How Victoria beat COVID (Part two)

How Victoria beat COVID (Part two)

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Jason Thompson was driving north on the Midland Highway when the familiar voice of Daniel Andrews came over the car radio to announce Victoria’s road map out of COVID-19 lockdown. As the Premier detailed the stringent conditions that would need to be met before restrictions were lifted, Thompson found himself admiring the chutzpah involved. ‘‘I was actually surprised they went for it,’’ he says.

It was September 6 and Thompson, a clinical psychologist and senior research fellow from the Melbourne School of Design, had emerged as an unlikely influencer behind a decision that would affect everyone living in the state.

With Victoria on the downward slope of its second wave and new case numbers falling to below 100 a day, heavy hitters within the Victorian and national business community had demanded a road map out of COVID-19 restrictions.

Prime Minister Scott Morrison and Federal Treasurer Josh Frydenberg were publicly campaigning for one. Restaurant and cafe owners were desperate, as were people who’d been cut off from friends and family for two months.

Thompson was a member of a Melbourne University research team, led by epidemiologist Tony Blakely, asked to provide scientific modelling to help inform the government’s exit strategy. The modelling didn’t tell the government what it should do but provided a series of projections about the risk of a further epidemic before Christmas.

The most important variable in the modelling – essentially a political one – was how far the government was willing to push case numbers down before it allowed things to reopen. Although Andrews didn’t say it out loud at his press conference, it was clear to Thompson as he drove from his Castlemaine home to Bendigo that the government had decided to go all-in; it planned to eliminate the virus.

Inside the public health response, the goal was well understood. Chief Health Officer Brett Sutton had already framed a new message for the new phase of the public health campaign: ‘‘We’re going for zero.’’ The road map modelling provided something straight epidemiology doesn’t. It was as much an exercise in predicting and forecasting human behaviour as the infection patterns of a virus.

This is where Thompson brought something different to the research team. Thompson had worked in client research for Victoria’s Transport Accident Commission, where he reshaped how the government’s statutory third-party liability insurer thought about road injuries.

Since its establishment, the TAC hadn’t kept records about whose fault an accident was. As a no-fault insurer, what did it matter? Thompson had a hunch that it did. He combed back through old police records and discovered that people injured in an accident that wasn’t their fault took substantially longer to return to work and were more likely to experience depression than drivers left with similar injuries from an accident that was their fault. The failure to understand this human response to culpability had cost Victorian taxpayers a lot of money.

Jason Thompson.

Jason Thompson.Credit:Justin McManus

The Melbourne University model was an attempt to take the flat, mathematical science of epidemiology and see how it played in the real world; a world where not everyone is going to wear a mask, some people will work when sick and a certain part of the population will never listen to the government’s message, no matter how many languages it is broadcast in. It was less worried about flattening the curve of Melbourne’s second wave, which was already on a downward trajectory, than in ensuring that once the virus was contained it wouldn’t come back.

‘‘It was a different way of thinking about what their options were,’’ Thompson says.

Those options provoked intense debate within the crisis council of cabinet, a group of seven ministers handpicked by Andrews to oversee Victoria’s pandemic response. The sticking point was whether Victoria should take the biggest step – lifting the stay-at-home orders, removing the curfew and allowing retail and hospitality to reopen – once the daily average of new COVID-19 infections had dropped to 10 cases, or to hold until cases dropped to an average of five. The crisis council was split between ministers pushing for a less conservative approach and those for whom the fear of a third wave was overwhelming.

The advice from Sutton was that Victoria needed to ensure all community transmission had been snuffed out. The Premier was torn between adopting this approach and his concern that a longer lockdown would erode public support.

As Thompson continued driving, the Premier reached the most critical junction in the road map. Retail and hospitality would remain shut until there was an average of just five new cases a day. ‘‘That’s gutsy to go for five,’’ Thompson thought to himself. ‘‘There is going to be a lot of pain between 10 and five. You will end up in a better position, but it is extremely politically gutsy.’’

Not everyone was convinced.

