Thread by @AlanBixter

So let's talk about Skeeter's four finger plan: 1st finger - that's nothing; it's more of the same. Let's skip for a minute to 4th finger, because if that isn't possible, then the two in between need to be considered on their own merits, not as a means to an end. /2

4th finger: "A complete return to normal life with quarantine-free travel for all those who are vaccinated, and no lockdowns or border closures remaining." Issue 1 is that about 5% of people can't be effectively vaccinated primarily due to health issues. /3

Issue 2 is that he has no intention of vaccinating people under the age of 16 - That's a little under 25% of the population. Issue 3 is that AZ has an efficacy of about 70% and it has been designated for use in 20% of the population - so another 2% not covered. /4

Issue 4 is that with the very best immunisation roll out we could possibly imagine, another 10% would be objectors. So in total, Skeeter is leaving 42% of the population without effective vaccine coverage. /5

Issue 5 is that, although no one is really sure about numbers, no one has suggested that vaccinating 58% of the population will be enough to provide herd immunity. Indeed, we know this because this is about the level of vaccination in the US currently. /6

In the US currently, with over 50% vaccinated, the people unsuccessfully vaccinated have no protection from death by COVID. So in summary, Skeeter plans - PLANS - to kill approximately 1% of the Australian population. That is quarter of a million people. /7

Which brings us to issue 6. The plan to use AZ in over 50's was made when it was known that about 1:1,000,000 would die of TTS. Skeeter planned to have 20 additional deaths, justified by the much larger number of lives saved by vaccination. /8

The actual rate of death from AZ has been very close to this figure. But when we got to 2 deaths - the expected number - the outcome was thought to be unacceptable, and the plan modified to exclude 12% of the population. Yet his plan is to kill 250,000. /9

So Issue 7 is that his 4th finger is ill considered and not politically attainable in a democracy. Let's quickly look at the other two fingers he's trying to squeeze in. /10

Finger 2: "A post-vaccination phase, in which the focus will shift from our current suppression strategy to minimising serious illness and death." Our primary strategies for preventing serious illness and death are vaccination and public health measures. /11

So, for the sake of half the population, we will still need public health measures. So still quarantine associated with travel , no lockdowns and border closures. So far, Fingers 1 & 2 are do nothing, and Finger 4 is politically impossible. /12

To Finger 3: "A consolidation phase where we implement plans for health authorities to manage Covid-19 like other infectious diseases such as influenza." This one is interesting. I know more than the average number of people working in health. /13

Everyone was astonished to find that flu could be controlled by public health measures. But now they know. And the thought of needlessly returning to 290,000-650,000 influenza-related respiratory deaths worldwide per year is not really acceptable. /14

Let's use the Australian figure: About 1,000 preventable deaths due to the flu each year. It seems to me that Skeeter's plan has the horse and the cart around the wrong way. It is easier & more effective to use the COVID public health model to prevent flu. /15

So Skeeter's Four Finger Plan is what Joh Bjelke-Petersen used to call "Feeding the Chooks." So what the hell do we do? This pandemic has two major features that are largely glossed over because they are a bit uncomfortable, but they are critical: /16

FEATURE 1: COVID is primarily an airborne disease: All super spreader events have characteristics of aerosol spread. Two hospitals in Melbourne have constrained COVID spread by installing portable HEPA air scrubbers. /17

SOLUTION 1: Regulate minimum ventilation standards for all internal spaces. Start with high rise buildings and hospitality venues. Provide support packages to help with air handler conversions and replacement. After a phase in period, enforce the standards.

FEATURE 2: COVID is primarily spread by ~10% of the population. These people need to be investigated to determine what biological factors contribute to this trait. Although this sounds invasive, it need not be. /19

The spread of MRSA (golden staph) was partly contained by swabbing the noses of health staff to see if they were infected and then treating infections with antibiotics. We don't know what the super spreader mechanism is, but it can be studied. /20

If it does happen to be as simple as some people having a nasal environment that encourages COVID, we may already have a solution. Australian company Starpharma, has developed an antiviral nasal spray that appears to be effective against COVID. /21

SOLUTION 2: The point isn't necessarily that Starpharma is the solution to super spreading, but that the problem is amenable to a scientific solution. Research into the super spreader state needs to be funded, preferably using academic/commercial partnerships. /22

SUMMARY: Skeeter's Four Finger Plan was supposed to be an aspirational goal, but was critically flawed because it aimed to go backwards to a misty eyed view of 2 years ago. There is no back. COVID is not going away. One vaccine will not save us. We need to keep moving forwards.

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*There is a rogue "no" in there. Please ignore it.