Renewed calls to end lockdown rejected by RACGP and other experts

Doug Hendrie

13/10/2020 2:33:32 PM

Dozens of healthcare professionals have signed an open letter calling for the immediate end to Victoria’s ongoing lockdown measures.

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Top Australian epidemiologists have cautioned that key measures must be in place before lockdowns can be eased.

The new letter states the response to the virus ‘will cause more deaths and result in far more negative health effects than the virus itself’.
Signatory and anaesthetist Dr Eamonn Mathieson said the ‘ongoing physical, psychological, social and economic harm is creating a new health crisis that far outweighs any possible benefits from continuing the lockdown’.
Overseas, more than 11,000 have now signed the US-based Great Barrington Declaration, which calls for the effective ring-fencing of vulnerable people, such as those in aged care, until herd immunity is achieved, while World Health Organization officials this week called lockdowns a last resort.  
But top Australian epidemiologists Professor James McCaw and Professor Catherine Bennett have cautioned that key measures must be in place before lockdowns can be eased.
Professor Bennett told newsGP she believes Melbourne is almost ready to take substantial steps towards reopening, though she was clear that meeting people inside their homes could remain off limits.
‘People have confidence in the health department redesign, but to move out of lockdown [we need] early testing, people not going to work when unwell, and masks to make it a safe step,’ she said.
‘I think we’re ready to take it to the stage where we can isolate cases and clusters before people are infectious.’
Victorian health authorities are now much better resourced and structured to respond to future clusters, as Professor Bennett has noted this week in The Conversation.
‘The devolved public health response is a real strength in our arsenal,’ she told newsGP.

‘We now have early warning systems such as sentinel testing and wastewater testing, as well as high-risk workplace surveillance of workers to protect places such as aged care settings where we don’t want that rapid acceleration of cases ever happening again.
‘We’ve been in a pretty good holding pattern even with what we’re doing this week, taking half a step out. We still have a pipeline effect of heavy restrictions, even if we go to step three [lower restrictions]. By then, the health department can be very confident its new systems are ready to deal with this.
‘We must be ready for this next step, to move from a reliance on population restrictions to a much more focused, nuanced approach that includes isolation of cases and clusters. This step is where we can manage to suppress transmission to the level where we don’t require lockdown.
‘That won’t be a day too soon if so many people are struggling.’
But Professor Bennett said the Great Barrington Declaration reflects the very different circumstances in the US and is not applicable in Australia.
‘[The US] can’t go into lockdown, so they’re looking to manage the outbreak with immunity, whether they can achieve that or not,’ she told newsGP. ‘But in Victoria, we do have the opportunity to manage this without lockdown using swift and comprehensive case follow-up, as New South Wales has been doing, and as Victoria is now doing.’
Professor McCaw told The Age that almost all infectious disease experts and epidemiologists are advocating for ‘careful staged relaxation of the current measures’.
‘[W]e strongly view you cannot continue with lockdowns over an extended period of time … but complete removal of the current restrictions right now would be a very poor decision and could lead to surge in infections,’ he said.

Melbourne has been under lockdown since early July. 

