New vaccines will help but Delta remains a ferocious enemy

As freedoms and warm weather beckon, we should watch the northern winter. It will show us our likely future – unless a new variant emerges, even worse than Delta.

People are seen out enjoying the hot weather in Bondi Beach on Sunday as we continue Covid-19 Lockdown in Sydney: NCA NewsWire / Gaye Gerard

Covid’s Delta variant is still rampaging around the world, unleashing stagflation, destroying governments and still making lots of people sick and causing many deaths.

The new mantra, not just in Australia but everywhere, is we must learn to “live with the virus”. The vaccine rollout makes this a possibility. But life with the virus is still going to be radically different from life before the virus.

There is no plausible prospect of putting the virus behind us. NSW Premier Gladys Berejiklian has determined NSW will end lockdown on the first Monday after the state reaches 70 per cent of adults fully vaccinated. But NSW on Friday scored another record day of more than 1500 Covid infections.

There are 1156 Covid cases in NSW hospitals, 207 in intensive care, and 89 on ventilators. There were nine Covid deaths recorded Friday, including people in their 30s and 40s.

Berejiklian has modelling showing infections should peak next week and hospitalisations will peak in October. But all such modelling is extremely fallible. No government in the world has successfully predicted the course of Covid, especially Delta.

NSW could well see its hospital system under extreme pressure, if not overwhelmed. Berejiklian is trying to change the conversation. She won’t do daily press conferences any more. She wants the focus on vaccination rates, not infections or even deaths. She has a road map for bringing the state back to something resembling normal life, which depends entirely on vaccinations. Victoria, which on Friday recorded 334 new Covid infections, doesn’t have a road map yet.

NSW Premier Gladys Berejiklian is trying to change the Covid conversation. Picture: NCA NewsWire/Dylan Coker

Neither Victoria nor NSW would ever admit to following the other, but NSW will be the test case for Australia. What happens when a jurisdiction has high vaccination rates and a large case load of infections? The answer from overseas is not entirely reassuring. There is no doubt that Berejiklian is right: lockdown cannot be sustained indefinitely. People are at the end of their tethers. This does not mean that those who always argued we should just “live with the virus” were right. Living with the virus with no one vaccinated is radically different from living with the virus when vaccinated.

But vaccinations don’t solve all problems, nor end uncertainty. Vaccinations limit Delta’s damage, but Delta is by no means defeated. In fact, if Joe Biden’s Democrats lose the Congress next November, Delta will be a bigger cause than the Afghanistan humiliation.

One of Covid’s deep lessons is that all victories against it have been only temporary. It sometimes lifts politicians up, only to smash them down, and then maybe lift them again.

Biden could tell Berejiklian, Dan Andrews and Scott Morrison all about this. Biden’s predecessor, Donald Trump, did a couple of big things right on Covid. He stopped travel from China and he developed vaccines at warp speed, as he puts it. But he was a disaster in communicating health advice. Much that he said about Covid, including his many predictions that it would just go away, was nuts. Everything seemed perfect for Biden. He came into office just as the vaccines were rolling out. At the end of Trump’s tenure, daily Covid deaths in the US were running at 3000, By the time Biden declared a great victory over Covid, on July 4, daily Covid deaths were 200 or so. Daily cases had been nearly 200,000 at the end of Trump and were 12,000 by July.

But that timing should be the first, big clue. Trump lost office in winter. Biden declared virus victory in summer. It turns out the virus takes more notice of the seasons than of politicians.

Around the middle of this year, Delta took over as the main variant in the US. Now, daily new infections in the US, frequently at over 200,000, are more than they were under Trump. Deaths are frequently more than 1500 a day. In the hardest-hit states in the south and the mid-west, intensive care units, while not overwhelmed, are close to absolute capacity.

Biden’s chief health adviser, Anthony Fauci, said the moment could be approaching when doctors will have to make terrible decisions over which patients get into ICU. Fauci hoped the US wouldn’t get to that point.

The Atlantic published a forecast that if current trends continue, there will be another 116,000 Covid deaths in the three months to December 1.

All this has produced a massive hit to Biden’s popularity. Approval for the way he has handled Covid has declined by more than 15 per cent in a matter of weeks. This has hit his general approval rating. A president’s approval rating is a good, though by no means infallible, indicator of how his party will fare in midterm elections.

Yet the US recently passed the milestone of 70 per cent of the population with at least one vaccination, and more than half the population fully vaccinated. So what gives?

In the US, according to Biden, there is a pandemic of the unvaccinated. So Biden has launched a new and urgent national strategy. He will require all federal employees to get vaccinated, and companies with more than 100 employees to have all staff either vaccinated or undergo weekly Covid tests.

Here’s another Delta triumph. It wickedly poisons and polarises politics. Republicans denounced Biden’s move as a gross infringement of civil liberties. They plan to sue in court. The courts could well stop or limit Biden’s moves.

The civil liberties questions are genuinely complex. There are 80 million unvaccinated American adults. This is more than enough potential Covid victims to clog up and overwhelm the hospital system. If that happens, lots of people who are vaccinated who then suffer a stroke or have a car accident or whatever, will not get treated in ICU and will die as a result.

