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Last week, mask mandates were reintroduced in Victoria, New South Wales and even the barely affected Western Australia to try and slow the spread of COVID-19.

This week there was a huge change, as part of an effort to “live with” the virus. The national cabinet’s decision to redefine a “close contact” to the bare minimum of someone living with a confirmed COVID-19 case or having spent more than four hours with them in a home, accommodation or care facility will inevitably mean cases — and therefore hospitalisations — will rise. Getting tested if you are a casual contact with no symptoms — in a workplace, for instance, or having visited a restaurant where there has been a confirmed case — is now over. Only close contacts and positive cases will need to isolate for seven days.

Prime Minister Scott Morrison called it a “gear change”, adding that if you’re not a close contact under the new definition, “you should go home, go to the beach, go and do what you want to do. Read a book in the park”.

The gear change has been sudden and, for some, jarring. Have we in effect given up on controlling the rapidly rising cases of the highly transmissible Omicron variant, concentrating on severe illness and hospitalisation, with the assumption, as NSW Health Minister Brad Hazzard puts it, that “we’re all going to get” COVID-19?

Health experts and epidemiologists have different views, mostly to do with timing. Is it too early to be giving up contact tracing and testing for most, when only 11 per cent of those over 16 years old have received a booster shot? Will the numbers be so high that, even while Omicron appears to be less severe, serious illness and death will swamp our exhausted health system?

Queensland’s new Chief Health Officer John Gerrard was blunt this week, saying that “in order for us to go from the pandemic phase to an endemic phase, the virus has to be widespread”. That could happen in two ways: people getting vaccinated or getting infected.

“Once we’ve done that, once the virus is spreading, once we all have some degree of immunity, the virus becomes endemic and that is what is going to happen.”

But Dr Stephen Duckett, the director of the health program at the Grattan Institute, does not believe it is inevitable every Australian will get COVID-19. While he agrees with the increased emphasis on rapid antigen testing, he says that those who had the AstraZeneca vaccine appear to have less protection against Omicron before their booster shot and notes children aged five to 11 will become eligible for their first jab only on January 10. ” Even if the virus is endemic, we cannot ignore the question of when is the right time for people to get it?”

Measures beyond masks, including a ban on large indoor gatherings such as nightclubs, are necessary at least in the short term, he says.

The debate is particularly intense in the lockdown-weary states of Victoria and NSW, where cases are rocketing to record levels each day. Governments are toeing the line of managing infection numbers to protect hospitals from being overwhelmed, without impinging on their already fragile economies and the social and psychological wellbeing of their citizens.

Governments are battling the question of whether we will all catch COVID and, if so, how it should unfold.Credit:Scott McNaughton

Professor Francois Balloux, the director of University College London’s genetics institute, delivered a message this week that, for the world, “it is time to give in soon”.

“Vaccine protection rates are as high as they may ever be in many places, and now we’ve got a couple of decent drugs,” Balloux said on Twitter. “Pretending we remain in control, of sorts, is just becoming too costly.”

Gradually removing all restrictions in coming months would end the pandemic, he said, by building population immunity and transitioning COVID-19 into an endemic virus that spread every year like the flu.

Ahead of a 2022 election, Prime Minister Scott Morrison is eager to normalise COVID, but the states bear ultimate responsibility for hospitals.Credit:Alex Ellinghausen

Professor Nancy Baxter is the head of Melbourne University’s School of Population and Global Health and a member of OzSage, a group of health experts who have urged more caution in the response to COVID-19. Baxter is scathing about the national cabinet’s shift this week. “The change will result in a major underestimate of case numbers as many people will now not be identified as close contacts, will not be tested,” she said. “Short term, the case numbers may stop increasing the way they have been, but I would expect our positivity rate to go up substantially.

“Hopefully with the high vaccination rate and the ‘mildness’ of Omicron, we can manage from an ICU perspective, but the hospitals and ER will be like the 10th circle of hell.”

Baxter advocates freely available — and free or subsidised — rapid antigen tests not just for close contacts of confirmed cases in homes but for all those who have come into contact with a COVID-19 case.

A statement from OzSage on Thursday focused on the NSW government’s response, which they described as “let it rip”, and rejected the redefinition of close contacts.

“Risk is not limited to arbitrary four-hour time frames within households,” it said. “Settings like nightclubs and restaurants have been sites of superspreading events, and if people exposed in these settings cannot get a PCR test, spread will accelerate.”

Yet Chief Medical Officer Professor Paul Kelly advocated for the changes, citing as evidence new research from South Africa. The research found the Omicron variant to be 73 per cent less ­severe than previous ­variants and Kelly said the emerging research should provide reassurance that, despite skyrocketing case numbers, intensive care admissions should remain low.

Hours-long testing lines and waiting times of up to six days for results have accompanied the boom in cases.Credit:Flavio Brancaleone

The South African government announced this week that data suggested the country had passed its Omicron peak without a big spike in deaths. “The speed with which the Omicron-driven fourth wave rose, peaked and then declined has been staggering,” said Fareed Abdullah of the South African Medical Research Council.

