covid-19 Update mid-November 000

I am still reading and not yet able to write a persuasive article.

But here’s my tentative view on current developments.

Victoria having zero “mystery cases” over fourteen days is a significant milestones achieved earlier than hoped for in the original “Roadmap”. Far more significant than the other two zeros – daily average cases and deaths. But 000 is still an “emergency”, although no longer a “disaster”.

The problem is that while things remain “as good as it gets” and even after the numbers start to rise, more and more people will act as though the emergency is over and ignore the monotonous repetion of official advice that it isn’t.

I did not expect zero “mysteries” over 14 days would be reached at all, because partially lifting restrictions in October would slow down the reduction in transmission prolonging the lockdown until it was abandoned without having actually eliminated community transmission.

I still think that happened – the restrictions were lifted too early so that the risks were not minimized. If lockdown had been maintained until 28 days with no “mystery cases” we could be significantly more certain of having eliminated community transmission.

But it is now plausible that 28 days could be achieved despite opening up. Even if 28 days was achieved there would still be some risk but it would be reasonable to describe as “minimal” in a context where the risk of outbreaks seeded from elsewhere would be much more important.

I still don’t expect that we will reach 28 days. But they have certainly achieved what they setout to do with an “aggressive suppression” strategy far closer to New Zealand’s elimination than the national framework.

The risk is now minimal in the sense that outbreaks that end up in a third wave that needs another lockdown are more likely to start in other Australian States than from residual local transmission in Victoria.

That may well be “as good as it gets”.

Certainly it is a good time to enjoy the opportunities available outdoors. (I have even had my annual haircut and beard trim!).

But precisely because people will indeed do so and opening up will accelerate, it is reasonable to expect that any residual transmission chains will become much harder to suppress when they eventually do become visible. It won’t get better over time.

While it is possible there may currently be none at all, I think it is far more likely that the remaining transmission chains would simply be harder to detect.

For example asymptomatic cases among school children could continue for quite a few generations before eventually some older person such as a parent or teacher becomes ill enough to get tested. If it happens to be a household in precarious employment, living in a community with a high proportion of other such households, it could be a few more generations before anyone gets sick enough to turn up at a hospital where they would certainly be tested. Because nobody has turned up at a hospital or other testing in 14 days we can be reasonably confident the numbers out there are quite small. With small numbers the stochastic character can either result in transmission dying out completely or exploding to higher numbers. The more the small numbers are in contact with others because restrictions have been lifted the higher the chances of transmission exploding.

Contact tracing works very well during lockdown because people have few contacts and know who or where they are.

After opening up it becomes a repeated game of “whack a mole” as in the “gold standard” of NSW. Note also today’s “mystery” in South Australia.

With greatly upgraded contact tracing and testing efforts, as well as slowly decaying compliance with physical distancing, registration etc, it will be quite feasible to deal with occasional, sporadic outbreak with a minimal risk of it spreading.

Then it is simply a matter of how many weeks you repeat taking that “minimal risk” before you end up needing to go into “surge” mode after more than 4 new confirmed cases (not in quarantine) per day per million population. Then how many times you repeat that risk of a surge before ending up exceeding surge capacity at 10 times that rate of new cases (40 per day per million) and having to go back into lockdown. See targets in:

https://www.health.gov.au/resources/publications/national-contact-tracing-review

I don’t think there is much risk of Australia ending up in the same situation as Europe or North America, let alone the rest of the world. When an Australian surge gets out of control at 40 cases per day per million, there should still be plenty of time before hospitals become overloaded for another lockdown to prevent that. (Victoria came nowhere near hospital overload despite delay in locking down resulting in 800 deaths from a peak of 750 cases per day).

How likely such a third wave is depends on how long before a vaccine has sufficient impact on transmission to eliminate the risk. (It also depends on many other factors, many hard to model).

Recent announcements suggest Australia could achieve herd immunity from vaccines by the end of next year.

It will certainly take a lot longer than that before the whole world has achieved eradication. I will discuss that and other issues such as testing etc in later articles.

I am certainly not in a position to estimate the probabilities of a third wave and lockdown in Australia better than the public health advisors who have been doing so.

But from what I have seen published about the models, I seriously doubt that they are in a good position to estimate either. Certainly their commitment to “stay open” hinders accurate estimation of when it becomes necessary to lockdown again.

That will also have to be for a later article.

Meanwhile, it is worth remembering that we are much less than half way through if it ends by the end of next year.

Some reduction in risk of transmission would result from the first tranche of vaccines targeted at Health and Aged Care workforces and others likely to be exposed and to expose others. But don’t assume a production line for vaccine and vaccine imports will produce a steady output of vaccine imports until herd immunity is achieved by the end of next year.

In fact the pilot plants for phase 3 testing have already continued production and some supplies may be available (elsewhere) as soon as approval is rushed through, perhaps even this month. The first mass production plants will also come onstream shortly after. But the requirement is for literally billions of doses.

I would assume there would be a classic “acceleration” as plants are first built to produce machines (bioreactors etc) and raw materials and train high tech workforces for new plants. Risks of a third wave might be significantly reduced when only half the population has immunity.

But don’t assume that occurs half way through next year. If the exponential growth doubles output each month then the half way point could be November next year with 100% following a month later.

Priority in deliveries should go to the poor countries that will be in a desperate situation by then. Australia with relatively few cases has major reponsibilities to assist others far worse off in our region, such as Papua New Guinea and Indonesia.

More likely the queue will be allocated supplies according to capacity to pay rather than need. Certainly individuals who can pay premium prices will be vaccinated before those given free supplies as a public health measure. There will be free distribution as a public health measure within capitalism, but there won’t be fully prioritized distribution according to need.

