Australian news, and some related international items

As coronavirus cases plummet, it’s time to ask: Is Australia ready for the third wave?

“They are so beaten up by the lockdowns and by the fear messages that they are saying “I don’t want to do anything”.”

Yet notwithstanding the testing, the tracing, the social distancing, masking, mathematical modelling, quarantining and investment in public health, Australians will continue to live with COVID-19 for the foreseeable future.

As coronavirus cases plummet, it’s time to ask: Is Australia ready for the third wave? By Catherine Taylor

An uncomfortable question looms over Australia’s steady exit from its second major outbreak of coronavirus: are we ready for the third wave?

Health experts say it’s a question with an equally uncomfortable answer: a third wave remains a real threat and without a tested vaccine all we have is our self-control, and luck, standing between us and a fresh outbreak.

“We should not expect that we can beat this wave, and then it’s done. It’s the beginning of the next phase,” says Professor Jodie McVernon, an expert in epidemiology, vaccinology and public health at the Doherty Institute, who has been working in isolation for months “like a princess in a castle” from the front room of her Melbourne home.

Professor Raina MacIntyre — head of the Kirby Institute’s biosecurity program — goes further: “The only really feasible exit strategy at this stage is vaccination otherwise we’ll continue to face the risk of third, fourth, fifth and sixth waves.

There is a recipe for reducing risk

What would it take to kick off a third wave in Australia? It could happen at any moment, or not at all.

“We’re going to keep seeing incursions and outbreaks. Some of those may take off to bigger waves,” says McVernon. “Any guarantee of certainty is a lie.”

And in an unsettling Catch-22, success in supressing the virus could create a context that leaves Australia vulnerable to its resurgence.

“It’s very hard maintaining that sense of alarm when there’s nothing active around you to be to feel alarmed about,” McVernon believes.

Months of studying, tracking and treating SARS-CoV-2, and lessons from Europe and Melbourne, have led experts to identify a recipe for risk. It looks something like this:

Contact tracing that works

Effective contact tracing has been the success story of NSW’s active suppression strategy. Capacity to follow up 20 or 25 contacts per new infection within 24 hours is the “gold standard” but achieving it needs trained public health workers and plenty of resources.

It’s been widely noted that compared with Victoria’s public health system, which has been criticised by some, including MacIntyre, for “being run down over many years”, NSW has a better structured and resourced public health system which was able to swing effectively onto this task.

But Victoria is exiting its second wave with vastly boosted capacity.

Professor Catherine Bennett, Chair in Epidemiology at Deakin University, says the system is capable of following up 100 per cent of contacts within 24 hours “and that probably includes the contacts of contacts”.

“We’ve got a much more front foot local team who can get to the site of a case or a cluster very quickly. That’s going to make the difference between having a case, and having a wave.”

Avoiding the wildcard superspreader

One of the most unpredictable triggers for a third wave could be a superspreader — the rare individual who has a large dose of virus and quickly transmits it widely. Melbourne’s second wave kicked off when leaky quarantine protocols met a superspreader.

To give an idea of the power of a superspreader to alter the trajectory of a new COVID infection, Stephen Duckett — a health economist and Health Program Director at the Grattan Institute — explains that similar quarantine breaches in NSW that didn’t involve a superspreader meant COVID-19 remained under control.

“They got away with it,” he says, of the state’s breach.

The emergence of a superspreader is where trust in government, COVID-safe behaviours and rapid testing and tracing will make the difference between an event that is contained and one that spirals out of control.

“All of it is all playing together,” says McVernon. “The public health response will only work if there’s community cooperation.”

Managing borders and bubbles carefully

Melbourne’s second wave delivered harsh lessons about the role of borders and importance of isolating international arrivals.

Duckett believes state border controls will continue to be important for managing future spread: “South Australia has a travel bubble with [several states and territories] but if I were SA I would not have a bubble with either NSW or Victoria at the moment. The states which have eliminated [the virus] have to be cautious about opening up to states which have not.”

