Our three year old grandson’s day care recently sent an email to all parents saying there’d been a case of COVID in a child. A week earlier, our boy had a rough night with a temperature and a cough.  Panadol syrup calmed him within 30 minutes. By morning he’d rapidly recovered his normal high energy self.

So when the COVID note arrived, we all wondered whether he might have had undiagnosed COVID the week before when he had a 12 hour elevated  temperature. His mum and  four of his grandparents had seen a lot of him up close. So we all tested ourselves, with me being the only one testing negative over 3 rapid antigen tests. All but I experienced minor symptoms lasting a day or two.

Day care is a universally acknowledged cesspool of infection. Between our three children (now in their 40s) and their five offspring, we’ve seen croup, RSV, Coxscackie disease (hand, foot and mouth), stomach bugs, ear infections and innumerable episodes of snotty noses, coughing, sneezing bouts and fleeting temperatures. Occasionally these saw trips deep in the night to hospital outpatients (for bad croup) and visits to GPs where rest, comfort and panadol and were prescribed.

This commonplace history, experienced by nearly all parents, teaches us childhood infections are inevitable and that rushing off to a GP each time is both unrealistic and unnecessary. It has long been understood that  some early childhood infections can promote normal immunological maturation and preventing atopic disease (eczema, asthma, hay fever).

As adults, we use the same decision tree about our own colds with coughs, congestion, muscular aches, and common gut problems. Experience teaches that these are mostly self-limiting unless they persist or are particularly severe. While we often take a day or two off for a bad cold and cancel crowded and close-up interactions, we don’t push the panic buttons that still hover for many about COVID unless there are signs of deadly serious diseases like sepsis and most notifiable diseases (see NSW list here).

But for some, COVID still remains cloaked in a whole different meaning. If you tell someone you have COVID, the experience is often still redolent with the portent that has surrounded diseases at different historic times like bubonic plague, smallpox, tuberculosis, HIV and ebola. Globally, COVID has killed a conservative 7.1 million and infected 780 million since 2019, so this is pretty understandable.

I am in a retirees’ walking group on Fridays and have played tennis on Sunday morning in the fabled Perpetual Wimbledon Qualifiers competition for over 25 years. Both groups have participants in their 60s and 70s, with three in their early 80s. These age groups are at most risk of serious adverse outcomes from COVID infection. Two in my tennis group have chronic conditions and are understandably acutely concerned to minimise exposure to infection.

I heard about my wife’s positive test result about 3 hours into our Friday walk. No one asked me to leave, but I sensed or imagined some anxiety and so caught a train home at the first opportunity. I tested negative when I arrived home, as I did on the next two mornings. I told my tennis group about my and my wife’s status and one of the immuno-suppressed friends said he did not want to risk exposure, regardless of tennis being an open air, non-contact sport. I decided to step down from the game that Sunday to allow him to play. Three players gave me the thumbs up and thank you emojis.

All this stimulated some brushing up on current COVID data and on government recommendations on vaccination, testing and isolation. Here’s a summary of some of the key parameters:

• The first orders for self-isolation for COVID commenced on March 26, 2020 with COVID notification becoming mandatory from January 2020.
• From 14 Oct 2022 in NSW, it was no longer mandatory, only recommended,  to self-isolate if you had COVID nor to report a positive test. Most mandatory COVID regulations were repealed at midnight on 30 Nov, 2022 other than those applying in some health and aged care facilities. Many vaccination mandates for health care workers remain (list here)
• In 2022, there were 3,345,187 cases of COVID notified to NSW Health. In 2023, the total number of notified cases fell to 307,076 (9.2% that in 2022). The first 111 days of 2026 have seen 12,226 cases. Extrapolated out to 365 days, this may see 40,263 cases notified for 2026, 1.2% of that notified in the peak year 2022. NSW Health has not published weekly COVID numbers since 20 October 2023. It states today that the best measures of COVID-19 in the community are admissions to hospital and in sewage monitoring. Much of the fall-off in COVID cases reflected the major drop-off in people testing with rapid antigen kits.
• As at April, 2024 there had been 24,414 COVID deaths among 11,813,144 national COVID cases  with 2.7% in those aged under 60 and 55% in those over 85.
• COVID vaccination and previous COVID diagnosis do not reduce the incidence of COVID, but critically, they greatly reduce its severity
• Young children are at much lower risk from COVID than older adults. Child care services need not notify cases. Parents and staff  “don’t have to self-isolate if [they] have COVID-19, but NSW Health strongly recommend [they] stay home to protect others”.
• Your child’s centre can’t tell you every time a child or staff member gets COVID. However, they will notify you of results which could be of concern to you and your family.

The dramatic fall in the incidence of COVID is explained by changes in immunity to the virus caused by the hybrid effect of huge numbers having been infected and by mass vaccination. Some 97% of adults have been vaccinated at least once in Australia. In the last 12 months,  1.382m doses of COVID vax were administered in Australia, with 60% of these in those over 65 years, and 30.6% in those over 75. Nearly all of these would be booster shots. The graph below shows the fall off across the  years of the pandemic.

Source

Discussing all this with a friend who is an international infectious diseases epidemiologist, he remarked “I wonder how many of those who want to keep far away from anyone with COVID  or even those living with someone with it, routinely isolate from others in their house and get themselves tested every time they have cold symptoms, because colds and COVID have a lot in common in their early stages. And do they expect or demand all those they live with to do the same? How does all that work out?”  

