Victoria may have eliminated COVID-19, but eradication is a distant dream


Michael Toole, Burnet Institute

Today Victoria satisfied a common definition of elimination for COVID-19, recording its 28th consecutive day of zero new cases. While there is no international definition of elimination, two average incubation periods without community transmission is widely accepted as local elimination, especially in a geographically isolated country like Australia.

It’s a remarkable achievement following a severe second wave which peaked at daily new case rates of around 700 in early August. But elimination is not eradication, and we can expect the virus to return at some point, as has happened in several countries that previously boasted minimal or no community transmission.

So how did Victoria get here, and what can it do to keep numbers as low as possible?

Elimination is not eradication

There’s no universal definition of elimination. As applied to other infectious diseases such as polio and measles, it means a prolonged period of zero local transmission in a country or region. For measles, the World Health Organisation (WHO) is very exacting and demands no community transmission for 36 months.

With more than 500,000 new daily COVID cases being reported globally, preventing new local transmission in Victoria will depend on the state building a virus-proof defence.

Several countries have shown the virus can return after a long period of minimal local transmission. The most pertinent example is New Zealand, which experienced 102 consecutive days of zero community transmission before a cluster cropped up in Auckland on August 11. Israel, South Korea, Vietnam and Hong Kong have also experienced reemergence of the virus following significant periods of minimal community transmission. And this month, we witnessed a cluster in suburban Adelaide that originated in a quarantine hotel, after South Australia had experienced many months of no community transmission.




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


Indeed elimination doesn’t mean the virus is completely gone. For example, Australia eliminated local transmission of polio in 1972. But it wasn’t until 30 years later, in 2002, that the WHO declared Australia polio-free.

Almost 20 years after that declaration, we still can’t say we’ve eradicated polio because eradication refers to the global removal of a human pathogen; only smallpox has achieved that status. One strain of the polio virus continues to circulate in Afghanistan and Pakistan. In 2007, a 22-year-old student from Pakistan was diagnosed with polio at Box Hill Hospital in Melbourne’s East.

So, how did we get to zero?

Since the grim height of Victoria’s second wave in July and August, several coordinated interventions have eventually borne fruit. One of the most important was the strengthening of the test-trace-isolate-support system. While details are emerging during the parliamentary inquiry into Victoria’s hotel quarantine system, some of the features of this strengthening are known:

  • decentralisation through regional hubs and metropolitan public health units

  • increased engagement and involvement of communities, through programs aimed at public housing estates and local initiatives led by GPs and community health centres

  • adoption of “upstream” contact tracing, identifying contacts of index cases before they developed symptoms as well as after developing symptoms. In both groups, contacts of contacts were identified. This led to the rapid control of clusters such as those in Kilmore and Shepparton.

Other important initiatives included the joint federal-state Victorian Aged Care Response Centre, which eventually managed the explosive outbreaks in residential aged care facilities, and more effective infection prevention and control in health-care settings.

And there were the containment measures that kept people from intermingling. Stage 3 restrictions were reimposed on July 8, limiting the reasons people could leave home. A study published in early August found these restrictions averted between 9,000 and 37,000 cases. From July 23, masks were mandatory at all times outside the home. On August 2, stage 4 restrictions and a night curfew effectively shut down Melbourne. From then on, the number of new cases steadily declined.

Perhaps the greatest achievement of Victoria’s response was to maintain a strong health focus amid a chorus of criticism, much of it from Canberra or the Sydney-based media, pushing the “economy first” mantra. In fact, data show countries that managed to protect the health of their citizens have generally protected their economy more effectively.




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How can we stay where we are?

The first requirement is an effective quarantine system for returned travellers. With cases surging globally, the proportion of travellers who are infected will increase significantly from the 0.7% reported between March and August. This will require arrangements that employ well-trained and adequately paid workers who are regularly monitored by infection control and occupational health and safety experts. The advance contact tracing, which will identify the close contacts of staff before they might test positive for the virus, announced by Premier Daniel Andrews would be a useful adjunct as long as confidentiality is assured.

Crucially, experienced teams of contact tracers must be on standby. They need to maintain the rigorous standards developed over the past few months and engage in simulation exercises that test their capacities. They must retain a focus on community trust and avoid the vilification of individuals that marred the South Australian response.

What’s more, the state must sustain proven containment measures such as physical distancing, hand hygiene, masks indoors, and getting tested if you have symptoms.

Australia is an almost COVID-free oasis, surrounded by a tsunami of virus. Maintaining this status for the next six months or so, while at the same time opening up, will be a huge challenge. Recent responses in Victoria, NSW and SA suggest we are up to it.

