Data from 45 countries show containing COVID vs saving the economy is a false dichotomy


Michael Smithson, Australian National University

There is no doubt the COVID-19 crisis has incurred widespread economic costs. There is understandable concern that stronger measures against the virus, from social distancing to full lockdowns, worsen its impact on economies.

As a result, there has been a tendency to consider the problem as a trade-off between health and economic costs.

This view, for example, has largely defined the approach of the US federal government. “I think we’ve learned that if you shut down the economy, you’re going to create more damage,” said US Treasury Secretary Steve Mnuchin in June, as the Trump administration resisted calls to decisively combat the nation’s second COVID wave.

But the notion of a trade-off is not supported by data from countries around the world. If anything, the opposite may be true.

Data from 45 nations

Let’s examine available data for 45 nations from the Organisation for Economic Co-operation and Development, using COVID-19 data and economic indicators.

The COVID-19 statistics we’ll focus on are deaths per million of population. No single indicator is perfect, and these rates don’t always reflect contextual factors that apply to specific countries, but this indicator allows us to draw a reasonably accurate global picture.

The economic indicators we’ll examine are among those most widely used for overall evaluations of national economic performance. Gross domestic product (GDP) per capita is an index of national wealth. Exports and imports measure a country’s international economic activity. Private consumption expenditure is an indicator of how an economy is travelling.

Effects on GDP per capita

Our first chart plots nations’ deaths per million from COVID-19 against the percentage change in per capita GDP during the second quarter of 2020.

The size of each data point shows the scale of deaths per million as of June 30, using a logarithmic, or “log”, scale – a way to display a very wide range of values in compact graphical form.

Log(deaths per million) by percentage change in Q2 2020 GDP per capita.

If suppressing the virus, thereby leading to fewer deaths per million, resulted in worse national economic downturns, then the “slope” in figure 1 would be positive. But the opposite is true, with the overall correlation being -0.412.

The two outliers are China, in the upper-left corner, with a positive change in GDP per capita, and India at the bottom. China imposed successful hard lockdowns and containment procedures that meant economic effects were limited. India imposed an early hard lockdown but its measures since have been far less effective. Removing both from our data leaves a correlation of -0.464.

Exports and imports

Our second chart shows the relationship between deaths per million and percentage change in exports.

If there was a clear trade-off between containing the virus and enabling international trade, we would see a positive relationship between the changes in exports and death-rates. Instead, there appears to be no relationship.

Log(deaths per million) by percentage change in Q2 2020 exports.

Our third chart shows the relationship between deaths per million and percentage change in imports. As with exports, a trade-off would show in a positive relationship. But there is no evidence of such a relationship here either.

Log(deaths per million) by percentage change in Q2 2020 imports.

Consumer spending

Our fourth chart shows the relationship between deaths per million and percentage change in private consumption expenditure. This complements the picture we get from imports and exports, by tracking consumer spending as an indicator of internal economic activity.

Log(deaths per million) by percentage change in Q2 2020 private consumption.

Again, no positive relationship. Instead, the overall negative relationship suggests those countries that succeeded (at least temporarily) in suppressing the virus were better off economically than those countries adopting a more laissez-faire approach.

National wealth

As a postscript to this brief investigation, let’s take a quick look at whether greater national wealth seems to have helped countries deal with the virus.

Our fifth and final chart plots cases per million (not deaths per million) against national GDP per capita.

Log(GDP per capita) by log(cases per million).

If wealthier countries were doing better at suppressing transmission, the relationship should be negative. Instead, the clusters by region suggest it’s a combination of culture and politics driving the effectiveness of nations’ responses (or lack thereof).

In fact, if we examine the largest cluster, of European countries (the green dots), the relationship between GDP per capita and case rates is positive (0.379) – the opposite of what we would expect.

Read more:
Vital Signs: the cost of lockdowns is nowhere near as big as we have been told

It’s not a zero-sum game

The standard economic indicators reviewed here show, overall, countries that have contained the virus also tend to have had less severe economic impacts than those that haven’t.

No one should be misled into believing there is zero-sum choice between saving lives and saving the economy. That is a false dichotomy.

If there is anything to be learned regarding how to deal with future pandemics, it is that rapidly containing the pandemic may well lessen its economic impact.The Conversation

Michael Smithson, Professor, Australian National University

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

View from The Hill: Scott Morrison hopes ‘open Christmas’ can still be achieved despite South Australian outbreak

Michelle Grattan, University of Canberra

South Australia is battling to prevent a serious COVID outbreak turning into a second wave, as several states slam restrictions on their borders to prevent the import of cases from SA.