But the plants located in Europe and North America will have plenty of demand from local States that have far greater need than Australia and also have the capacity to pay for what they need.

covid-19 – Notes on Trump 52 – “platitudes matter”

After predicting a landslide against Trump and getting a 10% increase in his vote as well as a reduction in the Demcrat majority in the House, the mainstream media has now officially given up on Trump voters.

Trump disputing the election and challenging it in the Courts (as announced in advance and expected) is being described as a fundamental assault on democracy.

In fact it is so outrageous for a candidate to dispute the results of an election and go to Court that his “baseless” claims must not even be reported.

This stuff should not be surprising from the people that reacted to Trump’s original election by denouncing him as a Kremlin agent and demanding that the intelligence agencies summarily remove him in a coup d’etat.

That went on for literally years, but the same clowns seem to imagine soothing platitudes about “healing” are going to prevent large numbers of people who voted against the swamp remaining hostile to it.

Here’s an explanation of the grave responsibility the media has taken on itself to protect the American people from Trump’s “baseless claims”.

https://www.abc.net.au/news/2020-11-07/conversation-to-stay-or-cut-away-as-trump-makes-baseless-claims/12859062

Here’s a good rendition of the way the adoring media has portrayed the new healer:

https://www.abc.net.au/news/2020-11-09/joe-biden-us-election-donald-trump-reality-check-stan-grant/12862038

[…]

And with that, Donald Trump suddenly seemed like yesterday’s news.

The appearance of Joe Biden as president-elect flanked by his vice-president Kamala Harris has immediately swept away the Trump years.

Not that Trump disappears or that his followers no longer matter — they do as much as ever — but the spell has been broken.

Donald Trump alone with his petulance and lies now looks small, like the Wizard of Oz — just a little man behind a big microphone.

Biden, dismissed by many — the man who had failed in two previous presidential campaigns — now looked and sounded presidential.

In Kamala Harris — the first female vice-president, African-American and the daughter of an Indian immigrant — Biden announces the next generation of the Democratic Party.

Moments matter and this was a moment: an historic moment.

Words matter, and these were words of healing and unity.

They are just platitudes but they are what a battered country needs to hear right now.

Stan Grant goes on to say that the platitudes the media thinks “a battered country needs to hear right now” are unlikely to work.

Another surprisingly perceptive article from the same ABC journalist is here:

https://www.abc.net.au/news/2020-11-08/us-presidential-election-trump-biden-divided-democracy-in-action/12855936

Both are well worth reading in full.

So is the full text of the platitudes from Biden and Harris.

The 76 million who voted Democrat are congratulated because:

“You chose hope and unity, decency, science and, yes, truth”.

As for the 70 million hopeless, disruptive, indecent, irrational liars who did not make that choice, it seems unlikely that they will be as impressed by the healing platitudes about unity.

We are again at a turning point that makes it impossible to predict how things will develop.

I still see no signs of a left emerging. But there is an opening for a movement that really does unite people against the populist demagogues on both sides.

I don’t claim to have much understanding of how things are developing in Australia, let alone America.

I won’t try to respond in detail to the points made here.

https://c21stleft.com/2020/10/31/understanding-america/

I don’t believe either the Universities or media were ever oriented towards telling the truth, nor that they have recently been taken over by some alien force antithetical to their previous orientation.

I think corporate liberals are just continuing to be corporate liberals.

Its just that this is becoming increasingly ridiculous.

A movement that expressed the same disgust that corporate liberals have for celebrity con artists like Trump and that Trumpists have for the corporate liberals should be able to form a very broad united front.

What’s still missing though is an actual program as to how things should be changed.

There are pressing issues in the USA that will come to a head quickly.

Biden has announced a task force to prepare an action plan to deal with both covid-19 and its economic consequences immediately on taking office on 20 January.

The epidemic will be much worse by 20 January. It would make sense to start implementing that plan immediately in Democrat States willing to accept his leadership and declare martial law and a national lockdown on taking office. But I would be surprised if that happened. I haven’t seen any sign of Biden proposing a lockdown at all.

Instead I expect that Trump will not be a “lame duck” President until January 20, but more like a “wounded bull”.

Majority control of the Senate will be determined by the outcome of two runoff Senate elections in Georgia, on January 5. The next day a joint session of both Houses presided over by Vice-President Pence meets to count and finalize the Electoral College results. That is the day the election results get finalized, not when the media “calls” them. If any disputes have not been settled by December 8 they may end up fought over then, during the height of an epidemic wave.

If all goes unexpectedly smoothly we will either be back to the usual Washington gridlock in which President Biden can blame the Senate for his inability to do anything just as Obama did for 8 years with Biden as his Vice-President. Or else Democrats do get both Houses and the Republicans and pseudo-left Democrats can blame Biden for his inability to do anything despite having control of both Houses and the Executive.

I would expect either of those to be an optimum situation for Trump, who will do far better posturing against the swamp from opposition than as President. I expect that Trumpists will still dominate the Republican primaries and could be swept back to a majority in the mid-terms if the platitudes continue as I expect they will.

It is all far too complex and murky to predict as opposed to just having vague “expectations”.

But for the record, I do predict that the Supreme Court will declare the Pennsylvania ballots that arrived after election day invalid. I haven’t seen any evidence either supporting or rebutting media claims that this won’t effect the result. If the numbers are as small as they say and if they were kept separate from the other ballots as ordered and as claimed, the court would not have an excuse to invalidate enough Democrat votes to affect the result.

But I would not assume the media claims are correct about that any more than I would be surprised at the rather notorious party machines in Democrat run cities encouraging voters dead or alive to vote often as well as early.

It is after all the plain duty of every red blooded American to do whatever it takes to prevent the monstrous Trump from continuing to pollute the White House. So why on earth would Democrat officials faced with the danger of a racist, fascist Kremlin stooge again disrupting national unity NOT rig the election, if they could?

