JACK WATERFORD.The big risk is this flu taking root in our neighbourhood, such as Indonesia, East Timor or PNGMar 3, 2020
Scott Morrison’s declaration of a coronavirus pandemic is premature, particularly for Australia, where the virus does not appear to have escaped quarantine and containment lines.
The very word pan means everywhere, and the word pandemic suggests that the virus has spread, like a serious, and sometimes deadly, influenza among the general population, with so many exposed to the virus that segregation of those at risk is no longer possible.
Still, getting ahead of the action has some advantages, not least of being able to command the coercive power of the state in preparing a response. Morrison has been at pains to say that he and his ministers have been following medical advice from the public health authorities at Commonwealth, state and territorial level.
But decisions about dealing with epidemics and pandemics are intrinsically political – involving judgments putting in the balance factors such as the risk to individuals ands groups, the health dividend from heavy-handed methods, impacts on the economy of decisions taken, and the political, social and economic costs of any measures which have the effect of seriously annoying people, without any demonstrable improvement of their safety.
Down the track, the biggest thing that the Australian government could do to protect its citizens from Covid-19 would be in putting maximum resources into fighting off the disease in places such as Indonesia, East Timor, Papua New Guinea and Pacific nations, ill-equipped to recognise, treat or otherwise deal with a pandemic – something far more inevitable than for Australia, and far more likely to be fatal when it takes hold.
These are nations with shortages of medical resources, including screening and diagnostic equipment, as well as numbers of skilled personnel appropriate to an epidemic, or, if a vaccine is developed, to a mass treatment campaign.
By that stage, it seems likely that infection will have moved generally into the population in most places in the world, particularly in the less developed countries. It is noteworthy that India has done little case-finding, and is itself a potentially enormous reservoir providing fuel, in South East Asia and the Middle East to an epidemic already on the march from China.
Sadly, our government is as yet showing little understanding that our best contribution to holding the line is to go international in our response. This is partly because at least some of the decision making is focused at making the prime minister look proactive and decisive, rather than seemingly clueless and behind the eight ball, as he did during the bushfire emergency. He may, moreover, entertain hopes that he can buy time by taking advantage of the fact that Australia is an island, able mostly to restrict the entry of potentially infected outsiders.
Yet one must wonder how he calculates that Australia could carry on smugly in the face of raging epidemics in our neighbourhood.
Right at the moment most Australians are not at any serious risk from Covid-19. The number of cases in the community of people blithely walking around unaware that they are carrying, and spreading, the virus must be extremely low, probably fewer than 10. There are more people undergoing treatment, or who may have the virus and who are being segregated from their families and the community, some in their own homes, but we are all safe from them, provided we are not doctors or nurses.
In the next few weeks, we are likely to see more people reporting themselves to medical authorities as having flu-like symptoms after having been in contact, or possible contact, with someone who has come recently from an infected area, for example Wuhan or Turin, or with someone known to have the condition. (The system, naturally enough, wants notification by phone, for home visits, rather than sitting around in a surgery or emergency department, infecting others.)
What the epidemiologists have divined about the virus since its existence was notified by China to the World Health Organisation suggests that transmission occurs only from person to person, most likely from being in close quarters and breathing in exhaled air from an infected person, or contact with that person’s secretions. Anyone, Chinese, Australian, Italian or Martian whose return from a foreign place was more than a fortnight ago almost certainly does not carry the virus, whether with or without symptoms. Put simply, few Australians are at this stage likely to be next to an infected person. It will be only after our borders are breached that the population generally will be at risk.
The more travel bans, the more quarantine restrictions and, generally, the more containment of people capable of bringing the disease into the community, the longer an outbreak can be avoided. But, sooner or later, most likely, containment will fail and the health authorities will be concentrating on mass treatment, individual treatment and general efforts to ameliorate the condition when found. With luck, the time gained might allow for the development of a vaccine, or an effective treatment, particularly for the old and otherwise vulnerable.
Mercifully, it does not appear that infants or young children are at particular risk. If they acquire the virus, they seem less likely to have it develop into a very debilitating flu, pneumonia, or sepsis. This is one of the reasons why the public health authorities are, or ought to be reasonably relaxed about schools and child-care centres, even when people attending have been in a danger zone. No reason, however, to drop the focus on washing hands
Jack Waterford is a former Editor of The Canberra Times