COVID-19 roadmap to recovery

Is the Victorian roadmap to recovery more of a roadblock?

Dr Brian McNamee AO and Sam Lovick

On Sunday, Premier Andrews announced his roadmap to recovery. It was not convincing, more of a pathway to misery.

We are all hoping that an effective vaccine will be available sooner rather than later. The Commonwealth, with CSL’s help, has given us the best chance if either our own University of Queensland candidate or the Oxford vaccine are proven. Even so, there are risks and we face many months without one. Premier Andrews’ chosen path has to be seen in that context.

His staged reductions in lockdown are triggered by state-wide infection rates that look at best, too conservative, at worst unachievable.

We would urge Premier Andrews to widen his pool of advice. Not just to adopt a different model to calculate a different target, but to understand that strategies based on management rather than elimination are likely to be better for us all.

Hard triggers are straightforward to estimate but are not always the way to go. We are sure that there are models to support them; there are good modelling groups in Melbourne. But what we are observing in this pandemic does not neatly fit the modelling assumptions, and there is more than one pandemic model to interrogate.

The reasons for large differences in spread between the East and West Melbourne, for example, are hard to explain in a model; a prescription that might eliminate transmission in the West might be excessive in the East or in regional Victoria.

To put these trigger levels into perspective. The next major relaxation is due October 26th, but only if the average number of cases over the previous two weeks is fewer than 5. NSW, counting only locally acquired cases, has managed this in just 7 of the last 54 days, and they didn’t start with over 400 daily cases. The next stage, scheduled for November 23rd, requires no new cases in the prior two weeks. NSW has achieved that exalted outcome for precisely 5 days in the last 179.

We doubt these stringent targets can be met. We hope they can, of course, but the more likely outcome is that they will be missed. If Premier Andrews is true to his word, then lockdown will continue, and the harm to the Victorian and broader Australian economy, which is already enormous, will extend further.

Lockdowns may reduce deaths from COVID-19, but that is not the only cost.

We have seen a 33% decrease in breast cancer screening in Victoria, no doubt getting worse in under stage 4 restrictions. Alarmingly, a 3 month delay in treatment can result in a 25% increase in mortality. And Victoria will have been in lockdown for at least 6 months before routine cancer screening is likely to resume. A UK study estimated 3,300 additional breast, colorectal, oesophageal and lung cancer deaths after 5 years from COVID-induced delays in diagnosis. If this is happening in Victoria, and the evidence suggests that it is, it translates into 315 more deaths.

Suicide is one of the leading causes of death in working age adults, 2,100 in 2018. Unemployed men are 5 times more likely to commit suicide than their employed male counterparts, women 8 times more than their counterparts. Job Keeper and Seeker are valuable safeguards, but if it takes a year for all the lost jobs to return once subsidies end, we could see as a worst case of 300 or more deaths.

Educational consequences are also dire. Final year students face the double whammy of disrupted training and a sclerotic employment market. If the US studies are to be believed, this could translate into lost lifetime income of $100,000.

Premier Andrews wants to avoid a start stop response to the pandemic and has pinned his hopes on elimination to do so. It is time for that policy to change.

We need to move to a management strategy. Accept that infections will persists, but when they do arise, tackle them. We minimise harm by testing, track and trace, rapid quarantine of infections and their contacts, and by protecting those most at risk.

The cornerstone is frequent and comprehensive testing with exemplary contact tracing. Premier Andrews must ensure that Victoria leads in these areas. If help from the Commonwealth or NSW is needed to do so, welcome it with open arms.

If community transmission does rise, we must enhance protections for those most at risk. Victoria’s Aged Care Response Centre, a joint Commonwealth and Victorian initiative, is a valuable step in that direction, a model due to be extended nationally.

Victorian regions should be opened up immediately, with the government focussed on testing, tracking and tracing, not enforcing the lockdown. Lockdown needs to relaxed more and faster in Melbourne. Restoring our economy, our jobs market and our education cannot be delayed.

Premier Andrews’ “cure “is already as bad as the disease, let’s not make it worse.