Australia would be much better placed to relax social distancing restrictions without risking a “second wave” of #COVID-19 cases if another two policies were implemented, according to Professor Guy Marks, a respiratory physician, epidemiologist, and public health physician at UNSW.
In the article below, he argues the case for:
- payment of a 14-day “COVID-benefit” to all persons who are diagnosed with COVID-19 and all persons who are required, by health authorities, to be quarantined because they have been in contact with a COVID-19 cases, and
- requiring everyone entering into mass gatherings to show an active COVIDsafe App as a condition of entry (“No App, No Go”).
Guy Marks writes:
Australia’s success in flattening the curve of the COVID-19 has been a source of great satisfaction and some surprise to many.
In fact, this success was a predictable consequence of the robust public health measures that were enacted and implemented to suppress the spread of the virus.
Key features of this response are:
- preventing entry of new cases into Australia by enforcing quarantine for all people arriving from overseas
- widespread testing to ensure that all cases are diagnosed and placed into isolation as soon as possible
- scaling up contact tracing capacity and response so those who are most at risk are also screened and quarantined, and
- community-wide social distancing to minimise the risk of transmission from unrecognised source cases.
The last of these has been by far the most economically and social disruptive and, as we become more confident that unrecognised transmission is less likely, these social distancing restrictions are being gradually, but somewhat nervously, released.
Some commentators have implied that we have a choice between the economy and health: suggesting that vigorous enforcement of social distancing measures to protect to health should be relaxed to protect businesses and the economy.
In fact, this choice is an illusion.
Alignment of interests
Business cannot thrive in the setting of a pandemic. Who will go into a restaurant, shopping mall, or workplace when they fear contagion? Who wishes to risk their life, and the lives of their loved ones, to go to the theatre or have a haircut?
The interests of business and health protection are aligned, not divergent: both will benefit from taking all possible measures to suppress the pandemic and restore confidence.
In the absence of an effective vaccine or treatment, sustaining effective suppression of the epidemic, and thus enabling confident relaxation of social distancing and reinvigoration of social and economic activity, requires that the first three elements of the response be highly effective.
We need to retain the 14-day quarantine period for all overseas arrivals from countries where the virus is still circulating. We need to sustain widespread availability of testing for diagnosis of COVID-19 cases and we need to optimise contact tracing.
I argue that there are two missing pieces of our response that, if corrected, would substantially enhance our ability relax the social distancing restrictions without risking a resurgence of cases (a “second wave”):
- payment of a 14-day “COVID-benefit” to all persons who are diagnosed with COVID-19 and all persons who are required, by health authorities, to be quarantined because they have been in contact with a COVID-19 cases and
- requiring all persons entering into mass gatherings to show an active COVIDsafe App as a condition of entry (“No App, No Go”).
The COVID-benefit is designed to remove one of the major barriers to testing: the fear of loss of income for those who test positive (and for their family or other contacts).
People without access to sickness benefits and with limited resources to fall back on face substantial hardship if they are required to isolate for 14 days because they, or a member of their household, are diagnosed with COVID-19.
They are likely to avoid being tested and, in doing so, place those around them, at work or in the community, at risk of acquiring COVID-19.
This benefit is designed to overcome that barrier and encourage testing. The value of the benefit should be modest but adequate, probably at the level of the JobKeeper payment.
As well as removing the disincentive to testing, it also represents a recognition, on the part of our society, that those who are isolating themselves because of COVID-19, are performing a socially useful action in doing so. As there are relatively few cases at present, and the duration of the benefit is only 14 days, the cost the public purse is limited.
Contact tracing is a procedure in which public health staff work with a person who has been diagnosed with COVID to identify all the people who they have been in contact during the infectious period: that is, the period starting two days before the onset of symptoms and extending up to five days after the onset of symptoms.
The public health staff then try to find all these individuals, screen them for COVID and advise them to self-isolate (quarantine) for 14 days in case they develop the disease.
The main limitation of this procedure is that most of us do not know, or cannot remember, all the people we have been in contact with over the past several days.
No App, No Go
The COVIDSafe App is designed to overcome this limitation of traditional contact tracing by recording, automatically, all the contacts that a person has had and allowing the public health staff to get in touch with those individuals, who may not be known to the person with COVID, screen them for COVID and advise self-isolation.
The COVIDSafe App is designed to make contact tracing for COVID-19 effective and thereby reduce the risk that one case of COVID-19 will turn into many (an outbreak).
However, it will only work in this way if each person with COVID-19 and all the people they are in contact with have the App activated.
This is where the balance of individual rights and responsibilities becomes important. In various countries a range of approaches to encouraging downloading similar Apps have been attempted but none have been very successful in achieving the level of uptake that is deemed to be necessary.
In Australia, governments and the community have, quite reasonably, baulked at the prospect of making use of the COVIDSafe App compulsory. Many believe this would be an infringement of our civil liberties.
On the other hand, it would seem to be reasonable to require that, if you wish to go to a place where many other people are gathering, such as a shopping mall, theatre, concert, football ground, or a club, pub or restaurant, you should be required to have the COVIDSafe App activated.
Your choice to attend such a place comes with a responsibility to keep others safe by activating the App.
This “No App, No Go” policy would be equivalent to the “No jab, no play” policy we use to keep children safe by requiring vaccination for those attending pre-school. It has the ancillary benefit of making everyone feel safer and therefore encouraging people to re-engage in social and economic life.
A rational fear
The COVID-19 pandemic has had a devastating impact on many aspects of our lives.
It is vital that we maintain control of the pandemic by preventing further outbreaks to protect our community and enable a return to normal life.
We have a highly effective set of policies in place: widely available virus testing, encouragement of enhanced personal hygiene, isolation of all cases and quarantine of contacts and overseas arrivals.
There is a rational fear that relaxation of the most disruptive element of the control measures, community-wide social distancing including closure of most public gathering places, will lead to a second wave of infections.
I propose that the addition of the COVID Benefit and the “No App, No Go” policy will make case finding and contact tracing effective enough allow this relaxation to occur safely at only modest cost and with minimal impact on the wider society.
Similar policies have been successfully implemented in Australia previously to catalyse the elimination of an overwhelming infectious disease threat, albeit a long time ago.
The Australian National Tuberculosis Campaign, which ran from 1943 to 1974, included widespread testing for case finding, payment of tuberculosis pension to those diagnosed with the disease, quarantine and contact tracing.
The proposed policies are well aligned with Australia’s culture of accepting and expecting mutual responsibility.
Once again, we are threatened with a serious infectious disease threat. We must grasp the solutions that are within our reach.
• Professor Guy Marks is a respiratory physician, epidemiologist, and public health physician at UNSW, and a chief investigator at the Centre for Air pollution, energy and health Research (CAR).