The Munk Debates Podcast - Be it resolved: The threat of new COVID-19 variants makes elimination of the virus the only viable, long-term public health strategy to end the pandemic

Episode Date: February 11, 2021

B117, N501Y, P1 - these are the labels for new variants of the COVID-19 virus that have led to new waves of infection in the United Kingdom, South Africa, and Brazil and are now spreading around the world. Studies suggest that these variants could be substantially more infectious and possibly more lethal than the early COVID-Sars-2 strains. Most worrying, the mutations that characterize these variants may reduce the effectiveness of the long awaited vaccines leading to new surges in cases, more deaths, and forcing vaccination efforts to achieve levels of mass inoculation that are a public health nightmare. In light of the ongoing threat of COVID-19, some infectious disease experts are pushing for what is being called a “Zero Covid” strategy to bring the pandemic to an end. They say that countries like Australia and New Zealand have proven it is possible to all but eliminate the virus and the rest of the world needs to follow their example. They argue that strict, comprehensive, and long-lasting lockdowns that bring COVID cases close to zero is the best way to deal with the original strains of the virus and head off the even greater threat posed by the new variants. Critics of an elimination strategy say that the kind of lockdowns it envisions are based on an irrational, overly fearful reaction to a pathogen that is no riskier than influenza for the vast majority of the population. They say that lockdowns are causing long term harms that far outweigh the public health impact of COVID-19. Countries which have tried to eliminate the virus have sacrificed the well being of their societies and economies for the epidemiological pipedream of zero Covid. The right approach is one based on learning how to live with COVID and managing the threats it poses to the elderly and vulnerable. Arguing for the motion is Stephen Duckett, the Health Program Director at the Grattan Institute in Melbourne Australia and the co-author of the “Australia should go for zero COVID-19 cases” report. Arguing against the motion is Simon Thornley, an epidemiologist at the University of Auckland and a member of New Zealand's COVID Plan B, a multidisciplinary group of experts pushing for a modified response to the pandemic. Sources: KHOU-11, BBC, CBC, Leading Britain's Conversation, CovidPlanB Webinar, Sky News, Stuff, Australian Broadcasting Corporation, 9 News Australia The host of the Munk Debates is Rudyard Griffiths - @rudyardg.   Tweet your comments about this episode to @munkdebate or comment on our Facebook page https://www.facebook.com/munkdebates/ To sign up for a weekly email reminder for this podcast, send an email to [e-mail].   To support civil and substantive debate on the big questions of the day, consider becoming a Munk Member at https://munkdebates.com/membership Members receive access to our 10+ year library of great debates in HD video, a free Munk Debates book, newsletter and ticketing privileges at our live events. This podcast is a project of the Munk Debates, a Canadian charitable organization dedicated to fostering civil and substantive public dialogue - https://munkdebates.com/ The Munk Debates podcast is produced by Antica, Canada's largest private audio production company - https://www.anticaproductions.com/   Executive Producer: Stuart Coxe, CEO Antica Productions Senior Producer: Christina Campbell Editor: Kieran Lynch Producer: Marilyn Mazurek Associate Producer: Abhi RahejaBecome a Munk Donor ($50 annually) to get 72-hour advanced access to the full length editions of Friday Focus and Munk Dialogues. Go to www.munkdebates.com to sign up. Hosted on Acast. See acast.com/privacy for more information.

There are options, and that's why we need to take this opportunity seriously. There's no way you can prevent global warming unless China is part of the solution. This is not normal male behavior. This is predatory behavior. We don't know how bad this bug is. We don't know what this bug does. All of that was thrown away in those eight minutes and 46 seconds, and that's the moment that I became an abolitionist. Extraordinary claims require extraordinary evidence. Welcome to the monk debates on every episode we, provide you with a civil and substantive debate on the big issue of the day to arm you,

the listener, with enough information to make up your own mind. Today's debate, via resolve, the threat of new COVID-19 variants makes elimination of the virus the only viable, long-term public health strategy to end the pandemic. Another day, another COVID-19 strain to tell you about this time, this one originated in Brazil. An expert... Oxford AstraZeneca vaccine doesn't appear to be protecting against mild and moderate symptoms caused by the South African variant. The virus has been energized by the ability to evolve and become better and fitter and better adapted to infecting us. Hello, I'm your moderator, Rudyard Griffiths. B117501.501.P1.P1. These are but some of the labels for new variants of the COVID-19 virus that are now spreading around.

