The bewildering decision to cut Australia’s foreign affairs capacity during escalating regional geopolitical tensions amidst a rampant and lethal pandemic fails to register the threat that other countries pose to Australian lives. It is sadly consistent with the Federal Government’s actions over the past seven years and the national response to the risk of death from environmental pollution, biodiversity loss and consequences of climate change in our National Disaster Risk Reduction Framework.
But protecting Australians from COVID-19 requires an entirely different approach from our country’s political leadership. Unlike deaths from environmental pollution or biodiversity loss, the attribution of death to COVID-19 is very fast and very real. Of all deaths during the Italian outbreak, 89 percent were directly caused by COVID-19 and more than 28 percent had no co-existing illness. International experience cited by the US CDC reported more than 25 percent of all people hospitalised are admitted to ICUs where between 39–72 percent of these people die. Governments’ responses must be direct and effective, otherwise the failure to save lives is clear for everyone to see.
The unspoken challenge for Australia is the reservoir of SARS-CoV-2 infection in equatorial Asia and the northern hemisphere.
The unspoken challenge for Australia is the reservoir of SARS-CoV-2 infection in equatorial Asia and the northern hemisphere. Uncontained spread is so large, the ongoing cycle of transmission will occur for years to come. The Spanish influenza pandemic killed tens of millions for over three years. Last week, the UK chief scientific advisor Sir Patrick Vallance advised a Select Committee in Parliament the virus will return “in different waves over a number of years”. While the Director of the US CDC Dr Robert Redfield said the autumn and winter in 2020 and 2021 will represent the most difficult time for Americans.
The Australian Prime Minster unequivocally stated the option of elimination is “not workable” and emphasised in June that we must learn to “live alongside the virus”. Australia will re-open its international borders and asymptomatic people will arrive. History suggests one small error in screening or a misunderstanding about quarantine, or the rare person who takes longer than 14 days to incubate, and we are off to the races again. As long as the transmission of SARS-CoV-2 continues in other countries, we all remain at risk. It might be a relative of a diplomat, a Hollywood film star, crew of a cargo ship or US Marines on mission in Darwin—the entry source is irrelevant because the outcome for Australians remains the same.
Transitioning the national COVID-19 response strategy
While targeted disease control interventions for diagnosing symptomatic cases, contact tracing and follow-up, and limiting socialisation have proven very successful at containing spread, now is the time to transition our national strategy toward a bespoke flexible and sustainable COVID-19 disease control plan. At the very least six principles need to underpin the strategy.
1. Risk reduction in high-risk settings
No-one with symptoms of any infectious illness should have ever been allowed to enter hospitals, nursing homes or childcare nurseries. Temperature testing and compulsory mask wearing for all people (including staff and patients) prior to entry to every high-risk setting in Australia must be mandatory. This intervention needs prioritising in all high-risk facilities no matter the level of localised COVID-19 community transmission.
2. Risk management for small and large business
Industry groups have been forced to create localised business response protocols and action plans in the absence of government guidance or direction (especially case confirmation notification processes; environmental surface cleaning; sick leave entitlement impact on EBA’s; pre-work temperature screening advice). Coalitions of business and public health advisories need to provide clear and transparent guidance for businesses to manage internal and external disease transmission risk.
3. Minimum standards for testing and reporting
The success of contact tracing in minimising transmission is dependent on timeliness of reporting. Co-operative agreements on minimum standards for pathology processing and reporting results need development for all communities including remote, regional and metropolitan centres.
4. Incidence and prevalence testing strategies
Understanding changes in the incidence and prevalence of infection and disease is essential for mapping community risk. Planning for incident response and opportunistic and population-based testing programs is essential to communicate changing community specific risks and the need to activate local disease prevention activities. An approach used for managing arboviral disease risk for decades.
5. Risk reduction across community settings
Wearing of masks, hand hygiene and increased surface cleaning recommendations based on local community transmission risk must become normalised. Australian communities have long demonstrated their capacity to change behaviour in a moment’s notice once warnings have been issued for other natural disaster risks such as fire, floods and cyclones.
6. Airport arrival testing strategies
Standardised community mask wearing, temperature testing and contingencies for all new arrivals have been successfully introduced in other countries, especially those affected by the SARS epidemic, such as Taiwan. Such requirements should be pre-tested and implemented at all international arrival gates in Australia before re-opening.
The path forward
‘Normalising’ COVID-19 disease prevention measures is essential to prevent Australian deaths in this pandemic and avoid more lockdowns. The key to success is to start responding to this pandemic in the same manner as all natural hazard disasters. Permanent changes and ad hoc actions to contain local risk must be communicated in a way that acknowledges community specific and community-centric characteristics that allows Australians the time to absorb, reconcile and accept.
Inviting different participants into the decision-making tent to help create an effective implementation plan is essential. This includes large and small businesses, multi-cultural groups, religious leaders, social support organisations, sporting organisations, educators, child support workers and health care providers. While this means a big tent, the engagement process will dictate the speed, acceptance and uptake of these measures across the whole country. This nature of engagement is necessary for all Australians to successfully ‘live alongside’ the virus.