The judgment I expect will be based on the Supreme Court reaffirming the well established principle that State legislatures have plenary power over Federal elections.

I do not expect that the Republican legislatures and Governors in Arizona and Georgia might take the opportunity to exercise that plenary power and decide to choose the State’s electors themselves and so reverse the results.

But the monotonous bleating from the media about how unpatriotic and undemocratic it is to dispute the media’s announcement of who won, suggests they are very worried indeed about something.

They are usually wrong but one cannot assume that they are always wrong.

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.

covid-19 Senior Constable Vogon of Fitzroy Police Station

This afternoon at 16:16 I had a 12’27” call to Fitzroy Police Station to inform the Sergeant about the conduct of a Senior Constable whose name was not Vogon.

The call was handled professionally so I hope the problem will be dealt with. I was asked at the end whether I would like to be called back with any follow up. I said that would not be necessary as I am merely informing the Sergeant about behaviour that should be confirmed by the other officer present and would be likely to be part of on an ongoing pattern. But I am available to provide evidence if needed.

These notes are not about the call but concern the incident I was calling about, while the facts are still fresh, in case there is need to assist further. I have added humorous embellishments for the benefit of other readers.

A little after 15:30 pm this afternoon I was sitting at a table in a public park close to my current accommodation eating a cookie and reading channel 9 Entertainment’s daily newspaper. My face visor and walking stick were clearly visible on the table, as was the cookie.

I saw two police officers approaching and put on both the visor and an N75 mask in view of the likelihood that they intended to come close enough to speak to me and therefore too close. They did.

One of them introduced himself as a Vogon seconded from the Vogon constructor fleet to assist the Murdoch press in discrediting the Victorian police. He did this by requesting that I remove my face mask so that he would be able to hear me speak clearly.

I’m not sure that I emphasized that clearly enough in conversation with the Sergeant. Just think about the newspaper headlines in “The Sun”. Dictator Dan’s police patrol public parks demanding that people remove their face masks! This isn’t some ordinarily incompetent bullying SC, but somebody quite “special”. He is either being paid to provoke people or he cannot help himself.

He made this quite breaktaking request in the manner of an exceptionally polite Vogon. I had no difficulty in suppressing my amusement and responding politely that I would keep my mask on and he would be able to understand anything I said.

My best guess is that he had been rather looking forward to lecturing me about the need to have my mask on and then exercising “leniency” by just giving me a warning and felt frustrated about my having put the mask on before he arrived, jumped to the conclusion that I had done so to avoid the lecture rather than because I would do so before conversing with anybody at all and was just too dumb to figure out some less bizarre opening remark.

A much less plausible theory is that if I had removed the mask he could then have delivered the lecture and issued an infringement notice that would inevitably be challenged. That would require actual collaboration from the other officer. I saw no sign of that. There was no direct intervention by the other officer. Whoever was senior, it would not be unusual for officers to avoid intervention against each other in public despite bizarre behaviour. It is interesting to encounter one officer behaving like SC Vogon, but two actually supporting each other in asking people to remove their masks so they could issue infringment notices for not wearing them seems a lot less likely.

Anyway, the other police officer avoided any potential escalation of the absurdity by professionally asking for my name, address and date of birth. I mentioned that I walked to and from the park for exercise, wore my mask only when entering shops and had removed the visor for eating. I was told that they were looking for somebody else involved in an incident nearby who matched my description. I complied, with the request, also mentioning that my name was not the same on my driver’s licence and that I was very young at the time of my birth and was only repeating what I had been told since.

SC Vogon stood further back while this was proceeding. I would guess this is standard infection control procedure and it was certainly welcome.

But when the other officer had finished and was prepared to leave he stepped forward and took over, demanding to know why I was in the park. I responded that I had already given the other officer the information required. He said that there were only four valid reasons to be out and I was required to leave immediately. I told him that I had downloaded and was thoroughly familiar with the CHO directions of July 19 and was in full compliance with those directions.

“Stay At Home Directions (Restricted Areas) (No 3):

  1. Leaving premises for exercise or outdoor recreation
    (1) Note 1. …Examples: Outdoor recreation includes sitting in a park…”

SC Vogon said that he was requiring me to pack up and leave immediately and that if I did not do so he would issue an infringement notice. I said that I would be making a formal complaint about him and would not be leaving until he provided his name and number. He did so before leaving and his Sergeant now has them.

If the other officer is truthful the Sergeant will know that SC Vogon engaged in two criminal offences:

  1. Abusing his membership of the Police Force to demand removal of the face mask of a person he knew to be over 70 and especially vulnerable to covid-19. Nobody stupid enough to go around asking anybody at all to remove their face masks in response to a directive requiring face covering should remain in the police force.
  2. Threatening to issue an infringement notice to a person sitting in a park by themselves, knowing that he had no authority to do so whatever. Nobody up themselves enough to go around doing that should remain in the police force.

I am in favour of rigorously enforcing public health directions in a pandemic emergency. Doing so requires removing saboteurs like SC Vogon from the police force.

It would be surprising if this behaviour is not part of a pattern that others can confirm and that any random Sergeant in any police station would want to stop.

So I am leaving it to the internal administrative processes.

But if there is some subsequent inquiry as to why SC Vogon was not dismissed before he caused real damage, my contemporaneous notes of what was known to his Seargeant about him as of today will be available.

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.

covid-19 – Do panic?

As far as I can make out there is no current plan for containing the second wave in Victoria. The effective reproduction rate is clearly still above 1, two weeks after returning to stage 3 restrictions but no plans to lower it have been announced.