the world. Studies suggest that these variants could be substantially more infectious and possibly more lethal than early SARS-CoV-2 strains. More worrying, the mutations that characterize these variants may reduce the effectiveness of long-weighted vaccines, forcing vaccination efforts to achieve levels of mass inoculation that are a public health nightmare. In light of the ongoing threat of COVID-19, some infectious disease experts are pushing for what is being called a COVID-zero approach. They argue that the enforcement of stringent lockdowns that do not relax until COVID-19 cases reach levels

where contact tracing is capable of rooting out new infections is the only way to bring the pandemic to an end. This is Richard Horton, editor-in-chief of the medical journal, The Lancet. The only way to reduce the risk of new variants is to be much more aggressive in the way that China, in the way that Australia has been, in the way that New Zealand has been about going for zero COVID. I don't understand why we haven't adopted a zero COVID strategy.

Why aren't we learning the lessons from countries that have got it right? Critics of an elimination strategy say that it is neither sustainable nor effective over the long term. Eliminating a virus that is no riskier than influenza for the vast majority of the population will destroy a common. economies, unleash deadly long-term health impacts, including a pandemic of mental illness, and run roughshod over people's basic freedoms and liberties. This is Alison Goodwin, a general practitioner in New Zealand. You know, at some point you've got to do a risk-benefit analysis and what's the cost of what we're doing

and what's the benefit and what we're achieving. And I'm just thinking that the cost of not being able to see dying relatives, the cost of not being able to be present for the birth of your baby, the cost of losing your business, the cost of unemployment, you know, who's counting all those health costs? And I haven't had a sensible straight answer. I can't see that anyone's actually counting those costs. Critics of COVID elimination argue that the right approach is one based on learning how to live with the virus and managing the threats it poses primarily for the elderly and the metabolically compromised. On this installment of the monk debates, we challenged the essence of these arguments, By debating the motion, be it resolved, the threat of the new COVID-19 variants makes the elimination of the virus the only viable, long-term public health strategy to end the pandemic.

Arguing for the motion is Stephen Duckett. He's the Health Program Director at the Grattan Institute in Melbourne, Australia, and the author of the Australia Should Go for Zero COVID-19 Cases Report. arguing against the motion is Simon Thornley, an epidemiologist at the University of Auckland and a member of New Zealand's COVID Plan B, a multidisciplinary group of experts pushing for a modified response to the pandemic. Stephen, Simon, welcome to the Monk Debates. Thanks, Roger. Thanks for having me. Well, I'm really looking forward to today's conversation. The struggles that Australia and New Zealand have had regarding COVID-19, both your country's respective responses to this pandemic over the last 10-plus months have been really the focus of international attention.

Many countries are our own here in Canada looking to Australia and New Zealand for lessons learned as we confront the prospect of the possibility of a third wave of COVID-19 here in Canada and possibly around the world this spring. So I think to have the opportunity to reflect on both your national experiences to tackle our motion today, which is the one I think top of mind for so many of us is a privilege indeed. That motion is be it resolved, the threat of the new COVID-19 variance makes elimination of the virus the only viable long-term public health strategy to end the pandemic. Stephen, you're going to be arguing in favor of our resolution today.

