covid-19 – Third Wave

According to Victoria’s Chief Health Officer there is now a “minimal risk” of a third wave.

There are two senses in which that could be true:

  1. The decision to open up may have been taken at an optimal time. Only a few days earlier the CHO said frustration was at “boiling point” as he confronted a baying pack of journo jackals foaming at the mouth against a 24 hour delay to actually look at the most recent test data before capitulating to business, media and national government demands for an immediate opening. Perhaps he thinks that any benefits of further delay would be outweighed by the outcome being a clear cut victory for the denialists as the State government and public health authorities were eventually forced to back down by local and national government pressure. He might believe that by choosing a moment when a significant outbreak had just been successfully contained, with zero cases after thousands of test results, the wave of relief and confidence may well be optimal for not losing control when it does again become necessary to impose restrictions in order to prevent a third wave. He might also be right about that.
  2. The risk in Victoria might now be less than in any other State or Territory of Australia. Apart from New Zealand, that is about as good as it gets for comparable countries. In most of the world there is no possibility of actually eliminating community transmission (“mystery cases”) before a vaccine. There is no debate about that. It is hard enough trying to avoid collapse of the European and North American hospital intensive care systems in the face of the obvious difficulties of locking down early and long enough to avoid being overwhelmed. Prolonging a lockdown in the hope of eliminating “mystery” cases would be seen by nearly all “experts” as an absurd fantasy. Again, the CHO could be right about the risk being “minimal” in that sense. But being perched on a slightly less explosive powder keg than the rest is not especially comforting. Almost the entire population of every State is still completely susceptible and the more confident they are in contact tracing the more complacent they will get.

But there is a third sense which I doubt that the CHO or anyone that knows what they are talking about could possibly believe and yet will be widely believed by many people.

Most people who don’t expect a third wave believe it will be prevented by greatly enhanced contact tracing combined with other changes since the first wave including enhanced community awareness of the need for physical distancing, masks etc, serious regulation of workplaces and enhanced capacity for testing, isolation and treatment.

The CHO could not possibly believe the risk is now “minimal” in that sense. But others will assume that is what he is saying.

Not long ago Victoria had a roadmap with a target of:

“no new cases for 28 days and no active cases (state-wide) and no outbreaks of concern in other States and Territories.”

That is a reasonable description of the conditions for “minimal” risk of a third wave. The remaining risk would be that some subsequent sporadic isolated outbreak (as in New Zealand) might get out of control (prevented in NZ by an immediate lockdown when the first cases were detected, not by relying on contact tracing). In China measures to maintain elimination of mystery cases have so far included testing EVERYONE in three large cities.

I thought, but did not write, that this target was not intended seriously. If it had been serious the hardest stage 4 lockdown would have been maintained until it was achieved. The planned relaxation at the end of October would inevitably result in progress slowing down drastically so that the November target could not be achieved.

In fact the target was openly abandoned when the revised roadmap was published on 18 October.

So the CHO knows perfectly well what is actually required to minimize the risk in that third sense and knows that it has not been achieved. That is what he means when he stresses that it isn’t over until there is a vaccine.

According to all the editorial bloviating, everyone must cooperate to intensify their vigilance in order to stay open.

Since that is logically impossible it logically implies that there will be a third wave. It is simply illogical to expect any other result from opening up while there is still ANY community transmission bubbling away. Appealing for everybody to do the right thing is as effective a strategy as the power of prayer..

The CHO does not seem to know how to explain the situation to others and to rally support.

Neither do I. That is why I have not been writing.

In my view the media has been quite successful in convincing most people that the solution is contact tracing. Since they were demanding an early opening after the first wave they could not have admitted that contact tracing inevitably gets overwhelmed if you don’t lockdown quickly enough and stay locked down until mystert cases are eliminated. The State government could and should have admitted that its failure to respond to the rising mystery cases by locking down was the critical factor that turned ordinary ineptitude over Hotel Quarantine into a “State of Disaster”.