The continued exponential growth is not unexpected since cases in the second wave are driven by “community transmission” from sources that remain unknown after contact tracing and consequently cannot be isolated. The first wave was mainly seeded from overseas and was contained with only a low level of untraceable community transmission remaining. Contact tracing was able to keep up when contacts were restricted by stay at home orders. But with restrictions lifted while transmission continued it is much harder to suppress the second wave. It is likely to require stronger restrictions as well as take longer, but no such plans have been announced yet.

The Australian Medical Association called for stage 4 restrictions nearly a week ago:

https://mobile.abc.net.au/news/2020-07-17/coronavirus-australia-live-news-covid-19-victoria-nsw/12464550

Instead of a plan there were three announcements today:

  1. First, there was an announcement about a future announcement. There will soon be an announcement about paying people who cannot afford to stay away from work while waiting for test results so that they can afford to do so. Obviously necessary but there is no more reason to expect workers in precarious jobs to quickly change their responses as a result than there is to expect a governent to take such an obviously necessary measure less than 3 months after a pandemic begins.
  2. Second, instead of a plan there was announcement today that the government is concerned that 90% of people who get tested because of having symptoms are waiting 3 days from onset of symptoms and half of those tested are not remaining isolated while waiting for results.

That does drive transmissions since it is well established people are most infectious for the few days immediately before and after onset of symptoms. The successful response to that has been extensive health monitoring and testing with immediate isolation in separate facilities, as in China (including HK and Taiwan). No other response has been shown to work.

Nobody has ever claimed that mere speeches at press conferences could possibly have a major impact on the predictable and expected delay between symptom onset and testing nor on the likelihood of people isolating themselves when they have got tested as a result of appeals to do so rather than with an expectation that they actually have the disease.

  1. Third, instead of a plan there is an incoherent press release about face coverings (with an exception to encourage people breathing heavily as they run past others to continue doing so). This press release has not even been turned into an enforcable “direction” but has been accompanied by a $200 penalty for “failing to comply with a requirement in relation to a face covering”.

https://www.dhhs.vic.gov.au/face-masks-covid-19

https://www.legislation.vic.gov.au/as-made/statutory-rules/public-health-and-wellbeing-amendment-further-infringement-offences

Recommendations to use cloth face masks were accompanied by instructions on how to sew one yourself on 20 July:

Click to access Design%20and%20preparation%20of%20cloth%20masks%2010%20July.pdf

Actually organizing supplies of cloth masks, should be easy compared with supplies of effective PPE such as P2 or N95 disposable masks. Instead, national stockpiles of PPE are being released to hospitals and aged care facilities to cope with the inevitable supply chain difficulties resulting from panic buying by the public in response to a panic announcement that use of masks would be compulsory from midnite tonight.

Cloth maks are of course even less effective than the surgical masks that health and aged care workers have been stuck with. They simply don’t adequately prevent aerosol transmission in confined spaces. Recent evidence indicates such aerosol transmission is more significant than previously thought.

Being in the same room as a confirmed case for more than two hours already makes one a “close contact” subject to mandatory 14 days quarantine. That was true when aerosol transmission was considered less important. Confined spaces encourage droplet transmission both direct from face to face and via face to hand to surfaces to hands to faces. Cloth masks and ordinary surgical masks can both reduce droplet transmission and should have been made compulsory in all confined spaces long ago (with cloth masks as merely a “better than nothing” expedient while supplies of disposable surgical masks were ramped up).

But a serious response to evidence that aerosol transmission is more important than previously thought cannot involve either cloth masks or standard surgical masks. It would require very strict controls enforcing effective PPE both on public transport and in workplaces (including schools) since crowding people into both results in breathing each others aerosols in confined spaces. That is radically inconsistent with the national policy of opening up the economy instead of first eliminating community transmission. It would involve prohibiting the use of cloth masks or surgical masks and requiring the correct use of effective diisposable PPE (N95 or P2 masks or Positive Air Pressure Respirators).

Mandatory cloth masks have been openly introduced in both the UK and USA to to reassure people that it is safe to go to work and school and shopping when it isn’t.

The stated reason for following the catastrophically stupid UK and US policies here is in response to a Lancet article published:June 01, 2020:

“Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis”

https://doi.org/10.1016/S0140-6736(20)31142-9

That article did systematically review a large number of previous publications and confirmed the well known fact that PPE is essential in health care settings. It did not shed any light whatever on the public policy issue of whether mandatory cloth masks would have greater benefits in making people more situationally aware and increase compliance with physical distancing and hygiene measures or whether it would do more harm by tending to reassure people that it is safe to enter crowded public transport, workplaces and shops etc. In healthcare settings cloth masks are used only when supplies of proper PPE are unavailable.

It is inherenty difficult to be sure about the effects outside healthcare settings. The evidence actually available is confounded by the likelihood that people who do wear masks when they are not mandatory are more cautious generally and therefore less likely to give or receive infection. The UK government may find people are not as reasssured as they hope.

But the only serious medical advice is that WHEN you are unable to maintain physical distancing AND you don’t have effective PPE, a cloth mask is better than nothing. Presenting that as though using cloth masks can substitute for greater restriction of physical distancing is purely cynical.

The Lancet study had no relevant information about likely effects of mandatory use. In fact it listed only one paper that was actually about Covid-19 and was not about healthcare settings. All the rest were either about other coronaviruses or about healthcare settings. The relevant paper was:

“High transmissibility of COVID-19 near symptom onset”.

medRxiv 2020; published online March 19:

https://doi.org/10.1101/2020.03.18.20034561

The title accurately describes the content. That title is the most important fact about COVID-19 that distinguishes it from other pandemics.

The implications of that fact are starting to sink in.

A debate is now starting about whether to attempt Elimination instead of the obviously failed current strategy. (The term “Eradication” should be avoided as impossible until a global vaccine whereas Elimination might be possible with strict border controls for island countries like Australia and New Zealand).

