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Melburnians will soon be able to have 2 visitors per day. It’s far riskier than an exclusive bubble



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Mary-Louise McLaws, UNSW

Victorian Premier Daniel Andrews announced on Sunday a further easing of coronavirus restrictions, as Victoria’s 14-day average of new daily cases continues to trend downwards.

Among the changes, Melburnians were told that from November 2 they can have two visitors at home per day, plus any dependants. Regional Victorians can already enjoy this rule, as their 14-day rolling case average is much lower at 0.4, compared with Melbourne’s 6.4.

This new rule replaces the “bubble” concept featured in the original roadmap. Under the previous plan in Melbourne, “step 3” of easing restrictions included a household bubble, whereby residents could nominate one other household with whom to socialise exclusively at home.

I understand the lifting of restrictions must be done compassionately with an eye on collective mental health. But from an outbreak-management perspective we must be very careful about indoor gatherings. The two people per day rule seems to be riskier than an exclusive bubble.

The bubble contains the infection risk

The risk of indoor spread is often greater because of poor ventilation, which might add to the risk of airborne spread. Further, people can unmask and fail to maintain physical distancing, which are more likely to happen indoors.

Close indoor contact poses the highest risk of transmission of SARS-CoV-2, the virus that causes COVID-19. Victorian Chief Health Officer Brett Sutton reminds us indoor contact is about “20 times more dangerous than outdoors”. This is reflected in one study from Japan, which is yet to be peer-reviewed, and estimates “the odds that a primary case transmitted COVID-19 in a closed environment was 18.7 times greater compared to an open-air environment”.

Transmission still does occur outdoors, but the risk is lower.

The practice of exclusive social bubbles likely makes outbreaks easier to contain. The only people an infected person would have close indoor contact with would be their own household and their bubble household. In this scenario, contact tracers would know exactly whom to contact for isolation, testing and interviewing.

Here’s why the new lifting of the social rule is riskier

The proposed new rule could make timely contact tracing more difficult. With Melburnians allowed to have two adults over per day, they could have up to 14 contacts per week who don’t come from the same household.

Let’s go through a hypothetical example.

Say you are exposed to the virus unknowingly, on day zero. Over the next few days you start having visitors to your house. You can become infectious up to three days before showing symptoms. When COVID-19 cases have been diagnosed while asymptomatic (symptom-free but infectious) and followed up for at least seven days, up to 20% remain asymptomatic but infectious to others. Half of all people infected will develop symptoms around day five and day six and 97% will develop symptoms within 11 days.

So, you could be infectious to your visitors between day three and day five after being exposed while asymptomatic. That leaves three days when you could be contagious without knowing. We think people are more contagious when showing symptoms, but it’s widely accepted now that people can, and do, transmit the virus while asymptomatic.

Under the upcoming rule, during this three-day window, you could theoretically pass the virus to six adults from six different households (assuming you’re an extrovert who has lots of friends round for dinner). They can then transmit it to their households and friends in three days’ time to 18 people while they are asymptomatic. If your friends also brought their children or other dependants, who then got infected and went to school, the number could be even higher. Under the exclusive bubble, the problem would have been confined to just two households.

Then, after your final two guests leave on the evening of day five post-infection, you develop symptoms. You get tested on day six because your cough or sore throat did not go away. Your positive result is returned on day seven and a contact tracer interviews you within 24 hours. On day eight your visitors will start to be interviewed. If they don’t get interviewed immediately, your friends infected on day three have now already infected two others. Over the next two days your other four friends also became infected and passed it onto their friends.

Obviously this is a worse case scenario. But you can see how the chain of transmission can easily get out of control. That’s why being tested as soon as you have symptoms is so important. It speeds up the tracing of every contact you had over the 72 hours prior to your symptoms.

Four people gathering indoors
Indoor close contact is a much higher coronavirus risk than outdoor contact with masks.
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If we added to our scenario continuous asymptomatic transmission (where you never developed symptoms) it becomes even more concerning. This is because your infected friends could go on to infect many others before someone becomes sick and alerts contact tracers. Even more concerning is when you delay testing, which makes it even harder for you to recall who your contacts where and when your day zero was.

This is just a hypothetical situation. But it illustrates why I’m concerned about allowing widespread indoor close contact.

The hope is that new daily case numbers, by the time this rule is implemented, are so low the risk of new chains of transmission is very low too. Meanwhile, Victoria’s contact-tracing team is more robust than ever before.




Read more:
Where did Victoria go so wrong with contact tracing and have they fixed it?


