All masked up, now for somewhere to go

After two years of blunders and scare tactics, it’s time to live with the virus.

Sydneysiders visit the markets while exercising the choice to wear masks. Picture: NCA Newswire / Gaye Gerard

Dr Clive Dix, former head of Britain’s vaccine taskforce, says Covid should be treated as an endemic virus like flu and mass vaccination should end: “We now need to manage disease, not virus spread.” Test, trace and isolate programs are akin to keeping a finger in the hole in the dyke after the village is already deep under water.

The Omicron variant rapidly encircled the globe, despite international travel being restricted to fully vaccinated and masked people. Two-thirds of 25 staff at Princess Elisabeth Polar Station, a Belgian scientific research station in Antarctica, caught Covid from a single positive case detected on December 14.

Based in one of the world’s remotest regions, all were fully vaccinated, passed multiple PCR tests and were quarantined before entry to the station. Could the utter pointlessness of this theatre of the absurd be any clearer?

Scott Morrison’s proposed pandemic pivot is a crucial effort to restore a semblance of sanity to the pandemic rule book and rebuild confidence that we can once again live with one more endemic respiratory virus among the many that circulate continually.

Most governments were panicked by the fast-spreading Covid in 2020. They threw out the existing rule book based on a hundred years of science and real-world experience as conveniently summarised in a WHO document in October 2019; conflated “cases” with positive tests using an unreliable test; used the redefined cases as the single metric to drive policy; subordinated all other public policy goals – health, economic, social, educational – to the imperative to crush and kill the virus; treated worst-case modelling scenarios based on flawed assumptions and faulty data as predictions; ignored the exceptionally age-segregated threat of Covid, with people over 75 10,000 times more at risk than those under 15; and silenced dissent and resistance using the full might of the state.

Two years on, actual data clearly prove that, with 5.5 million deaths worldwide, the strategy of defeating Covid via lockdowns for everyone failed to protect the most vulnerable. Scotland’s Covid rate has been higher than England’s despite tougher restrictions, humiliating “Britain’s dismal lockdown establishment” with a collapse of the apocalyptic narrative. After two years of doing it tough, on January 11, Fortress Australia had 3405 cases per million people, one of the highest rates in the world, around 50 per cent above the Britain and US.

Lockdown restrictions caused massive damage to cancer, cardiovascular and diabetes patients; inflicted incalculable harms and deaths on hundreds of millions of children worldwide through cancelled schooling and immunisation programs and return to poverty, reversing decades of progress; worsened mental health, alcoholism and drug abuse.

It saw one of the greatest violations of civil liberties and human rights in the history of Western democracies, with entire populations put under house arrest, the state dictating the most intimate aspects of personal relationships and taking charge of essential daily activities as if freedoms are a reward to be handed out at the pleasure of governments rather than inalienable rights held by citizens; yet failed to halt the march of the disease.

The balance sheet helps to explain why governments have either refused to conduct or publish cost-benefit analysis using the long-established quality-adjusted life years (QALY) metric that guided public health decisions before 2020.

In a recent review, David Redman and Ari Joffe of Canada show that all 11 studies that used QALY as a common metric concluded that costs of lockdowns exceeded benefits by between 2.5 times at the lowest to 26 times at the highest end of the cost-benefit ratios. Conversely, using Oxford University’s Stringency Index as a guide, the level of restrictions does not correlate with Covid mortality for US states or with excess mortality rates in Europe.

Governments then made the mistake of over-promising vaccines as the solution and downplayed its risks, producing a gradual erosion of public trust in leaders, experts and institutions. UK Health Security Agency data show a 55 per cent majority of England’s Omicron cases are double-vaccinated and the triple-vaccinated are 4.5 times more likely to test positive for Omicron than the unvaccinated. On January 6, the Agency published the weekly vaccine report for the final four weeks of 2021. Around 68 per cent of Covid deaths and 50 per cent of hospital admissions were the double-vaccinated compared to 28 and 42 per cent unvaccinated. Per capita, however, unvaccinated adults are between four and six times more likely to die with Covid for different age groups and between two and six times more likely to require hospitalisation. Thus vaccines do offer significant protection. But with infections, among people aged 18-79, the risk of infection for the vaccinated is double and higher. In Novak Djokovic’s age group, the infection rate for the double-vaccinated was 2.4 times higher than that for the unvaxxed. The policy conclusion is not that vaccines carry higher risk. Rather, healthy people should worry less about the unvaccinated and more about the infected irrespective of their vaccination status.

In Britain, one-third of patients in hospital are “Covid incidentals” – admitted for another ailment and tested Covid-positive in hospital. With NSW and Victoria admitting to a similar situation, Morrison is right to call for a change from “cases to hospitalisations” as the key metric for policy settings.

We have health, not Covid, ministers. They should take a whole-of-health responsibility for their portfolio and stop neglecting other life-threatening ailments. The cabinet is no less responsible for children’s education, people’s livelihoods, mental health and the community’s emotional wellbeing. Those of us of advancing age might be the most vulnerable to Covid, but we also have fewer years left in which to enjoy quality time with children and grandchildren.

Omicron spooked NSW Premier Dominic Perrottet into reintroducing mask and check-in mandates that have demonstrably failed to halt transmissions. Omicron is exceptionally infectious but very mild, with only 2383 of 337,818 (0.71 per cent) of NSW’s active cases in hospital, 182 (0.05 per cent) in ICU and 60 requiring ventilation on January 12. And it’s infecting the low-risk disproportionately while the high-risk elderly are nearly all vaccinated. Previous infection adds another protective layer of defence. Noting that population immunity is achieved by the twin routes of vaccination and infection, Queensland chief health officer John Gerrard said the spread of a transmissible but mild virus is necessary to transition from a pandemic to an endemic status.

If, as NSW Health Minister Brad Hazzard claims, every Australian is going to be infected by Omicron, then why persist with testing everyone instead of diagnosing and treating only the sick?

It’s unconscionable to demonise and exclude from all social and economic activity 99,996 people because four of their cohort are in critical care, while extending full membership to 999,994 vaccinated people even though six of their number are in ICU.

The unvaccinated have made their choice and are willing to take their chances.

The combination of high transmissibility, mild symptoms, shorter hospital stays and rapid peaking has sparked speculation among Japanese infectious disease experts that Omicron could signal the endgame as we transition to an endemic. As Steve Brine noted, while he was health minister, 20,000 Britons died of flu in a bad season, “yet it has never been a legal requirement to stay at home if you have flu”. Data from the real world contradicts, as it has from the beginning, the dire warnings of the doomsday modellers and indicates we are now in a good place to be able to get through Omicron with minimal deaths and no more restrictions: just individual precautions based on personal responsibility.

Ramesh Thakur is emeritus professor at the Australian National University’s Crawford School of Public Policy and a former UN assistant secretary-general.