I liked this article in today's SMH. It sums up many of my thoughts on how we move forward.
**We need to talk about death so we can live with COVID-19**
It is not possible to eradicate COVID-19 from the globe, nor is it possible to keep it out of Australia. We need to start talking about the likely outcomes of COVID-19 circulating in the community. We need to start talking about accepting death as an outcome of disease.
As a doctor, I accept death as an outcome every day. I discuss it with patients on a one-on-one basis. I discuss it with their families when treatment is futile, or when I know a patient could have a disease to which they will succumb. Our politicians and health leaders need to start to speak this way to the whole population.
About 1200 people died from influenza in 2017 and people were not especially worried. We did not shut down the economy, nor close schools, nor even institute any of the simple manoeuvres that would probably have prevented many of those deaths (wearing masks, hand washing, and social distancing). It is time our political leaders started to listen to balanced advice.
There is no solution that will not entail deaths. It may be deaths from COVID-19, or deaths of young women who could not access breast cancer screening. Or patients with brain aneurysms that sustain a stroke, or die from the aneurysm rupturing. Or patients with colon cancer who could not access treatment when the disease could have been cured at a younger age. These are just some examples.
I found it confusing to read in the news about three patients in their eighties who died living in a nursing home when on the same day, at a busy teaching hospital in Sydney, I looked after three patients who also died, from intracranial haemorrhage (bleeding in the brain), and these deaths did not reach the news.
COVID-19 needs to be thought of as endemic, and not as a pandemic. It is very likely COVID-19 will lead to a significant increase in deaths – it is not the flu or a common cold. It might be there is a 10 per cent or even 20 per cent increase in the number of deaths per year. Of note, however, is that we had only 37 deaths from influenza last year and none this year, so the outcome may eventually be even. Are we prepared to accept a trade-off in death from different causes? It would be a significant tragedy if young people who have curable diseases such as cancer or even mental illness succumb to these in years to come because of lockdowns and COVID-19.
Australia has been lucky because of our geographical isolation, but we have been educated to be afraid of death from COVID-19, and not accepting of the fact that patients will die from this disease.
The average survival after one is admitted to a nursing home is less than 12 months, so it is not surprising people in their eighties who are living in a nursing home might die from COVID-19. It is sad for their families, but it is equally sad for the families of all the other patients from nursing homes who die each year.
The only sensible approach is that when we reach suitable vaccination thresholds, we open up the economy and our society. I hope we can reach these vaccine thresholds but if we cannot, we still have to open up. People may choose to isolate themselves and that is reasonable, especially if that person chooses not to have a vaccine, but we cannot be held back by those who are unvaccinated.
Those that are vaccine-hesitant should consider their vaccination will protect children who cannot be vaccinated now, the way the whooping cough vaccine does. Adults are not particularly at risk of whooping cough, but how many of us have had a booster when visiting someone with a new baby? Maximising vaccinations will also allow our excellent health system to continue to care for all patients, not just those who have COVID-19.
In our society we do not talk about every death as a tragedy. Our politicians do not talk about the 25-year-old who died from a ruptured aneurysm two weeks ago under my care. I am not suggesting they should, but equally we must stop talking about every death from COVID-19. I call on our political and health leaders to start talking rationally about how we can survive with COVID-19 rather than trying to eliminate a disease which cannot be eliminated.
Dr Rodney Allan is a senior neurosurgeon working in public and private hospitals in Sydney and the president of the Neurosurgical Society of Australasia.