MLinsights_JULY2020

“Life after Lockdown”

This week we hosted our first KDS Connect Alumni webinar. We were privileged to have one of Australia’s best-credentialed journalists and popular ABC radio hosts, Raf Epstein, in conversation with Professor Sharon Lewin who is one of the leading infectious diseases physicians and a former Melburnian of the Year.

Raf and Sharon, who are both part of the King David community, discussed the topic “Life after Lockdown” and focused on how we will live with COVID in 2021 and beyond. Since the talk I have been overwhelmed by a stream of positive responses and thought that the wider community would like to read a synopsis of the session.

Raf asked Sharon for a snapshot of where Victoria is up to at the moment. Sharon responded that rather than our public focus on new daily COVID infections, it is important to look at a seven-day average for overall trend of infections. She pointed out that similar to stock market analysis, we cannot take one day’s numbers on its own, it is far more beneficial to consider trend lines.

Sharon stated that some of the statistics given publicly are quite “crude”. She is most interested in the “mystery cases”. These, however, are declining which is positive and it seems that Melbourne is on the right track. Sharon did suggest that our National Dashboard of relevant statistics is not operating at best practice. She believes that we should have one of the best dashboards worldwide as we don’t have the volume of infections like other countries.

When Raf asked Sharon to make some predictions she stated that she believes that both the curfew and 5km travel limits are likely to be lifted in September. When asked about where we might be by the end of the year she stated that we will likely still be wearing masks. She felt that Melbourne will likely be operating similarly to how NSW is right now. She felt that there was not great likelihood of the lifting of domestic travel bans though she doubts their efficacy.

Sharon believes that a key to living alongside the virus will be that we will improve our tools for testing, treating and preventing infection. She explained that the FDA licensed an antigen test for saliva which works by looking for protein and this may lead to improved testing methodology. She mentioned that there are some 1900 clinical trials being conducted around the world relating to COVID 19 at present

Sharon celebrated mask wearing as a highly successful intervention that has been very well adopted. She said that she has been pleasantly surprised by compliance and that masks offer dual protection to both prevent transmission from and to a wearer. Sharon pointed out that face shields are not effective as a prevention strategy against COVID unless coupled with a face mask.

Raf then asked Sharon about contact tracing. She pointed out that effective contact tracing is vital to be able to manage life alongside the virus. She said the U.S. has no contact tracing as the numbers are too high and that Singapore and Taiwan have been most successful with contact tracing. She said that effective tracking and tracing both improves public confidence and also alerts when infections increase, allowing restrictions to be responsively tightened.

Raf explained that the COVID tracing app is not being used as it is not very effective as it has not had 80% penetration in the population. Also, with the lockdown in place many people are aware of who their close contacts are so the app does not provide additional useful information. The app identifies all people close to a person and there have been cases of false contacts with people in the next apartment as the technology does not identify that there was a wall between them.

Sharon explained that the virus does not last long on objects so it is much more important to focus on human to human contact. Previously, the virus was seen as being carried in big droplets. Now there is an understanding that there have been cases linked to aerosol spread which changes our approach in preventing transmission. She also pointed out that the virus lasts longer in cold conditions.

Sharon highlighted a problem for governments that given the lack of available existing research and the requirement for immediate restrictions and action that some decisions were being based on what was thought to be accurate at the time but has subsequently been called into doubt.

For instance, she mentioned that while initially the exposure in health care settings was thought to be from external sources, over time we have come to realise that most of the workers’ infections occur within the setting.

Joking that I would want to kill him for raising the question, Raf asked Sharon, “How safe are schools?” Sharon acknowledged that it is better educationally and emotionally for children to be in schools but explained that evidence shows that the risk of infection is still there. She said that we are still learning about infections with kids. It seems that while they are less likely to have symptoms and get sick they can still get infected. Overall, she said that the relative safety of schools is determined by how much community infection is present.

Later, Sharon was asked about the prospects of running VCE exams this year. She said that she believed that running exams with 300 students in a hall would not be an option as the risks would be too great. Raf pointed out that there was a lot of availability of other venues that might be utilised by larger schools. I do not predict that this will be required at KDS given the size of our Year 12 cohort compared with much larger schools.

Raf pointed out that Donald Trump has promised a vaccine by end of the year and asked how close we were to a vaccine. Sharon explained that a lot of vaccines are in Phase 3 already which means it has already been proven to protect from the infection. She said that usually, a vaccine is produced after Phase 3 data. In Russia and China, teams have produced a vaccine before Phase 3 data. She believes Phase 3 data will be available by year’s end. She pointed out that Trump is spending billions of dollars to get a vaccine out fast.

Raf acknowledged that there has been incredible public engagement with the science of this virus and wondered if it is increasing our “science literacy”. Sharon responded that she believes that this is the case and that we have a very good public health system and we’ve done very well.

She said that she is most intrigued about why elderly people get so much sicker than other groups. She said that usually the strongest antibodies are made by people who are the sickest so elderly should be showing better immune response but in this case, they aren’t – therefore this virus is very unusual.

Sharon was asked about what the appropriate balance was between protecting lives and maintaining lifestyles and livelihoods. She reminded us that this is a highly dangerous and infectious virus in which around 20% of people infected require hospitalisation. She said that with a lesser response, hospitals would be overwhelmed. This was evident in New York and Italy. She said we need to continue our focus on containing the virus so we do not have this situation here.

Sharon said that the Chief Health Officer, Brett Sutton, has said that it is hard to show success when you are preventing something. She believes that without the restrictions there would be 30,000 cases in Vic.

Once again, I thank Sharon and Raf for sharing their insights and advice. It was a very valuable for us to hear from such well informed and interesting speakers.