12 Apr They’ve got your whole world in their hands – and want to save it
Dana McCauley – The Sydney Morning Herald – Sunday 12 April 2020
As millions of Australians spend Easter at home, pressure is mounting on authorities to give people a sign that heavy restrictions on social and economic activity will eventually be eased.
Those who are obeying the rules this weekend are skipping the usual trips to the coast and big family gatherings to help “flatten the curve” of the coronavirus pandemic – but even the most conscientious social distancers want to know when the lockdown will end.
Health Minister Greg Hunt has declared the state and federal government restrictions – including shutting the nation’s borders, banning large events and, more recently, limiting gatherings to no more than two people who don’t live together – a success.
So, many are wondering when beaches, gyms and pools will reopen – and what about cafes, restaurants and bars? How soon should parents send their kids back to school?
These are the questions being examined by an expert taskforce made up of more than 80 leading academics from Australia’s Group of Eight universities, which the national cabinet has tasked with preparing advice on “the challenge of recovering from the current state of pandemic shut-down”.
Experts are divided on what level of restrictions should be maintained and for how long, but most agree that it would not be possible to maintain a lockdown for the 12 to 18 months it is expected to take to find a vaccine.
University of Melbourne professor of epidemiology Tony Blakely says the detail of which restrictions could be lifted, how soon and in what order remained uncertain, as modelling had not yet been done on the impact of each layer of social distancing.
“One of our tasks in the next week is to assemble that list, in priority order,” Professor Blakely tells the Sun-Herald and Sunday Age.
Allowing people to have a small number of visitors in their homes would be a “sensible loosening to try initially”, he says.
Associate Professor Adam Kamradt-Scott, an expert in health security with the University of Sydney who is advising the government, says public spaces like beaches and gardens “are not problematic themselves” and could be reopened if social distancing rules are observed, while gyms and nightclubs are more likely to remain closed.
Professor Jodie McVernon, director of epidemiology at the Doherty Institute – on the panel of modellers advising the national cabinet – says researchers are still “uncertain about the actual contributions of different measures that have been implemented” to reducing the virus’s spread.
“Things like school closures, people are trying to unpick these from observations in Europe, but it’s still very unclear,” she says.
“We’re now closely observing what’s happening in Australia to see what our measures are doing.”
Prime Minister Scott Morrison has repeatedly primed Australians for their lives to be disrupted for “at least six months”, but has recently spoken of trialling an easing of restrictions in some jurisdictions around the country and warned the government’s capacity to prop up the economy is “finite”.
Corporate titan Richard Goyder, the chairman of Qantas, Woodside Petroleum and the AFL Commission, has called for a swifter easing of restrictions, warning that balancing health and economic concerns would become difficult as the virus stretched Australia’s balance sheet.
Professor Blakely warns the health impacts of relaxing social restrictions must be weighed against “all the costs of lockdown”, both social and economic – saying “there is a real risk the societal cure we choose may do more harm”.
Not only do lockdowns damage employment and GDP, he says, but these effects can feed back into health impacts such as increased suicide and heart disease.
“We need to quantify that, and weigh it up,” he says.
Mr Hunt says the strategy being worked on “needs to be very, very nuanced and carefully thought out” and “sustainable in the medium term” while research into COVID-19 treatments and a vaccine continue, while deputy chief medical officer Nick Coatsworth says the exit strategy is “weeks or months”, not days, away.
NSW Premier Gladys Berejiklian has promised to review the state’s restrictions on a monthly basis, and has said some rules could be loosened as early as next month, while Victorian premier Daniel Andrews says strict social distancing measures “are with us for the medium term”.
Professor Blakely says the timing of lifting restrictions depends on “what our endgame strategy is”.
If it’s to eliminate the virus – assuming that is even possible – restrictions could be lifted in four to eight weeks, he says.
If the aim is squashing the curve to keep rates of infection “really low until a vaccine is found”, he says “a very gentle easing” is possible after some weeks of “meticulous planning”.