Let me put two minutes on the clock and turn the program over to you. Well, I should say that I'm speaking from Melbourne here in Australia, and a couple of kilometres away, the Australian Open is being played in front of smaller audiences than it used to be, but it's still there with audiences occurring. And that's one of the virtues of getting to a situation where there's essentially no transmission of COVID in the Australian community. We have occasional outbreaks, and in fact, probably once every week or so, there is a new outbreak from hotel quarantine, but it is one person and they are followed up very rapidly. And so what's happened here in Australia is we've returned to normal life. I go to restaurants,

I go out, I can go to work and so on. And we are living in a situation where the population has very low risk of catching coronavirus being infected and being seriously with COVID. And we're doing the normal things. Admittedly, the path to getting here was hard. but it was worth it. It was hard in the sense that our liberties were constrained. You know, I couldn't go out. I had a one hour maximum time for going for exercise any day. I kept my job. Other people lost their jobs because businesses closed down, at least temporarily. People were locked indoors in Melbourne where I live 110 days straight with only limited reasons for going outside. And obviously there were mental health and domestic violence issues

associated with all of that. But on the other hand, the benefits to the population were huge. Our economy has bounced back more rapidly than anywhere else in Australia, partly because it went down so far, but the economy has bounced back. So the economic impact was short. Importantly, the public supported all this, and indeed, they restricted their own activities before government did. So the strategy of elimination, which we went for here in Victoria, especially explicitly, it was much better than the two alternatives. There are only two other strategies that can be pursued. One is to control the virus and try and manage the virus so that it doesn't overwhelm the

health system and herd immunity. And herd immunity, I think, has been rejected by everybody. So we're in a good situation and the elimination strategy proved to be the best one for us and I think it's the best one for all countries. Well, thank you for that opening statement, clear, concise to the point. Let's now hear the contrary view. Two minutes on the clock. Let's hear an opposing argument to our motion today.

Okay, nations now face an important choice, whether to learn to live with COVID-19 in its new variants or whether to go for zero COVID. In order to resolve this, we need to assess how dangerous the virus and its new variants are, and whether zero COVID, which entails firmly restricted borders and the threat of ongoing lockdowns is really worth it. We now know that the early predictions of 3 to 4% mortality were false, and we know that it attacks the elderly, infirm and frail.

But as an epidemiologist, what I notice is that age-specific death rates are indistinguishable from background before COVID came along. This means that it is hard to argue that many years of life are being lost from the virus. Postmortem studies from Germany show deaths from COVID occurring in people with many comorbidities, making it difficult to attribute the virus as the only cause of death. The main question about this debate is whether the new strains mean we need to change our strategy to meet them. The evidence so far is that they are a little more infectious, but not more deadly.

Studies of 37,000 people in New Zealand. the UK, show that the new variant is no more deadly than other strains in terms of symptoms, disease, severity and duration. We need to remember now that since COVID-19 principally affects the frail elderly and the WHO itself states that more than 99.95% of people who have COVID-19 will survive. The myopic focus on COVID-19 is leading to detrimental effects on the economy, children's mental health and mortality from other conditions. It is now apparent that the real victims of COVID are the poor and disadvantaged. All around the world, we're seeing the rich get richer and the poor getting poorer as a result of the response.

We need to re-evaluate the importance of the virus and get on with normal life while doing our utmost to protect the frail and elderly in rest homes and hospitals. Thank you, Simon. Let's now have the opportunity for the two of you to react to what you've just heard from each other. So, Stephen, another two minutes on the clock for you to give us your comments on Simon's opening statement. So there's a lot to agree with with what Simon is saying, but also a lot to disagree with. First, Simon talks as if deaths of older people are inevitable at the time they occur and something we should accept. What we do know about COVID so far is that, yes, there's a very high death rate in older people,

but it is bringing forward deaths that might have occurred six months, 12 months, 18 months later. We don't know when they might have occurred. But certainly, yes, there is high rates of death of older people, but that doesn't mean we should dismiss it as something which is of no importance. Secondly, Simon raises the issue of the inequity involved in COVID. that is that a lot of the impact is being felt by poorer people and people in precarious employment. I absolutely agree with him and that's something we need to be concerned about and that means that the costs of the restrictions that we've imposed, the reduction in employment and so on,

needs to be taken into account and compensated and governments have to have plans to actually pay people to make sure they can continue to live. Thirdly, it's as if we're we think that death is the only outcome from COVID. We now know more about long COVID, that is people who have been infected, including young people, have ongoing impacts on their daily lives as a result of that infection.

