COVID case numbers exploded in the Hunter and across NSW on Friday, but University of Newcastle associate professor Nathan Bartlett says the nation is in as good a position as possible to deal with the surge.
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The viral immunologist answered the Newcastle Herald's questions on Friday, soon after NSW announced a record 21,000 new cases and the Hunter 1983.
Presumably we'll miss a lot of cases now we're only testing people who are symptomatic?
"Yes, that's right. I think we've moved beyond that point now. It's just not feasible to identify every single case.
"The PCR testing is just not able to cope with those sort of numbers. Now it's just about implementing the measures to have some control over those numbers. It's about just regulating the rate of increase just to make sure it's not going to spike to the point where it's going to overburden health care systems. It's about making sure vulnerable groups are protected, people in aged care settings, disability et cetera as circulation inevitably goes on."
What do you make of the new definition of close contacts being limited to household members?
"I don't think the government had much choice, really, because the current definition was putting so many people out of action. It was essentially like a lockdown. Essential workers were forced to stay at home so systems were breaking down. Something had to be done to relax those constraints."
How worried should people be?
"It was going to get out eventually, but we've delayed it certainly far beyond what other countries have done. That's put us in a position to try to regulate those numbers a little bit by the reintroduction of some measures like the QR check-in codes and masks.
"Perhaps the numbers around PCR testing could have been predicted that that system would have been overwhelmed, but again I guess that was one of those things that had to happen.
"We've got one of the highest vaccination rates in the world and the booster program is well under way."
Is it fortunate that the variant of the virus causing a massive spike in case numbers is relatively mild?
"We need to be a bit careful there. We still don't have firm data on whether omicron is milder than delta. That's not to say delta has gone away, either. A lot of the numbers are being driven by omicron, but delta is still out there.
"It's a different phase in terms of understanding the capacity of this virus to cause disease in the background of very high population immunity. That was not the case 12 months ago. That changes the whole equation. We all have some level of immunity, so that's going to alter the disease potential of omicron.
"We still don't know if you were to take a completely non-immune group and compared delta to omicron, whether one's more or less pathogenic than the other.
"Certainly in the current situation where there's a good level of immunity in the population, yes, omicron does appear to be less severe. How much of that is due to the virus and how much is due to good levels of immunity we don't know. It's likely to be both."
We've had 44,000 positive tests in NSW in the past three days. Some of those tests are from days ago. When can we expect a proportion of those people to end up in hospital?
"You're looking at about a week to first symptoms and determining whether you're going to become severe enough to end up in hospital, so you'd start to be seeing those hospital rates increase if there was an impact on disease severity.
We're really going to know in the next week or two whether this spike in cases we're detecting now is going to have a knock-on effect.
"We're really going to know in the next week or two whether this spike in cases we're detecting now is going to have a knock-on effect. Presumably they are.
"If you look at hospital numbers, they are slowly creeping up. They're not jumping up proportionate to the number of cases, which suggests the vast majority of us are being protected from severe disease.
"Those numbers will keep going up. Even if this virus is going to cause less disease, if you have enough people infected, you're still going to see large numbers of hospitalised people."
Hospital admissions jumped up again to 832 in NSW on Friday and to 35 in the Hunter. Will the hospital system be overwhelmed?
"I don't think so. The numbers are nowhere near what were in the previous wave in terms of hospitalisation. We're much better placed to handle this now."
The ratio of PCR tests coming back positive has gone above 14 per cent, or about one in seven. In England the positivity rate is almost one in four. Is 14 per cent an accurate picture of where we're at?
"It's probably higher than that. A lot of people just aren't getting tested because they can't. A lot of people are testing positive on rapid antigen tests and just staying home saying, 'I know the drill. I'm going to isolate and get tested a week later.'
"Some people just can't get tested by PCR. If you feel ill, you're not going to want to sit in a car for six hours waiting. You physically wouldn't be able to. Some people are just accepting that they have COVID: 'It was bound to happen. Why go wait in a PCR queue? It's going to confirm what I know already.'
"The concern would be if you were an at-risk person. If you had an underlying health issue, you should definitely contact your GP, and they will be able to advise you whether you need to go to hospital or confirm that by PCR. You may be needing to take some other treatments to protect you from the higher risk of developing disease. For those people, chronic diseases, cardiovascular diseases, diabetes, pregnant women, certainly the elderly. You would have to take additional steps."
If someone develops COVID symptoms, is it reasonable for them to take a RAT and manage the illness at home?
"The advice is, if you're symptomatic, you should get a PCR test. However, if it's not feasible for you to do so, then people are openly saying in the media, 'I'm not going to bother.' I think people are making those fairly sensible sort of decisions that they'd rather their spot in the queue goes to someone who needs it more."
We're moving very much away from a system where the government monitored people and fined them for breaking isolation to one where people are managing their own illness?
"We have to. The system can't cope with these sort of numbers. When we were dealing with hundreds of cases a day, you could do that. We had the resources to individually have a conference with a positive person, check that they're isolating, all that stuff.
"When we're talking tens of thousands, it's just physically impossible. This is a new phase, moving towards living with COVID where we're now accepting that there's going to be very high transmission of this virus and we need to understand what resources we have to manage that. A lot of this is now about people taking ownership of their infection and behaving appropriately."
Should the elderly be moderating their behaviour?
"Absolutely. Any vulnerable group needs to be cautious in the current scenario with the huge amounts of virus transmission. I would suggest very much limiting socialising and exposures to people you don't know at supermarkets and such. Anyone at high risk.
"Certainly age has a direct relationship to developing severe disease, certainly beyond 60. And certainly beyond 75, 80 much higher risk of developing severe disease, as you are with any respiratory virus. Anyone immunosuppressed, having cancer treatment. If you do go out, wear a well fitted mask, get in and out quickly."
Is there any overseas evidence yet pointing to how long this wave may last?
"It's impossible to say. It will come down to how our population interacts, how our systems work. Every country will be unique. It's summer here, whereas it's winter in the northern hemisphere. All of these factors will play into how long this goes on for. Will we flatten the curve and drag it out longer or are we going to get more of a spike? It's uncharted territory."
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