As coronavirus restrictions ease, here’s how you can navigate public transport as safely as possible

Hassan Vally, La Trobe University

As coronavirus restrictions continue to ease, one of the key challenges we face is how to deal with people moving around a lot more.

In particular, as more of us start to head back to school and the office in the coming weeks and months, more of us will be getting on buses, trains and trams.

So what is public transport going to look like as we relax restrictions, and how can we navigate this safely?

Read more:
To limit coronavirus risks on public transport, here’s what we can learn from efforts overseas

Workplaces can help

Victorian premier Daniel Andrews has emphasised working from home will be one of the last measures the state will ease.

But even when restrictions are relaxed, do we all need to go into the office as much as we used to?

Working from home has become the “new normal” for many of us, and we’ve learnt a lot about how to do this successfully. Employers have adjusted too, with some indicating they will encourage increased remote working moving forward.

So one of the obvious things we can do to reduce the numbers of people using public transport is to continue to work from home where possible.

Read more:
If more of us work from home after coronavirus we’ll need to rethink city planning

Another option is for workplaces to implement flexible start times. If we can reduce the numbers of people using public transport during peak times, this will make a significant difference in reducing crowding.

Public transport providers and governments

State governments have introduced additional cleaning practices on public transport networks. These will continue, and may even be increased, as more people return to public transport.

Although increased cleaning is important, physical distancing remains the key to safely moving large numbers of people again. Governments will need to consider some changes to ensure people can keep a safe distance from others on their commute.

Many people touch the same surfaces on public transport.

As we’ve seen with the easing of restrictions, different states will take different approaches.

For example, New South Wales has imposed limits on how many people can board a bus or train. A maximum of 32 people are allowed in a train carriage (normally one carriage holds 123 passengers), while buses are limited to 12 passengers (capacity is normally 63).

Further, markings on the seats and floors of buses and trains indicate where people can sit and stand.

Marshals are also being stationed around the public transport network to ensure commuters are following the rules.

In a similar move, the South Australian government revealed they will remove seats from Adelaide trains.

Read more:
Coronavirus recovery: public transport is key to avoid repeating old and unsustainable mistakes

In contrast, Queensland is not imposing any passenger limits, instead asking commuters to use their common sense. The government says there is plenty of room on public transport in Queensland at present, and the risk of virus transmission is low given the small number of active cases.

Similarly, Victoria has not imposed passenger limits. But the government has indicated commuters will be able to access information about which public transport services are the least crowded to assist travel planning.

Some states have flagged extra services may be needed to avoid overcrowding, though the extent to which this will be possible is dependent on resources.

In addition to extra services, NSW has indicated it will boost car parking and enhance access for cyclists and pedestrians.

What can you do?

The main responsibility around keeping virus transmission suppressed as we relax restrictions rests with us as individuals to behave sensibly and responsibly.

The same principles apply when we use public transport as when we navigate all public spaces.

Maintaining physical distance from others and washing our hands regularly are possibly even more important when we’re using public transport, given we potentially come into contact with a lot of people in an enclosed space.

We know SARS-CoV-2, the virus that causes COVID-19, is more likely to spread indoors than outdoors. We also know prolonged contact with someone infected with the virus increases the risk of transmission, as compared to a passing encounter.

So public transport commutes have the potential to pose a significant risk of virus transmission, especially if you’re sitting next to an infected person on a long journey.

Masks are a hot topic.

Taking hand sanitiser when you use public transport is a good idea so you can clean your hands while travelling. You may be touching contaminated surfaces, for example the bars and handles for balance.

In addition, washing your hands thoroughly with soap as soon as you arrive at your destination should become a part of your routine.

Importantly, if you’re sick you should not be leaving the house, let alone taking public transport or going to work.

What about masks?

Wearing a mask on public transport is an issue of personal preference.

But if you choose to wear a mask, it’s important to understand a couple of things.

First, masks need to be put on and taken off correctly so you don’t inadvertently infect yourself in the process.

And while masks potentially offer some additional protection to you and others, it’s still critical to follow physical distancing and other hygiene measures.

Read more:
Who’s most affected on public transport in the time of coronavirus?

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.

Immunity passports could help end lockdown, but risk class divides and intentional infections

Nigel McMillan, Griffith University

If you’ve already recovered from the coronavirus, can you go back to the workplace carefree?

This is the question governments including in the UK, Chile, Germany and Italy are trying to answer by considering immunity passports. These would be physical or digital documents given to people who’ve recovered from COVID-19 and are immune from the disease for a period of time. This would enable them to return to the workplace or even travel.

But there are serious concerns that immunity passports could create two classes of citizen and provide a perverse incentive to contract the virus deliberately.

You’re probably safe from reinfection – for a bit

When we are exposed to a virus, our bodies rapidly respond by giving us fevers, runny noses, and coughing. This initial immune response works by raising our body temperature and activating many cellular changes that make it harder for the virus to replicate. These are signs our immune system is activating to fight off infection. These defences are not specific to the virus but merely serve to hold it at bay until a more powerful and specific immune response can be mounted, which usually takes 7-10 days.

We then start to build a targeted immune response by making antibodies (among other things) that are specific for the virus infecting us. This immunity peaks at about day 10 and will continue to work for the rest of our lives with some viruses, but sadly not coronaviruses.

Read more:
Can you get the COVID-19 coronavirus twice?

Immunity to most normal coronaviruses, including those that cause some common colds, only lasts around 12 months. This is because the immune system’s response to coronaviruses wanes over time, and because these viruses slowly mutate, which is a normal part of the viral “life-cycle”. We don’t know yet how long immunity will last for COVID-19, but we might reasonably expect it to be similar, given what we know about our immune responses to coronaviruses.

Immunity passports will only work if people really are immune to reinfection. Earlier reports from South Korea and China suggested some people tested positive again after having recovered. This prompted the World Health Organisation (WHO) to declare in late April there was no evidence immunity passports would be reliable.