So we shouldn't just dismiss COVID as something that, yeah, we're just going to have to live with. What we should be doing is saying, we need to ensure that the transmission is minimised and that we try and eliminate the virus from, circuit into the community and just deal with the small outbreaks and try and get on with our lives in an ordinary sort of way, but looking after everybody in the process of doing so. Thank you, Stephen. Simon, your opportunity for a rebuttal here. Take us away.

Well, when it comes to death, I think a lot of people have been watching what is happening in Sweden. People made a lot of the high COVID mortality compared to its neighbours. However, the reality is that their live with the virus approach had fatality rates for 2020 no greater than previous years. People are dying at the same rate in Sweden with COVID as they were dying in years gone by. Sweden, which was supposedly this charnel house

and disasters, if you go and you look at their average deaths overall from start of the year to this month, they're on about par with what they were back in 2010. So, you know, this whole idea that this is We've lost our perspective by prioritising COVID over everything else. The world has been mobilised against this disease like never before, but when we look at the fatality rates, I believe we've responded to the wrong virus.

So Stephen mentioned that the freedoms in Australia are fantastic and then is extrapolating this approach around the world. It's absolutely crystal clear that the virus is out of the box around the world, that nations like the United States, the UK, will never be able to eliminate this virus. And cost-benefit analyses just simply don't support that approach. In New Zealand, the government's own cost-benefit analysis when lockdowns and elimination were compared against other things that we might do in the health sector, the costs outweighed the benefits by 100 to 1.

I've seen various other estimates, 200 to 1. The UK's with a generous look at how beneficial lockdowns are. They've estimated 10 to 1 costs versus benefits. So we need to think more broadly than just COVID alone. We have spent $50 billion in New Zealand on the virus so far. We need to reevaluate how COVID fits with other priorities that the health sector have. Thank you, Simon. This is a fascinating debate.

So many questions to dig in with you both as we move to the moderated middle portion. of our conversation. And Stephen, let me start with you. And let me go back to our resolution because it teased up the idea that the threat of the new COVID-19 variants of the virus are really what now make

elimination a necessity. I'd like to hear a little bit more from you about why you see the new variance as a particular threat that warrants this more stringent public health response in the face of, of the increased infectiousness of the new strains?

So, as with every virus, it mutates, and we're seeing new variants emerge, and we know more about some of them than about others of them. What appears to be the case is that the ones we know about are both more infectious and also that is easier to transmit and also lead to severe disease significantly. their stories emerging over the last couple of days about that maybe AstraZeneca doesn't work so well with these new variants.

So the new variants make the world a little bit more uncertain than it was three months ago. And so we've got to say, what do we do now? Do we just hope that the vaccine works and then just say, that's life, folks, or what do we do in our view, my view, is that we should continue to worry about this disease? Thank you, Stephen. And so, Simon, to build on that, the new variants clearly are more infectious. Doesn't that raise the risk of greater levels, maybe not of death, but of illness and of hospitalization, which would strain health care systems and therefore possibly warrant the type of more severe public health restrictions that Stephen is urging other countries outside of Australia to embrace to head off the potential here for a third wave?

I think the issue with the increased infectiousness is inconsistent mutation is a feature of their existence. And that complicates the very motion that's being put forward to eliminate COVID-19. But even in New Zealand, the Prime Minister is now saying that we will never eliminate COVID-19. ongoing. We need to treat it as a, just another respiratory virus. Our goal has to be though to get the management of COVID-19 to a similar place as we do seasonally with the flu. It won't be a disease that we will see simply disappear after one round of vaccine across our population. She's obviously banking on a vaccination. on vaccination.

But I think overall, I want to get back to the point I made early on that the fatality rate from this virus has been dialed back considerably. Yes, healthcare systems have been overwhelmed in some very densely populated parts of the world. But for example, in the US and New Zealand, and I understand in Australia too, hospitals, had little work to do throughout the peak of the pandemic in many areas. Also, we've seen, for example, in New York, one of the hotspots, hospital mortality has reduced by 70% cheap, effective treatments,

improving our ability to deal with the virus in the hospital. We know now a lot more about its infectiousness, how to do effective infection control, that the focus really should be on rest homes where about half of fatalities worldwide have occurred. So we've learned a lot and we've also dialed back the fatality rate. So I think this means that we need to take a more proportional response to the virus and we need to learn to live with it. and even the data on the new variants, I believe, support their view.

