Introduction
On Monday 26th October 2020, for the 1st time since July, new Covid cases in Melbourne, Australia, are ZERO, and deaths are ZERO. The rolling 7-day average of new cases is 3. And best of all, our draconian stage 4 lockdown restrictions have been significantly eased.
With the majority of my readers being from the USA and UK, I have a message of hope for you. Australia (population about 25M) and New Zealand's (population almost 5M) have excellent results in Covid control. I want to reassure my many readers now seeing skyrocketing new Covid cases as they come into their 2nd wave - a Covid wave can be crushed, but it will require VERY strong lockdown restrictions and will take 3-4 months minimum.
Note that after both "waves", infections were got down to almost zero. The 2nd "wave" is almost entirely from Melbourne, Victoria.
Beginnings - Hit it Fast and Hard
Australia has a long history of strong quarantine controls on our international borders, mostly related to plants and animals. So when the news of Covid-19 broke, even before WHO pronounced it a 'pandemic' and recommended international travel restrictions, Australia imposed stringent international arrival controls, with cancellation of all flights from China - this was in February 2020. Initially, all international arrivals were directed to self-isolation.
A National Consensus Approach
On 13th March, Prime Minister Morrison establish a "National Cabinet". The Prime Minister and heads of all states (Premiers and Chief Ministers) and Chief Medical Officers, met virtually, initially daily, to formulate a coordinated response to Covid. In May, the New Zealand Prime Minister Ardern, joined to discuss trans-Tasman implications and responses. A national consensus agreement was reached of the steps and stages required to manage COVID, but it was the responsibility of each state to implement these to their own timetable.
Divide and Conquer
From hard lock-down of international borders,
voluntary self-isolation was used, but found insufficiently effective,
so a program of compulsory quarantine in government hired hotels, was
instigated.
In March, the "Ruby Princess" debacle cost almost 900 cases and 28 deaths. Many passengers flew home interstate and some overseas. As a result, all cruises in and out of Australia were banned.
After "Ruby Princess" with most of Australia's cases in the state of New South Wales, 3 states with low numbers closed their borders and setup local quarantine for approved interstate arrivals. Effectively, all interstate air travel ceased. In time, all state borders closed.
National sporting codes ended up negotiating quarantine hubs for entire teams and staff in low virus count states. With the hubs usually being tourist resorts, the only hardship was being away from family for many months.
Victoria's Quarantine Failure - 2nd Wave
Just as Australia was relaxing its 1st wave restrictions, when the Australia wide COVID levels were very low, Melbourne in the state of Victoria, started to see increasing numbers of clusters around 4th July (Melbourne has a population of about 5M, about the size of Chicago or Manchester). Suddenly we had a 2nd wave breaking out. As new cases started to grow exponentially, peaking at 700/day at 31st July and projected to reach 1000/day within a week, the state government implemented a state-of-emergency with very hash lock-down restriction.
Around this time, genomic analysis of test samples pointed to an original source in a quarantine hotel from an international arrival. Subsequent inquiries uncovered a string of bureaucratic failures with no-one taking responsibility for hiring the quarantine staff and unskilled, unequipped, virtually unmanaged staff guarded the qurantainees. One of those 'guards' lived in a share-house with an Aged Care nurse. The dam burst. Unfortunately quite a number of Aged Care Homes had major outbreaks, and our majority death toll was in those elderly.
Victoria's Stage 4 Lock-down
Victoria took 'containment' to another level. 'Lock-down' restrictions were tried in a couple of suburbs, but not found practical. A policed 'ring of steel' quarantined Melbourne metropolitan area from the rest of the state.
"Divide and conquer" was taken to another level. 'Stay at home' orders for non-essential workers, outside movement only for shopping, exercise (1hr/day) and essential activity, only within 5km of home.
Most businesses, offices and retail were shut-down. Hotels, bars, restaurants and cafes were shut, unless a Covid-safe take-away service was implemented. Night-time curfew, restrictions on outdoor 'gatherings', initially of 2, then 5. Restrictions on in-door gatherings to 5 for weddings and funerals were enforced. All of these were backed by strong policing and fines. Working from home became widespread as well as home schooling with e-mail and zoom classes. There was a massive upswing in on-line shopping, click-and-collect etc. And of course, mask wearing was mandated, with heavy fines for non-compliance.
Despite these draconian, some say dictatorial, restrictions, there appears to have been better than 90% compliance. Consequently, by early October, daily new cases were in single figures and restrictions were eased slightly. On 26th October, we have ZERO case and deaths for the first time since early July, and only 0-2 daily cases since. New cases are now almost exclusive international arrivals and people already in isolation due to close contact to a previous case.
Protests about breach of personal freedom rights have been moderate. But the fact remains, new daily cases have fallen more than 99% over 8 weeks of stringent lock-down. So it can be done.
Other Australian states have typically had only 0-10 cases per day during Victoria's 2nd wave.
Contagion When Off-Guard
Despite all the restrictions put in place, the insidious nature of infection by this virus, takes advantage of even the simplest off-guard action. Once it is 'in the wild' in the community, its exponential contagion comes to play, with daily new cases doubling roughly every 10 days.
An aged care nurse reported that after a long shift in full PPE all day, it was a relief at the end of the day to take off her mask and have a coffee and cigarette with a colleague, then share a ride home. At an abattoirs where there had been a Covid cluster, despite masks whilst working, at the end of the shift, workers from the finishing shift and the next shift, all shared the same locker room to de-mask and change clothes. At a shopping centre, despite wearing masks at work inside, on their break, workers have been seen sitting on the curb-side outside without masks smoking together. These are the chinks in our Covid protective armour where the virus can slip through.
