JACK WATERFORD. The snares of proclaiming victory against the virus

With success beyond all expectations in the struggle to contains the coronavirus in Australia, one might imagine that the next task before the prime minister is discerning that exact moment at which it is appropriate to roll back the various forms of social distancing and quarantine so as to concentrate on rebuilding the economy.

He and the premiers may indeed have navigated to the point that some of the controls can be loosened soon. But they know well the dangers of prematurely declaring victory, and the reasons for extreme caution in doing anything which increases the risk of an upsurge of fresh cases – this time almost all of domestic origin rather than from recent travellers abroad.

Here and in the United States are commentators saying that the time to go is now – if it wasn’t a fortnight ago. Some seem quite indifferent to the fact that this increases the risks of death, particularly among the infirm and the old, arguing, reasonably enough, that society always seeks to draw a balance between general public safety and economic health on the one hand, and risk of death and injury to individuals on another. Thus, for example, our speed limits can be described as an effort to weigh the convenience of speed with the risk to people who get in the way of cars and trucks.

We build bridges and high-rise buildings knowing that there is a substantial risk that workers may die in the process. As our concern about this rises, we may increase occupational health and safety rules and the disincentives for bad practice. But we can never entirely eliminate risk and the public would seem to agree that the benefit of what is constructed outweighs the human costs. Those arguing the sums will claim, of course, that the very existence of the bridge or building may save lives that should also be put in the balance, or create wealth that allows others to enjoy better health.

These are political choices, for politicians to make. We hope, of course, that they take expert advice about the relevant risks. In the case of COVID-19, we hope, of course, that politicians attach great importance to human life and are repulsed by those whose agitation for an immediate resumption of business as usual is indifferent about some casualties. A time comes, nonetheless, when it can be argued that the general damage to the economy, and the human misery that causes (including, perhaps suicide) outweighs the real risks to the lives or the health of a few.

It’s a judgment politicians have to make, one which cannot be avoided unless government is so prepared to use coercion to enforce its will that the general need for a consensus about social costs can be ignored. But not everyone will agree on what that point is, and critics will make politics about anything that can be argued to be a misjudgement or a callous misjudgement. Look for example at Tony Abbott’s entirely unjustified but highly successful campaign blaming Keven Rudd personally for the deaths of some roof insulation installers, on the basis, apparently, that it ought to have been obvious to Rudd (though not to installers) that stupid people might put nails in live electrical wire. The Abbott campaign and its consequences was much aided by a partisan section of the media. But it was also much helped by the fact that the Rudd government failed either to explain and sell its program, or to defend itself against attack. Likewise, Morrison will be blamed for any deaths if he returns the economy to normal too early.

Scott Morrison has already discovered that when an epidemic is loose in the community, those who call for stronger measures against the disease will always seem more virtuous and public-spirited than those who hesitate to impose controls they know will be unpopular. If Morrison ever had any hopes that his “national Cabinet” would operate under some sort of doctrine of collective responsibility – bound for example by a vote – he was quickly disabused. Premiers and chief ministers were keen to co-operate, but they would always put their own circumstances and needs, as they saw them, ahead of consensus when it seemed to them to matter. Thus the two most populous states—one Labor and one Liberal –who were already stretched by COVID-19 cases – read the situation differently from the outlying states, where there were fewer cases. This led to different decisions about school closures, and about strict quarantine controls at the borders. Morrison had to be nimble to obtain a general consensus open to local variations, and to be philosophical about it, even when he was furious.

The combined effect has exceeded all hopes and expectations and raises the prospect that whole regions of Australia will soon be free of active COVID-19 cases, or acute ones requiring major hospital intervention. The theory is that the virus is infectious for no more than a fortnight, even among those who are asymptomatic or have it so mildly that they do not associate it with Coronavirus. Getting to this point has been assisted by forced isolation of travellers and efforts to limit human movement. If, after a fortnight with such controls, there are no fresh cases, one can regard that region as free of the virus.

That’s a situation which will continue only as long as no person arrives from outside the region carrying the virus. She may have no symptoms and no consciousness that she has been in contact with another carrier. We now know from actual research, as well as a general principle, that asymptomatic and mild cases shed and spread the virus as much as florid cases, and that some of those infected will go on to develop serious, perhaps fatal COVID-19.  One can use screening devices on roads, public transport, docks and ports, but it is almost inevitable that some cases will get through. With a high proportion of the population having no immunity (at least until there are vaccines) just one person can spur a fresh epidemic calling for the reimposition of controls.

At least until the vaccine, the virus, like the poor, will always be with us. Its impact on the population will differ. Most young children, other than those with existing autoimmune diseases, asthma and on cancer treatment, may completely avoid any sort of severe complications if they get infected, although their secretions will be a risk to those with whom they come into contact. Most adults up until 50 will not develop severe symptoms unless they already have conditions – perhaps diabetes, autoimmune diseases, respiratory conditions or they smoke, in which case their susceptibility may be similar to those 20 years older. From 50 on, a significant proportion of those infected develop severe respiratory (sometimes gastric) complications. Severity and fatality seem to increase markedly with age. Apart from the already frail, or those who have predisposing conditions, frontline medical workers are at considerable continuing risk – and not necessarily by getting it from someone currently infected, but by picking up a virus 10 or more generations older than any about at the moment.

It seems, right now, unthinkable that Australians would abandon the interests of those who are already sick, older parents, and grandparents. One must assume that there will be continuing efforts to keep the “hump” as flat as possible and that all will get care, at least until a point where available care must be rationed. That said, it is almost inevitable that the general public will tire of continuous containment measures – controls on travel and association bans on free movement, social distancing, and loss of income from work. These restrictions may be lifted in a staged way, with the public told that some will be reimposed if there is a fresh upsurge. But it is not hard to guess that it will be difficult to get effective compliance with restored tight controls when there is a resurgence. That will be the time when Australians decide that a certain mortality and level of long-term disability is acceptable.

 

Jack Waterford is a former Editor of The Canberra Times

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John Waterford AM, better known as Jack Waterford, is an Australian journalist and commentator.

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