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.

covid-19 Roadmap to Recovery

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

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

The first is continued restrictions for longer to “Eliminate”.

The second is for quicker lifting of restrictions for “Controlled Adaptation” accepting some ongoing level of infections while avoiding the health system getting overwhelmed.

The second is current Australian government policy accompanied by a steady drumbeat from business and the media insisting on a rapid return to work. The first is a clearly viable better alternative.

I find the pretence at academic neutrality between the two options quite irritating and the proclamation of “ethical principles” even more so.

But they have struck a blow that will make it much harder for “business” to get its way. The report release is well timed as efforts to reopen schools are being rushed in an effort to pre-empt a policy of Elimination.

The two page “snapshot” version makes it obvious that “Eliminate” is the way to go.

The 28 page summary obscures this with academic waffle.

The 192 page full report will not be read by many.

A major weakness is the parochial focus on Australia. An “Aussies all together” program of national service is proposed “to inclusively engage the young from across the nation in the process of social reconstruction across the country.” (p16)

Any country lucky enough to be able to “Eliminate” has major responsibilities to help the rest of the world. Australia will have particular responsibilities to help PNG and Indonesia as well as joining with New Zealand in support of others in the region. That is far more engaging and inclusive than a vision limited to “across the country”.

Some minor weaknesses:

  1. The section on “Six imperatives in the implementation of Recovery” is confusing as much of it applies mainly to “Controlled Adaptation” rather than to both approaches, but it appears before either approach has been set out. (p17-22)
  2. The next section on ” 1 An Ethical Framework for the Recovery” adds nothing whatever. (p23-25).
  3. After a very brief introduction, the report should have simply started with “2 The Elimination Option” (p26-57) followed by “3 The ‘Controlled Adaptation’ Strategy” (p58-82).

In fact I strongly recommend readers should simply skip everything before page 26. Just read the separate 2 page “snapshot” first rather than getting bored by academic pontification either in the summary or preceding the full report.

  1. Section 2 should start with a clear explanation that “Elimination” does not mean zero cases but rather, as explained by the New Zealand government, “zero tolerance” of cases, with any occasional sporadic outbreaks promptly suppressed. The opposite impression was created on p10.
  2. Key Performance Indicators for contact tracing cite a pre-print by Lokuge et al but do not provide any means for accessing it. The doi URL should have been included:
    https://www.medrxiv.org/content/10.1101/2020.04.19.20071217v1
    This technical paper is very important. It rightly stresses the importance of upstream tracing.

In discussing KPIs for contact tracing, reference should also be made to:

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

  1. Lokuge et al includes a reference to Ferretti et al and to Imperial College Report 9. But it omits the essential confirmation in Imperial College Report 15, that testing cannot replace, but must be combined with, digital tracing , citing Ferretti et al. See links at:

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

A full appreciation of that should result in clearly linking public acceptance of digital tracing to a goal of “Elimination”. A government aiming at anything less than Elimination will not be able to get whatever level of public tolerance of dataveillance it needs for “Controlled Adaptation”. As Ferretti et al document, pre-clinical transmission itself has a reproduction number almost high enough for an uncontrolled epidemic without any symptomatic transmission. So success at Elimination requires far more contact tracing than can be achieved without popular enthusiasm. Transmission chains can be detected from primary care surveillance of symptomatic cases but with restrictions on social contact lifted the necessary upstream and downstream contact tracing could not get anywhere close to the results achieved manually under near lockdown conditions.

I included those references together with links on transmission through Schools because the battle over reopening schools will largely determine whether the outcome is Eliminate or not.

  1. Suggestions that Elimination could be achieved in 30 to 60 days “assuming no major institutional or other outbreak events” weakens the argument. Epidemics are inherently stochastic. The argument should simply be that although local outbreak events can be assumed, they can also be locally suppressed. That is New Zealand’s “zero tolerance” as opposed to “Controlled Adaptation”. The uncertainty arising from risk that one might be infected in an outbreak is no different from normal risks of accidents. It is very different from living in a society that has “adapted” to a stream of deaths from “controlled” infection.

I only skimmed the alternative “3 The ‘Controlled Adaptation’ Strategy” (p58-82) as I don’t really take it seriously. Not sure whether it is meant to be taken seriously. Seems obvious that if it was possible to “control” an epidemic with R just under 1 it would make sense to go for Elimination with a lower R. I did not notice any evidence supporting the idea that there is some way “gradually” lifting restrictions could change the reality that lifting them enough to resume normal economic activity would leave R above 1 and an epidemic explosion as already demonstrated around the world.

