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The coronavirus endgame

Apr 21, 2020 • 15m 10s

As the number of coronavirus infections in Australia stabilises, talk has turned to how and when this crisis might end. Today, Mike Seccombe weighs up the different exit-strategies and analyses the coronavirus end game.

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The coronavirus endgame

206 • Apr 21, 2020

The coronavirus endgame

RUBY:

From Schwartz Media, I’m Ruby Jones, this is 7am.

As the number of Covid-19 infections in Australia stabilises, talk has turned to how and when this crisis might end.

With some countries gunning for a full elimination of the virus, and others allowing a controlled spread, what solution makes the most sense for Australia?

Today, Mike Seccombe on the Covid-19 end game.


Archival tape -- newsreader:

It is the question we are all asking, how long will these restrictions last? The Prime Minister says 6 months at least...
How long do you suppose this is going to last?

RUBY:

Mike, I'm just going to ask you straight up the question that everyone wants to know the answer to: when will this end?

MIKE:

And I'm just going to give you the answer that we keep getting back, which is who knows.

RUBY:

Mike Seccombe is the Saturday Paper’s national correspondent.

MIKE:

The federal government has planned basically for a six month economic hibernation, in inverted commas of the economy, which, you know, is more accurately described as an induced coma, hibernation being a voluntary thing, in this case, businesses being shut down because they're made too. And the assumption is that in that time, we will wrest control of the spread of Coronavirus. And then after that, the government's hope is that the economy will wake up, recover reasonably quickly and go back to functioning more or less as before.

The problem there is that the evidence seems to be increasingly suggesting that that's such a quick recovery is unlikely. And, you know, and the health crisis will continue for rather longer than they originally planned for.

RUBY:

Right. So we’re looking at six months minimum before we can hope to get back to normal. So how will we transition out of this - what are some of the different exit strategies that are being considered?

MIKE:

Well, looking around the world in the first instance, I guess you could say exit strategies fall into three broad categories. At one end is the sort of let it rip idea, which is based on the premise that the virus will inevitably spread, so you might as well allow it to, and thereby gain so-called herd immunity and keep economic disruption to a minimum.

Sweden's doing that cautiously. The Brazilian president, Bolsonaro, is doing it completely incautiously, basically, you know, denying that there is a big problem here and letting it take its course.

At the other end of the spectrum is what New Zealand is trying to do, which is lock everything down tight until there are no cases left, and then keep things locked down until there's a vaccine.
It's sort of the difference between ripping a Band-Aid off really fast in one case and suffering the pain, leaving the Band-Aid on indefinitely, or removing it gently and gradually, and we’re in the gentle and gradual removal part of the approach.

RUBY:

And is that working, the gentle and gradual approach?

MIKE:

So far, Australia has done exceptionally well in limiting the spread. The daily rate of new infections has fallen dramatically over the past couple of weeks, and we've done even better when it comes to limiting the number of fatalities. In fact, we've done so well that some experts now think that the prospect of going the New Zealand route and completely eliminating the disease in this country is a realistic option.
But of course, this would require the maintenance of really rigorous social distancing for at least another few months. And of course, it would also mean essentially sealing Australia's borders indefinitely until other countries manage to eliminate their infections or until there's a vaccine against the virus.
I mean, overseas tourists aren't coming here anyway. Migrants aren't coming here anyway. If we did eliminate the virus, well, then domestic tourism could start again and could fill the gap left by overseas tourists.

RUBY:

Ok I can see the appeal of that. We could completely get rid of the virus and then make contact with other places that have managed to do the same thing, and build a kind of new post-Covid economy that way.

MIKE:

Yeah, you're right. It is quite attractive. I mean, like I said, it would mean that once it was eliminated - may take a little longer and a tighter lockdown to eliminate it - but once it was eliminated, then, you know, the domestic economy could start up again, completely unrestrained.

And we might even have a competitive advantage when it comes to, you know, for example, attracting students and visitors from China, because, you know, they would rather come here, for example, to study than the United States, where the virus continues to rage.

