Something close to normal life won’t return in Victoria until at least October 26, with curfews lifted, home visitors allowed, and restaurants and cafes open — though this is contingent on case numbers dropping to less than five a day on average.
New infections continue to fall: this morning, Victoria recorded a 10-week low of 41 new cases.
But experts are divided over whether such harsh restrictions are the right way forward, whether elimination is feasible, and if lockdowns are the way to do it.
Is Victoria’s strategy essentially elimination?
Victoria is calling its strategy “aggressive suppression”. But under Victorian Premier Daniel Andrews’ plan, Victorians won’t get to enjoy “COVID-normal” until there are no new cases for 28 days straight.
That looks a hell of a lot like an elimination, rather than suppression, Australian National University professor and infectious diseases physician Peter Collignon told Crikey.
“The final stage is basically no community transmission for 28 days,” Collignon said. “I think that’s very difficult to achieve, and I don’t think that’s sustainable.”
Deakin University epidemiology chair Catherine Bennett said the goal of complete elimination was farcical — especially with daily flights arriving into Australia.
“We won’t pick up every COVID-19 case,” she said. “There’s always the risk you have asymptomatic cases, and cases arriving from abroad.”
Waste water testing, for instance, has found COVID-19 in Victoria’s Apollo Bay, where there have been no recorded cases.
“But we can shut down local transmission … especially if we sort out aged care and health care transmission,” Bennett said.
Does science support the restrictions?
World Health Organization expert Dr Maria Van Kerkhove has said blanket lockdowns are no longer the preferred response to COVID-19 outbreaks — calling them a “blunt, sheer force instrument”.
Instead, she said, countries needed to adopt a “tailored, specific, localised” approach.
In the same vein, Bennett said Victoria’s broad rules ignored epidemiological data.
“I’m surprised we’re staying with a strong blanket approach to lockdown. The approach could be more specific,” she said.
“We have rich data we could base restrictions off on where transmission happens most.”
Outbreaks have most commonly be reported in residential aged care settings, workplaces, educational facilities and healthcare facilities.
Victoria uses the number of new daily COVID-19 cases, averaged across 14 days, as the key to lifting restrictions. This approach has also been used in Denmark.
Other Australian states did not make their lifting of restrictions contingent on specific case numbers.
New Zealand used the likelihood of community transmission to determine restrictions.
Bennett stressed that flexibility was key to enforcing Andrews’ plan.
“According to the road map, if regional Victoria still has four cases on average, metropolitan Melbourne has no room to move … We need a nuanced approach to enforcing the steps. There’s still a bit of work to do.”
But University of South Australia biostatistics chair Adrian Esterman told Crikey that Victoria’s data painted another picture.
“If anything, Victoria should have gone harder. In hindsight, they should have gone into stage four lockdown when they went into stage three,” he said.
“Lockdowns have worked, and we’ve seen it work … I think Victoria is doing the right thing. Cases have dropped substantially.”
In contrast, Grattan Institute’s health policy expert Stephen Duckett said restrictions should be less specific — not more.
“The good news is the road map aims for zero,” he said, though added it was more complex than necessary, with some criteria based on politics over science. Curfews, for example, have a weak evidence base.
“Simpler is better for criteria,” he said. “In the meantime, we need to ramp up testing.”
But Victoria’s success also relies on good, quick contact tracing. That’s an area where Collignon says Victoria’s record has been “really poor from the start” compared to the rest of the country, the result of a highly-centralised and under-funded public health structure. Even now, Victoria has cases from weeks ago without a known source of transmission.
NSW, overseas tell a different story
Still, Victoria’s plan seems more draconian than any other state in the country. Under the plan, NSW, which has so far managed a low but steady number of new infections, would still be locked down.
“NSW is in a different situation, they don’t have the levels of community transmission that Victoria’s got, they haven’t have the kind of numbers we’ve had to move through,” Victorian chief health officer Brett Sutton told ABC News Breakfast this morning.
“Wherever there are grumbling cases that just continue along, there’s always a risk of it taking off again, is it did in South Korea, in Singapore.”
But Collignon said the NSW approach, to accept and manage low-level community transmission until an effective vaccine is widely available, was more sensible and realistic.
“I reckon a good strategy is to have suppression down to really low levels,” Collignon said. “And by doing that, you’ll get elimination in some areas.”
New Zealand appeared to lead the way in COVID-19 elimination — for more than 100 blissful days, the country recorded no locally-acquired cases of COVID-19.
That all changed on August 11, when a new case emerged in Auckland and quickly spread to a cluster, forcing the city back into lockdown.
Taiwan and Fiji both successfully pursued an elimination strategy, though have had limited numbers of imported cases.
Collignon said the outbreaks in New Zealand and Victoria — jurisdictions which both favoured an elimination approach early on — added to the growing body of international evidence that managed suppression was a more sustainable approach than hard lockdowns.
“Hard lockdowns haven’t correlated with medium- to long-term success,” he said. “Look at Japan, look at Korea. Meanwhile, New Zealand and Victoria had the hardest lockdowns and not necessarily the greatest success.”
