Health Opinion

What living with COVID would really mean for Australia

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Controlling the pandemic, including maintaining a high vaccination rate, is key to living with COVID (Screenshot via YouTube)

Through careful management and planning, it would be possible for the Australian Government to take control of the COVID-19 pandemic, writes Professor John Quiggin.

DESPITE CONTINUING high numbers of COVID-19 cases, lockdown restrictions have mostly been removed in New South Wales, at least for fully vaccinated people, with Victoria likely to follow suit. These moves have been justified by the claim that we need to start “living with COVID”.

As with a lot of three-word slogans, the appeal of this idea depends in large measure on its ambiguity. One version of “living with COVID” is, in essence, a continuation of the policies that have been followed in Australia for most of the pandemic, derided as “zero COVID”, but more accurately described as “suppression”.

The idea is to keep border controls at a level where outbreaks can be controlled through a combination of limited lockdowns and contact tracing, backed up by high and increasing vaccination rates. In this case, “living with COVID” means relaxing controls and counting on vaccination to offset the resulting higher frequency of outbreaks.

Given the highly infectious nature of COVID Delta, a policy of this kind can only work if vaccination rates are near 100%, or if the unvaccinated are kept isolated from everyone else through vaccine passports and employment mandates. That’s the direction taken by European countries like France and Italy, where case numbers are now heading for zero.

What most people who talk about “living with COVID” in Australia seem to have in mind is something different: a situation where there is a steady but manageable flow of cases, say 1,000 per day in Australia and where a limited set of restrictions is maintained indefinitely. To keep in touch with reality, with a fatality rate of 0.7%, a hospitalisation rate of 5% and an average 14-day stay, that would correspond to over 2,000 deaths a year and 700 hospital beds occupied.

Unfortunately, this version of “living with COVID” represents a mathematical impossibility. The reason this is that infections diseases display exponential growth, or contraction, measured by the (effective) reproduction rate — R. If R>1, the pandemic spreads until it runs out of people to infect and if R<1, it contracts until the number of cases dwindles to zero, or there is some new introduction. (Things are more complicated than this, because R will be higher for some communities than others, so we really want to look at the maximum R across communities.)

To illustrate, suppose that R=1.1 and people are infectious for seven days. Then the number of cases doubles every seven weeks. If you start with 1,000 cases a day, you’ll have around 200,000 a day a year later. But if R=0.9, you’ll be down to five.

What this means is that a stable number of cases can only be maintained with an unstable policy, involving repeated tightenings and relaxations, just as we have seen in all countries that have chosen to “live with COVID”. Most recently, this cycle has played out in Singapore. It seems likely that England, which celebrated “Freedom Day” with the rest of the UK in July, will have to follow Scotland and Wales in reimposing controls before long.

Finally and most alarmingly, there is the “let ’er rip” solution adopted by the far-Right in the U.S. and its allies in Australia (including a small number of extremists in the economics profession, I’m sad to say). This involves allowing the pandemic to spread until it is hoped everyone is either effectively vaccinated, infected and recovered, or dead.  As numerous U.S. states have found, the most likely outcome is rapid growth in cases until hospitals are overwhelmed and are forced to choose who will be treated and who will be sent home to die. At some point, people begin taking their own precautions and infections decline until the cycle repeats itself.

The cost of relying on rationing to motivate self-protection is not just deaths from COVID-19, but deaths from other conditions that are treatable but go untreated. In the U.S., for example, there were a little under 400,000 deaths attributed to COVID-19 in 2020, but over 500,000 more deaths than in the previous year.

Almost certainly, we will have to live with outbreaks of COVID-19 for the foreseeable future, as is also the case with infectious diseases like measles and mumps. But as with these diseases, we should be aiming to suppress outbreaks as they occur. 

Equally importantly, we need to join the global effort to suppress the pandemic, particularly in Africa. The fewer cases there are in the world, the less rapidly new mutations will evolve and the better our chances of developing more effective vaccines and treatments.

John Quiggin is Professor of Economics at the University of Queensland. His latest book, Economics in Two Lessons: Why Markets Work So Well, and Why They Can Fail So Badly, is out now from Princeton University Press.

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