A scan might have found the cancer now killing Daniel van Roo. Instead his doctor gave him 50 STI tests, which van Roo believes was because he is gay.If I hadn’t taken action and if I hadn’t seen a doctor then, you know, then where I am is just where I am. But because I did do those things, I am probably going to be upset about it when I am laying in the hospital bed at the end.
Victoria’s spike in Covid-19 cases
A cluster at a Brimbank meatworks, a teacher at an Albanvale primary school, outbreaks at two Melbourne hotels where travellers were quarantined, a Coburg family, staff at a McDonald’s and an H&M, a toddler at a Prahran childcare centre, a Coles worker at a Laverton distribution centre, an Essendon AFL player who returned a positive and then a negative test. Then, on Wednesday, the first death from coronavirus in Australia in a month.
For more than a week now, the line recording new coronavirus cases in Victoria has continued its upward trajectory, with the state recording double-digit case number growth each day.
Victorian Premier Daniel Andrews has warned Victoria is “absolutely at risk of a second peak” as the state’s estimated rate of virus transmission, its “reproduction value”, jumped from below one to 2.5 in a week.
Commentators, meanwhile, have speculated about how the state, which was the last to ease tough restrictions, so quickly became almost totally responsible for Australia’s uptick in locally acquired cases.
Stephen Duckett, director of the Grattan Institute’s health program, says Victoria is seeing the results of “a combination of bad luck and bad management”.
He points to two separate coronavirus clusters linked to quarantine hotels in Melbourne – the Stamford Plaza and the Rydges on Swanston – which he says involved “bad management by the government, bad management by the hotel and bad management by the security company”.
Victoria’s deputy chief health officer, Annaliese van Diemen, said this week that security guards at these hotels potentially breached social distancing requirements. Duckett questions why there has been no penalty imposed for this, given the hotels are contracted by the government to quarantine international arrivals.
On Wednesday, it was reported 1000 Australian Defence Force members would be deployed to Victoria to help with hotel quarantine monitoring and other logistical support – but on Thursday, Andrews revised the request down to about 150.
Professor Benjamin Cowie, a Melbourne-based infectious diseases physician and epidemiologist, agrees with Duckett that Victoria has been unlucky.
“There’s a lot of chance at play,” he says. “No one wants to hear that it is random, but when you get an infection like this down to very low levels of transmission, the impact of chance becomes very significant.
“We have very low levels and an almost completely susceptible population and so a single security guard becoming infected and then not social distancing is suboptimal.”
But there’s also the fact that three of the six areas in Melbourne identified as having outbreaks have large migrant populations, and Cowie says it’s clear the public health messaging has somewhat failed these communities.
A factor in this might be a minor bureaucratic difference, he says.
“In Victoria, all infectious disease notifications come through one central office and are responded to centrally, while in New South Wales they have local health districts and each of those local health districts have a public health unit who are responsible for the surveillance and response to notifiable diseases,” he says. “These units could have a stronger connection to local hospitals, GPs and community leaders.”
Cowie says engagement involves more than “just printing resources in a different language”.
“We’ve seen broader community transmission amongst culturally and linguistically diverse communities who are not served by the existing system in places like Singapore or Germany, where there have been later significant outbreaks,” he says.
The Victorian government has declared it will “redouble” efforts to engage with culturally and linguistically diverse communities by visiting homes, train stations and shopping centres. It was revealed this week that the company engaged to manage crisis communication for the virus was only asked on Monday to communicate to Victorians in languages other than English.
Duckett backs tough measures to get Victoria’s case numbers under control, including closing the state’s borders. He was due to travel to a meeting in Brisbane next week and sought approval from the Queensland chief health officer to enter the state. “She said no and that was absolutely the right decision, given what has happened in Victoria,” he says.
He also supports the government’s current stay-at-home directions in suburbs where outbreaks are clustered – but acknowledges the difficulty of locking down a suburb in inner-city Melbourne.
“One of the hotspots they’re talking about is Casey, which currently has eight active cases in a population of 340,000,” says Benjamin Cowie. “The idea that you can put somewhere like that in lockdown because of eight cases is an overreaction.