South Korea, cited by Andrews and Sutton as a cautionary tale about opening up too early, did not go into lockdown when cases started rising again in late August. Instead, churches, outdoors rallies, nightclubs and bars were closed. Since August 27, daily case numbers have continued to fall.
The hard lockdown is working. I wish everyone complaining would just bugger off and let the government finish it off ASAP. Business will recover quicker and more permantely.
Rubbish. The hard lockdown was a facile solution to a problem requiring an intelligent reaponse. This government was spooked into it because if their massive failures with quarantine. Quite simply they freaked when it dawned on them that they had committed a major, fatal error of government.
Victorians died because of their errors. Victorians are suffering now with their second wave of government errors.
Facile. So what was your solution shonkseer? Please, enlighten us.
Would require too many words DB, and you would nit pick at all of them until you felt you’d “won”. We Need to move beyond that non thinking, point scoring, approach.
Keeping it to a a few truths,
1. We will always have this virus in our community, even if we are lucky enough to discover a vaccine. Even then, anti vaxxers, other lunatics, people won’t take it for a variety of reasons.
2. A vaccine is by no means guaranteed. Don’t mention mutations.
3. Lock downs are not sustainable, they are only perceived to be sustainable by those who are not living in one.
4. Somewhere between “let it rip” and lockdown there’s a best case solution. We need to find it. I don’t have it, you don’t have it, but if we can’t find it nationally, with all our pooled resources, then without a vaccine, we’ll be living in a place that sacrifices it’s young.
Start from there.
Of course you’re right, Iupreza, , but the alternative has no double blind experiment to prove the doubters/Birthers/anti-vaxers wrong, so it will always be challenged by those of lesser minds, as it is here on the comments page.
What if “ASAP” is 2 years away? And then we relax restrictions, and wham, third wave?
Or what if it’s a month away, and wham, third wave?
What is your response, lock down again and again?
We need processes that counter reoccurring potential future waves of virus.
PS the Victorian labor government is betting the farm that this lockdown will work, and we’ll be back in normality. Given the obvious math of virus contraction, without a vaccine, what do you think is the most likely outcome?
I agree, lupeza, but whole swaths of NSW, Central Coast, New England, Northern Rivers have not had cases for months now and are still not able to visit family or do business across the QLD border. Surely there’s a case for expanding the lock-out regions or even better locking down the hot spot areas.
In the beginning…..Scotty let the virtue in by not shutting borders and letting people in from the US, then a cruise ship in nsw-they were not allowed to dock in WA for instance. The rest is history, aided by a lot of stupid people who can’t seem to do the right thing.
…err, umm “Scotty let the
virtuein by not shutting borders…” – VIRUS?Although given that what he may consider a virtue most would consider an insidious mind worm, who knows?
Kinda sumps it it BJ. If we could remove the electoral component from the decisions (PMs & Premiers) the policy would be more effective and a lot less sensational.
This is sadly, so true. Take most of the media away and you’re on the path to a better place .
So, not that I disagree with you, what do we do next? People will remain stupid, we can’t have permanent lockdown. We’d devolve into something quite unacceptable. This is where the need for smarter management exists.
Peter Collignon has some valid points but to describe The NZ outcome as not necessarily being a success is failing giving credit where it’s due. Despite two additional deaths, the outbreak from an unknown source is being successfully contained. The NZ overall death rate is remarkably low and even with the disappointing failings in Victoria, Australia is still tracking very well compared with similar countries.
Yes. WA has had no community transmission since April and when I mentioned how popular our closed border was to my daughter in law I was startled at how emphatically she supported it, reminding me of the stressful weeks of our lockdown and how “normal” things are here at the moment.
I’m sure there’s a way put forward that can balance he economy and restrictions on people without sacrificing too much liberty, but I have zero confidence that such a system won’t be denounced as arbitrary by portions of the media and ignored by enough people that its efficacy would suffer.
The luxury we have that those in power don’t is our speculations about what might possibly work won’t be put to the test by what actually happens, whereas the people making the decisions have to contend with that.
Let’s not forget that Victoria’s second wave was triggered, purportedly, by just FOUR infections. Within about two months, that had blown out to 746 new cases a day. Leaving the blame game aside for the moment, that is an indication of just how infectious this virus is. It should also make clear why Andrews is right to be worried about a possible third wave.
Hopefully, a third wave won’t happen. If it does, hopefully some of the vulnerable areas like aged care will be a lot better prepared next time around and we will see neither the spread nor the deaths.
Whether a target of five a day is too low or too high depends on which side you’re coming at it from. If your major aim is to open up as soon as possible and you’re looking at how long it will take to get from where we are today to there, then you’d probably say it’s too low. If your primary aim is to prevent a third wave, then I think it may be a bit too high: every day we may be generating more new cases than those that started Wave 2.
Andrews has said his first aim is to prevent Wave 3 (or thereafter). His actions are consistent with that aim.