The other relaxed restrictions are less concerning

The other relaxed restrictions are of little concern. Allowing ten people to gather outdoors, from only two households, poses a negligible risk.

The extension of the 5km travel radius to 25km makes epidemiological sense. The risk increases when you allow people from high-risk areas into low-risk areas, so maintaining the “ring of steel” between metropolitan Melbourne and regional Victoria is logical. This approach of “ring-fencing” is a well-established tool and is why Wuhan, the city where the pandemic began, controlled the outbreak early and is now welcoming millions of tourists.

The next step, planned for November 2, also sees the return of retail shopping. This poses negligible risk as long as shoppers wear masks, maintain hand hygiene, and use QR codes on entry. In my view, the risk of transmission from wandering through shops is much lower than having people over to your house.The Conversation

Mary-Louise McLaws, Professor of Epidemiology Healthcare Infection and Infectious Diseases Control, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

When and how should the Victoria-NSW border reopen? Is fishing allowed in Victoria? When can I travel between Melbourne and regional Victoria? Your COVID-19 questions answered


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Hassan Vally, La Trobe University

Victoria recorded one new case of COVID-19 on Monday, another fantastic result that suggests the coronavirus outbreak there is now being well controlled. Premier Daniel Andrews said on Tuesday the state was “well placed this weekend to be able to make very significant announcements about a further step to opening”.

It’s worth acknowledging what a fantastic job everyone has done in Victoria. Huge sacrifices have been made, people have done the hard yards in difficult circumstances, and now it’s time to step our way out.

Here are answers to common questions about emerging from lockdown and how to make sure you’re doing it safely.




Read more:
Melbourne is almost out of lockdown. It’s time to trust Melburnians to make their own COVID-safe decisions


When and how should the Victoria-NSW border reopen?

The Sydney Morning Herald reports the NSW-Victoria border could reopen within a month (and Andrews said he would like to see NSW reopen to regional Victoria as early as this week).

The Herald quoted NSW Premier Gladys Berejiklian saying:

We are very keen to see what happens in Victoria once further restrictions are eased because that’s the real test […] And if Victoria demonstrates that they’ve […] upped their contact-tracing capacity, that they’re able to demonstrate they’re not going to have uncontrolled outbreaks while they’re easing restrictions, well that will give us confidence to open the borders.

So there’s a bit of guesswork here but if you match her comments up with the current roadmap to ease restrictions, it sounds like there’s a chance the border could be reopening some time in the first half of November.

There will be a period of watching closely how well Victoria does as restrictions ease; this will be the real test of where Victoria is at in terms of suppressing transmission.

But once you have confirmation NSW and Victoria are pretty much tracking the same way, there’s no reason to keep the border closed. There are plenty of good economic and social reasons to have it open.

Even though the numbers look fairly similar between Victoria and NSW, the shape of the two outbreaks has been and remains slightly different. In NSW, most new cases are from overseas arrivals and the number of mystery cases is lower, as shown in this excellent breakdown published by the Sydney Morning Herald and The Age.

So, quite reasonably, there’s a bit of caution about letting Victorians into NSW; there’s more uncertainty around exactly where Victoria sits in terms of controlling the spread of the virus. But as long as things continue to go well in Victoria as it opens up, NSW can have greater confidence it’s safe to reopen the border.

How should the opening of the border be managed? Well, I don’t think you can attempt a staged opening of a border. The whole point of a border reopening is to allow free movement between the two states. Either you wait until you’re confident and then open the border, or you don’t do it at all. You can’t half open it.

Is fishing allowed in Victoria?

For Melburnians, the answer is basically yes, assuming there’s a fishing spot within your 25km radius and you’re sensible about it. As with all activities, it’s important to stick to the restriction changes announced this week and follow hygiene and distancing rules. (Use this ABC tool to find out what’s within 25km of your Melbourne home.)

For regional Victorians, you can go fishing as long as you’re being COVID-safe and following the restrictions (outlined in the Instagram post embedded above).

The Victorian Fishing Authority says:

When fishing or boating you must keep a 1.5m distance from other participants, wear a fitted face covering at all times (except for children under 12 or where an exemption applies), practice good hygiene and not share equipment.

I’m not much of a fisherman myself but, as an epidemiologist, I think fishing sounds like a lovely, low-risk, relaxing outdoor activity — if you don’t mind dealing with the fish.

When can Melbourne people travel to regional Victoria?

