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RUBY:

From Schwartz Media, I’m Ruby Jones. This is 7am.

It’s happening again.

Ahead of these holidays, infections of COVID-19 are spiking.

And at the same time we’re also seeing major announcements from the Federal Government on changes to COVID-19 policy, which signal the beginning of treating the virus like other respiratory illnesses.

So - how should we be thinking about the virus, three years in?

Nobel laureate Peter Doherty has written about that question, in this weekend's edition of The Saturday Paper.

Today, Professor Peter Doherty, on what we can still learn from COVID-19, and the future of global pandemics.

It’s Thursday, December 15.

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RUBY:

Peter, hello. It's nice to have you back on the show.

PETER:

Oh, it's good to be back.

RUBY:

So, Peter, as we speak, we’re experiencing a fourth COVID wave, infections and hospitalisations are rising once again.

So, why - three years in - we’re still vulnerable to COVID-19?

PETER:

The basic issue is, in fact, that this virus has been ahead of us all along. We've had certain ideas about how pandemics work, especially pandemics with respiratory virus infections. But they're mainly embedded in our very long experience of influenza, and of childhood respiratory infections and so forth, which tend to be seasonal. We've been learning from the virus basically, and instructed by nature, which is what often happens in science.

So this latest wave, nobody was sure whether it would happen until, of course, it started to happen in the northern hemisphere. And of course, once we've got open borders, whatever happens in the northern hemisphere will also happen here. The exact shape of it may be a bit different because Australia has a heavily vaccinated population with still many people who have not had COVID. So pretty predictable from what was happening in the north of the world.

How short and sharp it will be, we're not really sure, but there's a tendency to think that that's what will happen. That it’ll be short and sharp.

RUBY:

Mm hmm. Okay, and so if this is Australia's fourth wave, although it feels like there's been many more than four waves, how many more are we likely to see? How long is this pattern going to continue for?

PETER:

We honestly have absolutely no idea.

We'd like to think that as we get these successive waves of variant viruses, they're building up our basic immunity and we're less likely to have severe problems or even to have infection at all that we detect. We speculate that maybe there's a whole lot more asymptomatic infection going on in this wave than we actually suspect. You know, the enthusiasm and the amount of effort to actually monitor what's happening, that's kind of fallen off. I mean, we're not doing the enormous PCR testing we were doing and all the rest of it, and that's understandable. You know, there's only so many dollars to go around and we can't spend all our dollars on medical issues.

So, we're hoping we'll get through this fairly soon. There’s a number of different virus variants circulating at the one time without any particular pattern of dominance. The doctors are of the mind that it's a much milder experience, whether that's related to the nature of the virus variants themselves or it reflects that we've got so many vaccinated people and many of those people have also been infected. So we have what people talk about as hybrid immunity. We really don't know.
You know, a part of the problem with this and why I've been backing off a lot from commenting on the pandemic is that a lot of the questions that are out there really will take time to unpick through doing good science and really seeing what's actually happening. That's going to take time to come through.

RUBY:

Ok and Peter, as you say, we’re really learning as we go here – and our approach has been to really rely on immunisation, and that has given us the licence to drop other precautions for better or worse. So can you explain exactly what the thinking behind that has been; and whether there are other lessons for us to learn at this point in the pandemic?

PETER:

Yeah, that was a tough call. I mean, if you are thinking in terms of, say, influenza, what we would have expected if it was flu is firstly the whole thing would have only gone on for two, maybe two and a half years at the most. The terrible influenza pandemic of 1918-19 was really over in two years. Once you've been infected with a particular flu strain, you're pretty solidly immune and you do have some cross-reactive immunity to other ones.

So the thinking in Australia was dominated by the idea that basically we buy time ‘till we get vaccines. And hopefully we get some antiviral drugs. The antiviral drugs took longer, but we had vaccines by early 2021 I guess, they were rolling them out in the US a bit quicker. But as we've all seen, the virus is changing and it blows by the vaccine.

So the last time that the virus was working pretty well with the vaccine was with the Delta outbreak. And then as we slipped into Omicron the perception has been, well, the vaccines aren't stopping us getting infected and we can still transmit. But they are keeping us out of hospital. That perception is still there. But the really solid evidence for it is not really that great. And that will take time to come through. So we did what was sensible and then we realised we couldn't do this forever because it's so vastly expensive and there are all sorts of other negative consequences, as we very clearly understand and we pointed out at the time.

So, basically we had to come off that and we have and we're getting repeated infections. So far, our numbers of total deaths are way below those for other parts of the world. But we'll just see. I hope we're not catching up.

