The first is continued restrictions for longer to “Eliminate”.
The second is for quicker lifting of restrictions for “Controlled Adaptation” accepting some ongoing level of infections while avoiding the health system getting overwhelmed.
The second is current Australian government policy accompanied by a steady drumbeat from business and the media insisting on a rapid return to work. The first is a clearly viable better alternative.
I find the pretence at academic neutrality between the two options quite irritating and the proclamation of “ethical principles” even more so.
But they have struck a blow that will make it much harder for “business” to get its way. The report release is well timed as efforts to reopen schools are being rushed in an effort to pre-empt a policy of Elimination.
The two page “snapshot” version makes it obvious that “Eliminate” is the way to go.
The 28 page summary obscures this with academic waffle.
The 192 page full report will not be read by many.
A major weakness is the parochial focus on Australia. An “Aussies all together” program of national service is proposed “to inclusively engage the young from across the nation in the process of social reconstruction across the country.” (p16)
Any country lucky enough to be able to “Eliminate” has major responsibilities to help the rest of the world. Australia will have particular responsibilities to help PNG and Indonesia as well as joining with New Zealand in support of others in the region. That is far more engaging and inclusive than a vision limited to “across the country”.
Some minor weaknesses:
The section on “Six imperatives in the implementation of Recovery” is confusing as much of it applies mainly to “Controlled Adaptation” rather than to both approaches, but it appears before either approach has been set out. (p17-22)
The next section on ” 1 An Ethical Framework for the Recovery” adds nothing whatever. (p23-25).
After a very brief introduction, the report should have simply started with “2 The Elimination Option” (p26-57) followed by “3 The ‘Controlled Adaptation’ Strategy” (p58-82).
In fact I strongly recommend readers should simply skip everything before page 26. Just read the separate 2 page “snapshot” first rather than getting bored by academic pontification either in the summary or preceding the full report.
Section 2 should start with a clear explanation that “Elimination” does not mean zero cases but rather, as explained by the New Zealand government, “zero tolerance” of cases, with any occasional sporadic outbreaks promptly suppressed. The opposite impression was created on p10.
Key Performance Indicators for contact tracing cite a pre-print by Lokuge et al but do not provide any means for accessing it. The doi URL should have been included: https://www.medrxiv.org/content/10.1101/2020.04.19.20071217v1 This technical paper is very important. It rightly stresses the importance of upstream tracing.
In discussing KPIs for contact tracing, reference should also be made to:
Lokuge et al includes a reference to Ferretti et al and to Imperial College Report 9. But it omits the essential confirmation in Imperial College Report 15, that testing cannot replace, but must be combined with, digital tracing , citing Ferretti et al. See links at:
A full appreciation of that should result in clearly linking public acceptance of digital tracing to a goal of “Elimination”. A government aiming at anything less than Elimination will not be able to get whatever level of public tolerance of dataveillance it needs for “Controlled Adaptation”. As Ferretti et al document, pre-clinical transmission itself has a reproduction number almost high enough for an uncontrolled epidemic without any symptomatic transmission. So success at Elimination requires far more contact tracing than can be achieved without popular enthusiasm. Transmission chains can be detected from primary care surveillance of symptomatic cases but with restrictions on social contact lifted the necessary upstream and downstream contact tracing could not get anywhere close to the results achieved manually under near lockdown conditions.
I included those references together with links on transmission through Schools because the battle over reopening schools will largely determine whether the outcome is Eliminate or not.
Suggestions that Elimination could be achieved in 30 to 60 days “assuming no major institutional or other outbreak events” weakens the argument. Epidemics are inherently stochastic. The argument should simply be that although local outbreak events can be assumed, they can also be locally suppressed. That is New Zealand’s “zero tolerance” as opposed to “Controlled Adaptation”. The uncertainty arising from risk that one might be infected in an outbreak is no different from normal risks of accidents. It is very different from living in a society that has “adapted” to a stream of deaths from “controlled” infection.
I only skimmed the alternative “3 The ‘Controlled Adaptation’ Strategy” (p58-82) as I don’t really take it seriously. Not sure whether it is meant to be taken seriously. Seems obvious that if it was possible to “control” an epidemic with R just under 1 it would make sense to go for Elimination with a lower R. I did not notice any evidence supporting the idea that there is some way “gradually” lifting restrictions could change the reality that lifting them enough to resume normal economic activity would leave R above 1 and an epidemic explosion as already demonstrated around the world.
