Covid booms as Christmas looms

| December 22, 2021

Jaya Dantas is Professor of International Health in the School of Population Health at Curtin University

Should we be tightening rather than relaxing restrictions? What can people do to reduce their risk over Christmas?

“There is a clear need to convey accurate community messaging to separate public health measures from lockdowns. The increase in breakthrough infections due to the Omicron variant among the vaccinated highlights the need to use masks, maintain social distancing, continue hygiene measure, avoid large gatherings, where possible have family gatherings outdoors and ask if family members and friends are vaccinated.

Public Health departments need to continue with Testing, Tracing and Surveillance and enhanced cleaning and ventilation of schools and offices.

We need as a priority to roll out Antigen testing at very low costs across states that are seeing a spike in cases. The large numbers of people needing to be tested waiting over five hours for a swab is unsustainable and creates a huge strain on testing laboratories, reagents, and staff.

Whilst Pandemic Fatigue has set in we cannot let our guard down, relaxing public health measures or refusing vaccinations or boosters.”

Is contact tracing pointless if it is not keeping up with this number of cases?

“We have done well in Australia with our contact tracing – our population is small as compared to other countries like the UK and Canada and we must try and continue with contact tracing through contact register and the Safe Apps.”

Are hospitals able to cope with the rising rate of infections?

“If there is a huge increase in cases that are severe and need hospitalisation then hospitals will not be able to cope as our health workers are already stretched, and are working long hours. We need to allow those who can manage isolation at home to do so. A just released MJA editorial states that from the published data and experience from other countries it is clear that high vaccination rates alone will probably not be enough, and other forms of public health measures should continue into 2022 if major surges in COVID‐19‐related hospitalisations and deaths are to be avoided.”

Is Omicron actually milder than Delta or other variants on COVID? What is the evidence and is it good?

“At present we do not know this as when the Delta variant spread across the world most countries were not vaccinated. With Omicron many developed countries have populations with two vaccines, developing countries partially vaccinated and/or with antibodies from COVID infections. And it can take up to two months to view the impacts of the Omicron variant on disease severity, hospitalisations, ICU presentations and impacts on people with co-morbidities. We know it has spread to over 90 countries in four weeks, there is an increase in breakthrough infections among the vaccinated

Should we be bringing boosters forward from 5 months? Should we change the definition of ‘fully vaccinated’ to include 3 shots?

“We should bring the boosters forward to 3-4 months and yes at this stage we change the definition of ‘fully vaccinated’ to include three shots with perhaps the caveat that vaccines will need to be reviewed if new variants emerge.””

Professor Adrian Esterman is Chair of Biostatistics at the University of South Australia

“In my opinion piece for The Guardian, I described the current situation in NSW as akin to “Alice in Wonderland”, where up is down and down is up. They have record case numbers, with the epidemic curve looking like the North Face of the Eiger mountain, so they decide to remove public health measures!  Both Scott Morrison and Brad Hazard keep saying that the number of cases is no longer important – it’s hospitalisations we need to focus on. Well guess what – hospitalisations in NSW are going up, which is no surprise given the massive number of cases.

They also forget that up to a third of infected people end up with long-term health problems, aka Long-COVID. UNSW modeling shows 25,000 daily cases by the end of January, and if only half this rate occurs, NSW hospitals will be in crisis.

There are currently conflicting reports as to whether Omicron is milder than Delta, however, the WHO recommend that we proceed with caution until we get more information about the severity of Omicron, i.e., don’t remove public health measures.

Full vaccination (either AstraZeneca or Pfizer) appears to give little protection against Omicron infection, although it still protects against severe illness and death. Those at risk, especially the elderly, urgently need booster shots to give protection against infection. ATAGI are currently meeting yet again to decide whether to reduce the time after second dose that people can have their booster. There is simply no reason why this interval can’t be reduced from 5 months to 3 months. In the meanwhile, thousands of people will get infected needlessly.