Certainly in Australia, the death rate in the first half of last year, the total death rate in Australia was over the average for the previous five years. In the second half of the year, it was under the average for the previous five years in a month-to-month comparison. Now, Simon has sort of drawn the conclusion that, that this means that COVID isn't as serious as it seemed to be. Another explanation is that in this same period, we reduced our activity in all sorts of ways,

fewer road traffic deaths, fewer suicides, fewer flu deaths. And so the restrictions that were imposed on us and we imposed on ourselves as a result of COVID also protected us from other things. When we look in Australia, because we were so successful, particularly in the first wave, in avoiding debts, we actually avoided both COVID deaths because of the interventions in place, but also flu debts because we did have the isolation which impacted flu, but we also had an early flu vaccine program and the largest uptake I think we've had in recent years.

So it is really hard to draw conclusions. until there are further, much more detailed epidemiological studies of what actually happened and what was the movement in total death rates. The second point is that again returning to the Australian or the Victorian experience in particular, we started to impose significant restrictions when our new cases were more than 700 per day and this was roughly the same rates as was occurring in other countries at the same time. So we started from a similar position and ended up with zero, and they ended up with tens of thousands. So I don't think it's fair to say that it's just not possible to move to a situation of zero in any circumstances.

Hi there, Rudyard Griffiths, the moderator of the monk debates. Look, this we know. Our society is becoming dangerously polarized. We don't listen to each other. We don't search out opposing views. Instead, too many of us live in tribes, convinced that we are right and they are wrong. It's time to put a stop to polarization before it wrecks our democracy. This is what the monk debates charity is all about, ending polarization, searching for common ground.

We do this by producing the world's only weekly debate radio program through our monk dialogue series and through mainstage debates on the big topics of the day. Support civil and substantive public debate by becoming a monk member. As a member, you get access to our 10-plus-year online library of great debates in streaming high-definition video, a free Monk debate book of your choice, ticketing privileges, and so much more. 30% off when you use the promotional code, Monk-201, at our website, monkdebates.com. Again, that promotional code, Monk-M-U-N-K-21 at Monk-Dubates.com. Join now and help fight the polarization of the power. our democracy. Now back to our program. Just to drill a little bit deeper here, we've seen, for instance,

in countries like Denmark, they have not been able to slow the spread of the variant and its ability to replace the earlier strains. So these countries are now faced, including possibly Canada, with a very stark binary choice, which is either a Melbourne-style lockdown to confront the higher R-NOT factor of these variants versus staying the course and allowing the variance to run the table, so to speak. And I'm just wondering what your advice would be to a country like Canada,

the United States, the United Kingdom that now face that really tough choice over how do you deal with a significantly higher R-NOT number? And are the public health controls that you envision, are they realistic to what a society now has the capacity to bear after 11 months of coping with this virus.

And not quite addressing your question, Rudyard, is that the vaccine changes a lot. So although it's not entirely clear whether the vaccines prevent transmissions, I think it is hopeful that they will. It is certainly the case that the vaccines dramatically reduce the mortality and severe morbidity risks. And the way I think about it is it starts to convert COVID into just another flu if you're vaccinated. And then I come more into alignment with what Simon has been arguing that we've got to then say, if we are all vaccinated, if the vaccine changes the nature of the probable outcome from mortality and severe morbidity to a much lower mortality rate and much lower

severe morbidity rate, then it is true that we need to live with it. But that's not the situation that any country in the world is at the moment. So it's still, we should be really trying to both vaccinate and also introduce restrictions to slow the spread while we possibly can. So Simon, what's your advice to countries, where the virus is endemic, like Canada, the United States, the UK, the list is long. And they are confronting the rise of these new variants, which if you wanted to try to blunt their replacement of the earlier strains, you arguably would have to institute tighter social controls. What would be your counter-prescription?

