Cases of COVID-19 in Europe are on the rise, with France, Spain and the UK recording thousands of daily cases each day in the past week.
However the European nations are among those opting to chart a new course, hoping to avoid a second lockdown and trying to achieve a stage of coexistence with coronavirus instead.
“To overcome the health crisis, we must learn to live with the virus,” French President Emmanuel Macron declared in late August as cases began to tick up.
Days later, Spain’s Health Minister Salvador Illa said: “From a public health perspective the current situation does not call for a new lockdown.”
UK Prime Minister Boris Johnson is also said to view a second national lockdown as akin to a nuclear deterrent, instead opting for local measures and a “rule of six” in the UK to avoid a second “hump”.
“All this is to say that: Christmas we want to protect, and we want everyone to have a fantastic Christmas,” he said on Thursday.
“But the only way to make sure the country is able to enjoy Christmas is to be tough now. So if we can grip it now, stop the surge, arrest the spike, stop the second hump of the dromedary, flatten the second hump.
“Dromedary or camel? I can’t remember if it is a dromedary or a camel that has two humps? Umm. Please check.”
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SHOULD AUSTRALIA FOLLOW SUIT?
With Europeans still able to enjoy socially distanced summer holidays, eat out and visit pubs without curfew, the approach differs to that in Australia where Victoria has seen a strict lockdown and borders closed between states.
But two health experts have rubbished the idea Australia should follow suit.
“The approach of ‘coexistence with COVID’ is really a term for ‘giving up’ on the challenge and giving up on their people,” Professor of Epidemiology Mary-Louise McLaws, from the University of New South Wales, told news.com.au.
“The pros of ‘coexistence’ are a perception that there is a minimal impact on the economy.
“But this approach will have an uncalculated expense from deaths with – and ill health from – COVID-19 termed long-COVID that includes a range of symptoms that last for a yet-unknown rehabilitation period.”
She said she could not see a “coexistence” that fails to utilise public health measures being accepted by Australians as we have one of the best health systems in the world.
“Giving up on the challenge is giving up on our young adults who will inherit health problems, the cost of loss of productivity and a reduction in their quality of life if they acquire COVID and suffer from long-COVID,” Prof McLaws said.
“If not for ourselves, then let’s think about ensuring our next generation of middle aged and leaders entering middle age are as healthy as possible and to achieve this we must support ‘reducing the risk’ approach.”
Professor Adrian Esterman, an epidemiologist and biostatistician at the University of South Australia, believes pushing ahead and living with COVID-19 is “a fool’s errand”.
“I wouldn’t go that way,” he told news.com.au.
“There are no benefits to trying to coexist with it because it will just keep infecting people.”
EUROPE’S SECOND WAVE
Spain ended last week with a record-high rise of new infections, at 12,183 on September 11, and there were 10,561 new cases in 24 hours confirmed in France on Saturday, September 12.
Italy has recorded between 1000 and 1500 new cases of COVID-19 every day of this month.
“We are in a living-with-the-virus phase,” Italy’s health minister Roberto Speranza said.
In an interview with daily newspaper La Stampa, he said there will not be a “new lockdown”.
Over the last few months, tourists flocked to European beaches and destinations for summer and a second wave is now sweeping across the continent.
The age distribution of coronavirus cases in Europe this time around is “mainly the young” who don’t seem to care, Prof Esterman said.
“We’re seeing the death rates actually going down and that’s mainly because old people have either died of COVID-19 or they’re being very careful, and we got better treatment,” he said.
“Young people are not realising that they could potentially have really severe effects.”
Prof Esterman said “it’s just coming through in medical literature” that more and more people infected with COVID-19, since the pandemic began, have “long-term major health problems”.
”Because this virus is very nasty, it causes lots of blood clots and can damage a lot of your different organs including your brain, kidneys, liver.”
He said it was “extremely horrifying” to see health services swamped, such as in the UK where almost 4000 cases are being recorded daily but a demand for tests has led to shortages.
Asked if the countries should be going back into lockdown, Prof Esterman said: “Absolutely.”
“They’re getting record numbers of daily cases now.”
Stricter restrictions have been announced in the French cities of Marseille and Bordeaux due to their rising infection rates.
Prof Esterman said localised lockdowns make sense if the transmission is also localised.
“I think it is sensible but I think at what stage the epidemic is in a country,” he said.
“If there’s widespread community transmission, then that doesn’t work.”