I don’t have time to read the rest before posting this and am more interested in first carefully studying the very important paper by Lokuge et al.

Overall my impression is that this report is more than enough for Victoria to hold out for Elimination and that is sufficient to put a spanner in the works of any pretence at “Controlled Adaptation”.

So despite both the major and minor weaknesses mentioned above, what I have read of the full report is a very welcome counter blast to the endless droning from the pro-death lobby. It does a job that needed doing.

covid-19 “What are we waiting for?”

“Are we nearly there yet” is a well known phrase from bored children on a long trip.

It is a developing theme in media coverage of the only measures that can save lives in the current pandemic. It keeps bubbling up in stories from the ABC and Nine Entertainment including The Age and The Sydney Morning Herald.

Usually expressed in a whiny questioning tone like bored children, “Are we nearly there yet” is also being pushed by a very serious campaign from the Wall Street Journal and its local expression The Australian.

The masters of the universe are really worried about all this talk of “essential services”. Deep down they know that what they own is essential in any society, but having them as owners is not. Health workers, supermarket stackers, teachers are all suddenly noticed as essential – they have the satisfaction of doing meaningful jobs that are obviously useful to society so it is not necessary to pay them as much as is needed to “compensate” useless parasites for having empty soul destroying lives increasing their own “net worth”.

The owners and their servants are desperately keen for a “proper balance” between saving lives and preserving their asset values. That means no more avoidable deaths than are strictly necessary to to get the economy going again. After all it is hard to make money from dead workers. So they don’t actually want the hospital system to be overwhelmed. But no less avoidable deaths either. If “the economy” demands sacrificial slaughter to be appeased then it shall have it. There must be as many avoidable deaths as the hospital system can handle in order to save their assets.

The priests of ancient cultures preferred slaughter of young virgins. We live in more enlightened times. First the owners of our economy have to mobilize popular opinion. That is hard work on a “pro-death” program.

“Why are we waiting?” is a popular anthem demanding “We want attention” from a crowd forced to wait, often a crowd of school children.

Andrew Bolt is a skilled and intelligent agitator on behalf of the owners of our economy. He makes the pro-death program of the Wall Street Journal far more presentable to a popular audience.

His subeditor picked a nice variation of “Why are we waiting” for his latest piece of bullying petulance.

The entire text is included below, together with review and analysis {enclosed in braces}

WHAT ARE WE WAITING FOR?

Thursday April 16, 2020 page 41

Herald Sun (Melbourne, Victoria, Australia) heraldsun.com.au
http://www.heraldsun.news.com.au/

Publisher: News Limited
Document Type: Bloviation

762 words

ANDREW BOLT: “Australia’s most read columnist”

“What exactly is the sign of success the Government is looking for before these stay-home laws can be eased? We deserve to know.”

THIS is extraordinary. Why won’t the Morrison Government tell us the sign it’s waiting for to release us all from home imprisonment?

Why won’t it level with us?

{The government did level with us when it warned that the restrictions needed to avoid the healthcare system being overwhelmed would need to be “sustainable” for “six months or more”. The 12 to 18 months expected before any vaccine is “six months or more” so technically they were being unusually “level”. Recently the government has started pandering to whiny journalists with ludicrous talk of being “on the cusp” etc. That gives an opening to Andrew Bolt.}

Haven’t we already achieved everything the government – and the state premiers, too – once said was the excuse for imposing on us a virtual police state?

{By “virtual police state” Bolt means businesses being shut down to reduce the number of avoidable deaths from a pandemic with no vaccine and no adequate preparations. He is not stupid. He kows what the stakes are given events in New York where the Wall Street Journal has its home. The answer to his question is that thousands have already died and are still dying in Italy, Spain, the UK and USA and the Australian government has not yet achieved everything it needs to do to avoid that here. He knows that, so he passes it off as a whiny “question” just like the usual crap from other media. But what he really means is a demand that they stop trying to avoid unnecessary deaths as fast as possible.}

Its medical advisers told us a month ago we had to stay shut in our homes because up to 150,000 Australians would die from the coronavirus.

