Hassan Vally, La Trobe University and Catherine Bennett, Deakin UniversityNew South Wales Premier Gladys Berejiklian today confirmed what Sydney was fearing: the city’s lockdown will be extended for another week.
With 27 locally acquired cases identified in the past 24 hours, this decision isn’t surprising.
Of some concern, seven of these people had been moving around in the community during part of their infectious period. Another seven appear to have been in the community for the whole of their infectious period.
These aren’t the numbers you want to be seeing when considering emerging out of a lockdown.
So what are health authorities looking for when when making decisions about relaxing restrictions?
The first key factor is whether the public health team is identifying the epidemiological links between cases.
The second is whether contact tracers are able to identify all potential cases and quarantine them before they’re infectious. This is clearly not yet the case in NSW.
Remind me, why did Sydney go into lockdown?
After health authorities identified the initial cluster, it looked like it could be brought under control. But then they discovered a new, significant chain of transmission.
While it could be traced back to the Bondi Junction cluster, there had been more than one generation of spread in the community. This included a seafood wholesaler in Marrickville, with transmissions going back a week before they caught it, and a flight crew member who travelled interstate while likely to be infectious.
It would take some days to identify, trace, isolate and test all contacts.
The second and equally important reason for lockdown was contact tracers weren’t able to keep up with all the cases, despite identifying this outbreak within the first generation of spread.
Contact tracers were finding the interval between exposure and becoming infectious could, in some cases, be as short as 24 to 48 hours.
They were concerned that known chains were still active and other significant chains of transmission were yet to be discovered. So they needed the extra level of transmission suppression that lockdown brings.
What’s happened since?
Fortunately, no other chains have been unearthed linked to large workplaces or complex setting. But the outbreak isn’t yet contained, so restrictions are still needed.
However, this could turn around quickly, as the number of new exposure sites diminishes.
An important element of the public health response has been the decision to ask the households of those who have been to key exposure sites to also isolate while the infection status of the person exposed is worked out.
This, along with people rapidly self-identifying when new exposure sites are listed or older sites are reclassified to “close cotact” status, will allow the contact tracers to get ahead of the virus. Then, new cases will only be found in quarantine.
At that point, new cases may continue to be reported, but lockdown will no longer be necessary.
So what needs to happen for Sydney to end lockdown?
When it comes to relaxing restrictions in Sydney next week, there is a lot to consider.
First, we have to take into account we’re dealing with the more infectious Delta variant. It’s around twice as infectious as the original strain that emerged from Wuhan. This has considerably changed the risk assessment, given the ease and speed at which it seems to spread from one person to another.
It’s also important to consider we’ve seen casual exposures in shared public indoor places contribute more to the spread in this outbreak. Indeed, this outbreak was seeded with a number of casual exposures resulting in new cases and widespread transmission within the first generation of spread.
Schools have become key transmission sites in this outbreak, and also in the smaller Delta outbreak in Melbourne in May. So, while schools were once seen as less worrisome locations, they’re now a more important consideration.
So far, the NSW government has delayed the return of students, with those in greater Sydney moving to home learning next week. The premier said this wasn’t because they were risky places, but to “stop literally hundreds of thousands of adults moving around and interacting with each other” at pick up and drop off times.
Hopefully the extra week of lockdown and home learning is enough to stamp out transmission, so NSW can start to get back to where it was a few weeks ago.
As Berejiklian said today, there is only one thing worse than a lockdown and that is cycling in and out of lockdowns, given the huge economic and social costs.
All the evidence shows that going hard to suppress transmission pays dividends many times over for both health and economic outcomes.
And of course, as soon as we reach a high enough level of vaccine coverage, lockdowns will be a thing of the past. This should be a big motivation for all of us to get vaccinated.
Hassan Vally, La Trobe UniversityOn Thursday, national cabinet agreed to list India as a “high-risk” country and temporarily reduce the number of people returning to Australia from the country by 30%.
Prime Minister Scott Morrison said other countries would soon be added to the high-risk list, although only India has been included so far.
Being an Australian who is of Indian heritage but has lived in Australia his whole life, the images from India over the past few days have pulled at my heartstrings in a way that has surprised me — just when I thought I’d become somewhat desensitised to the destruction the COVID-19 pandemic can wreak.
India is in the midst of an unparalleled catastrophe, even by the devastating standards we have witnessed over the last year. On Thursday it reported the largest single-day increase of COVID cases for any country since the pandemic began, with 314,835 new cases. Many hospitals are running out of oxygen.
It’s not necessarily surprising, given many substantial drivers of transmission are present in India: poverty, areas of very high population density, a lack of resources and limited lockdowns, to name a few. What’s also very clear is that, as alarming as the COVID numbers being reported are, they’re clearly an underestimation of the true level of spread.
With one in three tests coming up positive in some parts of the country, the real number may be several times higher than what’s being detected.
I have to admit I’m torn by the Australian government’s response to this situation. From a disease-control perspective, I understand the rationale. By limiting entry of people from high-risk countries, we certainly limit our exposure to risk in Australia.
As we have seen many times during the pandemic, hotel quarantine is not perfect and the risk of infection escaping these facilities is very real. Clearly, one of the triggers for this decision has been the hotel transmission of cases seen over the past few days in Perth.
But from a humanitarian perspective, I feel uneasy. One could argue those wishing to return from India need us to look after them more than ever right now. With transmission uncontrolled and lives at risk due to infection and a lack of hospital resources, we shouldn’t abandon people in India or any other country facing a similar situation.
As hard as it is to make a decision like this, it’s not without precedent. Limiting or preventing travel from high-risk countries to reduce the risk of importing disease has been a mainstay of the pandemic response in Australia and elsewhere. This policy of reducing traveller numbers from high-risk areas looks similar to the UK’s “red list”, which bans people travelling from certain countries (unless they’re British or Irish citizens, who can enter but have to quarantine at their own cost and test negative).
It does raise the question, however, of how we will define “high-risk” from now on. Expecting a rigid definition is probably unreasonable, given how many variables need to be considered, including which variants of the virus are circulating in other countries.
But despite this, I think it will be important for the government to communicate as much as it can about how these determinations will be made.
The more transparency and clarity we have on these decisions, the more confidence we can have in their fairness. If we understand the basis for these decisions, it may help us understand when and why a country is added to the list, and of course when and why it should come off again.
The response to this crisis in India speaks yet again to the complexity of public health decision-making. Although one has to listen to the science, the science cannot tell you what what your policy settings should be. In setting policy, one has to factor in fairness, consider the human perspective, and at the same time balance what’s acceptable to the wider community.
We’ve seen the challenge of balancing these various, and often competing, considerations in other difficult decisions that have been taken during the pandemic. This is just the latest example.
The federal government has probably landed on a pretty reasonable and pragmatic response to protect Australians by not closing the border to India completely, but instead reducing the risk of importing COVID by restricting the number of arrivals. Like many, however, I’m deeply concerned by the situation in India. The unfolding crisis highlights that until we bring virus transmission under control in all countries, we still have a long way to go for this pandemic to be behind us.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.”
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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.