Take freedom slowly or the cycle of lockdowns will start all over again

By Kathy Eagar October 7, 2021 â€" 7.12pm

We are all impatient for greater freedoms and for life to get back to normal. That will start to happen from Monday when fully vaccinated people will enjoy new freedoms not available to others. We can then have 10 visitors at home, catch up outdoors with 30 people and have 100 people at funerals and weddings. Indoor pools will reopen and small choirs can sing together again.

Beachgoers at Bondi in lockdown ... there’ll be more on the way come Monday.Credit:Edwina Pickles

Monday will be the essential and welcome first step. Yet be careful what we wish for. Unless we are careful next week, “freedom” will inevitably come at a huge cost. As NSW opens up again, COVID is not going away. Even if all the fully vaccinated comply with the remaining restrictions â€" a big ask rules â€" COVID in NSW, and internationally, is fast becoming an epidemic of the unvaccinated.

Schools will progressively reopen with all students back in class, a week earlier than had been planned, by October 25. But we are yet to see teachers fully vaccinated or a NSW plan for school air quality and ventilation.

Reaching 70 per cent vaccination is an enormous achievement given where we were just a few months ago. But, with 8.2 million people in NSW, that still leaves 3.3 million people not fully vaccinated. Seventy per cent must be seen as just one step in the journey and not a destination. At 70 per cent, we run the risk of many thousands more infections and hundreds of deaths if easing out of lockdown is not managed well.

Even at 80 per cent, 2.6 million of us will not be protected by vaccine. We really need to get closer to 95 per cent to achieve anything close to herd immunity.

Three groups will not be protected when lockdown ends from Monday. The biggest is those who cannot be vaccinated. They include 1.3 million children too young to be vaccinated and a small number of adults with underlying health conditions. While only a small percentage of children become critically unwell from COVID-19, even a very small percentage of 1.3 million children is too many.

Then there are those who choose not to be vaccinated. With vaccine resistance now down to about 10 per cent, they number around 700,000.

Finally, there will be about 1.3 million who are still waiting to get fully vaccinated. They include many people with disabilities, people in regional NSW and people with poor access to services. Vaccine distribution has been prioritised till now to those in COVID hot spots. And that is fair enough. But we must now address vaccine equity so everyone who wants to be vaccinated gets the chance to do so.

COVID management outside Greater Sydney must be urgently improved. While COVID numbers in Sydney are coming down, they are increasing in the rest of NSW. In the past two weeks, case numbers have decreased by 48 per cent in the 12 COVID hot spot LGAs and 45 per cent in the rest of Sydney. But they have increased by 74 per cent in the rest of NSW.

The COVID picture in NSW. Credit:Juliette O’Brien covid19data.com.au

NSW is starting to move out of lockdown even though regional NSW is yet to peak. The regions with the highest-percentage increases in COVID cases also have the lowest vaccination rates, a potential recipe for disaster for regional NSW.

The government has a big challenge and getting the timing right won’t be easy. Once we start to open up, a momentum will develop to just keep going. But the new NSW Premier, Dominic Perrottet, will need to be nimble and adjust the plan to make sure the pace doesn’t get so fast that it does not overwhelm the health system.

Every NSW health district is already on “code red” and there are still more than 900 COVID cases in hospital, down from a peak of 1001 on September 14. We still have more than 10,000 people receiving COVID health care at home.

COVID patients in NSW hospitals today are occupying the equivalent of 30 wards, each with 30 beds. These are not additional intensive care units and wards for the pandemic. They are existing units and wards which are therefore unavailable for other patients.

And the people delivering the care are not new staff who have magically appeared. These units are staffed by thousands of existing staff and by staff redeployed from elsewhere in the health system. Community health services, palliative care units, rehabilitation units, surgical units and many other services have been closed or reduced to free up capacity to care for COVID patients.

Easing some restrictions at 70 per cent and more at 80 per cent vaccination inevitably means that COVID cases and deaths will rise again. There will simply be too many partially vaccinated and unvaccinated people for it to be otherwise. If NSW moves too fast, many thousands of surgical, medical and rehabilitation patients will be waiting even longer for the services they need.

We do, however, have reason for optimism. As a community, we have shown our ability to adapt to social distancing, QR codes, masks and regular COVID testing as the “new normal”. They all need to continue. From a very slow start, we have no sign yet that vaccinations are close to peaking. And early intervention and treatment for COVID patients is rapidly improving, and that is starting to flow through to declining rates of hospital and ICU admissions and to falling death rates.

But coming out of lockdown needs to be guided by the principle that what is good for our health is also good for our families, our community and our economy. While we can all look forward to better times ahead, we are not there yet. Moving too fast runs the risk of starting the whole COVID cycle â€" cases, deaths, lockdowns â€" all over again.

Professor Kathy Eagar is the director of the Australian Health Services Research Institute in the Faculty of Business and Law at Wollongong University.

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