Four ways our COVID-19 response was a triumph; four ways it fell short

Four ways our measures were a triumph and four ways they fell short.

Four ways our COVID-19 response was a triumph; four ways it fell short

Stephen Duckett, Grattan Institute and Anika Stobart, Grattan Institute

Australia’s response to the coronavirus outbreak so far has been among the most successful in the world. From a peak of more than 400 cases a day, the rate has fallen to fewer than 20 new cases a day.

Australia has avoided the worst of the pandemic, at least for now. Comparable (albeit larger and more densely populated) countries, such as the United Kingdom and United States, are mourning many thousands of lives lost and are still struggling to bring the pandemic under control.

The reasons for Australia’s success story are complex, and success may yet be temporary, but four factors have been important.

Success 1: listening to experts

The formation of a National Cabinet, comprising the prime minister and the leaders of each state and territory government, was a key part of Australia’s successful policy response to COVID-19.

States and territories have primary responsibility for public hospitals, public health and emergency management, including the imposition of lockdowns and spatial distancing restrictions. The Commonwealth has primary responsibility for income and business support programs. Coordination of these responsibilities was crucial.

The National Cabinet was created quite late – in mid-March 2020 when cases were beginning to increase exponentially – but has proved an effective mechanism to resolve most differences as Australia’s dramatic and far-reaching measures were put in place.


Read more: Explainer: what is the national cabinet and is it democratic?


Within a week of the National Cabinet being formed, Australia began to place restrictions on social gatherings. On 22 March, ahead of a National Cabinet meeting that evening, Victoria, New South Wales and the Australian Capital Territory announced they were proceeding in the next 48 hours to shut down non-essential services. This helped push all other governments into widespread business shutdowns announced by Prime Minister Scott Morrison that night, to take effect the following day.

National cooperation was further enhanced by the Australian Health Protection Principal Committee (AHPPC), comprising Australia’s Chief Medical Officer Brendan Murphy and his state and territory counterparts. From the start of the crisis, this forum helped underpin Australia’s policy decisions with public health expertise, particularly with regard to spatial distancing measures. Professor Murphy has frequently flanked Morrison at national press briefings.

Success 2: international border closures and quarantine

Australia’s decision to close its borders to all foreigners on 20 March, to “align international travel restrictions to the risks” was a turning point. The overwhelming number of new cases during the peak of the crisis were directly linked to overseas travel, and overseas sources account for nearly two-thirds of Australia’s total infections.

A week after closing the borders, Australia instituted mandatory two-week quarantine for all international arrivals. Together, these measures gave Australia much more control over the spread of the virus.


Read more: Is it time to reopen our borders? For states still recording new cases, it's too soon


Success 3: public acceptance of spatial distancing

Australia’s rapid adoption of spatial distancing measures reduced the risk of community transmission.

Perhaps galvanised by images of Italy’s health system on the brink of collapse, Australians quickly complied with shutdown laws. In fact, many people had already begun reducing their activity before the restrictions were imposed.

Australians’ compliance is demonstrated by the low number of community transmissions, despite having less strict lockdown laws than some other countries such as France and New Zealand.

Success 4: telehealth

One of the federal government’s early moves was to radically expand Australians’ access to telehealth. This allows patients to consult health professionals via videoconference or telephone, rather than in person.

Australians have enthusiastically embraced telehealth, with more than 4.3 million medical and health services delivered to three million patients in the first five weeks. A survey of more than 1000 GPs found 99 per cent of GP practices now offer telehealth services, alongside 97 per cent offering face-to-face consultations.


Read more: Coronavirus has boosted telehealth care in mental health, so let's keep it up


Unfortunately, Australia has also had failings, and it might have been in an even better position today if it had acted more decisively. Although it eventually “went hard”, the federal government spent the early weeks of the crisis mired in uncertainty.

