“The exercise showed that societies are more fragile than perhaps we were expecting,” says Heslop, from the university’s school of public health and community medicine. “What you ended up with were strategic dilemmas all the time about where and how to allocate resources … and how best to use very limited stockpiles.”
Nor far removed, in fact, from what is happening now in Spain, Italy and New York.
Heslop fears Australia has acted too cautiously and too slowly to avert some of those scenarios playing out here. “I feel we will look back in 20 years and recognise that we were unable to respond in a way which is rapid and most effective for this crisis,” he says.
“I think we will look back and be critical of the way this has been handled. In coming months we will be looking for the answers as to how we got here because the impact is probably not yet in the national consciousness about what is going to unfold. That is best described as the most significant and profound national crisis – from a social, moral and medical perspective – that the nation has ever faced.”
On Friday, emerging from the latest national cabinet meeting with state and territory leaders, Prime Minister Scott Morrison remained relatively upbeat in the face of the pandemic, announcing tougher enforced quarantine for overseas arrivals and declaring “here in Australia it’s a vital time, but we are getting on top of this”.
“I would rather be in Australia now [doing what we are doing] than in any other country in the world today,” he said.
The nation’s health authorities continue to reassure that the country is in a far better place than Italy, Spain or the US in terms of testing rates, death and intensive care rates and the extent of community spread.
Yet MacIntyre remains alarmed by Canberra’s dogged determination to proceed by way of incremental steps – what officials call “scaleable, proportionate and sustainable” measures. “The window to have acted decisively has grown a lot smaller,” she says. “Because we have only been testing people with symptoms, we remain on a similar trajectory to the United States and Italy.”
New South Wales alone was heading towards 1500 cases on Friday, a threat exacerbated by the disgorging of thousands of untested passengers from the Ruby Princess cruise ship in Sydney the week before last (a blunder which has led to energetic finger-pointing between NSW Health and the Australian Border Force).
MacIntyre labels it a “debacle”. “It means there will be people without symptoms who are transmitting it, it’s going to be spreading silently throughout our community” she warns. “You may not see a hit on the health system for 4 to 6 weeks through a couple of incubation cycles. But that has compounded everything.”
So she takes little comfort from the fact that so far, there are low numbers of COVID-19 patients in intensive care here. She and others expect that to change markedly in coming weeks, perhaps as soon as late April or early May, a fear underscored by an article in the Medical Journal of Australia on Thursday warning Australian hospitals do not currently have the capacity to accommodate what they foresee might be the demand on intensive care beds.
Heslop feels that significant numbers of Australian lives, “many thousands, into the tens of thousands” are now at stake.
With medics and nurses fearful of shortages of personal protective equipment, MacIntyre alerted health authorities last June to the fact that 30 million respirators, or P2 masks (which filter out airborne particles) would be needed if there was a serious epidemic lasting six months in Sydney. It is understood this was nowhere near the amount the nation had stockpiled.
Sydney University virologist associate professor Tim Newsome also doubts history will judge the country to have acted fast enough. “Will we look back and say we did enough? Our trajectory is looking disastrous at the moment.”
He adds the proviso that “every country is different. Singapore is a city state, China has measures which it can deploy as an authoritarian government. But the social measures we’ve adopted up until this week have not, in European countries, led to a significant drop; they’ve had to go much stricter.”
Chris Richardson, a director of Deloitte Access Economics, lays out stark numbers. “We have never before dealt with a problem that gets four times bigger every week,” he says. “People don’t understand the immensity of that. After five weeks the problem is already 1000 times bigger. After 10 weeks it’s a million times bigger. When you have a geometric crisis, a decision taken today is four times more effective, four times more valuable, than the exact same decision taken a week later.”
He does not envy our political leaders their agonising dilemma. “Every day you buy is a stunningly valuable commodity in terms of lives saved. But don’t forget how awful the trade-off is, the knock on of jobs lost, mental health, domestic violence. There are no good answers, every answer is terrible.”
He says the case for more emphatic social and workplace restrictions remains open, but “the faster the acceleration in case numbers , the greater the weight of economic argument swinging towards that.”
The walking-the-wire act the government is trying to pull off has appeared to be under growing strain at several points this week.
Morrison has declared it a “twin crisis, a crisis on a health front which is also causing a crisis in the economy. And both of them can be as equally as deadly”. Finance Minister Mathias Cormann says the government is trying to keep the economy in the “best least bad shape possible through this period”.
The outcome on Tuesday night was a somewhat surreal press conference in which Morrison and Chief Health Officer Brendan Murphy laid out a long list of new measures – a laundry list, as some described it – designed to keep Australians at a distance from one another, while seeking to keep faint signs of life pulsing through the economy.
But the anomalies were puzzling. Five at a wedding, 10 at a funeral, no gatherings outdoors but 10 in a boot camp was okay. A whole raft of small businesses providing personal services shut down but not hairdressers, who could tend to their clients for 30 minutes and no more (a stricture relaxed a day later).
Murphy declared the intent was to “put restrictive measures in place without destroying life as we know it”. But even while shopping centres and many non-essential retailers were allowed to stay open, customer traffic was falling off a cliff.
I think we will look back and be critical of the way this has been handled.
David Heslop, Associate Professor, UNSW
On top of the strictures placed on clubs, pubs, restaurants, cafes, and events, Tuesday’s proclamation tipped tens of thousands more into the ranks of jobless with big-name retail brands including Just Jeans, Portmans, Athlete’s Foot, Skechers, General Pants and others pulling down the shutters.
For many businesses it’s become the death of a thousand cuts, and there is a growing view, espoused by the likes of the Grattan Institute’s incoming director, Danielle Wood, that the economy might be better off with a New Zealand or British-style full shutdown (barring essential services) for a defined period.