The outbreak is a setback the goal of having most of Australia open by Christmas – although Scott Morrison on Monday was quick to say he hoped it would not stymie that timetable.

Queensland, Tasmania, and Western Australia as well as the Northern Territory announced border clamps on travellers from SA. In WA’s case it had only just eased restrictions for them.

NSW and Victoria are leaving their borders open. Victoria will impose health checks on people flying into Melbourne from Adelaide.

SA on Monday announced 18 new cases, in people aged from one through to their 80s. Thirteen of the cases are linked to a Parafield Gardens cluster.

The outbreak started from hotel quarantine. A hotel worker and two security guards have tested positive. The worker spread the virus through a large family.

The SA outbreak and the reaction of various states once again shows the split between leaders over the issue of “living with COVID”.

Morrison and NSW Premier Gladys Berejiklian argue small numbers of cases can be managed while the economy, and borders, remain open. But several state leaders take more conservative approaches, confident they have the support of their populations.

The SA outbreak will test the effectiveness of the state’s contact tracing. The federal government last week released the report of chief scientist Alan Finkel, who found states’ systems were now generally sound while recommending some improvements.

SA premier Steven Marshall said: “Time is now the essence and we must act swiftly and decisively”.

“We will throw absolutely everything at this to get on top of the cluster.” He said the next 24 hours would be critical.

The SA government is closing gyms, recreation centres, and trampoline/play cafes for an expected two weeks. Community sports fixtures and training are also cancelled.

Among a range of caps, gatherings at private residences will be limited to 10 people.

All international flights to Adelaide are suspended for the rest of the week.

The state’s chief public health officer, Nicola Spurrier, said “What we are facing is, indeed, a second wave but we haven’t got the second wave yet. We are in very, very early days.”

AnglicareSA said two employees from its Brompton aged care home had tested positive to COVID-19 on Sunday.

The workers hadn’t been at Brompton since Friday 13 and had not worked at any other AnglicareSA residential aged care home.

On Friday national cabinet committed to having internal borders – apart from WA’s – open by Christmas.

Morrison said on Monday: “It is not a surprise that [an outbreak] can occur from a quarantined facility. What matters is how you respond in these situations”.

Acting Chief Health Officer Paul Kelly said he was confident the systems were in place to deal with this outbreak.

The Australian Health Protection Principal Committee held an emergency meeting on Monday.

Asked about the different responses between NSW and WA on borders, Morrison said the AHPPC had not recommended collectively any one response.

“What is important is these don’t get sort of locked in as part of another enduring disruption and as soon as South Australia is able to get on top of this I would be expecting that states would keep on the path that we have set towards Christmas.”

After the disastrous consequences of Victoria’s second wave for residential aged care, with residents accounting for most of the deaths, Morrison said: “We have stood up the aged care response centre in South Australia. That is important to ensure that we deal with any potential risks or issues in residential aged-care facilities. I particularly spoke to the premier about that today”.

Addressing a Committee for Economic Development of Australia dinner on Monday night, Reserve Bank Governor Philip Lowe highlighted the link between what happens on the health front and the trajectory for the economy.

“There is still considerable uncertainty about the [economic] outlook,” he said.

“If we do get further good news on the health front, we could have a rapid rebound.

“At the same time, it is still possible that we experience further outbreaks. And the hoped-for medical advances may be delayed and could face production and distribution challenges slowing their rollout. This means that there are downside scenarios too.”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.

Today marks the official end of the second wave in Victoria, as old freedoms return

Hassan Vally, La Trobe University

Victorian Premier Daniel Andrews today announced the most significant easing of Melbourne’s coronavirus restrictions since the state went into “stage 3” lockdown on July 9.

From 11.59pm on Tuesday night, retail, restaurants, cafes and bars will finally be able to open up in Melbourne. Gatherings of up to ten people outdoors are now allowed from any number of households, and the four reasons to leave your home have been abolished. Outdoor contact sport for under-18s returns, as does outdoor non-contact sport for all ages.

Residents will have to wait until Tuesday for confirmation on how many visitors they’ll be allowed in their homes, as Andrews reiterated that indoor gatherings represent the highest risk of transmission. But he ruled out a “bubble” approach, which I think is smart — if the rules are too complicated they become harder to follow.