On August 31, the Monday before the road map was publicly announced, about 150 people representing business interests across the state and nation dialled in to a Zoom meeting with Department of Jobs, Precincts and Regions secretary Simon Phemister and Deputy Chief Health Officer Allen Cheng.

There were too many people on the call for anyone to ask a question. The longer it went on, the more the frustration of business owners and representatives grew.

A lonely shopper in Glen Waverley in August,

A lonely shopper in Glen Waverley in August,Credit:Joe Armao

Throughout the pandemic, a contrast had emerged between the way businesses were able to engage with the government of Gladys Berejiklian in NSW and the Andrews government in Victoria.

Throughout the initial, national lockdown introduced in March, the NSW Treasury established weekly meetings with business groups and leaders, while the federal government called in Gordon De Brouwer, a former environment and energy secretary, to lead a business liaison unit. In both these forums, information flowed freely, both ways, between government and business.

Business Council of Australia chief executive Jennifer Westacott says this approach benefited everyone. ‘‘It was democracy at its best; constant discussion, weekly meetings, highly structured,’’ she says. ‘‘As a result of that, decisions were made early on that allowed the country to come back more strongly.’’

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In Victoria, it was a different relationship. Business found it difficult to access basic information from the Andrews government or to meaningfully engage with decision makers. Where in NSW business was invited into the response, business in Victoria was met with a closed door.

“It was collaborative in Queensland, it was collaborative in South Australia it was collaborative in NSW and the ACT,” says Restaurant & Catering Australia chief Wes Lambert. “In Victoria we weren’t part of the decision process, we were just being told what was going to happen.”

‘‘Nobody was disputing we had to take drastic action at 700 cases a day,’’ Westacott tells The Age. ‘‘No one at the serious end of business was saying the health stuff didn’t matter. The health stuff mattered enormously. What we were saying was ‘let us help you problem-solve our way through this so we don’t end up with other consequences, like entire industries having to shut down.’’

By the time the Andrews government announced its road map, its relationship with business had turned toxic. Ben Logan, a former opera singer who discovered a second career running the city restaurant of chef Ronnie di Stasio, found himself channelling the anger of an industry scorned.

What began as a series whimsical messages on his LinkedIn account morphed into an online message board for restaurant owners, waitstaff and chefs locked out of their own kitchens. The pot boiled over when the Premier on October 25 announced a ‘‘cautious pause’’ — a 24-hour delay on easing restrictions. The next morning, Logan was invited onto Fran Kelly’s ABC Radio National program.

‘‘It has been Armageddon for the hospitality industry. We need people and honestly, people need to get back to restaurants. People need to be social, people need to start re-engaging with each other,’’ he began.

‘‘The Premier has lied to Victorians. The Premier has time and time again given Victorians a road map. Today, if you look at the numbers, there are no new cases of COVID-19 in Victoria today. There are none. There has not been one single death. For the past however many hundred days we have had Dan’s daily sermon. The man has come out and said ‘just hold faith, hold the line, today is a good day’. Well, it is not a good day, Dan, when my children only had the opportunity to go back to school today.”

Ben Logan.

Ben Logan.Credit:Justin McManus

‘‘Victoria is broken. It is incredibly hard – and I do get emotional, I really do – it is hard to describe how broken Victoria is. One of the things the Premier could start doing is pick up a dictionary and look up what empathy means. Because in the last six months the man has not had any empathy for any Victorian businesses, individuals, families — anything by way of our normal way of life.’’

Looking back from where Melbourne is today, with stores open for pre-Christmas shopping and restaurants and cafes able to welcome guests mask-free for office party bookings, it is tempting to dismiss Logan’s outburst as an overreaction. What was one more day, given Melbourne had been locked down for 110? To do so is to misunderstand the despair felt by those who thought the Premier was oblivious to the impact his decisions were having on their lives.

‘‘Throughout that real hard lockdown, there was no hope,’’ Logan tells The Age. ‘‘When there was the expectation that things would ease we had hope again, only for the rug to be pulled out from underneath our feet. It was a pause but it was just shattering.’’

