Covid Elimination? What then?

Queues of people unable to afford food, stretched for hundreds of metres in Melbourne on Easter Sunday. And I’m getting emails from people who are behind on the rent and worried they're at risk of homelessness. 

State and federal governments, following health advice, have triggered a serious economic depression. The government decisions that caused this have wide support, but the toughest decisions lie ahead. And these decisions should be made publicly, not behind closed doors.

The public health orders that confine us to our homes, close borders and venues and ban gatherings have saved our hospitals from being overwhelmed, and daily infection numbers are down to a trickle. We may be on the brink of eliminating local transmission of the coronavirus.

And as the worst hit regions of the northern hemisphere begin to recover, soon, Australia’s supply chain for ventilators, gloves and masks will improve. Our hospitals may not be quite ready, but within a month or two, they may be as ready as they’ll ever be.

If the number of new local infections reaches and remains at zero for a couple of weeks, we will have effectively eliminated local transmission. We could, step by step, allow people to return to work. Casual workers and international students with little or no income could return to work as shops and cafes reopen, if they haven’t closed forever.
Of course, if we don’t first eliminate transmission, we won’t be able to relax restrictions much, if at all.

But successful suppression of the virus will confront us with a painful choice. Do we keep our borders closed for a year or two, hoping for a vaccine, allowing only trade and those few travellers willing to submit to a regime of tests and quarantine? Or do we put the new ventilators to work and allow the coronavirus to spread through the community, at a controlled rate, so that we can allow free travel to and from Australia?

Could we keep the incidence rate low enough for hospitals to cope? This would likely require some level of physical distancing, and a public commitment to infection control measures such as hand hygiene, and staying home at the slightest hint of a cough. Not all businesses could reopen. And many people would die, no matter how hard we tried to protect vulnerable people from the virus. It might not work very well, and even if it did, it would be a distressingly long time before the number of immune individuals in the community slowed the epidemic.

Last month I was leaning toward allowing some controlled transmission of the virus, but the more I hear about this virus, the more uncomfortable I get. Stopping it at the airports sounds more appealing.

But there are only wrong answers, unless somebody invents a safe, effective, affordable vaccine that can be produced in sufficient quantity. The history of infectious diseases is littered with failed vaccines and there are no guarantees of a successful vaccine for this virus.

So how will Australia (or Victoria) choose the least worst of the unappealing answers to our dilemma?

So far state premiers and the Prime Minister have formed a national cabinet, advised by chief health officers. They have, as far as we can see, followed doctors’ orders and got us this far. With fewer deaths from COVID-19 than virtually any comparable nation, it feels like success.

However thousands are out of work, some homeless and even hungry, as a result of what may only be a postponement of the Australian COVID-19 epidemic. We can’t meet our friends, or congregate in pubs, or travel in and out of Australia. We can’t sit in the sun in a park. Social distancing, isolation and unemployment will also increase domestic violence, homelessness, depression and probably suicide. But how do you weigh all this against the lives we save or prolong with these restrictions?

These are the most difficult decisions our leaders have yet faced. Whether it’s going to war, or an order from the Chief Health Officer to stay home, many of the biggest decisions in our history don’t require a vote in parliament. They are announced without debate at carefully managed press conferences.

I don’t envy our National Cabinet, and I’m impressed by their work so far. But I have one request. As they wrestle with the dilemma of what do next, I want them to do this as publicly as possible and preferably in parliament. If we can see the facts and the reasoning underpinning their decision, we’ll be more likely to accept it, imperfect as it must necessarily be.

Before being elected, Tim Read was a doctor treating and researching sexually transmitted infections.