RUBY:

Mm. But I suppose what you're kind of alluding to there is just because we know what happened with Omicron and what happened, you know, compared to other strains wasn't that bad. We can't suppose the same thing will happen with the next variant.

PETER:

Well, at the moment, all the variants we're seeing are derivatives of Omicron. Up ‘till Delta that were different mutants coming off at different parts of the viral genetic theme. What we're seeing recently, it's all variants of the Omicron strain, which suggests to me they're actually immune escape variants, that we make an immune response and the virus escapes from it.

That may or may not be true, but that's the way, as an immunologist I look at it and how much we can build up a really solid immunity through multiple exposures to those things, we're not really sure. And that really working that out takes some very detailed and hard science actually. We're equipped to do it, we're doing it at our institute. Other people in Australia too. So, you know, the scientists will have a much better story in three or four years' time when nobody's probably likely to be interested, but we'll be interested and we'll be in a lot better shape next time something like this happens.

RUBY:

Yeah, that's interesting. I mean, when we talk about the kind of shape that we might be in the next time something like this happens, do you think that we are absorbing all of the right kinds of lessons now that would, help prevent the next pandemic level virus, something that could like COVID did jump from animals to humans.

PETER:

Yes, they'll learn, individuals learn. To some extent, institutions learn. The extent to which governments learn is not nearly so clear. That's why you need standing professional committees of people who have real expertise. Feeding advice in the way it's worked here is through Chief Medical Officers or Chief Health Officers, then to the government. So basically the memory will be in the people, the scientists and the investigators and the diagnostician and the doctors. That memory then will hopefully inform the way we formulate further policies. I think we've got a pretty smart government at the moment, and I think we'll get some good policy settings out of it.

Archival Tape – Mark Butler:

“…vaccines and treatments. And today I'm releasing the government's COVID Health Management Plan for 2023, a plan that involves the investment of an additional $2.9 billion in special COVID measures over the course of that year.”

RUBY:

Yeah. I wanted to ask you about that, because this week we've seen changes to the federal response to COVID-19.

Archival Tape – Mark Butler:

“COVID admissions to Australia's hospitals will be funded in the standard way under the National Health Reform Agreement…”

RUBY:

We're going to be transitioning into managing COVID in a similar way to how we manage other respiratory viruses from next year.

Archival Tape – Mark Butler:

“This plan strikes the right balance, we're confident, to protect vulnerable Australians, to protect the integrity of our health and hospital system while transitioning safely out of the emergency phase of the pandemic.”

RUBY:

I just wonder what you think of that idea and the angle that it looks like Australia is going to be taking from next year on.

PETER:

Yes, from what I've heard of the proposals, what they're saying is pretty sensible because there's not an unlimited money in any federal budget and there's a hell of a lot of priorities apart from medicine. And we spent a lot of money in this area. And, you know, if you want to get more, then pay more taxes and there's no great enthusiasm for that.

So, yes, I have to back off and I have to take things in a more routine way if there's a possibility of a nasty surprise. But we're all hoping that won't happen. There's no particular reason to think it will happen. But it could happen.

RUBY:

We’ll be back after this.

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RUBY:

Peter, can we talk about some of the negative consequences of infection, because, we know we're seeing repeat infections now and there are some concerns about what that could mean. So what do we know and should really this give us a reason to change any of the policy settings we've had so far?

PETER:

Basically, in the end, we didn't know how severe it was going to be. We didn't understand a lot of how it worked. We didn't know that this isn't just a respiratory infection. Flu is just an infection of the respiratory tract and can kill you, but the virus stays pretty much in the respiratory tract. This virus gets around the body in the blood, so it's a different ballgame. The other thing, of course, is this blood coagulation story and clotting story.

That's a bit of a concern with it. Lots of studies from very, very large datasets on large populations. There are some concerning things there, like maybe there's a more incidence of heart attacks after the initial infection and so forth, but that'll take time to work through. So basically different countries around the world and even different states in Australia did slightly different approaches with slightly different experiments.

We need to look at these very seriously in the long term academics of the people who should do that really because they go in-depth and try to understand what's happening. We should be able to provide better insights to policy makers because they rely on professionals to get those insights and know what the actual evidence is.

RUBY:

Yeah. Well, I suppose one of the positive things to come out of this is that kind of growth in our institutional and scientific knowledge over the last few years.

