Navigating relaxed restrictions during a pandemic

By Professor Stuart Berzins

When the COVID-19 pandemic began in late 2019, it quickly became clear that the virus was highly infectious and was causing high hospitalisation and mortality rates. This led to unprecedented public health orders, including mandated mask use, strict quarantining and working from home, which saved millions of lives but also had significant negative impacts.

Now, with over 90 per cent of eligible people vaccinated, governments are relaxing restrictions and empowering businesses and individuals to decide what additional steps they will take, if any. These are important decisions — too few precautions could see spikes in infections and deaths, but too many could needlessly damage the economy and people’s psychological wellbeing. Here are some recent findings about COVID-19 that may help people decide on the ‘right’ balance for them.

Isn’t COVID-19 getting weaker?

In July 2022, most COVID-19 infections are caused by the Omicron subvariant BA.5. Variants such as Omicron and Delta result from mutations that occur randomly as viruses replicate and can change how the virus behaves. BA.5, for example, is the most infectious form of COVID-19 to emerge but is less likely than Delta to cause serious illness. This is a mixed blessing. For individuals, the chance of being hospitalised or dying from Omicron is much lower than earlier in the pandemic, but because so many more people are being infected, the overall number of hospitalisations and deaths remains very high, and healthcare facilities are once more at risk of being overwhelmed.

An additional concern is that up to 10 per cent of people with COVID-19 will probably develop ‘long COVID’, where debilitating symptoms persist for months after the initial infection. Common symptoms include fatigue, shortness of breath, headaches, cognitive problems such as ‘brain fog’ and an inability to concentrate. We don’t understand why long COVID develops in some people and not others or how to prevent or treat it, but it can develop from very mild or asymptomatic cases of COVID-19 as well as more severe cases. Based on 50,000 new infections per day, Australia can expect about 3,000 of these people to also develop long COVID.

We are therefore in a setting where most people are vaccinated and the virus is usually only causing mild symptoms, yet infections, hospitalisations and deaths are all nearing new peaks. For now, Omicron will be manageable for most people who are fully vaccinated (including boosters) and otherwise healthy, but immunity from vaccination and prior infections will slowly wane, so there are concerns of increased vulnerability to serious illness and long COVID unless we continue to boost our immunity, or otherwise protect ourselves.

I’ve been vaccinated – why aren’t I fully protected? 

Being recently vaccinated against COVID-19 means that most healthy people won’t become seriously ill, but this immune protection is not complete, nor is it permanent. The mutations that made Omicron more infectious also made the vaccines less effective because they were designed to protect against earlier variants. Furthermore, the antibodies produced after vaccination that protect against infection slowly disappear over time.

Fortunately, the immune protection that prevents serious illness is more long-lived, but protection against symptomatic infection is largely gone six months after vaccination. This increases infections among healthy people and places those aged over 70 or with risk factors such as obesity, diabetes or hypertension at far greater risk of serious illness.

New vaccines targeting Omicron have been developed that are likely to improve protection, but until they are available, the current advice is that eligible people should be vaccinated or boosted as soon as possible with existing vaccines. There are several reasons not to wait for newer vaccines. Firstly, we are in a large wave of Omicron infections and need protection now, whereas new vaccines are unlikely to be available before 2023. Second, current vaccines provide long-term protection against serious illness and boost short-term protection against infections. Third, new variants may emerge, reducing the benefits of an Omicron vaccine.

In addition to vaccines, protection is available from new treatments. Some (e.g. monoclonal antibodies) have already been rendered redundant by Omicron, but anti-viral drugs such as Paxlovid remain highly effective. These treatments are now available for high-risk groups but should be taken within three to five days of testing positive because they are less effective once the person is seriously unwell.

Should I hide under the bed?

There are many actions beyond vaccination and medication that reduce infections and ease the burden on healthcare. Some are public health regulations, such as the requirement to quarantine when infected. Others are organisational policies, such as improving ventilation, encouraging video conferencing instead of in-person meetings or working from home where the circumstance allows. These may already provide a comfortable level of protection, but people can choose to adopt more precautions if they wish, based on their own personal circumstances.

Choices around masks, social distancing and other preventive measures are now up to the individual, but hopefully this article has helped those decisions be made in context of a better understanding of the COVID-19 pandemic.

The answer for most people is likely to be one of balance. Perhaps consider wearing a mask inside or attending short gatherings in well-ventilated areas, but decline all-night raves in stuffy venues. Our personal circumstances relating to the risk profiles of our family and friends will also be factors. There is no ‘right’ answer to what we should do, but it makes sense to keep abreast of new information as it comes in and take the precautions that make the most sense to you.

Stuart Berzins is Professor of Immunology at Federation University. His group studies the role of specialised immune cells in diseases, including cancer and COVID-19.

Related reading:

Why we need to take a cautious approach with long COVID