Australia is at a coronavirus crossroads: ‘Go early, go hard’ is the best approach
On July 15, there were 238 new cases of COVID-19 recorded in Victoria of which only a small proportion could be traced to existing cases.
Until the Melbourne lockdown, cases in Victoria had been doubling every seven days and almost all are a result of community transmission.
Lockdown of greater Melbourne, and soon the entire state, will suppress the virus but the multibillion-dollar question is, what to do next?
As we wrote on March 30, we have consistently argued for a ‘go early, go hard’ approach; to impose a national lockdown to first suppress and then to eliminate community transmission.
Based on our modelling, we showed that elimination (NO COVID) generated the best outcome for both public health and the economy.
This is because elimination allows Australia to get close as is possible to the pre-COVID way of life, as our Kiwi cousins are currently enjoying.
Elimination greatly reduces the risk of a very expensive lockdown-relaxation-lockdown ‘yo-yo’ that Melbourne is now experiencing.
What we need to do, and should have done, is aim for elimination of community transmission and also build the best possible testing, tracing and supervised quarantine system.
So far, at a national level, we have failed to do either.
Fast forward to mid-July and we see that a country that did eliminate the virus, New Zealand, with a nine-week ‘full-on’ lockdown, has done at least as well in terms of its decline in GDP as has Sweden, which never had a lockdown.
But in terms of public health outcomes, NZ is light years ahead.
NZ has about half the population of Sweden yet had only 22 COVID deaths, while Sweden has had more than 5500 deaths (more than 100 times higher death rate than NZ), with more deaths to come.
Elimination was one of two options provided to the national cabinet at the end of April by researchers from the Group of Eight universities.
The national cabinet chose not to go for elimination and, instead, opted for suppression (but not elimination) of the virus and to live with low rates of infection in the community.
This decision was taken so as to minimise the economic damage associated with an extended lockdown.
But the paradox of lockdown is that early relaxation when there is still community transmission is high risk.
It ends up costing the economy much more compared to elimination because the infection will bounce back as social distancing is relaxed, as we are seeing in Victoria and in other places in the world.
The success of the LOW COVID and a sustainable NO COVID strategy is contingent on a ‘platinum plus’ system of testing, contact tracing and quarantine of possible and confirmed cases.
Despite testing hundreds of thousands of Victorians, the system has not been good enough and there has been hidden transmission in Melbourne for weeks.
Some people have refused to get tested because, if they are in casual employment, they will lose income when they self-isolate and await their test result.
The incentive, therefore, is to go to work even if sick.
This incentive even applies to some of our casualised healthcare workers, and not just in Victoria.
How crazy is that in the middle of a pandemic?
Several Australian jurisdictions, not just Victoria, have also failed to test all arrivals in quarantine hotels.
As we now know (and should have known) there is a very real danger the virus could be seeded from quarantine to generate a renewed outbreak elsewhere.
This is especially true in Australia because almost all quarantine arrivals are located in our largest cities where a COVID-positive ‘escapee’ could infect many people in a short period of time.
States that sensibly imposed interstate border controls over the past few months have been vindicated despite legal action taken by Clive Palmer (supported by the federal government) in the High Court against these closures.
Several (WA, SA, NT and Tasmania) appear to have eliminated community transmission.
Australia is at a coronavirus crossroads – eliminate or suppress. Photo: TND
The alternative to state border controls is what we are currently seeing in the US, a half-hearted attempt at a LOW COVID outcome (in most states) with virus transmission from state to state, and back again.
The solution to the ‘what next’ question is easy to answer but much harder to implement effectively.
First, Victoria needs to ‘go early, go hard’ and rapidly impose lockdown at the state level with the goal of elimination.
NSW must also act immediately by successively reimposing social distancing restrictions before the infection becomes unmanageable in that state.
Second, Australia (and Victoria is the priority place for deployment) needs a ‘go early, go hard’ strategy in terms of testing, contact tracing and much better supervised quarantine.
Australia needs (but does not have) the world’s best possible testing, tracing and quarantine system.
It should not take hours of queuing to get tested, as is happening in some places in NSW, and everyone should get their results within 48 hours (some people are waiting four days or more to get their test results).
Quarantine should, as much as is possible, be away from large population centres, testing should be mandatory on arrival and before exit, and the facilities should be managed by properly trained and resourced police and/or defence personnel supported by healthcare professionals.
Quarantine is not a ‘tick box’ exercise but is a critical first line of defence against transmission to a vulnerable Australian population.
Third, we need to employ relatively low cost but effective measures that reduce transmission.
These include the 1.5-metre social distancing rule, proper hand washing, and the wearing of masks in public spaces.
These measures need to be maintained so long as there is any community transmission within a state or territory.
There are no guarantees in this pandemic, but our modelling and the experience from pandemics elsewhere, including COVID, suggests that a ‘go early, go hard’ strategy for social distancing, quarantine, testing and contact tracing is the best.
This is what Australia should do going forward. There are no winners in the COVID game, but we can minimise the loss of life and the impact on the economy if we act smart and go early, go hard.
Quentin Grafton is professor of economics and Australian Laureate Fellow at the Crawford School of Public Policy, the Australian National University.
Tom Kompas is professor of environmental economics and biosecurity in the School of Biosciences and the School of Ecosystem and Forest Sciences at the University of Melbourne and one of three Chief Investigators in the Centre of Excellence for Biosecurity Risk Analysis (CEBRA).
Dr John Parslow is a mathematician and modeller. He has more than 40 years of national and international experience in applied environmental modelling and natural resource management.