“If that is the threshold then we are going to have communities in and out of lockdown for years and I don’t think people are going to tolerate that.”
While the federal Health minister, Greg Hunt, this week linked Victoria’s recent rise in Covid-19 cases to the June 6 Black Lives Matter rally, Duckett says “there is no evidence that there was any transmission from the rallies”.
Cowie concurs. “You’d have to say there is really no evidence whatsoever to suggest that these protests had anything to do with what is going on with coronavirus in Victoria at the moment,” he says. “End of story.”
He says Australia will face this “new reality” of clusters popping up well into next year, and perhaps beyond, as we continue our strategy of reducing the spread of the virus so the country’s health system can cope, rather than pursuing elimination of the virus.
“The experts tell us that, largely, the numbers are being driven by families – families having big get-togethers and not following the advice around distancing and hygiene,” Victorian Health Minister Jenny Mikakos told The Saturday Paper.
She said recent actions by the state government were taken “on the advice of our public health experts to slow the spread and boost engagement with those communities” that have seen outbreaks.
Until at least July 12, household gatherings will be limited to five guests and outdoor gatherings to 10 people while restaurants, pubs, auction halls, community halls, libraries, museums, gyms, cinemas, theatres and places of worship will all stay at a maximum of 20 people in any one space.
On Thursday morning, Premier Andrews confirmed 26 of the 33 new cases reported overnight had been acquired locally, and announced there would be a 10-day “suburban testing blitz” across 10 priority suburbs: Broadmeadows, Keilor Downs, Maidstone, Albanvale, Sunshine West, Hallam, Brunswick West, Fawkner, Reservoir and Pakenham. The tests will be available to people with or without symptoms.
“I just can’t stress this enough,” he said. “We will see these numbers go up in coming days.”
Prime Minister Scott Morrison has said Victoria’s case numbers should not delay the reopening of the economy because we “can’t just shut everything up forever”.
But University of Melbourne professor of economics Chris Edmond says the resurgence of community transmissions “reiterates what a lot of economists have been saying all along” – that a proper economic recovery can’t be expected in Victoria or elsewhere until the pandemic is “tightly controlled”.
“There was a lot of pressure to relax the lockdown quickly and a lot of us were saying, ‘That is short-sighted because you’ll simply have a resurgence of cases,’ ” he says. “We have pretty good evidence, especially from the United States, that even states that haven’t notionally locked down very much have been suffering just as much on the economic front as those that have.”
Edmond refers to the popular “hammer and dance” metaphor in which the “hammer” – lockdowns and isolation measures – suppress coronavirus case numbers until we are left in the “dance” – the easing of restrictions and an ongoing battle with the virus until there is a vaccine or effective antiviral drugs.
“There was always going to be a dance of many lockdowns and it was just a question of who would have to do it first,” says Edmond. “[Victorians] are surprised at how quickly we’ve had to start dancing because we have had tighter controls.”
The economy will benefit from the total or near elimination of the virus, but Edmond says there needs to be an ongoing social safety net to support those who can’t return to work.
“You need to make it easier for people to err on the side of caution when they’re sick because there is an economic disincentive to shrug it off and be in denial if they have mild symptoms,” he says.
“An economically precarious worker coming to work because they feel like it is a big hit to stay home is coming into contact with people who are just as economically precarious and facing the same incentives.”
The Andrews government has implemented a one-off $1500 payment for people who don’t have access to sick leave and have either tested positive to Covid-19 or are a close contact with a confirmed case.
This is a step in the right direction, Edmond says, as the economic burden of the lockdown is not borne uniformly.
“I don’t think it is a coincidence that we have seen [new coronavirus cases] in places where people work in close proximity and where they really need the money,” says Edmond. “We haven’t seen an outbreak among university professors.”
This article was first published in the print edition of The Saturday Paper on Jun 27, 2020 as "Viral spiral".
A free press is one you pay for. In the short term, the economic fallout from coronavirus has taken about a third of our revenue. We will survive this crisis, but we need the support of readers. Now is the time to subscribe.