I don’t have time to read the rest before posting this and am more interested in first carefully studying the very important paper by Lokuge et al.
Overall my impression is that this report is more than enough for Victoria to hold out for Elimination and that is sufficient to put a spanner in the works of any pretence at “Controlled Adaptation”.
So despite both the major and minor weaknesses mentioned above, what I have read of the full report is a very welcome counter blast to the endless droning from the pro-death lobby. It does a job that needed doing.
“Are we nearly there yet” is a well known phrase from bored children on a long trip.
It is a developing theme in media coverage of the only measures that can save lives in the current pandemic. It keeps bubbling up in stories from the ABC and Nine Entertainment including The Age and The Sydney Morning Herald.
Usually expressed in a whiny questioning tone like bored children, “Are we nearly there yet” is also being pushed by a very serious campaign from the Wall Street Journal and its local expression The Australian.
The masters of the universe are really worried about all this talk of “essential services”. Deep down they know that what they own is essential in any society, but having them as owners is not. Health workers, supermarket stackers, teachers are all suddenly noticed as essential – they have the satisfaction of doing meaningful jobs that are obviously useful to society so it is not necessary to pay them as much as is needed to “compensate” useless parasites for having empty soul destroying lives increasing their own “net worth”.
The owners and their servants are desperately keen for a “proper balance” between saving lives and preserving their asset values. That means no more avoidable deaths than are strictly necessary to to get the economy going again. After all it is hard to make money from dead workers. So they don’t actually want the hospital system to be overwhelmed. But no less avoidable deaths either. If “the economy” demands sacrificial slaughter to be appeased then it shall have it. There must be as many avoidable deaths as the hospital system can handle in order to save their assets.
The priests of ancient cultures preferred slaughter of young virgins. We live in more enlightened times. First the owners of our economy have to mobilize popular opinion. That is hard work on a “pro-death” program.
“Why are we waiting?” is a popular anthem demanding “We want attention” from a crowd forced to wait, often a crowd of school children.
Andrew Bolt is a skilled and intelligent agitator on behalf of the owners of our economy. He makes the pro-death program of the Wall Street Journal far more presentable to a popular audience.
His subeditor picked a nice variation of “Why are we waiting” for his latest piece of bullying petulance.
The entire text is included below, together with review and analysis {enclosed in braces}
“What exactly is the sign of success the Government is looking for before these stay-home laws can be eased? We deserve to know.”
THIS is extraordinary. Why won’t the Morrison Government tell us the sign it’s waiting for to release us all from home imprisonment?
Why won’t it level with us?
{The government did level with us when it warned that the restrictions needed to avoid the healthcare system being overwhelmed would need to be “sustainable” for “six months or more”. The 12 to 18 months expected before any vaccine is “six months or more” so technically they were being unusually “level”. Recently the government has started pandering to whiny journalists with ludicrous talk of being “on the cusp” etc. That gives an opening to Andrew Bolt.}
Haven’t we already achieved everything the government – and the state premiers, too – once said was the excuse for imposing on us a virtual police state?
{By “virtual police state” Bolt means businesses being shut down to reduce the number of avoidable deaths from a pandemic with no vaccine and no adequate preparations. He is not stupid. He kows what the stakes are given events in New York where the Wall Street Journal has its home. The answer to his question is that thousands have already died and are still dying in Italy, Spain, the UK and USA and the Australian government has not yet achieved everything it needs to do to avoid that here. He knows that, so he passes it off as a whiny “question” just like the usual crap from other media. But what he really means is a demand that they stop trying to avoid unnecessary deaths as fast as possible.}
Its medical advisers told us a month ago we had to stay shut in our homes because up to 150,000 Australians would die from the coronavirus.
{A month ago was March 16. That’s when the UK government was told by its advisors that current policies would result in a catastrophe similar to Italy. Doing nothing would result in say half a million avoidable deaths in the UK and over 1 million in the USA. The UK along with most European countries quickly followed advice to suddenly slam on the brakes. So did New Zealand. Australia took slightly longer but had the huge advantage of being further behind on the same trajectory.}
But just 63 of us have so far died. Even around the world the death toll is fewer than 130,000.