And as the story of the sharp-eyed doctor in Adelaide showed us — when she tested a patient in the emergency room who’d initially felt “weak” but had very few COVID symptoms, alerting authorities to the previously silent spread of the virus — to maintain elimination we’re also going to need a little luck.




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South Australia’s 6-day lockdown shows we need to take hotel quarantine more seriously


The Conversation


Michael Toole, Professor of International Health, Burnet Institute

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

Victoria’s $5.4bn Big Housing Build: it is big, but the social housing challenge is even bigger



Shutterstock

Katrina Raynor, University of Melbourne

The Victorian government has announced the big social housing investment for which housing advocates, industry groups, academics and social service providers have been clamouring for decades.

The A$5.4 billion “Big Housing Build” aims to create over 12,000 homes in four years. Of these, 9,300 will be social housing. The rest will be affordable or market-rate housing. The program will replace 1,100 old public housing units.




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The headline programs include:

  • $532 million to build on public land, including six “fast start” sites, resulting in 500 social housing homes and 540 affordable and market homes

  • $948 million to spot-purchase homes, projects in progress or ready-to-build dwellings from the private sector, adding 1,600 social housing and 200 affordable homes

  • $1.38 billion for community housing projects to build up to 4,200 homes

  • $2.14 billion for “new opportunities” with private sector and community housing providers, producing up to 5,200 homes.

Chart showing numbers of homes to be built over four years
The Big Housing Build time frame.
Homes Victoria/Victorian government, CC BY

Up to $1.25 billion will go into regional Victoria, which is welcome.

In addition, $498 million was announced in May to refurbish and build public housing.

Just how big is the Big Housing Build?

A target of 9,300 new social housing units over four years is definitely “big” by recent Victorian standards. The state’s social housing stock grew by just 12,500 dwellings over the past 15 years – about 830 dwellings a year.

The only comparable investment in Australia in the past two decades was the Commonwealth’s $5.6 billion Social Housing Initiative in 2009. This post-GFC stimulus program built around 19,700 social housing dwellings and repaired 12,000.

Chart showing number of social housing dwellings completed each year in Australia from 1969-2018

Australian Bureau of Statistics, Author provided

Is it enough?

No. It will take a long time and continued commitments of a similar scale to overcome the massive shortages in Victoria and Australia.

Victoria has a history of spending less on social housing per person than the rest of Australia.

Chart showing net recurrent spending per head of population for states and territories

Productivity Commission, Author provided

University of Melbourne research estimated a 164,000 shortfall in social and affordable housing in Victoria in 2018. The Australian Housing and Urban Research Institute estimated an extra 166,000 social units would be needed by 2036.




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The Big Housing Build aims to increase social housing dwellings in Victoria from 80,500 to about 89,000 – about 3.5% of all housing. That’s still less than the Australian average of 4.2% and the OECD average of 6%.

Chart showing social housing stock as percentage of total housing in Victoria and OECD countries.

OECD (data from 2018 or more current available), Author provided

What the scheme gets right

This program leans heavily on the use of state and local land to reduce the cost of the new housing. My colleagues and I have previously pointed out the large swathes of “lazy” government land across Victoria that could be used for this.




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Offering $1.38 billion in competitive capital grants for community housing providers is also substantially more cost-effective for government than models that rely on private finance and provide an operating subsidy to providers. It appears the entire amount will be spent on supporting construction, rather than on creating a seed fund that drip-feeds investment returns into the not-for-profit sector like the Social Housing Growth Fund does.

Victoria is also joining Canada and the state of California in spot-purchasing homes from the private sector in response to COVID-19. This will deliver social housing quickly. It will also support developers in a depressed market while capitalising on lower prices.

The focus on victim-survivors of domestic violence, Indigenous Australians and people living with mental health conditions is welcome too.




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Remaining concerns

Privatisation of social housing

This announcement continues trends across Australia to shift social housing provision from a state responsibility (public housing) to a more partnership-based model led by community housing providers (community housing).

This approach can leverage substantial contributions from other sectors in the form of land, capital, skills and ideas, producing exemplary outcomes. An example is the Education First Youth Foyer partnership, which is changing how “at risk” young people access housing, education and other services.

However, complex arrangements between multiple partners, especially when using private finance, can be inefficient and costly. Such partnerships are often opportunistic rather than strategic, with priority given to commercial over social outcomes. Community housing residents have less tenancy rights than those in public housing and sometimes pay more of their income on rent.

