Why do the states have such mismatched approaches to beating the virus down?

Compared to the rest of the world, Australia’s COVID-19 restrictions seem draconian. A single case of the highly contagious strain which infected a cleaner at a quarantine hotel caused Brisbane to go into a sharp three-day lockdown (which will be lifted this evening).

Yesterday, NSW Premier Gladys Berejiklian took a swipe at Victoria’s harsh border restrictions, urging states to talk to one another before making rash decisions affecting hundreds of thousands of people.

The rules are so strict because — without ever actually saying so — most states and territories seem to be pushing to eliminate COVID-19, rather than just suppressing it. Yet the state not pursuing elimination is also Australia’s most populous.

Prime Minister Scott Morrison has called NSW the “gold standard” for outbreak response. The state recorded three new local COVID-19 cases this morning, all linked to the Berala cluster.

Where did elimination come from?

Officially, Australia is pursuing an aggressive suppression strategy with the goal of no community transmission, as agreed to in a July 2020 National Cabinet meeting. Deputy chief medical officer Nick Coatsworth said at the time pursuing elimination would present “false hope”. 

But University of South Australia biostatician Adrian Esterman told Crikey Australia’s aggressive suppression approach is just elimination by another name.

“Elimination doesn’t mean the virus won’t come back, it means aiming for an extended period of time, such as 28 days, with no cases,” he said.

States and territories have interpreted this differently. WA Premier Mark McGowan has openly gone against a suppression strategy, saying last week he supported elimination.

Victoria opted for a hard lockdown during its second wave, only easing restrictions once the state recorded 14 consecutive days of zero cases.

NSW on the other hand has taken a localised approach, with Berejiklian reiterating this morning there is no way to eliminate the virus without stopping all overseas travel.

When the Avalon cluster hit, NSW shut down part of the Northern Beaches rather than the entire greater Sydney region. NSW only closed its border to Victoria in July when the state was recording 120 cases a day.

Unity could limit confusion

The differences in approach have caused regions to react faster than they might have if everyone was on the same page, Esterman said.

“You could argue if everyone took the same approach as NSW things would be fine with clusters coming every few weeks,” he said.

But NSW has a track record of fast contact tracing, while other states do not. Victoria has once again struggled. There was confusion following the latest outbreak, with venues not notified of positive cases.

Esterman said that, in light of the new virus variant, NSW might want to consider changing its approach.

“[It’s] the big joker in the pack,” he said. “As we’ve seen in the UK, hotspot and cluster suppression does not work with this strain … it’s just too contagious.”

States need to have faith in the system

Sydney University infectious diseases expert Adam Kamradt-Scott told Crikey that while he wasn’t sure if these states were pursuing elimination, he didn’t think their approach was the right one.

“What we’ve seen in recent months has been a tendency for premiers and chief ministers to have a knee-jerk response to announcements of new clusters. This speaks to a fundamental distrust in other jurisdictions’ public health capacities,” he said.

Kamradt-Scott added that while this approach may have been appropriate during the start of the pandemic, better control and contact tracing systems had since been implemented.

“We need to see a more nuanced approach where state border closures are used as a last resort when there’s evidence of widespread community transmission.”

He added that Australians need to keep adhering to social distancing and health guidelines for this approach to work, especially in the face of the new mutant variant.

“All it takes is a momentary lapse [at the borders]. We need the public to recognise we’re in a pandemic and behave accordingly with social distancing, face masks and handwashing.”