RACGP Victoria Chair Dr Cameron Loy previously said that such campaigns ‘have the capacity to undermine confidence in the official health advice and discourage people from abiding by the restrictions put in place to stop the spread of the virus … This would be a disastrous outcome’.
Speaking to newsGP, Dr Loy claimed there is a different agenda to the local letter. He said second-guessing Victoria’s medical leadership and epidemiologists is not helpful.
‘I am not a public health expert. I don’t have access to all the information, considerations, training and expertise the Chief Health Officer or Chief Medical Officer has. They have the information, and I don’t – so I’m not an expert,’ he said.
Dr Loy said signatories of the local letter and the US declaration are aiming for herd immunity without a full understanding of what the virus could do.
‘They’re saying let the virus slowly walk through the community until we get herd immunity,’ he said.
‘Herd immunity sounds great when you’re talking about vaccines, when you can protect the small number who can’t have a vaccine. But when you try and use that term for a wild infection with a 1–2% death rate, when we don’t fully understand who is vulnerable, the premise is wrong.
‘If we do that strategy, a lot more people are going to die.’
Letter co-writer and Melbourne urologist Geoff Wells told newsGP the campaign has no formal links to any political party.
‘I’m totally apolitical,’ he said.
Mr Wells said more than 500 people have signed the letter, though he admits the website hosting the letter had to be taken down over concern people were ‘tampering with it’ by inputting fake AHPRA numbers. The actual number of doctors who have signed the letter is unclear.
Mr Wells said the letter has come about due to concern among doctors about the broader impacts of lockdown, ranging from mental health issues to missed cancer diagnoses to social isolation.
‘We thought we should protect the vulnerable and let the rest of the population go about their business,’ he said. ‘Epidemiologists are not at the coalface. They’re not seeing what we’re seeing.’
Mr Wells confirmed his group wants to aim for herd immunity.
Asked about the prospect of a third wave if lockdown is lifted too soon, Mr Wells said Australia has to ‘learn to live with the virus, as we did for all other viruses’.
‘With all others, we don’t go into enormous lockdowns. There are huge unintended harms to the longest lockdown in the world,’ he said.
As a result of the letter, Victorian Premier Dan Andrews is understood to have set up a meeting between a number of signatories and newly appointed State Health Minister Martin Foley.
A Victorian Department of Health and Human Services spokesperson told newsGP every decision taken since the pandemic began has been ‘based on data and advice from the public health experts.’

‘[A]s we take cautious steps towards COVID-normal, we’ll continue to work with them to keep Victorians safe and slow the spread of this deadly virus,’ the spokesperson said.  

‘We know all Victorians want certainty about the future – for them, for their family and for their work. We understand everyone is making huge sacrifices, but this strategy is working and we must stay the course and drive the numbers down.

‘If it’s possible to safely and responsibly make changes to the roadmaps then we will do that, but only when we can be sure that we are not risking hard-won gains.’ 
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Dr Steven Julius Sommer   14/10/2020 8:00:58 AM

Watching what is happening right now in the UK, Europe and the US along with my own experience of almost dying in ICU earlier this year (suspected Covid - turned out to be septicemia - extremely unpleasant), I really do not understand why some doctors are pushing to let this virus out of the bag just before we have adequate strategies in place (literally just weeks). I applaud the RACGP's stance.

We must face reality and bring our patients, especially our young people, with us. Help them to be brave and responsible and have confidence in science. Let's continue with proven strategies rather than flit into fantasies about herd immunity.

Dr David James Maconochie   14/10/2020 10:53:42 AM

I am not elderly or in a Nursing Home, so I would not be rign-fenced in this plan. However I am over 60, a GP, and constantly exposed to viruses brought in by my patients.

Were I working in Victoria, and COVID allowed to run free, I would certainly become "at-risk". Even if I survive infection (and lets not forget that many relative young doctors and nurses have died of this probably through accumulated exposure) there is a high probability of not returning to full health, and of being significantly unwell for an extended period.

My conclusion is that my own health comes first, and I would cease working as a GP until either a vaccine is available or community spread ceases. For that reason I applaud the approach taken by the Government of WA whose management has been exemplary.

Dr Ash   15/10/2020 10:51:33 PM

It is interesting that there is no real consensus with regards to virus policy.
It has been clearly stated by the WHO that lockdown should be only used as a last resort to lessen the burden on health infrastructure during rampant case rises. The reason stated is the well documented negative impact on peoples health and welfare as a result of lockdowns. However our own public health expert is using extended lockdown as a mechanism to achieve practical elimination of the virus at very low current case loads. In my opinion, a recipe for disappointment, and disaster.
The people most affected by the lockdown both health wise and economically are going to be of low SES. Working from home and 'choosing' not to work are luxuries that are only afforded to the wealthy. The comment above states 'my own health comes first'... an apt statement for those that want this lockdown to continue. We can't let personal (and political) fear govern our health policy.