Recent infections in NSW demonstrate how fragile is our control of community acquired Covid infections. As it will be many months before Australians are immunised and immune to Covid-19 we must focus on stronger containment strategies now. It’s time to mandate mask wearing and not just ask people to wear masks.
We have learnt a heck of a lot about the Covid-19 virus in the past 12 months and now understand why it is so difficult to stop its spread. Having developed extremely efficient ways to attach to and penetrate cells lining our mouth, nose, respiratory tract and even our eyes it is incredibly infectious.
Relatively small amounts of virus may see many, perhaps most, of those infected have few or no symptoms yet be able to efficiently pass the virus on to others. Over the year mutations have been recognised wherein the virus has become even more infectious. It is having a great time capturing 76 million people and killing 1.7 million of those it infects.
The virus can ‘live’ on certain hard surfaces for many days and can be transmitted from our hands to our mouth should we touch an infected surface. However, the overwhelming majority of infections occur when we inhale aerosolised tiny viral particles. We used to think that during speaking, singing and even coughing the virus would not travel more than six feet from its host.
Recent studies from South Korea, however, show exhaled virus travelling across quite large rooms and staying airborne for far longer than we had suspected. The implication of this research is significant, as it suggests the distance required for adequate ‘social distancing’ is much greater than we had thought.
From the early days of the pandemic, hand hygiene and keeping away from each other as much as possible were obviously important tactics but the case for wearing masks was controversial. At first it was suggested that masks could prevent an infected individual from infecting others but many months and much research later it has been clearly established that masks can very significantly reduce one’s chance of being infected.
Clearly masks do not provide complete protection but the Centers for Disease Control in the US, looking at all the research applied to the issue, have concluded that if 90% of the population wore masks when social distancing was difficult, transmission of the virus and the associated severe to fatal complications would be reduced by 70%.
In America President Trump’s politicisation of the Covid epidemic and his disparaging of mask wearing has actually resulted in the millions of adherents to the Trump ‘cult’ avoiding masks to show support for their leader. Trump and his team have consistently said it was up to the individual to decide if they wanted to wear a mask.
Fierce opposition to attempts by a number US governors to mandate the wearing of masks and social distancing have included riots and death threats. Unbelievably the US Supreme Court agreed that states could not mandate social distancing in places of worship. One judge, totally ignorant of the science underpinning the public health measure, said that restrictions on the numbers of worshippers were intolerable while liquor stores were left open!
Personal freedom, it seems, is all important. Many countries have seen similar resistance expressed with large rallies and protest marches
Many other countries, on the other hand, are and have been mandating the wearing of masks. In Australia we have been both lucky (Island at the end of the world) and sensible in utilising lockdowns to hose down infection surges. Mandated mask wearing was a feature of the most severe restrictions such as the recent Melbourne outbreak. In the heat of the battle we did very well but we are not being so smart when it comes to maintaining the peace.
Numerous studies have revealed that the true incidence of Covid infections in communities is some 6-24 times larger than is obvious. Examination of sewerage tells us the virus is still circulating in our communities. We have learnt the hard way how destructive to health, psyche and the economy are the efforts needed to stamp out a flare of the fire. Complacency is obvious and exposes us, as it has all around the world, to sudden explosions of new infections.
Politicians are wary of ‘mandates’. Enforcement is a problem and contentious. It’s one thing to impose during an obvious emerging crisis but more difficult to do so to maintain control. So we have premiers, health ministers and chief medical officers telling Australians that the presence of the virus should see us practising social distancing and wearing masks. In NSW the Premier actually used the word “begging” when asking people to wear masks in supermarkets, on public transport and any indoor occasion where social distancing was difficult.
My contention is that begging is not working.
It is obvious that as we cannot close ourselves off completely from the rest of the world where infections are far more prevalent than they are here, A lack of routine adherence to protective public health measures leaves us vulnerable to an imported case exploding into the community.
