When will we be out of the COVID pandemic phase?

Tegan Taylor: Hello, Norman Swan.

Norman Swan: Hello, Tegan Taylor.

Tegan Taylor: I have to absent myself from most of today's Coronacast because it seems that it is a showdown between two semi-aquatic animals. You, Dr Swan, are going to be joined by Professor Crabb, Professor Brendan Crabb.

Norman Swan: Well, that was a long bow to take but yes, we're muscling you out here, to use another aquatic phrase, 'mussel'.

Tegan Taylor: Oh no, that's terrible. All right, with that I'm walking out the door. It's Coronacast. I'm health reporter Tegan Taylor on Jagera and Turrbal land, but not for much longer because it's over to you…

Norman Swan: Norman Swan, I'm a physician and journalist, speaking to you from Gadigal land, which is part of the Eora Nation.

And the reason we're talking to Brendan Crabb is that he has a lot of prominence as head of the Burnet Institute, an expert in both pandemics and in diseases of low to middle income countries, as well as what was going on here based on what he knew. And I thought it was time that we did a bit of a catch up with Brendan, which is what I did.

So Brendan, from where you sit, you've got a lot of experience of pandemics, of infectious diseases, you've certainly been very prominent during the pandemic as a commentator, from a research perspective in Australia, from where you sit, where are we sitting right now with Covid in Australia?

Brendan Crabb: Well, in Australia and pretty much in the world I think we're at sort of the pandemic equivalent of DEFCON 3, you know, in a sort of military sense, with DEFCON 1 being the worst and DEFCON 5 being the least amount of concern. I think in pandemics we were at one or two, and we've gone to sort of four or five all of a sudden, but really we're somewhere in the middle. You know, this year, we will still have over 4 million deaths from Covid, these days measured most accurately in excess deaths. We had about 6 million last year, about 11 million in in 2021, and 4.5 million in 2020. So we're back to about 2020 levels.

Norman Swan: So these are global numbers you're quoting.

Brendan Crabb: These are global numbers, yeah. And, and in Australia, the numbers are still, for us, really large. We had 20,000 deaths last year, excess deaths, 14,000 or so official Covid deaths. This year we probably won't reach that number, but it won't be far off, the sort of 15,000 deaths range.

Now, what all this means is that life expectancy for the first time in sort of 70 years in the world has gone down substantially, a good couple of years. And in Australia we don't have the official figure yet, but life expectancy will decline. And so while these are not end-of-the-world figures, and there might be some improvement, they're still very large numbers. And we still see substantial burdens of Covid around the world. There's a significant uptick at the moment in the UK and the US and many developed countries, of course, we will follow soon. We don't tend to see huge peaks anymore, but we see a lot of Covid all the time.

This is one of the least appreciated things I think with Covid is just the sheer volume, the number of people in each country, Australia is no different, where it's the majority of the country get exposed to the virus each year, often multiple times. Nothing else is like that. Before you get into what the actual disease is—is Covid like the flu and is Covid like the common cold and so on—the numbers are extraordinary, and nothing is really changing there because viral evolution continues to outpace, or at least do very well against the immunity that we're building up through vaccination and infection. So, still a very big challenge on our hands in the developed world. And of course, even more so in the developing world that we don't hear much about where you get the direct effects of Covid and then all the indirect effects on the health issues that are there already.

Norman Swan: Haven't vaccination and exposure helped us?

Brendan Crabb: Not a lot. I mean, of course it's helped us. To get vaccinated has no doubt prevented tens of thousands of [lost] lives in Australia, there's no doubt about that. The question, like a lot of Covid, is not a binary one as to whether vaccinations helped us or whether hybrid immunity works, this notion that after vaccination you can get infected and get better immunity, all of those things are true. Infection based immunity is why individuals recover from Covid, and it's why waves disappear. It's in fact why viral evolution gets going and you get new variants, so immunity is good. The point is, it's just not good enough.

