wildly more contagious.

Lethality, transmissibility and vaccine evasiveness are always the three key questions about mutations. There may be some kind of in-built biological limit to how radically Covid can mutate, but we don’t know. Measles, polio and other diseases mutate quite a bit but haven’t been able to defeat vaccines. Our Covid vaccines are brilliantly good and the mRNA technology means they can be changed quickly to target new variants. But there is no guarantee Covid won’t mutate in a way that significantly smashes through the vaccines.

The evidence from Israel is that vaccine immunity significantly reduces in less than a year but can be restored with booster shots. So we will certainly need booster shots and might need them more than once a year.

NSW has 113 Covid patients in intensive care. That’s equivalent to two big hospital ICUs. Indeed two big hospitals, Westmead and Blacktown, have refused to take any more Covid patients for 24 hours. With 10 million unvaccinated Australians, and a new variant just a fraction more vaccine evasive, and with early vaccine recipients finding their immunity fading, you could imagine 500, or 1000, people in ICU beds in NSW, even with 80 per cent vaccinated.

Then you confront the health system being overwhelmed. Whatever we’ve said about no more lockdowns, any government will respond to that situation with tough restrictions, whether they’re called lockdown or something else.

The debate this week has been realistic and good, but don’t for a moment think that anything is settled.