PETER:

Yes, it's been a bit like a war. It's not only advanced the field in this area with respect to coronaviruses, it's actually advanced a lot of other things. There's still some controversy around them, the mRNA vaccines, which clearly need a bit more work in places, have become a feature of our landscape.

We've seen how we can use monoclonal antibodies for treatment. This virus has blown past them too. Considering what's happened with vaccination with this, there's a general thinking we really should be developing some more antiviral drugs. I mean, the thing about the antiviral drugs is because viruses are unique entities in their own right and they grow within our cells, it's very hard to get broad spectrum antivirals in the way you can get broad spectrum antibiotics.

With antivirals you've got to design them, particularly class of viruses. But the Tamiflu antiviral, for instance, which works very well if you give it when people are just infected. And we know how to detect that. Now, with RAT tests, for example, that works against all the flu virus, the influenza A, the influenza B, all mutants, all the variants.

Now the same type of drugs can be designed for Coronaviruses and Henipavirus, Theiloviruses… These are some of the virus viruses that could potentially cause severe pandemic.

RUBY:

Hmm. Okay. And just finally, when you think about the way in which COVID jumped from animal to human and the potential for that to happen again, I mean, it's happened before COVID. Presumably it could happen again. Are there things that we could look at right now that could prevent that from happening?

PETER:

You know, viruses have jumped across from other species into us forever. Measles virus probably came from bovine rinderpest viruses maybe a thousand years ago. The closer domestic and wild animal populations live together, the more risk there is. But a lot of that risk in the past has been local.

Viruses did travel between continents. The yellow fever virus, we believe, travelled from Africa to the Americas at the time of the colonial invasions of the Americas. But now, of course, viruses get around the planet very, very fast in aeroplanes, especially respiratory viruses. And so we've got an issue here. Two new common cold coronaviruses, both of which were picked up in big airport cities, Amsterdam and Hong Kong. The MERS virus, the one that goes from camels to humans and kills about a third of the people and infect and of course, CO 2. Now four of those are still circulating. So before 2000 we had two human coronaviruses circulating. Since 2000, we have six.

So what's changed since 2000 is, I think, increasing prosperity in countries that have live animal and live bird markets and passenger air travel out of those countries.

And the more we are interlinked, the more people are going into areas where there are wild animals. And this is happening with clearance of forests and food shortages in developing countries. The more risk there is, the more threat there is. So I think the threat level from this type of thing has increased dramatically. And we need to think this through clearly and develop strategies to try and stop this happening in the future. And if we do that and if we make, for instance, panels of antiviral drugs that could be used rapidly, we might be able to contain these things because as we've seen, this is enormously economically and socially disruptive, and this is a virus that actually kills relatively few people.

We thought initially it was killing 1-to-2 per cent of people. That was just based on clinical symptoms early on, but it's much less than that. But if we had a virus that's killing 5 per cent of people, now you've got a very, very different situation than we've had with CO 2.

RUBY:

That's a scary thought.

PETER:

It's pretty scary. And you know, this is a real concern for us. We like to think we're in control. Well, the example I always use is when did we last make it rain or stop raining?

We're basically instructed by nature and we better accept that.

RUBY:

Peter, thank you so much for your time today.

PETER:

You're welcome.

RUBY:

You can read Peter Doherty’s essay in The Saturday Paper, this weekend.

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RUBY:

Also in the news today…

Archival Tape – Royal Commission:

“When discrepancies were flagged, a review would be undertaken. Are you listening at all?”

Archival Tape – Scott Morrisson:

“I am, absolutely.”

Archival Tape – Royal Commission:

“Thank you.”

Former Prime Minister Scott Morrison has appeared before the Royal Commission into the Robo-debt Scheme for the first time.

In a lengthy appearance, Morrison was questioned over what he knew about the legality of the scheme in his role as Social Services Minister at the time of the launch.

Archival Tape – Scott Morrisson:

“The department has, and under the act, has an ability to raise debts. I don't think there's any dispute about that.”

Archival Tape – Royal Commission:

“That's not the question.”

Morrison insisted he gave the cabinet all necessary information when he presented the proposal ahead of the 2015 budget, but said he did not think he needed to ask the department whether legislative change was required to implement the scheme.

And,

Scientists in the US have achieved a major breakthrough in nuclear fusion.

Using the same process that powers stars, a US laboratory confirmed for the first time in history, more energy was produced in a fusion reaction than was used to start it, in a process called ‘ignition’.

The findings could have the potential to revolutionise clean energy, but experts say it could still be decades before nuclear fusion can be used to power homes.

I’m Ruby Jones, this is 7am. See you tomorrow.

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