What syphilis and measles can tell us about the coronavirus endgame

What syphilis and measles can tell us about the coronavirus endgame thumbnail
Tegan Taylor: Hello, this is Coronacast, a podcast all about the coronavirus where we answer your questions. I'm health reporter Tegan Taylor.Norman Swan: And I'm physician and journalist Dr Norman Swan. It's Friday, 3 April.Tegan Taylor: So as we been discussing over the past few days, health authorities have really started focusing on community transmission,…

Tegan Taylor: Hello, this is Coronacast, a podcast all about the coronavirus where we answer your questions. I’m health reporter Tegan Taylor.

Norman Swan: And I’m physician and journalist Dr Norman Swan. It’s Friday, 3 April.

Tegan Taylor: So as we been discussing over the past few days, health authorities have really started focusing on community transmission, and in Victoria we are starting to see this becoming a thing. The state’s Health Minister says there’s nearly 60 community cases, which is a significant increase on the day before. Norman, where do we think this is heading?

Norman Swan: And New South Wales has really clamped down with the lockdown, with police enforceability and fines. That situation is being tipped for the next 90 days, so that’s getting really serious. So I think the states are well ahead of the Commonwealth, as they have been for some time now. The Commonwealth hasn’t really taken control of this, the states have really done this. I don’t think you’ll find the Commonwealth complaining about it but the states have really moved ahead. This is the hope that we’ve talked about before, trying to really get a hold of this epidemic, we’ve just got to pull together as a community to get this under control.

Tegan Taylor: Do you think people will be surprised by this increase in community transmissions though? The impression that we’ve been getting from the fall in numbers maybe was suggesting that we were getting to the top of the curve.

Norman Swan: Well, let’s talk about the research now, we might as well…

Tegan Taylor: Yeah, let’s get into it.

Norman Swan: Because each day we talk about a piece of research, and this research was actually published in the Conversation and we’ll have a link to that. And this is by a group of three or four data people and infectious disease epidemiology people, this is the justification for the ‘go hard, go quickly’ process which says if we all get behind this, we stay at home, we minimise our mixing with other people, we do it tough, kids stay at home, and we do it tough for a period of time, you could get this down to really low levels if your testing regime goes beyond what it is now.

In other words, the testing regime has to move towards, at a minimum, everybody with symptoms, and finding a way to get to asymptomatic people too, which is…largely how you do that at the moment is you identify people at risk who are people who might have come off a cruise ship or off an airline or something like that, and that’s all hopefully coming to an end, although there are more cruise ships out there, so I hear. But essentially there has to be a very big, extensive testing program put into place over the next few weeks around Australia so that when you get to a point where there are low numbers, so instead of hundreds every day there are low numbers, then the system can actually jump on those low numbers, so if it pops up you get onto it.

And then what has to go with that is no letup in the strict isolation. So if you’ve got COVID-19, you’re isolated, you’re isolated away from other people. If you’re quarantined, you’re quarantined away from other people, you are tested properly and allowed out when you are truly negative. That sort of regime where you’ve got quarantine isolation, extended testing, we get down to very low levels, and at that point when you’ve got the systems in place, that’s when you might say, well, let’s just take our foot off the pedal a bit. And again, as a community, there is a trade-off here, we do the right thing, government does the right thing, we won’t get back to normal, by the way, until there’s a vaccine, but we get to the point where it’s manageable.

And if we don’t go completely nuts…maybe there will be a long, long time before we lift our borders, before we allow international flights, a long, long time before that happens, but if we could get back to people starting going to work, if we can get back to kids going to school, I think it’ll be a while before universities could open because that 22- to 29-year-old group is high risk, but you just do one thing at a time, steadily, and see what happens; can you control it or are people misbehaving and it’s going to go nuts, because you can get a second and third wave which can be even worse than the first wave, and that’s what Singapore is seeing right now. They are risking losing control of their epidemic in Singapore, having done well up until now. So you do not lose vigilance. But if you do it and we all pull together as a community, look after each other, we could get to the point, maybe in four or six weeks, where you could start letting your foot off the pedal.

Now, this 90-day thing in New South Wales suggests they are not going to do it for three months, but I imagine that if we are really doing well and we are down to really low levels, then they might say, well, for certain circumstances we might let it off and let’s see what happens. In other words, not having this nihilistic, economy-destroying the view that it’s going to be for the next 12 months is that if you really get on top of it, it could be that we slowly get back to it, but it will be a situation for a year or 18 months where we are vigilant, we are testing, we are isolating, we are quarantining, we are not behaving entirely as we did before the pandemic but it’s more normal that it was.