The 25km travel limit and the “ring of steel” between Melbourne and regional Victoria will be removed from midnight on November 8. Gyms and fitness centres will also reopen from that date.

Second wave defeated

Although we’ve been through a rollercoaster of emotions over the past 36 hours, the recording of zero new COVID-19 cases today and the further relaxing of restrictions marks the official end of the second wave in Victoria.

By working together, after the peak of more than 700 new cases a day in early August, Victorians have brought virus transmission under control, and now squashed it completely. For this, all Victorians should be commended.

This is a significant achievement — our equivalent of overcoming a ten-goal deficit at half-time in the grand final and starting the final quarter with a slender lead. Although the work is not done, and we’re exhausted, we should celebrate what we have been able to achieve.

Read more:
Of all the places that have seen off a second coronavirus wave, only Vietnam and Hong Kong have done as well as Victorians

Cluster-busting is key

Of course, we cannot ignore what happened in the northern suburbs of Melbourne this past week. The timing of this cluster was unfortunate, and the resulting postponement of the announcement of the relaxing of restrictions yesterday was, for many of us, devastating. But to frame it as a positive, if there was any lingering uncertainty about our capacity to respond to clusters, this should now be laid to rest.

The incident provided the perfect opportunity to show how effectively we can handle clusters. By targeting contacts of known cases as well as contacts of contacts, we’ve shown that, rather than crude geographic lockdowns, we can control transmission of the virus by bringing lockdowns to where the cases are.

This is what best-practice public health looks like, and the government should be commended for continuing to refine and improve the public health response to these clusters. We should now be able to place our trust in the public health response.

With relaxed restrictions comes personal responsibility

But it’s important to be aware these newly regained freedoms come with obligations. As prescribed restrictions ease, the pendulum swings towards individuals taking responsibility for managing their risks, rather than government telling you what you can and can’t do.

As Andrews said, “this virus isn’t going away”. So it’s expected that we continue all of the behaviours we’ve come to know, such as regular and frequent hand-washing, practising physical distancing, avoiding large crowds, and wearing masks when you leave the house.

And most important of all, make sure you get tested as soon as possible if you develop even the slightest of symptoms.

Victorians have shown how responsible they are, it’s time to reward them with the trust they’ve earned.

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

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.

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


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.

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.

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

Hassan Vally, La Trobe University

Last week the World Health Organisation’s special envoy on COVID-19, David Nabarro, said:

We in the World Health Organisation do not advocate lockdowns as the primary measure for the control of the virus.

This has created confusion and frustration, as many people have interpreted this as running counter to WHO’s previous advice on dealing with the pandemic. Haven’t most of us spent some or most of the past few months living in a world of lockdowns and severe restrictions, based on advice from the WHO?

Dig a little deeper, however, and these comments are not as contrary as they might seem. They merely make explicit the idea that lockdowns are just one of many different weapons we can deploy against the coronavirus.

Lockdowns are a good tactic in situations where transmission is spiralling out of control and there is a threat of the health system being overwhelmed. As Nabarro says, they can “buy you time to reorganise, regroup, rebalance your resources”.

But they should not be used as the main strategy against COVID-19 more broadly. And the decision to impose a lockdown should be considered carefully, with the benefits weighed against the often very significant consequences.

Lockdowns also have a disproportionate impact on the most disadvantaged people in society. This cost is greater still in poorer countries, where not going to work can mean literally having no food to eat.

Read more:
Is lockdown worth the pain? No, it’s a sledgehammer and we have better options

So if lockdowns are best used as a short, sharp measure to stop the coronavirus running rampant, what other strategies should we be focusing on to control the spread of COVID-19 more generally? Here are four key tactics.

1. Testing, contact tracing and isolation

The key pillars in the public health response to this pandemic have always been testing, contract tracing, and isolating cases. This has been the clear message from the WHO from the beginning, and every jurisdiction that has enjoyed success in controlling the virus has excelled in these three interlinked tasks.

No one disputes the importance of being able to identify cases and make sure they don’t spread the virus. When we identify cases, we also need to work out where and by whom they were infected, so we can quarantine anyone who may also have been exposed. The goal here is to interrupt transmission of the virus by keeping the infected away from others.

