Issue #104: Where are we with COVID and what’s next?

Written by Nobel Laureate Professor Peter Doherty

Over the past seven weeks I’ve taken a break from writing about COVID-19, partly because I’m trying – like many others I suspect – to get my head straight on where we actually are with this. Reporting in ‘real time’ is, of course, the business of journalists, but that’s not generally how scientists work. We wait, watch, investigate and ‘interrogate’ (data sets rather than people) until we think we have a valid story to tell, then go ‘out there’ with a research paper that would not normally be available for scrutiny till it appears in a peer-reviewed journal.

Many such publication formats had already become ‘open access’ for all to read before COVID-19 hit but, for those unfamiliar with the way such reports are structured, they can be alien, unfamiliar and easily misinterpreted by the lay reader. I discussed that way back in 2015 (The Knowledge Wars), and also gave some hints as to how people might navigate their way through this type of specialised writing. With COVID-19, of course, the move to publish ‘preprints’ has allowed us to access such information earlier, though it has not made them any easier for most to understand!

As I’ve mentioned earlier, the 103 essays that preceded this one have been drawn from: information in scientific preprints and published papers, what’s appearing in the general media and discussions with colleagues. That’s been assessed in the context of living with the science of virus infections, immunity and pathology/pathogenesis for almost 60 years. My own research career has largely been based in laboratory experimentation but, all through that time I was attending scientific meetings, reading reports and serving on committees and task forces where I encountered the findings, conclusions and thinking of clinical colleagues.

As I’ve gone through what’s ‘more or less’ familiar from earlier studies of other virus infections, I’ve been deliberately avoiding some topics, either due to the limitations of the available information (including obvious parallels), or because the underlying science is more distant from my areas of personal expertise. One example is Long COVID, another is the blood clotting (coagulopathy) aspect of the disease we call COVID-19. But it’s beyond time to, in the words of Shakespeare’s King Henry V, ‘stiffen the sinews and summon up he blood’ and put down in print my understanding of what looks to be happening. What is certain is that whatever I write now will be, at best, an interim report. These are complex situations, and there is a lot that is unclear from the data sets available to date.

When it comes to experiments and COVID-19, much of that has been straightforward and concerned with vaccine and drug development, then testing these products in preclinical and clinical trials to ensure safety and efficacy, topics I’ve already discussed at length in this series. The biggest ‘experiment’ was, perhaps, giving millions of people the new mRNA vaccines (Pfizer and Moderna). We’ll probe the issue of efficacy in different contexts further over the next few months, but it is possible to summarize the vaccine safety data.

As of 24 April, Australia’s TGA has “received 544 reports which have been assessed as likely to be myocarditis from about 39.4 million doses of Comirnaty (Pfizer) and 86 reports which have been assessed as likely to be myocarditis from about 4.2 million doses of Spikevax (Moderna).” Note the conservative language of, “assessed as.” These cases have mainly been in 12-30 year old males with, as of 10 April, 2022, nine requiring treatment in an intensive care unit. None have died, while we have had 7355 deaths linked to infection with the SARS-CoV-2 virus. These vaccine safety numbers are (relative to population size) comparable to those recorded in other countries, but the COVID-19 mortality counts are very low.

The other massive experiment that’s been done across the planet is at the level of how different nation states have calibrated their public health response. By that measure, we would have to consider the public health ‘experiment’ we’ve all been part of to have been very successful. Comparing on a population basis Australia would, if we had experienced the type of outcomes seen in the UK and the USA, have had around 70,000 deaths. It will, of course be interesting to look again at this relativity in 12 months time.

Apart from the early experience with the Wuhan virus, and the ‘escape’ of the Delta virus into Victoria and NSW during the second half of 2021, most of the infections here have been with the ‘milder’ Omicron strains in a heavily vaccinated population. Additional to that, the mortality rate in the elderly and immunocompromised should now drop with the greater availability of the antiviral drug, Paxlovid, which must be given early in the infection to be maximally effective. The main danger there is, of course, that a drug-resistant mutant may emerge.

Now, as a consequence of the great ‘opening up’ that resulted from both decisions made at the political level and frustrations in the community concerning restrictions on movement and so forth, we are on much the same playing field as the rest of the world. Across the planet, variants of the Omicron strain dominate. Over the next couple of months, I’ll try to clarify my own thinking re where we are with COVID-19 and pass that on.