{How upsetting. If only the world had done as the Wall Street Journal demanded we could have appeased the economy with far more deaths! “Why are we waiting?” “All we are saying… Is give death a chance”}
The government also told us we had to be banned even from sitting alone on a park bench so that we could “flatten the curve” of infections.
{That is certainly what Italy and France did when they shut the parks. New Yorkers were ordered to “shelter in place” which certainly prohibits going out to sit on a park bench. No such order was made in Australia nor will it be needed unless we get closer to the 1000 deaths per day that New York is experiencing, as Andrew Bolt and the WSJ demand.}
But that curve is now as flat as a pancake. For days we’ve had 50 or fewer new infections. Many more people are getting better than are getting sick.
{“All we are saying… Is get more people sick”}
It also told us it had to ban elective surgery so hospitals wouldn’t run out of intensive care beds to save the masses dying from this virus.
{Andrew Bolt desperately needs a facelift because his portrait is starting to look like Dorian Gray’s}
But those 2200 ICU beds – and the many more emergency beds we’ve now added – have for many days had just 80 or so virus patients in them. Thousands of beds lie empty.
{“Why are we waiting?” “What do we want? Fill those ICU beds! When do we want it? NOW!}
If all this isn’t success, what is?
{Success will be continuing to avoid the 23% per day growth in cases that forced the government to suddenly slam on the brakes less than a month ago when we last had only 50 cases and those cases suddenly started doubling more than twice a week because restrictions had not been imposed and nothing else stops a virus that has no vaccine.}
What exactly is the sign of success the government is looking for before these stay-home laws can be eased?
{Well currently they are pandering to the whining by explaining that during the next four weeks they need to:
Establish adequate testing.
Develop industrial scale levels of surveillance to track each infection and isolate all contacts.
Be able to respond locally to sudden outbreaks like the need to isolate 5000 people in Tasmania on just one day.
But actually I don’t think they are that stupid. They know that a lot longer than 4 weeks will be needed and that “community transmission” is still increasing, not declining, at the current levels of suppression.
My guess is the government think pandering will help keep the public on side better than simply telling the truth. That instinct is natural to politicians. But I don’t think they are looking for a “sign of success” expecting to “ease” anything. I think they are waiting to be told by the Chief Medical Officers when it is necessary to impose further restrictions.}
What is the key metric it’s looking for to ease the restrictions that have cost hundreds of thousands of Australians their jobs and their savings?
{Their usual politicians Key Performance Indicators have been suspended for the duration. Careful measurement of the volume of bellowing from a whole army of Andrew Bolts is unlikely to overide the advice of the CMOs. But they will keep pandering and that will only encourage Andrew Bolt to bellow louder.}
We deserve to know. Yet when I interviewed Health Minister Greg Hunt this week, he repeatedly refused to say what the government was waiting for.
{I don’t watch TV. The Minister ought to have said “Which part of ‘six months or more’ did you not understand?”}
Was it when we had not a single new death? Hunt would not say. Was it when we had no more infections at all? Hunt would not say. Was it when we had inflection rates this manageably low for another week? Two weeks? Hunt would not say.
{No. A week or two weeks is not “six months or more”. A month is more than four times a week and more than six months is more than 26 times a week and more than 13 times two weeks.}
What’s the big secret? Shouldn’t we all know what the government is aiming for, and debate the costs and benefits of that target?
{There is no big secret. In Wuhan the provincial Andrew Bolt’s of the police were able to briefly bully doctors in December last year to keep an imminent global pandemic secret. But everyone knows now and there is nothing Andrew Bolt could say that will change the impact of what people have seen unfolding right next to the Wall Street Journal in New York.}
Clearly, it can’t keep insisting these stay-home bans will last “six months”, given Hunt admits the death toll is much, much lower than it had thought possible.
{I won’t argue about whether Hunt is as weak as piss. But whether he pulls himself together and tells Andrew Bolt where to go or not, any government official in the developed world that ignores what its Public Health Units tell it must be done during an epidemic will be promptly replaced. Andrew Bolt would do well in Belarus, but not here.}
And what was so magical about six months?