Time is of the essence. People should be tested as soon as they develop symptoms, and should isolate immediately until they know they are in the clear. For positive cases, contact tracing should be done as quickly as possible. All of this helps limit the virus’s spread.

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

2. Responding to clusters

Responding to disease clusters in an effective, timely manner is also vitally important. We’ve all seen how certain environments, such as aged-care homes, can become breeding grounds for infections, and how hard it is to control these clusters once they gain momentum.

Bringing clusters under control requires decisive action, and countries that have been successful in combating the virus have used a range of strategies to do it. Vietnam, which has been lauded for its coronavirus response despite its large population and lack of resources, has worked hard to “box in the virus” when clusters were identified. This involved identifying and testing people up to three degrees of separation from a known case.

Read more:
Europe’s second wave is worse than the first. What went so wrong, and what can it learn from countries like Vietnam?

3. Educating the public

Another crucial element of a successful coronavirus response is giving the public clear advice on how to protect themselves. Public buy-in is vital, because ultimately it is the behaviour of individuals that has the biggest influence on the virus’s spread.

Everyone in the community should understand the importance of social distancing and good hygiene. This includes non-English speakers and other minority groups. Delivering this message to all members of the community requires money and effort from health authorities and community leaders.

4. Masks

After some confusion at the beginning of the pandemic, it is now almost universally accepted that public mask-wearing is a cheap and effective way to slow disease transmission, particularly in situations where social distancing is difficult.

As a result, masks — although unduly politicised in some quarters — have been rapidly accepted in many societies that weren’t previously used to wearing them.

Read more:
Victorians, and anyone else at risk, should now be wearing face masks. Here’s how to make one

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.

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

Catherine Bennett, Deakin University

After days of speculation, today’s announcement by Victorian Premier Daniel Andrews was pretty much as we expected: a significant lifting of restrictions, albeit only a half-step out of lockdown.

From 11.59pm tonight, Melburnians will be able to travel up to 25km from home, with no time limits on exercise or recreation, bringing the chance to play a round of golf or visit the hairdresser.

Even more encouragingly, we may only have to wait a week until the lockdown is lifted, the “four reasons” to leave home are removed, and retailers and other businesses can once again open their doors.

Andrews said the planned move to step three of the COVID-19 roadmap could be brought forward a week from its provisional date of November 1 if case numbers — now tracking at 7.5 new cases a day for metropolitan Melbourne and just 0.5 in the regions — remain favourable.

“Victorians have stayed the course, and we just have a little longer to go,” he said.

I agree Victorians can rightly be proud, because this lockdown was a very big ask. In fact, I see no reason why we can’t remove blanket rules such as the 25km radius and Melbourne’s “ring of steel” immediately.

Buying time

The blanket restrictions in Melbourne, which have been in place since early July, have bought time to rebuild our public health response, with stronger measures for testing, contact tracing and isolating outbreaks. The idea is to “bring the restrictions to the virus”, meaning we can now contain it wherever it might appear.

As a result, restricting the general public’s movements with the help of blanket rules makes less sense, because many Melburnians now have a minuscule risk.

Read more:
A 14-day rolling average of 5 new daily cases is the wrong trigger for easing Melbourne lockdown. Let’s look at ‘under investigation’ cases instead

I don’t understand why we need to impose a 25km limit. It’s such a big radius but will still exclude people who live at opposite ends of the city from seeing each other. Perhaps the fear is too many people will congregate in popular or scenic places. But surely that can be managed by scrutinising those particular places.

In contrast, when Singapore was coming off its second wave, it lifted restrictions when COVID-19 cases were at 60 per million people, per day. Melbourne’s current average is just over 1 case per million people, per day. If Andrews were to promote Victoria’s strategy to the rest of the world, I’ve no doubt they would agree it’s been a success, but they would probably also wonder why it is taking so long.

We had an extended blanket lockdown that was enough to quash the virus multiple times over in households. But we weren’t able to contain it in aged care, certain workplaces, and complex households.

With cases now so low, the idea that all public movement equals viral spread is not true. There’s a lot more to this virus than this sort of reductionist approach. We know probably 70% of people don’t even pass it on, and that many cases are the end of a chain of infection. If we do get a cluster, we will likely pick it up. This gives me confidence Melbourne will be able to open up fully next weekend.

The wholesale rebuilding of our contact-tracing means we are now very much on the front foot. Health authorities should continue urgently interrogating and isolating new cases, particularly mystery ones.

