COVID 19: What’s The Endgame?

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With various governments around the world utilizing the full spectrum of responses to the COVID 19 outbreak, it stands to reason that some of the more draconian measures should have some sound reasoning behind them.

For comparison, countries like Sweden, the USA, and Brazil, amongst others, have loose restrictions, arguing that they are only looking to achieve herd immunity or are only aiming to ensure their health systems are not overwhelmed while waiting for better treatment options or a vaccine. Compare that to Australia. Australia doesn’t seem to have any realistic endgame and relies on a completely effective vaccine to rescue us from lockdown.

Initially, the government was pragmatic about the prospects of a full-blown pandemic, and with little known about the virus, they prepared for the worst. We were going to have to do everything we can to flatten the curve as the virus ran its course through the population.

The most crucial objective was not to suffer the same fate as Italy, where the aging population and lack of social distancing completely overwhelmed the health system. Horror stories emerged from Italy describing the daily dilemma the triage doctors faced. If a young person came into the emergency department needing a ventilator, an older person must be sent home to die to give the younger and more resilient patient the treatment they needed.

Hence, the Australian government focused on the “Flatten the Curve” strategy. Shut the economy down, halt elective surgeries, and prepare the health system for the worst so that everyone who needs emergency treatment can have the best chance of survival.

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 This strategy worked well, almost a little too well. With a large portion of the workforce sitting at home, pubs empty, shopping centres deserted, and events wholly abandoned, the infection numbers dropped dramatically.

Hospitals never really came anywhere near capacity, quite the opposite; many were nearly empty. With electives cancelled and people too afraid to attend the hospital for anything but an emergency, the hospital capacity dropped far below pre-COVID levels. Unlike US hospitals, Australian hospitals are always run at nearly 100% capacity. With more beds available, the hospitals just accept more electives and treatments. So with the COVID 19 lockdown strategies in place, Australian hospitals were the most empty they had ever been, even amid a pandemic.

  Soon enough, though, with infection numbers continuing to drop, the state governments decided to reinstate electives, as there wasn’t much point continuing to halt them. People still needed procedures performed, and the catastrophic scenario initially envisioned never came to fruition. Even today, as Victoria is in Stage 3 and Stage 4 lockdown due to renewed surges of infections, Victorian hospitals are still running 75% of electives with plenty of room to spare if needed.

  So what is the plan? Are we doomed to continue this cycle of severe lockdown – reopening – severe lockdown into perpetuity until rescued by a vaccine and can go back to life as usual? Nobody seems to be talking about this seriously. It appears that the government is surprised that the virus has been kept to manageable numbers and is frightened of what to do next. So far, the consensus from the UN health bodies has been to lockdown, shutdown, shelter in place, and any deviation from that advice is met with a hail of criticism.

They hold up the “New Zealand” example as the golden standard. The sparsely populated island nation initially proved that through sheer force of state power, it is possible to cause the extinction of COVID 19. Or so they thought. As of writing, a new cluster has emerged 102 days since the last case had been stamped out, and they have no idea where it came from. It’s likely the virus had been bubbling under the surface, passing between asymptomatic carriers avoiding detection due to a lack of severe symptoms.

Just recently, the US director of the National Institute of Allergy and Infectious Diseases Dr. Anthony Fauci reported that up to 50% of COVID 19 carriers were asymptomatic, with no symptoms at all, and a large proportion of the remaining infected had very mild symptoms. With this kind of uncertainty and transmissibility, is the extinction of the virus ever really possible? New Zealand’s National Health Chief Ashley Bloomfield thinks not, commenting during the period of zero cases that it wasn’t a matter of IF there are new infections but WHEN.

 From the first weeks of the virus gaining global attention, the race has been on to develop a vaccine. Surely this will be the saviour of the world, the saviour of ruined economies, and the hope we need to defeat this fear. All that everyone needs to do is stay home, social distance, wear a mask, and wait. Because sooner or later, someone is going to make the vaccine we need and beat this pandemic, just as we did to measles, polio, smallpox, and nearly every other deadly pathogen that once plagued humanity.

Just a few days ago, Russia claimed to have a vaccine, and they quite likely do. The problem is that it’s entirely possible that it isn’t going to be quite as effective as people are hoping. So far, they have only confirmed that it elicits an immune response.

The Russian vaccine is of a type that utilizes the adenovirus, the common cold, which is very closely related to COVID 19. Instead of the adenovirus containing its standard package of DNA and replication instructions, it contains custom proteins similar to COVID 19 to trigger “an immune response similar to that caused by the coronavirus itself” as described by Vadim Tarasov, head of Sechenov University’s Institute for Translational Medicine and Biotechnology.

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There are several problems with expecting the Russian vaccine to be the game-changer that is needed. The Russian vaccine triggers internal antibodies.

Professor Ian Frazer from the University of Queensland explained that many coronaviruses are responsible for colds and the immunity gained from catching a cold lasts for several months. You can catch another cold soon after, but you may have some antibodies that will reduce the severity.

But as Professor Frazer points out, humanity has never in history created a vaccine for the upper respiratory tract, which is the region primarily targeted by COVID 19. The upper respiratory tract is an entirely different system to that covered by internal antibodies, being an external surface. He said

“One of the problems with corona vaccines in the past has been that when the immune response does cross over to where the virus-infected cells are it actually increases the pathology rather than reducing it”

“So that immunisation with SARS corona vaccine caused, in animals, inflammation in the lungs which wouldn’t otherwise have been there if the vaccine hadn’t been given.”

Professor Ian Frazer

Even in the best-case scenario where an upper respiratory tract immune response is achieved and 100% effective, there is still the issue of longevity of protection. Every other coronavirus has had protective antibodies that only last a short time, months to a year.

Currently, researchers around the world have found there to be varying antibody responses in different patients. Nature magazine reported that recovered patients had significantly low levels of antibodies. Researchers in Spain have also discovered not only worryingly low levels of antibodies but rapidly decreasing levels of antibodies. 

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But 100% effective is a tall order. The measles vaccine is 98% effective. The flu shot is between 20% and 60% effective depending on the year due to its seasonal mutations. COVID 19 is no different; several cases of mutations are already reported.

Chinese researchers have documented two different varieties, the L-type and the S-type. The United States is currently experiencing West Coast and East Coast strains that took different pathways to reach North America, one coming directly from Asia and the other having travelled through Europe. 

 At the moment, the reality of the “vaccine saviour” to rescue Australia from lockdown is looking grim. The best-case scenario likely involves regular vaccinations of low effectiveness, mostly aimed at blunting the severity of the virus. The worst-case scenario is that the vaccine is worse than the disease, creating inflammation and scarring within the upper respiratory tract, increasing the severity of a COVID 19 infection.

It’s becoming more likely that the experts were right from the start, that COVID 19 will probably just enter the group of viruses perpetually afflicting humankind as colds and flu do. But what does this mean for the country’s response? If the universality of COVID 19 is inevitable, why is the government still stuck between policies intended to “eradicate the virus” and “flatten the curve”? How much more debt do the grandchildren of Australians have to repay due to a lack of foresight and a COVID 19 endgame?

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