But more recent data suggests these tests were picking up dead lung cells which contained dead virus. Since then, experiments have also suggested animals that have recovered from SARS-CoV-2 infection could not be reinfected (although this study has not yet been peer-reviewed).

Read more:
Researchers use ‘pre-prints’ to share coronavirus results quickly. But that can backfire

We also know SARS patients from 2002 had antibodies that lasted an average of two years. People who had been infected with the MERS coronavirus seemed to retain antibodies for at least 12 months.

The WHO has since updated its advice to recognise that recovering from COVID-19 will likely provide some level of protection from reinfection.

Therefore, people who have recovered from COVID-19 are likely to be immune for a period. This means they could potentially be carrying SARS-CoV-2 but won’t develop the disease of COVID-19, and are therefore less likely to pass it on. But we don’t know for sure how long this immunity might last.

Of course, to issue immunity passports we must be able to reliably detect immunity. There are many tests that claim to detect SARS-CoV-2 antibodies but are not yet reliable enough. To assess the presence of antibodies, we must use more reliable tests done in pathology laboratories, called ELISA tests, rather than on-the-spot tests.

Read more:
Why can’t we use antibody tests for diagnosing COVID-19 yet?

Passports might be most useful for frontline workers

We know there are a number of professions which are highly exposed to the virus. These include frontline medical workers like nurses, doctors and dentists, as well as transport workers like bus drivers and pilots. We also know there are particular situations where the virus is easily spread – large crowds of people in close contact such as in aeroplanes, buses, bars and clubs, as well as in hospitals.

Immunity passports could be used to allow people with immunity to help out on the front lines (with their consent). I have personally been contacted by people who have recovered from COVID-19 and want to volunteer to help in highly exposed roles. For example, they could take up administrative roles in ICU wards in hospitals to take pressure off nurses and doctors.

Further, hospitals might choose to roster staff with immune passports to treat COVID-19 patients, because the risk of them contracting and spreading the virus is significantly lower compared to those who haven’t had the virus.

In these instances, immunity passports might be useful for individual hospitals to allocate staff based on immunity.

Similarly, bus and taxi drivers with immunity passports could cover for colleagues who might be older or have medical conditions that make them particularly vulnerable to COVID-19.

And of course your passport isn’t forever – it would need to be reviewed over time with another blood test to see if you are still immune.

Two classes of people

But using immunity passports in broader society, and managed by the government, would risk discrimination by creating two classes of citizens. Holding one might become a privilege if it enabled people to go about their lives in a relatively normal way. For example, if it was compulsory for certain jobs or for being able to travel overseas.

But the second class, who don’t have immunity passports, would still be subject to health restrictions and lockdowns while waiting to gain immunity via a vaccine.

Similar to a “chicken pox party”, immunity passports would then create a perverse pull factor and encourage people to deliberately become infected. This incentive might be particularly strong for those who are desperate for work. This would obviously be extremely dangerous as we know the virus has a significant mortality rate and people of all ages have died from COVID-19.

Immunity passports could be effective when used in a targeted way such as in specific hospitals or businesses facing higher exposure to COVID-19. But using them across broader society carries a great risk of discrimination.

This article is supported by the Judith Neilson Institute for Journalism and Ideas.The Conversation

Nigel McMillan, Program Director, Infectious Diseases and Immunology, Menzies Health Institute, Griffith University

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

7 questions answered on how to socialise safely as coronavirus restrictions ease

Hassan Vally, La Trobe University

You can almost hear the collective sigh of relief as coronavirus restrictions are eased across Australia.

But as we emerge from our bunkers and dust off our social skills, we must think about how to navigate this transition safely.

Read more:
As restrictions ease, here are 5 crucial ways for Australia to stay safely on top of COVID-19

The winding back of restrictions does not mean the pandemic is over, although it is a recognition of how well we have done to control the spread of COVID-19 in Australia. There is still a long way to go, and it’s everyone’s responsibility to limit the chances of the coronavirus spreading.

So what should a social gathering look like now we’re allowed to get together? Here are answers to some common questions.

How big should my gathering be?

At the time of writing, you can have five visitors in your home and gatherings of up to ten outdoors in Queensland, New South Wales and Victoria. In Tasmania you can only have two visitors to your home; in the ACT, South Australia and the Northern Territory you can have ten, while in Western Australia you can have 20.

Whatever the restrictions in your state or territory, it’s important not to crowd too close together. You need to use common sense in deciding how many people to invite.

Do we still need to socially distance and wash hands regularly?

Wes Mountain/The Conversation, CC BY-ND

We should carry on doing the things that have so far proved successful in curbing the coronavirus.

This includes staying at least 1.5 metres from other people, and being vigilant about hand hygiene.

Make sure you have plenty of hand sanitiser available if you are hosting or attending a social gathering, so you can disinfect your hands regularly without having to go to the bathroom repeatedly.

Read more:
Economists back social distancing 34-9 in new Economic Society-Conversation survey

How should we greet each other?

Wes Mountain/The Conversation, CC BY-ND

The same rules about physical contact still apply, so we should not be hugging for now. We could adopt some of the new ways of greeting, such as the elbow bump or the foot shake. Or just stick to saying hello for the moment.

Read more:
Miss hugs? Touch forms bonds and boosts immune systems. Here’s how to cope without it during coronavirus

Should I bring my own cutlery to a dinner party?

Assuming you trust the general hygiene standards of your friends (which I sincerely hope you do), this is not necessary. Cutlery should be washed properly with detergent in hot water and handled only with freshly washed hands.

Cutlery is no different to any other food surface such as crockery, glassware or chopping boards – just make sure it’s as clean as possible.

Can we share food?

Wes Mountain/The Conversation, CC BY-ND

Although there is no evidence coronavirus is spread through food, there is still a risk of cross-contamination while eating food from a shared plate. So this is probably not a sensible thing to do right now.

While it might feel less sociable, avoiding shared grazing plates is a simple tactic to limit the risk of virus transmission. It might even stop your friend scoffing all the dip.