Westacott says Logan was not alone in feeling this way. ‘‘It’s that lack of respect for business,” she says. Whether you like big companies or not, they have very complex decisions to make. A small business owner who has got stock in to run their cafe cannot suddenly get rid of all that without consequences.’’

In response to these criticisms, the Andrews mantra was clear; until you defeat the virus, you cannot rebuild the economy. This message did little to appease business but resonated strongly elsewhere in the community. Until the final day of lockdown, the overwhelming majority of Victorians remained resolutely compliant with the restrictions in place.

The economic cost of Victoria’s second wave has started to emerge. Federal Treasury deputy secretary Luke Yeaman, called to give evidence to Senate estimates on the day of Victoria’s ‘‘cautious pause’’, laid bare the bleak calculus confronting the state. For every day that Melbourne was locked down in August and September, an average of 1200 people lost their jobs and $100 million in economic activity was foregone.

These figures do not make the case that Melbourne shouldn’t have gone into lockdown. When Andrews announced stage four restrictions on 2 August, the decision was supported by Morrison, welcomed by other state and territory leaders and not opposed by Victorian Opposition Leader Michael O’Brien. ‘‘We simply must prevail and get this virus back under control, despite how bitter the medicine is,’’ O’Brien said.

As Melbourne University professor of economics Bruce Preston pointed out to The Age at the time, the greatest cost to the economy was the virus, not lockdown and either way, a recession was unavoidable. It was only on the downward slope of the second wave epidemic that the political consensus fractured over the duration of lockdown and the government’s caution in lifting restrictions.

The worst part of the economic tale will be in the tail; the lingering unemployment that every recession brings. In his November budget, Victorian Treasurer Tim Pallas forecast that unemployment should be peaking about now at 8.25. Yeaman told the Senate hearing the effective unemployment rate in Victoria was already 14.5 per cent. This counts people receiving the JobKeeper subsidy as well as the JobSeeker payment.

The jobs tally will become evident at the end of March, when the JobKeeper scheme runs out. In the meantime, some costs are more difficult to calculate.

On May 15, shortly before the first COVID-19 case broke out of hotel quarantine, Professor Patrick McGorry presented a sobering insight into what the pandemic would mean for the mental health of Victorian teenagers and young adults. Standing next to Martin Foley, Victoria’s Minister for Mental Health, McGorry warned that as many as 370,000 additional Victorians, including 82,000 between the ages of 12 and 25, would experience mental health disorders.

The prediction was based on modelling conducted by health economist Matthew Hamilton and commissioned by Orygen, a Melbourne-based research, policy and education organisation which specialises in youth mental health. The modelling showed the greatest risk to young people was not the virus but damage to mental health caused by disengagement from school, work and friends and ongoing loss of employment prospects. The ‘‘mental health wave’’ would peak three years from now, once COVID-19 had disappeared from headlines.

Patrick McGorry.

Patrick McGorry.Credit:Luis Enrique Ascui

McGorry, the executive director of Orygen, says the modelling has proven to be accurate, with one important caveat; where Hamilton expected there to be a delay in young people presenting with mental health problems related to the pandemic, they have come on in a rush.

‘‘We are seeing a 30 per cent rise in need for care and that is spilling into the emergency departments because our system is at capacity, it can’t absorb new cases,’’ McGorry says. ‘‘If you talk to any emergency department director, that is what they are seeing, especially young people with self-harm and suicidal behaviour.’’

Mental health problems are often multi-faceted. This makes it difficult to attribute causation to either Melbourne’s second wave or the lockdown measures. McGorry has no doubt the COVID-19 crisis and the public health response were diabolical for mental health. Writing last month in the Australian Journal of Medicine, he explained why:

‘‘After acute disasters, most people experience a transitory wave of distress that is considered normal and they do not generally require professional care. COVID-19 is fundamentally different. It is not a single shock, but a vast, expanding disaster with no end in sight, producing chronic stress, disruption and multiple losses, and many of the usual mitigation strategies are banned or unavailable.

‘‘Modelling and earlier recessions show that it is the economic consequences, especially financial stress, unemployment, and educational failure, that fuel mental ill health and suicide risk.

