Extract from ABC News
When Brendan Crabb finally caught COVID for the first time late last year, it was because he'd broken his own rule — he took a risk he says he shouldn't have. Since 2020 Professor Crabb, director and chief executive of the Burnet Institute, had been sticking to a rigorous anti-COVID routine, effectively using layers of protections to avoid getting the virus.
And then in a moment of lapsed judgement, he joined a crowd of hundreds of people at an awards event in a small room in Sydney, without his portable air purifier and N95 mask. "The waiters couldn't even get to us to give us a drink," he says — it was that tightly packed. "That's a situation I never get myself into … and three days later, I tested positive."
Fast-forward a couple of months and a similar story has been playing out for thousands of Australians as COVID surges again. Partly it's because the highly mutated new subvariant JN.1 has driven a worldwide spike in infections, hospitalisations and deaths. But it's also probably because so many of the precautions we used to embrace — masking, testing and isolating, vaccination — have been abandoned, deemed unnecessary by those who think the danger has passed, or who misguidedly believe COVID is "just a cold" or necessary to catch for immunity.
Some commentators have described this situation — the crashing of wave after wave of COVID, a steady drip, drip, drip of death and mounting chronic illness — as the "new normal". But other experts insist it doesn't have to be, and that continuing on the current trajectory is unsustainable — especially in light of data showing that COVID has decreased life expectancy, will cost the global economy an estimated US$13.8 trillion by 2024, and is decimating the lives of millions of people who have developed long COVID.
Meanwhile, studies continue to pile up showing COVID can cause serious illness affecting every organ system in the body, even in vaccinated people with seemingly mild infections. It can cause cognitive decline and dysfunction consistent with brain injury; trigger immune damage and dysfunction; impair liver, kidney and lung function; and significantly increases the risk of cardiovascular disease and diabetes. Then there's long COVID, a debilitating disease that robs fit and high-functioning people of their ability to think, work and exercise.
All of this is why governments must invest in long-term strategies for managing COVID into the future, experts say — particularly by introducing standards for indoor air quality. But until then, they say, Australians can and should take precautions against COVID to reduce transmission and protect their health. And doing so is relatively simple: it just takes a little planning, preparation and common sense.
Here, three of Australia's leading COVID experts share their personal COVID safety strategies and reflect on what must happen if we're to blunt the growing health crisis the pandemic is causing — and prepare for the next one.
'It's the apathy that's the concern'
Stuart Turville, virologist at the Kirby Institute
When the COVID pandemic hit Australia in 2020, Associate Professor Stuart Turville had been working in the Kirby Institute's level-three physical containment (PC3) lab, researching another well-known RNA virus: HIV. His team quickly pivoted to SARS-CoV-2, capturing the virus and characterising it very quickly. Still today when the NSW Ministry of Health's genomic surveillance unit identifies a new variant of interest, Dr Turville, a virologist, will use a swab from a positive case and grow the virus to understand its mutations and virulence.
Scientists working in the PC3 lab must wear robust personal protective equipment primarily for respiratory safety. Before he enters the lab Dr Turville dons several layers of gear: a full-face Powered Air Purifying Respirator (PAPR) mask, a collar with its own HEPA filter ("it's like being in a scuba suit"), two pairs of gloves, a disposable Tyvek suit, a generic gown that is laundered after use, booties, gumboots and little plastic socks that go over the boots. "Not only could [getting infected] impact our research colleagues and the general community," he says, "but we could also take the virus home."
For Dr Turville, the risk of taking COVID home was particularly serious. In 2020 he was caring for his elderly father who had heart problems and his mother was also at risk of severe disease. If he brought the virus into his dad's aged care facility, it would be put into lockdown and "he would be eating cold meals in his room alone". "So for me personally it was incredibly important to maintain that protection and ensure I remained negative," he says. "I've still only got it once — I got it from undergraduate teaching, which will teach me."
