With the benefit of hindsight, I’ve looked at Victoria’s community transmission of Covid19 in the last six weeks. If this happened in NSW, how should we know when to take action earlier? And if so what action should we take? If we could rerun history, maybe a testing blitz a week or so earlier, together with masks on public transport and shopping centres as soon as the local transmission got above (say) an average of 5 cases per day in the city. But easy to say in hindsight!
As a significant part of Melbourne goes back into lockdown this week, because of a big spike in community transmission rates, I thought I should look at what is happening there. This graph shows the transmission sources in each state in Australia, and I’ve shown just Victoria’s local transmission below.
Back on May 19th (just before the beginning of this graph), I posted this about Victoria:
As Victoria has overtaken NSW on both numbers of daily tests and numbers of reported daily cases, I’ve been wondering whether the greater number of cases in Victoria is because they are testing more. Last week, Victoria tested an average of 12,500 people a day, with a positive rate of 0.07% (around 8.5 positive cases per day). NSW last week tested an average of 7,500 people a day, with a positive rate of 0.04% (around 3 positive cases per day). Are Victorians more conscientiously going and getting themselves tested with the slightest symptom? Or is there genuinely more Covid19 in the community in Victoria?
Even though that was more than six weeks ago, I think the answer was that there was genuinely more Covid19 in the community in Victoria even then. And Victoria was just unlucky compared with NSW that the trailing cases ended up having a few superspreaders amongst them. In the six weeks since then, NSW has identified 13 locally acquired Covid19 cases, and Victoria had more than 30 more locally acquired cases by the end of May.
Over the last seven days to 2 July, Victoria tested an average of just under 20,000 people a day, with a positive rate of 0.3% (four times more than it was six weeks ago). In the last three days, the positive rate is more like 0.4%.
NSW tested an average of 14,450 people a day, with a positive rate of 0.04% (the same as it was six weeks ago).
There is no detailed epidemiological information about the spread, but the thing that strikes me about the graph above is how much unknown local transmission there is. While the identified clusters are mostly families who were meeting for meals, plus the notorious quarantine hotels, there are almost as many cases again with no identified means of spread. So what could Victoria have done differently?
In Victoria, they have taken two major actions – a testing blitz, and then a suburb lockdown. I imagine if they were to rerun the last month again, they would have done the testing blitz at least a week earlier, with the hope that the suburb lockdown might have been avoided.
And I imagine there has been a huge amount of debate by the decision makers about mandating masks. As the rest of the world increasingly mandates masks, I’m still of the view, as I posted before, that masks enable communities to stay more open without lockdown (hence lower economic costs) at the same time as reducing the rate of spread.
I’m not sure how much my analysis is adding to the many articles available on Victoria – the whole of Australia seems to be expert on Covid19 spread by now! But at the same time as Victoria’s cases really started to increase, I read this article about Iceland from the New Yorker – which I highly recommend. While Melbourne has nearly 15 times as many people as Iceland, the strategy there (which worked) was very similar to what Melbourne is now doing – intensive testing and intensive quarantine tracing. So I feel optimistic that Victoria will get on top of this.
By mid-March, confirmed covid cases in Iceland were increasing at a rate of sixty, seventy, even a hundred a day. As a proportion of the country’s population, this was far faster than the rate at which cases in the United States were growing. The number of people the tracing team was tracking down, meanwhile, was rising even more quickly. An infected person might have been near five other people, or fifty-six, or more. One young woman was so active before she tested positive—going to classes, rehearsing a play, attending choir practice—that her contacts numbered close to two hundred. All were sent into quarantine.
If you were returning to Iceland from overseas, you also got a call: put yourself in quarantine. At the same time, the country was aggressively testing for the virus—on a per-capita basis, at the highest rate in the world.
Link
This link suggests that we should be getting ready now to work out how best to roll out a vaccine if it arrives. It suggests a novel approach to working out the best way to gradually distribute the vaccine, given it will be impossible to give it to everyone at once. There will be competing needs of essential workers, high risk people, and opening up the economy.
Most would agree that important decisions like these should be based, at least in part, on what the citizenry prefers. But who can know this given the current context? Abstractions like ‘need’ must be defined to be useful but can mean a range of things depending on one’s principles and priorities. Who is best placed to do it? The government? Doctors? Policy makers, bureaucrats?
…It’s also too complex for a survey. The questions need considered deliberation, with participants first gaining a basic understanding of the underlying issues (how the vaccine works) and the trade-offs involved (X amount of people in Y age bracket will likely die if we pursue option Z).
Citizens’ juries are the best available approach. A handful of juries of appropriate size, expertly facilitated, could easily be conducted across the country in the December quarter of this year. The financial outlay would be negligible considering what is at stake. Follow-up juries could be convened soon after to sort out any conflicting preferences from the first round.[5]
The resulting information can complement expert advice to help the national cabinet decide what to do with limited number of vaccines. The decisions will be controversial regardless. But it will have more legitimacy if based on meaningful consultation with the most important stakeholders of all. It can also minimise unbecoming political squabbles, vacillation and the perception of influence by vested interests. There’s much potential gain for relatively little pain.
I’ve been coming across this idea of citizen juries in a number of different places, and it does seem to have a lot to recommend it. Having been on a couple of juries, they are not perfect, but everyone who was on a jury with me was conscientious, and quite capable of considering the issues, with expert guidance. We came from quite different angles, but the diversity of backgrounds improved the outcome. It seems to me that this concept would improve our democracy, providing it was a genuine consultation, and not just an attempt to find a group to agree with an outcome that had already been decided at the political level.
Life Glimpses
Ever since NSW started opening up, I’ve been hoping we would still be open in early July, as I’m planning to go down to the South Coast with a group of friends next week. When we first planned the trip, the number of guests permitted per house was only five (which for our group of 15 or so between two houses would not have worked). But now we are allowed to have up to 20 people, as long as we are sensible, and I’m really looking forward to seeing people in person.
It is going to be quite strange to be in a different neighbourhood after all this time at home.
Bit of Beauty
When I started this series, I had to think hard to find photos for this section. Now I seem to see beauty every where I look, which is an unexpected benefit. This is the street parallel to ours, with a beautiful autumnal tunnel up the path. One of the unexpected benefits of this lockdown has been the chance to find beauty in the everyday.
We are not commenting on Covid19 in Israel, it is not good. As to your bit of beauty, our friend Will
from Stratford-on-Avon, I think said “beauty lies in the eyes of the beholder” You really find lovely spots.
The concert was great, the music, the atmosphere, to see a live orchestra was such a pleasure. The programme was
F.Delius On hearing the First Cuckoo in Spring. A Copland Appalachian Spring R.Schumann Symphony No.1 (“Spring”). There was no interval. The audience looked odd, all in masks, an avant garde play came to life.
Make the most of your visit to South Coast Love
Your question, Jennifer, is exactly the right one to ask, even if it is hard to answer. NSW does need to learn from Victoria to conclude when to take pre-emptive action. I suspect that you are right about deploying a testing blitz earlier, perhaps triggered by an uptick in the community transmission rate.
I have been thinking about masks while admitting that I don’t wear one. Reflecting on my recent experience of meeting people in small groups and travelling on public transport, the main benefit for me is psychological or behavioural. It is a clear reminder to me that we have NOT returned to normal and that care is needed.
Thanks for the link to the Iceland article. Very interesting. I’d love to read something similar about our Aussie Chief medical officers and their response.