Thursday, July 16, 2020

Coronavirus in Australia: Experts say suppression was a mistake

You hear it all the time. “Is this our second wave?”  But it turns out the question posed by reporters at press conferences and pondered by colleagues over zoom chats has been poorly worded. Because Australia didn’t have a first wave … until now.

Professor Nick Talley is the editor-in-chief of the Medical Journal of Australia and has been watching the curve carefully since the pandemic reached Australia.

He told Victoria and NSW are experiencing the real first wave of the virus and that it was a mistake to try for the suppression method when Australia should have been aiming to eliminate COVID-19 altogether.

“Obviously in March when we were all very worried, it was a little bit unclear how much of the virus was in the community,” Professor Talley said.

“Some of us worried it was widespread. But if it was, the first lockdown knocked that off. It looks as if most of it was international travellers.

“Now in Victoria and possibly NSW we have widespread community transmission. That is new. That’s why I say this is the first real wave. We had a trial wave. We eliminated it, but now we are not in that situation so it’s all changed. It’s a different enemy.”

He said Australia has a chance before the virus takes off on an exponential curve to eliminate the virus, but it won’t be easy and Australians won’t like it.

“New Zealand’s experience shows that if you’re an island nation like Australia then you can eliminate the virus. “In my view it can still be done. There will some short-term pain to make that happen.”

Professor Talley said what happens next depends largely on what happens in NSW and Queensland.

“In Victoria they’ve shut down Melbourne. They may have to go wider than that. It may be in the regions. The real issue is the length of shutdown. The type of shutdown is appropriate, it’s the length that matters now.”

He said that elimination would require a very aggressive strategy. It could be considered a success when there are zero new cases nationally for two incubation periods.

“The theory that we can ringfence and eradicate the virus in Victoria has failed.”

Victoria recorded 270 new cases of the virus on Tuesday. Of those cases, 242 were spread through the community by an unknown source. In NSW, there were 21 new cases on Monday.

Naturally, as case numbers grow, the conversation about eliminating the virus in Australia is gathering momentum.

The ABC’s resident coronavirus expert, Norman Swan, told the 7.30 program: “The next four or five weeks will shape how Australians will live until a vaccine comes along.”

Victoria’s Chief Medical Officer Brett Sutton told reporters: “As a public health person, I’d be very happy if elimination were a feasible thing to achieve.”

He continued: “I would hope that as we move through this phase in Victoria … that we don’t close ourselves off to a re-evaluation … of what the pros and cons (of elimination strategy) are.”

Professor of Epidemiology at UNSW and WHO adviser, Mary-Louise McLaws, told she still supports “attempts to achieve ‘close-to-eradication’ and so I still believe going for suppression is not in the long run the most effective approach”.

“It is not yet too late for Victoria,” she said. “NSW case numbers without the return travellers (who have not been a high risk for spread indirectly to the community through hotel staff) have been low over two incubation periods which is used to determine the level of eradication and control.”

But Professor McLaws believes NSW could be on the cusp of a significant uptick in cases if the current number is not controlled.

She told The New Daily: “If it gets to about 100 cases across two incubation periods – about 14 days each – in very quick succession it doubles and then after that, it can double and triple each period.”

NSW Premier Gladys Berejiklian is now facing some difficult decisions. But if the virus continues on its current trajectory, so too does Prime Minister Scott Morrison.

Queensland Premier Annastacia Palaszczuk already made a hard decision. On Tuesday morning, she announced that residents from NSW hotspots are banned from Queensland.

“Travellers who have been in a COVID-19 hotspot within the past 14 days can’t quarantine in Queensland and will be turned away at our borders,” she said.


'Best doctors and nurses': Australia leads world in COVID-19 ICU survival rates

Australians severely ill with COVID-19 have recovered at an extraordinary rate throughout the pandemic, with 85 per cent of patients admitted into intensive care units surviving the deadly virus.