In the past couple of weeks, just as we were hoping for an end to restrictions, a new outbreak was identified in some northern suburbs and a couple of schools. After intensive contact tracing, the source was traced to a single nurse, working in a Covid ward. Despite wearing PPE, she still contracted the virus, took it home, then children to school, and relatives in other households. In total, 39 positive cases were found across 15 households. Over 700 close contacts and contacts of contacts, were asked to self isolate. Popup testing centres were deployed across those suburbs and 10's of thousands of residents tested - fortunately, all negative, and no new cases have been found.
It is now recognised that one of the most common places of infection is in family groups at home around the dinner table - masks off, in close proximity for extended periods of time.
Free at Last
Compared to the lock-down, we are "free at last", but in reality there are still a lot of restrictions. Hospitality is doing it tough with limits of 10 customers per room. But easing of outside seating restrictions have brought a real al fresco mood to these warming autumn days.
But we are just entering the spring racing carnival season, and the usual large crowds were deemed too dangerous. So the "Race That Stops a Nation" on Tues. 3rd November (no, I don't mean the geriatric nags in the USA race), the 3 year-old thoroughbreds, will be raced in front of stable staff and jockies only. The magnificent display of roses at Flemington will have no public to appreciate them, so after the Melbourne Cup day, the roses will be picked and made into bouquets to be distributed to residents of hospitals and Aged Care Homes.
Innovation and Research
Australia has a long history of innovation. A distillery turns to sanitizer manufacture. The State Theatre company turns the wardrobe department and seamstresses, to mask making. Instrument makers switch to ventilators. A couple of university students design a face shield frame for 3D 'printing' then form a startup company to manufacture them.
Like
most countries, medical researchers immediately started trying to
understand how this virus operates, infection rates and severity of
illness. But St. Vincent's Hospital in Sydney, setup a research project "ADAPT"
from the very early stages, to investigate the long-term impact of
COVID-19 - from lung, kidney, brain, heart (from stroke to Parkinson's). Early research in Wuhan discovered that 40% of Covid deaths ended with heart failure. It has been discovered that the virus invades the blood stream, attacking the 'D3' receptors that line blood vessels throughout the body. With more than 6 months data, it has been found that about 40% of Covid sufferers that recover, even if not having suffered seriously, can have long-term medical conditions. Early Covid symptoms of loss of the senses of smell and taste have been traced to the impact of nerves and blood vessels in the front of the brain, which are also often related to early onset Parkinson's Disease. Only long term tracking will discover if this is another Covid long-haul condition.
Sydney cardiac surgeons developed a colour 3D ultrasound that can be fed into the heart percutaneously. So they can now work in the Covid ward, without moving the patient to theatre, to diagnose then guide the implantation of a miniature heart pump to support a failing heart long enough for medication to aid recovery.
The CSIRO research unit in Geelong (Victoria's largest regional city just south of Melbourne) has been working closely with the Oxford vaccine study, from the beginning.
One positive to come out of Australia's pandemic recovery, is that the widespread mandating of masks and sanitization, has led to a significant drop in influenza cases and deaths in 2020. In the last 3 years, influenza deaths in Australia have ranged from 400 to 700 per year.
But one of the negatives has been the dramatic drop in people presenting to hospital for other serious and elective conditions, such as heart checks, hips, etc.
Political Aspects
The interstate border closures became quite a political football between adjacent Labour and Conservative governments. We ended up with border towns split down the middle where people living in one state were stopped from shopping or going to work or school in the other half of town across the border.
An outbreak in Queensland, was immediately classed a "Victorian Virus", akin to Trump's "China Virus".
There have been 4 elections, a New Zealand national election, a Queensland state and 2 Australian Territorial elections. All incumbent parties were returned on the basis of their minimization of Covid infections and border lock-downs. The Victorian situation is very mixed. The state government is being held responsible for the bureaucratic in-competencies that lead to this 2nd wave outbreak. On the other hand there is fairly strong support for the hard lock-down that crushed this 2nd wave.
International Comparisons
| Country | Cases/M Deaths/M Tests/M |
|
|
|
(Data from 'worldometers' as at 31st Oct. 2020)
Summary
Australia is lucky being an island nation. An early, fast, hard response and quarantine of international arrivals minimized the 1st wave. Two massive bureaucratic stuff-ups lead to large out-breaks. But a 'divide and conquer' approach restricted this large 2nd wave outbreak to one city in one state. A very harsh lock-down of 'stay at home', mandatory masks, travel restrictions, curfew, closure of most shops and restaurants, and restricted gathering sizes, all brought the virus cases down from 700+/day to zero in about 3 months.
After both our 1st and 2nd waves, Australia got its case load down to single digits in most jurisdictions. The lesson here is to NOT ease off the lock-down restrictions too early. Hang in there for the last month or two of the "long tail".
Our cases and deaths might be low by international standards, but the 900+ dead are grand-parents, parents, aunts, uncles, beloved family members. And lets not forget the medical staff that put their lives on the line for the community, and despite all their protection and care, some still got sick and some did die.
Foot Note
As I watch the USA figures growing exponentially, and POTUS Trump claiming that the US is "Rounding the bend with Covid", the only "bend" I see is curving ever more steeply upwards.
"Mommy. Look! The Emperor, Caesar Trumpus has no clothsmask!".
"Beware the Ides of November" sayeth Joe Brutus, "Caesar, You're Fired!!!".
"Make America Sane Again"