We have policy setting in most of the world where we are relying heavily on infection in the least susceptible people, you know, in so-called healthy people, to drive an immunity on the back of vaccination that will get us out of this. It's just not enough, it is working, but it's not enough. And you won't be surprised to hear me say that I think there's more we can do in this sort of DEFCON 3.

Norman Swan: Such as?

Brendan Crabb: Well, I think we could be much more concerned about the air we breathe. You know, we've learned a lot, we don't have to set and forget. In the same way as we treat cancer differently now to how we treated cancer even five years ago, you know, depending what it is, we've learned a lot. And one thing we've learned clearly is that Covid is largely an indoor air quality issue. So what are some strategies, some low-hanging fruit, and then maybe some more sophisticated strategies to ensure that our highest-risk places have clean air, have that air monitored and displayed and purified?

Norman Swan: I mean, there's been some interest in that and you had a conference is not so long ago about it, what should be happening and what's not happening?

Brendan Crabb: Well, mostly it's just not being taken anywhere near seriously enough. I mean, there is movement but, you know…

Norman Swan: So we're hoping that the pandemic is over and we don't need to bother about it anymore.

Brendan Crabb: Well, I think that's true, and that we could go back to what was 2019 and prior and not learn those lessons. There's just so much to be gained from cleaner air. And I've said it multiple times, that the biggest international misstep in the pandemic from WHO, right through to our own response, which had so much good about it, but it is in the inability to get over this droplet dogma, you know, the idea that basically Covid is transmitted by large droplets, which is not the case as the primary mode. These ventilation strategies, they sound very nice and like a little afterthought, it's actually central, it's central to why we had outbreaks during the pre-vaccine period of quarantine, they were all breakdowns in airborne controls, from my perspective.

Norman Swan: Dirtier air inside than outside.

Brendan Crabb: That's right. So we can do a lot, starting with monitoring, there are ways to monitor the air that have good surrogate markers, and then actions that you can recommend, whether it be just opening the windows, of course, until those numbers improve with CO₂ that you're monitoring, for example. It might be you don't have that option, and so you might wear a high-quality mask. And when I say high-quality mask, it's a mask that fits you well, we call it an N95, or a KN94 mask, if you're in a high-risk area.

I'd like to see it easier to get vaccinated. I think we're a very pro-vaccine country in general, but our attitude to Covid vaccination is dropping off, I think because of this reliance on infection to do the job, which is not enough and, in my view, quite a dangerous way to do it because it ignores the effects of long Covid, for starters. It's not really taking into fact that it's not working well enough, you know, we've had 5,000 deaths already this year from Covid, officially Covid, as opposed to excess deaths, which is close to 10,000 deaths. Compare that to flu where we've had about 300 deaths, you know, so it's a huge difference. And we need to get everybody vaccinated, in my view, and there's very strong argument for young kids to get vaccinated as well, who cannot at the moment.

And we're dropping the ball on testing, we're saying testing is no longer needed. It's incredibly powerful to get tested, to know how to protect those around you and to get treated. There is actually a good treatment and more treatments emerging. You can't get treated if you're not tested. So there are definitely things we can and should do and we could promote much more strongly.

Norman Swan: And we've just come through a very warm winter, the northern hemisphere has gone through the warmest summer on record. What's climate change going to do biologically to the risk of pandemics?

Brendan Crabb: Well, it's sort of what we know it's going to do at least in the medium term, versus what's going to happen at the end of this summer, and it's less predictable as to what will happen this year and into next year, we can say very likely we'll have health threats related of course to heat and of course to extreme storms and floods and fires.

In the more medium term, this change to our habitat, changes to our climate and our habitat means that diseases move from where they used to be to somewhere else, or they increase in places they were once there at low levels, or they decrease. For example, mosquito borne diseases are things that…we're seeing a lot of rain at the moment. We're seeing a lot of hot weather, of course, but a lot of rain, and this brings very different patterns of mosquito borne diseases. We mentioned malaria before, but there's quite a number of viruses in that category.

