The problem is the virus runs rampant with ease, and unless it’s in very isolated small outbreaks, controlling viral cases by just testing and tracing can prove very difficult.
In Melbourne, suppression hasn’t been a winning strategy. Test and trace were overwhelmed in Victoria very quickly.
And if the virus gets a stranglehold, as it has in the US for example, it can be devastating.
New Zealand eliminated COVID-19. NSW was so close. So how does NSW now stop this virus dead in its tracks while we wait for a vaccine? We know how.
The answer is limiting infected people spreading the virus to others. Breaking the transmission chains. No transmission, no virus. Social distancing is key but alone it’s not enough.
We now know people can often transmit the virus when they have no symptoms at all, and this can be anywhere from two to 15 days before symptoms begin; you are most infectious when you have no or mild symptoms. Some people seem to spread to many (super-spreaders) and pose a very high risk for us all.
How then do we make sure people keep their distance when shopping, travelling on public transport, or having their hair done? It’s hard.
Would wearing face masks in NSW make a difference? The short answer is yes. There is evidence we should all be wearing masks when out and about in outbreak areas. A Lancet report of all the evidence found ordinary masks were at least 67 per cent effective in reducing the risk of spreading infection.
Masks play a really important role in stopping you, if infected, from spreading the virus to others. They also help reduce your risk of catching the virus.
Research indicates the virus can likely spread even in tiny droplets for up to several metres. And if there is no ventilation (like an open window), the virus can stay in the air for hours. Even speaking produces little droplets, thousands of them, that float in the air. Laughing and talking loudly sprays the droplets out around you. So, distancing is really important but it’s difficult when indoors or on the bus.
A simple cloth mask can protect. It needs to have multiple layers, and preferably be made of water-resistant cloth. You can learn how to make one at home, and putting it on is easy with a little practice. Washing your hands before putting on the mask and after taking it off is important. Washing a cloth mask after you return home every day is also important.
Critics of masks have pointed out there are no randomised trials proving a benefit. This is true, but how would we run such a trial safely and ethically, and should we ignore all the other evidence?
Others have suggested face masks would encourage people not to socially distance, but this isn’t supported by any compelling data at all. People seem more likely to avoid you and keep their distance if you wear a mask.
If more than 70 per cent of us wear masks out of our homes, and if masks are about 70 per cent protective, modelling data show masks alone would crush the virus curve.
If everyone wore a mask at work it would also likely provide protection to customers, as was reported when infected hairstylists with masks didn’t transmit to anyone.
But if only 20 per cent of people wear a mask, it won’t do much at all in terms of community transmission.
Will a lockdown be needed in NSW if current testing and tracing fail? Only if the virus runs out of control. To win, the curve needs to be crushed.
Tighter restrictions, short of a lockdown, to promote social distancing plus widespread mask use (which should be mandatory in outbreak areas) would make a big difference.
The public need to take the virus even more seriously in NSW, as they are, now, in Victoria. Yet there is no updated national guidance on face masks.
When the HIV epidemic hit, there was a federal government campaign nationally promoting condom use. Some did not welcome such a campaign back then. But it saved many lives.
Like condoms, face masks provide protection. Australia needs a national “Mask Up-Plus” campaign. It’s not just about wearing face masks – combining hand washing, distancing, sensible decisions about avoiding crowds and face masks is most likely to succeed in crushing the curve.
Unless we prefer more lockdowns. Or the virus running out of control.
A revised national campaign including face masks is urgent. Most of the community needs to be on board for it to work. It can succeed.
The aim? No new viral cases in the community in NSW for at least two weeks. Business and life can then go back to close to normal. Suppression just doesn’t cut it.
Professor Nick Talley is a clinician researcher and the editor-in-chief of the Medical Journal of Australia. He is a neurogastroenterologist and a leader in the medical and university sectors.