COVID-19: Why we need to aim for elimination

With permission of Alan Moir, moir.com.au

Until the second wave of COVID-19 hit Victoria, Premier Daniel Andrews was riding high in the polls because of his earlier “tough” stance on flattening the curve.

The past few weeks have put paid to that.

First, there was the buccaneer management of the quarantine hotels, where the cheapest, most poorly trained and supervised security personnel were employed — an example of how privatisation and cost-cutting can kill.

Then, the government launched its poorly-planned and hamfisted lockdown of public housing estates, even while the disease was spreading more broadly in the community. The record-breaking cases for Australia are not predominately in any of the housing estates.

Given the composition of the housing estates, it is hard to avoid describing Andrews’ hard lockdown as more of his government's victimisation of migrants and poor working-class people. This approach would not have been taken if a virus outbreak had been found in a richer suburb.

Community groups, unions and political parties (even some within Labor) rallied around to deliver food and other essentials to the residents, and hopefully some lessons have been learned.

However, this experience has also led to a re-emergence of the debate around whether governments should be pursuing a suppression or an elimination strategy.

I can’t see why all are not supporting elimination, considering that six out of the eight states and territories have effectively eliminated the virus at the community level.

Anita Heywood and Raina MacIntyre, both professors at University of New South Wales, canvassed the various strategies in the The Conversation on July 16.

They first defined what epidemiologists mean by disease “elimination” as “the absence of ongoing community (endemic) transmission”.

“Elimination generally sits in the context of a global eradication goal. The World Health Organisation sets a goal for eradication, and countries play their part by first achieving country-wide elimination,” they said.

“Cases and small outbreaks may still occur once a disease is eliminated — imported through travel — but these don’t lead to sustained community transmission.”

They said that Australia’s current “suppression strategy” which seeks to quash community transmission can be classified as “disease control”.

They also said that eradication was now not feasible, even with a vaccine, because, “People without symptoms may be able to spread COVID-19, which makes it difficult to identify every infectious case”.

They argued that suppression and elimination strategies both “employ the same control measures” and that for COVID-19, these include: “Rapid identification and isolation of cases; timely and comprehensive contact tracing; testing and quarantining of contacts; varying degrees of social distancing (lockdown, banning mass gatherings, keeping 1.5 metres distance from others); border controls: restricting entry through travel bans and quarantine of returning international travellers; and face masks to reduce transmission.

“The differences between a suppression strategy and an elimination strategy are the strictness, timing, and duration with which these measures are applied, especially travel restrictions,” they said.

However, because the elimination strategy involves the potential for an immediate higher economic cost on government and businesses, it seems that both are determined to go for the failed suppression approach which we know has its own set of problems, and they are not just economic.

As others have noted, every time we have to go into lockdown, working people experience a greater amount of economic hardship. And the accompanying social costs, including mental health and domestic violence that increase, or worsen, under lockdown conditions, should not be discounted.

Professor Peter Collignon from the Australian National University, a supporter of suppression, argued on the ABC's July 15 7.30 Report that “the hardest lockdown [during the first wave in Melbourne] has had the poorest result … I’m very sceptical that we’ll be able to achieve elimination anyway.”

But Professor and epidemiologist Tony Blakely from the University of Melbourne contended that as a 6-week lockdown is already happening, why not go harder to eliminate the community spread?

“If we don't eliminate the virus, this will happen again and again .. until such time as we get a vaccine,” he said. “Each time we open up society, we'll get to the point where the virus takes off again.” He said the nation needed to have “some important discussions … as to what our goal is here”.

Living in Geelong, right next to locked down Melbourne, elimination as the goal sounds like the best idea, especially if it helps limit the number of deaths.

As Dr Aaron Bloch, an infectious diseases doctor at a Melbourne metropolitan hospital wrote from isolation (after having been exposed to a presymptomatic colleague who he thinks caught COVID-19 via community transmission) said on July 17: “Suppression has failed — we need an elimination strategy now … Advocates of suppression present us with a false dichotomy between suppression and elimination.

“If suppression has failed in Victoria, one of the most cautious states, it can fail anywhere … Elimination doesn't mean we can go back to our pre-COVID lives. We must still maintain all of the same safeguards of a suppression strategy.

“But, if we aim to eliminate the virus first, we can save lives, we can save jobs and we can all sleep easier at night.”

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