Before we can plan for the future, we need to understand what it will look like.

It seems to me that one of the current problems with the way Australia is planning for the future of the COVID-19 pandemic at both Federal and State level is the way in which that future is being understood, both by those in power and by the citizenry in general. Sometimes I think that what I perceive to be implicit and explicit misunderstandings or misapprehensions are views that individuals genuinely hold. Sometimes I think the suppositions underlying the views being expressed merely suit the political inclinations of those speaking; that they do not really believe the implications or presumptions of what they are saying, it simply being the case that the position they are presenting is advisable from a political point of view. Either way, it is a problem. If we are to respond to the virus appropriately over the next few months, there needs to be a collective acceptance and understanding of the way COVID-19 is going to unfold over the next few months, particularly now the delta variant has become predominant. In my view the following points go relatively unacknowledged in current public discourse. Nevertheless, I also think them to be unconvertible.  

1. There is no possible future where COVID-19 is not endemic to Australia. 

In the early days of the pandemic, Australia was incredibly, almost incomprehensibly, lucky. The idea that a novel corona virus with pandemic potential could emerge in Wuhan, spread in the manner that resulted in extensive infections in Europe and America, but not Australia, continues to be a remarkable turn of events. The initial Australian response was no different to that of the USA or Europe. The fact that this is a relatively isolated island continent of <26 million people certainly contributed to our ability to keep the virus out once we effectively closed our international borders. However, our luck ran out when it came to gambling on vaccine development. It ran out during the vaccination ‘stroll out’, and it ran out with the advent of the delta variant. Even so there was no future where SARS-COV-2 would not become ultimately become endemic to Australia. Unless we instituted extensive quarantine requirements and built dedicated facilities to facilitate them, it is simply not possible to keep out a virus that is endemic in the rest of the world. It now seems likely that the delta variant will undo any such facilities, even if we had elected to construct them. 

More than this, it now seems clear that it will not be possible to bring the current extended outbreak in NSW to an end. Sydney will never again be COVID Zero. Consequentially, SARS-COV-2 will inevitably become endemic to NSW. There is an outside possibility that the ACT and Victoria will again reach COVID Zero but I do not think it a realistic one (and, at the time of writing the Victoria Premier, Dan Andrews, seems on the cusp of abandoning the COVID Zero Strategy). As a result, it is also inevitable that SARS-COV-2 will become endemic to the ACT and Victoria. Once it is endemic to NSW, the ACT and Victoria, it will become endemic to SA, WA, NT, Queensland and Tasmania. This is the near future reality for COVID-19 in Australia. As such, there is every reason to suppose that virtually all individuals will, at some point, become infected with SARS-COV-2. Ultimately, it will be as unavoidable as the flu or the common cold and, eventually, about as worrisome. 

2. Vaccination will not completely prevent infection or transmission. 

As the above suggests, the vaccinations we currently have are not going to prevent individuals from becoming infected with SARS-COV-2. Infection of individuals cannot be prevented by vaccination; vaccination can only result in a more rapid and more effective immune response. In ideal cases, this response will be so quick it will prevent an individual from becoming infectious, meaning that it will not be passed along. This is not the case for COVID-19 vaccinations. As a result, it will not be possible to eliminate SARS-COV-2 from the human population or any subpopulations. The kind of ‘herd immunity’ we can produce through the use of childhood vaccines like MMR is unachievable when it comes to SARS-COV-2. Some kind of herd immunity is achievable, but only in the sense of lowering transmission rates. This kind of herd immunity is a matter of reducing the length of time that individuals are infectious. SARS-COV-2 is here to stay. The simple fact is that the global elimination of a virus has only been achieved once, in the case of Smallpox. It may shortly be achieved for the second time, in the case of Polio. However, both of these diseases are very different to SARS-COV-2 and it is entirely unrealistic to suppose that elimination can be achieved in relation to the latter. It cannot be achieved and, absent a significant development in vaccination or our ability to combat viruses and viral infections, it will not be achieved. 

The implication of this is that, over the long-term, everyone will eventually become infected with SARS-COV-2. Vaccination will lower the incidence of severe cases and, therefore, of hospitalisation and death. It should also lower the rate of transmission. Nevertheless, everyone should expect to contract COVID-19 at some point. Those who have been vaccinated, and those who were already in lower risk groups, have little to worry about. Indeed, for most, the result of being infected with SARS-COV-2 is akin to vaccination; it will further improve our immune response and, therefore, our ability to respond to future encounters with the virus. Given this is the case, and the fact that vaccinated individuals have the strongest immune response around a month after their second vaccination, it is arguable in the interests of individuals to become infected around this time rather than, say, six months or a year later. However, this is not a point that can realistically be accommodated within a public health strategy. 

Certainly, like any post viral syndrome, long COVID remains a concern. However, we do not really understand post viral syndromes and we are unlikely to suddenly discover how to prevent them. Consequentially, the possibility that some will experience long COVID cannot substantially alter our response. The spread of the virus is inevitable and whilst there are various ways in which its spread throughout a population can be slowed, it cannot be prevented. As such, long COVID is simply a consequence that we are going to have to live with. 

3. The present moment is about transitioning our strategic response to COVID-19. 

Our early good fortune in the spread of SARS-COV-2, as well as the geography of our island continent of (only) 26 million people, has meant that COVID Zero was a realistic strategy for the first 18-20 months of the global pandemic. There have, of course, been significant costs. Melbourne, for example, is the world’s most locked down city and we should be endlessly grateful to those who live there and the way in which they have borne the costs of preventing the spread of COVID-19 across Australia. It is, however, clear that COVID Zero is no longer an achievable goal. That does not mean we should immediately abandon the strategy. The end goal might be unachievable but the way in which we have pursued that goal— by lowering rates of infection and slowing the geographic spread of the virus—continues to be worthwhile pursuits. 

However, given the need to change our end goal, these means might be pursued in different ways. Lockdowns have costs. These costs are highly varied. They can be mental, interpersonal, developmental and educational. They can be professional, financial and economic. Balancing these costs is not easy. The idea that lockdowns prevent death, and that death is something that must be prevented at all costs, is powerful. However, we do not commonly prevent death at all costs. Certainly, we seek to prevent preventable deaths and avoid avoidable deaths. But we still drive cars and we do not lockdown for flu. We drink alcohol, consume sugar and whilst fewer and fewer of us smoke, we still permit the sale of cigarettes. Whilst it is a case of comparing apples and oranges, that is the kind of task we must face up to. 

Whether or not the costs of lockdown are justified is related to the goals we are trying to achieve. Reaching COVID Zero in order that we can continue as before offers one kind of justification. Attempting to delay the spread of SARS-COV-2 so as to achieve a particular level of vaccination in the population offers a different form of justification. Given COVID Zero is no longer a realistic goal, the expectation that lockdown will simply end and not reoccur is an illusion. Therefore, the costs imposed by lockdowns should be scrutinised and careful consideration should be given to the ways in which they can be mitigated. In short, we must replace hard lockdowns with smart lockdowns. Asking everyone to stay home until the end of the year, and perhaps beyond, is not tenable.