That’s kind of the hope and promise, but the risk will always be of a second and third wave, which means really vigilance. That vigilance will cost money but that money will be a tiny, tiny fraction of the billions and billions of dollars that we are pouring into support people in the economy, absolutely rightly, the billions that we are pouring into the healthcare system, absolutely the right thing to do, but maybe for a small investment on the side we could actually get on with it.

Tegan Taylor: Can we talk really quickly about what’s happening in Singapore because that’s one of the countries that was really held up as doing everything right earlier in the pandemic.

Norman Swan: By doing everything right, they were good with quarantine, they were good at monitoring people and using apps with people who are actually leaving their place and not behaving properly, but they didn’t close schools, they didn’t have a lockdown, and they were very good at communication. So they had a WhatsApp messaging system. My daughter lives there and twice a day she gets a WhatsApp message from the Singapore government telling her exactly what’s happening, where the situation is, but I think it has just not been enough. So my daughter and her boyfriend are now confined to quarters, they are not allowed to go to work and they are working out of home. Singapore is progressively moving to clamp down much more strictly.

Tegan Taylor: Well, Coronacast is all about answering your questions about coronavirus, so if you want to send in a question, go to abc.net.au/coronacast and fill in the form.

And so this question kind of follows on from what we were saying, Norman; what is the endgame with the measures that we are taking at the moment? If a vaccine is a long way off, are we going to get it eventually, or can we assume we can eradicate it completely?

Norman Swan: I think the smart money is on this virus will be with us for evermore. It’s not going to be like SARS-1 where it kind of disappeared, largely because it was only symptomatic people who got it and therefore you could really jump on it and there was no spread, eventually you stopped the spread after about 8,000 people got infected. This one I think is going to go into the community and it’s going to keep on being there and probably there for evermore.

So, two or three things will happen. One is that…it’s called the virus–host relationship, so the virus and us as humans, a new infection in humans comes to terms with us. So, for example, when syphilis first broke on the world in Italy in the 15th century, it was a very nasty skin disease, very toxic, people died of it. And eventually it became still a serious sexually-transmitted disease but it settled down a lot over many, many years, as the humans and this bacterium actually came to terms with each other. And that’s what will happen with this, is that the virus will mutate and almost certainly become less aggressive, so the mortality rate will drop, probably its spreadability will drop, but that’s a process that will take a much longer time than hopefully a vaccine would take.

And the other thing that can happen is there is no vaccine, which is what happened with measles (sorry this is a long answer but it’s a fascinating story)…so, for example, with measles before there was a vaccine, if you lived in a large enough city or population, measles was always circulating. So you would always get measles around and kids would get it as part of growing up. It was a bad disease to get and a percentage of children would have a brain destroying complication of measles, so it was a nasty disease, people died, but it was always there and circulating.

But if you look at Iceland, Iceland was never big enough to have a sustained population to sustain measles all the time. And what would happen with Iceland is somebody would arrive on a boat from Denmark with measles, it would run a riot through Iceland, people would die, it would be a nasty disease because there was no natural immunity. A generation or two would go by because they were immune, but 25, 30 years later there would be no immunity, somebody would come off the boat from Denmark and then there’d be another measles epidemic.

And that’s what could happen here, is that…so, coronavirus, we get used to it, if there is no vaccine, and then we develop a bit of herd immunity but that herd immunity might die out and then we get another episode, another pandemic or an epidemic of it, and that’s the pattern of things, which is why we need a vaccine. So the endgame here really has to be a vaccine, and hopefully (we’ve spoken about this before) the SARS-1 vaccine turned out to have dangerous side effects, but it seemed to be disappearing anyway so it wasn’t pursued, I don’t think. Now they know of the potential for these side effects and they will be looking for that to make it safe. But there are so many vaccine technologies out there, you’d hope that one of them would turn up with a safe vaccine that could be scaled up easily.

Tegan Taylor: That’s it for Coronacast today. A reminder, you can send in a question at abc.net.au/coronavirus, or you can find the link on the Coronacast website. And talking about the website, we now offer transcripts of each episode, starting with yesterday’s. You can also find those on the Coronacast website.

Norman Swan: And this week you’re going to have a bonus episode of Coronacast, another kids special, out on the weekend. We’ve had so many emails, we thought we’d try to answer as many kids’ questions as we could, so if you liked the first kids episode, keep an eye out for another one over the next few days. We’ll see you soon.

Tegan Taylor: See ya later.

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