As for how he protects himself outside the lab, day to day? For starters, "As a scientist I don't get out much," he jokes. He drives to work, avoiding crowded public transport. If he's going on an overseas trip, he'll plan to get a booster vaccine four weeks before he gets on a plane. "I know from the studies that we do and other people do that if you get a new formulation vaccine you're going to encourage the mature B cells to generate better cross-reactive antibodies," he says, "and so you're going to have better protection if you're exposed to [COVID]."
If someone in his family gets sick, he says, they immediately isolate themselves. "It's only happened once or twice where one of us has been positive but they've generally been isolated to one room and wearing a P2 mask" to protect the rest of the household. "Another thing we've been doing, which has been somewhat of a side benefit of looking after my father in aged care, is RAT testing before going into those facilities — even though we might be asymptomatic," he says. "I think it's really a situation of common sense in the context: if you don't feel well, you isolate, you keep germs to yourself."
Still, Dr Turville is acutely aware of the vitriol frequently directed at people who promote COVID safety. Strangers will circulate photographs of him in his lab kit, particularly on social media, to mock him: "They'll say, 'Oh, this guy is an idiot, why is he using that, he shouldn't fear [the virus] anymore'." This both puzzles and amuses him. "It's my job; I'm not going to bring it home when I have a sick father — pull your head in," he says. "Unfortunately there is a lot of negativity towards people who choose to protect themselves. We never really saw that in the HIV era — there was never really a pushback on condom use."
Then again, the differences between how the two pandemics — HIV/AIDS and COVID — were managed in Australia are probably quite instructive, says Dr Turville. With HIV, experts and health ministers collectively built a strong public health strategy that they strove to protect from politics. "When we look at COVID, it was political from the start and continues to be," he says. We also now lack a "mid to long-term plan to navigate us through" this next phase of COVID: "Some argue that we are no longer in the emergency phase and need to gear down or simply stop," he says. "But should we stop, and if not, what do we gear down to as a longer-term plan?"
Perhaps one reason Australia lacks a long-term plan for managing COVID is the complexity of instigating one in light of the community's collective trauma. The first couple of years of the pandemic were stressful and frightening and as much as border closures, lockdowns and other restrictions saved tens of thousands of lives in 2020 and 2021, they are still resented by some people whose livelihoods or mental health suffered — and who now push back against precaution. This backlash is so fierce in pockets of the community that some seem to conflate any kind of protective action with lockdowns.
"There might have been some things we went too hard with but I think we have to look at it in perspective," Dr Turville says. "We didn't have those really, really dark months in Australia — we never had the mass graves like we saw in Italy or New York. We got a scare during [the] Delta [wave] and that helped get us our really high vaccination rates … But my worry now is, are we stepping away too soon?"
Aside from much of the general public abandoning measures like masking, he says, political support for genomic surveillance work is also now "shrinking". And without the critical data it generates, he says, there's a risk scientists like him will miss new, more dangerous variants. "I think there's a lot of patting on the back at the moment — job well done. And that's nice, but I think it's somewhat job well done, there goes the rug," he says. "I think it's the apathy that's the concern. And I think it's coming top-down, it's coming very much from the government. I just don't understand why, like we had with HIV, there can't be a mid-term strategy."
'Air is out of mind until it's a problem'
Robyn Schofield, aerosol scientist at Melbourne University
Associate Professor Robyn Schofield can rattle off data on the harms and benefits of clean indoor air as breezily as if she were reciting her own phone number. We breathe in about eight litres of air a minute. We consume 14 kilograms of air a day. Our lungs have the surface area of half a tennis court. Globally, nine million people die from air quality issues every year. In Australia, she says, it's somewhere between 3,000 and 11,000 deaths — "way more than the road toll". But people generally don't know any of that, she says. "They don't appreciate how important breathing is until it's hard to do. It's like the air: you can't see it, so it's out of mind until it's a problem."
In 2020, the air became a massive problem. The main way COVID spreads is when an infected person breathes out droplets or aerosol particles containing the virus — think about aerosols as behaving similarly to smoke, lingering in the air potentially for hours. An atmospheric chemist and aerosol scientist at Melbourne University, Dr Schofield quickly began working with respiratory specialists to understand how to reduce the risk of viral transmission by improving the ventilation and filtration of indoor air.
