The most uncomfortable question about COVID-19 is still ahead of us (2022)

Since the pandemic first found its way into our consciousness, Melbourne emergency physician Stephen Parnis has been working on the crest of every COVID-19 wave.

His job demanded long hours: treating patients, keeping across new therapies and life-saving strategies, while managing the impact of surging virus numbers and multiple lockdowns on overworked hospital staff and grieving families.

Every day as he went to work, Dr Parnis knew the virus could take the upper hand, and month after month he carried with him the weight of two questions: how many lives could be saved today? How many would be lost?

Then three months ago, Dr Parnis hit the wall.

"I was burned out. For most of us in healthcare, the pandemic has posed the biggest single challenge of our entire careers and mine began in 1992," says Dr Parnis, a former vice-president of the Australian Medical Association. "I've done a lot of soul searching, looking at where my limits lie and asking how I sustain myself through this?"

For the first time since 1995, DrParnis took three months' leave.

"I wasn't myself and if I'd continued doing what I was doing I might have ended up having some sort of flame out," he admits. "It was important to have time and space. My GP and my psychologist have been an important part of that time, but so have trusted friends and colleagues."

The key lesson, Dr Parnis says, was understanding how to lower his expectations on himself: "I don't have to be perfect. My colleagues don't have to be perfect. We don't have to have all the answers. We just need to know where to look for them".

The most uncomfortable question about COVID-19 is still ahead of us (1)

It is ironic that as Dr Parnis prepares to return to work tomorrow, Australia has the highest number of COVID-19 infections, hospital admissions and deaths of any time during the pandemic. His medical colleagues remain under pressure.

"My timing is impeccable," he says with irony. "I'm coming back at it at a time when things are in some ways diabolical. I'm humbled by the support that my colleagues have given me and a little shocked by the numbers of people who have come to me saying they have felt the same way."

On Friday, Australia recorded 44,203 new cases of COVID-19 in the previous 24 hours with the nation’s total caseload now nudging 10 million. The hospital system is juggling 5,122 patients with COVID-19, including 162 in ICU.

The saddest statistics of all are the deaths. A total of 157 people died with COVID-19 across Australia on Friday. The pandemic has taken the lives of 11,669 Australians so far.

"I would say the hospital system is holding its head above water, but only just," says Dr Parnis, who met with hospital colleagues last week for an update before his return.

The experts contacted for this story — from frontline doctors like Dr Parnis, to epidemiologists, virologists and health policy researchers — agree that the trajectory of this wave of the virus is steep, and the peak could still lie ahead.

The most uncomfortable question about COVID-19 is still ahead of us (2)

Modelling predicts August will see a significant further rise in cases before the curve begins to fall again.

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Deakin University's chair in epidemiology Catherine Bennettsays the week ahead will offer a clearer idea of how long this wave may last.

"I think we will know in the next week or so whether these are true plateaus forming now," she says, noting that every state is different," Professor Bennett says.

BA.5 has rewritten the rules

COVID-19 has forced us to grapple with so much rapid change — from lockdowns tothe "new normal" — that it is hard to believe only this time last year state premiers were still fronting the media each morning with detailed COVID-19 updates.

Double doughnut days remained the goal back then andlockdowns were an ever-present possibility. Australians under 40 were still not eligible for vaccination.

On July 31, 2021,in NSW for example, the state was deep in a lockdown that ultimately lasted more than 15 weeks. In the previous 24 hours, 210 cases were recorded and contact tracing was still attempted. The pandemic'stotal cases in NSW had reached just 8,725 infections.

Fast-forward a year and, on Saturday, NSW had177,013 active cases across the state, with 2,210 of those in hospital and68 in intensive care. In the 24 hours to Friday afternoon, 46 people died with COVID-19.

In hindsight, concern over such low figures, when compared with our current situation, feels almost overblown.

Yet the disparity says a lot about both how far we have come, and how far we have to go.

Without vaccines and lockdowns, many, many more people would have died during last year's wave, says Professor Bennett.

But this year, in spite of the rollout of vaccines and offers of third and fourth booster doses, the pressure on the hospital system is intensifying as the rise of the highly transmissible BA.5 variant —potentially as infectious as the most contagious viruses on Earth, measles and chickenpox —has rewritten the rules yet again.

New data suggestsmore than 46per cent of Australianshave had a COVID-19 infection, a figure that is likely to be a significant underestimation, Professor Bennett believes.

'The next epidemic'

Notwithstanding the deaths —and those who have suffered as a result of their infections —many have beentempted to ask why we still worry about COVID-19, given widespread experience of only mild disease. The fear of what a COVID-19 infection might mean has dissipated for some who ask:"Isn’t it time to just get on with things?"

The experts are resolute that this approach remains cavalier. And the potential for pressure on the healthcare system is only one reason.