But for the wider public, it is now important to instil a sense that the government trusts people to be sensible for themselves. The more rules we have, the harder it is for people to have a sense of agency.

The rules should now be focused on areas where there is greatest risk. Unnecessary blanket rules might get in the way of people buying in. For instance, the ring of steel shouldn’t be necessary, given the testing and tracing measures we now have in place. What’s more, I think it will be a long time before people go back to their old patterns of movement, given that people have become acclimatised to staying at home.

This also means it’s easier to consider lifting border restrictions. While we’ve been busy fighting off the second wave we’ve built the health response to a point where we can live with the virus. So things like borders become less crucial.

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

If authorities aren’t busy policing things that don’t make much of a difference, such as the 25km rule, it will free up resources and also mean people have one less rule, and one less fine, hanging over them.

I would also urge authorities to allow people to wear masks only in situations where it makes a real difference, as opposed to everywhere. It’s easier to trust the public to do that when they’re not being told to wear them all the time.

Over more than three months, Victorians have grown used to being told what to do in intense detail. Now it’s time for people to get back some control, and I’m hopeful we can do that in a way that’s safe.The Conversation

Catherine Bennett, Chair in Epidemiology, Deakin University

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

Sorry Melbourne. The chance of reaching an average 5 COVID-19 cases by mid-October is under 50%


Jodie McVernon, University of Melbourne and James McCaw, University of Melbourne

Melburnians are addicted to the Victorian health department’s daily tweet of the state’s new COVID-19 cases. This figure contributes to the all-important rolling 14-day average, which alongside the number of mystery cases, tells us whether we’re on target for the next phase of reopening.

How likely is it we’ll get to the target of an average of no more than five new daily cases by October 19 and fewer than five mystery cases — the triggers for the next stage of restrictions to be lifted?

Our regular modelling updates contribute to assessment of epidemic trends in Australia. This work suggests the chance of achieving the target is 50% or less.

In the words of Victoria’s Chief Health Officer, Brett Sutton, it’s looking like a “line ball” decision.

Why aren’t the numbers going down?

Daily case reports have dramatically decreased from the hundreds seen only weeks ago. However, now numbers are low, any minor fluctuations are highly visible. We’re still seeing small outbreaks that seed chains of transmission, contributing to this day-by-day variation.

The recent outbreak linked to the Butcher Club at Chadstone shopping centre is a prime example, with workers transporting the virus back home across Melbourne and into regional Victoria. Essential work is a valid reason to leave home and travel beyond 5 kilometres, facilitating long-range spread. The potential for further outbreaks like this remains.

Then there are the cases in “stubborn” settings such as aged care. We have seen the potential for outbreaks in these environments, which are essentially residential settings housing large numbers of people at risk of severe outcomes.

While there have been major efforts to reduce introduction and spread of infection in these environments, rumbling chains of infection spread have proven difficult to stamp out.

Read more:
Victoria’s path out of COVID-19 lockdown – quick reference guides

At the moment, the vast majority of cases are linked, and related to spread in occupational and residential settings.

So what happens if we’re still at an average of ten cases by mid-October? By late October? Into November? Are the measures that would remain in place proportionate to these numbers, and is there good evidence those measures are needed to prevent a third wave?

It’s clear Melbourne cannot stay in lockdown indefinitely. Lockdowns are an emergency brake on widespread community transmission.

How can we safely free up society and the economy without dashing all the efforts of the past months?

Read more:
Now everyone’s a statistician. Here’s what armchair COVID experts are getting wrong

Super-spreaders are who we should be focusing on

The biggest challenge for containing COVID-19 is the potential for super-spreading events. Many infected people do not spread the virus. But some, the super-spreaders, infect many others. Those newly infected people then return to their own homes, schools or workplaces, each with the potential to seed new infections.

So rapid identification of super-spreading events is key. This is achieved by working backwards whenever we identify a new case — a concept known as “back tracing”.

Where resources are limited, they’re best applied to investigating where a known infection came from (as that “parent” source was clearly contagious) and following up on their close contacts as quickly as possible.

At our current low case numbers, we can also focus on who the newly identified person (the “child”, who may or may not be contagious) has subsequently been in contact with.

We also need to minimise the chance of these super-spreading events from happening in the first place. We can do this by limiting the number of people who mix together in workplaces and social situations.