According to the Department of Health and Human Services, for Melburnians:

Travel to regional Victoria is still only allowed for permitted purposes even if this is within 25km. This means you cannot travel into regional Victoria for exercise or recreation.

This is the “ring of steel” you have heard so much about, the aim of which is to protect regional Victoria from the virus in metropolitan Melbourne.

The government’s Roadmap for reopening currently says when there have been zero new cases in the community for more than 14 days, the state can move to the roadmap’s final step. Then, travel within Victoria will be allowed (but you can’t enter any restricted area).




Read more:
As holidaymakers arrive, what does COVID-19 mean for rural health services?


Can regional Victorians visit Melbourne?

According to the third step in the roadmap, regional Victorians:

…must not travel into metropolitan Melbourne under current restrictions, except to buy necessary goods and services, for care and compassionate reasons or permitted work or education. While in metropolitan Melbourne you must comply with the metropolitan Melbourne restrictions.

A man fishes in Melbourne.
Fishing is a low-risk, relaxing outdoor activity.
Shutterstock

You can travel through metropolitan Melbourne on your way to a holiday in regional Victoria but shouldn’t stop unless it is for one of the three permitted reasons.

Being smart about it

As the pendulum shifts away from the government telling us what we can do, to us making our own decisions, it’s important to be COVID-safe in the way we navigate this new normal.

That means limiting your contact with people, wearing a mask, practising social distancing and hand hygiene, staying home when sick, and getting tested if you have symptoms.




Read more:
WHO is right: lockdowns should be short and sharp. Here are 4 other essential COVID-19 strategies


The Conversation


Hassan Vally, Associate Professor, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Beyond the police state to COVID-safe: life after lockdown will need a novel approach


Meg Elkins, RMIT University and Robert Hoffmann, RMIT University

As second-wave outbreaks of COVID-19 around the world demonstrate, it’s a tricky transition from hard lockdowns to more relaxed, but still effective, measures.

The responses of different nations (Sweden and Taiwan, for example) have their champions, but the truth is there no shining example to follow on how to keep the coronavirus in check while returning, as much as possible, to living life as before.

Right now the government of Victoria, Australia’s second most populous state, is involved in just such an experiment. Its success in moving beyond lockdown to a sustainable “COVID-normal” will hold lessons for nations still on the upward curve of their own second waves (such as Austria, France, Germany, Italy and Britain).

There are also lessons for other Australian states, which have relied (perhaps too much) on hard borders to keep the virus out rather than new social norms to manage the virus.

The Victorian response will prove to be a template to emulate. Or dissected for pitfalls to avoid.




Read more:
As a second wave of COVID looms in the UK, Australia is watching closely


As behavioural economists, we’re interested in what drives cooperative, and non-cooperative behaviour. We’re particularly interested in how rules, and law enforcement, shape social norms, as well how they can inadvertently lead to greater resistance and rule-breaking.

One clear point evident from the Victorian experience is how blunt the tools of lockdown and law enforcement are to achieve social conformity to new behavioural norms. Moving to “COVID-normal” will require looking for other, less punitive ways to get people to do the right thing.

Policing the rules

Till now the approach of the Victorian government has been very blunt indeed. Its stage 4 rules have been among the more severe imposed in any democracy in the world. These rules have been criticised as excessive or unnecessary, but they have been simple and straightforward. Both to follow and to enforce.

This the Victorian police force has done with zeal, empowered by harsh fines for breaches of public health directives. Though their job has undoubtedly been made harder by rule breakers emboldened by conspiracy theories, videos of police forcefully arresting resisters have both confirmed protesters’ paranoia about living in a police state, and eroded community support.

Polling by Roy Morgan in mid-September showed just 11% of Victorians now rate the Victorian police very highly for honesty and ethical standards, compared to 37% in 2017. Overall approval has fallen from 76% to 42%.

This loss of trust reflects scandals such the Lawyer X case (which led to a royal commission). But “heavy-handedness” enforcing COVID-19 rules was the next most cited concern, with the poll taken after the circulation of videos including police forcibly removing a woman from her car and arresting a pregnant woman in her home for promoting protests on social media. Community support for restrictions is also fraying.




Read more:
WHO is right: lockdowns should be short and sharp. Here are 4 other essential COVID-19 strategies


Deterrence, permission, resistance

Laws are necessary, but philosophers since Plato have told us that societies only function when people comply with social norms when no one is looking. It is impossible to maintain social order solely through the deterrent effect, by detecting and punishing wrongdoers.

