Should Australia switch from suppression to elimination?

Doug Hendrie

14/07/2020 4:43:22 PM

Top epidemiologists and virologists are calling for Australia to pursue an explicit coronavirus elimination strategy as Victoria grapples with the fallout from rising community cases and its second lockdown.

Australia and coronavirus
Current lockdowns could afford the chance to eliminate – rather than suppress – the virus.

Melbourne University epidemiologist Professor Tony Blakely wants Australia to seize the window of opportunity afforded by a second lockdown and push to eliminate the virus, given six out of eight states and territories had achieved that goal.
‘We need the leaders of Victoria and New South Wales to say, “We are going for elimination”,’ he told newsGP. ‘We don’t want the population to say, “Let’s go back to the pub”, when cases are back down to 10 per day.
‘Let’s keep going and knock the bugger on the head.
‘Essentially, it’s game on [for elimination]. In the last couple of days there has been a pronounced shift in the expert dialogue about this. The population is growing tired of this suppression strategy. Let’s make use of this window before JobKeeper runs out in September.
‘We’ve already gone into lockdown, so the marginal cost is not that great. Let’s capitalise on that and eliminate this thing. It’s just taken a while for the established science to suggest it’s possible.’
Modelling undertaken by Professor Blakely and his team suggests that Victoria stands an 80% chance of eliminating community transmission in the six-week lockdown if mask wearing were to become mandatory, schools were shut and the definition of an essential worker significantly narrowed.
Professor Blakely said the early thinking around flattening the curve is premised on the idea you could never totally get rid of the virus.
‘I didn’t know which way to go three months ago, but the evidence has tipped now to an elimination strategy,’ he said.
‘The [original] argument was that it would always be lurking somewhere in asymptomatic carriers. It was valid at the time, but it’s since been disproven.
‘New Zealand, Taiwan and six of eight Australian jurisdictions have done it. We could lock ourselves off from the rest of the world and make sure no one gets out of quarantine.’ 
Victorian Premier Daniel Andrews has pointedly refused to rule out stage four restrictions, which could include mandatory closures of all businesses bar essential services such as supermarkets and pharmacies, if the state followed the New Zealand model.
New Zealand famously achieved elimination of the virus using strict stage four restrictions, which Prime Minister Jacinda Ardern summarised as ‘go hard, go early’.
New NZ cases have continued to pop up in returned travellers, but the quarantine appears to have held to date, with more than two months passing since the last community-acquired case of unknown origin. 
Victorian Chief Health Officer Brett Sutton floated elimination as a potential strategy in an ABC interview earlier this week, and on Tuesday said if cases were slashed to single digits – down from 277 new cases overnight – then elimination could be considered.
‘The seesaw of locking down and easing up will be almost intolerable,’ Professor Sutton told the ABC.
‘We need something that is sustainable … that might be elimination if we’ve got any feasibility of getting there, or it might be suppression that doesn’t involve really significant constraints on behaviour.’
A likely drawback to elimination strategies would be the impact on tourism and international students, with Professor Sutton suggesting on the ABC that an even harder border lockdown would be required.
University of Queensland virologist Associate Professor Ian Mackay told newsGP there is no reason why Australia could not aim for elimination, given how close the country got before the Victorian outbreak. 
‘I think we could have got rid of it in the first lockdown. We were almost there,’ he said. ‘For some reason, [elimination] wasn’t on the cards. If it had failed, it would have been egg on the face of the politicians.
‘New Zealand took a different approach, stuck to it and achieved that. We could have done that and we still can. It will save us money, heartache, lockdowns and businesses having to stop.
‘Victoria should be a really good lesson for us to take elimination seriously.
The virus is raging everywhere else outside [Australia’s] borders, but if we could eliminate it locally and stop these sorts of outbreaks from happening, we could open up [domestically].
‘We crushed the flu, therefore we can crush SARS-CoV-2.’

New modelling suggests Victoria stands an 80% chance of eliminating community transmission in the six-week lockdown if mask wearing were to become mandatory.

Experts like Associate Professor Mackay who are pushing for elimination have been emboldened by recent data showing precipitous drops in influenza numbers of around 99% during the first nationwide lockdown.
Calls for local coronavirus elimination have grown louder in recent days as Victoria’s cases continue to climb, with health policy expert Stephen Duckett calling for Australia-wide elimination of the virus given the ‘enormous’ return on investment.
In the Nine outlets, Kirby Institute epidemiologist and infectious diseases physician Professor Greg Dore said he has changed his mind on elimination after empirical data from New Zealand and all Australian jurisdictions other than Victoria showed it is possible to eliminate community transmission.
Professor Blakely said the ‘rough and tumble’ nature of Australian politics may have contributed to the early decision to aim for suppression over elimination.
‘We need to empower our politicians. It’s okay to put a goal out there that has a better than 50:50 chance, though still with a risk of failure,’ he said.
‘It’s better than the failure of not having a goal.’
In response to Professor Blakely’s previous calls, Federal Health Minister Greg Hunt last week said he does not want to ‘overpromise’.
‘We’ve been very cautious because New Zealand set out a certain standard and then when cases emerged there was a great national sense of disappointment and outcry,’ he said on 3AW.
‘Given that it’s a global pandemic, given that it’s been within the community in Australia, we don’t want to overpromise.’
Professor Blakely told newsGP another option is to wait until treatments for COVID-19 have improved to the point that allowing the virus loose is preferable to lockdowns.
‘If vaccines are too far away, we could pivot to letting this wash through to get to herd immunity when we’d worked out more treatments and how to protect people,’ he said.
‘At the moment, this isn’t viable – if we’d pivoted to herd immunity and mitigation [for the first wave], we probably would have had 135,000 deaths.’
But Professor Blakely said finding more treatments alongside the two proven options of dexamethasone and remdesivir could change that equation, if better ways were also found to prevent the virus from gaining access to the most vulnerable in aged care facilities.
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Dr Wilson Chong   16/07/2020 2:10:47 PM

That's all good and well, and I'm not arguing that elimination isn't possible, but what about the long term goal? Eventually we're going to have to open back up again to the world and then we're guaranteed to see a rise in imported cases associated with travel