RUBY:

So Mike if those are the potential benefits, then what are the risks of the elimination strategy?

MIKE:

Well, I spoke to Peter Collignon who's a professor of infectious diseases in the medical school at the Australian National University.

He says that the main problem here is that Covid-19 is so variable in the way it manifests - and I might say this is the majority view among health experts - because there are so many cases out there of people who have minor symptoms or none. It's very, very hard to track everybody. So, you know, it's inevitable he says...

Archival tape -- Peter Collignon:

You are going to have low levels of this that’ll go undetected, which is why we need to have even more testing...

MIKE:

And therefore, you know, you will think you've eliminated it, and it’ll bob up again. The other problem, of course, is that elimination means that you don't develop herd immunity. So therefore, the entire country remains vulnerable to future outbreaks. So we would have to seal ourselves off, you know, pretty much indefinitely until there was a vaccine discovered. Collignon says that's only a 50/50 chance that we will get a vaccine.

Archival tape -- Peter Collignon:

We’ve tried very hard for HIV, Hepatitis C, a very common virus called RSV...there's lots of viruses that we haven't been able to. Look I’m optimistic. Well, I'm trying to be optimistic, but it’s by no means 100 percent sure, because even influenza, the vaccine we’ve got is only 50% effective anyway.

MIKE:

The other thing that he points out is Australia may not actually be over the worst of it.

Archival tape -- Peter Collignon:

So whatever we do, in my view, we're going to wait and see. We don't know enough, but we’re gonna have to wait at least eighteen months, two years before we know what's really on the cards.

MIKE:

So that stretches the timeline out considerably.

RUBY:

We'll be back in a moment.

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RUBY:

Mike, we're talking about a potential end game to the Covid-19 crisis. The fact that there's still so much that we don't know about the virus makes a strategy of elimination risky...tell me more about how those unknowns are impacting our response.

MIKE:

Well, there are just so many fundamental things about the virus that aren't clear. We don't yet know entirely how contagious it is, for example. We don't have much certainty on how many people even die from the virus - what is the...what they call the case fatality rate? You know, I was looking at some data from a place called the Centre for Evidence-Based Medicine at Oxford University, which looks at case fatality rates around the world. And they vary wildly. I mean, in Italy, for example, case fatality rate twelve point eight, three. So, you know, for every hundred people who come in with the virus, 12.83 die. In Singapore, it was 0.31. So that's one mystery: why does it seem to be different by country?

Another one is why do some people with a high what they call viral load - which means a lot of virus in their systems - why do some of them have no symptoms? And why do others die? Does recovery from the disease confer future immunity? And if it does, how long does that immunity last? Why do so many more men die than women? Why do so few children get sick? How effective are children as vectors for spreading the disease to others? What drugs might be useful for treatment? And then the big one, of course, how many asymptomatic cases are out there? So you can see with this much uncertainty why it's hard to bank on a particular exit strategy and especially one as risky as the elimination strategy.

RUBY:

Ok so given all of those questions… What do we know for sure about Covid-19? And how could the knowledge that we do have help us navigate a way out of here?

MIKE:

Well, the one thing we do know with considerable certainty is that overwhelmingly it's a danger to the elderly and the immunocompromised and the already sick. In Italy, the average age of people who are deceased and Covid-19 positive was seventy-nine point five years. So almost 80 years old.

Another Italian study of 355 fatalities found that among them, only three had no prior medical conditions and nearly half of those people had three or more conditions. And as a result, in only 12 percent of those 355 cases could the death certificate actually attribute direct causality to Coronavirus, which is to say that a lot of people appear to be dying with Coronavirus, but not necessarily of Coronavirus. To be blunt about it, a lot of these people probably didn't have very long to live anyway, and they had other conditions that might well have killed them.

