Coronavirus crisis: How the world is trying to stay ahead of the Delta variant

This week, Indonesia overtook India to become the COVID-19 epicentre of Asia. Daily case numbers reached 54,517 on Wednesday — an astonishing increase from the 2385 daily cases reported two months earlier — and an average of 900 people are dying each day. Hospitals are overcrowded and running out of oxygen, and drone footage of a widening grid of graves at Jakarta’s Rotoron cemetery, pictured, captures the extent of the tragedy. In Peru, which has the world’s highest COVID mortality rate, there are less than 3000 ICU beds for a population of 32 million. Locals are scrambling to buy oxygen tanks on the black market for loved ones who have been turned away from hospitals. Elsewhere, Britons and Americans are returning to pre-pandemic life, buoyed by their nearly 50 per cent vaccination rate. They are attending packed concerts and taking summer holidays, but there are fears their progress could be jeopardised amid rising case numbers. In Australia we remain in the grips of the virus, with millions of people in Sydney and Melbourne back in lockdown as the highly contagious Delta variant spreads, and the national vaccination rate sits at 10 per cent. Despite the progress that has been made since the pandemic began, the Delta strain — predicted to soon become the dominant strain worldwide — coupled with increased social mobility and shocking vaccine disparity means the crisis is far from over. In fact, as the grim milestone of the four millionth COVID death was reached this week, the World Health Organisation warned we are “in the early stages of a third wave.” Delta on the march Described as a “formidable foe,” a “tricky bugger” and a “guerilla fighter”, the Delta variant, or B.1.617.2, emerged quietly in the Indian state of Maharashtra in October 2020. At the time, the focus was on the Alpha strain which was devastating the country, but by May Delta had created a massive second wave of almost 400,000 daily cases in India. This prompted the WHO to add it to its “variants of concern” along with Alpha, which originated in the UK; Beta, the South African strain; and Brazilian variant, Gamma. Delta is now present in 111 countries and is 55 per cent more transmissible than the Alpha variant, which was itself around 50 per cent more infectious than the original Wuhan virus. In the early days of the pandemic, 15 minutes was given as the time it could take for COVID-19 to pass between people within six feet of one another. With the Delta strain, that has fallen to just 10 or 15 seconds and can now involve fleeting contact. We saw evidence of this at a brewery in Mindarie late last month, when the virus jumped between two people dining separately, prompting Perth’s snap four-day lockdown. And we have seen it in Sydney in recent weeks, jumping between strangers at a cafe or walking past each other in Bondi Junction. Curtin University Pro Vice Chancellor Archie Clements, a professor of infectious disease epidemiology, says the nature of Delta, combined with the low vaccine rate, meant restrictions and lockdowns would continue to be a part of life in Australia. “It’s the reality for the foreseeable future, until we get our vaccination coverage sufficiently high to prevent outbreak and transmission in the community,” he said. He said the world faced a “long journey” in the battle against COVID-19 with just 12.4 per cent of the global population fully vaccinated. “We need to get up to 80, maybe 90 per cent coverage in order to make this go away globally, and that’s not going to happen for at least two or three years, so we have to learn to live with the virus in the meantime.” Global vaccine disparity Vaccine diplomacy is shaping as a key issue with some countries boasting immunisation rates of more than 50 per cent while others — mostly impoverished South African nations — have a rate of less than 2 per cent. This disparity has the WHO greatly concerned as countries like Israel and Bahrain look at introducing booster shots to fully vaccinated citizens and 20 nations now vaccinating 12-year-olds, while others — Australia included — remain vulnerable. “Countries in a position of power develop the vaccines and have the resources to get them,” Professor Clements said. “But that’s not the most strategically beneficial way of doing it for humanity. We need to target vaccines where they are having the most impact, from a health perspective and to dampen the spread of the pandemic.” The game-changing nature of Delta has prompted United Arab Emirates, Bahrain, and Israel — all considered to be world leaders in the vaccine roll out — to give booster shots, offering them initially to vulnerable adults. Pfizer is seeking approval from US health officials to distribute a booster shot but this has so far been resisted, with US chief medical adviser Anthony Fauci insisting there was not enough evidence to support a third shot and US officials requesting more data. Britain has also foreshadowed ordering 60 million more doses of Pfizer/BioNTech’s vaccine ahead of a potential booster program. The WHO has rebuked countries pushing ahead with booster shots while many underprivileged nations were still trying to secure initial doses. Professor Clements said it was selfish and short-sighted for developed countries to pursue this agenda. “They are not going to be safe until all countries are safe, until the whole world has dealt with the problem,” he said. He is also worried about the UK pushing ahead with its “Freedom Day” tomorrow, when remaining COVID-19 restrictions will be lifted. Laws mandating the wearing of masks will be scrapped, with the onus on businesses and individuals to make their own decisions. Images of maskless crowds at Wimbledon and the Euro 2020 — among them the Duchess of Cambridge — suggested masks had already been packed away as the vaccination rate reached almost 50 per cent (with 70 per cent having received one dose) and the country breathed a collective sigh of relief. But experts are divided on whether Prime Minister Boris Johnson’s re-opening has come too soon, as the Delta strain points to a worrying uptick in both cases and deaths, and the country is yet to reach herd immunity. Between July 8 and 14, UK deaths increased 42.2 per cent to 229 and there were 245,830 positive cases, an increase of 27.4 per cent. The WHO’s special envoy on COVID-19, Dr David Nabarro, said it was too soon to be abandoning all restrictions. He