I think we've got to remember that there's an economic recession happening at the moment. Globally, the World Bank is saying we are now facing the greatest recessions, World War II. In New Zealand, demand and food banks has doubled or trebled, and we've now more than 50,000 adults in New Zealand put on the unemployment benefits since March when lockdowns began. In Melbourne, there's been an increase in hospital admissions for children with anxiety disorders.

There's been an increase in parasilicides as a result of the lockdowns in many countries, the effect on the economy, on the link between employment and health. So it's not just a question of saving lives from COVID. When we lock down, there's many, many unintended consequences that stem from the economic and the mental health effects of these restrictions. The loss of social liberties, which has been a cornerstone of Western countries, has just gone within the blink of a line. We're living with that spectre, even in countries that have so-called eliminated the virus, such as New Zealand and Australia. So it really cannot be a long-term strategy from my point of view. it just does not make sense to lock down populations that have such low risk, low fatality from the virus.

We need to see the big picture. So, Stephen, what do you think is going to happen in Australia over the next period of time? Because in a sense, you're going to be a bit of a lab here, a bit of an experiment with trying to contain this virus through keeping the case count low. I presume that gives you the advantage of contact tracing that can actually work. how do you transition out of that? In a sense, what is the endgame that your prescription of a more firm public health response ultimately leads to? So, Rajid, you're quite right. The virus is essentially not circulating in Australia, but we have the occasional outbreaks.

And with an occasional outbreaks, we introduce restrictions. The New South Wales Premier has announced a mask mandate in indoor areas for midnight after the state recorded seven new local coronavirus infections. A couple of weeks ago, for example, I didn't have to wear a mask when I was indoors, mostly except on public transit. Now I have to wear a mask if I go into shopping centres or into an office. So the types of restrictions are calibrated or titrated to the risk. that's around. So when we've got this current outbreak under control, which I expect to be in the next, we'll declare that in the next week or so, then we'll go back to fewer restrictions. At the moment, employment office space can only have 50% of the normal staff. It was planned to go to 75% this week, but because of the virus circulating, it went back down again. These are not particularly onerous. What is the longer term?

the longer term, obviously, will be getting the population vaccinated. But yes, I think we should be maintaining elimination until we've reached a stage where we can say that both the virus is still not circulating and also if it does have significant outbreaks, the population is protected against it. And do you, Stephen, just to build on that, I mean, if in 2022 or 2023, you learn of a new variant that has emerged somewhere in the world because this virus will be endemic for many years to come, despite our best efforts in developing countries. What is the government responds then? Do you recommend a return to stricter public health controls immediately to try

to prevent or preempt the arrival of the variant in Australia? We know that this virus will mutate. And just like we have an annual, flu vaccine injection, so too are we going to probably have to add a annual COVID vaccine to manage the new and emerging strains. It's going to be part of the new way of life that we will be protecting ourselves and the rest of the community against this virus forever. The real question then is, does Australia completely open its borders and have no quarantine on arrival? While state leaders continue to debate whether to open domestic borders, we've been given more clarity on our international position,

with overseas travel likely to be off the cards until next year. I think we should be moving towards a more open situation probably next year. That is not in 2021, but as a larger proportion of the total world population is vaccinated, including in best developed countries, then we can be more confident that the number of cases that come into Australia is within the bounds that we can tolerate. And Simon, similar question

about what you think the endgame in New Zealand will be because, look, for just someone outside of your country consuming your media indirectly, largely filtered through our press, there's a perception that there's a great deal of public support in New Zealand for these strict lockdown measures and controls. Do you envision your country as a result being, in a sense, closed, quarantined for an extended period of time? And why do you think that isn't in the interest of your fellow Kiwis?

Yes. Well, there has been a tremendous public support for the lockdown and for the elimination strategy, which obviously I don't agree with. I think it's clear that COVID cases have been orders of magnitude lower in the Asia-Pacific Oceania region than they have been, for example, in Europe and North America. And I think mistakenly, the public has seen our measures as evidence that we've succeeded and kind of knocked the virus out of the park. The vaccine is coming.

