The story behind the data is never what it seems at first glance. You can’t prevent every death. And there are no easy answers,or “one-size-fits-all” solutions – although everyone you meet wants you to tell them there is.
There are no easy solutions to disease control.Getty
Take the new malaria vaccine (RTS,S),for example,which has been hailed as a breakthrough in the fight against malaria. A large,multi-site clinical trial which ran from 2009 to 2014 established the vaccine’s safety and efficacy,with a substantial reduction in malarial fevers in infants and young children.
Extrapolating these trial results to the hundreds of thousands of children who die each year from malaria in Africa,there was a feeling among many of us newer to the field that rolling this out continent-wide was a “no-brainer”.
Yet it took a mountain of additional modelling and pilot studies for the just last week for widespread use across Africa. The reason? The resistance of older children and adults to malarial fevers in endemic settings is conferred by past exposure – that is,fewer bouts of malaria in childhood can mean more as an adult.
So the pros and cons of this new intervention had to be weighed carefully and a balance struck across a great many complex epidemiological,economic and socio-political factors.
COVID-19 case numbers have skyrocketed in Victoria,with today's tally of 2297 setting a new national record.
COVID-19 is a very different disease to malaria,but the same lessons hold true. For epidemiologists advising politicians and debating control measures in the public arena:excess haste,over-simplification and exaggeration will lead us into dangerous waters.
These days I am working at the Telethon Kids Institute in Perth,where our vision is “happy,healthy kids”,and I am not one to downplay the risks of COVID-19 to children. But I bristle when I see my fellow epidemiologists,such as scientific lobby group,scaremongering with statistics such as,“ may become hospitalised with COVID”,meaning “”.
The 1-3 per cent figure is drawn from the cohort of children who became symptomatic and sought testing. However,research by the has estimated that clinical symptoms manifest in only 21 per cent of 10-19 year olds.
Aligning multiple sources of evidence,the estimates that 0.6 per cent of these children with symptoms will be admitted to hospital,giving an overall risk of 0.13 per cent that a child will be hospitalised with COVID-19 – substantially lower than the 1-3 per cent estimated by OzSAGE.
Schoolchildren in year 3 and over will wear masks.Getty
OzSAGE also,“within two weeks of schools reopening without vaccines or masks,8 per cent of children were absent with confirmed or suspected COVID-19″. This latter furphy appears to have come about from a misreading of a in which the 8 per cent describes all-cause absences,while COVID-related absences are noted as less than 1 per cent.
Worryingly,the 8 per cent figure was,Professor Brett Sutton,in his announcement of mask mandates for schoolchildren from year 3 and above.
Likewise,“apples to oranges” comparisons between countries – such as comparing England’s second wave experience to that of (270,000 cases versus just seven transmission events) – risk exaggerating the potential impacts of masks in schools.
During Melbourne’s second wave,the all-aged mask mandate introduced in July 2020 was credited by Burnet Institute researcher,Dr Nick Scott,with achieving a in the effective reproduction ratio. An important factor in Victoria’s defeat of the second wave,but by no means the only one.
Beyond this there are urgent,but challenging,societal issues to address that cannot be solved with a single grand gesture.
Australian Medical Association president,Dr Omar Khorshid,has given detailed evidence to the Senate Select Committee regarding the urgent changes that must be made to our healthcare systems,which have been operating at capacity long before this pandemic.
An optimal strategy of in-community case management must be delivered to save our emergency and ICU wards from being overwhelmed by increasing caseloads. This requires a co-ordination of resources between state and federal governments,and of labour and case management strategies between GPs and hospitals and between public and private providers. Not easy to deliver,and not readily served up as a soundbite on the radio news.
The children at greatest risk of severe COVID are those with specific health conditions,such as Type 1 diabetes,cardiac anomalies,trauma and stressor-related disorders,and neurodevelopmental disorders. Active engagement of their carers must be made to ensure that vaccination options are made readily accessible and that appropriate shielding and care escalation plans are in place.
Many of these risk factors (excepting Type 1 diabetes) are prevalent among Indigenous Australians. Even in the unlikely scenario of 100 per cent vaccination coverage there is a desperate need to deliver an improved standard of care to Aboriginal and
Torres Strait Islander peoples,should COVID break out in these communities. Painful decisions that recall a history of injustices will need to be made around the quarantining of remote settlements to combat outbreaks that can leave entire communities devastated.
These are the conversations we need to be having. And there will be no easy answers.
Ewan Cameron is an epidemiologist specialising in statistical methods for epidemiology and in mechanistic modelling of disease transmission. He is an Honorary Research Fellow with the Geospatial Health and Development team at the Telethon Kids Institute in Perth.