The next ‘circuit breaker’ could break us

6 minute read

Even those who have applauded Victoria’s past tactics are justified in questioning the wisdom of the latest lockdown.

We in Victoria have just endured our third lockdown in 11 months.

Having lived through two previous lockdowns, including the harshest one globally lasting over 100 days, we might justifiably ask for the indications for this latest lockdown, even if it went only five days.

It was dubiously labelled “the circuit breaker”, which implies we were on the precipice of a major calamity and the five-day lockdown was essential to prevent a catastrophe.

Over the two weeks leading to the lockdown 16 cases of community transmission were identified, largely emanating from the Holiday Inn at Melbourne Airport. During the five days of lockdown, a further three cases were identified, all related to the Holiday Inn cluster.

Around 130,000 tests were carried out in these five days, including a record 40,000 tests on the last day of the lockdown. These failed to identify a single case of community transmission beyond direct links with the Holiday Inn. Two days after the easing of the lockdown, the DHHS revealed a further three cases connected with the Holiday Inn. All of these cases were in isolation at home.

Given the absence of community transmission beyond those directly linked to the Holiday Inn it seems reasonable to question the five-day lockdown. The official justification given by the Premier Dan Andrews on medical advice, was that the virus had the morphology of the highly contagious UK strain and it was necessary to lock down to stop the virus in its tracks.

However, after more than 130,000 tests there was no evidence of secondary transmission. So what does this tell us? Is the virus not as virulent as expected? Could it be that the virus does not do so well in the warm summer as it has done in UK, Europe or North America in the midst of a harsh winter? Could it be that the lockdown was misguided?

Early in January there was an outbreak of COVID-19 linked to the Black Rock Café also in Melbourne. Some 38 cases were detected in community transmission, twice the number linked to the Holiday Inn, yet there was no lockdown.

Lockdown is a crude tool for managing pandemics, but is justified when we are dealing with large numbers spread across a large geographic region. When numbers are small, tracking, tracing and testing are the appropriate tools for containment. This has been shown again and again to be effective when there are relatively small outbreaks.

Certainly, when we had a second wave in Victoria with case numbers exceeding 700, lockdown was essential. The “reproduction ratio” may have resulted in several hundred thousand cases, far beyond the capacity of tracking and tracing.

The WHO declared its position on lockdowns as recently as December 31, which is as follows:

“Lockdowns can have a profound negative impact on individuals, communities, and societies by bringing social and economic life to a near stop. Such measures disproportionately affect disadvantaged groups, including people in poverty, migrants, internally displaced people and refugees, who most often live in overcrowded and under resourced settings, and depend on daily labour for subsistence.

“WHO recognises that at certain points, some countries have had no choice but to issue stay-at-home orders and other measures, to buy time.

“Governments must make the most of the extra time granted by ‘lockdown’ measures by doing all they can to build their capacities to detect, isolate, test and care for all cases; trace and quarantine all contacts; engage, empower and enable populations to drive the societal response and more.”

So is our tracking and tracing unable to manage an outbreak of 19 cases all linked to a single source?

We are going to have to live with mutations of COVID, some more virulent than others. We have experienced this with the flu virus which does this regularly. Are we going to call lockdowns each time there is a community outbreak linked to a cluster?

This third lockdown has had devastating consequences on the mental wellbeing of the population and businesses that have had a further setback just as they were begining to recover from previous lockdowns. The fact that the lockdown encompassed Chinese New Year and Valentine’s Day, meant that Melbourne restaurants lost over $100 million. Some have now permanently closed their doors. Lifeline took 3000 more calls than for a comparable weekend a year ago.

I have generally been a supporter of Victorian government’s handling of the pandemic. However, recent inconsistencies leave me in a troubled state.

Carols by Candlelight, a time-honoured artistic and religious outdoor event was cancelled even when it was possible to accommodate 5000 people with appropriate social distancing outdoors. Not two days later, 30,000 patrons were able to attend the cricket and no holds were barred to ensure the Australian Open was able to proceed a few weeks later, albeit with some crowd restrictions. Sport always trumps the arts in the inconsistent administration of policy.

Like Melbourne, Perth and Brisbane have also had lockdowns with minor outbreaks. Sydney has managed its outbreaks without resorting to lockdown. COVID has yet again revealed a failure of national approach when it comes to managing this pandemic.

The trigger for the current lockdown was once again a failure of the quarantine system. It had failed before and led to the first two lockdowns, and it failed again this time. The difference this time was that we were told that we had the best system for managing quarantine in the country and our methods were so good that they were being adopted by European nations.

We were also told that there will be occasional failures. I accept that no system is perfect but it has become clear that running quarantine out of air-locked city hotel rooms with suspect air conditioning is a recipe for failure. Finally, the Premier has announced plans to build a Northern Territory style facility 40km from the CBD adjacent to Avalon Airport. Quarantine is constitutionally the responsibility of the commonwealth, which seems to have abrogated its responsibility and hand-balled it to the states.

We have been very compliant as a nation, and particularly as a state in Victoria. However with these lockdowns, particularly when there were only 16 cases, run against WHO guidelines, destroying business confidence, creating further uncertainty and exacerbating mental illness, our patience is running thin and our tank of goodwill is running dry.

Lockdowns have locked people into the prison of their own home and into the dark interstices of their own minds. They have locked out businesses from making a living and supporting employment and, in many cases, they have led to businesses locking up permanently.

It is time our political leaders and their medical advisers were honest with us, admit their own insecurities and uncertainties, and avoid the rush to lockdown each time there is a small cluster of cases.

Professor Leon Piterman is Professor of General Practice at Monash University and has been in clinical practice for 40 years.

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