It’s just a date plucked from a calendar, and six months of these bans would drive many Australians crazy and many more broke, as well as leave our economy devastated.
{True enough. It is possible that anti-viral drugs will improve the situation in six months, but it won’t be over until a vaccine which is not seriously expected in less than 12 months. Many Australians will be driven crazy, especially fans of Andrew Bolt. Many others will die.}
I don’t mean to criticise the government for what it has done until now. Hunt is right to boast: “The steps we’ve taken have literally saved lives and they’re making a massive difference, as difficult and as tough as they are.” Correct. All praise to Hunt and the rest of the government.
In fact, I supported the bans – and wanted more of them sooner – back when we had no idea how lethal this virus was or how fast it would spread.
Now the argument is a different one: where to go from here? Which bans actually make a difference, and which don’t?
{Yes Andrew Bolt is far more intelligent and skillful than the lunatics who denied that anything needed to be done at all. He knows that he needs to whip up resentment of minor irritations and a mood of “Why are we waiting”. The business readers of the Wall Street Journal can relate to a simple demand that their asset values be preserved. But the Herald-Sun has a working class audience many of whom live from pay check to pay check with no assets to preserve. So Andrew Bolt cannot speak as plainly as His Master’s Voice}
For instance, does Victoria’s ban on even surfing and fishing make any sense? Hunt told me we couldn’t relax because a “second wave of infections” might come, as we’ve just seen in China and Singapore.
{Ooh look, over there… surfing and fishing. There are very good reasons for rushing out dead simple rules to “stay at home” and sort out the details later. There are equally good reasons for Andrew to pretend he is just arguing about which bans actually make a difference when he is in fact demanding that more lives be sacrificed to preserve asset values.}
But what if it doesn’t? We could be waiting months and months for a second wave that may never come, and wait at an horrendous financial and human cost.
{The pretense is so transparent that Andrew Bolt actually forgets himself and becomes comical. Just imagine how awful it would be if a second wave was prepared for and never came! Fear not Andrew Bolt. There is no way to avoid repeated outbreaks when nearly 100% of the population has not been infected yet and is still Susceptible because there is no vaccine. You will get opportunities to present your demands many times over the next year or more. Every time the death rate subsides you can pop up and demand “Give death a chance”.}
Surely it makes sense to fight any second wave if and when it actually comes. We’ll be far better prepared then, and can bring back all the restrictions we like when required.
{Surely. Just like it made sense for New York to not fight the first wave until it hit them and they had a thousand deaths per day.}
Tasmania this week actually set a more realistic and affordable model for fighting a “second wave”.
It had an outbreak of infections – 78 new cases – at two hospitals in Burnie. It blitzed that outbreak at its source, closing the hospitals and putting 5000 people there in quarantine.
{Utterly brilliant! Andrew Bolt knows he has some really, really stupid fans. They will have heard that instead of being “flat as a pancake” at 50 cases per day as Andrew claims, Tasmania had to isolate 5000 people in one day and needed help from the military to do it. So simply tell them that this was a “more realistic and affordable model” and they will just remember that it was part of their hero’s argument for doing nothing instead of thinking it showed that the curve is not “flat as a pancake” like their “dear leader” says.}
This must be our future. Yes, let’s have stricter quarantining of the infectious; better isolation and support of the most vulnerable, who are overwhelmingly aged over 70; and aggressive testing and tracking down of people who might have the bug.
But let the rest of us slowly get back to work to pay the monstrous bill. Just tell us the key to start that great engine.
{Essential services are at work. That unavoidably results in community transmission, even in hospitals as seen in Tasmania. But it is unavoidable no matter how carefully peope leaving their homes to work try to avoid contact. Andrew’s problem is that the longer essential services are the focus the more obvious it becomes that the people he bellows on behalf of are in no way essential.}
What is the government waiting for, and why won’t it say?
{Good question. I think the government is too gutless to simply arrest and quarantine Andrew Bolt as a biosecurity hazard. But watch out for the CMOs.}
BLOG WITH BOLT blogs.news.com.au/heraldsun/andrewbolt/HERALDSUN.COM.AU
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