The latest data provided to the federal and Victorian governments on Tuesday suggests that, so long as the second wave of infections does not overwhelm the intensive care capacity of hospitals, Australia is unlikely to face a catastrophic loss of life.

As NSW health authorities work to contain its border outbreak, Victoria is bracing for a surge in hospital admissions, with the state’s Chief Health Officer Brett Sutton predicting that the current caseload of more than 1000 infections would result in at least 200 more patients in COVID-19 wards by the end of the month.

Data gathered and shared by Australia’s leading intensive medicine experts shows that even the sickest of these patients – those requiring mechanical ventilation and specialist nursing in an intensive care unit – have very good survival rates compared with other countries.

As of last Friday, a total of 214 confirmed COVID-19 patients had been admitted to ICUs since the start of the pandemic. Of the 200 cases where the outcome is known, 170 survived and 30 died.

Of 118 patients placed on mechanical ventilators, 78 per cent have survived.

The overall ICU mortality rate of 15 per cent compares to 40 per cent in Britain, 44 per cent in China, where COVID-19 originated, and up to 70 per cent in the US, where nearly 140,000 people have died from the disease.

The data does not include deaths from COVID-19 among people not admitted to ICU.

Federal Health Minister Greg Hunt described the survival rate of patients admitted to ICUs as one of Australia’s most important achievements throughout the pandemic.

"Not only are hospitals well equipped with ICU capacity and surge capacity, but arguably they have the best doctors and nurses and systems in the world," he told The Age and The Sydney Morning Herald.

"We have an integrated system where information on patient care, the latest treatments and medical research is shared through the Communicable Disease Network of Australia and the Medical Expert Panel. In short, our doctors, nurses and systems are saving lives and protecting lives."

A key source of information is data collated on a weekly basis by the SPRINT-SARI Australian Study, a collaboration between Monash University and the Australian and New Zealand Intensive Care Society Trials Group.

The project takes real-time data on COVID-19 patient treatments and outcomes across 77 intensive care departments in Australian hospitals and shares that information with government and an Oxford-based international consortium of researchers that tracks emerging respiratory infections.

The latest findings build on data previously reported by The Age that showed similarly promising survival rates during the early stage of the pandemic in March.

Monash University associate professor Craig French, the director of intensive care at Western Health, a hospital group treating patients from COVID hotspots in Melbourne’s north and western suburbs, said the high survival rates recorded by Australian ICUs reflected a "business as usual" approach throughout the pandemic.

"This is a form of viral pneumonia," he said. "It does have differences to other viral pneumonia but our results are very good and we should continue to treat patients as we normally would treat them.

"The message to the average punter out there is to do what the government says in terms of public health prevention. Not only is that reducing the number of patients with COVID-19, it means that if you are unfortunate enough to get sick enough to need intensive care, you are coming into an environment that is not overwhelmed and can give you the attentive care you need to have the best possible chance of getting better."

Since the first wave of COVID-19 infections, Victoria’s ICU capacity has increased from 476 beds to nearly 700 and about 1200 ventilators have been distributed to health services. At the Western Health’s Sunshine and Footscray hospitals, a newly designed COVID-19 hood is being trialled so that non-invasive ventilation and other oxygen therapies can be used without putting staff and nearby patients at risk of infection from airborne droplets.

Australia currently has 105 COVID-19 patients in hospital and 27 in ICU. Of those, 85 are in Victorian hospitals and 26 in Victorian ICUs. Professor Sutton said those numbers would increase over the next two weeks.

"We have over 1800 active cases in Victoria," he said. "That's a really significant number of people with coronavirus and it does mean that in the next fortnight, we're going to see a number of people who will require hospital.

"There's often 10 per cent to 20 per cent of all coronavirus infections who require hospitalisation, so that's a couple of hundred individuals at least."

Dr French said there were "ample beds available" within the state’s intensive care units and that, if people observed the public health directions already in place, the risk of the system being overrun was "extremely low".