One way of protecting others at Christmas is to give yourself a rapid antigen test before family gatherings. Unfortunately, they are not available in shops or pharmacies in South Australia – I have no idea why! Which really speaks to the desperate need for an Australian CDC where we can have national regulations about testing, close contact rules, etc.  New Year’s resolution for Scott Morrison?”

Professor Fiona Russell is a Senior Principal Research Fellow focusing on infection and immunity and Group Leader of Asia-Pacific Health at the Murdoch Children’s Research Institute and The University of Melbourne.

“Omicron is so fast moving that we will all get infected at some stage as the vaccines are less effective against infection. Within a very short time, Omicron became the dominant variant in London.

However, Omicron appears less severe in several provinces in South Africa. The percentage hospitalised was far less for Omicron than previous waves for all age group including children.

The reason for this is unknown. It may partly be due to the high percentage of people having previously been infected (natural immunity) as vaccination coverage is only less than 40 per cent. But it may also be due to a less virulent variant causing milder disease. Many hospitalisations were in the unvaccinated.

In Denmark (whose surveillance aims to capture and sequence every case), Omicron cases have skyrocketed. Early indications (in a country with high coverage of Pfizer) suggests 60 per cent fewer Omicron hospitalisations than Delta. However, this is early days and there is considerable uncertainty.

We are still awaiting data from the UK on how well AstraZeneca performs against severe disease which is relevant for our context. In the UK, many people have also had prior infection. So far, data analysis has only been released on a very small dataset (24 Omicron hospitalisations) which is clearly insufficient but further analysis will be forthcoming.

Vaccines have been shown to be less effective against symptomatic infection- for AstraZeneca this is very low to 0. But we will all get infected with Omicron because reinfections are so common anyway, with or without vaccination. The most important focus right now is how well does it protect against severe disease.

This is critical to know for planning and what the public health responses need to be. The vaccine effectiveness following 2 doses of Pfizer against hospitalisation is about 70 per cent down from ~90 per cent with Delta. For AstraZeneca we do not know as yet. Lab data shows reduced neutralising antibodies against Omicron. But, this is only one part of the immune system. T cells also protect us too and this is less affected by Omicron.

We will have lots of infections and it is likely we will have more hospitalisations because of it- the extent of this is unknown. The majority of the people hospitalised will be unvaccinated and the clinically vulnerable. We still have 10 per cent of the eligible population unvaccinated- this is a lot of people. They should be encouraged to get vaccinated.

The majority of people who received AstraZeneca are over 60 years and/or clinically vulnerable. Most of them should be due boosters about now and in January. This group needs a booster now, if they have had their 2nd shot 3+ months ago. ealthcare/frontliners should get a booster if they have had their 2nd shot 3+ months ago.

For the rest of the population, they are at lower risk of severe disease. Most of them would have had Pfizer which has 70 per cent effectiveness. We need to understand that we will all get infected at some stage whether we are vaccinated or boostered. This is clear. In the face of considerable uncertainly we must focus on the clinically vulnerable and those at high risk. The main focus has always been to prevent serious disease and death. Anything else is a bonus.

To reduce infections and the likely increase in hospitalisations over the holiday period where there are more parties and social gatherings, some public health and safety measures are needed in the short term. Wearing a mask inside, socialising outside, social distancing, improving air flow etc. Engaging the community in why these measures are important is critical. These must be wound back as soon as further information is known. This will not only help everyone stay healthy over the holiday period but also protect the vulnerable and take care of our healthcare workers.

Because there will be so many infections, the contact tracers will not be able to keep up. PCR testing in UK is also maxxed out, so using cases as a guide will no longer be possible. The focus on outbreak testing should be the high risk nursing homes. Seroprevalence surveys to determine the percentage of the population infected are way overdue and more relevant than ever. More use of RAT testing for large events is needed moving forward.

We need publicly available hospitalisation, ICU, and death data broken down by age and vaccination status.”