Keep to your bubble

It’s also useful to distinguish between mixing with known and unknown people. It’s clear SARS-CoV-2, the virus that causes COVID-19, spreads very effectively in households, where we understandably let our guard down.

Limiting our social contacts to known, repeated people or small groups or “bubbles” reduces the overall risk and makes contact tracing easier in the event of an infection. Meeting up in outdoor settings further reduces those risks.

But socialising in public places, like restaurants, provides opportunities for mixing with unknown people. That’s why COVID-safe operating practices to limit group sizes in restaurants and cafes and minimise between-group interactions are so important. And of course there are outdoor dining options if the Melbourne weather chooses to be kind.

Hong Kong managed its “second wave” very effectively without lockdowns by reducing mass gatherings, promoting remote working and learning, introducing seating restrictions in restaurants and closing bars. All these measures were explicitly focused on reducing super-spreading risk.

Read more:
Friday essay: COVID in ten photos

Individual behaviours still matter

No matter where we are or who we’re with, we can all reduce our individual risk of catching or spreading SARS-CoV-2. Whether or not we are staying “at home” is arguably a lot less important than how we behave when we leave.

Despite poor choices by some, Victorians’ compliance with personal behaviours to reduce infection spread are the highest in Australia and holding steady over time, helping keep the potential for transmission down.

What happens after October 19?

Thanks to early, proactive responses to COVID-19, Australia is in the fortunate position of having achieved near-elimination.

However, it is inevitable SARS-CoV-2 infections will continue to be imported, particularly as we look to reconnect with the wider world.

As a global community, we will be living with and adapting to this virus and its impacts for years to come. We need a view beyond the next fortnight to find sustainable ways to live, work and respond.

Lockdowns have served us well. Australia has avoided catastrophe. But it is not lockdown or bust. We have other alternatives.The Conversation

Jodie McVernon, Professor and Director of Doherty Epidemiology, University of Melbourne and James McCaw, Professor in Mathematical Biology, University of Melbourne

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

Curfew lifted and COVID-19 roadmap is ‘ahead of schedule’ as Melbourne inches towards end of lockdown

Stephen Duckett, Grattan Institute

Victorian Premier Daniel Andrews has announced an end to the curfew and a COVID-safe return to work for 127,000 Melburnians, as restrictions ease at 11.59pm tonight. He has also flagged a provisional early lifting of many other aspects of the lockdown on October 19.

The downward trend in new COVID-19 cases has been better than expected, with the crucial 14-day moving average of daily new cases reaching 22.1. This is good news for Victorians, prompting Andrews to move metropolitan Melbourne to the second step of the state’s roadmap to COVID-normal.

According to the roadmap, today’s announcement was contingent on the 14-day rolling average being below 30-50 cases. The 50-case mark was passed on September 17, and the lower bound of 30 cases was reached a week later, on September 24.

Graph of Victoria's COVID-19 cases

Rather than easing restrictions when the criterion for new cases was met, the government had also, unnecessarily, set a date for moving to the second step: September 28.

Before today’s announcement, the better-than-expected decline in case numbers, coupled with the reduction in the number of “mystery” cases with an unknown source, had led Andrews to flag the possibility of easing restrictions faster than the provisional dates in the roadmap.

This is indeed what he has announced, with the next step potentially moving forward from October 26 to October 19. The government will now rely predominantly on epidemiological thresholds rather than dates. But Andrews added it is necessary to monitor the effects of today’s announcement for a further three weeks.

Andrews and his advisors had to keep in mind the ultimate goal of reaching zero active cases. Lifting restrictions too soon would jeopardise that.

Read more:
Daniel Andrews has flagged a quicker easing of Melbourne’s restrictions. But cases are still in the ‘red zone’

The main changes are cautious ones, and still consistent with the zero target. The key changes are shown below.

One of the most welcome changes will be the abolition of the curfew. It had no real evidence base, given the other restrictions in place, and it became a policy orphan with no one owning up to recommending it.

Read more:
Worried you might test positive and put a spanner in Victoria’s COVID roadmap? Here’s why you should get tested anyway

The other major change is to formalise the return of on-site schooling. The research evidence on schools is complex, with different countries adopting very different rules about whether children can attend. But evidence suggests transmission risk is lower for kids under ten, so primary school return is welcome.