Similarly, avoid the temptation to clink glasses with your friends. It’s only a small risk but we should take every opportunity to reduce the virus’s chances.

Should I wear a mask?

A mask is not essential for social gatherings, assuming you maintain a safe distance and wash your hands regularly. Having said that, a mask can give people some extra reassurance so they can relax a bit more.

That’s assuming it is worn (and taken off) correctly, and that people understand a mask does not guarantee protection from infection. There is no harm in wearing one, but remember to be extra friendly as your friends can’t see your smile!

Read more:
Are you wearing gloves or a mask to the shops? You might be doing it wrong

I don’t feel 100% – should I take a raincheck?

It is important to factor in your personal health and risk factors in determining how you navigate your newly reinstated freedoms. For example, a 75-year-old with a pre-existing health condition, such as a heart condition or asthma, should still be very careful about limiting their contact with others, as the implications of getting sick are very serious.

You should also consider your responsibility to other people. A 25-year-old who feels slightly unwell should err on the side of caution and not socialise, to protect others.

Despite the lockdown lifting, we still need to take responsibility for our own health and also be considerate about the health of others. That way we can all start to enjoy one of the most rewarding aspects of humanity: being sociable.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.

Grattan on Friday: Border wars split political leaders and embroil health experts

Michelle Grattan, University of Canberra

Who’d be Queensland premier Annastacia Palaszczuk right now?

Facing a tough election in October, Palaszczuk is coming under huge pressure to open the state’s borders, so visitors in search of winter sun can start to get the tourist industry back on its feet.

She’s in the sights not just of the federal government, with Peter Dutton (“a proud Queenslander”) leading the charge, but of NSW premier Gladys Berejiklian as well.

Palaszczuk so far is holding firm, saying she’ll follow the advice of her chief health officer, Jeannette Young. The border closure will be reviewed monthly; it could stay shut until September, and Young says possibly even longer. It depends on the number of active cases in NSW and Victoria, which have far more than Queensland.

It might be Queensland first opens up to South Australia and the Northern Territory before re-opening the border with NSW.

In political terms, Palaszczuk is on risky ground whatever she does.

Depriving the state’s economy of much-needed dollars will give ammunition to her opponents. On the other hand, if an open border led to a serious outbreak in a tourist centre, forcing fresh shut downs, she’d carry the blame.

It’s a dilemma to which there is no “correct” answer.

So far, Palaszczuk has voters’ support in how she’s handled the pandemic (although her government’s rating is lower than those of other state governments.)

In the Essential poll published this week, 66% of Queenslanders answered good or very good when asked “how would you rate your state government’s response to the Covid-19 outbreak?” In WA 86% rated the McGowan government’s performance positively. (The federal government received a tick from 73%.)

But voters are fickle, and opinions can change quickly.

We saw this over kids being in school. At first many parents insisted their children must stay home; after a few weeks they were pressing for schools to take them back.

The schools debate produced fault lines in the national cabinet, and now the row over borders is doing the same. That useful body remains intact, but this creates tensions, even though border policies are the decisions of individual states, not the collective.

The conflict might also be something of a reality check on the idea the national cabinet would enable a harmonious road to future economic reform.

A notable feature of the COVID federalism model is that under the national cabinet umbrella, line ups vary according to the issue.

Victoria (Labor) and NSW (Coalition) were the loudest in urging early heavy restrictions, including in relation to schools.

The Morrison government, with its eye on economics, instinctively preferred a lighter hand; it needed a shove to go further. Where it couldn’t be moved and the states had the power, they went their own ways.

On schools, Canberra was adamant – Scott Morrison always wanted them open. Similarly, Canberra wants borders opened.

The border issue sees another cross-party grouping. The Labor jurisdictions of Queensland, Western Australia and the Northern Territory, and the Liberal states of South Australia and Tasmania all have their borders closed.

NSW and Victoria have never gone down this path.

Berejiklian is pushing hard for a re-opening to promote recovery. She’s suggested WA premier Mark McGowan and Palaszczuk are courting popularity.

In the crossfire, McGowan has accused Berejiklian of bullying tactics, and hit where it hurts. “New South Wales had the Ruby Princess … And they are trying to give us advice on our borders, seriously?” he said this week. Palaszczuk said: “We are not going to be lectured to by a state that has the highest number of cases in Australia”.

As notable as the fracture among governments, is the very public division between the health experts.

We saw this on schools, where Victorian chief health officer Brett Sutton took a much more conservative position than others.

While Young and WA chief health officer Andrew Robertson were adamant this week on keeping their respective borders shut for the time being, federal deputy chief medical officer Paul Kelly said “from a medical point of view, I can’t see why the borders are still closed”. (McGowan had earlier said: “I don’t know who Paul Kelly is – clearly not the singer”.)

Kelly said neither the national cabinet nor the Australian Health Protection Principal Committee (that advises it) had made decisions or given advice on state borders. Decisions on what to do were entirely up to the states.

Both Young and Robertson are on the AHPPC, which is described as a “consensus body”. “We talked through these matters and we decided not to have a position on borders,” Kelly explained.

While it has been welcome in this crisis to see the politicians turning to the experts, we are now being sharply reminded experts can differ. How often have we heard from politicians in recent weeks, “We are relying on the medical advice.” But that doesn’t always lead in one direction, and “consensus” can be a useful concealer.

As the border argument intensifies the question of whether the closures are constitutional, canvassed early on in the crisis, has come back.

One Nation’s Pauline Hanson has accused Palaszczuk of “running roughshod over the constitution”, appealed for anyone affected who might want to mount a challenge to come forward, and said “I have a pro-bono, constitutional lawyer who will represent you in a High Court challenge under Section 92”.

Section 92 provides for “trade, commerce, and intercourse among the states” to be “absolutely free”.

No one could be sure how, if there were a case, the High Court would rule. The Court in the past has recognised public health circumstances can justify measures that otherwise would breach section 92. But would special circumstances still apply when the virus threat had apparently receded?