“This impact is anything but short lived, and will produce a long, deep second wave of mental ill health and suicide.’’

Andrews described Victoria’s second wave as a public health bushfire. Professor Ian Hickie, the co-director of health and policy at the University of Sydney’s Brain and Mind Centre, says the mental health impact is worse.

‘‘From a mental health point of view chronic, unpredictable stress is much worse than acute, predictable stress,’’ he says. ‘‘While terrible things happen like bushfires and floods, their longer-term mental health effects are mitigated by the fact they are over quickly and communities pull together. This thing is chronic, unpredictable, ongoing and socially dislocating.’’

Hickie says the Victorian response to lockdown, although successful in snuffing out all traces of the virus, was a ‘‘very draconian, very law and order-type approach’’ driven by a top-down focus on case numbers at the expense of other public health considerations.

‘‘The health effects are not simply related to the virus – the number of doughnut days etc – because there clearly is a cost. In the health debate we need some honesty about the trade-offs. Yes, of course we don’t want to be in the UK or US situation where the virus is entirely out of control. But NSW hasn’t done the same as Victoria.

‘‘Are the mental health consequences being treated as seriously as some of the other consequences? You would have to largely say no.’’

Nathan Grills, an expert in public health at Melbourne University, makes a similar point: ‘‘If you come from an infectious disease background all you can see is the infectious disease or the virus. From a public health point of view you look at the bigger picture; what is the effect of the lockdown on the community, what is a proportionate response given the impact on education, mental health, the economy or livelihoods?

‘‘The danger when we get obsessed about one part of that picture is we have a single-disease response without considering the broader impact on society. That doesn’t mean the lockdowns and interventions weren’t correct. It is a matter of doing it with balance.’’

This does not mean the social and economic restrictions to bring the second wave under control were wrong; only that we will likely be counting the cost for years to come.

The criticisms of the Andrews government response don’t underestimate the immense benefit to everyone in Victoria being COVID-free. And no one blames this government alone for the parlous state of public health in Victoria, an unintended consequence of decisions made a quarter of a century ago, when the Kennett government devolved the health system.

As Australian Medical Association Victorian president Julian Rait points out, when Victoria was hollowing out its public health resources, NSW was establishing the regional and suburban public health units which responded so effectively to outbreaks across Sydney.

Deakin University epidemiologist Professor Catherine Bennett says she can’t remember another time when her field of scientific expertise has been so politicised. Throughout the pandemic, she became a familiar voice of calm, measured dissent; a respected and experienced epidemiologist increasingly concerned at how and why decisions were being made.

She questioned the scientific justification of the curfew and five-kilometre rule and more broadly, why the government was intent on linking the spread of the virus to the movement of people in the absence of data supporting this. She questioned why masks needed to be worn in the open and why, beneath the damning headline of the genomic report which linked the entire second wave to hotel quarantine, the government was unable to recognise its own success in stopping the first wave of the virus.

‘‘We had every chance, if it hadn’t been for hotel quarantine, to have eliminated transmission Australia-wide back in June,’’ she says. ‘‘Fear and guilt prevented the government from learning from what it did right first time round.”

Deputy Chief Health Officer Allen Cheng.

Deputy Chief Health Officer Allen Cheng.Credit:Simon Schluter

Victoria’s response to the COVID-19 crisis is scaling down. The DHHS has nearly 1000 contact tracers paid up until next June but blessedly, they are without a case to trace. Professor Allen Cheng, the Deputy Chief Health Officer brought into DHHS at the height of the crisis, has nearly finished his secondment and will soon be back at his day job at The Alfred hospital.

Before he goes, Cheng would like us to consider one last thing: The “prevention paradox’’ of public health. When public health is doing its job the community feels safe and sooner or later, governments question whether they can cut things a little to save money.

“Prevention is always difficult to get funding for,” he says. “I hope this has shown the value of a good public health system and thinking about it long-term and setting up structures that will endure.’’

If you or anyone you know needs support call Kidshelpline 1800 55 1800, Lifeline 131 114, or Beyond Blue 1300 224 636.

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