If it does turn out that the current second wave in Victoria is entirely or even just largely from strains of the virus that were not in circulation before the ending of stage 3 restrictions that will be fairly conclusive evidence of the bankruptcy of current policies to “Adapt and Control” (and claim to “Suppress”).

It would imply that elimination was feasible in Victoria since the previously existing small levels of community transmission had been eliminated in Victoria just as in New Zealand, Western Australia, Tasmania etc. It would also imply that the “slow and careful lifting of restrictions” was in fact completely fragile since it had been able to rapidly produce a second wave.

Unfortunately advocates of an elimination strategy are not explaining clearly how hard it will be and what sort of measures are required.

Elimination first requires greatly prolonging restrictions for enough weeks and months after zero cases per day until there have been no new cases outside quarantine isolation for a month or so. Pretending that would be quick or avoiding the issue only helps opponents.

Pretending that Elimination would not be fragile and require major preparations against another epidemic is even more helpful to opponents. It is blindingly obvious that with the large majority of the population still fully susceptible to infection and an announcement that the virus is not circulating at all the conditions would be ideal for “normal” behaviour to resume and so for any new outbreak to become another epidemic exactly as before.

The following are necessary to prevent subsequent sporadic occasional clusters becoming outbreaks and then epidemics during the long period in which the overwhelming majority of the population remains susceptible because there is no vaccine:

  1. Tight quarantine isolation. That lesson has probably been learned although still not applied to “contacts” and people “waiting test results”. Absurdly, people considered likely to be infectious are still being encouraged to isolate at home and infect their households. I thought that idiocy was over when the AMA in Tasmania recommended medi-hotels and the Commonwealth Health Minister indicated being open to it. But it isn’t over. Police were used to confine infected people in “vertical cruise ships” to their cramped large households rather than escort them to safe quarantine accommodation.
  2. Massive continuous testing, especially for all workers in contact with the public (shops and schools as well as healthcare etc). That requires serious industrial effort to deploy test workers, equipment and supplies. Pooled tests can immediately expand the numbers by an order of magnitude without waiting for more equipment and supplies, but it still requires a major workforce for which there does not seem to be any current plan. More than an order of magnitude increase is required for continuous testing so large long term investments are necessary for capacity to produce equipment and supplies as well as to train staff. This should also be part of an effort to help other countries in a less fortunate situation.
  3. Rapid contact tracing. Basically not possible without mandatory use of tracking devices. Targets for manual contact tracing within 24 hours are not being achieved during stage 3 restrictions and could not possibly be achieved once restrictions are lifted following Elimination. It is unclear whether achieving those 24 hour targets would be sufficient to stop another outbreak anyway. Instant contact tracing is achievable only with mandatory tracing devices.

Manipulating people to “opt in” to trusting governments with mass surveillance was a cynical ploy rejected by a substantial majority. The tracking must be switched off whenever it is NOT a public health emergency and switched on only during sporadic outbreaks for the purpose of rapidly suppressing them.

covid-19 – Total Lockdown and Henrik Ibsen

Today’s announcement of additional postcodes returning to stage 3 restrictions and a total lockdown for 3,000 people in public housing could be encouraging:

Statement From The Premier

It implies that governments are following public health advice to ensure the hospitals do not get overwhelmed.

There is still no recognition that the need for this retreat indicates that the current level of opening up is already unsustainable. But perhaps it indicates that if and when that does become clear, the resulting shutdown will be clearly aimed at Eradication.

Even with successful Eradication (at least a month with no new cases) it can be expected that occasional sporadic outbreaks would occur (both from quarantine failures and the very long tail of asymptomatic or pre-clinical carriers). The point is that sporadic outbreaks can be contained by the sort of local measures successfully undertaken relatively easily in regional Northern Tasmania and now being taken with greater difficulty in suburban Melbourne. The resources available for testing, contact tracing and isolation can contain an outbreak that really is just local, sporadic and occasional.

But with any level of underlying “community transmission” there is simply no way to avoid the statistical certainty that some of the regular inevitable clusters resulting from that will become outbreaks, some of which will again become epidemics.

According to the current testing results we now have an unacceptable level of community transmission from untraced sources whose contacts are unknown and cannot be isolated. That level is higher than when Australia abruptly went into stage 3 physical distancing. We are now restoring the same level of “stay at home” orders in 12 postcodes that we had more widely in March, plus a total lockdown for 3,000 people (enforced by 500 police, 1 for every two or three households!).

It may well be feasible to contain the current epidemic wave without the wider response that was needed in March, because:

  1. We are able to do far more testing now and can be more confident that the level of community transmission is not already dramatically higher than we are aware of.
  2. The surge capacity of the hopsitals has been greatly increased.
  3. We know that if containment fails we can revert to stage 3 restrictions and expect them to work rapidly enough to avoid the increased surge capacity being overwhelmed.

Obviously it is better to impose these restrictions locally than nationally if that can work, just as it is better to isolate large numbers of “contacts” than to shutdown the whole society.

But the main reason for confidence that these local shutdowns could work is the genomic evidence that they originate from a single common cause. The virus strains of many current cases were not known in Victoria prior to the shutdown and so can reasonably be assumed to have arisen from failures of quarantine of incoming travellers rather than from underlying
“community transmission”.

If that was not the case, it would be illogical to attempt just shutting down local areas, except as a way of preparing for a wider shutdown. The underlying community transmission could not reasonably be assumed to be sufficiently localised for that to work.

We won’t know if it is sufficiently localised now until the current efforts have either succeeded or failed. But we do at least have a path towards a full shutdown again by simply adding postcodes as the efforts fail. Obviously the public health authorities making the local attempt are in a better position to judge the likelihood of success than anybody else and are entitled to a “margin for appreciation” in not knowing what to do quickly enough.

But is that situation acceptable?