Attorney-General Christian Porter has dodged on whether the border closure could be unconstitutional.

Porter, a Western Australian, has been measured on the issue itself. “These aren’t easy decisions for state premiers to make but there’s a health imperative, there’s an economic imperative and there are strict constitutional rules around what is permissible and impermissible”, he told a news conference on Thursday.

Porter no doubt has in mind the thread of isolationism traditionally running through his state’s thinking, and of the polling showing enormous support for the McGowan government’s COVID management.

The day before, Porter noted “that the federal government’s position,
on a whole range of issues, is to be forward leaning and develop workarounds to get our economy moving again”.

Indeed. We can expect the Morrison government’s “forward leaning” will only increase in coming weeks, with its desperation to boost economic activity. Meanwhile, premiers might need their chill pills before they meet, virtually, at national cabinet next week.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.

As restrictions ease, here are 5 crucial ways for Australia to stay safely on top of COVID-19

C Raina MacIntyre, UNSW

As Australia’s coronavirus restrictions are gradually lifted, we may well see an upswing in cases of COVID-19. The World Health Organisation has warned of the need for “extreme vigilance” in countries that are now emerging from lockdown.

A vaccine remains the best possible tool to guard against the virus. But with a vaccine still months or even years away, we will have to rely on other epidemic control measures, of which there are five key pillars.

Read more:
Australia starts to re-open, but the premiers have the whip hand on timing

1. Finding every new case

We need to find and isolate every new case of COVID-19, to prevent transmission. Testing is the way we identify cases. Because even people without symptoms can transmit the virus, the testing regime should include high-risk, asymptomatic people.

Read more:
To get on top of the coronavirus, we also need to test people without symptoms

Expanded testing criteria in some states allow any doctor to order a test if they suspect COVID-19, but national criteria still do not recommend testing of high-risk people (such as family contacts) who do not have symptoms.

In closed settings where COVID-19 cases have been identified – such as an aged care facility, cruise ship or household – everyone exposed should be tested, as there is a high rate of asymptomatic and pre-symptomatic infection that would otherwise be missed.

This was not done aboard the Ruby Princess cruise ship, where only those with symptoms were tested. This may have resulted in missed infections and further outbreaks. It is vital to avoid further incidents like this as we move out of lockdown.

2. Rigorous contact tracing

Every person who has come into contact with a known COVID-19 case needs to be traced and quarantined for two weeks. Ideally, they should be tested. Using the COVIDSafe app will help identify all contacts more thoroughly.

3. Continued social distancing

Extreme social distancing measures such as home lockdowns are now coming to an end in Australia. But we should keep practising lesser measures, such as maintaining a distance of 1.5 metres from other people.

4. Ongoing travel bans

Travel bans prevent infections being imported from countries with severe epidemics. In Australia, more than 60% of cases up to May 12 were imported through travel. Keeping the borders closed will allow further lifting of restrictions within Australia.

It is also important to continue quarantining return travellers, and testing Australians arriving home from high-risk countries. The Emirates airline has gone further, announcing COVID-19 testing for all passengers.

5. Face masks

Everyone in the United States has been advised to wear a face mask, because peak transmission occurs in the two days before symptom onset or on the first day. This can help flatten the curve, even if mask use is only modestly effective, especially if combined with social distancing.

It is not a recommendation at this stage in Australia, but masks can also help ease restrictions safely, and may be something to consider in the coming months in crowded public places.

Know your enemy

Besides on-the-ground tactics such as widespread testing and contact tracing, we also need a clear understanding of infectious disease epidemiology, and defined criteria to alert us when we may be heading into an epidemic period.

In countries that have flattened the curve and achieved low incidence of COVID-19, such as Australia and New Zealand, there has been talk of “elimination” of the disease.

Read more:
We may well be able to eliminate coronavirus, but we’ll probably never eradicate it. Here’s the difference

But because of the low total infection numbers in these countries, most people remain susceptible to COVID-19. This means fresh outbreaks are possible in the 12-24 months or longer until we have a vaccine.

The concepts of “elimination”, “eradication” and “control” arose from vaccination programs. Eradication is global, whereas elimination is national or regional, and “control” is a goal when elimination is not possible. For measles, outbreaks may still occur during elimination, usually imported through travel, but do not lead to sustained transmission.

The World Health Organisation criteria for the elimination of measles include:

  • low incidence with an R0 below 1 (meaning each person with the disease infects less than one other)

  • high-quality surveillance

  • high population immunity.

But with no vaccine for COVID-19, low incidence and high population immunity are mutually exclusive propositions. For a novel disease with no vaccine, it is premature to talk about eradication.

Ideal infections for elimination and eradication have no presymptomatic transmission and no animal host – for these reasons, eradication of COVID-19 is unlikely.

This means for the time being at least, we need to aim for “control” of COVID-19 – keeping the disease at a manageable level. For this, we need to differentiate between sustained community transmission and sporadic, non-sustaining outbreaks.

Widespread testing is the key to this. It will tell us how much infection is present, and if it is increasing. A stark reminder of the consequences of failure to test is the case of the United States, where the growth of the epidemic was not detected until it was too late.

How do we distinguish between sustained and non-sustained outbreaks? One possible definition of a sustained outbreak would be a certain number of generations of transmission from an original case. Another would be demonstrating ongoing community transmission over a defined period of time (such as three months), or a rise in the R0 value, a measure of how strongly the outbreak is growing. Contact tracing will clearly be vital to assessing this.

Detection of a sustained outbreak would be a warning sign that we are potentially heading into another epidemic period. This might therefore signal the need for increased testing, stronger social distancing, and other measures.

It is likely we will face alternating epidemic and non-epidemic periods, and will need to continue to manage COVID-19 with intermittent returns to stronger restrictions. That is, until we have a vaccine, at which point we can begin working towards bringing the COVID-19 crisis to a genuine close.The Conversation

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW

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

Vital Signs: rules are also signals, which is why easing social distancing is such a problem

Richard Holden, UNSW

Australia’s states and territories have begun relaxing the restrictions put in place to contain COVID-19.