The most uncomfortable questions are:

  • Who will become the casualties of this fresh wave?
  • Will it be the elderly who, despite vaccination and the availability of new oral anti-viral medication, are not able to fight off the virus?
  • Will it be the teens and 20 or 30-somethings who often drive virus transmission being infected for the second or third time with long-term ramifications still unknown?
  • Will it be children receiving treatment for chronic conditions like rheumatoid arthritis that lowers their immunity?
  • Will it be women who are emerging as the cohort most likely to suffer long COVID-19?

When you talk to these experts, leaders in their fields, who have devoted well over two years and thousands of hours to trying to understand SARS-CoV-2 it is uncanny how frequently one phrase continually comes up: "We just don't know."

"The fact is that we've got more people dying from this virus than any other virus. If things keep going in this direction COVID could be the single greatest cause of death, exceeding heart disease," Dr Parnis says. "That's unacceptable. How bad does it get? What are the long-term consequences? There are a lot of things we just don't know."

Sarah Palmer is a virologist — andco-director of the centre for virus research at The Westmead Institute for Medical Research and professor in the faculty of medicine and health at The University of Sydney — saysit is the unknowns that harbour some of the greatest potential threats, arguing that, without care, rampant infection and reinfection threatens to make long COVID "the next epidemic".

The most uncomfortable question about COVID-19 is still ahead of us (3)

Professor Bennett agrees with Dr Parnis and Professor Palmer that, if COVID-19 numbers continue to explode, it is going to become an important cause of death and disability in Australia, driven simply by the maths: a small risk multiplied over a large, infected population still delivers concerning numbers.

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"To say it's disappointing is an understatement," Professor Bennett says, pointing out the BA.5 variant that is driving the spike in infections is escaping the immunity built up — by those who contracted BA.2 — more efficiently than hoped.

"We've got more than half the population vaccinated but people who are in the firing line of the virus are getting multiple infections," she says.

"That keeps the force of infection up and it pushes out into the community and is sustained. Although you might have very low risk if it's sustained week after week, at some point you might have that unlucky exposure."

What are we going to do, Professor Bennett asks.

"We want to encourage people to stop spreading the virus but we don't want to go back into lockdown because what are you waiting for then? You have to stay there for the rest of your lives. It just doesn't work."

While the Omicron variants have proven persistent and resistant, Bennett sayswe should be grateful that "it's not a brand new variant".

"We're not going through that moment when we have absolutely no idea how the virus is going to behave," she says.

"Omicron is sitting in place longer than other variants have managed to do and that that may be a good thing. As long as it doesn't evolve into something we're more worried about."

The problem,she points out,is that, while BA.5 is spreading rapidly through the population, the opportunity for the virus to mutate again remains a threat.

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The most uncomfortable question about COVID-19 is still ahead of us (4)

Some good news —a variant-proof booster is near

Just as the capacity for SARS-CoV-2 to mutate is one of its most concerning features, it is also driving some of the most-exciting developments in treatment.

And, while so much of the news around COVID-19 continues to feel bleak, a small bright spot is emerging in the field of variant-proof boosters and vaccines.

When SARS-CoV-2 arrived in Australia back in 2020, ProfessorPalmer suspected immediately what it might be capable of doing.

Professor Palmer had spent large portions of her career working with HIV, a ribonucleic acid (RNA) virus she describes as "the most genetically diverse in the world".

And her HIV work made her "worry from day one" about SARS-CoV-2, which is also made from RNA molecules.

"When I saw that it was an RNA virus, I knew we would start seeing variants," she says.

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But as Professor Palmer reflected on the knowledge she had built up from her HIV research, she had an idea. Every virus has portions that remain the same no matter what variant emerges.

Professor Palmer reasoned that, if she could determine which portions of COVID-19 remained the same across different variants, then this information would offer potential to create a vaccine or booster that targeted these stable portions, meaning any variant that emerged going forward could be brought down by what she calls a "universal booster".

Since then Professor Palmer and her colleagues —along with teams led by Colin Pouton from Monash Universityand Ranjeny Thomas from the University of Queensland —have been working on this one-shot wonder.

And just last week there was a breakthrough.

Using code generated by Professor Palmer's team, Professor Pouton's Monash team has successfully created an mRNA "construct" of the protein segments the virus uses to replicate.

There's a long path ahead, but this mRNA construct can now be tested, first in a cell culture. Professor Thomas's team can then test the construct in a mouse model containing the cells of humans who have had previous COVID-19 infections.

What Professor Palmer and her collaborators are hoping is that the mRNA will stimulate the immune system's killer T-cells to enhance the antibody response to any variant of COVID-19 that emerges in the future.

It's a huge step forward after more than two years of gruelling research.

