Victoria should aim to eliminate not suppress COVID-19

LEADING epidemiologists have presented a 10-point plan to help Melbourne and Victoria achieve the elimination of COVID-19 within the 6-week lockdown period.

Professor Tony Blakely, an epidemiologist and public health physician at the University of Melbourne, and colleagues wrote, in the Medical Journal of Australia, that “Melbourne and Victoria should not waste the opportunity this lockdown presents”.

“We know from New Zealand and Taiwan that elimination of community transmission is achievable in island jurisdictions, both having no reported community transmission for over 2 months as of 10 July,” Blakely and colleagues wrote. 

“The advantage of elimination is that despite international border closures or strict quarantine, citizens can go about life with a near-normal functioning of their society and economy.

“Living in a state or country that has achieved elimination is a far better option than suppression in the short- to medium-term, compared with the high likelihood of recurrent outbreaks precipitating recurrent lockdowns with attendant social and economic disruption.

“Our case for an explicit elimination strategy in Victoria, now, is that given the state is in lockdown for 6 weeks there is only a marginal cost of ‘going hard’ with a rigorous public health response that increases the probability of achieving elimination,” they wrote.

The authors examined four policy scenarios:

1. Standard, reflecting the first Australian lockdown, with key parameters including 85% of people observing physical distancing; of those observing physical distancing, they do so 85% of the time; 30% of adult workers are essential workers; 93% of people asked to isolate doing so; 20% uptake of COVIDSafe app; but no closure of schools and no mask-wearing.   
2. Standard plus masks at 50%, above plus 50% of people wearing masks when in crowded indoor environments.
3. Stringent with masks at 50%, schools closed and essential workers restricted to 20% of workers, otherwise as above.
4. Stringent with masks at 90%, above with mask use increased to 90%.

Blakely and colleagues determined that under the “Standard” policy approach, there was no chance that all infected people would have cleared their SARS-CoV-2 infection by 19 August (6 weeks after lockdown started). 

“The probabilities for the other three policy approaches are 5% for ‘Standard plus masks at 50%’; slightly more at about 7% for ‘Stringent with masks at 50%’; and nearly 50% for ‘Stringent plus masks at 90%’,” they wrote.

Their 10-point plan includes the following:

1. Strong and decisive leadership with strategic clarity. An explicit goal of elimination should be articulated. A clear set of targets for loosening of policies needs to be articulated, so citizens know what will likely happen – when.
2. Convene an advisory group of experts in the elimination strategy and SARS-CoV-2 public health response, reporting weekly to the Victorian Chief Health Office (CHO), with the agenda, papers and minutes made publicly available.
3. Close all schools until such time as the daily rate of SARS-CoV-2 infection without a known source falls beneath a target set by the CHO.
4. Tighten the definition of essential shops to remain open. Supermarkets and chemists need to remain open. However, department stores, hardware stores, and such like should be closed. A staged re-opening based on set target levels of daily numbers of SARS-CoV-2 infection without a known source should then be implemented, so long as mask-wearing by both staff and patrons is mandatory, as is hand sanitizer use on entry and exit from stores.
5. Require mask wearing by Melbournians in indoor environments where 1.5m physical distancing cannot be ensured, like supermarkets, and (especially) public transport.
6. Tighten the definition of essential workers and work. There is currently a loose definition of who is an essential worker and what is essential work; this needs urgent tightening.
7. Require mask wearing by essential workers whenever they are in close contact with people other than those in their immediate “household bubble”.
8. Ensure financial and other supports to businesses, community and other groups most affected by more stringent stay-at-home and lockdown requirements. Enhancements, targeted where warranted, to programs such as JobKeeper and JobSeeker.
9. Further strengthen contact tracing to ensure the majority of notifications (and their close contacts) are interviewed within 24 hours of the index case notification and placed in isolation if necessary.
10. Extend suspension of international arrivals into Victorian quarantine and divert resources.

“We cannot guarantee that our 10-point plan will achieve elimination; we cannot guarantee high compliance in measures by the Victoria population if a more stringent lockdown was imposed; and if the outbreak in NSW restarts community transmission then both NSW and Victoria will need to have elimination strategies for Australia to eliminate,” Blakely and colleagues concluded. 

“But we argue that it would be a bigger failure to not enhance the probability of elimination by augmenting the current lockdown now.”

The article is online now and open access at https://www.mja.com.au/journal/2020/maximizing-probability-6-week-lock-down-victoria-delivers-covid-19-free-australia   

All MJA COVID-19 articles are available at https://www.mja.com.au/journal/covid-19 and are open access.

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