We hear about cases of people who are 20 years old and in otherwise good health and who die from Coronavirus. But as Collignon said, they are so vanishingly rare, it makes international news when we find one. That doesn't necessarily argue that we should let the virus rip and sacrifice our elders - as a friend of mine calls it the ‘let granny die’ approach - but it does mean that it can allow our measures around social distancing to be much more targeted and focussed than they currently are. And Collignon argues quite strongly for that.

RUBY:

So what would that look like?

MIKE:

Well, his real worry is that if we overdo it and come down too tight - and in particular, if we put in rules that don't actually make what he calls biological sense - people are going to become resentful. And particularly people in the sort of 20 to 30 year age group who we know actually transmit the virus more than anyone else but have low risks themselves. And so he says while we will obviously need to keep social distancing happening for a long time into the future. And that means things like bars and clubs and crowded indoor spaces are off the agenda.

We're being far too tough on people doing things outdoors in particular. You know, people driving around in their cars or sitting on park benches or catching a wave at the beach, provided they’re obeying social distancing rules, are not really much of a risk. He says given that we have to keep people on board with this whole distancing thing, at least until October or November, November this year and maybe for a couple of years, you can't turn everyone into hermits.

You have to consider the social and other consequences to people's livelihoods. You know, social, mental, economic harm. And when I say economic, I don't mean arbitrary things like share prices, but, you know, the impact on people's real lives, on real incomes.

RUBY:

It sounds like the most likely outcome here is a sort of balance between total elimination and that just let it rip approach. And that looks like a kind of staged winding back of the lockdowns that protects the most vulnerable, but eventually let's most people live their lives in a relatively normal way.

MIKE:

Yeah, I think that's a pretty good summary of where we're going to end up actually. But it changes all the time. A couple of days ago, the Health Minister, Greg Hunt, seemed to be hinting Australia could go down the New Zealand path of elimination. And since then, of course, Scott Morrison has come out and said, no, we're definitely going the middle path of managed flattening of the curve, and has said that social distancing might be in place for a year.

And furthermore, he has acknowledged finally that we might never get a vaccine. So, you know, to take it back to the original question, how long is this going to take? How long is a piece of string? I mean, it seems that the government is now planning for fairly significant measures to be in place for at least another 12 months and possibly longer.

RUBY:

Mike, thanks so much for your time today.

MIKE:

Thank you.


RUBY:

Elsewhere in the news...

A new report published by the Grattan Institute has predicted up to 3.4 million Australians will be out of work as a result of the Covid-19 lockdown.

According to the report lower-income earners will be the hardest hit.

The report also predicted that Australia’s unemployment rate will rise to between 10 and 15 percent.

New Zealand Prime Minister Jacinda Ardern has announced the country will move out of its level 4 lockdown from next Monday. This will allow more New Zealanders to go back to work, while social distancing restrictions remain.
Ardern is still urging people to stay home where possible, warning that the country must get the next phase right to ensure that levels of Covid-19 in the country don’t rebound.

And a gunman posing as a police officer has killed 16 people following a 12-hour shooting spree in the Canadian province of Nova Sco-sha.

Officials said the 51-year old gunman died during a standoff with police.

It’s the worst act of mass murder the country has seen in modern times.

I’m Ruby Jones, this is 7am, see you tomorrow.

As the number of coronavirus infections in Australia stabilises, talk has turned to how and when this crisis might end. With some countries gunning for a full elimination of the virus, and others allowing a controlled spread, what solution makes the most sense for Australia? Today, Mike Seccombe on the coronavirus end game.

Guest: National correspondent for The Saturday Paper Mike Seccombe.

Background reading:

How this crisis will end in The Saturday Paper
The Saturday Paper
The Monthly

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7am is a daily show from The Monthly and The Saturday Paper. It’s produced by Ruby Schwartz, Atticus Bastow, and Michelle Macklem. Elle Marsh is our features and field producer, in a position supported by the Judith Neilson Institute for Journalism and Ideas. Brian Campeau mixes the show. Our editor is Osman Faruqi. Erik Jensen is our editor-in-chief. Our theme music is by Ned Beckley and Josh Hogan of Envelope Audio.

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206: The coronavirus endgame