covid-19 – Strategic Direction – “No Community Transmission”

https://www.health.gov.au/news/australian-health-protection-principal-committee-ahppc-statement-on-strategic-direction

“Our strong public health advice is to pursue no community transmission, which many areas of the country have achieved. A goal of no community transmission has been a part of our suppression strategy from the start of the pandemic. AHPPC recommends that this now be more strongly pursued.

This involves knowing that single cases will occur. Success will rely on finding new cases early and stopping chains of transmission. If new chains appear, it is important to quickly find, contain and stop them.”

That statement on July 24 is worth reading carefully in full. Taken at face value it implies a strategic switch to “Elimination” despite being worded to obscure that. The wording avoids objections from the media campaign against Elimination, that Australia cannot be completely shut off so there will inevitably be some new chains.

Accountability for the previous policy and the pathetic claim that elimination of community transmission has been “a part of our suppression strategy from the start” can be left until later. It would be sufficient if the Chief Health Officers of the AHPCC now know that opening up while there was still community transmission in the largest States was a blunder even if they don’t want to spell it out.

But eliminating community transmission does require that WHEN (not “if”) new chains of transmission appear the capacity exists to “quickly find, contain and stop them”.

Acquiring that capacity requires first acknowledging that it does not currently exist. Instead of wording intended to obscure that and pretend continuity from the start it requires open and frank explanation of the difficulties and mobilization of the resources needed to overcome them.

On the same day, the following came:

“National Cabinet agreed to a new set of data and metrics to ensure that the Commonwealth, states and territories all have access to transparent up-to-date jurisdictional data on contact tracing, tracking and other metrics to ensure health system capacity. This will better help guide the public health response and support the coordination of efforts by the Commonwealth, states and territories…

National Cabinet recommitted to the suppression strategy to address COVID-19. The goal remains suppression of COVID-19 until a point in time a vaccine or effective treatments are available, with the goal of no local community transmission.”

https://www.pm.gov.au/media/national-cabinet-24jul20

Presumably the obscure wording from the AHPPC is intended to assist “National Cabinet” sliding in “the goal of no local community transmission” while proclaiming it has “recommitted” to the “suppression strategy” that produced a surge in community transmission.

In updates to my post of 31 March I pointed out that Australia had no serious modelling capability as demonstrated by the release of toy models supposedly representing “the science” guiding policy:

https://c21stleft.com/2020/03/31/covid-19-four-corners-looks-back-ignores-urgent-need-for-quarantine-accommodation/

In April I provided some links about contact tracing KPIs here:

https://c21stleft.com/2020/04/29/covid-19-roadmap-to-recovery/

Despite this I was reassured by news (Update 6) that the need for quarantine accommodation to isolate at least people known to be infected so that they would not infect others in their household had been endorsed by the Tasmanian AMA and would inevitably percolate through to government action.

Now I know that did not happen. The necessary preparations to cope with the much larger numbers that now need to be isolated (including contacts and others waiting for test results) simply have not been made in the months since. Even infected Aged Care residents are being kept in their existing residences to infect others and police were used to confine confirmed cases in the “vertical cruise ships” instead of escorting them to quarantine accommodation to prevent infecting others in their cramped “public housing”.

There are large numbers unemployed and an enormous amount of work for them to do. Apart from lots of front line workers that need to be trained in proper use of PPE while testing, isolating etc there are many other tasks such as ensuring adequate ventilation of essential workplaces. Mobilizing the public has not even begun.

Recent announcements make it clear the situation with modeling is far worse than I thought. Not only do they not have the capability for models to guide policy but they do not even have metrics for the Key Performance Indicators that need to be monitored for acquiring the necessary data for models. I thought they just didn’t want to release the sort of KPIs that New Zealand released because of their hostility to public scrutiny. The National Cabinet announcement indicates that the various governments did not even have adequate “data on contact tracing, tracking and other metrics” themselves!

On the positive side they will now get those metrics, which is a necessary step towards actually being able to carry out any policy whatever, whether it is called “Suppression” or “Elimination”.

It ought to be self evident that there has been a breakdown in contact tracing from the massive blow out in numbers of cases “under investigation”.

Instead of a plan to deal with the problem we got a speech from the Premier of Victoria complaining that 90% of people who were confirmed as infected did not get tested within 3 days of having symptoms and more than half of those tested did not isolate themselves while waiting for test results. The three lags between symptom onset and testing, results of tests and full isolation are absolutely critical KPI metrics that should have been monitored continuously.

The links I provided showed that pre-clinical transmission before people even develop symptoms can be about 90% of the minimum necessary to generate an epidemic in the absence of restrictions. Isolating an infected person within 24 hours of developing symptoms may not be fast enough. Hence the need for continuous tracking and automatic notification of contacts. But currently test results are taking an “average” of two days (with many taking far longer and difficulty prioritizing correctly). Adding 3 days for getting tested means five days of transmission without isolation, which is most of the usual infectious period. That means failure to “quickly find, contain and stop them”.