The return of VCE and VCAL students is presumably based on the assumption older teenagers should be able to follow physical distancing guidelines.The Conversation

Stephen Duckett, Director, Health Program, Grattan Institute

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

Daniel Andrews has flagged a quicker easing of Melbourne’s restrictions. But cases are still in the ‘red zone’

Mary-Louise McLaws, UNSW

Victorian Premier Daniel Andrews flagged on Wednesday that metropolitan Melbourne’s restrictions could be eased further than initially planned on Monday September 28.

The 14-day average of daily new cases has fallen to 29.4. This is below the 30 to 50 required for the second step of the roadmap out of restrictions, planned for 11:59pm this Sunday.

Andrews wouldn’t confirm which restrictions will be eased, but from an outbreak-management perspective, we should be cautious about easing anything too quickly.

It would be a huge shame to see Victorians’ pain and sacrifices undone, and I hope the restrictions will be eased early based on epidemiological advice, rather than mounting political pressure.

Fortnightly average still in the ‘red zone’

The 14-day case average of 29.4 is based on the new cases announced each day, though sometimes cases are reclassified later on. According to my corrected data, the new case average is 30. Either way, it’s a vast improvement compared with the peak in early August when the 14-day average reached over 460.

Nevertheless, the current figure is still in the “red zone” of more than 100 cumulative cases in the past fortnight, where cases can spiral out of control if restrictions are eased too suddenly.

Ideally, the most significant easing of restrictions would only happen when the 14-day average hits the “green zone” of fewer than five cases, which is currently planned for October 26.

Read more:
New South Wales on a knife edge as cumulative coronavirus case numbers spiral into the ‘red zone’

It’s risky to relax too soon, because there are still many “mystery cases” for which the source of infection is unknown. Victoria’s Deputy Chief Health Officer Allen Cheng confirmed these mystery cases are currently spread across 18 local government areas. He said:

Most of those are still in the areas where we are concerned […] Each local government area has a relatively small number of cases and I guess it does reflect that there has been community transmission out there.

These areas include Casey in Melbourne’s southeast, and Brimbank and Hume in the city’s northwest.

I would be very cautious about easing restrictions ahead of schedule when there are still mystery cases. There is likely still some community transmission that is yet to be detected by contact tracers.

Cheng added, however, that if the number of mystery cases continues to decline, this would give confidence there has been minimal further community transmission.

The early easing of restrictions could be justified if the new cases are within known risk groups and we are confident that the risk has been contained.

Curfew to stay

Andrews confirmed he wouldn’t yet budge on the nightly curfew, which has been subject to intense questioning by journalists and commentators, and criticism from some members of the public.

From an outbreak-management perspective this is the right approach. The curfew has several aims, one of which is to restrict the movement of younger people. Younger people have been disproportionately COVID-positive during Victoria’s second wave. Younger adults tend to be more socially connected, have more daily contacts with one another, and often work at several workplaces. All these factors increase the chances of acquiring and transmitting COVID-19.

Read more:
COVID-19 cases are highest in young adults. We need to partner with them for the health of the whole community

Aged care still a risk

There’s an ongoing risk to Victoria’s case numbers from residential aged care. If the virus continues to circulate in aged care, it poses a risk to residents and staff, and might also escape to the wider community via infected staff.

Aged-care homes must provide adequate personal protective equipment. There have been concerns among staff that surgical masks are not enough to prevent contracting COVID-19. The World Health Organisation does recommend a surgical mask and face shield, but this requires a minimum safe airflow change in rooms to prevent exhaled infectious particles from hanging in the air and causing airborne spread.

Scientists believe most transmission occurs through droplets, but poorly ventilated environments might explain the increased risk of airborne spread in confined spaces.

Read more:
Is the airborne route a major source of coronavirus transmission?

Most residential aged-care facilities will not be able to meet the safe level of room airflow of 40-80 litres per second per resident.

Therefore, in situations where airflow is not adequate, surgical masks should be replaced with respirator masks, such as N95 or P2 masks, to prevent staff acquiring the virus at work.

It’s likely that transmission in aged care homes will continue if this issue isn’t addressed. The issue of poor airflow could also apply to other workplaces like abattoirs, factories and shared office spaces. Going forward, they too should consider the risk of airborne spread.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.

New Zealand relaxes COVID-19 restrictions, except for Auckland. How much longer will the city have to wait?

