, This was published 6 months ago
OpinionThe best approach for Australia to move forward in dealing with the coronavirus pandemic remains controversial. Follow Sweden and what some describe as a “let it rip” approach except for those most at most risk? Or the New Zealand approach – a prolonged and quite stringent lock-down?
What will save the most lives but with the least collateral damage to people’s livelihoods, mental stress, and social cohesion? What will let our health system still cope?
Bondi Beach is closed due to the coronavirus lockdown. Credit:Rhett Wyman
We lack a lot of data to adequately answer many of these questions. Particularly missing is how many people with infections have not been diagnosed because they were so mild. Have we missed 10 per cent or 90 per cent of cases? Once we get population-based serology (antibody) studies, we can then answer many more important questions. Surprisingly, China has not released this data yet, but hopefully it will come from Germany soon.
The problem with the Swedish approach is it continues to allow intermingling crowds in restaurants, bars and elsewhere. Despite having a much smaller population than Australia, its total numbers of deaths are more than 1,200 compared with 63 here. When compared as rates per million, the numbers look even worse – for Sweden 118 deaths per million v 2.3 per million here. So I do not think the Swedish model is the way forward for Australia.
What about the NZ model? It, like New York and London, has adopted the complete lockdown approach. For NY, this is appropriate because it has widespread and uncontrolled community transmission. So much so, that NY can’t even measure cases accurately – just deaths. That is not the case in Australia – and is not likely to be. We have extensive testing (which will increase) and no evidence of much spread in our community, yet alone widespread and uncontrolled spread.
With the NZ model, if you look at its epidemic curve, it does not appear to be doing any better than Australia. It currently has about 10 to 20 new cases a day. In comparison Australia has about 20 to 50 new cases a day. While we both have thankfully reversed our epidemic curves, NZ has still higher per capita daily infection rates than Australia. So, I can’t see how its lockdown has been more effective than what we have done in Australia – with our comparatively less stringent restrictions.
This virus is unfortunately a problem we will have for at least six months and more likely for another 18 months to two years (when, hopefully, we have safe and effective vaccines).
In Australia we have a sustained fall in the number of new cases each day. Our peak in new cases was around March 25, then numbers started falling and have continued to do so. This is much better than just flattening an epidemic curve – it’s turning it around.
Some states have recently put in overzealous rules (almost lockdowns), they give very mixed messages and do not have biological plausibility (not being allowed outside to sit in a park, for example). Not only will this cause unwarranted and increased social, mental and economic harm, we run the bigger risk that substantial parts of our society in a few months’ time (our winter) might increasingly rebel against many restrictions.
So, what is best way forward? The measures we agreed nationally and have put in place since mid to late March are appropriate, with some modifications over time. The Prime Minister and our Chief Health Officer in their latest announcements are looking at these measures and at how these might be somewhat relaxed. But most restrictions will likely need to be continued at least till the end of winter.
While Australia is among the best in the world so far in its approach to this pandemic, winter will be our next major test. This virus will invariably still be around and spread for months or even years to come. So, we will continue to have small numbers of cases that will persist and reappear as isolated cases and clusters.
However, we are now in a better position to control these and stop further spread without further NZ-style restrictions. We have very efficient public health investigative teams. By any international comparisons we already do a lot of testing. Our testing capabilities are increasing and may soon include testing for the virus in sewage. We have locked our international borders, quarantined returned travellers and anybody else who is a close contact of a known case, kept people with infections isolated until we believe they are no longer infectious. In addition, we have stopped large gatherings of people – particularly indoors where infection is much more likely to spread. We have closed bars, clubs, churches, and restaurants.
Social distancing has been taken up very vigorously by nearly all of us from what I can see in the streets, supermarkets, parks and in the workplace. All those interventions when combined, appear to have had a major effect and we are seeing the evidence of this in the fall in numbers of new cases and they will mostly need to be maintained until the end of winter.
We need to find a balanced way forward, somewhere that’s between the two extremes of NZ and Sweden. The approach we put in place nationally in mid to late March with some modifications will take us there.
Peter Collignon is a professor of infectious diseases at the ANU Medical School.
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, http://www.smh.com.au/national/neither-sweden-nor-nz-australia-must-steer-its-own-covid19-course-20200419-p54ku0.html, The Sydney Morning Herald