Michael Tanner weighs the evidence as Victorian Premier Dan Andrews charts a way out of the state’s lockdown.
The debate over Covid-19 lockdowns has reached fever pitch.
The bipartisanship that was crucial to Australia’s success in the early days has given way to political bickering. Scott Morrison and Josh Frydenberg’s attacks on Annastacia Palaszczuk and Daniel Andrews mark a profound increase in the politicisation and polarisation of the response to Covid-19.
Healthy debate is the cornerstone of a functioning democracy. Intense polarisation is not. One needs only look at America for evidence of that. Deaths are approaching 200,000 and show few signs of abating. Yet US President Donald Trump maintains an approval rating that has not dropped below 85% among Republicans this year; it has not exceeded 15% among Democrats.
This polarisation has been central to the undoing of the American response to Covid-19. The Trump administration was slow to react because a virus that hit Democratic states hard – particularly New York City – was of political benefit. It was only as the pandemic infiltrated the red states of the south that action began. Even then, changes have been half-hearted, and social distancing and mask wearing have become political statements rather than actions of heeding health advice. Meanwhile the virus rampages on.
Back in Melbourne, the insidious beginnings of a similar polarisation have begun. The anger over extended lockdowns is close to bubbling point, with anti-mask and other protests growing.
Roadmap not a political decision
The decisions of the Andrews government are increasingly being viewed through a political lens. But the extended lockdown and the roadmap out are not political decisions. In light of the visceral public anger, frustration and despair, it is obvious these decisions are not made to boost approval ratings.
Victoria’s crisis has been brought about by a failure of both state and federal governments. State Labor’s hotel quarantine disaster was exacerbated by the chronic underfunding of the state’s public health system; particularly the pen-and-paper contact tracing system.
But failures at the federal level abound. The failure of Scott Morrison’s federal government to develop and roll out a comprehensive federal aged-care plan contributed significantly to sky-rocketing case numbers and unnecessary deaths. As did the refusal to demand each aged care home appoint a designated infection control manager, a recommendation made eight years ago by a coroner.
And then there is the increasing casualisation of the workforce in the last decade of Liberal governments, leaving millions of Australians without sick leave, forced to choose between feeding their families and undergoing quarantine to stop the spread.
Path ahead is unclear
There have been calamitous mis-steps. But despite the apoplexy of the business, retail and hospitality sectors and the growing concern among some doctors regarding the reduction in cancer screening and presentations to emergency department, the best path forward is far from clear.
Chief concerns are the shock to the economy and skyrocketing unemployment on the business side; and on the health side, the reduction in people seeking medical care, as well as growing mental health concerns. These are big issues.
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But to what extent are these purely due to the lockdown?
Some point to Sweden as a model of Covid-19 control. Despite one of the highest per capita death rates in the world, the country is now seeing relatively few daily deaths. It is easy to assume Sweden is living as if Covid-19 was not a spectre haunting the horizon. But Sweden should not be compared to Australia. Like other Nordic countries, Sweden has a relatively homogenous culture; trust in government is far higher than in Australia; and 40% of households are single-person households, compared to less than 25% in Australia. These are all factors that promote adherence to the light touch of the government.
Economist Nicholas Gruen points to a 70% decline in road traffic in Sweden in the early days of the pandemic, at a time when Australia’s, in comparison, was 80% under strong lockdown measures. Fear of the virus led to voluntary social distancing and self-isolation.
On a per capita basis, at the height of transmission, the three-day average of infections in Victoria exceeded 90 per million population. This is roughly the same rate as seen in the United Kingdom at the peak of its first wave. It is fanciful to think that the Swedish approach would be effective given what we witnessed in Victoria during our second wave in July – despite the implementation of stringent restrictions.
Nor did Sweden’s light touch mitigate the economic harm. As Greg Jericho reports in The Guardian, countries that saw the greatest number of deaths per capita also experienced the worst economic decline. In the quarter to July 2020, Sweden’s GDP declined 8.6%, more than the 7.4% drop seen in Denmark and the 3.2% fall seen in neighbouring Finland. The EU average sits at 12%. Australia’s declined 7%, by comparison. Sweden also recorded five times more deaths than Denmark, and 10 times more than Finland.
Looser restrctions don’t guarantee a bounce back
Looser restrictions do not guarantee a vibrant economy because, as Bernard Keane noted in Crikey, there will be no recovery without people feeling safe. “Removing lockdown is not going to restore confidence: only when people are no longer concerned about the risk of dying, or infecting a loved one, will they lose their caution and start spending.” Loosening restrictions does, however, guarantee an increase in the number of cases without strict adherence to public health measures.
Health care concerns are valid and important. Cancer diagnoses are down in Australia, and the delay in elective surgery is likely leaving many people in pain.
But cancer diagnoses are down in Sweden, the Netherlands, and in countries all around the world, with or without lockdown. A reduction in preventative health care is largely a result of a global pandemic, of fears of infection, and of overburdening the health system. While lockdowns probably contribute, easing restrictions are not the panacea.
Despite early fears of increases in suicide, a recent coroner’s report found that the number of suicides is no higher than 2019. However, history has shown us time and time again that recessions lead to suicides – the great depression, the economic crises in Russia in the early 1990s and east Asia in the later parts of that decade; the global financial crisis. Restarting the economy is paramount, but failure to control Covid-19 will remain an anchor on growth. The virus remains a health crisis that begat an economic crisis. It must not become politicised.
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Political interests are, however, growing. The closure of state borders remains an ongoing issue, and will hinder economic recovery.
State governments that have closed borders have seen their popularity skyrocket. While NSW, South Australia and Tasmania accepted a definition of a hotspot to try to open borders, Queensland and Western Australia remain obstinate. It remains to be seen whether Prime Minister Scott Morrison is eventually going to risk angering voters in these states by forcing open state and territory borders.
Victoria a pariah state?
If restrictions ease too early in Victoria, cases will rise. State borders will then definitely stay closed. We can then say goodbye to the prospect of state borders opening to Victorians before widespread vaccination is available – which is unlikely to happen before the end of 2021, at the earliest. Victoria, in essence, is likely to remain a pariah state until there is a vaccine. What if one is never found? Do we wish to accept that we will not be able to leave Victoria until there is widespread vaccination? No visiting children, or sick relatives? No interstate travel? I personally do not.
The road map has flaws. The criteria for loosening restrictions should not be based solely on case numbers. This disincentivises testing when people only have mild symptoms. The proportion of tests returning positive should play a major role in deciding when to ease restrictions. The thresholds for easing are too strict – as Tim Colebatch reports, only one of 39 high income countries meets the standard set by the Andrews government.
A campaign to ensure people still visit their GP or hospital should have begun in April, but it is never too late to start. In the Netherlands, such a public awareness campaign appeared to halt the decline in cancer diagnoses that occurred following the first diagnosed case of Covid-19 in the Netherlands – prior to the implementation of strict social distancing measures.
Restrictions should be more targeted to settings where high transmission rates occur. Exercising outdoors with two or three other people, providing there is adequate social distancing, poses a minimal risk. The curfew is contentious, but pragmatic: it is likely to reduce clandestine gatherings and should have a minimal effect on those adhering to restrictions, particularly as it is extended to 9pm.
The decision of when to ease restrictions is likely to be one of the most challenging and complex decisions ever made.
Correction: An earlier version of this article incorrectly stated that more suicides had occurred in 2020 compared to 2019. There has not been such an increase. Apologies.
Michael Tanner is completing a Doctor of Medicine/Doctor of Philosophy. His writing explores the intersection of economics, the media and public health. His writing has also been published in The Age.