News National I’m a doctor on Melbourne’s coronavirus front line. Suppression has failed
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I’m a doctor on Melbourne’s coronavirus front line. Suppression has failed

melbourne covid nurses
Nurses and aged-care workers feature prominently among Victoria's new COVID infections. Photo: Getty
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There has been considerable media debate around suppression vs elimination with commentary from epidemiologists and business leaders.

However, we have not heard enough about the impact pursuing a suppression strategy has on nurses and doctors on the front line.

As a frontline doctor in Victoria’s fight against the virus, my view is that the rate of health-care worker infection is unsustainable.

In fact, I am writing this from hotel quarantine after exposure to a presymptomatic colleague who caught COVID-19, most likely via community transmission.

Each day across Melbourne, more of my colleagues are exposed, quarantined or infected.

Our voices should also be heard in this debate.

A man with a stethoscope around his neck smiles
Dr Aaron Bloch is in hotel quarantine after a colleague contracted coronavirus. Photo: Aaron Bloch/Supplied.
If suppression has failed in Victoria, one of the most cautious states, it can fail anywhere.

From my own perspective — widely shared by my colleagues — suppression cannot win.

Coexisting with COVID-19 means lives lost, repeated lockdown and gripping uncertainty, which will take a giant toll on our collective mental health and undermine the confidence necessary for economic recovery.

Suppression has failed because it underestimates this virus, it overestimates our ability to control it, and it fundamentally misunderstands human nature.

We are all human — we slip up

Each time this pandemic slips out of control, our leaders chastise ordinary Australians for doing the wrong thing.

Undoubtedly some do.

But on the whole, Australians have done a great job. We tolerated lockdowns with positive attitudes. We embraced social distancing. We stayed home and saved lives.

But we are human.

At the core of our humanity is the desire for touch and intimacy. Who hasn’t hugged someone in the past three months? Who hasn’t slipped at least once in their social distancing as the threat appeared to recede? Try as we might, natural instincts will break through.

Once is all it takes.

Suppression relies on sophisticated, human and technology-based surveillance systems to rapidly detect outbreaks, isolate cases and their contacts, and break chains of transmission. But it is not succeeding.

Our technological solution, the COVIDsafe app, needs urgent reworking.

Our public health colleagues — heroes who have been working around the clock for months — are now once again under enormous pressure. Victoria’s only option seemed to be lockdown.

If we continue to attempt suppression, this will more than likely happen again.

A group of women wearing blue PPE gear and wearing masks stand in the street.
Would you dine in a cafe or send your child to school knowing that a grassfire was “under observation” nearby? Photo: Patrick Rocca/ABC News

Each day, more doctors and nurses get sick

Healthcare workers are our last line of defence.

And we are in the battle of our lives. But as we try to care for you, our suppression strategy means COVID-19 has infiltrated our workforce.

Despite our best attempts, it is near-impossible to socially distance in a hospital.

Each day, more doctors and nurses are diagnosed with COVID-19. Many of their work contacts are quarantined, leaving an even greater challenge for remaining exhausted staff.

This time around, our stocks of PPE, medicine and ventilators are bolstered, but our physical and emotional resilience is depleted.

We escaped the initial feared tsunami, but do not underestimate the ongoing physical and emotional toll. Many of us have not had a good night’s sleep in a long time.

With one flame, it spreads quickly

Transmission is devilishly difficult to control. People are most infectious before they show symptoms, and may transmit the virus even if asymptomatic.

By the time a person tests positive and overworked contact tracers have identified and isolated their contacts, they may have already infected several people, who in turn may have infected others.

Daniel Andrews rightly describes this as a bushfire. It starts with one flame, and spreads just as quickly.

On June 9, Victoria recorded no new cases.

Just one month later, with raging community transmission and almost 300 cases a day, the whole of metropolitan Melbourne is back under Stage 3 restrictions.

Ultimately we have been let down by a flawed strategy. Would you dine in a cafe or send your child to school knowing that a grassfire was “under observation” nearby? Nor should we do the same with COVID-19.

We need to reassess our strategy

We face a tough few months ahead in Victoria.

We will get through it together. But we cannot do this again and again, and that’s what a suppression strategy demands of us.

Businesses will open and close, people will regain and lose their jobs. And each time we visit our elderly or vulnerable loved ones we will think: Can I justify the risk, could I infect them?

Now is the time to reassess our strategy. To ask, do we open prematurely and risk this happening again? Or do we grit our teeth and lock down until we have eliminated the virus?

For nations where COVID-19 has killed thousands, elimination is no longer an option. But, as evidenced in New Zealand and other parts of Australia, we still have that chance.

Advocates of suppression present us with a false dichotomy between suppression and elimination. Elimination doesn’t mean we can go back to our pre-COVID lives. We must still maintain all of the same safeguards of a suppression strategy.

But, if we aim to eliminate the virus first, we can save lives, we can save jobs and we can all sleep easier at night.

Aaron Bloch is an infectious diseases and general medicine doctor at a Melbourne metropolitan hospital.