told the BBC the pandemic was advancing “ferociously” and the world had not got through the worst of it, despite the vaccine roll out. “This dangerous virus hasn’t gone away, it’s variants are coming back and are threatening those who have already been vaccinated – we have to take it seriously,” he said. And the British Medical Association also warned of “potentially devastating consequences,” referencing modelling which showed the Delta peak would not come until August. “It’s irresponsible – and frankly perilous,” BMA council chair Dr Chaand Nagpaul said. Professor Clements agreed, suggesting it was arrogant to open up with 50 per cent of the population still to be fully vaccinated. “I think they need to be a lot more careful... they think they’ve got the vaccine now, and the virus is behind them, but it’s not. It won’t be until they get 90 per cent vaccination, or whatever the threshold is.” “If they don’t have high coverage by November, they could be in for another bad winter.” Can vaccines keep up? Another emerging concern is just how well the existing vaccines can protect people against mutating strains. So far, they seem to be holding up. A study from Public Health England found the Pfizer vaccine was 36 per cent effective against Delta after one dose and 88 per cent after two doses, while AstraZeneca offered 30 per cent protection after one dose and 67 per cent after two. However the vaccines were 94 and 96 per cent effective against hospitalisation. But a study out of Israel found Pfizer protected 64 per cent of inoculated people from Delta infection, down from 94 per cent protection against the Alpha strain. University of Sydney infectious diseases expert Professor Robert Booy said while slightly less effective then they were against other strains, the existing vaccines were still highly effective, particularly when it came to reducing the severity of infections. But he said the spread of Delta meant there was a “compelling need” to administer the second vaccine as soon as possible. He welcomed updated advice from the Australian Technical Advisory Group on Immunisation this week that the gap between the first and second AstraZeneca doses could be reduced from 12 weeks to between 4 and 8 weeks for people living in “outbreak situations.” Another variant global health bodies are keeping a close eye on is the Lambda, which originated in Peru. It has been declared a global variant of interest by the WHO but is not yet a variant of significant concern. A returned traveller in a NSW hotel tested positive for the Lambda strain in April. Professor Jaya Dantas from Curtin University’s School of Population Health said the Lambda was as contagious as the Delta and had so far spread to 29 countries. Peru, with a vaccine rate of 11 per cent and an under resourced health system, has been decimated by the strain, which accounts for 80 per cent of all cases. “It will spread, countries are opening up and people are mobile, and these countries are seeing if they can live with the virus,” Professor Dantas said. “But to do that, they need to get the vaccination rates up, and unfortunately in many parts of the world, like South Africa, the rates are very poor.” What about children? Among the many crises facing Indonesia is a worrying infection rate amongst children, many of whom are already immunosuppressed, and who account for one in eight — or 270,000 so far — cases and more than 700 deaths. These figures, like the nationwide case numbers, are expected to be a huge underestimate because only about 49 tests are carried out for every 1000 Indonesians. In the US state of Mississippi, seven children are in intensive care, including two on ventilators, after being struck with the virus. Closer to home, eight COVID patients in Sydney hospitals last week were under the age of 35, including a teenager. America has approved Pfizer for adolescents 12 and older, and manufacturers are testing lower doses of the vaccine to use on even younger children. Twenty European countries are either currently vaccinating 12 to 18 year olds or planning to do so, alongside the UAE, Israel, Japan, Singapore, US, China, Canada, and the Philippines. These countries hope the strategy will break transmission chains in schools and households, as well as protecting children. “The Delta disease can harm those who are not vaccinated, and that is the children,” Israel’s new president Naftali Bennett said after his teenage daughter, Michal, was vaccinated this week. In Australia, Pfizer is provisionally approved by the Therapeutic Goods Administration for 16 years and older, but increasing adult vaccination remains the priority. AMA WA spokesman Andrew Miller this week called for an “open discussion” on vaccine eligibility for children, saying the impact of Delta on children seemed higher compared to other strains. “The international data shows there is a low, but not zero, risk for younger people,” Dr Miller said. Professor Booy said teenagers “did not suffer nearly as much” from COVID as someone in their 20s or 30s. He said UK data suggested there was a risk of one in half a million of children dying from COVID. “I think we need to concentrate efforts on at-risk adults, and the elderly, and if we do extend it to people under 18 it should only be, to begin with, children with chronic medical conditions,” he said. Amber Heaney is among the parents across WA who are starting to discuss the prospect of vaccination with their children. Her son Stanley Vickery has just turned 12. “At first he said, ‘I don’t think so’ but then I asked how he would feel if it meant he could go overseas again and he changed his tune pretty quick,” he said. Stanley said while he wasn’t a fan of needles, he received the flu shot each year and would receive a COVID vaccine if it meant the world could return to normal. Normal remains some way off, and the road to get there is hugely challenging. Based on the daily global vaccination rate of almost 31 million, it will take another eight months to cover 75 per cent of the world’s population. In Australia, at the current pace of more than 900,000 doses a week, the adult population could be vaccinated by March next year. But as Professor Clements warned, getting the first 50 per cent of the nation immunised was the “easy” part. “Supply is the issue at the moment. But at some point we will have enough supply, and the issue will become secondary to uptake... and trying to convince individuals who are sceptical,” he said.