So climate change brings really an environmental damage that goes with it, where people are living closer to animal species that that wouldn't normally live close to, deforestation drives this. It means that we see more pandemics, we see more infectious diseases, not all respiratory, some transmitted by insects, or transmitted by waterborne routes, a very serious threat to pandemics. There's no doubt we're going to see more and more threats. We've seen a lot over the last 40 years. Of course, only this one, since HIV, has really taken hold. But we've had quite a number of scares, SARS, MERS, Zika virus and so on. And that number is expected to increase.

So there's a lot of scope to handle this much better, which is what the UN high level meetings are going to address. But at the moment, we act very parochially, not very collectively, we act very slowly. And you know, speed and partnership and a one-world approach is the only way to tackle these things, and including climate change itself, not just the health effects. So we've got some work to do. It sounds all very scary. It needn't be that way. Covid needn't have been that way. We took some, you know, very bizarre casual decisions as a world, not Australia, they took the good decisions, but the world took some very slow decisions back in January, February, March 2020. And here we are nearly four years later with an illness that's cost 25 million people, still millions are dying a year, and has set the world back economically and back on its heels for so many other health reasons. So I hope we've learned our lesson, but I'm concerned that it may take a while yet for that to sink in.

Norman Swan: Just finally, is this an infection which will ever move out of the pandemic phase?

Brendan Crabb: I think there's scope for Covid to be dealt with. But it's going to take two elements for that to happen. We don't have to think of Covid as a forever virus. I mean, at the moment it's certainly looking that way. But firstly, we've got to face that it's still there, you know, 4 million deaths a year that we're going to face this year, and the next most important disease that we've talked about already, tuberculosis, is 1.5 million people. And we think of tuberculosis as close enough to the worst infectious disease we've ever faced. So Covid is still huge.

But if we face it, firstly face it with the tools we've got and the modern science that we have, we know so much more now about what to do about acute Covid, what to do about long Covid. We're still learning of course, but the insights just in the last little while…for example, just in the last little while we've learned what you might have predicted, but is now clear, that the dose you get infected with, not just whether you get infected or not, but the dose of virus that you get infected with matters a lot. So if you get less virus, because you've been trying to breathe clean air or whatever, then you're much better off. Now, that makes intuitive sense, but now we know that's the case. So there's a lot we can do, if we're aware of it.

And then secondarily is to use a sort of Operation Warp Speed approach to the tools that are going to knock this on its head, we can have much better tools than we have. we can have a nasal spray that protects us for life, for example, or at least protects us from infection for a decent period of time, that's feasible, that's in train. We can have drugs that that work much more effectively, therapies, than the ones that are there at the moment, not just for acute disease but also for chronic disease. These sorts of inventions are happening, they absolutely are happening. We're approaching them a bit casually.

Warp Speed, of course, the President Trump terminology for accelerating in a very positive way, the vaccine program in 2020, a miracle I never would have predicted we could have made a vaccine in anything like that speed. We need that same sort of urgency, and the cost is tiny compared to the impact or ongoing impact of Covid, which is in the trillions of dollars, and we could see the end of it, there is no question. Just like we've seen the end of TB in the developed world. Of course, we haven't seen the end of tuberculosis in the developing world because there's no will to do it. But with Covid, with the will and with the tools, we can see the end of it in the same way as we've seen the end of other infections.

Norman Swan: I was terrified we wouldn't get to a positive ending point but we have. Brendan, thank you.

Brendan Crabb: You're welcome. Thanks very much, Norman.

Tegan Taylor: And that of course was Professor Brendan Crabb of the Burnet Institute. Norman, that was quite a good chat.

Norman Swan: Yep. And, as always, Brendan's got a lot to say and very sensible.

Tegan Taylor: Yeah, maybe he should be your co-host from now on.

Norman Swan: You could do with Brendan, leave me behind, find another man.

Tegan Taylor: I would never. Oh well, we better leave that there for now. We'll catch you all next week.

Norman Swan: See you then.