Explaining that is critical for ensuring that the next lockdown comes quickly enough to avoid a third wave that could be bigger than the second (which was far short of overwhelming the hospital ICU capacity, unlike the current situation elsewhere).

The biggest danger I see is from contact tracing. They now have a capacity to delay a necessary general lockdown for quite a long time by locking up a large proportion of contacts and contacts of contacts. That does not significantly increase the capacity to trace and isolate the upstream sources of new cases. That becomes much harder when things are opened up so the proportion of “mystery cases” can be expected to grow from the present very low level of about 1 every 5 days. From such a low level the growth will be slow for a long time. But when it starts growing fast again it will take much longer to eliminate than it would have if they had finished the job this time.

New Zealand’s contact tracing capacity was exceeded at only 100 cases per day in March. That is what forced them to lockdown quickly and hard. Their success came entirely from locking down quickly, not from contact tracing.

The same campaign that forced abandonment of the roadmap in mid-October is likely to prolong ignoring a slow growth in “mystery cases” and pretending that it can be reversed by intensified contact tracing and isolation of only downstream cases.

I will try to write something persuasive later.

Meanwhile I am just getting this off my chest as another half-baked article.

5 thoughts on “covid-19 – Third Wave

  1. I had to laugh when Glen said that he cut his economic teeth on Samuelson. I cut mine on Anti der Samuelson.
    Everyone has a past and I guess its useful to know a persons past to see how they got to where they are now.
    Glen’s past is that he was about to take a position in the Reagan administration but his personal life went into a downward spiral and he did other things instead but its worth remembering that he was OK working for Reagan a man who opposed the Civil Rights Act 1964, opposed the Voting Rights Act of 1965, who vetoed the Civil Rights Restoration Act of 1988. A man who privately called Africans monkeys and who described Jefferson Davis as a personal hero. He also opposed the release of Nelson Mandela. Now Glen is not responsible for Reagans views and actions only that he was prepared to work for him and also to take a freebee private trip to South Africa. In those days prominent black people who were prepared to visit apartheid South Africa were a given the status of honorary white. Now this was all a long time ago and Glen’s ideas have evolved but sometimes smart people do some dumb things.
    Just on the pool testing Glen expresses surprise that this is the first time he has heard about it as he “is a pretty well informed guy” well not that informed because I had heard about it back in June when Dr Fauci went public about seriously considering the idea. Ill be generous because the clip is not date stamped maybe its an old clip.

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  2. On the issue of pool testing well of course it’s a great idea but it does have some draw backs. If your looking for a single case of syphilis in a group of 100 soldiers its perfect. You can command the soldiers to give a blood sample divide them into groups of 10 and with 10 tests eliminate 90 soldiers from your search.
    But if you are looking for an airborne disease in the community its a lot harder. With the syphilis we can reasonably assume that the soldiers arent fucking each other (at least for the duration of the test) but in the community we would expect an airborne disease to spread while the testing is underway. Plus the federal government doesnt have authority over testing, thats a state role and with some senators calling covid a hoax we have a reluctance to cooperate. Once the disease has taken off you may have 10 infected people in your group of 100. Its possible that you could divide them into 10 groups do 10 test and eliminate no one. Now to be clear I am saying that this method will work early in the outbreak most strategies do but once the outbreak has taken hold its much harder as everything is, plus you can test today and because its so easily transmitted the picture may have completely changed by tomorrow when you get the results back.
    Glen hits the nail on the head when he asks if this is so simple why hasn’t anyone tried it?

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    • Kotlikoff dodged question about why nobody has tried it. Seemed to be suggesting that it was some new idea that he was a major contributor to (and Trump the major blockage). Actually it has been widely used from the start. China has tested 9 million out of 11 million in Wuhan over 10 days in May, well below this July video. Since then similar in Tsingdao and just now Kashgar. In each of these cases they were correctly using pooled PCR tests for catching small residual numbers. Not like Slovakia or Glen Loury and Laurence Kotlikoff trying to stop an epidemic wave without lockdown (and in Slovakia’s case not using PCR tests). Will write a separate post on these issues soon.

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