An emphasis on mixed-tenure developments can lead to cherry-picking of “acceptable” tenants and destroy tightly knit communities. Previous public housing renewal programs based on private sector involvement left a legacy of poorly integrated communities and loss of public land for negligible gains in social housing. We cannot afford to make those mistakes again.

private garden area at Carlton housing estate redevelopment
Previous Victorian housing estate redevelopments have led to segregated areas of public and private housing.
Kate Shaw



Read more:
Social mix in housing? One size doesn’t fit all, as new projects show


Lack of a strategic plan

The program comes with a new government agency, Homes Victoria, and the promise of a ten-year policy and funding framework. This level of strategic leadership has been lacking in Victoria and will require bipartisan support. Strong partnerships with local councils will also be needed.

Good policy depends on many elements, including:

  • research
  • housing targets with geographical and population-group breakdowns
  • transparent decision-making
  • clearly identified funding streams and responsible agencies
  • shared definitions
  • monitoring and evaluation mechanisms
  • clear time frames
  • integration with other policy areas and levels of government.

These elements appear to still be a work in progress for the Big Housing Build. The risk is that this announcement will follow Australia’s pattern of “lumpy” funding and inconsistent policy on social and affordable housing.

Without long-term funding streams, providers find it hard to to scale up, make strategic decisions, invest in internal capacity and plan development pipelines. Without overarching strategy and monitoring, Victoria’s lacklustre history of social housing provision may continue.




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Reduced community engagement

Planning approvals for larger social housing developments will be streamlined. In many cases, the state will take over final decision-making from local government. This will reduce opportunities for community consultation and the state government will need to work hard to ensure high-quality design is integrated into developments.

Where to from here?

As COVID-19 has made clear, everyone needs a home and society benefits from caring for those in need. The speed with which governments moved to house rough sleepers, a seemingly intractable problem before COVID, shows homelessness and severe housing stress can be overcome.




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The Big Housing Build is not perfect and will not solve Victoria’s huge housing challenges on its own. It must be the start of regular cycles of funding to sustain social housing in Victoria. It should also be tied to longitudinal evaluation of outputs and an aligned research agenda to shape best-practice outcomes.

And powers-that-be in Canberra, the list of partners in this program has a large federal-government-shaped gap. When are you going to come to the party?The Conversation

Katrina Raynor, Postdoctoral Research Fellow, Hallmark Research Initiative for Affordable Housing, University of Melbourne

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

Biden’s Electoral College win was narrow in the tipping-point state; Labor surges in Victoria



AAP/AP/Carolyn Kaster

Adrian Beaumont, University of Melbourne

With all states called by US media, Joe Biden won the Electoral College by 306 votes to 232 over Donald Trump, an exact reversal of Trump’s triumph in 2016, ignoring faithless electors. Biden gained the Trump 2016 states of Michigan, Pennsylvania, Wisconsin, Arizona and Georgia; he also gained Nebraska’s second district.

While Biden’s win appears decisive, he won three states – Wisconsin (ten Electoral Votes), Arizona (11) and Georgia (16) – by 0.6% or less. Had Trump won these three states, the Electoral College would have been tied at 269-269.

If nobody wins a majority (270) of the Electoral College, the presidency is decided by the House of Representatives, but with each state’s delegation casting one vote. Republicans hold a majority of state delegations, so Trump would have won a tied Electoral College vote.

Wisconsin (Biden by 0.6%) will be the “tipping-point” state. Had Trump won Wisconsin and states Biden won by less (Arizona and Georgia went to Biden by 0.3% margins), he would have won the Electoral College tiebreaker.

The national popular vote has Biden currently leading Trump by 50.9% to 47.3%, a 3.6% margin for Biden. This does not yet include mail ballots from New York that are expected to be very pro-Biden.

Biden is likely to win the popular vote by 4-5%, so the difference between Wisconsin and the overall popular vote will be 3.5% to 4.5%. That is greater than the 2.9% gap between the tipping-point state and the popular vote in 2016.

Prior to 2016, there had not been such a large gap, but in both 2016 and 2020 Trump exploited the relatively large population of non-University educated whites in presidential swing states compared to nationally.




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This article, written after the US 2016 election, has had a massive surge in views recently.

Relative to expectations, Democrats performed badly in Congress. In the Senate, Republicans lead by 50-48 with two Georgian runoffs pending on January 5. In the House, Democrats hold a 218-203 lead with 14 races uncalled. Republicans have gained a net seven seats so far, and lead in ten of the uncalled races.

Before the election, Democrats were expected to win the Senate and extend their House majority. The House would be worse for Democrats if not for a judicial redistribution in North Carolina that gave Democrats two extra safe seats.