Dr Andy Flies is a Senior Research Fellow at the Menzies Institute for Medical Research, University of Tasmania

“The ATAGI recommendation of five months before receiving a booster shot (3rd shot overall) is based on the best available evidence. However, as many clinical trials are ongoing, the best current vaccination regimens cannot be considered optimised due to the limited availability of direct comparisons between vaccines, timelines, and new variants of concern.

Shortening the time between booster shots could be helpful, particularly for people who received the AstraZeneca vaccine initially. A limitation of the AstraZeneca vaccine is that the immune system makes antibodies that neutralise the AstraZeneca vaccine before it can produce the coronavirus spike protein. This is one of the reasons that a longer interval between doses one and two was recommended for AstraZeneca compared to mRNA vaccines. This limitation of pre-existing immunity to the vaccine itself is largely removed for people that switch from AstraZeneca to the mRNA vaccines for the booster.

In summary, a shortened interval between the initial doses and the boosters, except for the case of three AstraZeneca doses, would likely be beneficial in the short-term but might not be the most cost-efficient way of using limited vaccine supplies. Most of the world is still waiting for their initial vaccines; sharing vaccines with developing nations is important for reducing the risk of future breakthrough SARS-CoV-2 variants like Omicron. “

Professor Tony Blakely is an epidemiologist and public health medicine specialist from the Melbourne School of Population and Global Health at The University of Melbourne.

“Should we be tightening rather than relaxing restrictions? Certainly not loosening.  Mandatory indoor masks required, and bringing forward of time from primary vaccine to booster to 4 or 3 months (as otherwise AstraZeneca recipients are penalised).”

Are hospitals able to cope with the rising rate of infections?

“Yes – to a limit.  We are well beneath those limits now.  Previous modelling for VIC and NSW inferred the tolerable limit is 2000 people in hospital on any given day – not that we want to get to that.  Omicron is probably between 10 per cent and 50 per cent as virulent (per infection) as Delta (i.e. hospitalisations per infection [not per case notified, as many are asymptomatic, etc]).  So, it seems likely that a higher infection rate in a given state will correspond to a lower hospitalisation rate.

For example, in recent times 1000 cases per day of Delta roughly equates to 300 to 500 people in hospital on any given day (in 10 days’ time due to lags).  We do not know what that ratio is yet for Omicron, but if my estimates are roughly correct, then 1000 cases of Omicron will translate to 50 to 250 people in hospital on any given day.  These estimates will firm up in future weeks.  Moreover, as we get boosted, this ratio may fall further (i.e. assuming boosters prevent hospitalisation even more so than any infection – but we have to wait and see).”

Is Omicron actually milder than Delta or other variants on COVID? What is the evidence and is it good?

“The estimates are still vague.  South Africa puts it at 10 per cent as virulent as Delta, and recent Imperial College London estimates at 70 per cent as virulent (but I suspect this is over-estimating the risk due to Omicron being more likely to be asymptomatic, and the UK analyses were (necessarily) just on those notified cases).  The evidence will firm up in the next 1 to 2 weeks.

Perhaps the most important evidence will be on hospitalisation rates in countries with similar vaccination infection profiles to Australia.  So far, hospitalisations are not taking off to a great extent in those countries experiencing Omicron.”

Should we be bringing boosters forward from 5 months?

“Yes.  Boosters greatly increase protection against any infection from Omicron, and (we assume – and immunological studies cross-walked to epidemiology by Imperial College) probably even protect better against hospitalisation. At a minimum, 60+ year olds and those who received AstraZeneca should be able to get boosters after 4 or 5 months, as AstraZeneca (two dose) appears to offer less protection than Pfizer (two dose).

AstraZeneca recipients are now being penalised by the extra 2 months they had between vaccine doses in their primary course, meaning many of them are less than 5 months since their primary course. Elderly people primarily received AstraZeneca – and will benefit most from boosters.”

Should we change the definition of ‘fully vaccinated’ to include 3 shots?

“Not right now (during Xmas), but yes – in early January.”

Is contact tracing pointless if it is not keeping up with this number of cases?

“Contact tracing can still play an important role.  It will increasingly need to be targeted to higher risk contacts, so as to maximise its benefits as case numbers exceed what contact tracers can manage.”

