Coronavirus infection rates continue to fluctuate along the country’s East coast. As Melbourne continues to record days of triple digit infections, and Sydney’s outbreak hotspots continue to grow, the question is being posed; how do we get down to zero and how do we stay there?
Experts have warned that until we are able to get healthcare infection rates under control, the move to relax restrictions and reopen cities to normal function remains dangerous and at risk of resulting in another wave of infection.
Tony Blakely, Professor of Epidemiology at the University of Melbourne, has warned that any efforts to bring down COVID-19 infections in the community may prove useless unless governments are able to control and stamp out infections of healthcare workers in the medical and aged care sectors. With healthcare workers in Victoria making up 337 of Victoria’s 2295 active cases, infections in the industry remain stubbornly high.
“If we cannot bring that down as fast as general population counts, we may struggle to consistently get less than 50 [new cases] per day,” said Professor Blakely.
As the Victorian government readies itself to unveil their exit plan for stage four lockdowns this Sunday, yesterday’s increase of 113 new COVID cases does not bode well for the strategy.
National think tank, the Grattan Institute, has released a report titled Go for zero: How Australia can get to zero COVID-19 cases. In it they have outlined some of the reasons Australian outbreaks have continued to fluctuate, how some states and our territories have managed to maintain a zero infection rate for some time, and what we need to do as a country in order to get to zero and stay at zero.
In the report, the Institute posits that if Victoria were able to withstand another eight weeks of harsh lockdown restrictions, the state would almost definitely see a zero new infection rate. Once that is reached, it would need to maintain the restrictions for at least five consecutive zero infection days before the state could begin to reopen and resume regular daily activities. However, this would come with some caveats.
Lead author, health economist Dr Stephen Dukett said that an infection rate of zero would only be achievable once high risk environments were brought under control. This includes hospitals, aged care facilities, public housing and abattoirs.
“We’ve known from the start that these are places to worry about,” Dr Duckett said.
Until infection control is improved and increased in these sectors, “you won’t get the [daily] numbers under 20,” he said.
“Opening up too early, while coronavirus is still in the community, runs the risk of future outbreaks, reimposed lockdowns, renewed economic disruption, and more deaths,” the report says.
“COVID is a classic case of short-term pain for long-term gain. Getting cases down to zero, and keeping them there, will be hard work – but it will save lives and enable the economy to recover more quickly.
“Victoria should ease restrictions only when new cases are below 20 a day. Victoria, NSW, and Queensland should ease restrictions further when new cases are below 5, and again at zero.”
While extending lockdowns is the last thing on people’s wish lists, the report says that this short-term pain would serve us well in the long run. According to the report, should Victoria maintain current restrictions and social distancing measures, including mask wearing and community movement restrictions, the state has a 99% chance of reaching zero new cases by the end of October. However, if restrictions are relaxed too early, this percentage chance reduces drastically to only 34%.
“The payoff will be greater freedom on the other side. Getting to zero means life can return to closer to normal, with a substantially reduced risk of future outbreaks,” it said.
However, not only does this require a minimum of 85% community compliance, but also severe updates to the infection prevention in the healthcare sectors. This includes updates to staff PPT and the ventilation systems of hospitals and aged care facilities.
Professor Raina MacIntyre, infectious disease expert from the University of New South Wales, said that focusing on controlling coronavirus in communities can never work until healthcare facilities are recognised as “high-risk zones” due to the infectious spread of airborne particles.
“Many hospitals have old buildings and poor engineering controls, creating a hazardous environment for health workers, who may be exposed day in, day out,” she said.
“If we do not put maximal effort and attention into stopping transmission in health and aged care workers, not only will they suffer illness and possibly death [but] asymptomatically infected health or aged care workers may set off community epidemics.”
Professor MacIntyre has supported the request that healthcare workers are given access to high level protection respirator masks in replacement of standard surgical masks, and that they are tested for fit and effectiveness.
“The most logical thing to do is throw everything at protecting these workers and stopping the ongoing transmission,” she said.
Image source: Kelly Sikkema via Unsplash