Fiona Goodall/Getty Images

Alex James, University of Canterbury and Shaun Hendy

New Zealand’s government today announced that after seven days of no new community cases linked to the Auckland cluster, most of the country will return to almost normal life, at alert level 1, from midnight.

But restrictions in Auckland will remain in place until midnight on Wednesday, and the city will then move to alert level 2 for at least another two weeks. This means Aucklanders have to continue wearing masks on public transport, but will be allowed gatherings of up to 100 people.

The decision to keep Auckland under stronger restrictions is sensible. Our modelling suggests the current cluster could have a long tail and there may still be undetected cases in the city.

A return to level 1 is premature for Auckland, but the absence of new cases over the past week suggests the cluster is well contained.

Before the entire country can return to level 1, we should consider updating alert level guidelines to keep the requirement of mask wearing and restrictions on large gatherings in place for longer.

Could it still unravel?

Auckland’s move to level 2 shouldn’t unduly increase the risk of a flare-up. Our modelling suggests there will be a 50-50 chance of eliminating the virus by the end of the month, provided the cluster stays contained.

The last time New Zealand moved to level 1, back in June, was after 14 days of no new cases and only two cases in the full month the country remained at level 2. When we made that move we were 95% confident the virus had been eliminated.

Before lifting level 2 restrictions in Auckland, health officials will want to be sure the cluster won’t flare up again at level 1. If we maintain high rates of testing for another fortnight and continue to see no new cases in the community, we can consider level 1 for the city.

Read more:
Auckland’s rapid lockdown has given New Zealand a better chance of eliminating coronavirus – again

We may still see new cases, but there is a big difference between a new case in a family member who is already in isolation and a new case appearing out of the blue that has been infectious for two or three days.

Level 2 does pose a higher risk than Auckand’s current level 2.5, which limits social gatherings to fewer than ten people. The public should remain cautious, especially when it comes to large indoor gatherings.

Even though street protests in Auckland a week ago broke the ten-person limit, they posed a lower risk than indoor gatherings. The Black Lives Matter protests in the US don’t seem to have caused any significant increase in spread there. If there are new cases from the protests in Auckland, we would expect to detect those in the coming week.

So far, only four cases were detected outside Auckland and they were quickly quarantined. Nonetheless, our modelling suggests the chance of an undetected case in the South Island may still be between 5% and 10%. As case numbers fall, this gets lower, but with Air New Zealand’s NZ$50 domestic flights now on sale, it could rise again.

To be sure the disease hasn’t spread outside Auckland, anyone with even the mildest COVID-19 symptoms should be tested. This translates to roughly 10,000 tests each day across the country — but testing rates in the past week have only averaged about 7,000 per day, mostly in Auckland. People in other parts of the country need to be tested too.

Read more:
6 months after New Zealand’s first COVID-19 case, it’s time for a more strategic approach

Risk of new outbreaks

Level 1 is not without risk. Even with the increased testing both in the community and of front-line workers, especially in quarantine and isolation facilities, we’ve seen four separate border incursions. At level 1, there is a greater chance an incursion will result in a large outbreak.

The first breach at the border has never been traced but was first spotted in an Americold worker and resulted in the current outbreak, with more than 150 new cases. The second, separate infection in late August was picked up by a maintenance worker at an isolation facility in Auckland. It was caught early and led to no secondary cases.

The third was from a nurse who was infected at work at a quarantine facility. There have not been any secondary cases reported, which is a relief given the large number of close contacts at the nurse’s gym. We could have seen a superspreading event.

Read more:
Here’s the proof we need. Many more health workers than we ever thought are catching COVID-19 on the job

Then, over the weekend, we learned about a person who developed symptoms and tested positive several days after completing two weeks in managed isolation. This may have been due to an unusally long incubation period or from contact with other travellers in the quarantine facility.

This equates to a new incursion every three or four weeks. Our modelling shows that while most of these incursions will fizzle out on their own, occasionally one will lead to another large outbreak and possible lockdown, most likely in Auckland.

To stop these incursions becoming major outbreaks requires a significant change in public behaviour supported by an update in the alert level guidelines. The use of masks on public transport and restrictions on large gatherings, particularly indoors, may need to be kept in place in the longer term.

It’s almost impossible to know where or when our next outbreak will occur, but if we stay cautious and alert to this possibility, then we can avoid another lockdown.The Conversation

Alex James, Associate professor, University of Canterbury and Shaun Hendy, Professor of Physics

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