‘The virus isn’t going anywhere’: Health experts on the weeks and months ahead

As each day brings announcements of easing coronavirus restrictions, many Australians are feeling hopeful that life may soon return to normal — or some new version of that.

The National Cabinet has outlined a three-step plan to relax restrictions across the next several months.

By July, it’s hoped that the whole country will reach the most relaxed “stage three”, where people can return to work and gatherings of up to 100 will be allowed.

But with new cases of coronavirus still expected to emerge, and a potential vaccine at least 12 to 18 months away, what exactly does this ‘new normal’ look like — and how long will it last?

We want to avoid a ‘second wave’

Predicting what will happen next with coronavirus in Australia and around the world is an almost impossible task, said Katherine Gibney, an infectious disease physician and medical epidemiologist at the Doherty Institute.

“A whole range of scenarios are possible,” she said.

What we’re trying to avoid is what people are referring to as a ‘second wave’ — a really large outbreak coming on the back of our success in preventing the initial outbreak from getting out of control in Australia.

Australia’s plan to gradually ease restrictions, with states and territories going at their own pace based on local incidence and distribution of the disease, was designed to do exactly that, she said.

But it would only work with “ongoing buy in”” from all Australians, which means everyone following social distancing rules and maintaining personal hygiene.

Occasional outbreaks, such as the recent one at the Melbourne meat processing company at the centre of Victoria’s largest COVID-19 cluster, are likely to continue, she said.

This is why governments have scaled up COVID-19 testing, and bolstered the capacity of health authorities to trace cases and “trap” local outbreaks.

Second wave ‘might not be as severe’

Overseas, some projections have suggested countries like the United States — which have been hit significantly harder by COVID-19 — may face a second deadlier wave later this year, or recurring outbreaks of equal size through to 2022.

Even countries previously praised for their success of containing the initial outbreak, such as Singapore and Japan, have re-entered partial lockdowns amid a surge in cases.

This chart uses a logarithmic scale to highlight coronavirus growth rates. Read our explainer to understand what that means — and what we can learn from countries that have slowed the spread.

While it’s unclear exactly what lies ahead, Dr Gibney said she expected initial COVID-19 outbreaks (rather than subsequent ones) to be the worst we would see.

“You would expect that even though they might have ongoing issues and a second wave in countries where they’ve had really huge outbreaks, that second wave might not be as severe,” she said.

We’re in ‘early stages of epidemic’

While the rate of new infections remains low in Australia, globally, COVID-19 continues to spread rapidly, said James McCaw, a University of Melbourne epidemiologist.

“There are seven billion people on the planet, and there’s been somewhere under 10 million infections,” said Professor McCaw, who is part of the team producing models of the pandemic for the Australian Government.

The world is in the early stages of this epidemic.

Since the vast majority of Australians remain susceptible to COVID-19 (because so few of us have been infected), he said physical distancing measures, hand hygiene, and staying at home when sick remained critical.

So far, the virus has infected fewer than 1 per cent of us, but would likely go on to infect 70 to 80 per cent of the population if no measures were in place, Professor McCaw said.

“If people don’t remain vigilant about minimising contact, then we will see the so-called large second wave, which would put us back to the start, and all of the excellent success to date would have essentially been squandered.”

The easing of restrictions was not a sign that COVID-19 was over, he said, but rather the beginning of the next phase of managing it.

The virus isn’t going anywhere — it’s here to stay. So we have to manage our path to living with it just as part of everyday life.

To do that successfully, Australia has to continue with its strategy of suppression, by maintaining low levels of community transmission, and keeping the virus reproduction number (the average number of people an infected person goes on to infect) below or close to 1.

Professor McCaw said although a potential vaccine would bring more protection, it wouldn’t mean the end of coronavirus.

“We have an influenza vaccine that saves many thousands of lives every year, but the flu virus is still part of our society,” he said.

“The coronavirus is becoming part of the world we live in.”

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Not clear if the virus will become seasonal

There is still so much scientists don’t understand about SARS-CoV-2, said virologist Sacha Stelzer-Braid, which makes it difficult to predict what might happen next.

“All respiratory viruses behave in slightly different ways, so we can’t make any assumptions about what this virus will do,” Dr Stelzer-Braid said.

While some respiratory viruses like influenza are seasonal, others, like rhinovirus (the predominant cause of the common cold), occur all year round.

At this point, it’s too early to say whether climate will affect coronavirus, despite speculation it might get worse as winter sets in.

“It might turn out to be something like the flu, where it kind of jumps from hemisphere to hemisphere depending on where the winter is,” Dr Stelzer-Braid said.

“Having said that, they get influenza in tropical countries as well.”

A transmission electron microscope image of SARS-CoV-2, the virus that causes COVID-19.

While the flu virus mutates rapidly, coronaviruses tends to be slower.(NIAID-RML)

Kirsty Short, a virologist at the University of Queensland, said despite the many uncertainties, it was clear that without further intervention, SARS-CoV-2 was very unlikely to disappear on its own.

“It would be possible in countries with really low rates to get rid of the virus, but it wouldn’t be sustainable because you would just have to completely shut your borders for an indefinite period,” Dr Short said.

“When you think about eradicating a virus, it’s no small feat. There is only one virus we have successfully eradicated from the world with intervention — that was smallpox.”

Like all viruses, SARS-CoV-2 has acquired mutations and will continue to do so (as the virus replicates, it makes mistakes copying its genetic code).

But Dr Short said the number of mutations so far had been very low, and that the virus appeared reasonably stable, despite reports a second ‘more contagious’ strain had emerged.

“It would be very unusual [for the virus] to mutate to become more virulent. That’s just not consistent with what we know about virus evolution,” Dr Short said.

Unlike seasonal influenza, which mutates so rapidly we need a different vaccine each year, she said there was no evidence of any significant mutations to the new coronavirus that would change the virus’s behaviour.

Health system is now prepared for COVID-19 patients

When it comes to how well prepared our health system is to handle any potential outbreaks, intensive care specialist Steve Webb said Australia was in an enviable position.

“The government and public health authorities have done an absolutely stunning job with protecting us from a major outbreak,” said Professor Webb, who works at the frontline of COVID-19 at Royal Perth Hospital.

“We’re one of the very few countries around the world to be in the situation that we are at the moment.”

The efforts of the Australian public had helped hospitals buy time to adequately prepare, he said.

Intensive care units now had plans to expand their capabilities if necessary, including for “double or perhaps even triple the number of patients” they would normally see.

“There’s lots of personal protective equipment available … and the systems, processes and policies have been put in place,” Professor Webb said.

While a vaccine is ultimately what is needed to combat COVID-19, he said in the interim, the development of effective drug treatments will also help to reduce the burden of the disease.

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