Professor Sarah Palmer is the Co-Director of the Centre for Virus Research at The Westmead Institute for Medical Research and Professor in the Faculty of Medicine at the University of Sydney

“A more cautious approach is warranted due to the infectiousness of the Omicron variant. Testing centres are already strained and will become more so in the weeks ahead. We will need to closely monitor hospitalisations which will increase.

More widespread mandatory mask wearing, use of QR codes and contact tracing are simple but effective steps for mitigating this unprecedented uptick in COVID-19 infection. Making boosters much more widely available would be another measure to address the rapid spread of the omicron variant. “

Alexandra Martiniuk is a Professor of Epidemiology at the University of Sydney

“We should currently be tightening the COVID19 restrictions (protections) rather than relaxing them.

Because data on the Omicron variant is still emerging in terms of virulence (severity) we cannot know for certain how our hospitals will be able to cope with the rising number of COVID19 infections as we do not yet know what proportion of cases are likely to need hospital/ICU.

What we do know is that our health care workforce is burnt out and needing a break. I know of several clinicians in hospitals in Sydney saying they are very short staffed due to colleagues needing to isolate due to COVID19 close contact.

With Omicron, it is anticipated that an extremely large number of infections will occur, so estimates – if done with lesser severity than Delta for instance – still show extremely large numbers of people needing hospital at the same time. Recalling that children are still not vaccinated and we still do not know how severe Omicron is for kids.

Data emerging on Omicron severity are variable. Some studies are showing Omicron causes more mild disease, other data is saying Omicron has the same severity as Delta and yet others are saying Omicron has the same severity as the original (Wuhan) strain.

Severity of disease depends on multiple factors (the variant in itself, as well as the context -vaccination, previous infection, age and underlying factors like chronic disease or malnutrition as well as the availability of treatments affecting outcomes).

We still do not have a good understanding of the protection of vaccination against severe disease/hospitalisations -especially for sub-groups (by age, months post dose, number of doses, brand).

Until we have more robust data on severity, as well as a better understanding of how well vaccines protect from severe disease— we cannot know for certain how Omicron case numbers will translate into hospitalisations, ICU need and deaths in Australia.

We should exercise care in the lead-up to Christmas and avoid New Year’s Eve potential superspreading events and take care in January as well. We also need to start thinking about schools returning in late January.

If cases rise very high healthcare workers are also likely to be infected or isolating due to contact with cases, meaning health systems risk experiencing a ‘collapse’ of staffing even if Omicron is not severe. Remember also that heart attacks, strokes, asthma attacks, diabetes, injuries… don’t stop either. Managers at hospitals overseas say they can barely make up 24hr clinical staffing rosters as people are getting infected with Omicron so quickly they cannot anticipate who is available to work shifts at the hospital.

It’s been justified by some that the lockdowns happening overseas do not reflect the situation in Australia because we’re not heading into winter and we have a high double dose vaccinated country, however the weather and double dose protection are not the only considerations.

From what I’ve seen from colleagues globally, the situation is not good. Public health restrictions must remain, and boosters must be given as soon as possible (some countries overseas have opted to give boosters at 3 months post 2nd dose (which means ramping up capacity), kids vaccines (5-11yrs) need to be rolled out ASAP, rather than wait until January 10 if supplies are on shore.

We need to improve ventilation, masking, restrictions on venue capacity. Testing and contact tracing are all required. Bring back QR code check in’s, and venue alerts. We need more testing centers and if possible increase our lab capacity to turn tests around quicker (some people are currently waiting up to 4 hours to be tested and then 1-3 days for results and rapid antigen tests are sold out in many locations).

Even in the face of high case numbers, contact tracing can help to ‘bend the curve’ downwards, slowing the influx of cases and reducing the hypothesised surge upon hospitals. Slowing/reducing any potential surge can save lives.

It is not time to panic. But to prepare. Omicron may turn out to be ok, or not. It is the time to err on the side of caution until we know more and until our booster rates are high.”