US polls understated Trump again

New York Times analyst Nate Cohn has an article on the polls. Biden was expected to greatly improve on Hillary Clinton’s 2016 performance with non-University educated whites and seniors, but the results indicate that Trump held up much better with these demographics than expected.

Trump also had large swings in his favour in heavily Latino counties such as Miami Dade, Florida; polls suggested a more modest improvement for Trump with Latinos.

After the 2016 election, most polls started weighting by educational attainment, but this did not fix the problem. Cohn has some theories of what went wrong. First, Republican turnout appears to have been stronger than expected. Second, Trump’s attacks on the mainstream media may have convinced some of his supporters to not respond to polls.

A third theory is that coronavirus biased the polls’ samples, because people who followed medical advice and stayed home were more likely to respond to pollsters and more likely to be Democrats. Polls had suggested Biden would win Wisconsin, a coronavirus hotspot, easily, but he only won by 0.6%.

While US polls understated Trump in both 2016 and 2020, it is not true that international polling tends to understate the right. At the October 17 New Zealand election, polls greatly understated Labour’s lead over National. Polls also understated UK Labour at the 2017 election.

Victorian Labor surges after end of lockdown

In a privately conducted Victorian YouGov poll reported by The Herald Sun, Labor led by 55-45 from primary votes of 44% Labor, 40% Coalition and 11% Greens. Premier Daniel Andrews had a strong 65-32 approval rating, while Opposition Leader Michael O’Brien had a terrible 53-26 disapproval rating. The poll was conducted from late October to early November from a sample of 1,240. Figures from The Poll Bludger.

A Victorian Morgan SMS poll, conducted November 9-10 from a sample of 818, gave Labor a 58.5-41.5 lead, a seven-point gain for Labor since the mid-October Morgan poll. Primary votes were 45% Labor (up five), 34.5% Coalition (down 5.5) and 11% Greens (up two). In a forced choice, Andrews had a 71-29 approval rating, up from 59-41 in mid-October. Morgan’s SMS polls have been unreliable in the past.

Labor wins Queensland election with 52 of 93 seats

At the October 31 Queensland election, Labor won 52 of the 93 seats (up four since 2017), the LNP 34 (down five), Katter’s Australian Party three (steady), the Greens two (up one), One Nation one (steady) and one independent (steady). Labor has an 11-seat majority.

Primary votes were 39.6% Labor (up 4.1%), 35.9% LNP (up 2.2%), 9.5% Greens (down 0.5%), 7.1% One Nation (down 6.6%) and 2.5% Katter’s Australian Party (up 0.2%). It is likely Labor won at least 53% of the two party preferred vote. The final Newspoll gave Labor a 51.5-48.5 lead – another example of understating the left.

Labor gained five seats from the LNP, but lost Jackie Trad’s seat of South Brisbane to the Greens. Two of Labor’s gains were very close and went to recounts, with Labor winning Bundaberg by nine votes and Nicklin by 85 votes.

Federal Newspoll: 51-49 to Coalition

In last week’s federal Newspoll, conducted November 4-7 from a sample of 1,510, the Coalition had a 51-49 lead, a one point gain for Labor since the mid-October Newspoll. Primary votes were 43% Coalition (down one), 35% Labor (up one), 11% Greens (steady) and 3% One Nation (steady). Figures from The Poll Bludger.

Scott Morrison is still very popular, with 64% satisfied with his performance (down one) and 32% dissatisfied (up one), for a net approval of +32. Anthony Albanese’s net approval jumped eight points to +4, but he continued to trail Morrison as better PM by 58-29 (57-28 previously).

A YouGov poll in former Labor frontbencher Joel Fitzgibbon’s seat of Hunter had a 50-50 tie; this would be a three-point swing to the Nationals from the 2019 election. Primary votes were 34% Labor, 26% National, 12% One Nation, 10% Shooters and 8% Greens.The Conversation

Adrian Beaumont, Honorary Associate, School of Mathematics and Statistics, University of Melbourne

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

Morrison government commits $1 billion over 12 years for new vaccine manufacturing supply



PMO, Author provided

Michelle Grattan, University of Canberra

The federal government has concluded a $1 billion agreement, funded over 12 years, with Seqirus to secure supply from a new high-tech manufacturing facility in Melbourne which would produce pandemic influenza vaccines as well as antivenoms.

This would boost Australia’s sovereignty when the country was faced with a future pandemic, and make for quick responses.

Seqirus, a subsidiary of CSL Ltd, will invest $800 million in the facility, which will be built at Tullamarine, near Melbourne airport. It will replace Seqirus’ facility in the inner Melbourne suburb of Parkville which is more than 60 years old. The Victorian government has supported the procurement of the land for the new operation.