Gary Becker, winner of the Nobel prize for economics in 1992, was the first to apply economic theory to why people obey or break laws. In his seminal 1968 paper Crime and Punishment: An Economic Approach, he explained how a “rational” individual weighs up the expected gains or losses from committing a crime and compares them to gains or losses of not committing a crime. That calculation includes judging the probability of being caught.

This framework assumes most people have an aversion to risk and that penalties (such as a large fine) therefore have a deterrent effect.

The problem is humans aren’t necessarily rational. Driven by feelings rather than cognitive assessments, most of us inaccurately assess probabilities. Behavioural research suggests 80% of us are prone to optimism bias when assessing personal risk. We tend to underestimate the likelihood of experiencing bad events such as divorce, being in a car accident, contracting a disease or getting caught breaking the rules.

While it’s impossible to know the motivations of the more than 20,000 Victorians so far fined for breaking lockdown rules, the anecdotal evidence suggests most have simply underestimated the chance of being caught, such as breaking the 5 km travel limit to buy a PlayStation controller, or curfew to buy cigarettes.

The limits of perception

Yet as the Victorian government moves to relax its restrictions, its main solution to ensuring adherence to the more complicated rules for “COVID-normal” social interactions appears to be increasing penalties for breaches. The fine for breaching social gathering restrictions, for example, has been increased from A$1,652 to A$4,957.

While these will have some effect, research suggests “deterrence perceptions” depend on an individual’s pre-existing “crime propensity”. That is, most people have no inclination to commit crimes like theft, vandalism and assault, so “deterrence perceptions are largely irrelevant”.

This make Victoria’s next stage of norm-enforcement highly problematic, given behaviour now outlawed isn’t criminal per se, but what used to be normal socialising. As questions asked at Victorian premier Danial Andrew’s press conference on Sunday indicate, there’s a much greater likelihood of confusion about rules – and therefore breaches.

Encouraging intrinsic motivation

The big question is how to move beyond external (or extrinsic) incentives and encourage intrinsic motivations. According to psychologists Richard Ryan and Edward Deci, who studied extrinsic and intrinsic motivations in school students:

Because extrinsically motivated behaviours are not inherently interesting and thus must initially be externally prompted, the primary reason people are likely to be willing to do the behaviours is that they are valued by significant others to whom they feel (or would like to feel) connected, whether that be a family, a peer group, or a society.

Economists Raymond Fisman and Edwards Miguel illustrate the power of non-punitive “nudges” to encourage these motivators in their book Economic Gangsters (2010). A classic example comes from Bogota, the capital of Columbia, where in the 1990s new mayor Antanas Mockus decided to tackle crime and problems such as traffic fatalities using “cultural persuasion” rather than more law enforcement.

Rather than employing more police to patrol the roads, the city instead employed hundreds of mime artists to mimick and ridicule drivers and pedestrians doing the wrong thing. As Mockus explained:

The idea was that instead of cops handing out tickets and pocketing fines, these performers would “police” drivers’ behaviour by communicating with mime – for instance, pretending to be hurt or offended when a vehicle ignored the pedestrian right of way in a crosswalk. Could this system, which boiled down to publicly signalled approval or disapproval, really work?

The evidence is it did. Within a decade traffic deaths were halved. Other novel strategies helped cut Bogota’s homicide rate by 70%.

Finding a new normal

These are obviously long-term results. They don’t provide a perfect template for governments seeking immediate society-wide adherence to new COVID-safe behavioural norms. There are no easy solutions, particularly given a small segment of the population is convinced flouting the rules is a noble stand against tyranny.




Read more:
Melbourne is almost out of lockdown. It’s time to trust Melburnians to make their own COVID-safe decisions


But with Victorian courts already facing a huge backlog of unpaid or contested fines, and the high likelihood we will need to practice “COVID-safe” behavioural norms for at least a year, it’s time to start thinking about other ways to promote social cooperation other than the long arm of the law.The Conversation

Meg Elkins, Senior Lecturer with School of Economics, Finance and Marketing, RMIT University and Robert Hoffmann, Professor of Economics and Chair of Behavioural Business Lab, RMIT University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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View from The Hill: New Zealand arrivals inject new irritation into federal-Victorian tensions


Michelle Grattan, University of Canberra

Victoria Premier Daniel Andrews’ angst at the weekend about the multiple New Zealanders who arrived in Victoria via the travel bubble from New Zealand to New South Wales is, as much as anything, a pointer to the pressure the premier is under.

Andrews says his state chose not to be part of the bubble at this stage and he didn’t know these people were coming to Victoria. Now, he says, 55 have “turned up” from NZ.