{A month ago was March 16. That’s when the UK government was told by its advisors that current policies would result in a catastrophe similar to Italy. Doing nothing would result in say half a million avoidable deaths in the UK and over 1 million in the USA. The UK along with most European countries quickly followed advice to suddenly slam on the brakes. So did New Zealand. Australia took slightly longer but had the huge advantage of being further behind on the same trajectory.}

But just 63 of us have so far died. Even around the world the death toll is fewer than 130,000.

{How upsetting. If only the world had done as the Wall Street Journal demanded we could have appeased the economy with far more deaths! “Why are we waiting?” “All we are saying… Is give death a chance”}

The government also told us we had to be banned even from sitting alone on a park bench so that we could “flatten the curve” of infections.

{That is certainly what Italy and France did when they shut the parks. New Yorkers were ordered to “shelter in place” which certainly prohibits going out to sit on a park bench. No such order was made in Australia nor will it be needed unless we get closer to the 1000 deaths per day that New York is experiencing, as Andrew Bolt and the WSJ demand.}

But that curve is now as flat as a pancake. For days we’ve had 50 or fewer new infections. Many more people are getting better than are getting sick.

{“All we are saying… Is get more people sick”}

It also told us it had to ban elective surgery so hospitals wouldn’t run out of intensive care beds to save the masses dying from this virus.

{Andrew Bolt desperately needs a facelift because his portrait is starting to look like Dorian Gray’s}

But those 2200 ICU beds – and the many more emergency beds we’ve now added – have for many days had just 80 or so virus patients in them. Thousands of beds lie empty.

{“Why are we waiting?” “What do we want? Fill those ICU beds! When do we want it? NOW!}

If all this isn’t success, what is?

{Success will be continuing to avoid the 23% per day growth in cases that forced the government to suddenly slam on the brakes less than a month ago when we last had only 50 cases and those cases suddenly started doubling more than twice a week because restrictions had not been imposed and nothing else stops a virus that has no vaccine.}

What exactly is the sign of success the government is looking for before these stay-home laws can be eased?

{Well currently they are pandering to the whining by explaining that during the next four weeks they need to:

  1. Establish adequate testing.
  2. Develop industrial scale levels of surveillance to track each infection and isolate all contacts.
  3. Be able to respond locally to sudden outbreaks like the need to isolate 5000 people in Tasmania on just one day.

But actually I don’t think they are that stupid. They know that a lot longer than 4 weeks will be needed and that “community transmission” is still increasing, not declining, at the current levels of suppression.

My guess is the government think pandering will help keep the public on side better than simply telling the truth. That instinct is natural to politicians. But I don’t think they are looking for a “sign of success” expecting to “ease” anything. I think they are waiting to be told by the Chief Medical Officers when it is necessary to impose further restrictions.}

What is the key metric it’s looking for to ease the restrictions that have cost hundreds of thousands of Australians their jobs and their savings?

{Their usual politicians Key Performance Indicators have been suspended for the duration. Careful measurement of the volume of bellowing from a whole army of Andrew Bolts is unlikely to overide the advice of the CMOs. But they will keep pandering and that will only encourage Andrew Bolt to bellow louder.}

We deserve to know. Yet when I interviewed Health Minister Greg Hunt this week, he repeatedly refused to say what the government was waiting for.

{I don’t watch TV. The Minister ought to have said “Which part of ‘six months or more’ did you not understand?”}

Was it when we had not a single new death? Hunt would not say. Was it when we had no more infections at all? Hunt would not say. Was it when we had inflection rates this manageably low for another week? Two weeks? Hunt would not say.

{No. A week or two weeks is not “six months or more”. A month is more than four times a week and more than six months is more than 26 times a week and more than 13 times two weeks.}

What’s the big secret? Shouldn’t we all know what the government is aiming for, and debate the costs and benefits of that target?

{There is no big secret. In Wuhan the provincial Andrew Bolt’s of the police were able to briefly bully doctors in December last year to keep an imminent global pandemic secret. But everyone knows now and there is nothing Andrew Bolt could say that will change the impact of what people have seen unfolding right next to the Wall Street Journal in New York.}

Clearly, it can’t keep insisting these stay-home bans will last “six months”, given Hunt admits the death toll is much, much lower than it had thought possible.

{I won’t argue about whether Hunt is as weak as piss. But whether he pulls himself together and tells Andrew Bolt where to go or not, any government official in the developed world that ignores what its Public Health Units tell it must be done during an epidemic will be promptly replaced. Andrew Bolt would do well in Belarus, but not here.}

And what was so magical about six months?

