Still in lockdown

Greater Sydney (basically metropolitan Sydney and surrounding communities within commuting distance) is still in lockdown as cases of covid still are being detected at around 200+ a day.

I mentioned at the start of this current lockdown the bizarre social-class dimension to covid outbreaks. With Sydney, this outbreak started out in relatively affluent suburbs and the state government hoped to contain the outbreak without a fall lockdown. It wasn’t quite a “lockdowns are the last resort” mentality but the tougher measures were still delayed by crucial days. The result of trying to avoid a lockdown was a) you get a lockdown anyway and b) it is longer because community transmission is more widespread.

Covid’s cruel punch-line to the social class dimension is that while the outbreak started in wealthier suburbs, it has become entrenched in poorer suburbs — mainly in the southwest part of Sydney’s urban sprawl. So as the measures have become harsher, the places and people feeling the worst of it are people with less income and fewer choices. https://www.theguardian.com/australia-news/2021/jul/29/nsw-covid-update-rules-tightened-in-western-sydney-as-state-reaches-record-high-of-239-daily-cases

In 2020 state and federal politicians showed more willingness to help people stay home rather than attempt to force people to stay home.

Across New Zealand and Australia, we’ve had 15 months of experience with managing outbreaks with mixed results. Other countries circumstances may be different (especially in terms of the practicality of limiting internal movement between major urban centres) but overall there is a clear pattern of what works: lockdown early and pay people to stay home by supporting impacted businesses. That approach leads to shorter lockdowns and quicker returns to normality. What doesn’t work is dithering about lockdowns and trusting in aggressive policing to get people to stay home. We’ve known since at least March last year that cases rise exponentially when unmanaged and that there is can be a delay of days in terms of knowing the extent of the spread.

Australia has also messed up two other aspects.

Firstly the hotel quarantine system has been doubly inadequate. It’s firstly been the source of multiple community outbreaks due to poor controls in place leading to infections spreading and by having the majority of quarantined travellers in the CBDs of major cities when infections spread from people returning, it is straight into areas with high population density. Secondly, the numbers that can be accommodated are too small to manage the number of Australians who want to return home but can’t get flights because of caps on numbers. As a stop-gap in 2020, the hotel-quarantine policy made sense but the government has had months to develop better options.

Secondly, the vaccine roll-out has been shambolic. Again, there was some wisdom in Australia taking a slower approach than say the UK at the start of the year. Even with the current outbreak, covid rates are relatively low compared to other countries but luck was playing a role in that.

A slower approach didn’t stop major errors, the biggest of which was initially putting hope in just one vaccine: Astra-Zeneca. A rare blood-clotting side effect meant that the vaccine was subject to shifting health advice, which in one sense couldn’t be predicted but in another sense was inevitable. Once vaccination happens en-masse, inevitably differences between the various vaccines would become more obvious and not just side-effects but potentially in efficacy or ability to cope with variants. Trusting in just one was a gamble. Even given that, health advice and vaccine availability has been muddled and difficult to navigate.

Overall, Australia has escaped much of the worst aspects of the global pandemic through luck, circumstance, geography, timing and some good policies. Looking at events now what worries me more is not covid but the next virus. There will be another global pandemic at some point, possibly another SARS type disease, possibly something else. That governments are still making avoidable errors with covid makes me apprehensive that the next big pandemic will proceed as badly as this one. It may even be worse given the more entrenched opposition to public health policy that has developed this cycle.

9 thoughts on “Still in lockdown

  1. The one upside I can see at the moment is that both the Pfizer/Modern rna and the AstraZeneca approach seem to have been able to demonstrate that we may not need to wait before beginning trials next time around, and trials may be shorter too. That’s not to say that there aren’t side-effect issues with any vaccine; sadly, there always will be, although again it’s worth remembering that they figured out e.g. why the blood clotting issue was happening very quickly and how to spot likely victims in time. [Then again, the really critical part will be to ensure that they can’t use this as a precedent or an excuse to short-cut ‘traditional’ drug trials; unfortunately, I suspect that this may not be the case.]

    But of course that does depend upon an infrastructure that is prepared for it, and there I can sympathise with your problems in Australia!