Seqirus says the complex will be the only cell-based influenza vaccine manufacturing facility in the southern hemisphere, producing seasonal and pandemic flu vaccines, Seqirus’ proprietary adjuvant MF59 ®, Australian antivenoms and Q-Fever vaccine.

Work on construction will begin next year; the project will provide some 520 construction jobs. The facility is due to be fully operating by 2026, with the contract for supply of its products running to 2036.

The present agreement between the federal government and Seqirus is due to end in 2024-25.

Seqirus is presently the only company making influenza and Q fever vaccine in Australia, and the only one in the world making life-saving antivenom products against 11 poisonous Australian creatures, including snakes, marine creatures and spiders.

Scott Morrison said that “while we are rightly focused on both the health and economic challenges of COVID-19, we must also guard against future threats.

“This agreement cements Australia’s long-term sovereign medical capabilities, giving us the ability to develop vaccines when we need them.

“Just as major defence equipment must be ordered well in advance, this is an investment in our national health security against future pandemics,” he said.

Stressing the importance of domestic production capability, the government says when there is a global pandemic, countries with onshore capabilities have priority access to vaccines.

Health minister Greg Hunt said: “This new facility will guarantee Australian health security against pandemic influenza for the next two decades”.

Seqirus General Manager Stephen Marlow said: “While the facility is located in Australia, it will have a truly global role. Demand for flu vaccines continues to grow each year, in recognition of the importance of influenza vaccination programs. This investment will boost our capacity to ensure as many people as possible – right across the world – can access flu vaccines in the future.”

To deal with the present pandemic, the government has earlier announced $3.2 billion to secure access to over 134.8 million doses of potential COVID-19 vaccine candidates developed by the University of Oxford-Astra Zeneca and the University of Queensland, Pfizer-BioNTech and Novavax.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 Victoria’s COVID-free streak continues, it’s probably time to consider changing the rules around masks


Lara Herrero, Griffith University and Eugene Madzokere, Griffith University

After a devastating second wave, Victoria yesterday recorded its twelfth straight day of zero new COVID cases.

In light of the state’s progress, Premier Daniel Andrews announced the easing of several COVID restrictions on Sunday, including removing travel limits within Victoria, reopening gyms and cinemas, and allowing greater numbers in hospitality venues. Restrictions are set to ease further on November 23.

But one of the notable measures to remain is face masks. Every Victorian must still wear a mask in public — whether indoors or outdoors — and they risk a A$200 fine if they don’t.

Is it time this rule was relaxed? After all, Victoria’s COVID situation is beginning to look more and more like other Australian states and territories, which have seen prolonged stretches of zero community transmission. Yet it remains the only state where mask-wearing is compulsory.

What does a mask do anyway?

A highly contagious virus called SARS-CoV-2 causes COVID-19. We believe the virus most commonly spreads when we breathe in tiny contaminated droplets which a person infected with SARS-CoV-2 has released into the air when coughing, sneezing, or talking.

The virus may also spread when we touch our eyes, nose or mouth after coming into contact with surfaces viral droplets have settled onto.

Face masks primarily target that first route of transmission, appreciating many people with COVID-19 won’t display symptoms. By preventing both inward and outward flow of virus-carrying droplets, masks can protect both the wearer and other people.

It’s also possible that if our hands become contaminated with the virus, wearing a mask may stop us touching our face and becoming infected that way.




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The effectiveness of any mask depends not just on its type, but also on wearing it correctly — so it covers your mouth and nose — and handling it carefully to avoid cross-contamination.

Widespread use of masks, together with sticking to other COVID-safe strategies, very likely helped Victoria to control its second wave. The use of similar approaches has been effective in other parts of the world, such as China, Italy and the United States, where the burden of COVID has been high.

Are masks as important outside as they are inside?

Wearing masks inside, or outside where physical distancing is difficult, helps to slow the spread of SARS-CoV-2. It’s especially important in areas where many people congregate including in shops, elevators, public transport, or at outdoor sporting venues.

There are a couple of factors that make wearing masks less important outdoors, particularly when we’re not near other people. First, the high airflow outside means any virus-carrying droplets are more readily dispersed, and so we’re less likely to breathe them in, compared with poorly ventilated indoor environments.

Second, evidence suggests outdoor environmental conditions such as higher heat or humidity can reduce the survival of SARS-CoV-2.

Taken together, the risk of transmission outdoors where physical distancing is in place remains low.




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Is it time to change the rules?

Victoria is one of numerous states and jurisdictions around the world that have mandated masks during the pandemic. Of course, many of these places are experiencing significant community transmission, which Victoria isn’t.