Yet McVernon points out “we can’t stay locked off forever”.

“As we take these baby steps out into the wider world we are going to have to assess and manage and reassess and improve our management of the risks along the way,” she says. “None of these things has a rulebook because they weren’t standard public health interventions.”

The indoor-outdoor connection

The risk of spread indoors is another area that needs a close eye.

“More ventilated places have less transmission than less well-ventilated places,” says Duckett. “The evidence is clear, being outdoors works.”

And the link to winter temperatures that drive people indoors is also clear. Colder weather is likely to bring a fresh transmission risk.

Trusting the rules and the public health message

Australians like to think of ourselves as laid-back larrikins, prepared to bend a rule or two, but when it comes to public health orders we are “generally pretty obedient”, says MacIntyre.

She believes trust in government — and a community’s willingness to obey public health orders such as mask-wearing, isolation or social distancing — is a key to reducing the risk of COVID spread.

She notes how segments of the US population have carried out armed protests against wearing masks, for example. “It’s chaotic in the US. Australia has always had a very civic-minded culture where people generally do the right thing.”

When compared with the UK, Australia also emerges favourably, MacIntyre believes. “A range of historical events in the healthcare sector … have eroded trust in government in the UK.”

Yet compared with many non-Western countries — Vietnam is a stand-out — where use of digital technology has offered better epidemic control — Australia is doing less well, she believes.

“The surprise has been that the countries that have the technology and the resources to enact good disease control, such as the US and UK, have just fallen apart,” she says. “We’ve always expected that in a pandemic the problems will be in low income countries, but in many Asian countries we’ve seen much better epidemic control, often using digital technology.”

Balance expectations to keep the social licence

But what happens if trust in government fails? Or if willingness to comply with restrictions wanes and “the social licence to pursue that strategy collapses”, asks Duckett.

“We’ve been in this for a long time and people are getting weary. There’s increasing talk in the media and from epidemiologists that maybe we shouldn’t be pursuing a target of zero,” says Duckett, who is an advocate of aiming for zero community transmissions.

McVernon notes that with case numbers in Victoria now lower on average than NSW many Melbourne residents are questioning the restrictions on their movements, even as they begin to loosen.

“All the cases we’ve had this week have been known so it doesn’t make sense that we’re held here, missing family connections,” she says.

Experts say that to reduce risk of a third wave, COVID-safe strategies will need to balance expectations of compliance with government laws or regulations against willingness to do so or the system will be threatened.

Changing our behaviour — and that means wearing a mask

Government enforced change to normal daily routines creates huge disruption. “It’s just so hard to manage a disease when your primary means of constraint is behaviour,” says the Doherty Institute’s McVernon. “People find it hard to modify their behaviour for the sake of others, yet we are asking populations, particularly the young, to do completely bizarre things in not socialising with each other.”

MacIntyre is an advocate of mandating masks. While not delivering guaranteed results they offer an important method of lowering the “dose response relationships”.

“The higher the dose of virus that you get the sicker you’ll become,” she says. “If you’re wearing a mask, you will be exposed to less virus … and that means a milder infection.”

She believes enforcing mask-wearing is an important step in parallel with loosened restrictions. “Until you mandate masks … people just don’t wear them. That’s been borne out everywhere in the world,” she says.

For Bennett, widespread compliance with COVID-safe behaviour is important while accepting that “you don’t need everybody to be 100 per cent compliant, 100 per cent of the time”.

The key, she says, is to “break those lines of transmission”, keeping outbreaks within groups that can be identified, tested, traced and isolated. Then the public health messages need to be delivered again to ensure they have an impact.

“It is about influence on our own outcome,” Bennett says. “And if people see that, then you’re more likely to get some engagement.”

Rethink out future investment in preparedness

The crisis in Victoria was caused in part as “a consequence of decisions made decades ago and of course every year since by every government at every budget”, says Duckett.

