State against state
After Australia’s deadliest weekend of the pandemic, relief could be some way off for Victoria. The state recorded 15 deaths over the past two days, and overnight recorded another record number of cases in one day — 532, and another six deaths.
One of those who died over the weekend was a man in his 40s, more evidence that the virus can be brutal regardless of age.
It’s a different story in NSW, where in spite of community transmission bubbling away for a couple of weeks now, ministers are, according to The Sydney Morning Herald, “quietly optimistic” that the state’s contact tracers could have the current COVID-19 spot fires under control.
But there’s also some disagreement in Premier Gladys Berejiklian’s cabinet over what to do if those numbers tick up — some ministers are reportedly willing to live with 250 new cases a day before returning the state to lockdown.
In the past day, NSW has recorded 17 new cases — eight in hotel quarantine and the remainder linked to known clusters.
The aged care alarm
One of the most worrying aspects of Melbourne’s current outbreak is the numbers of cases in aged care.
The virus has now been linked to 38 aged care facilities, with more than 250 residents and 250 staff infected. The mortality rate for people in aged care is about one in five, leading experts to suggest there could be 50 deaths in the next two weeks in Victoria.
There’s also been increasing focus on how a lack of preparedness, funding and oversight in the aged care sector got us here. Stocks of personal protective equipment were inadequate. The family of a dying resident wasn’t given proper information on his condition. There are now calls for the military to be brought in to help manage outbreaks in the sector.
How does Victoria stack up?
Victoria isn’t the only place to be suffering a virus second wave. In mid-May, Israel had new case numbers in the single digits. Now, after people were told to go and have fun once the lockdown lifted, there have been more than 1000 new infections nearly every day for the past three weeks.
In Europe, as tourism kicks off again, infections are rising too.
Spain, which was one of the hardest hit countries in Europe, is seeing cases surge again after restrictions were lifted. On Friday, it recorded 2255 new cases. Around 900 of those were in Catalonia, a region with a population only slightly bigger than Victoria’s.
And as always, the numbers in the United States put our situation into some perspective. Florida, with a population less than all Australia, recorded over 12,000 new cases and 125 deaths on Saturday.
Black Lives Matter debate continues
Yesterday, the NSW Supreme Court, in effect, prohibited a Black Lives Matter (BLM) rally planned for Tuesday.
But the protest, organised by the family of David Dungay Jr, a Dunghutti man killed in police custody in 2015, could still go ahead. The organisers are appealing the court’s verdict, and say they’ll still take to the streets, unless SafeWork NSW and the Department of Public Prosecutions investigate Dungay’s death.
BLM rallies have been vigorously opposed by police in NSW.
Last week, commissioner Mick Fuller claimed the rally could set the state’s recovery back by a decade. But despite claims made by Fuller, and some fairly desperate reporting in the News Corp papers, there’s no evidence BLM rallies in June had any connection with Victoria’s current outbreak.
And in Fuller’s own state, where there were also substantial protests, there were no cases connected to the rallies.
Kishor thank you for this article.
I think the single most important (and perhaps least reported) lead problem measure is the amount of tracing backlog. While this statistic isn’t reported directly, we can see it in Daily Transmission Sources by state (e.g. here), where it shows as pink, while community transmissions show as gold, local transmission appear as blue, interstate transmissions as green and the now-diminished overseas transmissions appear as black.
An effective containment/suppression strategy needs fast, effective tracking and tracing (the Prime Minister has recently quoted tracing within 24 hours.) When the number of untraced cases gets into daily backlog, as has happened in Victoria, potentially infected people aren’t notified — or even if they suspect being ill, they essentially self-isolate and test on a voluntary and discretionary basis.
Which is precisely the ‘trust’ policy Sweden has, and we already know what it is producing in Melbourne metro: 90% non-isolation while sick, and 50% of people have been working while waiting for Covid tests.
To avoid a Swedish-by-default pandemic policy, tracking and tracing need to be comprehensive and effective: people don’t do what we expect; they do what we inspect.
But working with each patient takes time; community transmissions can take more time than local transmissions because you have to work out where a patient has been and then find who else has been there. So blue local transmissions can drop out of the pink quickly (as we can see in Victoria), yet we’ve seen that often, the gold community transmissions that are more dangerous.
Thus, when transmissions outstrip tracking and tracing, community transmissions snowball, which loads the tracking and tracing backlog further.
It’s broadly reported that Victoria’s ICU capacity is not being stretched by current case numbers: The Age reports that cases could hold quadruple numbers for ten days and Victoria still won’t hit surge capacity (though staffing with healthy, trained, alert, well-rested personnel may be another matter.) But the suppression strategy demands effective tracking and tracing.
CovidSafe has so far proven all-but useless in clearing backlog, so states are betting that community transmissions will stay small. So far that’s true in NSW as it wasn’t in Victoria.