Assuming they are right and the current second wave is contained locally, what does that tell us about the policy of “Suppression”?

No matter how egregious the blunders that produced this particular outbreak might be, we know that there will be more outbreaks regardless of how well those particular blunders are dealt with. The public health officials in charge have confirmed this repeatedly.

We also now know that at the present levels of social distancing etc a small single cause outbreak can easily become an epidemic.

To me that necessarily implies the present levels need to be tightened. Yet Government policy continues to be for further loosening and opening up.

So far that policy has not cost many lives. Do we really have to wait until it does before reversing it? The USA and Brazil are not outliers. The UK and several European countries where public health advice is not being spectacularly ignored still have larger death rates and are pressing on to open up their economies. There doesn’t seem to be much other than “luck” preventing Australia joining the club.

The least developed countries do not have an option for attempting Eradication. China, including Taiwan and Hong Kong have demonstrated that it is at least worth attempting. Australia and New Zealand still have the option.

That option was explained in the “Group of Eight” Universities Report to Government but has been rejected.

I am not competent to say whether Eradication is feasible in Australia. It will certainly take a lot longer for States with community transmission. We are now more or less back to the starting point level of community transmission in Victoria, just from one major outbreak becoming an epidemic wave.

But I am competent to say that there has been no clear coherent justification for the current policy of not attempting Eradication. An attempt may not work and could take much longer than people hope, without working. That much has been coherently explained.

But we also know that the policy of Suppression is not working. The current level of opening up has already led to one epidemic wave and can be expected to result in more, even though economic activity is nowhere normal levels.

If we narrowly escape having to go back into Stage 3 more widely, how much worse off would we be if we had instead prolonged the previous Stage 3 for longer? The government proclaims that an “on off” policy of successive waves would be worse. True enough. But why would narrowly avoiding the first “on off” be confirmation that they are on the right track? Doesn’t it rather confirm that their policy of lifting the restrictions to the present level was a blunder that has not resulted in opening up the economy but rather left us in limbo waiting for the next outbreak?

There needs to be some serious detailed study based on scientific evidence.

That is not the function of an administrative inquiry.

But there is now an administrative inquiry. If it does its job it should at least spell out the need for a scientific inquiry:

https://www.premier.vic.gov.au/judicial-inquiry-into-hotel-quarantine-program/ Wed 2020-07-02

The administrative inquiry to examine the operation of Victoria’s hotel quarantine program for returning travellers will begin promptly to examine a range of matters that includes “policies” and “decisions and actions” of government agencies.

With a budget of $3 million a report is due by Friday, 25 September 2020. That is about 10 weeks.

The inquiry is headed by one of the former Royal Commissioners into Institutional Responses to Child Sexual Abuse with experience on the Coroner’s Court.

The necessary administrative changes have presumably already been made. A formal inquiry may or may not contribute to fully absorbing lessons learned, and either deflecting or promoting political, and legal accountability both civil and criminal.

But wouldn’t it be interesting if the inquiry did take up its mandate to examine “policies”?

It has been proclaimed loud and clear that the underlying policies are “suppression” as opposed to “eradication”, that outbreaks and deaths are to be expected as part of the “new normal” in adapting and learning to live with the virus.

The aim of that policy is to avoid overwhelming the hospitals with a surge of cases while opening up the economy as rapidly and safely as feasible. The current lockdowns in Victoria are cited by public health officials as a textbook example of that policy in action, with deaths expected as a result.

That policy is the underlying root of this and every future outbreak, any one of which could become another epidemic wave as long as there is no vaccine and the current lack of restrictions remains in place.

Any coroner investigating the deaths should be able to draw attention to the underlying problems that will result in more such deaths and do so with sufficient vigour to result in a scientific inquiry.

Here’s a submission rebutting the “evidence” from business pleading to open up faster:

https://www.marxists.org/archive/eleanor-marx/works/enemy/index.htm

This play was censored in China following performances in September 2018.

The audience recognized that the Norwegian local business interests rejecting medical advice to protect public health were exactly like the Chinese officials who initially covered up the Wuhan outbreak of covid-19 a year later. The Chinese officials recognized the resemblance too and simply cancelled the play.

https://en.m.wikipedia.org/wiki/An_Enemy_of_the_People

It is available as video Starring Steve McQueen:

https://m.ok.ru/video/1040526478004

Well worth watching. I initially thought the play presented the behaviour of local businesses a bit too crudely.

But a glance at today’s media in full cry for “opening up” shows a level of shamelessness that is hard to caricature.

Our national government told everybody that it was their patriotic duty to download the Covid-safe app in order to enable the government to safely open up the economy.

A large majority decided not to do so.

There are many reasons why people don’t trust governments. But governments do know they are not trusted.

The lie that the economy is being opened up “safely” should be exposed.

Promotion of Henrik Ibsen’s play could be a major contribution.

covid-19 Teetering at the Rubicon

Perhaps Australia is teetering on the edge of the Rubicon rather than having crossed it.

The pause in rollback of restrictions in Victoria suggest at least a certain hesitation about actually crossing.

My view was and is that a flat rate of daily infections implies that the rate is likely to start rising.

That is because the declining numbers from incoming travellers are presumably being roughly balanced by the increasing numbers of “community transmission” from untrackable local sources.

I wrongly thought that the week or so of roughly flat numbers at around 50 marked the bottom of the trough, but in fact that was a temporary blip and the numbers continued to decline.

But restrictions were lifted while there was still community transmission so I assumed the relevant authorities were aware of the consequences and fully committed to a much higher rate of infection (while also committed to not risking the hospitals becoming overwhelmed).

