Australia

Beware the promise of easy answers when it comes to COVID

The 1-3 per cent figure is drawn from the cohort of children who became symptomatic and sought testing. However, research by the London School of Tropical Medicine and Hygiene has estimated that clinical symptoms manifest in only 21 per cent of 10-19 year olds.

Aligning multiple sources of evidence, the Imperial College COVID-19 Response Team estimates that 0.6 per cent of these children with symptoms will be admitted to hospital, giving an overall risk of 0.13 per cent that a child will be hospitalised with COVID-19 – substantially lower than the 1-3 per cent estimated by OzSAGE.

Schoolchildren in year 3 and over will wear masks.Credit:Getty

OzSAGE also states that in England, “within two weeks of schools reopening without vaccines or masks, 8 per cent of children were absent with confirmed or suspected COVID-19″. This latter furphy appears to have come about from a misreading of a Guardian article in which the 8 per cent describes all-cause absences, while COVID-related absences are noted as less than 1 per cent.

Worryingly, the 8 per cent figure was repeated by the Victorian Chief Health Officer, Professor Brett Sutton, in his announcement of mask mandates for schoolchildren from year 3 and above.

Likewise, “apples to oranges” comparisons between countries – such as comparing England’s second wave experience to that of San Francisco (270,000 cases versus just seven transmission events) – risk exaggerating the potential impacts of masks in schools.

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During Melbourne’s second wave, the all-aged mask mandate introduced in July 2020 was credited by Burnet Institute researcher, Dr Nick Scott, with achieving a 22-33 per cent reduction in the effective reproduction ratio. An important factor in Victoria’s defeat of the second wave, but by no means the only one.

Beyond this there are urgent, but challenging, societal issues to address that cannot be solved with a single grand gesture.

Australian Medical Association president, Dr Omar Khorshid, has given detailed evidence to the Senate Select Committee regarding the urgent changes that must be made to our healthcare systems, which have been operating at capacity long before this pandemic.

An optimal strategy of in-community case management must be delivered to save our emergency and ICU wards from being overwhelmed by increasing caseloads. This requires a co-ordination of resources between state and federal governments, and of labour and case management strategies between GPs and hospitals and between public and private providers. Not easy to deliver, and not readily served up as a soundbite on the radio news.

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The children at greatest risk of severe COVID are those with specific health conditions, such as Type 1 diabetes, cardiac anomalies, trauma and stressor-related disorders, and neurodevelopmental disorders. Active engagement of their carers must be made to ensure that vaccination options are made readily accessible and that appropriate shielding and care escalation plans are in place.

Many of these risk factors (excepting Type 1 diabetes) are prevalent among Indigenous Australians. Even in the unlikely scenario of 100 per cent vaccination coverage there is a desperate need to deliver an improved standard of care to Aboriginal and
Torres Strait Islander peoples, should COVID break out in these communities. Painful decisions that recall a history of injustices will need to be made around the quarantining of remote settlements to combat outbreaks that can leave entire communities devastated.

These are the conversations we need to be having. And there will be no easy answers.

Ewan Cameron is an epidemiologist specialising in statistical methods for epidemiology and in mechanistic modelling of disease transmission. He is an Honorary Research Fellow with the Geospatial Health and Development team at the Telethon Kids Institute in Perth.

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