Preparing for endemic COVID-19

Endemic COVID-19

Despite the severest of lockdowns, New South Wales has not got the reproductive Index (RI) for the COVID-19 Delta strain below 1.0 as at the first week of September. The combination of the restrictions and the seasonal influences should have caused the peak to be in late August. However, it is now rife in the Western NSW aboriginal community, where continued spread is inevitable. The NSW Government currently expects the peak new infections to occur by mid-September. So far, Victoria hasn’t also been able to supress the Delta strain.

Professor Sir Andrew Pollard, director of the Oxford Vaccine Group, when giving evidence in early August to the UK’s All Party Parliamentary Group on COVID-19, admitted that herd immunity was “mythical” with the Delta strain^[1]. People who have been immunised or have been previously infected can still catch the virus and infect others. This was obvious in Mumbai in March and reported in Misplaced Coronavirus Complacency^[2].

For people who had been infected with the Alpha strain in England more than 180 days prior, the probability of being reinfected with Delta has been calculated at 237% higher than the probability of being infected with Alpha, which was 50% more infectious than the original strain. For those who had more recently been infected with Alpha, the probability was 79%^[3].  The New England Journal of Medicine reported that the Pfizer vaccine initially has an effectiveness of 88% after two doses and the AstraZeneca vaccine – 67%^[4]. Unvaccinated people, however, have about 25 times the probability of hospitalisation and death from Delta than recently vaccinated people^[5].

Because of the Delta strain, everyone will eventually become infected COVID-19. Evidence from Mumbai suggests that because it is likely that even more infectious strains^[6] will follow, people will eventually get infected more than once, irrespective of their vaccination status. Therefore, governments around the world must now plan their strategies to deal with endemic COVID-19. Pandemic-type restrictions can only work to slow the RI infection rate down sufficiently to enable hospital systems to cope while vaccination levels are maximised. 

Angela Merkel has announced that free COVID-19 testing will end in Germany from 11 October^[7]. Other countries will follow suit. Eventually, coronavirus testing will be done for clinical reasons. So, patients will be tested on admission to hospitals and medical treatment centres, during treatment and upon discharge. Serology testing, such as that used in Australian sewerage treatment plants, will be used to keep track of the extent of the community spread of the virus.

Endemic COVID-19 has implications for the actuarial profession. It means that there will be waves of strain on medical and hospital systems and higher mortality and morbidity rates. Fortunately, reasonably healthy vaccinated people, on being infected with the Delta strain, will mostly only have symptoms of a head cold; stuffy nose, headache, sore throat, and cough. Some, usually those with underlying medical conditions, will develop more severe illnesses. For a small number of cases, it will still be fatal.

Hospital systems

Public hospital systems will come under stress with each new highly infectious strain of COVID-19. So too will private hospitals. Already in NSW, at least two private hospitals are accepting COVID-19 patients. The NSW Government modelling suggests that the peak stress on the hospital system will be around mid-October. Staffing will be a critical issue. Doctors and nurses will catch COVID-19 due to their continual exposure to it, despite their personal protective equipment. Although nearly all of them won’t get seriously ill as they have been vaccinated, they won’t be able to continue their professional duties for fear of infecting other hospital staff or non-COVID patients. The second critical issue will be COVID-19 intensive care beds and the third COVID-19 ward beds.

Plans have been made to turn operating theatres into COVID-19 intensive care wards and provide ward type COVID-19 treatment facilities outside of the hospital environment. Already, thousands of NSW COVID-19 patients are being treated successfully at home. But that also takes staff. Nurses attending homecare patients can still catch the virus.

Some staff of co-located private hospitals have already been seconded to their co-located public hospital. But wider secondment is occurring. To get JobKeeper funding, private hospitals had to agree to staff being deployed elsewhere if required. Elective surgery is almost completely unavailable in public hospitals. Private hospitals are now getting substantial bookings from the public system, particularly those whose staff haven’t been seconded. Also, as occurred in 2020, private hospitals with intensive care facilities are preparing to take overflow from the public system.

Adapting to endemic COVID-19

Hospitals will prepare for future outbreaks of COVID-19 infections much in the way they prepare for the flu season. Although new strains could spread rapidly through the population at any time it is likely that peaks will occur in the mid-winter to mid-spring season. Almost certainly a booster COVID-19 vaccine will be a component of the annual flu vaccine administered in Autumn. For the next few years there will have to be a dedicated COVID-19 ward in most public hospitals.

Oximeters will become standard first aid equipment in home medical cabinets for those who don’t have a smart watch with an oximeter. People will be encouraged to monitor their blood oxygen levels, particularly when they have symptoms of COVID-19. Medical advice will be to get to hospital if their blood oxygen levels have been consistently below 97% (say) for some hours or have dropped below 95% (say). Fitness levels, age and co-morbidities will temper such advice.

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