It’s just a date plucked from a calendar, and six months of these bans would drive many Australians crazy and many more broke, as well as leave our economy devastated.

{True enough. It is possible that anti-viral drugs will improve the situation in six months, but it won’t be over until a vaccine which is not seriously expected in less than 12 months. Many Australians will be driven crazy, especially fans of Andrew Bolt. Many others will die.}

I don’t mean to criticise the government for what it has done until now. Hunt is right to boast: “The steps we’ve taken have literally saved lives and they’re making a massive difference, as difficult and as tough as they are.” Correct. All praise to Hunt and the rest of the government.

In fact, I supported the bans – and wanted more of them sooner – back when we had no idea how lethal this virus was or how fast it would spread.

Now the argument is a different one: where to go from here? Which bans actually make a difference, and which don’t?

{Yes Andrew Bolt is far more intelligent and skillful than the lunatics who denied that anything needed to be done at all. He knows that he needs to whip up resentment of minor irritations and a mood of “Why are we waiting”. The business readers of the Wall Street Journal can relate to a simple demand that their asset values be preserved. But the Herald-Sun has a working class audience many of whom live from pay check to pay check with no assets to preserve. So Andrew Bolt cannot speak as plainly as His Master’s Voice}

For instance, does Victoria’s ban on even surfing and fishing make any sense? Hunt told me we couldn’t relax because a “second wave of infections” might come, as we’ve just seen in China and Singapore.

{Ooh look, over there… surfing and fishing. There are very good reasons for rushing out dead simple rules to “stay at home” and sort out the details later. There are equally good reasons for Andrew to pretend he is just arguing about which bans actually make a difference when he is in fact demanding that more lives be sacrificed to preserve asset values.}

But what if it doesn’t? We could be waiting months and months for a second wave that may never come, and wait at an horrendous financial and human cost.

{The pretense is so transparent that Andrew Bolt actually forgets himself and becomes comical. Just imagine how awful it would be if a second wave was prepared for and never came! Fear not Andrew Bolt. There is no way to avoid repeated outbreaks when nearly 100% of the population has not been infected yet and is still Susceptible because there is no vaccine. You will get opportunities to present your demands many times over the next year or more. Every time the death rate subsides you can pop up and demand “Give death a chance”.}

Surely it makes sense to fight any second wave if and when it actually comes. We’ll be far better prepared then, and can bring back all the restrictions we like when required.

{Surely. Just like it made sense for New York to not fight the first wave until it hit them and they had a thousand deaths per day.}

Tasmania this week actually set a more realistic and affordable model for fighting a “second wave”.

It had an outbreak of infections – 78 new cases – at two hospitals in Burnie. It blitzed that outbreak at its source, closing the hospitals and putting 5000 people there in quarantine.

{Utterly brilliant! Andrew Bolt knows he has some really, really stupid fans. They will have heard that instead of being “flat as a pancake” at 50 cases per day as Andrew claims, Tasmania had to isolate 5000 people in one day and needed help from the military to do it. So simply tell them that this was a “more realistic and affordable model” and they will just remember that it was part of their hero’s argument for doing nothing instead of thinking it showed that the curve is not “flat as a pancake” like their “dear leader” says.}

This must be our future. Yes, let’s have stricter quarantining of the infectious; better isolation and support of the most vulnerable, who are overwhelmingly aged over 70; and aggressive testing and tracking down of people who might have the bug.

But let the rest of us slowly get back to work to pay the monstrous bill. Just tell us the key to start that great engine.

{Essential services are at work. That unavoidably results in community transmission, even in hospitals as seen in Tasmania. But it is unavoidable no matter how carefully peope leaving their homes to work try to avoid contact. Andrew’s problem is that the longer essential services are the focus the more obvious it becomes that the people he bellows on behalf of are in no way essential.}

What is the government waiting for, and why won’t it say?

{Good question. I think the government is too gutless to simply arrest and quarantine Andrew Bolt as a biosecurity hazard.
But watch out for the CMOs.}

BLOG WITH BOLT blogs.news.com.au/heraldsun/andrewbolt/HERALDSUN.COM.AU

Covid-19 Two weeks from catastrophe – here – now

Poorest countries likely to be devastated

Even the Wall Street Journal finds it “troubling”:

https://www.wsj.com/articles/coronavirus-is-advancing-on-poor-nations-and-the-prognosis-is-troubling-11585149183?mod=hp_lead_pos10

Ten days till Intensive Care Units full in Australia. Two weeks till more than 20% avoidable death rate in hospitals.