From today, for instance, the most populous state, New South Wales, is allowing outdoor gatherings of ten people, the use of public pools and playground equipment, and home gatherings with up five visitors. Restaurants and cafes can also serve up to ten diners, so long as they follow the “four square metres rule” (meaning a premises will need a dining area of 40 square metres to seat ten patrons).

Many will welcome these developments. But they represent a difficult choice for governments.

Read more:
Past pandemics show how coronavirus budgets can drive faster economic recovery

Allowing the public greater freedoms will help boost both morale and economic activity. But it risks a second-wave outbreak of COVID-19 and a return to more stringent restrictions.

Easing off on social distancing rules while keeping COVID-19 under control with good but imperfect testing and contact tracing is a tough balancing act.

It’s made even tougher by the fact government rules do more than simply define what is permissible.

The rules also send a message to the public about the information authorities have, influencing personal perceptions and therefore behaviour, regardless of whether it is permitted.

Hearing the wrong story

So governments need to take into account not just the direct effect of rules but, crucially, the broader message absorbed by the public.

There’s a risk people will hear only part of the story, interpreting the easing of restrictions as a sign we’ve beaten the virus and are on our way back to normal.

This, in part, explains why New South Wales Premier Gladys Berejiklian urged continued vigilance when she announced relaxing of restrictions on May 10. “Just because we’re easing restrictions doesn’t mean the virus is less deadly or less of a threat,” she said. “All it means is we have done well to date.”

An extra layer of complexity

Trying to ensure the public doesn’t misinterpret government messages makes decisions on when and how to ease restrictions particularly complex.

The key risk, of course, is that people infer from relaxed restrictions that the government now thinks risks are minimal and everyone can go back to life as it was in January 2020.

This signalling effect means governments need to be more cautious about relaxing restrictions.

On the other hand, the longer they seek to impose rules, particularly if other jurisdictions are easing restrictions, the more they risk losing their authority.

This conundrum can be seen in Australia’s second-most-populous state, Victoria. It has regularly imposed rules going further than those recommended by the federal government.

ABC Q&A host Hamish MacDonald captured this nicely when he asked Victorian Premier Daniel Andrews this week:

Dan Andrews, you would have seen all of the images of people out in Victoria over the weekend, clearly going beyond what was formally allowed in terms of social distancing. Have some Victorians, do you think, seen this federal three-step plan, observed that you’re going to take somewhat longer to deliver on some of the steps, and just taken matters into their own hands?

It doesn’t help that the Victorian and federal governments differ despite both apparently acting on the advice of public health experts.

“Follow the medical advice” has been a powerful aphorism, but it is likely to weaken the further the response to COVID-19 moves from the “hammer” phase – using strict social distancing measures – to the “dance” phase – using more targeted measures such as contact tracing to contain the spread of the virus until there’s a vaccine.

Leading by example

One thing leaders can do to mitigate this problem is communicate to the public through their own behaviour.

Other countries have seen some some disturbingly mixed messages. Britain’s prime minister, Boris Johnson, for example, proudly talked about shaking hands with COVID-19 patients just weeks before he almost died from the virus. US President Donald Trump, among other things, has refused to wear a mask while Americans are being encouraged or required to.

Read more:
Governments can learn from consumer psychology when it comes to public health messaging

Australia’s politicians have generally done better. A notable example was federal Health Minister Greg Hunt admonishing mining magnate Andrew Forrest to maintain proper social distance at a press conference last month. That was a powerful reminder, as has been the sight of the prime minister, the chief medical officer and cabinet members standing appropriate distances apart.

The ‘horror-case scenario’

Perhaps what governments fear most is a breakdown in public compliance with social distancing that leads to large enough second-wave outbreaks to warrant a return to the conditions that applied in April.

Read more:
Politics with Michelle Grattan: Paul Kelly on the risk of a COVID-19 second-wave

This would be a huge blow, both to the economy and the national psyche – which is what will drive business and consumer confidence. Household spending accounts for nearly 60% of GDP, so confidence is crucial to recovery.

That confidence will depend not only on what rules governments put in place but what messages they send to the Australian public in coming months.The Conversation

Richard Holden, Professor of Economics, UNSW

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

It’s hard to know when to come out from under the doona. It’ll be soon, but not yet

Becca Schultz/Unsplash

Peter Robertson, University of Western Australia

In the wake of our success so far in containing the spread of COVID-19, the prime minister has been prodding us to come out from under the doona.

With the premiers, he has prepared a three-step plan.

The problem, he said on Friday, is that it would be tempting to stay in lockdown tucked up under the doona forever.

And you know, you’ll never face any danger. But we’ve got to get out from under the doona at some time. And if not now, then when?

The treasurer Josh Frydenberg says continuing the lockdown is costing the economy A$4 billion per week.

Economists have sharply polarised positions.

To stay safe, or to live boldly

The preamble to an open letter by 265 Australian economists published in The Conversation last month said that to use those costs as a reason to end the lockdown would represent a “callous indifference to life”.

Others seem to think that the lives lost matter less than the huge economic and social costs staying locked down.

In between those extremes lies a huge band of uncertainty.

A more circumspect comparison of the risks of unlocking compared to the risks of staying locked down suggests that, in purely economic terms, the restrictions make good sense so far.

You start by putting a value on lives

One way to evaluate the merits of relaxing restrictions is to put a monetary value on the fatalities avoided, and compare that cost with the cost imposed by the restrictions.

Putting a monetary value on human life is often viewed as unsavoury. But, whether explicitly or implicitly, it is what is being done every time a government or non government entity makes a decision that affects the risk of increased mortality, from whether to put up a road sign to how to conduct hospital triage.

Being explicit gives some assurance that the proposed measures are proportional. It can alleviate fears that what’s proposed is an under or over reaction.

