Inside the NSW plan: Now live with the virus
As other states enter lockdown, NSW has abandoned plans to return to Covid Zero. It intends to begin opening up in a month.
All through the worsening Covid-19 crisis in New South Wales, Gladys Berejiklian has insisted her government’s response accorded with medical advice. Except that’s not true.
In evidence before the NSW parliamentary Covid-19 inquiry on Tuesday, the state’s chief health officer disclosed that she had not provided any advice to the government about when the state’s lockdown might be eased. This tacitly contradicted the premier’s hopeful prediction that Sydney could start to emerge from lockdown on August 28, if vaccination rates hit 50 per cent.
Although Kerry Chant said she was “optimistic” about reaching 50 per cent vaccination by the end of the month, she noted the Doherty Institute modelling commissioned by the federal government that nominated 70 per cent as the safe rate before there could be any significant easing of restrictions and at least 80 per cent to obviate the need for lockdowns such as those now affecting millions in NSW.
“I can’t speak for the premier, but certainly I’m very committed to the issues around getting our vaccine coverage up, but very much recognise that we need that 70 per cent,” Chant said.
“Clearly the premier has used a target, but the premier is also well versed with the Doherty report and its contents and the implications.”
Chant did not specifically address the question of why the premier, in the absence of supporting medical advice, had nominated an inadequate vaccination rate as the trigger for unspecified measures that would ease the lockdown. “I have not provided specific advice about any restrictions that I would be prepared to ease,” she said. “It is too premature.”
The NSW Health minister, Brad Hazzard – who appeared with Chant before the Covid-19 oversight committee to answer questions about the government’s handling of the latest outbreak – suggested Berejiklian’s announcement was intended to boost public morale.
“I think it’s fair to say that the premier is trying to give a sense of hope to the community…” he said.
Contrary to the approach of other states, Berejiklian is not pursuing a return to zero cases. There will be no doughnut day. Her strategy is to open up and live with the
virus. The numbers being watched will not be infections but hospitalisations and deaths. She hopes for some opening up by the end of this month and a broader opening up by October.
Early last month, after a meeting of crisis cabinet, Hazzard told a media conference that NSW might never control the outbreak. According to ministerial sources, Treasurer Dominic Perrottet had argued in that crisis cabinet against the continued lockdown, saying the state would have to accept community infections.
The day Hazzard canvassed that possibility, there were 27 new cases of community transmission and a total of 347 active Covid-19 cases in NSW. Five weeks later, there are 300-plus new cases a day.
The outbreak that began in Sydney’s eastern suburbs has spread to the west, then to the regions, and then to other states – which so far have done a better job of controlling it.
What seemed at the time like frustration from Hazzard is now, more or less, government policy. Construction workers can go to work with only a single dose of vaccine. Business leaders have met with the premier to discuss similar provisions for office staff, in the hope of reopening the CBD. The lockdown has become a whack-a-mole strategy, imposing harder restrictions on certain local government areas only to see the virus take off in others.
“We will never get back to Covid Zero, if the strategies aren’t changed,” says Professor Mary-louise Mclaws, epidemiologist and expert in infectious diseases at UNSW Sydney. She finds it “perplexing” that the government had not listened to the science and employed more robust methods against the virus.
“You can’t keep employing the same strategies and thinking you’re going to get a different result,” she says.
“Today [Wednesday] is the 47th day of lockdown. We have had 5857 cases, and on average a death every second day. And I think this deserves a change in strategy, not giving up on this.”
A year ago, Berejiklian’s approach was widely accepted. Scott Morrison argued that Australia might have to learn to live with some community transmission, because lockdowns were so damaging to the economy. The same argument about economic cost was being pushed by the Business Council and other employer groups, and by many in the media, particularly the Murdoch media.
“That was the conventional wisdom that shaped some people’s thinking – not Grattan’s, I might add, but many people’s thinking,” says Stephen Duckett, a former secretary of the federal Health Department and health program director at the Grattan Institute.
But several things have changed over recent months. Vaccines, for one. “And there’s been Treasury modelling, which says, ‘Oops, we now realise that lockdowns are a better strategy.’ ”
Morrison himself has expressed concern about Berejiklian’s decision to step away from a Covid Zero approach. He says there are no shortcuts out of lockdown. “Australians have made great sacrifices to be able to get us into the position we have been in,” he says. “We are not going to squander that. It’s important that we stay home. It is important we make this lockdown work. It’s important that we don’t give up on it.”
Another factor in this, Duckett says, is the realisation that lockdowns and the pursuit of Covid Zero are politically popular. Elections in the Northern Territory, Queensland and Western Australia have proved that.
“Western Australia is the best example, where tough management of the pandemic was mightily endorsed by the public,” Duckett says, noting that the anti-lockdown opposition was all but wiped out in their March election. “So the political reality dawns on the federal government, and they’ve now got a fig leaf from the Treasury modelling, which says lockdowns actually work.”
Somehow, Duckett says, NSW didn’t get the message.
“Rather, a significant component of the NSW cabinet, including the NSW treasurer, is of the view that lockdowns are bad for the economy.