The federal government counters that Victoria was at the meeting of the federal-state health officials committee where issues of New Zealanders travelling on were canvassed.

Andrews claims when Victoria asked the feds for details of the arrivals they were slow to pass it on. The feds deny a delay but say dealing with internal border issues is up to the states anyway.

The point is, this is a dispute of little consequence. New Zealand doesn’t have community transmission – the visitors are at the very bottom end of risk.

Andrews might be annoyed that these New Zealanders, and thus the Morrison government, have found a way to circumvent his refusal to sign up to the COVID “hotspot” definition and become part of the (one way) trans-Tasman bubble.

But Victoria has an open border for people going in (it’s a different matter for those exiting, for whom other states make the rules). So provided they’re told to abide by the current state restrictions, the presence of the New Zealanders is neither here nor there.

Western Australia is also complaining about New Zealand arrivals – it is in a rather different position because it has a hard state border.

The overall takeout is that those travelling from New Zealand in the “bubble” – which also involves the Northern Territory – might need to be given more information about the restrictions in particular states and internal borders before they leave NZ.

The micro takeout is that Andrews is picking an unnecessary fight. The verbal Victorian-federal tennis match over the New Zealanders is another indication of the tensions between the two governments.

Federal ministers tried to twist Andrews’ arm ahead of Sunday’s announcements about the next stages of opening in Victoria.

Andrews announced a range of restrictions would be relaxed from midnight. People can travel 25 kilometres from their home for shopping and exercise (widened from five). Groups of up to ten from two households will be able to gather in an outdoor places for exercise or a picnic.

Hairdressers can open, but people can’t have visitors over to watch next weekend’s AFL final (played in Queensland).

Retail isn’t scheduled to reopen open until November 2, when restaurants will be open to diners (with limits), and people will be able to leave home for any reason.

With new cases in single figures for the last five days, Andrews indicated the timetable could move faster than outlined.

The politically embattled premier is determined to minimise risks in bringing the state out of lockdown. The federal government and business community continue to rail. Andrews may judge that he’s taken the attacks from those quarters and the greater immediate danger to him is the possibility of a fresh tick-up in virus numbers.

The eventual fallout – in lost businesses, in the public’s judgement of Andrews – will be months, possibly years, in the coming.

In the meantime, whether his ultra-caution is excessive or well-judged will be fiercely debated.

He maintains it’s all on the health advice.

When asked how come his advice was at odds with the position of the federal government and epidemiologists who disagree with him, his edginess was obvious.

“I will put it to Minister [Greg] Hunt and anybody else
who has a view about these things, I don’t accept that anybody has a more complete picture of what this virus is doing in Victoria than the Victorian chief health officer, the Victoria deputy chief health officer, the Victorian health minister and the Victorian premier.” And so he went on.

Some Victorians will welcome the timetable as tangible hope in a bottle. More than a few small business owners will see the hairdresser across the road opening and ask, why not us?

The Australian Industry Group described the announcement as “plodding steps in the right direction”, while raising a nightmare scenario, saying businesses “still have no certainty that [they] will not be forced to shut again after they have been allowed to reopen”.

The federal government’s impatience with Victoria was on show again in a Sunday statement from Prmie Minister Scott Morrison, Treasurer Josh Frydenberg and Health Minister Greg Hunt, which highlighted economic and mental health costs.

“Victoria’s three-day rolling average is now below two cases per day. Maintaining this result will make a strong case for the retail and hospitality sectors to reopen before the next review date in November,” they said.

“The continued health, mental health and financial impacts of these restrictions will be profound on many Victorians. That is why we encourage Victoria to move safely and quickly towards the NSW model of strong contact tracing and a COVID-Safe but predominately open economy.”

As Morrison and the ministers say, “the national picture is a positive one” in terms of case numbers and handling them. Yet politically, the national handling of COVID continues to fray.

The conflicts around the blunders and inadequacies that led to the Victorian second wave, the imminent Queensland election in which Premier Annastacia Palaszczuk is relying substantially on her COVID record, with its tough border policy, and WA’s semi-secessionist mindset are all straining the federation.

The national cabinet initially managed dissent among the various governments. But presently the disunity is swamping the unity.
To the extent possible, it is important Morrison keep together what has become an unwieldy beast.

While COVID in Australia may be substantially under control when we say a thankful goodbye to 2020, 2021 will be a challenging year that would only be made more difficult by excessive fractiousness within the federation.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.