“There were a lot of people [economists included] early on dismissing the scale of this,” Wood says. “They did not understand the health shock, what the exponential curve was going to mean for cases and hospital admissions.”
But she believes a short sharp shock now would be a better way to go. “I think it’s the uncertainty that is killing business right now,” she says. “What we really need to do from an economic perspective is make sure that what is a temporary hit to income does not become a permanent hit to the productive capacity of the economy.
“That’s an easier problem to address when you know that [a shutdown] is for a fixed, between six and eight weeks, period … But if you want to talk about this rolling on for six months or more because you are just going for a halfway-house approach, I think that will see a lot of businesses go to the wall.”
Founder and CEO of hairdressing chain Just Cuts Denis McFadden put it bluntly on Thursday night: “We need the government, now, to shut us down!”
But Morrison again on Friday made clear that keeping people in jobs remains a top priority for himself, and other leaders. In the “absence of a compelling health reason”, he said, “I will fight for every job I can because I know that that job means something very important to that person and their family.”
Inside the national cabinet of state and territory leaders the Prime Minister presides over, tensions over strategy have at times broken into the open. The two biggest states, with by far the greater burden of cases, have been increasingly restive about the incrementalism of the social distancing measures adopted to date.
Victoria’s Chief Medical Officer has openly flagged his wish for tougher action. NSW has signalled the time might come when it wants to do the same, though so far Premier Gladys Berejiklian has not revealed what the trigger for that might be, apart from saying it will depend on the rise in community transmission of the disease and how the hospitals are coping. On Friday NSW Labor leader Jodi McKay called on Berejiklian to press for a full lockdown at national cabinet or else go it alone.
In Melbourne, the head of the prestigious Burnet Institute, Professor Brendan Crabb, broke his silence to tell the Herald and The Age that “I would urge speed, and the clarity that would bring to the messaging”.
Referencing the horrors unfolding in Italy, where the death toll is currently running at close to 10 per cent, he says “you can’t say we are on track to be Italy, but we don’t know that we are not, either. My answer is to do everything you can now, to buy yourself some time”.
Measures more akin to the lockdowns in New Zealand and in Europe would, he argues, buy precious time: time that could be spent drumming up more supplies of personal protective equipment, hundreds more vital ventilators, time for reserve health workforces to be trained up into intensive care roles, and time for the expanded testing regime announced on Thursday to get a better handle on the silent spread of the virus through community transmission.
The government rightly underscores that most cases are still coming in from overseas, whether through infected travellers or their direct contacts. But the proportion of cases with no clear origin of infection is growing. That is the ticking time bomb that has public health experts so concerned.
Our death rate is thus far mercifully low, at 0.37, or 13 deaths so far from around 3000 cases.
But for how long? It was chilling to hear New York Governor Andrew Cuomo saying this week that he’d pleaded for 30,000 ventilators from federal authorities yet only 4000 were on the way. “You pick the 26,000 people who are going to die,” he said, in a voice breaking with anger and frustration.
In Australia, cuts to elective surgery are a small taste of the ethical dilemmas likely to confront the health system in a few weeks’ time. More than 1000 Australians, for instance, will now need to spend months more on dialysis, their hopes for kidney transplants on indefinite hold.
They’re the kind of choices that no wants to make, and which drive the urgency of those who don’t want governments to wait another day, let alone a week, a fortnight, or month, to slam the brakes on the virus with every ounce of collective will .
A group of experts convened by the Group of Eight prestige Australian universities at the request of Chief Medical Officer Brendan Murphy a fortnight ago were asked to give the government their view of the severity of social distancing measures that should be adopted. The overwhelming majority in the group urged a strategy of “go now, go hard and go smart”.
The “doubling time [of case detection] is approximately 1.6 days in Australia compared to 6 days in February” they wrote On March 22. “[This] is an indicator that the window for proactive intervention is very small. At this rate Australia could theoretically expect … over 50,000 cases by Easter.”
But “go now, go hard” did not find favour in Canberra. As Deputy Chief Medical Officer Paul Kelly later explained, what was at issue was “essentially two schools of thought”. One was go hard, go fast, while the other was what he called a “scalable proportional response”. And he added, “I’m a scalable, proportional responder”.
There are still many voices in the academic community who support the government’s more phased approach, prominent among them the Australian National University’s infectious diseases expert Peter Collignon.
There are others who confess, in private, to increasing unease about taking a contrary position publicly.
Yet most are agreed on one thing: there must be full transparency about the science and the evidence going forward to the Australian Health Protection Principal Committee (AHPPC), the peak body of government medical advisers.
Late this week the Australian Academy of Science said making this data open to all the nation’s many experts, as had occurred in Britain and New Zealand, was critically important.
Chief executive of the academy Anna-Maria Arabia says she has been fielding calls from her members across the country. They were, she says, “the most distinguished scientists in the nation, who want to and can be doing more but they don’t have any insight into what is informing and underpinning the government’s decisions and modelling”.
Much of that confidential modelling is being provided to the AHPPC by the Doherty Institute in Melbourne but its director, Sharon Lewin, says the decision to release it has to be one for the commonwealth, as the contractor which commissioned the work. A Department of Health spokesperson said “we are not releasing any specific modelling at this time”.
Chris Richardson has no doubt what’s at stake for the country’s leaders. “The decisions being made at the moment run the risk of saving, or losing, more lives in Australia than did the big battles in the world wars. And history will most likely throw stones, rather than remembering the sheer speed of this crisis.”
Deborah Snow is a senior writer for The Sydney Morning Herald.