Read more:
The calculus of death shows the COVID lock-down is clearly worth the cost

But numbers alone can not tell us what is the right thing to do. That requires making value judgements – which is the job of politicians.

It is nevertheless helpful to understand how the COVID-19 policy responses measure up to standards used in normal public health decision making.

Making this difficult is the is enormous uncertainty over some of the key variables.

It’s hard to know how many lives

A critical number is the infection fatality rate.

The Oxford Centre for Evidence Based Medicine puts the infection fatality rate at between 0.1% and 0.4% of the population.

For Australia, if 90% were infected, this implies 22,000 to 90,000 thousand fatalities.

This range could further be increased by as much as 50% if not enough intensive care units are available.

Professor Tony Blakely of the University of Melbourne, and Professor Nick Wilson of the University of Otago have reported a larger estimate of 134,000 fatalities.

For planning purposes the Department of Prime Minister and Cabinet values a full statistical life, when converted to 2019 dollars – allowing for inflation and growth – of approximately A$5.1 million.

Reasonable arguments could be made that it should be many times larger or smaller.

Saved, Tony Bullimore’s book about the rescue.

As an example, when the lone British sailor Tony Bullimore was rescued from the Antarctic Ocean by the HMAS Adelaide in 1997, the nation celebrated as he emerged from under the hull after hour days trapped in winds of up to 160 km per hour.

Australia’s defence minister dismissed any criticism of the cost.

“We have an international legal obligation. We have a moral obligation obviously to go and rescue people, whether in bushfires, cyclones or at sea,” he said.

In today’s dollars it cost about $10 million to save 57 year old Bullimore’s life. When age is factored in this represents a value that is many times more than the normal value of a full statsitical life used by the prime minister’s department.

A reference figure is $150 billion…

Nevertheless, taking $5.1 million as a conservative estimate of the value of a full life and reducing it by two thirds to take account of the fact that most of the people who die from COVID-19 are in the final third of their lives, gives a conservative cost of 90,000 COVID-19 fatalities in a “do-nothing” scenario of about $150 billion, or 8% of gross domestic product.

By comparison, at $4 billion per week, the economic cost of the first month of restrictions amounts to a little under 1% of gross domestic product.

Spending many times that much to avoid a health crisis that could cost 8% of gross domestic product, and perhaps much more, seems reasonable.

This makes Australia’s lockdown and social distancing regulations eminently justifiable by standard public policy criteria.

…which means we can’t keep doing this forever

But there’s a catch: continuing the regulations indefinitely isn’t an option.

Lockdowns make more sense if there is an exit strategy or end game – such as a vaccine or medical intervention.

Unfortunately, neither are likely within six to twelve months, if ever.

Like cures for cancer, it’s possible they will always remain just over the horizon.

This kind of indefinite time-frame would see the economic and social costs of restrictions rise over time and potentially exceed the statistical value of the lives saved, all the while leaving the vast majority of the population susceptible. Even if COVID-19 were eliminated in Australia, so that economic activity resumed, this would impose substantial costs on tourism and accommodation sectors – potentially for ever.

Read more:
COVID lockdowns have human costs as well as benefits. It’s time to consider both

There is a danger of a double tragedy. Without a plan to exit and with no vaccine, we could find ourselves having spent 8% or more of gross domestic product in lockdowns and still face the threat of a national epidemic.

Waiting for a vaccine could become like having yet another go on the pokies – without a commitment to exit, you end up broke with nothing else to spend.

At the moment, the restrictions are justified in financial terms.

But rising economic and social costs mean we will need an exit strategy. This may simply mean learning to live with COVID-19.

With that end-game in mind, taking a cautious peek out from under the doona, soon, makes sense.The Conversation

Peter Robertson, Professor, University of Western Australia

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

The stepped approach out of lockdown is the only way forward, but how much we’ll allow the curve to rise is still an unknown

Tony Blakely, University of Melbourne

The federal government has laid out a three-step guide for the states and territories for relaxing the physical distancing measures that have served Australia so well. We need to get back to school, work and play.

Australia is one of the lucky countries, blessed by being “girt by sea”, with a little bit more time to respond to the COVID-19 pandemic – and some good, strong early leadership (such as closing the border to China). We have used that time well, getting the case numbers down to not much more than New Zealand’s low rate, even though they faced a more severe lockdown. Some states, such as WA, may even have succeeded in eliminating community transmission.

Morrison’s language last week of expecting ongoing outbreaks suggests the goal is not to eliminate, but to suppress case numbers. This means accepting there will be grumbling transmission of the virus that pops up here and there as (hopefully) small outbreaks we can stamp out. But there is a risk of things getting out of control, with a second wave of infections possibly much greater than the first.

Read more:
We may well be able to eliminate coronavirus, but we’ll probably never eradicate it. Here’s the difference

The best way forward in a suppression world

Think of it like a seesaw. On one side we have things we want back – the kids at school, going back to work, going to the pub, playing team sports. The problem is each one of these things will make it easier for the virus to circulate. If we went straight back to our old normal ways, it’s inevitable COVID-19 would take off as an epidemic that would swamp our health system – and cause substantial illness and death. We are not going to do that.

So we have to stack the other side of the seesaw with the counterbalancing of really good surveillance systems, testing, keeping our distance, and contact tracing (in which case, yes, the COVID-Safe App can help here).

Read more:
COVIDSafe tracking app reviewed: the government delivers on data security, but other issues remain

With each of these things together, it will in theory allow us to get out and about without the epidemic taking off again.

But we do need to remember it is a theory the world has not tested before. We need to approach this cautiously, learn as we go, and generate the evidence in real time.

How do we do that? By relaxing measures in batches. Hit “release” on the first tranche, then monitor what happens very closely for three to four weeks. (And do not stuff it up by muddying the waters with more loosening ups before the three to four-week window has passed.)

If by three to four weeks, there has not been an unacceptable surge in cases, then release the next tranche and repeat the cycle. If and when the case load gets too high, we then have reached the tipping point for the seesaw – and we will need to stabilise or even tighten up again.