"We're super excited and really hopeful that we can develop a very effective universal booster," she says. "But we have a long way to go."

Universal boosters and vaccines are the goal for many vaccine researchers, including those at Pfizer.

An inoculation that never has to be updated is also in development.

Professor Palmer's research is unfolding in parallel with work from scientists around the world, includinganother University of Sydney team that is collaborating with India's Bharat Biotech and Switzerland's ExcellGene SA to create a universal vaccine designed to protect against all variants.

Led by Jamie Triccas, this research hopes to create what is known as a "protein sub-unit vaccine" containing pieces of COVID-19 variants, that can stimulate the immune system to generate broad protection against all current and future variants of SARS-CoV-2.

Megan Steain, a member of the USYD team, says the vaccine will "future proof" us against SARS-CoV-2 variants.

What do we do now

Returning to the current crisis in hospital admissions and runaway infections, and it's clear that a universal booster or vaccine would be valuable in slowing down the transmission of new variants, offering vulnerable groups added protection, and reducing pressure on the healthcare system.

What do we do while we wait?

Notwithstanding the gobsmacking transmissibility of this variant, virologist Ian Mackay from the University of Queensland saysfar more should be done on both an individual and government level to take control over that spread.

Associate Professor Mackay is emotional when he speaks about what he sees as a "massive failing of leadership in public health" that is impacting not only lives but also the economy.

He argues that, two years ago, we were asked to follow rules on lockdown and masks, for example, but now "when it actually matters, we've abandoned the public and we've abandoned health and science. It's really frustrating".

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Dr Mackay is an advocate of what has been called the "Swiss cheese" model of risk reduction: using layers of intervention to maximise the chance one will prevent transmission.

He sees particular value in investing in air purification — and ramping up communicationcampaigns to keep the value of masks, distancing and self-isolation when symptomatic — top of mind.

"We're essentially running an unfettered epidemic," Dr Mackay says.

"We held out until everyone got vaccinated and believe everything's hunky dory. We did a great job and prevented deaths in the beginning, but we can't have a vaccine-only strategy. We need a multi-layered approach and the more layers you stack together the better. The goal now must be to reduce transmission."

He's not alone. Professor Bennett, Professor Palmer and Dr Parnis agree. And so does Grattan Institute's program director for health and aged care, Peter Breadon.

"We've got a longer struggle ahead with COVID than we probably hoped," Mr Breadon says.

He is concerned by what he terms "binary mindsets", where positions for or against a particular behaviour become entrenched and are often tied to political affiliations, masking-up being one of particular concern.

He saysthe time has come for a new COVID-19 literacy campaign to refresh people'sunderstanding of how behaviours like masking or physical distancing can influence their risk of a new infection, quite apart from the need to vaccinate, which is being addressed in a$11.5-million government campaign.

However, Mr Breadon sees vaccine equity as a key area to focus on, pointing out that transmission is higher in some communities than others and, unfortunately, many of those are also more vulnerable.

Along with the rising pressure on hospitals —that can then impact all areas of healthcare — MrBreadon echoes Professor Palmer's concern about not knowing how multiple infections with SARS-CoV-2 will affect health over the long term.

The evidence so far doesn't look good.

"It shows that with every reinfection you get cumulative health impacts,"he says, with increased risk of cardiovascular complications of particular concern. "And that's significant."

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The most uncomfortable question about COVID-19 is still ahead of us (5)

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FAQs

Is COVID-19 still a pandemic? ›

With over 1 million deaths this year alone, the pandemic remains an emergency globally and within most countries. "The COVID-19 summer wave, driven by Omicron BA.4 and BA.5, showed that the pandemic is not yet over as the virus continues to circulate in Europe and beyond," a European Commission spokesperson said.

What should I do I'm having anxiety because of the coronavirus disease pandemic? ›

Concern about the coronavirus outbreak is perfectly normal. However, some people may experience intense anxiety that can affect their daily life. Try to focus on the things you can control, such as your behaviour, who you speak to, and where and how often you get information.

What is Every Mind Matters in the context of COVID-19 pandemic? ›

Every Mind Matters provides simple NHS-approved tips and advice to start taking better care of your mental health. If you are still struggling after several weeks and it is affecting your daily life, please contact NHS 111 online.

When was COVID-19 declared a global pandemic? ›

On 11 March 2020 WHO declared the COVID-19 outbreak a global pandemic due to the rapid spread and severity of cases around the world.

Is COVID-19 still a global threat? ›

With over 1 million deaths this year alone, the pandemic remains an emergency globally and within most countries. "The COVID-19 summer wave, driven by Omicron BA.4 and BA.5, showed that the pandemic is not yet over as the virus continues to circulate in Europe and beyond," a European Commission spokesperson said.

