covid-19 Roadmap to Recovery

The “Group of Eight” major research Universities has released a “Roadmap to Recovery” which spells out two alternatives for recovery from covid-19:

Media release: Go8 provides evidence-based “Roadmap to Recovery” report to Federal Government

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:

  1. 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)
  2. The next section on ” 1 An Ethical Framework for the Recovery” adds nothing whatever. (p23-25).
  3. 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.

  1. 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.
  2. 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:

Rapid Audit of Contact Tracing for Covid-19 in New Zealand
Dr Ayesha Verrall
University of Otago
10 April 2020
https://www.health.govt.nz/publication/rapid-audit-contact-tracing-covid-19-new-zealand

  1. 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:

https://github.com/dentarthur/next-waves/blob/master/Schools_and_TTT.md

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.

  1. 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.

5 thoughts on “covid-19 Roadmap to Recovery

  1. I forwarded this piece to On-Line Opinion and they have published it today. I do this occasionally with Arthur’s and other posts. The level of debate at OLO isn’t what it once was, in my opinion, but I do think it’s important – vital – to ensure the widest possible circulation of such good articles. I also tweet the link to them and share on facebook and with facebook groups that comment on the topic. I’m mentioning this in the hope that others might consider doing the same – tweet and share on facebook. And if you know of any other on-line discussion forums, like OLO, please let me know or send the link to them directly.

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  2. Blogged this:why you should download the covid19 app
    http://billkerr2.blogspot.com/2020/05/why-you-should-download-covid19-app.html

    Do you think we are headed for the next wave due to lack of understanding of the nature of this virus? I see the key issues as “know thy enemy”, explore the true nature of the virus more deeply.
    Key issue so far: R(presymptomatic) roughly 0.9 (Ferrattti et al)

    Few are listening or know how to discern the real experts?
    Is Dan Andrews the only leader who will resist the call from business to reopen? Then savaged by Federal ed minister. For how long will he hold out?

    Teachers at my school are no longer social distancing, the students never did (during breaks). Not a problem yet since no new cases here (Alice Springs) for over a month and only 4 in total (since sent to Darwin). But the virus will return. Perhaps on an asymptomatic FIFO worker or an essential transport worker. If it gets into remote indigenous communities then all hell will break loose.

    Chief Minister Gunner did not mention download the app in his “return to (new ab)normal” plan.

    I tried to download the COVID19 app but received a message saying my android (4yo) was not suitable. I’ll explore more

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  3. Bill I found this article to be really useful in understanding why NYC was such a disaster
    https://www.washingtonexaminer.com/news/new-york-cutback-on-subway-trains-helped-spread-coronavirus-mit-study
    Coupled with the fact that NYC has JFK and La Guardia airports which would have been major transmission hubs when Trump announced that he was going to ban planes from Europe. Many of those people making the panicky overcrowed rush to return would have at least passed through the fine airports of NYC. Like most natural disasters the results are dictated by our actions. Did our leaders say everyone stay in place or did they say nothing to worry about, herd immunity will kick in. In NYC de Blasio restricted the number of subway trains there by making the remaining trains packed. It seems that the cities that pose the greatest risk are those with extensive mass transit systems and leaders who failed to comprehend the magnitude of the problem. I thing that Tehan has since apologized to Andrews about his unwarranted attack.
    Again as in every crisis keep your eye on the rich. During the Black death they wernt slow to leave London and retire to the country estate. Our crop of rich are doing the same sort of thing have you seen the recent price of a bunker I mean a decent bunker not some crappy back yard job.

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  4. Bill, i never imagined i’d put something supporting the ALP in print but i reckon Andrews has done well here. Like with the bushfires he’s given us consistent,concise messages. Back to the lifting restrictions with Covid 19,yes ‘how long can he ‘hang on’?

    The pro-death forces seemed to have wheeled out a new spokesperson, a Nobel Lauriette Professor Michael Levitt who’s a fan of herd immunity. He cites Sweden as having done ‘better’ than Australia in dealing with the pandemic but seriously ! Sweden has a population of 10.2 million, 23,918 infections,resulting in 2,941 deaths. Australia has 25.3 million people, 6,875 infections and 97 deaths. Professor Levitt, Andrew Bolt,Janet Albrechtson,and the rest of their ilk need countering when they peddle their herd mentality,lift the restrictions nonsense.

    We’ve done quite well working our way through the first wave of Covid 19 but it’s a long way from over. As we’d be aware the second wave of the Spanish Flu was more virulent,killing more people than the first wave. But as well as the death and illness related to the actual virus there are ,many more issues. Steve mentions the rich wanting their safe bunkers but at the other end of the income scale there are a estimated 1.1million casual workers not ‘eligible’ to access the jobkeeper allowance. There are the immigrant workers on visas tossed aside, like those Woodie Guthrie sung about in ‘Pastures of Plenty.’

    Mental health issues re Covid 19 ? Lifeline reported an increased 20% of calls during the early stages of the pandemic.I notice Beyond Blue now has a designated phone number and open forum for those suffering mental health issues related to the pandemic.

    If we’re working on a roadmap for a recovery we need to acknowledge it’s a long journey to a new form of ‘normality’. Hopefully this torturous road leads to a brighter future.

    Glen!

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