When a system breaks: a queuing theory model for the number of intensive care beds needed during the COVID-19 pandemic
Hamish DD Meares and Michael P Jones
Med J Aust
Published online: 26 March 2020 (preprint)

https://www.mja.com.au/journal/2020/212/10/when-system-breaks-queuing-theory-model-number-intensive-care-beds-needed

The very simple model fits the data from Italy and the current rates of admission to hospital (increasing 23% per day i.e doubling more than twice per week).

Confirms what I’ve been saying, most deaths from unavailable care. Estimates almost a quarter of hospitalized cases will die from unavailable ICU care, not from covid-19, starting 2 weeks from now

“Now, instead of a steady state, imagine the number of total positive cases in the community increases by 20% every day (23% currently in Australia [7]). On the day you have 100 total positive cases, you will have approximately 120 the next. Those 20 new positive cases will require one new ICU admission and a 10-bed ICU to service that rate of admissions.

That implies that the number of ICU beds needed is approximately 10% the Total Positive Cases or 50% of the number of new positive cases. Australia has around 2200 ICU beds, which implies if public health measures fail to curb the rate of growth, Australia’s ICU capacity will be exceeded at around 22 000 COVID-19 cases sometime around the 5 April, 2020. Other sources [8] have suggested that Australia could cope with up to 44,580 COVID-19 cases, but even if this is true it only grants a 3-day extension to the 8 April, 2020. The practical impact on ICU capacity of this scenario is made clear in Figure 1″ [at end of the pdf version]

“Figure 2. ICU admission rate per 100,000 population in Lombardy initially increases exponentially followed by a steep linear increase”

“In Figure 3 we found the mortality rate among hospitalized averaged 8.8% from Day 1 to Day 14 and was essentially steady (p=0.9), but from Day 15, the mortality rate dramatically rises (p<0.001) with an average mortality of 22.7% from Day 15 onwards.”

“The authors’ conjecture is that initially the 8.8% mortality is predominately from COVID-19 patients in ICU but from around Day 15 onwards, the increased demand for ICU beds outstrips the capacity of the system to supply them, and patients perish not from COVID-19 per se but from lack of access to an ICU bed. This is also illustrated in Figure 3 (available in the PDF version) where the ICU admission rate falls as demand increases, with a corresponding increase in the mortality rate.

“These data imply that the eventual mortality rate of COVID-19 may be much higher than currently estimated because once the system reaches breaking point and there are insufficient ICU Beds, mortality rises dramatically.”

Conclusion

“While the specific form of the proposed model can be debated, it does appear to represent a realistic clinical scenario, is consistent with international data and suggests the conclusion that the impending demand for ICU beds could overwhelm capacity in even the largest Australian hospitals in the near future. Australia must immediately take all available measures to rapidly decrease the rate of new cases and radically increase the number of ICU beds otherwise we may face the same fate as Italy, or worse.”

My conclusion is slightly different. Radically increasing the number of ICU beds will only delay catastrophe a few days although that will certainly be a good thing and even more useful for later waves.

The whole focus right now must be on “all available measures to rapidly decrease the rate of new cases“.

That includes Quarantine accommodation which can be rolled out much faster than ICU beds and without diverting any resources from efforts to increase ICU beds.

Hopefully Victoria’s Chief Medical Officer will again “jump the gun” as he did in stress testing the pharmacy supply chains by advising people to stock up for two months lockdown. He should start the full lockdown today and then insist on prompt Quarantine accommodation for ALL cases, and separately for vulnerable people living in households with others, not just household isolation. If he does, others will follow.

Personal refection on above from MJA Editor:

https://www.mja.com.au/journal/2020/212/10/sars-cov-2-medical-profession-ventilator-beds-and-mortality-predictions

Henry Ergas joins the WSJ campaign for more deaths to save the economy

The Australian has reported the above story:

https://www.theaustralian.com.au/nation/tougher-lockdown-key-to-health-system-coping-research-reveals/news-story/4cf57becfbe8165adeb49ebface1902d

But it is still pushing the WSJ’s “pro-death” campaign.

https://www.theaustralian.com.au/commentary/coronavirus-it-will-be-unhealthy-to-ignore-the-cost-of-all-this/news-story/60f5e2f3c1708aa9036aa1778933f15b

As a biosecurity hazard The Australian should also be shut down – now – and stay shut down until it agrees to stop campaigning for more deaths.

