Low blow: Covid goal too hard, says WHO adviser Dale Fisher
A senior World Health Organisation adviser has warned that Victoria’s targets for easing lockdown are ‘very challenging’.
A senior World Health Organisation adviser has warned that Victoria’s targets for easing lockdown are “very challenging” and the state should instead boost its capacity to manage outbreaks to live with higher infection rates.
Dale Fisher, who ran Singapore’s early successful COVID-19 program, said it was not clear why there needed to be fewer than five daily infections before a curfew and stay-at-home restrictions in Melbourne could be lifted.
“Why does (Daniel Andrews) need the numbers to be so low, to be less than five,” Professor Fisher said. “Why can’t it be less than 10 or less than 20? He would probably say that, above that, you exceed the capacity to manage.
“You don’t have to be an infectious disease professor to realise: increase your capacity to manage.
“If the concern is that the contact-tracing teams will get overwhelmed, you simply wonder why you can’t have more contact-tracing teams.”
Professor Fisher’s comments came as other senior infectious disease experts expressed scepticism about the road map and modelling announced by the Victorian Premier on Sunday, and federal Health Department secretary Brendan Murphy labelled the plan “very conservative”.
Professor Murphy, the former chief medical officer, said: “There’s no rule book for this virus but I think some of us feel that, if there were more confidence in the public health response capability, you could take some slightly more generous triggers.”
Under the road map, most restrictions in Melbourne will not ease until there are fewer than five daily cases on average for a fortnight and there are fewer than five cases with unknown sources. Public gatherings of up to 50 people, and home visits of up to 20 people, will not be allowed until November 23 — and only if there are no new cases across the state for 14 days.
“There are not many countries achieving that and there is usually a significant price to pay,” Professor Fisher said.
“I think it is very challenging to get those sort of numbers across a state the size of Victoria.”
However, Professor Fisher said setting targets as the road map had was “incredibly community-empowering”. “It really is up to the community — the government can’t do everything,” he said.
Business Council of Australia chief executive Jennifer Westacott used public concerns expressed by some of the country’s leading epidemiologists on Monday to question why the modelling on which the Victorian road map was based had not yet been released by the government.
“The authors of the modelling themselves have described the modelling as a guide, and we understand it’s a challenge to model, but that’s why we need transparency of data and sharing of information,” she said.
The modelling was prepared by Melbourne University researchers Jason Thompson, Mark Stevenson and Tony Blakely, and University of New England health academic Rod McClure.
After running 1000 simulations, it concluded that easing restrictions when daily new coronavirus cases reached a fortnightly average of 25 would lead to a 60 per cent chance of Melbourne having to return to lockdown before Christmas.
UNSW epidemiologist Raina MacIntyre said that was a solid basis for the government’s road map, . “You have to have some kind of goalposts and measurable outcomes,” she said. “You need to set targets and then work to achieve them and that‘s the only way to get to suppression or elimination. I think that is achievable and the numbers are going in the right direction.”
Deakin University’s senior epidemiologist, Catherine Bennett, questioned if the modelling had looked at scenarios beyond the worst-case stage 4 restrictions.
“Modelling can be useful for policymakers to test different scenarios, but it appears the modellers were not asked to test stage 3 restrictions, even if they have this option within their model,” Professor Bennett said.
For metropolitan Melbourne to reach tep 3 of the road map on October 26, there must be fewer than five new COVID-19 cases per day across a 14-day average.
If this threshold is reached, the 9pm curfew will be lifted, some students will return to school and people will no longer be restricted from leaving home.
Archie Clements, epidemiologist and pro-vice chancellor of health sciences at Curtin University, said: “Five is a little conservative. At five cases you are down to random-variation territory, and making policy on that number is tricky. I think you could go somewhat higher than five and still get on top of instances of local transmission. At five or 20 cases, public health authorities would be successful in containing local transmission.”
Peter Collignon, an infectious diseases physician at Canberra Hospital, said Victoria was locking itself into very tough criteria to meet.
“While they don’t say it, the (Victorian) government is going for elimination, not suppression,” Professor Collignon said. “This is okay in the short term, but until a vaccine is 90 per cent effective it is extremely hard to sustain.
“I think Victoria has opted for a very hard measure. On the Melbourne criteria Sydney would be in lockdown now.
Jodie McVernon, the Doherty Institute’s director of epidemiology, said limiting cases in Melbourne to fewer than five a day by late October would be “very challenging”, and a simple daily maximum was too blunt an instrument.
“In looking at thresholds for numbers coming out, five cases in family members of healthcare workers at home is very different from unknown cases,” Professor McVernon said.
With the daily COVID-19 case count at 41 on Monday, Victorian Chief Health Officer Brett Sutton didn’t rule out moving through the road map more quickly than envisaged. “I think we would always go through a process of review, that we wouldn’t say different circumstances shouldn’t lead to a re-look at how we’re tracking and the risk of moving to a different stage,” Professor Sutton said.
Professor Blakely has previously said that improved contact tracing is the key to suppressing the future outbreaks predicted by the modelling. “If we do our contact tracing better than we did three months ago, the contact tracers may be able to hold the case count without it going up again as badly as our model suggests,“ he said on Sunday.
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