9
Jul
2020

Epidemiologist putting up hand in protective gear for coronavirus

Why Australia should switch course and try to eliminate COVID-19

by Stephen Duckett and Will Mackey


Published in The Sydney Morning Herald, 9 July 2020

The explosion of new community transmissions in Victoria is a harsh reminder of the power and speed of COVID-19.

The lockdown of Melbourne is the right response, and lays bare the uncertainty that comes with the nation’s suppression strategy, which involves lifting restrictions while there are still active infections in the community. National cabinet should abandon the suppression strategy and instead explicitly aim for elimination.

The nature of the virus has not changed. Given the chance, it will spread rapidly around Australia, as it has around the world. If our behaviour returns to pre-COVID normal while there are active cases in the community, outbreaks are inevitable.

Victoria now has more community transmission than at any point in the crisis. In the initial peak, in late March, there were 46 daily local cases identified. In the past fortnight, Victoria has had more than 60 local cases every single day. It only took a month for new local daily COVID-19 cases in Victoria to go from about one to more than 100.

An enormous team of public health officials is working around the clock to test tens-of-thousands of Victorians each day, and to trace the contacts of the thousands of people in self-isolation. But Victoria’s Chief Health Officer says they are at their limit.

To control the spread, locking down was the only option for the Victorian government. And this shouldn’t come as a surprise. Lockdowns – and the drastic disruption of daily life that come with them – are the main tools in the suppressionist’s toolbox. Pursuing a suppression strategy means there will continue to be outbreaks. There will continue to be lockdowns. There will continue to be uncertainty until a vaccine or cure is found – which may be years away, if ever.

Businesses in Melbourne – which opened their doors just a month ago – will now need to shut back down. They might be able to open back up in six weeks if the city’s case numbers start to fall. But as restrictions loosen and our behaviour reverts, further lockdowns are all but inevitable. This uncertainty harms business and investor confidence. It means more businesses will have to close their doors. And it means more unemployment. The uncertainty that comes with a suppression strategy adds a substantial layer of complexity and risk to our economic recovery.

State borders must remain closed, even under a suppression strategy. Places that have eliminated the virus would be foolhardy not to be cautious of travellers from areas with outbreaks. There will be continued disruption for border towns, and for the hundreds of thousands of people who live in a locked-down area but work elsewhere.

Domestic tourism will continue to be hurt, as travel plans for next week or next month are thrown into chaos by the implementation and reversal of lockdowns. School attendance and childcare will continue to be uncertain as the rules respond – as they must – to unmanageable outbreaks.

For areas that have not eliminated the virus, the yo-yoing between partial freedom and hard lockdown is life under a suppression strategy. It will be so for months or years – until or unless a vaccine is developed or a cure is found.

The Melbourne lockdown is an opportunity for the Victorian government and the national cabinet to reassess their explicit strategy. They should adopt an elimination strategy: setting out to eliminate the virus from Australia and restore domestic economic and social activity to almost-normal, while controlling our borders until there is a vaccine or a cure.

Pursuing an elimination strategy will require leadership. It will require lockdowns to be extended, so that they continue even when local transmission is nearly gone. It means the Melbourne lockdowns should continue until active cases in the community reach zero and remain there for two weeks. Where there are active cases, the government should encourage people to wear masks in public spaces.

An elimination strategy is not without risk. The long and variable infectious period during which a person can transmit the virus means that local cases can emerge days and weeks after an area is determined COVID-free. As the virus picks up speed around the world, quarantining of arrivals will remain a challenge. Victoria is failing that challenge at the moment, and must prove it can safely manage quarantining international arrivals before allowing more people to arrive into Melbourne.

But the return on an elimination strategy is enormous. As Victoria heads back into lockdown, Western Australia – which hasn’t had a locally transmitted case since April – will remove all internal restrictions from next week. Movement within that state will be free. As long as testing remains routine and border restrictions remain firm, life will more or less return to normal.

New Zealand has pursued an elimination strategy to “keep it out, find it, and stamp it out”. That worked. The last locally transmitted case in New Zealand was in May. International arrivals have been safely quarantined. Life across the ditch is the envy of the world.

Australia’s national cabinet should explicitly pursue an elimination strategy similar to that of New Zealand. The current suppression strategy carries the certainty of repeated outbreaks and lockdowns, shattering business confidence, confusing the public, and prolonging the COVID-19 ordeal. It will cost the economy more than an elimination strategy. If we reassess and refocus, the benefits of elimination are within our reach. If not, we must all prepare to live with uncertainty