Professor Raina MacIntyre is Head of the Biosecurity Program at the Kirby Institute at the University of NSW. She is an expert in influenza and emerging infectious diseases.

 “Should we be tightening rather than relaxing restrictions? Tightening is a value laden term. People conflate minimally intrusive but highly protective measures such as masks and QR codes with lockdown. So in NSW, for example, while cases are surging to unprecedented levels, people are Christmas shopping maskless and partying in poorly ventilated venues, while ATAGI drags its heels on shortening the interval to the 3rd dose.

We need to uncouple lockdown from other measures if we are to come out on top during this pandemic, which is nowhere near over. This means accepting that we need to use masks, testing, tracing, ventilation and other measures for the foreseeable future. Magical thinking and denial sees many countries dropping all measures, and then going into lockdown when COVID surges and starts overwhelming the health system – a rinse and repeat cycle.

We have had enough time to surely learn that a vaccine-only strategy is not enough, and that if we drop all other measures and pretend it’s 2019 again, it will not make it so. It will only end badly.  OzSAGE has provided advice on avoiding catastrophe in NSW which may be helpful.

Are hospitals able to cope with the rising rate of infections?

No. Anyone who works in a hospital in NSW will tell you they are already having emergency meetings and large numbers of staff are furloughed. We have seen a cycle of dropping of all restrictions and then lockdowns. It’s time to learn the clear lesson that maintaining a constant level of measures like masks, testing, tracing and ventilation is the only chance we have of avoiding lockdowns.

Lockdowns occur when the health system cannot cope. We are seeing lockdowns in Canada, in The Netherlands and other countries so we need to stop believing we are somehow exceptional. Health workers are burnt out, suffering from long COVID and leaving the health system in droves.

The things we take for granted, like being able to get an ambulance quickly and get treated quickly if we have a heart attack, are all under threat. NSW Health is already preparing us to turn our homes into hospitals and to manage our COVID ourselves – they released an infographic saying if you are under 50, manage your COVID at home.  This is the end result of ‘personal responsibility’. What next? Buy your own home oxygen and have no expectation of healthcare as a right?

Is Omicron actually milder than Delta or other variants on COVID? What is the evidence and is it good?

It is too soon for making definitive judgements, as the data are mixed from different countries, and there are no peer reviewed studies yet. Data from South Africa suggest it is about 29 per cent less severe, but data from the UK suggest no difference from Delta.  Any reduction in severity will be cancelled out by the substantial loss of protection of 2 doses of vaccine against symptomatic omicron infection.

What can people do to reduce their risk over Christmas?

OzSAGE has released Advice on a safer Christmas and festive season.

Should we be bringing boosters forward from 5 months?

Absolutely. It is urgent as an epidemic control measure. Australians are sitting ducks with only two doses, and waiting 5-6 months means the Omicron epidemic will peak with only a small fraction of Australians optimally protected with three doses.  That is why other countries are shortening the interval.  It can be given safely and effectively any time from 2-6 months after the second dose. Given states like NSW are abandoning most control measures, people are terribly vulnerable having to wait longer for dose three.

Should we change the definition of ‘fully vaccinated’ to include 3 shots?

Yes, state and federal governments have promoted “double vaccination” as the end game, which will give many people a false sense of security. We need people to understand that they are not well protected against omicron with two doses, especially if they had two doses of AstraZeneca. Most people had the interval shortened from 12 to 6 weeks for AstraZeneca to speed up vaccination during the Delta epidemic – this means they will be less well protected.

Data from the UK suggest there is virtually no protection against symptomatic infection after two doses of AstraZeneca, and about 34 per cent after two doses of Pfizer. The Pfizer and AstraZeneca both wane substantially by 6 months, and also lose protection against Delta due to waning. So we need people to know it’s not over and they need their 3rd dose.

Is contact tracing pointless if it is not keeping up with this number of cases?

No. If we have 3000 cases today, those cases will have 30-60,000 contacts, and the contacts are the most likely to become the next tranche of cases. If we don’t find the contacts, alert them and ask them to test and isolate, the epidemic will explode.