Other Australian states recommend masks — particularly where it’s difficult to maintain physical distancing — but don’t mandate them.

While the continuation of the mask rule may be confusing and disappointing for many Victorians, the rationale is to keep the population safe and to safeguard the state’s strong progress.

A woman wears a mask in the supermarket.
It’s more important to wear a mask indoors than outdoors.
Shutterstock

That said, if Victoria’s zero community transmission streak continues for more than 14 days altogether (which is enough time for most people to develop symptoms if infected) the state should start considering transition to an “indoors only” mask strategy.

This approach would require masks to be worn indoors, particularly in crowded and possibly poorly ventilated environments like shops and restaurants, and in transit, such as on public transport or in taxis.

Wearing masks outdoors would be recommended if physical distancing is difficult or if a person is more vulnerable to COVID. But the decision would be up to the individual.

Hopefully in time for summer

Masks become less tolerable as the weather gets warmer. There’s little doubt Victorians would be glad to be free from masks when going out walking, or for a picnic, or to the beach.

If Victoria remains on the path of no new cases — or at least none with an unknown source — we would think, and hope, that the current mask rules will be eased in time for the summer holiday period.

The challenge for Victoria’s health department will be to ensure the transition occurs safely. Venues need to maintain strong COVID-safe plans, including hand hygiene, distancing, regular sanitising, and “check ins” for easy contact tracing.

The success of an “indoors only” strategy or any relaxing of mask rules would likely depend on both residents and visitors to Victoria strictly adhering to remaining COVID restrictions. It would be important for people to use their judgement, and if they’re in a crowded place where it’s difficult to maintain physical distancing, to put on a mask.




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The Conversation


Lara Herrero, Research Leader in Virology and Infectious Disease, Griffith University and Eugene Madzokere, PhD Candidate in Virology, Griffith University

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

Hotel quarantine interim report recommends changes but accountability questions remain



James Ross/AAP

Kristen Rundle, University of Melbourne

The division of the findings of the Victorian COVID-19 Hotel Quarantine Inquiry into two – the interim report published today, with a final report due December 21 – is aimed at making a timely contribution to the redesign of the quarantine systems that will remain key to Australia’s management of the COVID-19 pandemic for some time to come.

With a view to the expected influx of returnees at Christmas, the national cabinet is due to discuss necessary changes later this month. Justice Jennifer Coate’s clear recommendations for how to devise and operate a quarantine system will surely be pivotal to its deliberations.

Key recommendations

Coate’s primary message is that quarantine – in whatever form it might take – is a public health operation. So any future quarantine system needs to be designed in a manner that ensures the centrality of this public health imperative.

We must wait until the final report to find out what Coate has to say on the larger governance and accountability questions surrounding “the decision” to contract out the front line of Victoria’s hotel quarantine operation to private security provision. However, her interim report already tells us a lot – if indirectly.

The report states it “is clear from the evidence to date” that the majority of those involved in the hotel quarantine program who contracted the virus were:

private security personnel engaged by way of contracting arrangements that carried with them a range of complexities.

It is therefore unsurprising that the issue of the appropriateness of contracting-out is the elephant in the room across a number of its key recommendations.

In particular, the recommendations record that the expertise of those involved in future quarantine operations will be crucial. Moreover, every effort should be made to ensure people working at quarantine facilities are “salaried employees” who are “not working in other forms of employment”.

Rydges on Swanston was one of the quarantine hotels where coronavirus outbreaks occurred.
James Ross/AAP

It takes little effort to surmise that contracted-out service delivery is unlikely to meet any of these demands.

As I have explained elsewhere, to contract out a statutory function in whole or in part requires that it be translated into a “service” that private sector providers are capable of delivering.

In the Victorian case, this meant the front line of the hotel quarantine operation was performed pursuant to an “observe and report” security services contract. It was carried out by an entirely casualised workforce with little infection-control training and no lawful powers of enforcement. Many or most of them worked in other jobs at the same time.




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Melbourne’s hotel quarantine bungle is disappointing but not surprising. It was overseen by a flawed security industry


Coate also recommended that, alongside the “embedded” presence of expert infection-control personnel, a 24/7 police presence be established at every facility-based quarantine operation. This clearly points to the failure of contracting-out from an enforcement perspective as well.

So, by implication or otherwise, the interim report confirms that too little thought was given to whether the contracted service could meet the dual public health and detention demands of the function at issue.

Coate’s conclusions on how a facility-based quarantine program should work make the multiple dimensions of this mismatch plain.

Where to from here?

The final report of the inquiry may well prove to be the most sustained critique of contracting-out, from the perspective of public expectations of government action, that Australia has yet seen. This would be a welcome shift from what has prevailed so far, with much more effort dedicated to refining and expanding the practice than to challenging it.