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    1. Well, in most places (I’m only really familiar with Canada, where I live, and the U.S., because it’s impossible to avoid) the vaccines still needed to be officially approved by the government, they just used an ’emergency’ approval method which allowed them to shortcut some of the usual time but was still only a probationary approval. So this becoming a regular thing isn’t necessarily going to happen, because any fast-tracked approval like this generally doesn’t last and can be rescinded at any time.

      My understanding is that in the U.S. at least one of the vaccines is well on its way to getting a full, non-probationary approval as well. Which will remove one of the excuses people use to not get the vaccine (it’s still experimental!).

      One of the interesting things is that the Astro-Zenica and Johnson&Johnson vaccines were actually using technology with more history and testing than the Moderna and Pfizer ones, so there was every expectation early on that they would be the safer ones… but none of that testing involved anywhere near the level of widespread use that happened with the pandemic. I suspect many of the previous vaccines developed using the viral vector technology are going to be getting a lot of extra scrutiny in the future.

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  2. The AstraZeneca problem also demonstrates the downsides on doing drug trials mainly on men. Because the vast majority of people who suffered dangerous or fatal blood clots, strokes, pulmonary embolisms, etc… were women of childbearing age who are often not well represented in drug trials. And because the side effect is so rare, it wasn’t noticed during the trials. Once the vaccine was in regular use, it was quickly spotted, because the first recipients were healthcare workers, many of whom are women of childbearing age.

    Another problem was that many countries clung to AstraZeneca for too long and even continued giving it to women in the endangered age range after the problems had become known. I could have gotten vaccinated earlier, if I had agreed to take AstraZeneca, a gamble I was not willing to take, especially since there have been blood clots and strokes on both sides of the family, so my risk might well be heightened beyond being a woman of childbearing age.

    An unfortunate side effect was that confidence in vaccines in general (every vaccination related death is ammunition for the antivaxxers) and the AstraZeneca vaccine in particular, even among people who had a high risk of dangerous covid outcomes and a tiny risk of complications from the vaccine (e.g. elderly men) was destroyed. AstraZeneca is no longer offered to anybody in Germany (even people who had their first dose of AstraZeneca are offered another vaccine for their second dose) and our remaining doses were shipped to Africa.

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  3. We only used AstraZeneca for all 65+ where there were little to none risk. Now when that vaccination is finished, we have stopped using the vaccine. I’m a bit unsure why Australia isn’t using it for the same group. Perhaps because they have already been vaccinated?

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    1. They are and younger people can get it as well after consulting with their GP (I’ve had one shot of AZ because I thought the risk was minimal for me). But even for older people it has been a disorganized roll out of AZ. The bad publicity and shifting advice on AZ didn’t help but even before that it was confusing.

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      1. Many aspects of the rollout have been a schemozzle. My dad is over 70 and should have been eligible to get vaccinated in the first phase of rollout, but couldn’t because his GP clinic decided not to do vaccinations and none of the others in his area would vaccinate people who weren’t already patients.

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      2. At least the US has done one thing better than Oz. Sure, we still have the “muh freedumb” vax and mask refusers, but you can get the damn shots anywhere. Not just doctor’s offices and hospitals, but for a while in stadiums and fairgrounds, every pharmacy that exists, no matter what size, from firefighters, so many places. Walk-in, nowadays. I got mine from a teeny pharmacy that I didn’t know existed because I didn’t think there were any buildings in that area. (It’s in the last one, kind of hiding next to the Starbucks, because there is ALWAYS a Starbucks.)

        An email I got yesterday says that California is providing free transportation to injection sites and back for those who need it, and even house calls if you qualify.

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    2. In Germany, part of the problem was that the Biontech and Moderna vaccines were originally reserved to older people, because they were thought to be more effective than AstraZeneca. Hence, AstraZeneca was given to younger people and the only people under 65 who were eligible to get vaccinated during the first round were healthcare workers, many of whom are women of childbearing age, for whom the risk of dangerous complications (though still small) is highest.

      Another issue is that when our vaccination commission decided to stop vaccinations of under 65s with AstraZeneca and informed the government about this a few days before updating their official advice, the government didn’t stop vaccinations at once, but still let people under 65 get vaccinated with AstraZeneca for several days, even though they knew the official advice would be changed. Again, this was not helpful for getting people to trust in the vaccines.

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