What she still finds thrilling is that indoor air quality can be assessed with a battery-powered CO2 monitor; popular devices like the Aranet cost about $300 but some companies are developing tech to allow smartphones to do the same. And the investment is worth it, many argue, because it can help you avoid catching COVID. It's also good for productivity, with studies showing higher CO2 levels decrease cognitive performance. If CO2 is 800 parts per million, Dr Schofield says, 1 per cent of the air being inhaled has been breathed out by someone else — and is therefore a good proxy for infection risk.
One of the findings from the past few years she finds "most exciting", however, is the role of relative humidity in indoor spaces. When relative humidity is below 40 per cent, Dr Schofield says, the risk of catching COVID increases. (A good sign of that, for those who wear contact lenses, is dry eyes, which she says is "a really good indication that you should get out!") "Because you are becoming the moisture source. Your mucous membranes — which are protecting you from getting COVID or the doses you acquire — are giving up that moisture, and so it's easier to be infected."
Dr Schofield is particularly concerned with preventing infection in healthcare settings. She bravely spoke out last year when, while being treated for breast cancer at Peter Mac in Melbourne, the hospital decided to relax its masking policy for patients. "COVID cases were actually rising at the time, so it was a bad call," she says. "And it was then reversed." But she was still "disgusted" and lost respect for the hospital's leadership, she says: she expected that staff would understand the science of COVID transmission and take steps to protect vulnerable patients.
Even before she was diagnosed with cancer, Dr Schofield was taking precautions — for starters, she knows where the "most risky settings" are. Trains, planes and automobiles are big red zones: "Buses are actually the worst," she says, because they recirculate air without filtering it. She regularly uses nasal sprays, wears an N95 respirator when she's indoors with other people — in meetings at work, for instance — and makes sure air purifiers are switched on. "If I walk into a space, I will also open windows. I just go around and open them," she says. "Because actually, no one's going to tell me not to."
When eating out, she chooses restaurants that have outdoor dining areas: a newly revamped boathouse in the Melbourne suburb of Kew is a favourite of hers, and Korean barbecue is "always excellent", she says, because there are generally extractor fans at each table. It's all about good ventilation — clean air. "I always take my Aranet [CO2 monitor] along, and if you sit close enough to the kitchen, the kitchen fans are very effective."
All of these issues point to an urgent need for governments to develop indoor air standards, Dr Schofield says — for air quality to be regulated and monitored, just like food and water are. Before the pandemic, in 1998, the economic cost to the Australian economy of poor indoor air was $12 billion per year — $21.7 billion in 2021 money. "So why aren't we learning from that, and moving forward?" she says. "This is not about going back to 2019, it's about having the future we deserve in 2030."
'We're living in a public health 'Barbieland'
Brendan Crabb, chief executive of the Burnet Institute
Four years into the COVID pandemic we're living in a "public health Barbieland", says Professor Brendan Crabb, director and chief executive of the Burnet Institute. Too many of us are playing "make-believe" that life has returned to "normal", he says, and there's an "enormous disconnect" in the community: a failure to grasp both the true scale of COVID circulating and the impact of infections on our health and longevity.
Australia recorded more than 28,000 excess deaths between January 2022 and July 2023, he says. "These are unheard of numbers, people who wouldn't have otherwise died, let alone the hundreds of thousands in hospital — we don't know exactly because no one publishes the numbers." Then there are the hundreds of millions globally with long COVID, the risk of which increases with each infection. "I find what we know about COVID concerning enough to call it an elevated public health crisis," Professor Crabb says. "And we need sustainable solutions to that now and in the longer term."
The lack of action against COVID, Professor Crabb says, is fundamentally a problem of a lack of leadership. "The most common thing said to me is, 'Brendan, I really do trust what you and others are saying. But if there was a real problem the prime minister, the government, would be telling us that'," he says. "I don't think people are all of a sudden profoundly individualistic and don't care about COVID anymore — that they're suddenly willing to take massive risks and hate the idea of vaccines and masks. I just don't think they're being well led on this issue."