Contact tracing is a pillar of epidemic control, and it defies logic when we have invested in the infrastructure for digital tracing to throw it all away. That is precisely what QR codes are for – to allow automated notification when case numbers are too large to keep up with manually.  If we throw it away, cases will surge even more resulting in avoidable illness and death.”

Dr Abrar Chughtai is a lecturer and the director of the Master of Infectious Diseases Intelligence (MIDI) program in the School of Public Health and Community Medicine at UNSW Sydney

“Easing restrictions were justified before emergence of Omicron variant, however we should be cautious in the current situation. Even if Omicron causes mild illness (this is yet to be proven), high numbers of cases may lead to more hospitalisations, which will overwhelm our health system.

This is a simple math and government does not need sophisticated modelling studies to prove this. Therefore governments should keep some restrictions (e.g. avoid large gatherings, mask use etc) to avoid rapid spread and large epidemics, resulting in lockdowns. Previous data suggested that these preventive measures avoided lockdowns in Australia and other counties.”

Are hospitals able to cope with the rising rate of infections?

“We should look at real time UK and US data. The number of hospitalisations are increasing gradually after an increase in the number of cases. Note that hospitalisation is a lagging indicator and soon we will see an increase in hospitalisation in NSW as well.”

Is Omicron actually milder than Delta or other variants on COVID? What is the evidence and is it good?

“Currently there is limited data from South Africa and the UK. South African data showed mild illness but this may be due to the young population which exhibit mild illness. The impact on the aging population may be different as COVID cause more severe illness among the elderly. Thus, the UK may be a better comparison for Australia and we are seeing a rise in hospitalisation in UK due to Omicron.

What can people do to reduce their risk over Christmas?

“Three main things to do are, get a booster ASAP, use masks for indoor gatherings, and avoid large indoor gatherings and arrange large family gathering outside.”

Should we be bringing boosters forward from 5 months?

“There is limited evidence on the timing of boosters and countries are adopting various approaches. Some countries (e.g. Canada) is recommending booster after 3 months, some (e.g. Australia and US) are recommending after 5 to 6 months. So there is no harm in bringing forward boosters.

However, boosters will only help some countries and is not a permanent solution. New strains will keep emerging from other countries with high virus circulation due to low immunisation coverage. So we should also promote equitable vaccine distribution and support vaccination in other low resource countries. Eventually, we have to learn living with virus but this is not possible without high vaccination coverage globally.”

Should we change the definition of ‘fully vaccinated’ to include 3 shots?

“In my opinion, it is not needed at this stage. We need more evidence around transmissibility, severity of cases, antibody levels in various groups etc. This is an evolving situation and we need more data to decide on this. That is why we should use masks and some other restrictions to slow the spread till most of the population get a booster.”

Is contact tracing pointless if it is not keeping up with this number of cases?

“At this stage, contact tracing is still helpful to prevent large epidemics, but we need to develop new/ automated systems for contact tracing and follow-up of close contacts. Already NSW Health started some good initiatives to automatically notify positive cases and to promptly identify high risk exposures in hospitals, aged care etc.

If there is a very large epidemic in NSW (like we have seen in some areas of UK, US and India before), contact tracing will almost be impossible and will not be helpful. Then you will have to go for lockdown, which nobody wants now. Mask use and other measures (e.g. avoiding large indoor gatherings) many avoid large epidemics and lockdowns, but should be implemented now. “

A/Prof Jill Carr is a Lecturer and Laboratory Head, Virus Research, College of Medicine and Public Health, Flinders University

“Certainly RT-PCR positive cases are rising but disease, hospitalisations and deaths are not – thanks to the vaccine. The relaxing of restrictions is needed but the public still needs to be cautious about behaviour and vaccination status at large gatherings, masking and physical distancing to reduce their own personal risk and risk to others more vulnerable.