But how likely is it long-term? Well, two weeks ago NSW had seventeen community hotspots; last week it added at least four more. Suppose the chance of missing a community hotspot is low: one in fifty. That puts the chance each week at around eight percent, and the monthly chance of missing a hotspot at around 28%. (Math available on request.)
And we have many months to sit this out.
Meanwhile, if the event comes up, then in Victoria it was a three to four week race before community infections threw tracking and tracing into a week-long backlog — and a week is important because of the incubation rate. For Victoria that race began in mid June, and Vic had lost it by early July.
It may be that tracking and tracing is faster in the other large Eastern states or has more capacity, but at the rate of four new hotspots per week it’s hard to see Sydney not being forced to run such a race in future — and potentially other large urban centres too.
Ruv, the tracing capability is different between NSW and Vic, as I have read principally around NSW having regional and Area Health Services as opposed to Vic where it is all centralised at the DHHS. That makes a difference, local knowledge can be crucial in directing resources (similarly for bushfire responses, and there are interesting similarities and language between fighting bushfires and viruses).
Otherwise, your logic is hard to argue. I would only add that at a point in the exponential growth the contact tracing becomes useful but a bit meaningless as it can never catch up. At that point widespread lockdown is the only feasible response.
As for eradication vs suppression, those who insist that we should aim for suppression are now defining it as ‘no community transmission’. By any other name this is eradication. These semantic games are being played out for some reason, almost certainly political rather than a health based assessment, but I can’t imagine what it is.
The nonsense position of ScoMo and Gladys that we can’t keep locking down and then opening up again are exactly what will occur with the suppression strategy. Through some tortured logic process they ascribe that outcome to eradication rather than suppression. As one M. Thatcher would say, there is no alternative. I only hope they are saying this for some arcane political point scoring motive, otherwise it points to a paucity of logical capacity at the very top of govt and health officials.
DB I agree about tracing capability: Victoria has been criticised for its tracing readiness here and it does seem to have hit its limit at a scary low 20 or so transmissions in a single day, with many or most being community transmissions.
However, assuming NSW’s capability better (as I hope it is), that just changes the threshold for what case-levels can be tolerated under a containment/suppression strategy: it doesn’t alter what happens when the tolerable threshold is crossed.
DB wrote: As for eradication vs suppression, those who insist that we should aim for suppression are now defining it as ‘no community transmission’. By any other name this is eradication.
The problem with eradication is how much it costs to remove the last few community cases within some nominated timeframe, DB. To oversimplify, if the new case levels halve (say) every week, then you can spend weeks of enforced inactivity to remove only a handful of cases, which politically amounts to imprisoning a state for the sake of one or two sick people. By contrast, tight suppression (if possible) doesn’t pay for that expensive tail but as you rightly point out, it secretly hopes to get it for free.
The hidden cost though is what I pointed out in the comment above: that when tracking and tracing is slow, limited or weak, a tight suppression strategy risks becoming ‘Lockdown or Sweden’. And as you rightly point out that can happen serially of course.
DB wrote: The nonsense position of ScoMo and Gladys that we can’t keep locking down and then opening up again are exactly what will occur with the suppression strategy.
The policy only makes sense if we see small numbers of community transmissions in low-value hotspots (like cafes) with small numbers of easily-traced patrons, with the hotspots rapidly detected and easy to shut down for cleaning.
It’s way harder when hotspots include aged care homes, hospitals or logistics centres because they don’t shut down easily, when patrons aren’t locals (e.g. travellers or holidaymakers), when patronage is larger, or when it’s not caught within days.
So to me, the policy looks fragile at best. I think the best way to deal with fragility is to expose its metrics rather than hiding them. Just as ICU beds and PPE units were originally critical but fragile metrics, tracking/tracing capacity and clearance rates are too.
An unfortunate choice of words – “some ministers are reportedly willing to live with 250 new cases a day before returning the state to lockdown.”?
For how many would they be willing to die? With or without consultation with the family.
Could this be an opener for a new round of agitation for euthanasia legislation?
Agni, there was a very effective ad campaign where a guy was asked how many road deaths he thought was a reasonable number. Just after he answered, approximately that many of his family, friends, relations etc walked around the corner. He was asked again, and his answer was none! Possibly the best road safety advertisement I have seen.
These cavalier politicians should be asked the same question about the Covid-19 numbers, as that many of their family walk around the corner, the elderly parents in front perhaps.
I just love how these dicks play with numbers, being neither particularly numerate, or particularly empathetic.
Imagine how many cases they would wait for if it only affected men between the ages of 50 to 70?
Fuller seems eager to ape his predecessor “Mighty Mouth” Scippione – talk big and wield a big stick.
This morning he claimed that “they are killing (!!) millions with mass gatherings…” which clearly does not apply to footie crowds when the MiracleMan, the Messiah from the Shire is present.