How Victoria can leave lockdown, safely, and avoid a return
Victorians are desperate to see a road out of their current situation. After one month of stage 4 restrictions, including a night-time curfew, and six months of varying degrees of restrictions, Melburnians in particular long for a return to some kind of normal life.
A few things are clear. First, lockdown works! For example, stage 3 restrictions averted between 9000 and 37,000 new cases in Victoria. The combination of mandatory masks and stage 4 restrictions has led to a steady decline in the seven-day average of new daily cases, which is now approaching double digits.
Effective as lockdowns are for the control of COVID-19, there is huge collateral damage and as a result it is very difficult to maintain community support indefinitely. And in any case, the idea of lockdown is not just to reduce coronavirus transmission, but to buy time to strengthen interventions that are proven to work but do not require disruptive lockdown.
These measures will allow us to live in a functioning society for at least the next 12 months, without a game-changing intervention like a vaccine, preventive therapy, or an effective treatment drug. Nevertheless, Victoria should resist external pressure to announce a time-bound “road map” until it is clear what the epidemiological situation is at the time of decision-making. It was a mistake when the state moved from stage 3 to stage 2 during the first wave of infections under pressure from the National Cabinet. Lifting the number of people allowed in a household from five to 20 overnight probably contributed to the rapid spread of the virus through north-western Melbourne in the early stages of the second wave.
In considering the transition from stage 4 restrictions, there are a number of criteria to consider. First, the elimination of community transmission, possibly for seven to 10 days, is an absolute criterion for easing restrictions. If we are to avoid another significant wave, this must be the aim.
Case numbers will need to be reduced enough to allow effective track and tracing. Credit:Paul Jeffers
After so much sacrifice, Victorians don’t want to move into stage 3 and find ourselves in the same situation as Sydney where health authorities have been putting out spot fires for the past two months despite an excellent, decentralised test and trace system. In spite of the low numbers, NSW is identifying new mystery cases almost every day. And for those who think Victoria could tolerate this level of transmission, it’s worth looking at South Korea. After months of low daily numbers, comparable with NSW, since mid-August the country has been reporting between 200 and 500 new cases every day, despite its excellent test and trace system.
The second consideration for exit is Victoria’s test, trace and isolate strategy. This needs to be enhanced in a demonstrable way, where both the community and the government can have confidence that spot fires can be detected and extinguished quickly following the easing of restrictions. For this we need greater adherence to testing guidelines (get tested as soon as you have symptoms) and we need to improve the state’s capacity for contact tracing. If everyone with a slight illness was diagnosed on day one of symptoms, and their close contacts were effectively traced within 48 hours, Victoria would see a rapid decline in new cases.
The key to improving both community buy-in and government performance is to be more community centred. Much work is under way by DHHS and local government organisations to enable us to be satisfied at a minimum that the system can cope and that community attitudes to testing are strong. When people are tested they should be assessed for their support needs so they can quarantine while awaiting their results and, if positive, self-isolate for 14 days. We would like to see authorities reporting publicly on its progress in specific areas of its test-trace-isolate capacity.
Thirdly, mask wearing needs to be improved. Masks work well in the Victorian community setting but there is every reason to believe we could get much more out of masks. Innovations like making high quality surgical masks available free to all Victorians, stronger recommendations among young people, including high school aged children, and providing additional incentives for their correct use should be adopted. Innovations such as the Victorian government’s advertising campaign are welcome in this regard. Recent studies have reinforced the effectiveness of masks in preventing coronavirus transmission. However, it is also now apparent that face coverings such as bandannas and scarves are not as effective as disposable masks and reusable masks that are made in accordance to recommended specifications. In addition, it is important to communicate that face shields, unless in combination with masks, are not effective.
Fourthly, we need watertight systems to prevent virus transmission in workplaces, especially those who have repeatedly demonstrated their vulnerability, such as meat processing plants. They should conduct urgent risk assessments and implement measures to prevent further outbreaks, such as screening for symptoms, including fever, on arrival at work and isolating quickly if required. They should also consider operational measures such as reducing the processing rate for animals and carcasses and mandating face coverings.
Finally, policies and procedures must be in place to protect the elderly in residential aged care homes and to prevent spread to our health care workers by improving infection control procedures. In residential aged care facilities, there need to be well-defined benchmarks of practice, such as having designated infection protection and control co-ordinators in each facility, adequate stocks of PPE and clear policies of referral of infected residents to hospitals.
With these elements in place, together with the existing commitment to tightening and optimising testing, quarantine and isolation, and adherence to mask wearing, physical distancing and hand-washing guidelines, Victoria is in a strong position to move out of stage 4 either on September 13 or soon thereafter. The better the test, trace and isolate system and mask wearing, the fewer ongoing restrictions will be required.
Michael Toole is an epidemiologist and principal research fellow at the Burnet Institute. Brendan Crabb is director and chief executive at the Burnet Institute.
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