The virus and social cultures: A national plan beyond Doherty

Sep 9, 2021
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Australia needs a new and realistic national plan for emerging from the worst of the COVID-19 pandemic.

The country needs a viable new national plan with continuing safe behaviour and vaccination rates of over 80% of the total population and higher for the vulnerable.

While the ideal four phases make sense the imagined vaccination numbers and the timetable don’t work. Despite its rhetorical grandeur the “national plan” often means many things. Aside from dissident WA and Queensland premiers, Gladys Berejiklian has discussed opening borders at 80% adult vaccination rate, while the national plan has that as Phase D, not Phase C.

The fundamental problem begins with the Doherty model which does not offer a suitable basis for a national plan, given its limitations and its serious omissions, including the missing key word “culture”.

The 25 usages of “scenario”, including “hypothetical scenarios” and the 30 uses of “assume” or “assumptions” indicate the limitations of the Doherty model, as do key omissions including the failure to recognise the rising transmission rates among young people and children. Note also the different conclusions about hospitalisations and predicted higher death tolls in the alternative Grafton, Hyde, Kompas model and in the Burnet model.

The other crucial omission from Doherty can be found in one absent word – “culture”. In that popular saying about the success or failure of sports clubs and other institutions, “it is the culture, stupid”. Culture may be difficult to model but it shapes social behaviour in a nation as well as an institution.

Without addressing the subject directly Doherty raises the question of uncertainties and difficulties in its predictions (p 2):

These findings are conditional on public health workforce and response capacity which varies nationally, population compliance with public health recommendations and orders, and persistence of immunity following infection or vaccination over 6 months timeframe …

It also acknowledges possible “vaccine escape” variants requiring “re-evaluation of targets and associated requirements for public health measures”.

Consider two specifics of culture relevant to “population compliance”, one local and one contemporary and international.

Old Australian “she’ll be right” attitudes have already been manifested in people waiting days or a week to present for testing when they have symptoms. The result is often unchecked transmission over multiple sites. A gender factor may exacerbate this judging by the initially low vaccination rates of younger men.

The second cultural factor comes from over half a century shaped by the consumer culture of individualism. As the T-shirt declares “It is about me’’. It is about “my desires”.

“Young freedom” desires are significant. Public health only works with an engaged and compliant people and a population educated in what needs to be done. It is all the more important given delta’s rising infection rates among the young.

“Open slather” opening up is dangerous. Like young colts ready to be let out of the paddock in spring – or even people of all ages ready to travel – the young vaccination announcements were met with intoxicated enthusiasm. Watching TV news, the loud theme of the vaxxing our way to freedom enthusiasts was “let’s party!” – “Weddings, parties, anything”, as in the song, and bars, nightclubs, concerts, sports, gyms, etc.

You could hear the shouts of “Whoopee” and “Let’s go”. Or “Just do it”.

Given delta spread, even among the vaccinated, that is disturbing regarding pandemic infection numbers and the original government plan’s lack of clarity about 12-15 year olds and vaccination percentages – 70% of the adult population is a dangerous mere 56% of the total, leaving 44% of unvaccinated. A great contrast to Germany’s aim of a 95% vaxxed population.

There seems to be little popular awareness of the transmission dangers. Double vaccinated young people (and others?) don’t realise that the vax is not an “open sesame” ticket to freedom. “Me first” is not a synonym for healthy practices and youth does not often correlate well with social responsibility. That’s an unfortunate reality.

A third social-cultural factor complements these two cultural factors. Vaccine hesitancy and large family interactions are realities among CALD (culturally and linguistically diverse) communities in working class suburbs, areas with large numbers of essential frontline workers. In a socially divisive tale of “two nations” these urban areas and some rural areas also have low vaccination rates. A more specific and grave danger is now apparent in Indigenous communities, such as Wilcannia.

These three factors for spread are found across the community and are generally quite separate from the small number of denialist and conspiracy protestors. However the latter do have unfortunate influence in encouraging vaccine hesitancy through unregulated social media.

Delta is spreading and a projected breaking of the numerical link between infection cases and hospitalisations/ICU needs remains imaginary. Nor, can we be sure that TTIQ (testing, tracing, isolating and quarantining) systems will still work as cases grow and hospital staff must isolate. We can’t forget case numbers with NSW rising above 1200, which may overwhelm existing systems and staff. We should note, in contrast, the Burnet Institute’s modelling of the number of cases and hospitalisations prevented by Victoria’s lockdowns.

In NSW Doherty already doesn’t work. Significantly, while Berejiklian trumpets the vax numbers, scarily, she copies US Republican governors in suppressing health information – not releasing all exposure sites and details of the rising proportion of infections in the community. The most worrying number – “unlinked” cases – is no longer being published by NSW health authorities.

This pattern is not “making NSW great again”. The virus does not have an electoral timetable despite the Prime Minister’s buzz words including “freedom”. As a salesman Scott Morrison has sensed the frustrations felt in the community and turned it to his advantage, relentlessly selling hope, even describing the Singapore vaccine swap as offering “doses of hope”.

The prime minister has controlled the narrative, co-opting the science, Doherty’s educated guesses, the treasurer invoking the theme that you can’t argue with the science.

However possible projections are not sacred science. The political simplifications forced the institute director Sharon Lewin to address the “many variables”, some unknown, and to detail the continuing public health measures, which may include lockdowns.

Habitually, the prime minister has been the salesman of positive news (“How good is that!”). Has he reshaped science into a simpler, political message? Given the popular desire to escape from what he termed the cave dwellers’ policies of heavy lockdowns, with their psychological and economic pressures, the tactics might work. Freedom appeals.

While in many respects Australians are co-operative and responsible, as we have seen so far, only a few infected individuals, families and workplaces can lead to exponentially rising outbreaks of the virus. These may be compounded by soon reopened schools and offices, many with unaddressed ventilation problems.

We need a path out of lockdown, but not one marked “Have we got a deal for you!” Australia needs a real plan, a new national plan which has realistic rather than hypothetical scenarios. Like most people I share the desire for greater activities and interactions. However, the foundation of a healthy economy is a healthy society, not the other way round. Relaxed responsibility for outdoor activities with public health restrictions, and penalties, and improved ventilation, after 80% are double vaxxed, is needed. Selfish conceptions of freedom from politicians and people have great emotional appeal. However, as recent summer openings up in Europe and the USA have shown, they will in fact
spread the virus.

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