Do we know how to live with the virus?

As the golden glow of the Olympic fades, we need to shift our focus to living with the virus.

Of all the records broken in the past two weeks at the Olympics, one that particularly struck me was the viewing audience numbers. By any measure, Channel 7’s ratings for the Olympics were record breaking, with the average full-day broadcast audience in the first week up 50 per cent on Rio 2016. Without doubt, the Olympics have provided a welcome distraction for the millions of Australians locked down due to COVID-19 outbreaks across the country.

But as the golden glow subsides, many of us will be slowly awakening to the reality of ‘living with the virus’. In the past two weeks, there’s been a clear policy shift in Australia – and especially in New South Wales – away from suppression and zero community transmission to the notion of living with the virus. Pandemic modelling in 2020 was all about what actions would take us to zero cases. But modelling released by the Doherty Institute, the Grattan Institute and the Burnett Institute recently have all turned their attention to another question – what population-level of vaccination will be needed to reduce infections and deaths to a level we can accept, while regaining some of our freedom? That the virus will be circulating among us is simply assumed.

That subtle policy shift has extraordinary implications.

As a Non-Executive Director of a disability provider, I see all too well the implications for our business. Both the disability and aged care sectors have long struggled to attract and retain high-quality staff to deliver essential services to some of our most vulnerable. One COVID-positive staff member or patient in a facility can force an entire facility’s staff into isolation and patients into lockdown. No distinction is made between those who are vaccinated and those who are not. There are simply not enough of us vaccinated for that to matter. Staff are diverted from elsewhere to support these patients’ complex needs, but energy, creativity and funding is needed to grow the back-up workforce to fill the growing gap.

Last week’s outbreak in Brisbane made the impact of staff in isolation abundantly clear when Queensland Chief Heath Officer Jeanette Young announced that a heart surgeon had been authorised to leave quarantine to undertake urgent surgery on a child. The outbreak centred on several private schools, and every paediatric cardiologist in Brisbane was isolating at home as a result. Indeed, more than 400 health staff, including doctors and nurses, were isolating at home after they were connected to exposure sites.

Food processor SPC is the first company in Australia to mandate COVID-19 vaccination of all staff. In the highest risk LGAs in Sydney, vaccinated construction workers will be allowed to travel outside their LGA to work on construction sites with unvaccinated colleagues from elsewhere. This is the first time in Australia movement has been linked to vaccination status. Expect more to come.

Living with the virus has extraordinary implications for these businesses and I suspect many others, too. Are insurers ready for the change?

I’ve been surprised by how many actuaries and business people I’ve spoken to in the past year use the term ‘post-COVID’ to describe some future (or, indeed, present) where the virus no longer affects us. Perhaps people envisaged a perfect vaccine that would be rolled out across the globe to eliminate the disease, much like we managed with smallpox? Smallpox was eradicated two decades after the World Health Organisation (WHO) first proposed global elimination, and if we can invent a vaccine for COVID-19 in just a year, surely eradication is just around the corner? 

But the smallpox vaccine had been refined and perfected in the 150 years before the WHO’s global elimination plan and, unlike COVID-19 vaccines, it was effective in preventing infection. COVID-19 vaccines reduce the severity of the disease, but the virus can still spread. It’s a completely different ballgame.

Perhaps some hoped the virus would mutate and that the less-deadly more-infectious strains would thrive, a pattern many other pandemics have followed? But COVID-19 is already different from other pandemics. It’s extremely infectious in people before they get symptoms, as well as in those who never get symptoms. The strains that thrive will simply be the most infectious strains – as we’re learning from Delta, they may be just as deadly, if not more so.

I suspect many of us simply hoped life would return to normal.

That too was the hope when the HIV crisis hit in the 1980s, and the reality is that it changed many things. Four decades on, wealthy countries can feel they’ve defeated the virus, but treatment is expensive and globally nearly a million people still die from HIV every year.

In all this hopefulness, have we done enough to prepare our organisations to live with the COVID-19 virus? I know many actuaries who are working hard with insurers to stress test products and model insurer solvency. But are we still looking at the future through a post-COVID lens? Have our ‘pessimistic’ scenarios already become reality?

When lockdowns become more difficult to enforce and the virus continues to circulate, are our insurance policies up to scratch? Are they delivering the insurance coverage that businesses and people need at a price that truly reflects the underlying risks? When borders are re-opened, do we have travel policies that will work? Do we know how to assess the risks in our products of people who have either experienced COVID-19 or been vaccinated against it? Do we have the right supports for our staff to help them to thrive? Are our financial institutions robust enough to withstand a second recession? What about a third?

Almost 18 months into this pandemic, people are responding as they have in other pandemics. Infections grow to their peak as people become frustrated and tired and no longer able to comply with restrictions. Suicides start to climb as the reality hits.

None of us want the virus to be here. But it is, and we have an opportunity now to help insurers position themselves for the reality of living with the virus for years to come.

Are we ready?

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Image of Andrew Croft
Andrew Croft says

13 August 2021

Short answer is no, of course, but we adapt in crisis very well out of necessity.
Like any other viral disease, COVID remains a pandemic of the unvaccinated carried by both vaccinated and unvaccinated.
However, we don't fully understand the disabling components of the disease, e.g. long COVID.
Although the most at risk have been mostly vaccinated, I remain struck by the quiet bravery of the unvaccinated young families of under 40s with small children testing their immune systems, knowing they are at risk and can't get any vaccine of any brand but getting on with life anyway.
It is pleasing to see rollout starting to extend to lower ages, needs to go a lot further yet. When we open up, Delta will spread everywhere and seeing kids in COVID wards is a possibility we would do well to avoid.
To directly answer your question, the US and UK seem to be deliberately running a trial "live with" program at the moment, which should afford us the education without paying the school fees. NSW appear to be unintentionally doing the same with its active but leaky suppression activities. The idea of living with the Delta variant seems about as unattractive as living with the in-laws, but it seems unavoidable, especially when commercial interest groups commence pressure campaigns to restart economies and travel in 2022-23.

Image of Brent Walker
Brent Walker says

14 August 2021

You are correct Kirsten. I doubt whether it will be possible to eliminate this virus from Australia. It will become endemic across the world. The problem with this coronavirus (and more so with the Delta version and subsequent strains that will follow) is that an infected person becomes infectious well before their immune system recognizes it. This is irrespective of whether the person is vaccinated or not. The virus uses techniques similar to cancers and HIV to hide to obscure it from our immune systems. What is becoming clear though, is that the more healthy your immune system is the more quickly it can respond. If you have been vaccinated once your immune system picks up the weak signals still provided by cells invaded by the virus at least it can respond immediately. This gives vaccinated people a few days advantage over those who are not vaccinated. Doctors and community leaders should not just be educating people to become vaccinated but educating them about how to keep their immune systems strong.

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