Thus the stepped proposal by the federal government looks like a good framework to follow.

The issue, though, is how far we can get before the seesaw looks like it is tipping. We may get a rude shock; we may not get much of our liberty back before we have to equilibrate, and even go back into lock-down if there is a strong surge in cases.

The fear that is often mentioned is that of a “second wave” of infections that could surpass the first. That will happen in the states and territories that have not eliminated the virus if we open up too rapidly – hence the need for a stepped approach that can be stopped at or before the tipping point that will lead to an unacceptable second wave.

What is an acceptable level of community transmission in Australia?

Understandably, no politician has been brave enough to state publicly how much of an increase in cases is acceptable. But we will find out once restrictions are relaxed and cases start to inevitably rise.

The “acceptable” number of cases we want to remain under might be as low at ten cases per day – a number that would see low levels of death and severe illness. Alternatively, and perhaps better, we may use the number of outbreaks – something like no more than one new outbreak per week in each state or territory.

An outbreak could be defined as one new case with no detectable infection source, through to dozens of infections from the same source (as per the current abattoir outbreak in Victoria).

Learning to live with the virus in this suppression world is likely to be hard work. Which gives reason to pause and ask “is elimination really off the table?” For the country as a whole, probably. The government (and society) has decided to trade off the risk of more infections for some of our freedoms back. Which is understandable.

Everything about COVID-19 is calculated risk-taking. While some states, such as WA, may have achieved elimination, most have not. So loosening up now will likely mean elimination is unachievable, and suppression our only path forward.The Conversation

Tony Blakely, Professor of Epidemiology, University of Melbourne

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

The calculus of death shows the COVID lock-down is clearly worth the cost

Neil Bailey, Monash University

Will the number of lives saved as a result of the COVID-19 restrictions be outweighed by the deaths from an economic recession?

This is a vital question to answer for governments responding to the current global tragedy.

Without numbers, there’s no obvious way of working out whether the economic impacts of the lock-down could be more harmful than the virus.

With health economics consultant Daniel West, I have attempted to estimate the numbers involved in Australia.

In order to provide a strong challenge to the status quo of lock-down the estimates we have used for increased deaths from a lockdown-induced recession are at the high end of the likely scale. The estimates we have used for deaths from COVID19 if the lockdown ends are at the low end.

Our analysis suggests that continuing strict restrictions in order to eradicate COVID-19 is likely to lead to eight times fewer total deaths than an immediate return to life as normal.

Lives the lock-down could cost

The most obvious deaths likely to follow from a lock-down-induced recession are suicides.

Studies in 26 European countries over four decades suggest that increases in unemployment of more than 3% are associated with increases in suicides by 4.45%.

A similar relationship was found in Australia during the global financial crisis.

The projections for increases in unemployment if the lock-down continues are grim, some pointing to an unemployment rate of up to 15% which might not return to normal for up to a decade.

Read more:
COVID lockdowns have human costs as well as benefits. It’s time to consider both

To account for the prospect that the coming recession will be more severe than most, we have used double the highest European estimate of the relationship between increased unemployment and suicide.

This estimate suggests that an increase in the unemployment rate to 15% followed by a gradual decline over ten years would produce a distressing 2,761 extra deaths due to suicide.

Loneliness takes lives too

Continued restrictions could also significantly increase loneliness, which, for those who are lonely, can increase deaths from all-causes by between 15% and 29%.

Research suggests that quarantine can increase the number of people showing psychological distress by about 20%, an estimate we have used as a proxy for the effect of loneliness, even though the lock-down restrictions are less severe than quarantine.

This points to an additional 4,015 deaths associated with loneliness from a lock-down of six months.

Read more:
Is your mental health deteriorating during the coronavirus pandemic? Here’s what to look out for

Although it would be reasonable to assume that a recession would increase the number of deaths from other causes, studies show this isn’t the case. Research into “all-cause mortality” consistently shows declines in deaths during recessions, due in part to a reduced number of heart attacks.

The current lock-down might also increase deaths in specific ways, such as deaths from alcohol abuse.

On the other hand, if hospitals are overwhelmed by COVID-19 cases, deaths from non-COVID-19 injuries and illnesses will increase as people cannot access health care.

Because we have no data on these offsetting possibilities, we have assumed they are roughly matched in size.

It is also worth noting that although we assume lock-down restrictions will hurt our economy more severely, cities that implemented more severe restrictions during the 1918 Spanish flu had economies that bounced back faster after the pandemic.

Lives the lock-down might save

We have estimated the number of deaths from COVID-19, suicide and loneliness under three different scenarios

  • an immediate return to life as normal, while still quarantining suspected cases

  • an easing of restrictions that allows the virus to slowly spread in order to achieve so-called herd immunity

  • the maintenance of restrictions until the virus is contained, followed by extensive tracking and tracing aimed at eliminating the virus

Scenario 1. Return to normal

With no lock-down measures other than the quarantine of suspected cases, the government believes 68% of people would contract the virus. Our estimates suggest this would result in more than 287,000 deaths from COVID-19 as the health system could not cope with the volume.

We assume this would produce a recession lasting five years instead of ten, with 10% initial unemployment and an associated 753 extra deaths from suicide.

Scenario 2. Herd immunity

The government says that to achieve herd immunity, about 60% of people would need to eventually contract the virus. If it is done slowly, intensive care units will not be overwhelmed, keeping the death rate per infection low.

Our estimates suggest the strategy would lead to 141,000 deaths from COVID-19.

We assume this would result in a deep recession of ten years with 15% initial unemployment and an associated 4,015 deaths from loneliness and 2,761 deaths from suicide.

Scenario 3. Eradication

Under the eradication scenario, 11.6% of people would be expected to contract the virus, resulting in 27,000 deaths from COVID-19.

As with the herd immunity strategy, we have assumed a deep recession over ten years with 15% initial unemployment and an associated 4,015 deaths from loneliness and 2,761 from suicide.