Swan Song

Here’s the ABC’s Dr Norman Swan with basically correct advice on what has to happen immediately for “social distancing” but a ludicrous claim that it will result in getting back to normal in say 4 to 6 weeks:

https://www.abc.net.au/news/2020-03-26/how-australia-could-beat-coronavirus-swan-nbk/12091688

He ends with this verbatim quote:

“How long is it going to last before people say ‘stuff this I’m going out’. And then you get the epidemic coming back. Short, sharp, time-limited, get back to our normal life over a period of time.”

It does need to be sharp and stressing “short and time-limited” may help get people to comply with sharp measures more quickly than they otherwise would. Trump seems to be doing that in the USA with his usual posturing against the medical advice while authorizing rapid sharp shutdowns for an initial 15 days and pretending that will be enough.

But 4 to 6 weeks is almost as ludicrous as Trump’s talk of the US economy roaring back after Easter. I think the difference is simply that Trump knows he has a more credulous and reluctant audience than the ABC and is facing either an election or postponement of elections in November. (Presumably the Electoral College mechanism in the US Constitution could still operate without public polling but the US Northern Command Combatant Commander might be just as plausible as either Trump or Biden to maintain a functional national government in that circumstance).

The period cannot be time-limited in advance. It can only be based on testing and a better understanding of how long it takes between triggers for lifting restrictions to increase the rate “R” to a level above 1 that again threatens hospital capacity and triggers for resuming restrictions to get it back below 1 (with increased capacity including ventilators and anti-viral drugs) to again cope. It won’t be “over” (for this season of this strain) until herd immunity via either a vaccine or most of the population having recovered from infection. This is clearly explained (for a technical audience) in Report 9 from the Imperial College covid-19 response team.

As Dr. Anthony Fauci, the USA’s top expert spokesperson says:

“You don’t make the timeline. The virus makes the timeline”

There may be a way to explain that clearly with texts and visualizations, but I don’t know how, and am convinced it urgently needs “Explorable Explanations” with widgets. I doubt that Dr Norman Swan COULD explain it to his ABC audience even if he DOES get it himself (which I also doubt).

Dr Swan is certainly right that people will be saying ‘stuff this I’m going out’ in a short, time-limited period unless they DO understand.
That short, time-limited period should be used to provide clear “Explorable” Explanations that it will NOT just be a single flattened peak and of many other things concerning how society will cope with the actual expected multiple waves.

The other point he stresses is the need for mass testing. That is certainly true and governments certainly do know it now and will get that happening a lot faster than they can possibly roll out ventilators and ICU beds. They simply don’t have enough test-kits yet, not a lack of understanding that they need them. I assume that capabilities to mass produce test-kits fast enough are being rolled out now without need for social mobilization to force them to do so. Like ventilators and ICU beds, test-kits, masks and alcoholic sanitizers cannot replicate themselves as fast as this pandemic virus. But unlike ICUs, they only need to be ramped up at achievable rates to avoid catastrophe.

More important than the tests to confirm who has it (which can be clinically diagnosed reasonably accurately very shortly after symptoms even without tests) are smaller random sample blood tests to see who has recovered from it without being recorded as a case. That data is essential for setting trigger levels for imposing and lifting restrictions in advance of hospitals becoming overloaded. It is a technical matter that does not need to be urgently understood by the general public and unlike Quarantine accommodation I am confident it is already being worked on as fast as possible.

USA likely to be hardest hit modern industrial country

While Spain is closely following the Italian trajetory to catastrophe and major European countries including the UK not far behind, Australia is still a couple of weeks further behind.

I haven’t been following the US situation but this article from Wednesday (25 March) suggests the US will end up worse off than others:

https://www.theatlantic.com/health/archive/2020/03/how-will-coronavirus-end/608719/

It also has some explanation of the protracted nature and multiple waves of the pandemic crisis and speculation about social changes in the aftermath (plus of course some of the usual incomprehension from Never Trumper’s of why Trump’s popularity has not collapsed – but perhaps less dominated by that than usual for “The Atlantic”).

