Focus should now be on boosting COVID immunity, not avoiding infection

The World Health Organisation (WHO) has cautiously flagged the “beginning of the end” for the pandemic. But in Australia, familiar voices have been lamenting shortened isolation periods, minimal mask-wearing and low coverage of COVID-19 vaccines among children less than 12 years of age.

They say advocates of less rigorous measures are driven by financial or self-interest and ignore expert health advice. These criticisms rang true as little as nine months ago when Omicron was devastating Australia, causing large increases in deaths in residential aged care due to low booster coverage. But the nature of the game has changed.

For the great majority of people, getting infected with Omicron (rather than Delta), with vaccines on board, should no longer be scary.

The main thing we ask from vaccines is to protect us against becoming severely ill with a virus, not to protect us against every infection.Credit:AP

In countries like Australia and New Zealand, where border and infection control measures have been the core of efforts to get to “zero COVID” it is hard to accept that it no longer makes sense to avoid infection at all costs. But as SARS-CoV-2 is here to stay and most of us will meet it many times – particularly children and young adults – we now need to focus on strengthening immunity, not avoiding infection.

As a paediatrician specialising in infections and vaccines for more than 25 years, two things are apparent to me. First, for a six-month-old baby who has lost all the antibodies from their mother, all viruses are new, so immunity must start from scratch. Second, the main thing we ask from vaccines is to protect us against becoming severely ill, not to prevent infection of any severity.

A good example is the rotavirus vaccine, which we give to babies. The vaccine does not stop them getting any rotavirus infection (which the vaccine is not so good at) – but stops them having diarrhoea bad enough to end up in hospital (which it is very good at). This is success.

Mask-wearing and testing for people without symptoms is no longer relevant in the post-vaccine, post-COVID zero era.

With SARS-CoV-2, the whole world has found itself the immunological equivalent of a six-month-old baby except that infant immune systems are much better equipped to deal with it, as every virus they encounter is new. As we grow older, or develop diseases, our immune systems progressively lose the ability to cope with a new virus.

Influenza viruses have been around for a long time but, ironically, when a new strain comes along (as it did in 2009 and even more so in 1918) people who are old enough to have “seen” an influenza strain virus like the “new” strain do best.

SARS-CoV-2, especially Omicron, seems to behave just like one of four coronaviruses which have been around for a long time.

They typically cause at least one “common cold” by the age of two years. COVID vaccines in young children are only important to directly protect the very few unlucky to have severe problems with their immune system.

Where does this leave us? Unfortunately, evading infection with Omicron will not be possible forever, or even in the medium term except for the most isolated people. We can see that from the number of strong public advocates of rigorous personal protection who have already been infected.

The good news is that infection and vaccination offer much stronger and more long-lasting protection than infection or vaccine alone. For those still at risk of severe illness despite vaccines and boosters, good access to early treatment with antiviral drugs makes a big difference.

But high vaccine coverage in children and anything short of China-style testing, masking and lockdowns won’t make the virus go away and even then, not in the long term. Yes, there will be new variants but so far, vaccines have protected us well from severe illness much better than against infection. Yes, re-infections occur, but all the indications so far are that they further strengthen protection against the next variant.

Yes, a small percentage of people will have persistent symptoms, but the worst of long-COVID belongs firmly in the pre-vaccine era. Mask-wearing and isolation remain important for people with symptoms who have a positive test. Mask-wearing and testing for people without symptoms is no longer relevant in the post-vaccine, post-COVID zero era.

For coronaviruses, emergence of a new variant which can both evade immunity and cause severe disease is very unlikely. If it happens, strong infection prevention measures would likely again get strong public support, but only if we do not damage that support by unnecessary mandatory measures now.

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