A crucial factor shaping Australians' apathy towards COVID in 2024, Professor Crabb believes, was the Chief Medical Officer Paul Kelly's statement in September 2022 that the virus was no longer exceptional. "It is time to move away from COVID exceptionalism, in my view, and we should be thinking about what we do to protect people from any respiratory disease," Professor Kelly said at a press conference. Those comments, Professor Crabb says, have never been turned around. "If I'm right — and I say that was a profoundly wrong statement — then that has to be corrected by the same people."
He also points a finger at two unhelpful ideas. "There is a strong belief, I think, by the Chief Medical Officer and many others that once we got vaccinated, infection was our friend," he says. Australia's vaccine program was highly successful, Professor Crabb says: most people were inoculated against COVID before large numbers were infected. "If we were the US, we'd have had 80,000 deaths … [instead] we had 1,744 deaths in the first two years," he says. But while vaccination broadly protects against severe illness and death, it does not protect against (re)infection or the risk of acute and chronic health problems.
The other idea is hybrid immunity, which holds that vaccination and infection provides superior protection against severe outcomes compared to immunity induced by vaccination or infection alone. For Professor Crabb, the concept is flawed: first, because it encourages infection, which he believes should be avoided, and second, because it does not work — at least not with the predictable emergence of new variants like JN.1 which are capable of evading population immunity. "Immunity is good," he says. "But it's not good enough."
In a perfect world, Professor Crabb says, political leaders would speak regularly about the pressure on health systems, about deaths, about the potential health consequences for children, which are often overlooked. "And then underneath that they'd set a blueprint for action around the tools we currently have being properly implemented: a vaccine program, a clean air program, advice around wearing masks when you can't breathe clean air, and testing so you can protect those around you and get treated." But who speaks matters, too: "If it's not [coming from] the prime minister, if it's not the premiers — if it's not consistent — it's probably not going to cut through."
In the meantime, he says, people can and should take precautions — they can be leaders in their community, and start conversations with their employers and kids' schools. For him, in addition to getting current booster vaccines, it means using a toolkit he built with his wife who, as a paediatrician who works in a long COVID clinic in Melbourne, comes face to face with the harm the virus is doing every day. The kit includes a well-fitted N95 mask, a CO2 monitor and a portable air purifier. "It's another line [of defence]," he says. "If you're in a restaurant, say, and … you've got a few people around you, putting one of those on the table, blowing in your face, is a good idea."
Masks, he adds, should be worn in crowded places or spaces with poor ventilation. Of course, the topic sometimes sparks heated debate. A Cochrane review which last year suggested masks do not work was later found to be inaccurate and misleading and subject to an apology. But the damage it did was significant. Since then a vicious culture war has raged, much to the dismay of respected scientists who continue to make the point: numerous studies show high-quality, well-fitted N95 and P2 respirators prevent infection when they're worn correctly and consistently.
Professor Crabb's home is also as "airborne safe" as he can make it. An "enormous amount of transmission" occurs in homes, he says. And his analysis of excess deaths from COVID between January 2022 and March 2023 paints a striking picture: Moving down the east coast from Queensland, excess deaths increase, with Tasmania recording the highest proportion — last year it was more than double that of Queensland. "There's no way Queensland has better COVID strategies than Victoria," he says. "So very likely it's to do with less time spent in poorly ventilated indoor spaces."
Ultimately, strong evidence supporting the benefits of clean air is why Professor Crabb believes the future of COVID — and other pandemics to come — is regulating indoor air quality: a responsibility for governments, public institutions and workplaces. "That's where we are really headed, and that's where I think there's strong interest at a government level," he says. "Of course everyone is stressed about what that will cost, but … let's at least have the conversation. We have to move towards an airborne future. How you do that in economically sensible ways is a separate discussion — whether we do it or not should not be up for discussion, and the gains are enormous."
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