Australian deputy chief medical officer Dr Nick Coatsworth on Wednesday cited France as a country experiencing “an acceleration in the spread of the virus” and an increase of cases.
“This is testimony to the significant burden that COVID-19 places on communities, on health systems,” he said.
“The significant burden it places on nations and economies.
“It demonstrates that the Australian response, even with what we’ve seen in Victoria in the second wave, remains an exemplar for the world and testimony to the quality of our public health units, the tireless work of our public health professionals, the adaptability and flexibility of our test, trace, isolate systems, and of course, the capacity of our healthcare system; one of the best in the world and one that has been able to provide care for Australians when and where they need it if they suffer from COVID-19.”
Prof McLaws said the epidemiology of the virus in France “will not describe a coexistence – it describes death and a high level of disease”.
“They have a high risk of COVID-19 with 6200 infections per 1 million population, in contrast we have one sixth of this level, and prior to our second wave we had one twentieth of their level,” she told news.com.au.
“Since the end of July, France entered into a ferocious second wave peaking at 10,000 cases on a single day five days ago and there is no evidence that the second wave curve is flattening any time soon.
“The case numbers in this second wave have contributed to 59 per cent of their total pandemic case numbers. The number of current infections is at a staggering 283,000 active cases. 30,000 deaths of the total 31,000 deaths since the beginning of the pandemic have occurred in their first wave.
“There will likely be an even higher number of deaths given the growth in the second wave isn’t slowing down and deaths start to occur after a month into a wave. Our approach is ‘reducing the risk of COVID’ and it is different and effective at keeping the community as safe as possible.”
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THE THREE APPROACHES
Prof Esterman said there are three approaches that can be taken to the fight against the virus and many European countries have decided on herd immunity.
“Which is basically, don’t do anything, just let it run through the population and if people die, so be it,” he told news.com.au.
“I don’t think the European countries should be taking the strategy of herd immunity.
“It will come back and bite you again and again.”
But he said some economists have very different opinions and “not all epidemiologists agree”.
“It’s been a very polarising situation,” Prof Esterman said.
The second approach is suppression, or living with the infectious disease at very low numbers.
“Really what New South Wales is doing at the moment,” Prof Esterman said.
“The problem with that of course is that there’s always some circulating around and it could break out at any time.”
The third approach is elimination.
“That means you don’t have any community transmission for quite some time,” he said.
“Some imported cases overseas but they can be well handled.
“That’s what most of the other states and territories have done including South Australia.”
Prof Esterman added: “To me, the best way is to suffer the economic pain and actually get rid of the virus completely in terms of elimination.”
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WHAT SHOULD WE DO IN AUSTRALIA?
Earlier this week, Prime Minister Scott Morrison again called for state borders to reopen despite Queensland Premier Annastacia Palaszczuk and Western Australia Premier Mark McGowan digging their heels in.
“Our health plan is critical to our economic plan,” Mr Morrison said.
“And during this pandemic by Australia pursuing both, we continue to do better than almost every other developed country in the world, when it comes to protecting lives and livelihoods.
“But as long as we are closed, we cannot claim success as a country.
“If we are shut, we are not living alongside the virus, the virus is actually keeping us from living.”
On Tuesday, South Australia decided to reopen its border to the ACT but not to NSW.
Prof Esterman said he was “quite concerned” about the prospect of opening to NSW where the “suppression approach” has been taken and where cases of community transmission exist.
“They are not willing to lockdown enough to get rid of it completely,” he said.
“What it means is other states are not going to want to open borders with them so economically, it will kill them.
“With the small number of cases you’re getting now, now is the time to have a short and sharp lockdown … and actually kill it dead. Rather than this saying we’re going to live with 10-15 cases a day.”
He said internal borders should open between states such as South Australia, Tasmania and Western Australia, which are “all in the same position”.
There are no active cases in the ACT, NT, SA or Tasmania and only four active cases in WA.
And eventually, Prof Esterman added: “There’s absolutely no reason why we can’t bubble, as they call it, with another country in a similar situation of having eliminated COVID-19.”
Prof McLaws said clarity and consistency is needed for outbreak management in Australia.
“A national approach would agree on the ‘unsafe level’ of case numbers, say a cluster of cases, to indicate when health leaders need to be pre-emptive with ring-fencing localised hot spots before the number escalate,” she said.
“A national safe level of 0-4 cases per day on average over 14 days allows for all contact tracing to be rapid and find the majority of contacts before day three to prevent the contacts from spreading infection. We would never have borders closed again.”