“Berejiklian’s entire strategy over the past 12 months has been: what is the least, the lightest touch, you can possibly do?”
The obvious comparison is with Victoria, where the government has gone much harder. It has not, for example, attempted to impose different degrees of lockdown according to postcodes, Duckett says, because it has understood there is simply too much movement between areas.
Berejiklian continues to hold out the prospect of even greater differentiation between local government areas, whereby those with lower transmission rates and higher vaccination rates could be opened up further. Such an approach would inevitably favour affluent areas, where households are on average older and smaller, and professionals can work from home.
David Shoebridge, the Greens MLC who chairs the NSW Covid inquiry, says Chant’s evidence raised the question of exactly what advice the government was following in its decision-making.
“I don’t think we are getting the full story from the premier. She keeps reiterating, ‘We are following the health advice.’ Well, clearly it’s much more complex than that,” Shoebridge says.
“We now know for the first time that Kerry Chant has been providing written advice to the government throughout the pandemic, and the government is refusing to produce it because they say it’s cabinet-in-confidence. If they want to retain a relationship of trust with five-and-a-half million people, well, then I think they have an obligation to share it.”
Shoebridge puts the government’s failure down to an erroneous belief in “NSW exceptionalism”, based on its previous good luck and good system of contact tracing.
“The mindset was to keep the state open, to rely upon NSW exceptionalism. And that led to a very slow implementation of the lockdown, despite all the evidence,” he says.
“I think there was a failure by the government to recognise what had become abundantly apparent from international experience, which was the incredible transmission rates of the Delta variant.”
The expert evidence given to his committee confirms his view. As Professor Peter Collignon of the Australian National University medical school summarised: Delta is 50 per cent more transmissible, is infectious earlier, and presents more asymptomatic cases than the Alpha strain, all of which makes detection and contact tracing harder.
Speaking later to The Saturday Paper, Collignon suggested the aspiration of Covid Zero is likely unattainable now.
“Even if it is possible to get NSW back to zero,” he says, “it will take quite a while, and what that effectively raises is whether it is worthwhile pursuing. Because once you get large numbers of people vaccinated, the whole plan, the road map, is that you would live with lower levels, because the consequences for people would be so much less.
“But it requires getting probably 80 per cent of the population vaccinated, which is achievable by about November, I would think.”
Given that Australia doesn’t yet have anywhere close to that proportion of the population vaccinated, this suggests a health crisis that persists for at least several more months.
That means balancing the economic and social consequences of restricting people’s activity against “the consequences of not only case numbers, but the deaths and hospitalisations”, says Collignon.
Judging by Berejiklian’s concession on Thursday – that the government now is considering a hard Sydney or statewide lockdown – there is a dawning realisation it has got the balance wrong.
This realisation is way too late, however, says Mary-louise Mclaws.
“They should have taken warning from the UK, from multiple countries overseas, that demonstrated the great difficulty of controlling Delta,” she says.
Mclaws has not given up hope that NSW and Australia could get back to zero, but says that would take months with more stringent measures, even if the infection rate peaked now.
The failure of the government to grasp the science and the need to do more is, she says, “soul-destroying”.
Take the decision to keep the construction industry going – albeit at reduced capacity – while allowing tradespeople to work after a single dose of vaccine.
One dose, she says, is efficacious in preventing recipients from severe infection, hospitalisation and death. But it is not very effective at preventing infection and transmissibility.
“So getting people back onto the construction site with the first shot will help them from overloading the health system and keep them alive – great – but they also can still be carrying infection.”
Recent evidence from Britain suggests that even fully vaccinated people, if they become infected, have a similar viral load to the unvaccinated, and may be as infectious.
What is needed, Mclaws says, is dramatically increased use of rapid antigen testing, not only on constructions sites but among other essential industries.
“They are for screening rather than diagnosis … perfect for identifying somebody who was contagious, very early on,” she says.
“And if someone is picked up by such a test, it should be mandatorily reported, and positive cases moved to the contact tracing team, and they should get an urgent PCR test and some sort of quarantine away from the family unit.”
Others emphasise different measures, although the importance of rapid antigen testing was agreed by all the experts before Shoebridge’s committee.
So was the need to clearly define what was essential work, and to direct vaccinations and testing accordingly.
As Shoebridge noted: “We live in a state where people are asserting that hairdressers are essential workers, as are construction workers, as are emergency department nursing staff.”
In short, priorities have to be adjusted, according to risk. “My own view,” says Collignon, “is that people who work in supermarkets are essential workers, and they are probably higher up the line than schoolteachers, for instance.”
Other suggestions from the health experts, before the Shoebridge committee or speaking to The Saturday Paper, included face shields for essential workers, full masking, stopping workers sharing cars, abandoning the concept of differential lockdowns by local government area, and clear, consistent messaging.
And straight answers from government, ones that don’t raise false hope about the next few months. Answers such as the ones Kerry Chant gave on Tuesday.
“A significant component of the NSW cabinet, including the NSW treasurer, is of the view that lockdowns are bad for the economy. Berejiklian’s entire strategy over the past 12 months has been: what is the least, the lightest touch, you can possibly do?”