We probably may be better protected against Omicron with a 3rd dose. It’s hard to tell if Omicron is more mild or not, but it is ‘SARS-CoV-2’ and we should avoid catching it.

Testing and tracing is always important to monitor what a virus is doing in the community, but now is probably the time to re-assess how this is done. The public (including myself) will become sick of long wait times, in hot weather, during their holidays to get a test and start to doubt the money invested in this process.”

Ross Gordon is an Advertising, Marketing and PR Professor at Queensland University of Technology and Member of the WHO Technical Advisory Group on Behavioural Insights and Sciences for Health

“Human behaviour is a key factor in the spread of COVID-19. The Omicron variant is spreading fast in Australia and in a way that is different to what has come before. The recent relaxation of restrictions in states such as NSW, issues with the supply and take up of booster vaccinations, and changes in people’s behaviours that helped mitigate the spread of COVID, mean that our current settings are nowhere near optimal.

Already we are seeing some people act with caution and apprehension, especially those with interstate or overseas travel plans, plans for a family festive season, or reliant on work income to get them through Christmas. Catching Omicron would be a disaster for these people. Despite the focus on ‘personal responsibility’ and economic interests by the NSW State Premier, tackling COVID-19 always requires action on the part of both governments and peoples. The current uncertainty and lack of measures are not actually good for business – and people are already voting with their feet.

What we need is a change of course back to promoting behavioural changes that will mitigate the worst effects of Omicron. First, although double vaccination rates are high across Australia, emerging evidence shows that this provides little protection against catching and spreading Omicron. Boosters are essential and we need a huge drive to get as many people a 3rd dose of an mRNA vaccine as possible.

Cutting the gap between 2nd and 3rd doses to four or even three months – similar to other countries such as the UK, is likely. Reopening mass vaccination centres, mobile clinics, and heavy promotion of booster shots will be needed.

Being counted as fully vaccinated will likely change to only those having received three shots – and this requirement will help vaccine uptake. Mask mandates, and bringing back mandatory check ins will also help, as well as returning to the publication of case locations in states such as NSW that have abolished such measures. It is unlikely that contact tracing will now be able to keep up with cases in NSW, but in other jurisdictions this can still be a useful measure.

Despite our hopes for a relatively COVID free Christmas, Omicron had other ideas. The familiar key behaviours of getting vaccinated with boosters, mask wearing, physical distancing, sticking to outdoor environments, hand washing, and testing and isolating when required will be needed more than ever to protect public health.”

Professor Paul Glasziou is from the Institute for Evidence Based Healthcare, at Bond University

“As most epidemiologists are saying, it is too soon to be clear about omicron’s potential impact, so I’d suggest some increased restrictions until data is clear. But possibly the best country to watch for Australia is Denmark.

Of the countries with sufficient duration and numbers of omicron cases – South Africa, UK, and Denmark, – Denmark has the best tracking and is closest in many features to Australia (but with a population similar to Queensland – both in 5 Millions). Their cases have been roughly doubling each day (see ) noting growth from Dec 1 to Dec 14. Without some further restrictions, Queensland’s numbers might be expected to grow to over 3,000 / day by early January.

The somewhat better news is about hospitalisation rates which are lower for Omicron (0.6%) than for Delta (1.5%) but not zero. Note that Denmark also does testing for asymptomatic cases, so detects more cases than most countries and hence the proportion hospitalised will be lower. Denmark has a similar vaccination rate but much higher booster (3rd dose).

Finally, the impact of vaccines on cases, hospitalisation and death is still uncertain but the Danish data suggests vaccines only offer a little protection against infection (A), but good protection against hospitalisation (B).

Dr Karina Powers is a Consultant Occupational and Environmental Physician in Western Australia

“At this time, with a dual wave of the Delta and Omicron variants spreading, enhancing control of the virus through the rapid roll out of even earlier third dose vaccines, safe indoor air ventilation, good quality masks and respirators is simply common sense.

Hospitals are not able to cope with rapidly rising cases in the uncontrolled spread of virus. The resultant moderate to severe disease admissions in a setting of general staff shortages and staff isolation and illness is not sustainable.