But if you are missing “the usual” from Never Trumper’s, “The Atlantic” is still a good place to find some:
https://www.theatlantic.com/ideas/archive/2020/03/presidents-character-unequal-task/608743/

BTW I’m not following US politics but headlines show Trump’s approval higher than ever in most of the polls. Interestingly Rasmussen poll which usually shows Trump approval significantly higher than others (because it only counts people likely to vote) is relatively static.

For deeper insight into why “Never Trumpers” lost the Republican Party, here’s one whining about his life being in danger as a doctor. The incompetent shortage of Personal Protective Equipment for health workers is very real and serious. But most of them are angry that they risk having to stop working for a few weeks when they get infected, thus further overloading their colleagues and reducing the health system’s capacity to save lives. They aren’t as intensely focussed on themseves as either Trump or this writer for “The Atlantic”:

https://www.theatlantic.com/ideas/archive/2020/03/were-failing-doctors/608662/

On the plus side, at least The Atlantic is strongly opposing the campaign to sacrifice a million or more lives for “the economy” being waged by the Wall Street Journal with a lot of traction on the right (and supported by the NYT’s Thomas Friedman):

https://www.theatlantic.com/ideas/archive/2020/03/national-shutdown-least-bad-option/608683/

I’m only attempting to follow the epidemiology of pandemic disease covid-19, not the virology of the virus responsible, SARS-CoV-2. But for those interested, The Atlantic does have an interesting article on that:

https://www.theatlantic.com/science/archive/2020/03/biography-new-coronavirus/608338/

Also interesting for those trying to follow aspects other than the epidemiology is an account of the dramatic Danish economic response, supported by all parties there:
https://www.theatlantic.com/ideas/archive/2020/03/denmark-freezing-its-economy-should-us/608533/

“Life in a time of Corona”

Here’s a relaxing video from an ABC Foreign Correspondent stuck at home.

https://www.abc.net.au/news/2020-03-24/life-in-the-time-of-corona/12086808 25 minutes Tuesday 24 March.

“Necessity is the mother of invention” so ABC Foreign Correspondent Emma Albericci stuck at home had the bright idea of interviewing her Italian relatives under lockdown. Starts with usual ABC ominous sound track with pictues of deserted Milan, but then shows Italians in near total lockdown coping well now that they know what they have to do and why they have to do it. Less reassuring but appropriately informative on what happened to Italian hospital system because they did not act fast enough to do what they now ARE doing. This is helpful for other countries to do it now instead of “proportionally” and worry less about reactions.

Visualization and Explanation

Quite a good item from the ABC on the actual data for cases, with a reasonably clear message (unlike their previous efforts with “9 charts” and then “13 charts” that were pointless). Worth reading, although I don’t agree with the explanations of differences between countries.

https://www.abc.net.au/news/2020-03-26/coronavirus-covid19-global-spread-data-explained/12089028

What the visualizations actually show is that most countries being tracked are closely bunched together along much the same trajectory of “community transmission” with a common doubling period of known cases of between 2 and 3 days. The outliers are China where containment was sucessful except in Hubei and four other Asian economies (Japan, Singapore, South Korea, Taiwan) that had experience from SARS and MERS. I won’t go into a detailed critique as the central message is good.

But a glance at the numbers makes it glaringly obvious the crisis is nowhere near ending in ANY of these countries. The numbers already infected might be say 10 times larger than the case numbers so far but there is no reason to expect that nearly all of them have recovered and now have at least short term immunity. Even if the numbers infected were 100 times the cases, that would still leave the overwhelming majority susceptible. eg South Korea currently appears to have covid-19 “under control” with total flattening out at around 10,000 cases. Even 100 times that is only 1 million which would still leave 98% of the population susceptible. It isn’t worth arguing about whether the actual numbers infected are closer to 5 or 10 times rather than 100 times as there is no practical difference between 98% susceptible and 100%. That is simply not mentioned.

Nor in my view is there much practical difference depending on what percentage of people infected remain as carriers when restrictions get lifted despite appearing to have either fully recovered or never had symptoms. There will still be a battle using tracking and isolation of cases in small outbreaks with the ongoing potential for eventual “community transmission” and no reason not to expect further peaks after getting the initial outbreak “under control”.

The end of the crisis comes only with a vaccine for herd immunity (followed by regular updated vaccines for new strains of a likely new endemic disease). That is still expected to be 12 to 18 months away.

Tensegrity

On an entirely different note, which somehow feels related to me:

https://tinyurl.com/sthh2fz

That’s all from me on reviewing the media. I’m going back to the technical literature now.