It’s plain there are some who seem to believe that COVID could be fully eradicated like smallpox, and until that time every precaution should continue to be observed as if serious illness and death were waiting around the next corner

My expert friend’s two clearly rhetorical questions obviate that most of us assume that signs of respiratory issues will be trivial, short-lived and passing.  Sneezing is universal with an estimated 95% of people sneezing up to four times a day. Adults typically have 2-3 colds a year, with children having more. If we isolated and informed those around us every time we had a sore throat, congestion with body pains or sneezed a few times, we might well rarely leave the house if our concerns were mirrored in others.

They also make it clear that as always, risk perception is only tenuously built on full comprehension and perspective on actual risk but far more on heuristic shorthand cognitive biases anchored to pre-existing beliefs and concerns. Our contagion-minimising behaviours are also inevitably confounded by uncertainty prior to any formal diagnosis.

If those who cohabit with someone who has COVID but who are asymptomatic and have tested negative should be nonetheless avoided, then how does this ethically parse differently to those who make their own assessment that precursor symptoms of possible COVID should not be tested, and they should go out in the world with a clear conscience?

COVID is far from gone, but for all but those with compromised health because of advanced age and co-morbidities like immunological vulnerability, it has mostly moved into the pantheon of sicknesses that will visit many of us from time to time, mostly with little consequence. Except for the very frail old, where COVID today still takes to the stage with ‘flu as a cause of death when death from some cause would have very probably happened within months anyway.

Since December 2023 NSW Health’s advice on minimising the likelihood of spreading COVID to people at higher risk from the disease includes:

• Monitor for symptoms. If you have or develop cold or flu symptoms (runny nose, sore throat, cough, fever), stay home until your symptoms have gone. Wear a mask to protect others if you have symptoms and need to leave home
• Maintain physical distancing where possible and get together outdoors or in well-ventilated indoor areas.
• Regularly wash your hands
• Consider doing a rapid antigen test (RAT) before visiting people at higher risk of severe illness. [my emphasis)

Note here, that the advice emphasises that self-isolation need only occur while symptoms are manifest. This is in spite of NSW Health information elsewhere (dated June 2024) saying that people can still be infectious after symptoms end for up to 10 days and that those with no symptoms can be infectious too.

When we test positive for COVID, we rarely know exactly who we acquired it from. When there are people close to us (family, colleagues friends), the principle of parsimony or Occam’s razor suggests that the simplest explanation is the one most likely. So, yes, our grandson did almost certainly spread it to four in his family. But when a family has an “index case” among them, and with many people positive people today not knowing they are positive and never experiencing any symptoms, it is not sensible to finger someone who has tested positive as the definitive  person who brought it into our homes or workplaces.

The most important take home in all this is that if you are in your final decade or two, you would be very sensible to do all you reasonably can to minimise the chances that you will be badly affected if you do get COVID.

As I prepared to end this post this, I read an excellent blog by an old South Australian colleague, epidemiologist Prof Adrian Esterman now 77, on the same topic. It has reliable, prudent information on what older people should do to reduce their chances of being seriously affected by COVID. Please read it.

My other blogs on COVID

⭐ over 500 reads ⭐⭐ over 1000 reads

⭐Should COVID vaccine refusniks now be restricted and fined. WordPress 19 Dec, 2021

⭐⭐The very best of cartoonists against COVID-19. WordPress 21 Aug, 2021

1 in 7 Australians still plan not to vaccinate: time to erode this with tough campaigning. WordPress 4 Aug, 2021

⭐⭐Should those avoiding AstraZeneca vaccination because of the clotting risk also avoid having an anaesthetic? WordPress Jun, 2021

⭐Eight common excuses for not being COVID-19 vaccinated and what you can say that might help. WordPress 27 May, 2021

⭐With the risks of AstraZeneca blood clots being tiny, what explains COVID19 vaccine hesitancy? WordPress 23 May, 2021

A reverse white feather? Let all who are COVID19 vaccinated wear a badge proclaiming and normalising it. WordPress 21 May, 2021

⭐⭐What should we make of 10 nations suspending the AstraZeneca COVID-19 vaccine rollout WordPress 15 Mar, 2021

Mandating masks rapidly and dramatically increases mask use: before law 7%, after 97%. WordPress 4 Feb 2021

COVID-19 mask laws drove use through the roof. So where are the data we should megaphone across the world? WordPress 2 Feb, 2021

⭐What’s to be done about Van Morrison and Eric Clapton’s anti-lockdown antics? WordPress 19 Jan, 2021.

Imagine a surgeon refusing to wear a mask. Gladys’ refusal to mandate public masks is this writ large WordPress 21 Dec, 2020

⭐⭐What Dr Fauci didn’t write about COVID19, but well could have. WordPress   14 Sep 2020

⭐The ethics of shaming prominent COVID-19 mask opponents. WordPress 26 Jul 2020.

When COVID-19 pandemic gets tough the conference scammers get going. WordPress  25 April, 2020

⭐⭐Indelibly sear this into the national public and political DNA: evidence-based prevention saves many lives so let’s honour our COVID-19 heroes. WordPress Apr 22, 2020

⭐⭐How can we erode self-exempting beliefs about COVID-19 contagion and isolation that might subvert flattening the curve. WordPress Apr 19, 2020.

⭐⭐Home isolation: except for food, medicine and exercise. So why are so many other stores open? WordPress Apr 7, 2020

⭐If self-isolating COVID-19 cases won’t isolate, should they be monitored with GPS wearables? WordPress Mar 10, 2020