Failure 1: the Ruby Princess

About 2700 passengers from the Ruby Princess cruise ship were allowed to disembark freely in Sydney on March 19, despite some showing COVID-19 symptoms. The ship has become Australia’s largest single source of infection. About 700 cases (10 per cent of Australia’s total) and 22 deaths (about 20 per cent of Australia’s deaths) are linked to the ship.

Failure 2: too slow to close borders

While Australia was comparatively quick to ban foreign nationals coming from China, it was slow to introduce further travel restrictions as the virus began to spread throughout the rest of the world.

It took more than six weeks after Australia’s first confirmed case for the federal government to introduce universal travel restrictions. Before this, restrictions were targeted at specific countries, such as Iran, South Korea and, belatedly, Italy – despite other countries such as the US posing similar or even greater risks.


Read more: Coronavirus has seriously tested our border security. Have we learned from our mistakes?


Failure 3: too slow to prepare the health system

Australia was too slow to ready its health system for the prospect of the virus spreading rapidly. When cases began to rise exponentially, Australia was ill-prepared for a pandemic-scale response.

This was particularly evident in the testing regime. At first, some people with symptoms went to community GP clinics and hospitals, without calling ahead, putting others at risk. On March 11 the federal government announced 100 testing clinics would be established, but this was only completed two months later, once the peak of the crisis had passed.

The result was that as cases began to increase in mid-March 2020, Australia suffered supply shortages for testing.

Australia also struggled to meet the rising demand for personal protective equipment (PPE). Australia’s stockpile of 12 million P2/N85 masks and 9 million surgical masks was not sufficient, and neither had it stockpiled enough gowns, visors and goggles to cope with the crisis. GPs complained of inadequate supplies hampering their work.

Eventually, on 26 March, elective surgeries were curtailed so PPE could be diverted to the pandemic frontline.

Failure 4: shifting strategies and mixed messages

The lack of a clear, overarching crisis strategy has resulted in a reactive policy approach, featuring confusing messages.

At first there was confusion about exactly which businesses or events (such as the on-again then off-again Melbourne Grand Prix) should be shut down. There were also inconsistencies between the Commonwealth’s position and the states’. For example, most states closed or partially closed their public schools around Easter and began reopening them when cases went down more than a month later. Despite concerns raised by some state governments, Prime Minister Morrison repeatedly insisted there was no risk in sending children to school. Childcare centres remained officially open throughout.


Read more: We've known about pandemic health messaging since 1918. So when it comes to coronavirus, what has Australia learnt?


The mixed messages have been particularly pronounced on Australia’s approach to the virus itself. The federal government initially talked about “slowing the spread”, but some states argued for a “stop the spread” strategy. This tension increased confusion about how far Australia’s lockdown restrictions should go. Debate raged between people who argued that “herd immunity” was Australia’s only realistic option, and those who pushed for “elimination” of COVID-19 in Australia.

Confusion reigned for too long. Even an 16 April statement from Morrison, designed to clarify the long-term strategy, conflated two different strategies by declaring Australia was continuing to “progress a successful suppression/elimination strategy for the virus”.

In the end, the case count provided its own answer. Several states began to record multiple days and weeks with no new cases, showing that elimination may indeed be possible.


Read more: We may well be able to eliminate coronavirus, but we'll probably never eradicate it. Here's the difference


As restrictions unwind, a new norm will set in. The risk of COVID-19 emerging again means Australians’ way of life will have to fundamentally change. Significant risks remain, particularly for states that ease restrictions too fast. Continual monitoring will be required to prevent further outbreaks or a second wave.The Conversation

Stephen Duckett, Director, Health Program, Grattan Institute and Anika Stobart, Associate, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Are you supportive of Australia’s response to COVID-19? What other measures do you believe should be in place?

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    COMMENTS

    To make a comment, please register or login
    Thoughtful
    4th Jun 2020
    5:01pm
    Closure of the borders was the key. And perhaps we were too slow to universally close borders. Not only does this stop virus coming in from overseas to the community, but it breaks the community into smaller numbers so that contact tracing is somewhat easier. I assume that is the reasoning behind the individual state borders closing though states are being savagely criticized for that now. Economy vs health. If we are to see an increase in new community cases, I think the use of masks in some places should be considered eg public transport. I certainly support it for plane travel.
    Horace Cope
    4th Jun 2020
    5:01pm
    "Are you supportive of Australia’s response to COVID-19? What other measures do you believe should be in place?"