Professor Andrew Udy, the deputy director of the Australian and New Zealand Intensive Care Research Centre at Monash University, said Australia’s survival rates showed the strength of its well resourced intensive care system and highly skilled staff; especially intensive care nurses.

However, he said Australia’s success also reflected the relatively low number of COVID-19 cases recorded here in the first phase of the pandemic, which had not tested the capacity of the intensive care system.

"The key to combatting this is not in the hospital; it is outside the hospital," he said. "If you get very sick with COVID and the system is able to operate within capacity, we can hopefully achieve very good outcomes for most of those patients."


NSW premier shuts down lockdown talk as cases rise

NSW teeters on the edge of a new coronavirus lockdown, but Premier Gladys Berejiklian insists it will not happen.

With Victoria already cut off from the rest of the country and Melbourne in lockdown at the heart of its coronavirus crisis, Ms Berejiklian indicated last night that NSW would not follow its southern neighbour even as cases grew.

"We can't shut down every time we have a cluster of cases," Ms Berejiklian told A Current Affair. "We can't keep shutting down and reopening, that is not a good way for us to manage the pandemic."

Ms Berejiklian said people must learn to live with coronavirus and the deadly threat it poses.

Her government's plan is for NSW residents to have a "good quality for life" for the duration of the pandemic, and manage the deadly threat without constant lockdowns. "We need to accept children need to be educated, that people need to go to work," she said.

"It would be unrealistic for us to assume we are going to see any situation where there's zero cases. "This is the nature of a pandemic – until we have a cure, we have to live with it."

Queensland has announced bans on people from NSW "hotspots", with multiple clusters having now taken hold, including the most significant stemming from the Crossroads Hotel with 30 cases.

Restrictions have been renewed on NSW pubs in an effort to halt further outbreaks.

Victoria recorded 270 new cases and two new deaths yesterday. The state's total active cases is now at 1803 and the national death toll is 110.

Chief Health Officer Brett Sutton said Victoria had not "turned the corner yet" since the toughest measures in the country were reinstated last week. "Further restrictions need to be considered," Mr Sutton said.

With hundreds of thousands of people out of work and state economies spluttering to restart, leaders are desperate to avoid pumping the brakes.

The vehement opposition to a lockdown comes not only from Ms Berejiklian but also federal cabinet, O'Keefe said. "Melbourne and Sydney are the twin engines of our national economy … (and) we've already lost one."

But that decision may become unpalatable as deaths continue to rise.


Only some violence matters

Bettina Arndt

Perhaps some of you might like to write to the Australian Institute of Criminology and possibly your local members of parliament and ask why this government organisation commissioned research that so selectively focused on one type of violence? The survey of 15,000 Australian women in May studied the prevalence and nature of domestic violence experienced by women during the pandemic.

You could mention this recent research report from the University of Queensland showing that’s only part of the story, with men and women equally likely to experience intimate partner violence – a finding replicated in thousands of other studies.

Perhaps the Institute could also have reported on experience of children locked up with violent fathers and mothers during that month. In fact, the Institute’s own research shows children report parents to be almost equally likely to be violent. The Institute’s 2001 Young Australians and Domestic Violence study found 23 per cent of young people were aware of domestic violence by fathers or stepfathers against their mothers or step-mothers yet an almost identical proportion (22 per cent) of young people were aware of domestic violence against their fathers or step-fathers by their mothers or step-mothers.

If we were really concerned about breaking the cycle of violence, the experiences of these younger victims of family violence would surely be relevant.

From: Bettina Arndt newsletter:

 Posted by John J. Ray (M.A.; Ph.D.).    For a daily critique of Leftist activities,  see DISSECTING LEFTISM.  To keep up with attacks on free speech see Tongue Tied. Also, don't forget your daily roundup  of pro-environment but anti-Greenie  news and commentary at GREENIE WATCH .  Email me  here

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