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Australia’s COVID-19 response may have saved more than 16,000 lives

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The University of Sydney-led research, published by the Medical Journal of Australia (MJA), is based on modelling that used the UK’s COVID-19 response as a template.
 
Led by Dr Fiona Stanaway, a clinical epidemiologist at the University of Sydney, researchers used data on all-cause mortality from England and Wales over the peak of the COVID-19 outbreak from March to May to directly estimate the number of excess deaths that may have occurred if the outbreak in Australia had been of a similar extent.
 
‘This resulted in an estimated additional 16,313 deaths in Australia: 9295 men and 7018 women,’ Dr Stanaway and her colleagues wrote.
 
In contrast, by 24 May there had been 103 COVID-19-attributed deaths in Australia – and 1340 excess total deaths, according to provisional mortality data released by the Australian Bureau of Statistics.
 
While the total deaths substantially increased to 875 as of 29 September as a result of Melbourne’s second wave, the rate of 34 deaths per million population remains substantially lower than during the same period in the UK, when there was more than 42,000 deaths and a death rate of 618 per million.
 
‘This enormous difference underlies the importance of Australia’s response using a combination of extensive testing and contact tracing, mandatory quarantine of people returning from overseas, and shutdowns to control community transmission,’ the authors wrote.
 
‘While acknowledging that these measures carry with them substantial social and economic harms, we wish to highlight the scale of the loss of life avoided.’
 
Speaking to newsGP, Dr Stanaway said a side effect of Australia’s comparatively successful response and low mortality rate may have led to a degree of complacency and difficulty in seeing the cost–benefit of measures taken.
 
‘That’s why we wrote the article, in fact; because when you’re successful people can sometimes think “Oh, it doesn’t matter”,’ she said.
 
‘What we were trying to say is all this stuff we’re doing, yes, it’s really hard and people have had to change their lives. But, actually, it really mattered.
 
‘I have colleagues in the UK and it’s terrible over there.’
 
Dr Stanaway said she and her colleagues used all-cause mortality data due to known undercounting of COVID-19 cases and related deaths in the UK, as well as a sharp increase in non-COVID deaths, up by 32% in weeks 13 to 20, compared to the last five years.
 
‘It seems to be a lot of cancer and cardiovascular disease deaths and that’s probably a combination of people being frightened and not using health services. It also could be strain on the health system, so people are perhaps not getting the same care that they would normally receive,’ she said.
 
‘So you get the COVID death, and then you get other deaths as well.’
 
Associate Professor Linda Selvey is a public health physician and an infectious diseases epidemiologist at the University of Queensland.
 
She told newsGP that while she suspects the estimate of averted deaths may be overblown – and closer to 10,000 – the conclusions drawn are important. 
 
‘That modelling was fairly crude,’ she said. ‘There has been other modelling done by infectious disease modellers who take a different approach; they look at the dynamics of the infection and then estimates of particular responses and look at it that way.
 
‘But, essentially, they all come up with the same answer, which is that in Australia we’ve averted a lot of deaths, and not just deaths, but morbidity as well.
 
‘That can be really important in terms of reminding the public that all the sacrifices that people have made are not in vain.’
 
While the research aims to highlight Australia’s strengths, rather than the UK’s weaknesses, Associate Professor Selvey says there is no denying geography has a key role to play.
 
‘It’s true that our response in terms of the cases and social distancing was really critical, but I don’t think you can underestimate the impact of our border responses and our ability to do that, given our geography that we wouldn’t have been able to do otherwise,’ she said.
 
‘The fact that there is some delay in Australia in terms of the sudden influx of cases that enabled us to manage it, and also much that it is more difficult to do border controlling in Europe.’
 
Looking to the UK, where 14,542 new coronavirus cases were recorded on 6 October alone, there are fears of the potential for a third wave as Melbourne moves towards easing restrictions.
 
While Dr Stanaway says being cautious is understandable, as Melbourne’s 14 day rolling day average stands at 9.9, she says Australia’s reality is vastly different.  
 
‘If you look at the case numbers in Europe and the UK, they never really got below a 14 day average of around 200. So they only got down to that point and opened up,’ she said.
 
‘That’s why [in Melbourne] they tried to push to get to that lower number because they know from that experience in Europe that getting down to 200 is not enough.’

Associate Professor Selvery says Melbourne brought lessons observed from abroad to home soil, demonstrating how quickly the public health response can become overwhelmed.
 
‘So knowing that, I think that really shows that our response wasn’t overblown because there’s a fine line, and once you cross over that returning back requires drastic measures,’ she said.
 
‘The UK can’t possibly manage their cases without doing another lockdown. They have to make a decision – which obviously is a political one – about do we lockdown or as a society do we put up with mortality and so on?
 
‘Their public health capacities are very questionable, clearly. But even with the capacity that we have, we wouldn’t have been able to cope with that number. The system just can’t deal with that number of cases – not just the hospital system, the public health system as well.’
 
What is now key, Dr Stanaway says, is that Australians do not become complacent – a warning that is both direct at the general population and Government response.
 
‘We’ve got a non-immune population, so there’s always a risk of it taking off again,’ she said.
 
‘So we have to have this constant surveillance so that we can jump on outbreaks really quickly, and we’re going to have to keep doing that until there’s a vaccine.
 
‘Keeping the hotel quarantine really, really tight, doing surveillance of the sewerage to pick up cases, and getting people to keep getting tested when they have minor symptoms just so that we can pick things up early.
 
‘Melbourne is a really good example of how you can have things under control and then it can just get away from you so quickly.’
 
Associate Professor Selvery agrees.
 
‘It’s important for jurisdictions to maintain their capacity for the public health response and that can get a bit tricky because when you’re not having many cases, systems can struggle to wind up – so switching on and switching off,’ she said.
 
‘New South Wales has really shown how with sufficient capacity and a really well organised response and good IT systems, they can manage and bring down cases without necessarily increasing a lot of their social responses. That’s really what we would ideally be emulating around the country.
 
‘But the message is, if we get beyond that capacity then there’s no other response than lockdown and the sooner you do it, the better in terms of how quickly you can then come out of it.’
 
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