by Patrick J. Byrne
What covid19 public-health infrastructure is needed to ensure a safe pathway towards, reopening Australia particularly to avoid what Victorians have experienced?
Lockdowns are a last-resort pandemic control measure, when a health department and government are caught unprepared with inadequate personal protection equipment (PPE), hospital equipment and training, inadequate face masks, sanitisation, contact tracing technology and quarantine operations.
In such cases the disease can spiral out of control, and hospitals can be overwhelmed, as was seen in places like New York.
A lack of senior public-health officials with professional public-health training, and inadequate central and regional health capabilities, make the matter far worse. Victoria appears to suffer from all of these problems.
Even World Health Organisation officials regard lockdowns as a last option, only justified “to buy you time to reorganise, regroup, rebalance your resources, [and] protect your health workers who are exhausted.”
Although home restrictions since March 30, expanded to stage 4 lockdowns on August 2, have been operational for almost seven months, Premier Daniel Andrews and the Department of Health and Human Services (DHHS) have still not produced a cohesive plan to manage covid19 and free up Victoria.
The recent easing of social restrictions and extending the 5-kilometre rule to 25 kilometres is pointless to businesses when they still cannot open. Reopening Australia means including a path forward for these establishments.
The Victorian Liberals have produced an eight-point plan to open up businesses, offices, professional services and schools; for easing restrictions on weddings, funerals, church services and sport; and has proposed adopting the NSW rules for restaurants, cafes, gyms and religious and other services “when new Victorian cases numbers drop to 10 per day”.
However, their plan is seriously short on the concurrent public-health policies necessary for reopening the state.
So, the NCC consulted experienced public-health experts to find out what public-health policies are needed to get the country open.
First, obtain a large stockpile of covid19 test kits that give a rapid, reliable result.
Second, facilitate a mix of rapid and regular testing at key infection sites to assess case numbers reliably. Current tests are too slow – they take up to a week.
Third, for people involved in covid19 clusters, ensure rapid pop-up testing capacity that processes swabbing within one hour. This requires a roving, surge unit and infrastructure that can be set up anywhere in Victoria within hours, not one to two days.
Prioritise those most at risk and who need to get through the queue fast: for example, the elderly, health workers, and women with children.
Fourth, obtain an enhanced IT system for tracing covid19 in the community that integrates other vital information into one system. A “people-led system” that relies on asking people where they were over the previous two weeks, since they might have become infectious, is inadequate for the level of spread possible with covid19. Additionally, contact tracing should extend from contacts to contacts of contacts. This is possible with a small number of reported new cases.
If the DHHS cannot trust its case numbers at current levels and rely on its recent IT enhancements, Victorians may accept a contact-tracing app as a condition of restrictions being lifted.
Fifth, create an effective, supervised quarantine system. Stop blaming people for bad behaviour and take a measured and reasonable response to the small number of people engaged in reckless conduct.
Sixth, establish permanent regionalised health units to manage outbreaks and to cover localised public-health management. Base this on the Victorian DHHS health regions, and in cities, according to sensible functional boundaries that bridge primary health networks, hospitals, primary care and local services networks.
Seventh, the DHHS requires a team of senior officers with deep public-health training across Victoria. These must hold the minimum industry standard of a Master’s in Public Health.
The current DHHS secretary’s background is in law and public administration, not public health.
Senior officials need experience in providing clinical health services and experience in generalist public-health skills, including not only infectious diseases control but also risk assessment and management, project leadership, policy, information management, communication and health economics. They need connections across the public-health sector that intersect with emergency, contract and defence services to enable fast action.
If such expertise cannot be found in Victoria, they should be brought in from the military, other states and overseas.
Victoria urgently needs a trusted public-health system so business, service industries, schools and churches can be allowed the freedom to monitor themselves and so form part of reopening Australia.
They may prove less risky than aged care, health and government agencies at spreading covid19.
Patrick J. Byrne is national president of the National Civic Council.