Now I’m not sure what’s going on. Victoria’s Chief Health Officer mentioned that the virus is doubling every week. I haven’t attempted to analyse the statistics and last time I looked some of the necessary information was not available (proportions “under investigation” that end up classified as “community” or “known source”). The raw numbers more than doubled over the past week but I assume he was referring to a more relevant estimate of the underlying effective rate at which each infected case generates another one before becoming non-infectious or dying (taking into account that many are isolated and unable to infect others while others transmit before ever being isolated or while ineffectively isolated).

If it is doubling every week under the present level of restrictions it would obviously be necessary to impose much tighter restrictions to prevent the hospitals eventually being overwhelmed.

Perhaps the local restrictions are intended to prepare the way for that and help neutralize the massive campaign that has been waged from “business” to reopen regardless.

But perhaps not.

Perhaps there is still some lingering belief that a “sweet spot” exists in which the level of restrictions and behavioural adjustments just keeps the virus “under control” with a relatively small number of sporadic outbreaks. each of which can be contained. It might be hoped that local lockdowns and the “pause” would tip the balance of behavioural changes sufficiently.

That doesn’t make sense to me. “Eradication” is the only such “sweet spot” – when the numbers are so low that new cases are merely “sporadic” outbreaks. That was not attempted in Victoria or New South Wales. I am not competent to say whether it was feasible but if they were going to attempt it they would need to maintain a much longer period of tight restrictions and I cannot estimate how long that would have needed to be or how feasible it would be to maintain restrictions for so long. Also far more would need to be done to ensure that subsequent sporadic outbreaks could not get out of control (eg the contact tracing app would have had to be mandatory).

The alternative to Eradication was and is successive “waves” of infection. Each time the restrictions are lifted the virus comes back at first gradually and then quickly so that another shutdown has to be introduced. That alternation continues until a vaccine.

But the current “pause” seems to indicate some sort of “teetering” between fully accepting a policy of successive waves and actively seeking to replace it with a policy of Eradication.

I don’t see how local lockdowns could prevent ongoing community transmission within a city like Melbourne. Such measures could only work against “sporadic” outbreaks. It will be interesting to see whether it can work in Beijing.

But perhaps others who know more about it than I do think it is at least worth trying. If so, perhaps they could still go in either direction – continue crossing the Rubicon or attempting Eradication.

covid-19 Inspiring Black Rights Matter Protest

The Melbourne rally and march was really enormous.

I stayed on the outskirts to keep about 8m away as most protestors were far closer than 1m. Unfortunately masks do make people feel too “safe”. So I missed out on the speeches, perhaps fortunately. But I did not miss out on the size or nature of the crowd as it went past while I waited to join in at the end.

It took more than two hours to go past! The usual suspects were hardly noticeable in such a large crowd of mainly young people, enthusiastic and lively.

The mass media campaign against it was a dismal flop and they are now just admitting that there were more than ten thousand present. There certainly were. I cannot estimate but two hours stretched across Bourke St is bigger than anything since the Vietnam moratoriums and a LOT more than just ten thousand.

Youth are on the move again.

Inevitably it simply was not possible for protestors to be properly organised for social distancing the first time. But it clearly is just the first time as lots of people who turned up will now know how strong they are compared with the mass media’s lies.

So it will be necessary to seriously prepare for spreading people out at far less than 1 person per four square metre. The same preparations can ensure the police remain just as absent from disrupting future smaller protests as they wisely were from this one. A self-disciplined crowd spread out can be even harder to suppress than one that blocked the entire CBD for two hours because it was just too big to avoid doing so.

The police prevented trams going down Collins Street for many more hours, perhaps out of frustration, more likely just stupidity. But it was obvious to anybody that this blockage was caused by a police van parked on the tram tracks rather than the protestors departing from the demo.

No doubt when the infection rate rises from the successful media campaign to loosen restrictions prematurely they will blame the protestors. But that won’t impress many.

With even the Courts and police knowing better than to try and suppress huge mass demonstrations reflecting popular feeling, the demands for suppression from the newspapers of Channel 9 and Murdoch have just highlighted both their hypocrisy and their impotence.

An international solidarity movement has just been born. It took a LOT longer to reach this level in the 1960s.

covid-19 Crossing the Rubicon

As far as I can make out, Australia is now fully committed to a policy of “Adapt and Control” as opposed to “Eradicate”.

This means infection rates will continue to grow, at first gradually and then suddenly.

The intention is to avoid the hospitals being overwhelmed while gradually lifting restrictions to get people back to work.

There is already an increase in the reproduction rate, “R”, above 1, from the reduced physical distancing that inevitably followed the announcements of success and plans to remove restrictions. It started rising weeks ago, which was triumphantly announced as still being below 1.

That growth is starting from a very low rate of community transmission, so the growth will initially again be “gradual”. But community transmission means untrackable and uncontrolled transmission. “Community” transmission is not stopped by testing and contact tracing because the carriers are often pre-clinical and don’t get tested. It is only limited by physical distancing preventing transmission. Lifting the restrictions simply means there is nothing to prevent community transmission growing again, at first gradually and then suddenly. This shows up weeks later as the numbers of known cases growing gradually and then suddenly and later still for the numbers of deaths.

Opening the schools removes the main obstacle to getting people back to work and at the same time opens a channel for wider spread of infections among households via schools even while the faster transmission between households via workplaces remains restricted.

As infected school children tend to have mild or no symptoms it is likely that they are less infectious and so transmission between them in schools would be relatively slow compared with transmission between adults at workplaces. That has been presented as though a slow rate of transmission means a decline in cases – with “evidence” such as the low numbers of clusters among school children and of household transmission from children to adults. But we don’t know much about mild or asymptomatic cases because pre-clinical cases obviously do not get much clinical study since they don’t seek clinical assistance. If some of them last longer than more severe cases that trigger an immune system response or result in long term carriers, then a slow rate of transmission can still result in a larger than 1 rate of reproduction, sufficient to cause a (slower) epidemic.