That would mean easing off the social distancing rules until the reproduction rate of the virus is about 1.0 but no more (meaning each infected person passes it on to one or fewer people), and holding the restrictions at that level for 18 months or until the vaccine is rolled out.
“We just do not yet know what that looks like – but many people are working on this, right now,” Professor Blakely says.
Professor Raina MacIntyre, head of the Biosecurity Research Program at UNSW Sydney’s Kirby Institute, says a “short, sharp lockdown” of between four and six weeks would be enough to bring Australia’s number cases to a “very, very low baseline”.
“I don’t think we need to be locked down for six months,” she says.
ANU Professor Peter Collignon says the current rules are too harsh and that authorities have overstepped by fining people for sitting on park benches or teaching their teenagers how to drive, warning that this approach will eventually drive people to civil disobedience.
“If you’re in a car, how are you going to give to anybody else or get it? We’ve got to have laws that make biological sense,” he says.
Queensland University of Technology behavioural economist Ozan Isler says the “unprecedented nature and scale of restrictions” make it difficult to predict how long Australians can be expected to tolerate them, but that some relaxation of the rules is needed soon.
Professor Collignon says a ban on visitors at home is “not sustainable”, but that closing pubs, clubs and bars and restaurants “was a good idea” and that they should remain closed “until at least September or October” as winter would be a danger period.
“What we put in place mid to late March – closing our international borders, quarantining high risk people like returned travellers and close contacts – we’re going to have to continue that for at least six months,” he says.
“We’re going to have to keep the 2m rule going for quite awhile and limit the number of people you meet – but that doesn’t mean we have to become hermits.”
The NSW education union is pushing for a stated return of students to schools, saying Year 12 and kindy should be prioritised.
The prospect of allowing the virus to circulate with the aim of achieving “herd immunity” has been raised repeatedly, despite scientific uncertainty over whether people who recover from COVID-19 are actually immune (something that won’t be settled until a reliable blood test is found).
Some commentators say the economic damage of ongoing restrictions could be more harmful to Australians than the virus itself.
Professor Blakely says if governments decided to pursue herd immunity by allowing the virus to circulate, they would ease off restrictions with the aim of achieving a rate of spread that generates a “manageable” three-week ICU caseload.
Borders would need to remain closed for six months even under a herd immunity plan, Professor Blakely says, and at least 18 months for either elimination or suppression.
Grattan Institute health economist Stephen Duckett says while the number of new cases is falling, the decrease has been driven mainly by “regaining control of the borders” and that the level of recorded local transmissions remains flat.
Dozens of new cases each day are still “way too many”, he says.
“You’ve got to get it really, really right down low before you can risk lifting the restrictions. Singapore were getting it down then it rebounded. Because this is a highly infectious virus, it is easy to get out of control again.”
But, Dr Duckett says, some loosening of restrictions is needed as the current rules could not be sustained for another five months.
The strategy of flattening the curve is aimed at buying time while authorities learn more about how the coronavirus is behaving in Australia, and build the capacity of the healthcare system, buying new ventilators and masks, training up health workers and finding more effective treatments.
University of Melbourne epidemiologist James McCaw, also on the panel of modellers advising the government, says while the curve is flattening, “if we reduced our if we sort of relaxed and went back to normal we would see a rapid and explosive resurgence in epidemic activity.”
Countries that have opted for fewer restrictions, like Sweden and Singapore, have had to introduce tougher restrictions after seeing cases rise dramatically.
Perhaps this is why the prime minister has been careful to warn Australians not to expect life to return to normal any time soon.
Chief medical officer Brendan Murphy says Australia is “on a life raft”, with infection rates falling in the wake of restrictions. “We now have to chart the course of where we take that life raft,” he says.
Which direction the nation is steering in will be closely scrutinised, with a Senate committee to examine the government’s response to the pandemic.
Liberal senator James Paterson, the committee’s deputy chair, says it will “carefully consider that economic cost on the lives of ordinary Australians” and question both government decision makers and the experts who advise them “about the alternative pathways available to us from here”.