When reporters at Sunday’s press conference (December 20) asked the Chief Medical officer why mask wearing in public wasn’t mandatory she said she was impressed at the community’s adherence to this measure. Interestingly I had a flurry of calls after this (which catalysed this contribution) questioning which city she lives in, for the perception of most is that the percentage of people wearing masks in supermarkets and on public transport is tiny.
Certainly those of us in Sydney, looking at the circumstances associated with the Northern Beaches outbreak, should appreciate the reality that adherence to mask wearing and social distancing would have protected us from this cluster of infections that have so disrupted Christmas plans for thousands.
We all accept the mandate that we wear seat belts when driving, we all accept the mandate that we cannot smoke in public places. We should all appreciate that a mandate to wear a mask is justified as the minor inconvenience involved can help prevent possible major disruptions to our lives and economy before vaccines have controlled the epidemic.
If government won’t impose this mandate we should issue a personal mandate to ourselves to wear a mask when in a crowd and commit to urging others to do the same. Without a whole of community response there could be a lot of Covid suffering between now and vaccine time.
Professor John Dwyer AO, is an Immunologist, Emeritus Professor of Medicine at UNSW and for many years heavily involved in efforts to improve the delivery of healthcare in Australia. He was the founder of the Australian Healthcare Reform Alliance.
Comments
6 responses to “Scott Morrison said NSW was the ‘gold standard’ in infection control but begging is not working in encouraging mask wearing”
I am having a great deal of trouble believing the figures from NSW. The decline in infections is too steep so I suspect they are not looking.
Given of the 9 cases associated with the Avalon cluster 1 ie more than 10% was in a traveler to Victoria we are either looking at one very unlucky girl, greater awareness and sensitivity in Victoria so that testing rates are higher, failure of the really sick to get tested in NSW or some number fudging.
May I quote from the Indian Express of Dec.7 about another arrow in the covid quiver, which UQ Prof. Wendy Hoy first advocated in the BMJ in April
“ Amit Mohan Prasad, secretary for agriculture, Uttar Pradesh in the Indian Express online 17.12.20, who runs the covid testing program in Uttar Pradesh, a state with more people than all but four actual countries.
“ Let me also discuss two strategic interventions, out of many, which we have taken. The first is the widespread use of the drug, ivermectin, not just for treatment of cases but also as a prophylactic. The state government provides free medicines to all patients in home isolation or in government COVID-19 facilities, which have more than 1.5 lakh [150,000] beds. We have used the combination of ivermectin and doxycycline to successfully treat over three lakh home-isolated patients with mild symptoms so far. This combination has also been used by the hospitals across the state for admitted COVID-19 patients. But what is more interesting is the state’s successful use of ivermectin as a prophylactic.
“In the beginning of the pandemic, the Agra model of containment had been hailed for its efficiency. But with a spurt of cases in May-June, there was a sense of despondency in the management team. That is when the team, relying on the wisdom of its young district surveillance officer who had been successfully using ivermectin as prophylactic for his rapid-response teams, started administering this medicine to the close contacts of positive cases in the district. This gave them positive results. We took note at the state headquarters, and asked a technical team to look into it. It recommended that it can be tried across the state as a prophylactic. Recognizing the sense of urgency, we decided to go ahead. Many other states have also followed suit. Last month, AIIMS Bhubaneswar published a study that found that ivermectin had prophylactic functions but we have been using it in the state from July itself with considerable success.””
The “gold standard” that Morrison referred to concerning NSW only about a week ago, is now quickly tarnishing, just as his ‘virus gone before Christmas’ nonsense months ago was a ridiculous claim when we are not in control of this pandemic. Was it going to be a Christmas miracle performed by Scott to get votes?
The worst thing about this virus in Australia apart from the deaths and suffering it is causing is that the federal government in this country has sought to politicise each state’s response at every opportunity (just like Trump) and used its usual venal main stream media to attack Labor states, but never Liberal states. It has done the same with different countries in the world in that China has received much berating from the prime minister and his media propaganda machine, yet the US with its appalling infection rates run by an incompetent fool where anything up to 3,500 deaths per day are now occurring receives very light treatment from the same prime minister.
