Over the past few weeks, holiday festivities have prised open the Covid floodgates. The Christmas season brought parties, festivals, family reunions with enthusiastic hugs, dinners, dancing and energetic karaoke sessions – an antidote to months of relentless doomscrolling and prolonged lockdowns – but Covid cases have now inevitably skyrocketed.
Things have changed; we’re not in the same situation we were two years ago – 91% of the Australian population have had two jabs and nearly 3.9bn people have been fully vaccinated across the world.
We know, definitively, that vaccination drastically reduces the risk of getting really sick or dying from Covid and we have effective, evidence based treatments for the virus.
Whilst breakthrough infections in vaccinated people can cause severe illness, it’s incredibly unlikely. Fewer than 0.5% of people with Covid in Australia are admitted to hospital and Covid-related mortality is very, very low.
Though you still don’t want Covid if you can avoid it, chances are you’ll be OK if you can’t.
Still, many Australians are having difficulty coming to terms recognising that avoiding Covid is no longer a feasible long-term option.
It’s hard to get your head around the psychological U-turn from Covid zero to Covid everywhere when we’ve been told to stay home for two years to avoid the killer virus at all costs.
Covid has been demonised in Australia for so long, compounded by the prolonged premise of “Covid zero”, a concept that was hopelessly naive at best and a dangerous political fallacy at worst.
Much has already been said of the tidal wave of Covid-related mental distress that has been flooding through our emergency departments over the past few months.
Now we have the addition of new infection-related health anxieties looming large, exacerbated by difficulties accessing reliable guidance or timely tests.
The vast majority of people don’t need to be in the ED and are safe to convalesce at home, sufficed with paracetamol and ibuprofen, plenty of fluids and a Netflix subscription, but reassurance is challenging after months of fear-mongering rhetoric.
It also goes against every gut instinct as healthcare professionals to advise people to think twice about coming to the ED if they’re sick or worried, but we know when to worry about Covid now.
The pressures of this virulent outbreak on the health system and the need to preserve our critical care capacity have proved to be an additional insult to years of injurious underfunding and insufficient resources.
The recent implementation of at-home rapid antigen testing is a welcome, albeit late, development. RATs work by identifying Covid antigens, the foreign structures containing the virus that trigger the body’s immune response.
If Covid antigens are present on a RAT swab, the liquid solution helps them stick to a specific chemical on the paper strip and generate a positive result.
Viral loads peak around five to seven days after infection, which correlates with when you’re most likely to have symptoms and so when your RAT is most likely to be reliable. However, if you don’t have an especially high viral load or enough antigens, a RAT will be negative even if you are in the early stages of infection.
The levels of detectable antigen also change over time so yesterday’s negative RAT doesn’t explain away today’s nasty headache or tomorrow’s annoying cough. Though a positive RAT reliably tells us everything we need to know, a negative RAT rules out nothing.
Conversely, PCR (polymerase chain reaction) tests essentially copy-and-paste genetic material from your swab until there’s enough material to look for the specific sequence of the Covid-19 virus.
When a PCR test identifies the presence of Covid, it’s almost certainly accurate and so it’s better at detecting early or asymptomatic Covid. A single PCR test requires significant manpower, however, and costs at least $100 – 10 times more than a RAT.
Whilst the sensitivity of PCRs are invaluable if you require hospital care, it is galling to think of how the cost of millions of PCRs could have been better spent in this pandemic if we’d had enough RATs sooner.
Millions of dollars could have been redirected to better supporting and protecting our frontline healthcare workers, towards lockdown related psychological support for young people or on longer term solutions to tackling endemic poverty.
I worked through the first two waves of the pandemic in an inner city London hospital hit ferociously hard by Covid in 2020. Our circumstances were in no way unique in the NHS; our oxygen pressures ran precariously low, we were forced to invent ICU spaces in the most creative of corners and we ran relentless rounds of futile resuscitation every night.
The youngest person to die in our hospital was in her late 20s, the same age as me, with no underlying medical conditions.
I think about her occasionally when I’m prescribing a young homeless lady sotrovimab or showing an elderly gentleman how to book his booster, because it’s difficult to convey how lucky we are in Australia even in our current state of crisis.
Less than two years ago we had no viable treatment options on the horizon, confirming Covid infection took a couple of days and we didn’t even know if vaccination was a true possibility.
Now, in 2022, it might feel like the cloud of doom overhead will linger forever but things are changing – we’re vaccinated, population immunity is rising.
We need to keep protecting our vulnerable communities and emergency resources and keep testing, keep our space and keep our masks on just a little while longer.