A decade or so ago, I spent a few days in ICU in a Melbourne hospital after an operation. I was on a ventilator for the first 24 hours or so and then had a couple of days in ICU before going down to the next stage of care, a high-­dependency unit. The doctors and nurses told me at the time, you only go to ICU if you would otherwise die. The nurses were absolutely brilliant, highly trained, expertly competent, always paying attention and compassionate as well. We are pampered in the first world, but that level of care cannot really be doubled and tripled and quadrupled overnight, even if there are enough machines, because the expertise of the people takes time to build up.

So the message national leaders are giving their populations – vaccinate or die – is pretty sound. But as I say, vaccination doesn’t solve everything.

A packed Bronte Beach on September 11. Picture: Julian Andrews

Delta has produced a wave of stagflation across the global economy. Earlier variants kept people at home and crippled spending. Governments provided massive fiscal stimulus that led to a lot of spending, much of it online. Northern hemisphere nations are desperately keen not to do lockdown again. They are all coming back to work. But a lot of them are getting infections, even if many don’t get sick, with Delta. Either way, they miss work and this hits supply lines and production. This is producing inflation and weak growth – stagflation like we haven’t seen since the 1970s.

Vaccines, though immensely beneficial, do not solve even all the medical problems. Consider Israel. No country vaccinated earlier or more thoroughly than Israel. It conquered and vanquished the pre-Delta variants of Covid. Some 80 per cent of its adult population, about 68 per cent of the entire population, is vaccinated.

But at the beginning of this month, daily infections passed 16,000. This is the highest daily infection rate Israel has known, even during its first wave. The hospitalisation rate is now much lower, with more than 1100 Covid patients in hospital. But that too is rising. Some 60 per cent of those in hospital have had two doses of Pfizer. Yikes!

But wait, like everything to do with Covid, this fact is both alarming and not alarming, complex and difficult to interpret. These are matters of dispute, but it looks as though Pfizer offers a little bit better protection than AstraZeneca at the start, but its protection may wear off a bit more quickly, say in six to nine months, than AZ. So Israel is now giving its population a third vaccine dose, and talking about fourth doses.

The Biden administration is also offering booster jabs. Britain is undecided.

Peter Collignon, professor of microbiology at the Australian National University, tells Inquirer he thinks the Israeli data is unclear. No vaccine is perfect, he says, so with so much of Israel’s population vaccinated, naturally a large proportion of those who get sick are vaccinated older people. If you adjust the data for age, and the fact vaccines are not perfect, he thinks the Israeli experience is less clear-cut in establishing declining vaccine efficacy. The thing to watch is hospitalisation and ICU admissions

Britain, also a highly vaccinated country, is also now seeing new infections surge, with 200,000 new Covid infections a week. Hospitalisations are now also starting to rise. Britain’s Boris Johnson is a good example of how Covid, and Delta in particular, lift leaders up and throw them down. Johnson’s early response to Covid was chaotic and ineffective. So he slumped in the polls. But then, using the freedoms afforded by Brexit, he got a lot of vaccines and Britain led the world in vaccination rates. Like Biden, he then became popular. But if Britain suffers hospitalisations rates so severe in the coming winter that it has to impose serious restrictions again in order to avoid hospitals being overwhelmed, Johnson’s fortunes will once again suffer.

Britain's Prime Minister Boris Johnson. Picture: AFP

These swings and roundabouts are not just a problem in the West. Southeast Asia was exceptionally successful in avoiding the worst of the first Covid wave. But Delta came along and defeated the region’s earlier successful strategies. In the past three months, South East Asia’s Covid mortality rate has tripled. A broadly similar story has unfolded in Japan.

So what are the implications for Australia? At 70 per cent vaccination, NSW will have only half its total population jabbed. That level of vaccination, plus summer, will probably bring significant respite. Some folks will foolishly declare victory over the virus.

It will likely furnish a moment of political opportunity. Forget Berejiklian, this will help Morrison too. He may consider a sunshine election, when the good weather is keeping Delta at bay. Delta will probably come roaring back next winter. Before then, those vaccinated early will need booster shots before some people have had their first jab.

It might be smart to have an election straight after school holidays because Delta, according to a recent study, may be five times as infectious among kids as the original Covid virus was. Even if it is not more deadly to them, that means a lot of school-age infections and, inevitably, a significant number of school-age hospitalisations once school is fully back.

We will need vaccine passports and eventually we’ll need vaccinations for kids under 12, but we should be cautious here. They shouldn’t be vaccinated for the sake of their parents and grand parents. The vaccine has to benefit them. It’s probably eight or nine months before we can have a ­certainly safe kids’ vaccine.

Spare a thought for Mark McGowan and Annastacia Palaszczuk. Opening up at 70 or 80 per cent vaccination means those of us in NSW and Victoria get freedoms back. For WA and Queensland, opening to free interstate travel means introducing Delta and death where it hasn’t been before. I believe WA and Queensland must open up then, but I respect that this is no easy or trivial matter.

In the meantime, if we have any sense at all, as a nation we will have to maintain a lot of restrictions and social distancing, certainly not lockdown, whatever our jab rates are. We will probably feel great in summer. But we should watch the northern winter. It will show us our likely future – unless, of course, the virus gives us new variants even worse than Delta.