We still really have very early data about its effectiveness in terms of preventing transmission. So it's very unlikely, even the government in New Zealand is now stating that, that it's going to be the panacea, that it's going to allow us to eliminate the virus long term. Even the New Zealand government that has done very well initially with this COVID strategy is now talking about seeing things from my point of view, which is living with the virus long term. The evidence is suggesting much, much less effective because of mutation. We cannot see the vaccine as a panacea that will get us out of this closed elimination tight border situation long term.

We need to think about a sustainable response. That's my view. Got it. Let's move to closing statements. I'm conscious of our time. So Simon, we're going to put two minutes on the clock for you now to kind of sum up the key arguments that you'd like to leave our listeners with in this really fascinating, illuminating debate. So Simon, take us away. This is the first pandemic of the social media age, and that means we have become irrationally gripped with fear and have taken disproportionate measures that have done more harm. and good. We should have the courage to dial back our responses as soon as we were aware that the virus was not as fatal as we initially thought. Studies show that the new variants are no more deadly or threatening than other varieties. There are over 100,000 variants and the virus will continue to mutate in the way that respiratory viruses do. Our aim should be for the vast majority of the working age population to return to normal and for COVID-19 to be considered just a

are the respiratory virus. Enhanced infection control in hospitals and rest homes where the majority of fatalities have occurred should be the focus of our preventive effort. We know now how to treat the virus better. Hospital mortality in New York has dropped by about 70%. They've learned that less aggressive use of mechanical ventilation is important.

Simple cost-effective treatments are driving the fatality rate down further. We should have no more lockdowns. We now know there are far, more harmful to public health than the virus itself. In New Zealand and Australia, we can cautiously open the border first to low prevalence countries while monitoring the effect on our health system. In my opinion, the data overwhelmingly support a strategy of focus protection for the elderly. Zero COVID is a pipe dream. The virus is well established in many countries, like many other viruses, which the vast majority of people cope with every day. Singling out this

one makes no sense and has already done a measurable harm. Our response to COVID-19 needs to be proportional to its threat. Thank you for those closing remarks. Stephen, we're going to give you the last word in this debate, two minutes on the clock for you to sum up. The reality is that zero COVID can be achieved. Both Simon and I live in countries where that is the case. There are only occasional outbreaks. Sure, the path to getting there had an immense burden on some people, an immense burden on the economy, but in the end, the economy is bouncing back, both in New Zealand and in Australia. In the end, we are living with and not unduly restricted in the way we work. The alternative is not just saying, let's protect the elderly. They're not the

only people at risk. There are also people who are immunocompromised already. So a person aged 35 with diabetes, for example, has a much higher risk of severe morbidity or mortality from COVID than a person without diabetes. What are we going to be saying to all of those people as well? Are we going to be saying, I'm sorry, we're actually just going to not allow you to wander around because you have a much higher risk of morbidity or mortality? So we've got to be looking at the whole population. We haven't been doing that as well as we ought, and there are people who have fallen out of our society in terms of their employment and protection and so on. But overall, the right strategy for any country is to try and get to a situation where we can return to

normal life, where we're all vaccinated, where the restrictions are gone, but that we keep an eye on this virus and that we respond very rapidly. And sometimes, yes, those responses will mean, inverted commas, lockdowns, or other sorts of restrictions. And that's, I think, one of the issues that we're going to have to be living with for quite some time. Thank you. And thank you both for a just thoughtful, educating conversation. You know, there's a lot of, obviously, quick off-the-hip comments and analysis around

these new variants, what their impact will be and how we should respond to them. And I think the opportunity for both of you to share with us your considered opinions, your deep insights into these challenging questions has been a really a privilege indeed for the monk community. So thank you gentlemen, both for your time. A pleasure. Thanks for having me. Well, that wraps up today's debate. I want to thank our participants, Stephen and Simon, for their considered thoughts and opinions. They certainly gave me a lot to think about. I hope they also opened your mind to some new arguments and ideas about how we should potentially be confronting a third wave of COVID-19.

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