Note that given Australia’s current success, it is very possible that with continued prudent restrictions, the number of deaths due to COVID19 will be well below 27,000.

The calculus of death

Regardless of the strategy, the estimated number of deaths from COVID-19 far exceeds the estimated number of deaths from suicide and loneliness.

Despite assuming that an immediate return to life as normal would prevent all further deaths from loneliness and 70% of deaths from the increased suicide rate associated with high unemployment, the life as normal scenario is predicted to result in by far the highest overall number of deaths: 288,000.

This is almost twice the number of deaths predicted for the herd immunity scenario (148,000) and more than eight times as many as eradication (34,000).

The Brain and Mind Centre at the University of Sydney has reported larger estimates for suicides from increased unemployment: an extra 750 to 1,500 suicides per year for five years. The top end of this range projects an extra 7,500 suicides, almost three times our estimate.

Even using this higher estimate, the number of lives that would be lost from COVID-19 without lock-down measures would dwarf the number of extra suicides.

Read more:
Coronavirus is stressful. Here are some ways to cope with the anxiety

People are understandably concerned about what the lock-down will do to their jobs, businesses and investments. That damage extends beyond lives lost.

The lives that will be lost are important. The implementation of preventative measures will be vital to reduce the risk of suicide.

Yet our calculations clearly suggest that, when it comes to human lives, far fewer will be lost by continuing restrictions than would be lost by ending them now.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

This article was produced in collaboration with Daniel West. An extended version can be found here.The Conversation

Neil Bailey, Research Fellow at the Epworth Centre for Innovation in Mental Health, Monash University

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

Australia starts to re-open, but the premiers have the whip hand on timing

Michelle Grattan, University of Canberra

Scott Morrison has warned of a potentially rocky road as COVID restrictions are lifted to reopen the economy, saying the process must proceed even in the face of expected fresh outbreaks.

“This is a complex and very uncertain environment. But we cannot allow our fear of going backwards from stopping us from going forwards,” he said, unveiling a plan agreed by national cabinet, but to be implemented at different rates in different states and territories.

Morrison made it clear he would be opposed to reimposing restrictions once the unwinding was underway.

The aim is a “Covid-safe economy” in July. According to Treasury, 851,000 jobs would be restored in the months ahead.

The “road map” has three steps, laying down baselines for restarting activities.

In the first stage, rolled out any time from now, people can have up to five visitors to their house and gatherings of up to 10 will be allowed outside of the home.

Small restaurants and cafes can reopen, but only with up to 10 customers at a time.

Playgrounds can open, as well as libraries and community centres; outdoor bootcamps can restart and auctions will be permitted.

Local and regional travel for recreation will be allowed.

On the work front, the advice is “work from home if it works for you and your employer”, which Morrison described as “a difference in emphasis” compared with the stronger encouragement previously for people to work from home.

Under the relaxed rules, funerals can have up to 30 attendees outdoors and 20 indoors, and weddings 10 people in addition to the couple and the celebrant.

Step two will allow outside gatherings up to 20 people, and gatherings up to 20 in re-opened indoor gyms, beauty salons, cinemas, theatres and amusement parks, galleries and museums.

Cafes and restaurants will be able to seat up to 20 people at one time.

States and territories may allow larger numbers in some circumstances.

Some interstate recreational travel would be considered, depending on the jurisdiction.

The third stage sees gatherings up to 100 allowed and people returning to their workplaces. Food courts, cafes and restaurants will be able to operate with up to 100 people, as will saunas and bathhouses. All interstate travel will be permitted.

In this stage consideration will be given to opening bar areas.
Strip clubs and brothels would remain closed.

There would be consideration in this stage of travel between Australia and New Zealand, Pacific Island travel and travel arrangements for international students.

Morrison said the pace of lifting restrictions “will totally be up to the states and territories. They’ll be responsible for setting their own timetable and communicating that to their citizens and residents in their own states and territories.”

He also said premiers and chief ministers “have asked me to stress there should be no expectation of step one starting on day one, unless they are indeed already there”.

Moving on these steps would take some preparation, he said.

Movement from one step to the next would depend on three criteria – that the medical evidence suggested further easing wouldn’t be an undue risk, widespread testing was identifying community transmission, and public health actions were able to trace cases and trap local outbreaks.

“Testing, tracing, trapping, as they were saying in the Northern Territory recently,” Morrison said.

National cabinet will review progress every three weeks.

Asked whether, when expected fresh outbreaks came, states, territories and Australians needed to hold their nerve and not snap back to tighter restrictions, Morrison replied without hesitation, “yes”.

But he also made it clear if there was a widespread outbreak the government would take the health advice.

Morrison said Australia’s health system and testing and tracing arrangements put it in a good position.

In this plan to lift restrictions, “we walk before we run. We know we
need to be careful to preserve our gains”.

But “if we wish to reclaim the ground we lost, we cannot be too timid. There will be risks. There will be challenges. There will be outbreaks, there will be more cases, there will be setbacks,” he said.

“Not everything will go to plan. There will be inconsistencies. States will and must move at their own pace, and will cut and paste out of this plan to suit their local circumstances. There will undoubtedly be some human error. No-one is perfect. Everyone is doing their best.”

Victorian premier Daniel Andrews, who has been the most conservative of the premiers, said he would not make announcements until next week.

He also hinted he might open schools – which in Victoria are providing distance learning to all but a few students – earlier than the current arrangement. Victoria has angered the federal government with its hard line on schools. The national health advice has been that schools can be safely open and Morrison has pushed that issue.

NSW also will not act before next week, with premier Gladys Berejiklian noting the state had already moved to lift some restrictions.

The state breakdown of the Treasury forecast for the jobs restored in coming months is: NSW 280,000, Victoria 216,000, Queensland 174,000, South Australia 55,000, Western Australia 85,000, Tasmania 18,000, Northern Territory 9000, ACT 14,000.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.