letter 220

An emergency room doctor in Melbourne shares her perspective

Registering to get the AstraZeneca vaccine at the Priceline Pharmacy in Cabramatta.
Credit…Matthew Abbott for The New York Times

The Australia Letter is a weekly newsletter from our Australia bureau. Sign up to get it by email. This week’s issue is written by Amaali Lokuge, an emergency room doctor in Melbourne.

Almost half of Australia is in lockdown again as New South Wales loses control of the Delta variant and the virus leaks across porous borders. In Melbourne, the despair we feel at this current bout of isolation is almost overwhelming. We barely experienced life again before everything was canceled. It piques more because it comes at a time when high levels of immunity in some parts of the world are enabling a relaxing of restrictions that we, in Australia, can only dream about.

Photos of thousands of maskless people reveling at the Kaleidoscope Festival in London or the story of Foo Fighters opening Madison Square Garden are difficult to bear because of the intense spike of envy they generate. At the same time, rising infections and hospitalizations in the U.S. highlight that, given only 24 percent of the eligible Australian population is fully vaccinated, a softer approach to containment would lead to an unacceptable death toll.

In the emergency department where I work, the face shields and disposable gowns that we so gleefully cast aside are back. Once again the PPE obstructs communication, making even the smallest interaction fraught. Whole wards are converted to treat suspected Covid patients.

This time, however, the palpable fear and anxiety among the staff has dissipated. With most of us vaccinated, that overlay of stress is less acute. We can concentrate on the patient struggling to breathe with less worry about becoming infected or transmitting the infection to those we love.

A few weeks ago, I wondered whether we would ever reach the vaccination targets required to permanently cease lockdowns and open international borders. Even though frontline staff and the vulnerable were vaccinated in March and April, the rate of vaccination for the rest of Australia has been dismal due to a combination of inadequate supplies, staggered immunizations and general apathy.

When I spoke to patients and friends about vaccination earlier this year, many wanted to “wait and see.” And who could blame their complacency? Geographical isolation and efficient lockdowns have protected us from the grim disaster that has been the Covid experience for most of the world. There was little incentive to get the vaccine when dying of Covid was not even a remote possibility.

Now, however, as we experience deaths in young and old, the relentlessness of this disease is brought into sharp relief. Data extrapolated from areas with uncontrolled outbreaks show that mortality from Covid for a 30-year-old was approximately 1 in 5,000, increasing to 1 in 10 for the elderly. In comparison, the risk of death from clots provoked by the AstraZeneca vaccine in the highest-risk group is only one for every million first doses administered. With the threat of uncontrolled infection, this side effect becomes less relevant, and it seems that Australians are listening to these facts. At the current rate of vaccination, we can be expected to ease restrictions by December with 80 percent of the population fully vaccinated.

The success of the Victoria lockdowns shows that we are mostly a compliant and civically conscientious society. I believe we will be the same with vaccinations. A sector of the population will always be opposed to vaccination for ideological reasons obscure to the rest of us, and many fear that this vocal group will prevent us from ever emerging from this crisis. In response, private companies and government organizations around the world are toying with the idea of mandatory vaccinations.

As an alternative to mandating vaccination, parts of Europe have developed vaccine passports to enable access to social activities. Some advocate a similar system in Australia. However, those who refuse the vaccine are not a homogeneous group of people: They are essential workers and those who can work from home, young and old, employed and unemployed. The unvaccinated cannot be realistically excluded from living life, and we may need to accept individual decision making in this.

In my mind, those who refuse to be vaccinated can be the unvaccinated 20 percent. We cannot be held to ransom to protect people who will not believe in science or take a necessary risk for the greater good. Lockdowns, face masks and social isolation are not living; they are a kind of slow death that we cannot survive indefinitely. Once adequate supplies are available and enough time has passed to allow everyone to have their second dose, we need to allow people to face the consequences of their choices.

Eventually, when Covid surges through the country — as it has in the rest of the world — the consequences for this unvaccinated group fills me with dread. I know that when restrictions ease for good, as an emergency doctor, I will see some of the unnecessary illness and death from which we have been relatively spared.

We cannot allow this disease to constantly dictate how we live or treat the general population. Covid is here to stay, and we need to prepare for this reality now. We must be more efficient in how we contain it. Throughout this pandemic, mistakes have been made: unexpected Covid exposures led to hospital staff furlough and the closure of wards; the threat of overwhelmed resources canceled elective surgeries and caused the ballooning of waiting lists; leaks from poorly ventilated hotel quarantine threatened everyone.

In 2020, the Victoria health system recommissioned the old Peter MacCallum cancer center with plans to use it as a Covid hospital during the pandemic. Currently, this site is being used to provide an extra pool of much needed beds for St. Vincent’s Hospital, and Covid patients are treated at tertiary centers that provide specialized care for the entire state. Like the TB sanitariums of old, it may be that as case numbers increase we need to direct Covid patients to isolated hospitals so we may protect other hospitals, patients and health care workers. Similarly, purpose-built quarantine facilities may minimize the risk of overseas variants circulating locally. It is time we used our extensive knowledge of this disease to prevent it from rampaging through our lives.

Only time will tell whether we will be able to maintain the momentum of vaccination spurred by this current outbreak. Maybe next year we will be looking forward to holidays that are not canceled, to expats traveling home to visit loved ones, to the end of lockdowns and home-schooling, and a glorious return to the freedom that we so foolishly took for granted.

Here are this week’s stories:

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Credit…Jenny Evans/Getty Images

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Credit…Gentl and Hyers for The New York Times.

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