    Absolutely in support. The Ruby Princess was a mistake but whose mistake it was will be made clear on completion of the Royal Commission. Closing the borders was not too late as the WHO accused Australia of doing the wrong thing when the borders were closed to China where the virus was presumed to have originated and countries where the spread had increased rapidly. The borders need to be kept open to allow Australian citizens to return home.

    The health system was initially geared to combat the proposed numbers that were thrown about including that between 50,000 and 150,000 people would die. When these numbers were known to be wrong, the testing commenced, returning travellers were quarantined for 14 days as were any who tested positive.

    The only suggestion that I would offer is that if there is a National Cabinet then the consensus of the group should be the decision for all members. Confusion has arisen because states have done things differently. Some have closed borders, some have a different method of schooling, some have different quarantine strategies and some have different rules on social gatherings. If the states won't agree with the majority then the federal government has to overrule the recalcitrant states.
    Aggle
    4th Jun 2020
    10:09pm
    Your last paragraph is an absolute must, if we find ourselves in this situation again sometime. Those of us living close to state borders certainly felt the differences between states was an annoyance.
    Eddy
    4th Jun 2020
    11:53pm
    But Horace every state is different, and in the case of WA, parts of the state are different. Look at the different outcomes between NT and Vic/Tas. NT had no cases for weeks and justifiably opened up (but not their borders though) whereas Vic continually had cases and, even though the Vic borders were not closed, had to keep restrictions in place. Should QLD, SA, NT, Tas and WA keep their borders closed is a moot point. Do the states have the right to close their borders, I suggest the High Court ruled decades ago that they do, irrespective what Ms Hansen or Mr Palmer may want to believe.
    KSS
    5th Jun 2020
    6:54pm
    I can not understand why people are 'confused'. After all, we all live in a single state or territory. The rules there are the only ones that are relevant to the individual. Issues such as border security are national issues and we all have the same rules - no international travel.

    All people had to do was listen to their own Premiere and State/Territory Chief Health Officer. No confusion at all if you do that.
    Gazza
    4th Jun 2020
    7:22pm
    The National Cabinet has been a success, consensus seems to work well with the Australian psyche.
    For those of us in NSW the royal commission will never find the true reason. Goes a bit too high is the word on the street.
    Eddy
    5th Jun 2020
    12:06am
    One thing that we must implement, stockpile adequate stocks of medical equipment, particularly PPE, for the next outbreak (we do not know when that will be). The Defence Department spends $billions each year stockpiling military equipment, a lot of which is never used before it becomes outdated. Since Defence has the expertise in purchasing, warehousing, maintaining and rotating large quantities of materiel maybe Defence could be tasked and funded to stock an Australian stockpile of medical equipment adequate for at least 90 days supply at the levels experienced during Covid-19.
    Golden Oldie
    5th Jun 2020
    1:29pm
    Eddy, that makes a lot of sense. Maybe also stockpile equipment needed for bushfires, which seem to get worse every year.
    Eddy
    5th Jun 2020
    6:32pm
    Good idea Golden Oldie. The two areas where we are most deficient seems to be health and bushfire fighting. I noticed that when the police and military in USA deployed to the street in response to the protests they did not seem the be deficient in PPE, unlike their compatriots in the health sector fighting Covid-19. That seems to indicate where 'the powers top be' priorities lie.
    KSS
    9th Jun 2020
    6:31am
    Because Eddy, they were not wearing PPE they were wearing riot gear!
    Julian
    8th Jun 2020
    8:21am
    Potential failure #5: public rallies which could undermine all of the previous social distancing practices and crowd gathering restrictions.

    Future outbreaks, if they happen, could be attributable to recent events, undoing the sacrifices of the last 10 or so weeks.


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