Coronavirus: Time to run trials to find paths back to normal life

The Spit, Coolangatta and Surfers Paradise beaches have been cordoned off in time for Easter. Picture: AAP

Just-released COVID-19 modelling would have been useful back in February, but not any more. Australia’s response can move on from the modelling of overrun hospital wards because, on current data, this simply won’t happen.

What’s more important is to understand the likely scale of this disease through winter. The crucial­ measure is “active cases” — total infections minus the number of recovered patients and those who die. Active cases are heading for a manageable equilibrium, with infection­s brought in by travellers and cruise-ship passengers run­nin­g their course while the ranks of the ­recovered increase.

So the bigger question is which lockdown measures need to stay and which don’t. The distant finish line is a vaccine early next year.

Like a high-stakes game of Jenga, there is no rule book on how and when to relax components of the response. Each working day of shutdown costs our GDP $1bn.

That is why the harder questions are how we minimise community transmission and which of our closure­s are indispensable. This process will take time to test, so the sooner we start localised trials of restoring something like normal life, the better.

Australia’s flattened COVID curve is both impressive and reassuri­ng. Chinese research ­published in medical journal The Lancet describes six days from infectio­n to the first symptoms, then a fork in the road 10 days later where about 10 per cent of patients require more intensive care. About day 20, those severe cases either recover or die. This allows reliable healthcare projections with a three-week horizon.

The acceleration of new infect­ions three weeks ago explains why our low death rates are suddenly rising. Despite that, our low rates of hospitalisation and use of intensive­ care units and ventilators remai­n world’s-best.

We can be reassured by copious testing, with less than 2 per cent found to be infected. It shows undiagnosed cases in the community are either uncommon or have little impact. That is supported by new cases of infections falling. If patients are initially refused a test and their condition worsens, they will return for testing, and a positive result goes into the data.

Some states were slow to report recovered cases, which muddied the waters and concealed an improving­ situation. Now that data has been updated, it will become clear from this week that the number of active cases are falling.

Thanks to contact tracing, we can separate out the infections origin­ating on cruise ships and incoming aircraft and better understand the risk that remains. The spread of the virus in the community among those who did not travel is what Health Minister Greg Hunt is determi­ned to prevent.

Promising falls in new cases over the past 10 days are due to a combination of lockdown measures, widespread and early detection, and possibly the weather being warmer than in much of the northern hemisphere.

As Deputy Chief Medical Officer Paul Kelly said, Australia is no Iran, Italy or Spain, meaning our experience of COVID-19 is likely to be less serious. Yet we can learn from other nations, especially those further advanced in the epidemic journey. Sweden, late to be affected and slow to shut down, now has 10 times our deaths. New Zealand jumped to complete shutdown, yet still its cases per million passed Australia’s on Tuesday.

Queensland is the first state to see a viable path through winter emerging. With daily cases increasing just 1 per cent a day recently­, it is heading for a degree of stability with less than 1000 active cases. Total numbers may reach 2000 but half will have already recovered by mid-June. Even if new infections were to suddenly ­double, this would require ventil­ating about 20 patients at any one time and is clinically manageable.

We can contrast Australia’s 50 COVID-19 deaths so far with the 1255 flu deaths in 2017. Our hospital system can take heart if active­ cases stabilise around 6000. With 500 hospitalised at present, it is well short of the 13,500 flu admissions over the 2017 season.

While it is tempting to sit on the ice floe like penguins fearing the re-emergence of the killer whale, the only way to understand how to deal with the next stage of COVID-19 is for public health expert­s to cautiously trial local relaxations. Physical distancing and isolation costs less than the closure of business, and can be monitored long-term. Economic shutdowns cost a fortune, so their public health benefit needs to be verified.

Just as states have a hotspot strategy for additional lockdowns, national cabinet needs to carefully trial the unlocking of “cooler spots” well away from areas of high caseloads. Stress-testing our response carries mortal risks. That is why we need closely monitored regional relaxations, fully supported from the top level of political leadership and clearly explained in regular media addresses.

With supply lines for personal protective items recovering, these can now be more liberally deployed­ in the workforce, particularly in areas that may be reopened. Since hair salons are still operating, these more relaxed rules could be extended to personal therapies, massage and yoga.

Childcare is open, so by extension play centres could be reopened. The activity of small group visual arts can extend to live-streamed orch­estras and entertainment productions. Spacing rules in retail can be applied to reopen gyms and smaller dining venues. Hospitals with adequate emergency supplies should return to normal operations, knowing they can switch to COVID work within hours. Isolating the aged and frail, and the bans on larger congregations and non-essential travel, will all ­remain for some time yet.

This disease will be endemic for longer than we can lock down, ­either economically or psychologically. That is why maintaining hope and direction is vital. We need to stick with the cheap stuff that works and progressively shed the costly measures that may not be contributing much.

Scott Morrison will eventually outline the steps which will lead us out of the dark basement of isolation. Evoking Easter as resurrection, it is our economy that must eventually be brought back to life. That has to begin with small steps — and as soon as possible.

Andrew Laming is a medical specialist, former infectious disease researcher and Queensland Coalition MP