Political priorities for limited health budgets have focused on hospitals and in recent years areas like disability and domestic violence have also been a focus, he says.

Will the pandemic era force all Australian governments to rethink where health budgets are allocated?

Duckett is sceptical. “They may say “oh pandemics are once in 100 years”,” he says, pointing out new public health challenges that have emerged because of COVID-19, particularly mental health and mass vaccination.

If a vaccine becomes available then the task of vaccinating the Australian population raises new health budget and policy questions. How is the vaccine allocated? How quickly does it need to be rolled out? Will immunity last or will a re-vaccination program be needed swiftly?

“There’s a kind of skewed understanding of pandemics in that people just think it’s about hospital beds and ventilators,” says MacIntyre. “We’re going to have to vaccinate 25-26 million people in a short period of time. You can’t do it in dribs and drabs over two years because I don’t want to be living with COVID that much longer.”

Australia’s existing vaccination program reaches around 5 million people a year, she says. “So we’re talking about going from vaccinating 5 million people a year to 26 million people within a month or two. That’s a big ask. We have to look at expanding resources now so that we’re not dealing with that problem when we get a vaccine.”

Pray we avoid bad luck

Will a superspreader emerge? Will that person be a homebody or a social butterfly? Will community compliance with a COVID-safe “new normal” remain high or will the community tire of the impact on lifestyle? Will contact tracing continue to work quickly enough? Will people be upfront with details about their whereabouts? Will someone in quarantine have a delayed incubation period and be released before testing positive? Will a cluster grow or just die out?

There are so many chance routes for COVID-19 to re-emerge in the Australian community it’s impossible to know what the future holds.

“Could the NSW health system have managed 700 cases a day like in Victoria?” asks Duckett. “I have no idea and neither does anybody else.”

“There is a chance element, but I think you can control chance,” says Bennett, returning to what we know of the science and capacity to contact trace and encourage COVID-safe behaviour.

Yet James McCaw, a mathematical biologist from the University of Melbourne, says even his maths models can’t determine the risk from chance and bad luck: “It’s almost not quantifiable and my maths models don’t give a number that’s meaningful, or easy to interpret. There’s always a chance that we’ll get a large third wave because of a sequence of unfortunate events.”

Pay attention to the risk model, even if there are few cases

McCaw can determine community risk from COVID-19 and his “infectious disease epidemiology toolkit” looks at numbers of daily recorded cases alongside data on community behaviour gathered from Commonwealth surveys and retrieved from Google, Facebook and Apple.

He spins these numbers to understand such things as how many people were meeting outside their home, what proportion wore masks and socially distanced, how often did they wash their hands.

“From this information we estimate how much the virus is spreading in the population at [a given] moment,” McCaw says. “We also measure something called the “transmission potential” which means if the virus was present in the average person in that population would it be able to spread?”

In states where the virus has been all but eliminated the risk of spread is extremely low however this hides a different kind of risk, he says.

“In those other states and territories people are all interacting enough now such that if the virus was introduced it could spread as it did back in February,” he says.

For Bennett, the behaviour change that has been forced on Victorians is likely to become ingrained even after lockdown and this will assist in keeping McCaw’s mathematical risk models lower than in other states.

“A lot of the population will be really trepidatious,” she says. “They are so beaten up by the lockdowns and by the fear messages that they are saying “I don’t want to do anything”.”

Yet notwithstanding the testing, the tracing, the social distancing, masking, mathematical modelling, quarantining and investment in public health, Australians will continue to live with COVID-19 for the foreseeable future.

“We will see flare ups, we will see things that [grow larger] than what we see in NSW at the moment and then we’ll see extended periods with few if any cases,” says McCaw. “But we can’t predict that with any confidence at all. We’ve got to trust that we have a system that’s able to respond as best as it can.”

What you need to know about coronavirus:

October 25, 2020 - Posted by | AUSTRALIA - NATIONAL, health

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