Today’s speeches about the latest record breaking numbers did at least have a start at preparing for the possible imminent further blow out in numbers. Training reserves of ambulance drivers is an essential step to prepare for large numbers of paramedics being unavailable due to isolation together with an increase in cases. Using paramedics already in isolation to help with contact tracing also makes sense. Likewise beds are being prepared etc.

What makes contact tracing possible is the fact that stage 3 restrictions sharply reduce the numbers of contacts that each infected person has.

Those restrictions were not first introduced until the very same day the Grand Prix was about to start with tens of thousands of spectators. Large crowds mean there is simply no way to trace the people an infected spectator came into contact with. The point of restricting “gatherings” to two people is to enable contact tracing. That worked in the first wave but has not been sufficient to suppress the second wave.

Most developed countries gave up contact tracing as already too difficult at much lower numbers than Victoria is still attempting to handle, so it isn’t that the Victorian Public Health officers are not working hard enough.

It just isn’t possible to keep up with the case load at the current level of social distancing restrictions. That was clear when the numbers continued to increase after locking down several suburbs to stage 3 and it remains clear two weeks after locking down the whole of Melbourne to stage 3. The AMA called for a move to stage 4 about a week ago.

Any plan has to start with shutting things down to the point where contact tracing can keep up. If governments won’t do it, local Committees of Public Safety will have to step forward.

The difficulty pointed out by Victoria’s Chief Health Officer is that most of the current transmission is connected with essential workplaces that would remain open in a “stage 4” lockdown. That increases the urgency of drastic measures to reorganize those workplaces as well as a more thorough lockdown elsewhere. But instead it has resulted in simply hoping that masks will turn out to be sufficient. They might, but wait and see is not a proactive policy for dealing with an outbreak when flying blind without adequate statistics about what happened weeks ago.

A policy of “wait an see” whether quaranting individual suburbs of a large metropolis could work merely allowed the case load to double.

The current plan is to “wait and see” the results of mandatory masks. But we already know the first two weeks of stage 3 restrictions has not stopped exponential growth and is close to overwhelming the test and trace capability. We also know that the original source of seeding has been cut off by diverting incoming travellers from Melbourne while quarantine hotels are tightened up.

That means the continued growth of cases is entirely local. The fact that numbers “under investigation” has blown out means most of that continued growth in local cases is “community transmission”. It doesn’t really matter if those numbers are eventually epidemiologically linked to a known local outbreak when the link is made too late to actually do much isolating either upstream or downstream.

Instead of waiting to see, a pro-active policy would be to do whatever it takes to bring the effective Reproduction number well below 1 and keep it as low as feasible until “No Community Transmission”.

Such a policy must be spelled out sharply as a break with the past, not obscured to avoid offending the pro-death advocates of sacrificing lives to save asset values for the owners.

The current situation is that most public discussion is basically uninformed about epidemics and contact tracing.

See for example the comment on my last article:

“The growth is not exponential and I suspect R0 is around 1, or less, given the extensive testing going on. Here is a graph” (linked to a search on Bing)

According to both the current Victorian guidelines (v23, July 10) and the National guidelines (SoNG 3.4) :

“Estimates for the basic reproductive number (R0) of SARS-CoV-2 range from 2–4, with R0
for confined settings, e.g. cruise ships, at the higher end of this range. Estimates of the
effective reproductive number (Reff) vary from between settings and at different time points
are dependent on a range of factors, including, public health interventions such as isolation,
quarantine and physical distancing to limit close contact between people (5, 6).”

Reference to R0 instead of Reff indicates that the person making the comment could not possibly have an informed opinion as to whether the growth was exponential, even if they were looking at accurate current figures and were able to notice when the graph they are looking at is simply a Bing bungle.

Suffice to say that there were 0 new daily cases at the start of June, rising to a record of 459 before the end of July.

Technically that is an infinite rather than merely exponential increase. But a glance at the actual curves for the first and second waves in Victoria enables anybody with their eyes open to see that the second is already much larger and still growing faster than the “exponential” period of the first wave.

Many people have their eyes firmly shut. This does not prevent them from pontificating about what they “suspect” after looking up “trends” in Bing.

https://www.dhhs.vic.gov.au/coronavirus-covid-19-daily-update

https://www.covid19data.com.au/victoria

It makes sense for conservatives to keep their eyes firmly shut and just hope things will sort themselves out. Conservatives naturally have faith that the authorities know best. There is no need for conservatives to propose detailed measures for mobilizing people to deal with problems. Simply thank them for staying home. “They also serve who only stand and wait”.

But anybody on the left will have less faith in the authorities and will be studying what needs to be done to mobilize people to tackle the problem. It is ludicrous to pretend to have confidence that people will transform capitalist society after an economic crisis while not being interested in concrete policies for dealing with a health crisis and just demanding that governments Eliminate the problem without proposing how to do so.

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