How do I stay active in and around the home during the COVID-19 pandemic? ›

Try and reduce long periods of time spent sitting, whether for work, studying, watching TV, reading, or using social media or playing games using screens. Reduce sitting for long periods by taking short 3-5 minute breaks every 20-30 minutes.

Why is it helpful to focus on the present during the COVID-19 pandemic when you're feeling anxious? ›

Focusing on the present, rather than worrying about the future, can help with difficult emotions and improve our wellbeing.

Where was COVID-19 first identified? ›

The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus was first identified in December 2019 in Wuhan, China.

When was the first case of coronavirus discovered? ›

The first case of the coronavirus (COVID-19) was reported to the World Health Organization (WHO) in December 2019 and was subsequently declared a public health emergency of international concern (PHEIC). This global pandemic is now expected to impact on the economic outlook for some time to come.

Has Canada dropped all COVID-19 restrictions? ›

Canada announced on Monday that it would remove all remaining coronavirus entry restrictions, including testing and quarantine requirements, effective Oct. 1, ending some of the worlds longest and most stringent rules.

Who might be at higher risk of becoming ill with COVID-19? ›

People who are at higher risk from COVID-19 and other respiratory infections include: Older people. Those who are pregnant. Those who are unvaccinated. People of any age whose immune system means they are at higher risk of serious illness. People of any age with certain long-term conditions.

How can one stay physically active during COVID-19 self-quarantine? ›

Walk. Even in small spaces, walking around or walking on the spot, can help you remain active. If you have a call, stand or walk around your home while you speak, instead of sitting down.

How should you maintain social distancing to prevent the spread of COVID-19 at home with possible infection? ›

Spend as little time as possible in shared spaces such as kitchens, bathrooms and sitting areas. Avoid using shared spaces such as kitchens and other living areas while others are present and take your meals back to your room to eat. Observe strict social distancing.

Why does the COVID-19 broadcast key change every 15 minutes? ›

As broadcast keys change every 15 minutes, diagnosis keys are associated with the daily code and the checking mechanism is in the hands of Apple Google, the app user's privacy and identity is protected. The anonymity of the user is preserved from the DHSC (government) and other app users by the functionality of the app.

How can social distancing be applied to prevent the spread of COVID-19? ›

Methods include quarantines; travel restrictions; and the closing of schools, workplaces, stadiums, theatres, or shopping centres. Individuals may apply social distancing methods by staying at home, limiting travel, avoiding crowded areas, using no-contact greetings, and physically distancing themselves from others.

Has Canada dropped all COVID-19 restrictions? ›

Canada announced on Monday that it would remove all remaining coronavirus entry restrictions, including testing and quarantine requirements, effective Oct. 1, ending some of the worlds longest and most stringent rules.

Where did COVID-19 origin? ›

The first known infections from SARS‑CoV‑2 were discovered in Wuhan, China.[17] The original source of viral transmission to humans remains unclear, as does whether the virus became pathogenic before or after the spillover event.[19][75][9] Because many of the early infectees were workers at the Huanan Seafood Market,[76][77] it has been suggested that the virus might have originated from the market.[9][78] However, other research indicates that visitors may have introduced the virus to the market, which then facilitated rapid expansion of the infections.

When was the first case of coronavirus discovered? ›

The first case of the coronavirus (COVID-19) was reported to the World Health Organization (WHO) in December 2019 and was subsequently declared a public health emergency of international concern (PHEIC). This global pandemic is now expected to impact on the economic outlook for some time to come.

Can I go abroad if I don't have the COVID-19 vaccine? ›

If you have not been fully vaccinated, you should continue to follow the entry requirements of the country you are travelling to, such as proof of a negative COVID-19 test on arrival. You should carefully research the requirements of your destination country before travelling.

Do smokers suffer from worse COVID-19 symptoms? ›

Early research indicates that, compared to non-smokers, having a history of smoking may substantially increase the chance of adverse health outcomes for COVID-19 patients, including being admitted to intensive care, requiring mechanical ventilation and suffering severe health consequences.

Where was COVID-19 first discovered? ›

The first known infections from SARS-CoV-2 were discovered in Wuhan, China. The original source of viral transmission to humans remains unclear, as does whether the virus became pathogenic before or after the spillover event.

Is COVID-19 caused by a virus or a bacteria? ›

The coronavirus disease (COVID-19) is caused by a virus, NOT by bacteria.

Can I get COVID-19 from my pet? ›

COVID-19 in the UK is spread between humans. There is limited evidence that some animals, including pets, can become infected with SARS-CoV-2 (the virus that causes COVID-19) following close contact with infected humans.

How serious is COVID-19 usually for most children? ›

For most children and young people, these illnesses will not be serious, and they will soon recover following rest and plenty of fluids.

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