But we don’t actually even know whether or to what extent infected children are less infectious than infected adults. Droplets are the main source of contagion, direct and via surfaces with transfer from hands to face. One would certainly expect that to be greater with symptoms such as coughs and sneezes that actually project droplets. Hence the emphasis on physical distancing together with washing hands and covering coughs and sneezes. Aerosol transmission by simply breathing is mainly known to be important in a healthcare setting where there is continuous close contact with infected patients. But aerosol transmission is important enough that religious ceremonies now permitted even in confined spaces in Germany are not permitted to sing. Singing projects larger quantities of virus into a confined space than merely breathing or talking, even though it does so less than coughing or sneezing. The cumulative effect of being confined in the same classroom as an infected child for hours each day over several weeks is simply not known.

The available evidence is quite sufficient to convince everybody who is utterly determined to get kids back to school so that their parents can get back to work. They are all chanting about it in unison. But since they live off other people’s work their livelihoods depend on them not understanding.

For example the livelihood of lobbyists for pubs depends on believing that a pub could maintain social distancing of 1.5m between customers if it was permitted to cram them in at 1 per 2 square metre instead of the current limit of 1 per 4. Consequently they can adamantly demand that the number allowed in be doubled so that they might be able to reopen some pubs. It simply does not matter that it would be physically impossible for anybody to get in or out. Their role is to lobby, not to understand things that their livelihood depends on them not understanding.

Rather more evidence should be needed to convince others. Why should one expect to have seen clusters among school children, given that children were withdrawn from schools well before governments shut them? Why would one expect a child to be reported as the first case in a household given that they usually only have mild or no symptoms? I would expect the first case reported to be someone with more severe symptoms who got tested as a result, with any child in the house subsequently found to be infected likely to be recorded as only as a subsequent case assumed to have been infected by the adult.

School childrn will now be spending many hours a day in the same confined classroom space with a cumulative effect on other children and teachers. So it may be possible there could be a gradual but substantial increase in the numbers of infected children before there is enough onwards transmission to more severe cases among teachers and households for this increase to be picked up from surveillance testing and contact tracing.

That could result in a substantial overshoot with the numbers of cases picking up again until it becomes necessary to slam on the brakes again.

The public health officials taking these decisions are not in the same position as politicians mouthing off. They have serious powers, responsibilities and duties, with corresponding legal liabilities for negligence, misconduct or refusal to perform those duties.

I don’t see how it would be possible to avoid a second wave from pre-clinical transmission given that the reproduction rate for pre-clinical transmission without physical distancing is itself nearly enough to cause an epidemic. The peak transmission rate for each case tends to occur just before they start to show symptoms so they are only tested after having already had the opportunity to infect others. We are starting from a position with the effective rate already above 1 even before the actual removal of restrictions.

If the decision makers have got it right, that second wave will be smaller than the first wave. They will be able to avoid overwhelming the health system while still substantially raising the numbers of cases and deaths, for some significant increase in the numbers back at work.

If they got it wrong there might be a more sudden increase in infection rates that discredits the “Adapt and Control” policy and forces a serious attempt at “Eradication”.

But I don’t see much likelihood of that reversal unless they get it so wrong that there is again a serious danger of the health system being overwhelmed. Nor do I see that as likely in Australia. The danger arose from failure to prepare in advance and was averted by the few weeks warning from the collapse in Italy. The next demonstration of spectacular incompetence seems more likely to be about something else rather than acting even slower for a second wave than for the first. It would require criminal misconduct rather than mere negligence and failure to perform duties for the brakes not to be slammed on before a second wave overwhelmed the hospitals. In Australia the consequences are likely to be a longer economic shutdown rather than an overwhelmed hospital system. The same may not be true in many parts of the USA and Europe and it certainly won’t be true in most of the countries ruled by kleptocrats.

I don’t know whether “Eradication” was likely to succeed. But we did have the option to try and no attempt has been made to find out. Australia still doesn’t have any seriouis modelling capability. Other developed countries did not have that option.

If an attempt had been made and had been successful, it could only have resulted in “Zero Tolerance” for outbreaks rather than zero outbreaks. There would have inevitably been occasional outbreaks, but only sporadically with each outbreak or set of outbreaks stamped out rather than becoming a continuous background rate of infection that would continue to grow, again at first gradually and then suddenly. Eradication means preventing that initial gradual growth, not preventing all outbreaks. The resources available for testing and quarantaining contacts and their contacts (“even unto the fourth generation”) are sufficient for sporadic outbreaks, but would be quickly overwhelmed when outbreaks become continuous rather than sporadic. Contact tracing is much easier when people have few contacts because they only go out for “essentials”. What was achieved by contact tracing under recent restrictions won’t still be possible without those restrictions. The last announced numbers for downloads of the “CovidSafe” tracing app would only cover less than 5% of contacts.

“Occasional outbreaks” seems to be what is being sold to people now. The story is that we can have less physical distancing and more people going to work or school together in confined spaces at the cost of some occasional outbreaks that will be kept under control.

That could have been true if we had Eradication first – i.e. zero community transmission for a few weeks before starting to ease up. It might even still be true for Western Australia etc. But it seems pretty implausble for Victoria and NSW now.

It remains to be seen how many people they will be able to get back to work but it seems reasonably certain that any economic recovery will be much slower than if there had been a successful Eradication first.

There doesn’t seem much hope of those responsible for this policy doing much to help other countries in a far worse situation, eg our neighbours in Papua New Guinea and Indonesia. They will be far too busy trying to drive people back to work.

For those in the vulnerable categories the danger of infection will now become significantly greater than it was with tighter restrictions and will remain present until a vaccine is developed.

What remains to be seen is how much longer people will remain tolerant of a ruling class whose unfitness to rule is now a matter of life and death.