As for where the interim report fits with the “whodunnit” exercise that has dominated so much of the interest in the inquiry’s work so far, Coate makes clear we must wait until the final report to find out more. Whether Victoria ended up with private security at the front line of its hotel quarantine program as a result of a “decision” by one or more individuals, or (as counsel assisting Rachel Ellyard described it) a “creeping assumption that became a reality”, is something that ultimately might never be clear.

Either way, the question of accountability will remain. Providing a clear answer to it stands to be every bit as complicated as it has been so far.

The inquiry, which found the bungled scheme cost the state $195 million, has shown the relationship between contracting-out and political accountability is incoherent. Substantial reform in both directions is needed to make it otherwise. Coate’s final report will hopefully guide that much-needed conversation.

But, again, we can already take a lot from the interim report about where – minimally – we need to be. Any future Victorian quarantine program must be operated “by one cabinet-approved department”, in accordance with a “clear line of command vesting ultimate responsibility in the approved department and Minister”.

That department must in turn be “the sole agency responsible for any necessary contracts”. Among other things, its responsible minister must also ensure senior members of its governance structure “maintain records […] of all decisions reached”.

Such is the vision for the future. But it also highlights why it is so important not to lose sight of the “why” questions when the issue of accountability for what actually happened in Victoria’s disastrous hotel quarantine program is again upon us.

If the front line of the hotel quarantine system was simply too important a responsibility to be outsourced, it is time to get to the bottom of why this was the case, and why it might also be the case for other high-stakes government functions that carry serious consequences for public health or safety.

Providing sensible answers to those questions needs to be the goal. But what matters above all else is that we actually start asking them.




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This piece was co-published with the University of Melbourne’s Pursuit.The Conversation

Kristen Rundle, Professor of Law, University of Melbourne

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

The NSW-Vic border will reopen this month, and ironically the risk is greatest for Victoria


Adrian Esterman, University of South Australia

New South Wales Premier Gladys Berejiklian today announced the border with Victoria will reopen on November 23.

It will be the first time people can freely cross the border since early July.

My preference would be to wait until both states have an extended period of time with zero community transmission of COVID. But I think the risk of a substantial outbreak from opening the border is low.

Victoria has done exceptionally well in squashing its second wave, and has now recorded five consecutive days of zero new cases. Even more pleasingly, the number of mystery cases — those with an unknown source — has dropped to just two in the past fortnight. In saying that, we’ll have to wait another week or so to see the effects of the latest round of eased restrictions.

For the first time in months, it looks as if the COVID situation is worse in NSW than Victoria. Arguably the risk of opening the border is greater for Victoria right now than it is for NSW. Indeed, Berejiklian said today that Victoria “may have, because of the lockdown, actually gone down a path of having eliminated it at this point in time”.

Today NSW recorded nine new cases, six of them among people already in hotel quarantine and three locally acquired. However, those three were already in isolation having previously been identified as close contacts of an existing case.

Elimination is on the cards

I’m concerned NSW is not going for elimination. It leaves the state as an outlier in Australia, with Victoria now joining all other states and territories by having zero community transmission (although Victoria’s official strategy is “aggressive suppression” rather than outright elimination).

I’d like to see NSW tighten restrictions in a few areas, because I think Australia now has a real shot at eliminating COVID. For example, NSW residents are currently allowed up to 20 visitors at a time, despite the Chief Health Officer recommending no more than ten. As homes are one of the greatest risk areas, why not follow this advice?

In saying that, NSW has shown it’s capable of controlling outbreaks with rapid contact tracing. And Victoria has substantially improved its contact-tracing system over the past few months.




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Time for a national approach

Unfortunately, border reopening is likely to make contact tracing more difficult. Many people will cross state borders during summer, particularly over Christmas and New Year.

Contact tracing is currently done on a state-by-state basis, by local teams using their own data sets. It’s not clear whether and how these data will be shared as borders reopen.

For example, if someone is infectious while on a road trip holiday and visits a restaurant in regional Victoria, before driving to towns in NSW and then Queensland, how will contact tracing be organised and shared?

I’d like to see a coordinated national effort to centralise these data. Ideally, there should be a centralised body, such as an independent federal Centre for Disease Control, which could handle national contract tracing, with regional hubs in each state and territory. This would ensure all states and territories would use the same contact-tracing software, using staff trained to the same level.

A national contact tracing database would then enable the tracking of people travelling interstate. Perhaps a QR code system could be implemented on a national level, so visiting a pub in South Australia means it is recorded in a centralised national database.

