A few #COVID19Aus things to analyse from this week. What has actually changed?? Because some who say open it up, “everyone for themselves” - they are crowing about a victory esp Murdoch press. Is that correct?

1. I am noting this week’s focus on Victoria & CovidZero. Yet CovidZero and elimination (Reff <1) are not the same thing, esp. when we have vaccines. CovidZero was coined in Aus and has been a useful shorthand to explain the best public health goal before widespread vaccination.
2. With widespread vaccination, CovidZero and elimination appear to diverge. This is NOT because the goal of reducing preventable hospitalisation and death has changed. The goal remains/ is the same.
3. So why the divergence? Well bless our public health ppl but ‘elimination’ doesn’t have the same plain english definition we use in normal life. In health it means maintaining an effective infection growth rate under 1:1, where 1 person *on avg* infects less than 1 other.
4. Pre-vax, zero was the only way to achieve Reff <1. With vax, ‘elimination’ means infections *can* occur but they flame out and *don’t* become outbreaks. i.e. Reff < 1. Key to ⬇️ hospitalisations. Oz has measles elimination status due to amazing vax, despite > 100 cases/yr
5. Elimination is at heart of National Plan + Doherty + Treasury advice. Call it suppression, or whatever else so as not to confuse ppl. All advice still says cases can’t get out of hand, which is the same as Reff < 1. Elimination here to stay. If not, why keep any restrictions?
6. A high level look at current country policy responses shows remarkable similarity across countries BUT very different salesmanship/political packaging. Australia, Israel, Iceland, Malta, NZ, S’pore, UK, US etc. So, how are they all so similar?
7. All are using a VaccinesPLUS strategy. ie Vaccines + masks, density caps, flight/travel limits, vax passport (👏🏽UK announcement this week). EU and UK just re-listed USA tourists on 🔴 list. Q’tine varies but is a feature not a rarity. Swift changes, lockdowns always possible.
8. Some leaders call this freedom or “learning to live with the virus”. But do those travellers, now banned, feel free? And we’re told we must live like this, *forever*? Other leaders call it managing covid. Whatever they say we’re all doing roughly the same thing. Why? Covid.
9. Covid has forced us into limited + hard choices. Some in UK and elsewhere seem to believe (but refuse to say) that combo of 1st Gen Vax + getting infected soon after is optimal. Research in Israel points to this ⬆️ immune response halting much onward infection (elimination!)
10. Yet VaccinesPLUS prevents this from becoming a real policy response. Well, that and the fact hospitalisations still grow too fast to be managed. Others hold that the precautionary principle is still wisest, and we need to buy more time as we learn more. ..Enter 2nd Gen vax..
11. It took about 10 years for humans to develop and rollout a 2nd generation vaccine that halts polio infections/transmissions (not just disease). Will it take ten years for a 2nd Gen covid vaccine? I doubt that, based on WHO’s covid vaccine development tracker.
12. While the science of intranasal vaccines remains under development, 8 intranasal and oral covid vaccines are in trials to change this. Bharat Biotech’s leads. Pros? Intranasal may prompt an immune response to halt infection, not just prevent disease
13. AZ is also trialling its vax in an intranasal form. Again, this is a challenging space due to the inconsistent dosing that can occur from spraying something in your nose. Will you sneeze it out? Will it stay in your nose cavity or drip out? Takes effort to make👃🏽 vax right.
14. All of this is to say, again: has anything really changed this week? Not that much. Elimination (Reff < 1) remains key response here and abroad - cases still matter as the lead indicator for hospitalisations. Meanwhile science is scrambling to achieve elimination w vaccines.
15. Multiple countries, having experienced covid’s toll and devastation - and the fatigue we feel of having to battle it - still conclude: limiting it and getting rid of it will be better than “living with it”. VaccinesPlus is the way, at least for now.
16. When 2nd Gen vax comes along, and we work to crush covid country after country - as we have with other diseases - will we still be hearing Covid is inevitable, elimination impossible? Mindset makes something inevitable. And, so many are working to make elimination inevitable

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