Kelly said on Thursday that just 1481 out of 110,000 cases in Australia had led to hospitalisations, with 122 in intensive care and 51 on ventilators ­nationwide. “It is a different virus, very different from previous versions of the virus we have seen over the last two years,” he added.

Health Minister Greg Hunt pointed out that two-thirds of people in ICU as a result of contracting COVID-19 were unvaccinated. That emphasised the need for booster shots as soon as people are eligible. With only 11 per cent of people over 16 having received third-dose booster shots, the race is on to accelerate the program in January.

But Roderick McRae, president of the Australian Medical Association Victoria, representing hospital workers, says staffing is becoming an urgent issue.

“Healthcare workers are also going out to see family, to the shops. They have a risk of exposure in the community just like everybody else with so many cases around,” he says.

Kerry Chant, the Chief Health Officer in NSW, where Premier Dominic Perrottet removed nearly all restrictions this month before reinstating some, said she did not want to see measures that put pressure on hospital capacity and might lead to measures such as the suspension of elective surgery.

“We are conscious that even though we might not have a lot of severity, just the sheer numbers are going to be a challenge for us,” she added.

Morrison spoke of the latest rule changes as “practical”, but there is tension between the practical and the pure health advice. In Victoria, Chief Health Officer Brett Sutton’s recommendation last week for all residents to wear a mask indoors was accepted by Health Minister Martin Foley, who has the final say under new pandemic laws.

Sutton also advised the government to implement density limits in hospitality venues and prohibit dancing on dance floors, but both proposals were ignored by the minister, who cited the need to balance the economic, social and human rights impacts of tougher rules.

Health Minister Martin Foley has the final say over Victoria’s restrictions, rather than Chief Health Officer Brett Sutton, under new pandemic laws.Credit:Chris Hopkins

The truth is, nobody knows what will happen in coming months, and the dilemma in Australia is mirrored across the world. Some countries are reinstating harsh restrictions while others are maintaining health measures such as masks indoors but accepting that Omicron will become widespread and loosening their rules to allow a form of normality to return.

What is certain is that cases are skyrocketing. For the first time this week, the global tally of new cases passed 1 million a day on average, with the World Health Organisation warning that Omicron could create a “tsunami” of infections.

The United States shattered its record for new daily coronavirus cases on Wednesday, topping 488,000 cases, according to the New York Times. But as the Times reports, “those increased cases have not resulted in more severe disease, as hospitalisations have increased only 11 per cent and deaths have decreased slightly in the past two weeks”.

In Portugal, one of the few nations with a higher vaccination rate than Australia, the government ordered a mini-lockdown days before Christmas, forcing nightclubs and bars to close and instructing people to work from home for at least two weeks.

“If we do not adopt these measures now, the consequences on everyone’s lives will be much worse after Christmas and the new year,” Portuguese Prime Minister Antonio Costa said.

Despite a higher vaccination rate than Australia, Portugal imposed a mini-lockdown before Christmas.Credit:AP

Disparate approaches suggest there is no clear answer on whether now is the time to let Omicron spread and, if so, how to do it responsibly.

There has been a major move away from PCR tests to reliance on rapid antigen tests. A close contact who has no symptoms now only needs to take a rapid test. Only symptomatic close contacts require a PCR test. Health and education workers as well as priority vulnerable groups will be provided with rapid tests along with close contacts of positive cases. The aim is to slash the long waiting times for PCR tests and to relieve businesses who are losing staff to isolation when they are not symptomatic.

For those who are not close contacts, the rapid tests will need to be bought — at a cost of about $15 each, although there are reports of price-gouging — at pharmacies and supermarkets. The Prime Minister said that “private industry” had sought assurances that governments would not provide them free to all. “It was agreed today that will not be the policy in Australia,” he added on Thursday.

Both NSW and Victoria have announced large orders of rapid tests in recent days, and Perrottet said on Wednesday — a day before national cabinet — that its order of 50 million tests would be distributed to the state’s residents for free from the end of January. In Victoria, the government has not released the details, but there are reports that Victorians will need to have been potentially exposed to COVID-19 to receive a free test.

If Australians are to increasingly rely on rapid antigen tests into 2022, those who will struggle to afford the tests will be disadvantaged.

At the Grattan Institute, Duckett said the policy was misguided: “The United Kingdom has been distributing rapid tests to everyone who wanted one since April. We have just been so far behind the contemporary best practice in testing strategies, it’s ridiculous.”

Professor Peter Collignon, an infectious diseases expert with the Australian National University, says Australia is moving to a “harmonised middle ground of what our lives should be like for at least a year, possibly several”.

“Even for the common cold, we need to change this ‘soldier on’ attitude. For masks, I think there has been a culture shift of acceptance that we need to keep established,” he says.

Accepting COVID-19 as endemic, which he believes will happen, is not the same as removing all guidelines now or in coming years: “It will kick up every winter, and we may need masks, density limits or more.

“Learning to live with COVID means accepting some ongoing changes to our lives but also avoiding a fear level that is higher than the actual risk.”

with Paul Sakkal

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