The transition to living with 'endemic' COVID could be rough

In the Orwellian world of the pandemic, Victoria Premier Daniel Andrews’s raising of the white flag on “COVID zero” was greeted positively by the Morrison government and with relief by many among the public who are at the end of their tether.

We’ve now officially moved into a new stage. As federal Health Minister Greg Hunt said on Thursday, “the pandemic has become endemic”.

In accepting Victoria couldn’t get back near zero, Andrews was following NSW Premier Gladys Berejiklian, who lost control of the virus, with daily new cases in that state now running well above a thousand and rising.

Only weeks ago there were hopes of suppressing the outbreaks in both states. When it was becoming obvious NSW was failing, Berejiklian was criticised for not locking down early and hard enough. Andrews went hard immediately – and failed too.

“Living with COVID is a reality – it’s not an option,” Berejiklian said on Thursday, sending the blunt message to premiers still set on COVID-minimalism that they’d have to accept the Delta world.

As they will. But not for some time, if they can help it.

Watching Australia’s third wave escalate, the Labor states of Western Australia and Queensland are dug in, trenchantly and vociferously, behind their efforts to keep cases out. The brawling between them and the Morrison government took on an even sharper edge this week.

In contrast, Morrison praised the Liberal premiers of South Australia and Tasmania, who are also pursuing COVID zero, but keeping their heads down.

Australia’s federation is now more fractured than at any time during this crisis, in a toxic mix of policy differences and politics, exacerbated by the approaching federal election.

WA’s Mark McGowan must be concerned as to how he’ll eventually reintegrate his state into the rest of the country, which he accepts must happen at some point. With WA vaccination levels lagging, he’s not tying himself down but says he’ll set a date when “the time is right” (assuming he’s not mugged by a runaway outbreak). He wants to ensure vulnerable sections of the population are fully protected. The state’s isolation and insulation help him.

Economic imperatives for WA’s opening will strengthen, but McGowan can usually outplay the federal government on the politics.

Last year Scott Morrison had to make an embarrassing withdrawal from the Clive Palmer challenge (subsequently lost) to the WA border closure, after it became clear local public opinion was strongly on the state government’s side.

This week federal Attorney-General Michaelia Cash, who’s from WA, mused about how an action could be more successful in the changed circumstances of a vaccinated population (not that the federal government is planning to launch a case).

McGowan seized the baseball bat. “West Australians don’t want me to bring [the border] down now, to give in to this sort of crazy bullying by the federal government, and infect our population, lose jobs and shut down part of our economy, including the mining industry,” he said.

This highlights, incidentally, a point often overlooked in the heated political rows. Talk about “opening” WA and Queensland refers to opening borders. Internally, these states are “open” – unlike the shuttered NSW and Victoria.

McGowan is usually careful to avoid overreach. In contrast, Queensland Premier Annastacia Palaszczuk went over the top when she defended her closed border with an emotive claim about the danger to young children.

“You open up this state and you let the virus in here, and every child under 12 is vulnerable, every single child,” she told state parliament on Wednesday. These children were “vulnerable because they are the unvaccinated”.

The federal government, and other critics, retorted that while young children caught the virus, very few got a severe illness, and they’ve not so far been vaccinated in other countries (although vaccination is being trialled in the US).

In the border wars, it’s worth remembering the big border decisions – about reopening Australia to the world – rest with the federal government.

There are multiple fronts – not just Australians travelling abroad and returning home, but also the admission of foreign tourists, students, workers to fill serious skill shortages, and migrants. The relaxation won’t be done all at once; even so it will be challenging – for example, needing home quarantine arrangements as well as vaccination requirements.

The government’s COVID strategy is built around the national cabinet “plan”, underpinned by the Doherty Institute’s modelling, and buttressed with the catchword “hope” and the promise of a great Christmas.

But grim realities will accompany the transition.

NSW is likely to reach 3,000-4,000 daily new cases this month, while Victoria is expected to rise above 1,000 daily. In NSW, the state government is bracing for the month of October to be very bad, in hospitalisations and deaths.

More generally, the Australian Medical Association wrote to Morrison this week warning of a looming crisis in the public hospital system.

“As it stands, our hospital system is not ready to cope with an easing of restrictions, even with increased vaccination rates,” the letter from AMA president Omar Khorshid said. “To prepare we must develop a detailed understanding of our current hospital capacity and model the impact of ‘living with COVID-19’, with the associated caseload increase.”

The AMA suggested a vaccination rate of higher than 80% of the adult population was likely to be required, “given the existing constraints on hospital capacity and staffing”.

With Friday’s national cabinet receiving a report on the health system and its workforce, the government appears inclined to regard the AMA pitch as part of its periodic appeal for more hospital funding.

But from what we’ve seen in NSW, with some hospitals coming under acute pressure, and evidence the WA system is already inadequate, hospitals are clearly a potential weak point in our defences as COVID cases rise quickly after restrictions are eased in coming months.

We know the Morrison government is now totally focused on getting life back to some normality. It stresses this will be done “safely”.

In fact, it is less a matter of opening “safely” than minimising the risks inevitable in opening. That goes beyond the state of the health system to include issues such as sub-groups in the population who might not be adequately vaccinated when the general community levels of 70% and 80% are reached. Dealing with the risks will demand more nuance than “the plan” seems to provide.

The government is banking on the attention of people – who are now deeply frustrated if they live in NSW or Victoria – shifting decisively off the health issues once life is freer. That, however, will depend on effective management of an unpredictable transition.