NSW has made many mistakes, and gave us the Ruby Princess to start with, then with the US being the one country where the virus appears to be totally out of control, it appears we are dealing with US aircraft crews in sloppy ways – even it they did not comply with restrictions, we should have been far more careful. We should have learned our lessons by now after a year of virus. Currently the US a very high risk country and the one that has brought coronavirus to this country on more than one occasion.
While the MS media gave us “dictator Dan” because he had to shut down Melbourne, we are not hearing Morrison’s media protection racketeers use such derogatory nonsense with Gladys. Na, she’s a Liberal.
As leader, Morrison should be supporting the entire country, everyone of us, but we are not seeing that, we are seeing 100% political bias as it is with the sports rorts, pork barreling , cronyism, Liberal donors, and only Liberal Party mates being offered diplomatic appointments.
The world is in so much need for good leaders now that actually care for their people in all honesty, those that play games for childish reasons like we see today are not worth a cracker.
On virus.
Anyone who understands the process of natural selection will understand the high risk that this virus now presents to the human race. As we are seeing in Australia with new US strains of the virus on the loose, and a 70% more infectious strain that is currently in the UK, we are at a new stage in this pandemic.
Given much of the world has been in lock down which stops travel and therefore limits interface between human beings as a way of controlling the spread of the virus, it has allowed many more strains to develop and mutate in isolation in different locations, and virus breed at astonishing rates making rats look lazy. Mutations must also be equally frequent.
As we try to break out of lockdown, it then allows for the possibility for different strains of this virus to hybridise. And as we try different ways to destroy the virus (you can’t kill them) since we have not had a vaccine, then it allows the strongest virus in any given population to survive and breed, potentially making more resistant strains. This is simply how it works in natural selection. So as we try to free up travel and try to return to normal life we are in greater risk in many ways than before, and the chance of more infectious and resistant varieties of the virus developing increases. The question is will the vaccines we are making be equally capable of working with many different international strains of the virus? Vaccines may never be any kind of 100% effective silver bullet.
Of note in the economic and political debate, is that it swings between two poles. One side says go back to normal and get the capitalist machine going again, the other side says stop all you are doing, lock down and avoid infection and transfer of the virus to other people. Masks are very important, but the evidence demonstrates that lockdown is far more effective, especially if done in conjunction with wearing masks.
So what does this tell us? Although humans have spent millions of years since learning to control fire to partition ourselves from the roughest sides of natural selection to become pretty much super survivors, we are still controlled by the natural laws that exist on this Earth. Exceed those laws and we are in trouble. We are also experiencing this with climate change, and the effects of environmental degradation. I’m not talking about magical laws and gnomes, I’m talking about the laws science knows about.
Essentially what has developed out of our economic system is capitalism which is driven in the corporate world mainly by profits. Even socialist countries seek profits mainly, and still promote consumerism and more use of resources to unsustainable levels. It can’t go on.
This virus which we see as ruining our way of life is nothing but a signal that is telling us that we are not outside the boundaries of natural selection ourselves, and that we are going to have to find ways to live on this Earth that are more harmonious with the natural laws which govern it.
Unfortunately, Mr. Wendell, we have interferred quite successfully withthe laws of ‘natural selection’ to the point that we have been breeding from medically dependent and other debased stock for some time.
I know, for I am one of those who, but for the intervention of modern medicine, would not have survived long enough to have offspring who themselves are heavily dependent on medical and psychological support.
That is why I say we are “super survivors”. Since learning how to control fire, we have introduced millions of ways to help us survive including modern medicine.
But I still will also say that what the virus is demonstrating to us, and the damage that is being caused by climate change (which is only in its initial stage), indicates that we are not independent from the natural laws nor natural selection if we continue to disregard damage to our natural environment and the laws that govern it.