Unchecked spread of disease leaves people to die in the streets or homes. We saw this with previous waves.

Uncontrolled spread of disease leaves people who have no immunity to face horrendous consequences. There is no overwhelming body of evidence that says Omicron is milder and even if it is, uncontrolled spread of disease will sink our health services. Many countries have chosen on current evidence to treat Omicron as a threat to National Security and we should too.

‘Fully vaccinated’ is ultimately what the virus shows us to be as fully vaccinated- at the present time our best path is at least three shots.

Contact tracing can be made easier to do en masse with QR codes and digital systems.”

Dr. Vinod Balasubramaniam is a Molecular Virologist and Leader, of Infection and Immunity Research Strength at the Jeffrey Cheah School of Medicine & Health Sciences, Monash University Malaysia

“While the vaccination rate in countries like Australia and UK is relatively high, it is still not enough with the new Omicron variant, where fully vaccinated status should include booster doses (3 shots instead of only 2).  It is also possible that the virus is evolving in response to increasing human immunity due to vaccination, something akin to a selection pressure.

In the beginning of the pandemic, no human had been exposed to SARS-CoV-2 before. That means everybody’s immune systems were equally bad at recognizing the virus. If there had been a variant that was good at evading the human immune system, it wouldn’t have risen to prominence because it wouldn’t have outperformed its viral peers.

However, if we look at the recent scenario, in many places around the world, there are lots of people who have already been infected and vaccinated and who have developed some level of immunity to the virus. So now, variants (in specific, the Omicron variant) that can evade the immune system have an advantage. They could grow and replicate where other variants cannot. And that variant could quickly become the dominant one.

We are witnessing the spike of COVID19 cases (Omicron driven) around the world with the majority being breakthrough cases. Some of the spread could originate from human behaviours, for instance more group gatherings under loosened restrictions. Apart from that, failure to comply with proper masking, social distancing, and proper hand hygiene could have also contributed to this, especially in countries which have high rates of primary vaccination.

This may have provided a false sense of security to relax strict public health measures as described above especially for social gathering in many public places. Compounding to that, waning immunity from the earlier primary shots of vaccines could have also contributed to the rise in variants.

We are seeing the overall effects of removing restrictions earlier as the combination of improper compliance towards public health measures, waning immunity of vaccines and vaccine inequity contribute to a rise in cases.

Vaccines alone will never win us the war. They should be boosted with all the available public health measures as explained above. And with the newer highly transmissible variant gaining momentum in the UK, it is possible that the strict measures of social distancing, targeted lockdown might be introduced.

Should Christmas be cancelled?

Considering the extremely high doubling time of this new variant, and extremely high number of new cases, any celebration which involves large gatherings should not be approved. While vaccinated individuals have some form of protection against the virus, they will still get symptoms and it can be bad for some, especially for those with comorbidities. We must not overburden the already strained health-care system which will reach a breaking point if the infection numbers don’t go down especially those who come with moderate to severe symptoms. “

Dr Paul Valent is Retired President of Australasian Society for Traumatic Stress Studies and retired President of Child Survivors of the Holocaust (Melbourne)

“In this new wave of the COVID pandemic, the fact that government restrictions are relaxing rather than tightening as epidemiologists advise, indicates a shift from scientific to emotional responses to the current danger.

‘Oh, no!’ is the natural response to suggestions of further lockdowns. After all we’ve gone through! When a joyous Christmas was to be our reward! There is no justice in being back at the start!

Fear is in the air: fear of the virus, fear of what further lockdowns will do to us and our relationships, and fear of increased community violence by those who see antiviral measures, not the virus, as dangerous.

And then, in seemingly endless danger, there is a tendency to say ‘What the hell!’ Let’s take what life we can now while we can, and worry about consequences later. Except in three months, we may regret not having taken stringent measures today.

This is the time to hold one’s nerve and understand our emotions. No pandemic has lasted forever. Solutions are on the way. Certainty has been uprooted but science is still the best way out.”