A federal disease control agency could also ensure consistency of hotel quarantining, and training of security staff.




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Rapid testing could help

In late September, the Therapeutic Goods Administration approved four rapid antigen tests for COVID.

These tests work by detecting proteins on the outside of the virus, called antigens, from nasal swabs. And they can deliver results in 15 minutes or even quicker.

Yes, their accuracy is not quite as good as the standard COVID tests in that they tend to have a higher rate of false negatives. But I think there’s potential for these to be used as interstate travel increases.

For example, interstate travellers could get one of these tests while waiting for their flights in airports, while crossing land borders by car, or when leaving or arriving by sea.




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Australia has done a fantastic job at controlling COVID, and is the envy of much of the world. Ideally, it would be good to have New South Wales take the extra step to eliminate COVID before borders are completely open, though this might be politically hard. Introducing additional measures like rapid antigen tests, and a hub and spokes contact-tracing system, would go a long way to ameliorating the small risks to other jurisdictions from New South Wales retaining its current suppression approach.The Conversation

Adrian Esterman, Professor of Biostatistics and Epidemiology, University of South Australia

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

A dedicated COVID hospital in Victoria would be good for patients and staff. But we can’t be sure yet it will be needed



Shutterstock

Hassan Vally, La Trobe University

On Saturday, The Age reported the Andrews government had been discussing the possibility of a single coronavirus hospital to treat and quarantine Victorians who test positive to COVID.

The designated hospital would aim to relieve pressure on the state’s health-care system and minimise the spread of the virus within hospitals and the wider community.




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The decision on whether to create a single hospital dedicated to COVID cases in Victoria is still some way off. And agreeing on a site and getting it up and running is even further away. But with reports the government is weighing up whether this is the right approach, it’s worth exploring the issues around this decision.

Localising risk

It’s important not to conflate the issue of whether establishing a single dedicated hospital makes sense with the issue of whether all COVID cases should be hospitalised.

These are two completely separate matters.

The question of whether all cases should be hospitalised, regardless of the severity of their infection, speaks to a broader range of issues. This article focuses on whether a single dedicated hospital makes sense for cases with severe illness.

The rationale for a dedicated hospital is primarily about giving better care to COVID patients who need medical intervention, while minimising the risk of disease being spread to other patients as well as health-care workers.




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Putting the practical issues of costs and logistics aside, the theoretical case for establishing such a hospital is based on several considerations.

What’s the case for a designated COVID hospital?

There’s no doubt it can be a real challenge to keep health-care workers healthy during a pandemic. Melbourne has seen well over 3,000 COVID infections among health-care workers since the beginning of the pandemic. More than 70% of them were infected at work.

Cultivating a very specialised workforce, with the most appropriate facilities, who are highly competent in Personal Protective Equipment (PPE), seems like a sensible option to keep health-care workers safe. A designated COVID hospital would also make it easier to design workforce strategies to contain a cluster in staff if it were to occur.

Locating all COVID patients at one site also helps prevent patients at other hospitals from being infected with COVID while in hospital.

Nurse in PPE
We’ve seen confirmed COVID-19 cases in healthcare workers soar over 3000 in Victoria since the beginning of the pandemic.
Shutterstock

It’s not just health-care workers and patients who stand to benefit. Adopting best-practice infection control at a dedicated COVID hospital would also potentially limit opportunities for infections to spread back into the community from health-care settings. If we’ve learned anything over the past few months, it’s how easy it is for infections to move from the community to high-risk settings and back again.

Other issues

While this sounds very promising, a single COVID hospital would also present challenges. Implementing it would be a considerable task — including finding a suitable site and equipping it with appropriate facilities and staff.

It’s hard to know whether the cost-benefit equation would favour the proposal.

The government would need to work to ensure, after focusing many resources on such a facility, it doesn’t become overrun if there is another wave. On the contrary, it also runs the risk of becoming a white elephant if it isn’t used enough to justify the time and money.

The problem, of course, is it’s hard to make predictions about the future course of COVID in Victoria.




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Things to consider

At this stage, according to the Victorian government, a single coronavirus hospital is on the table as just one of many options to help navigate this once-in-a-generation pandemic.

The fact it is being discussed, whether it is deemed appropriate or not, is a good thing. Victoria needs to be exploring all available options. We should hope for the best while planning for the worst.

As with most things, the detail of the proposal will be key to determining whether this is the right path to take. How patients and health-care staff are managed will need to be considered carefully.

We also know many COVID patients with severe disease will have a range of other illnesses too. For this reason, it will be important any dedicated coronavirus hospital has the expertise to manage patients’ full range of needs.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.