Caught in the middle: NSW reconsiders how to 'live with the virus'

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Caught in the middle: NSW reconsiders how to 'live with the virus'

By Michael Koziol

Infectious disease expert Peter Collignon, who lives in Canberra, was in Sydney's Potts Point last month and grew uneasy with what he saw. "I walked past a number of restaurants and I thought: there are too many people in here too close together," he says. "We were invited into a restaurant and we thought 'no thanks'. We sat outside eating a pizza next to a heater."

That was early July. Pubs and restaurants have since been the epicentre of COVID-19 outbreaks in Sydney that have kept daily case numbers bubbling away between 10 and 20. While fast, aggressive contact tracing has kept the outbreaks under control, there is a growing sense that socialising at venues poses a risk to the state's continued success.

An empty Circular Quay: data from Apple and Google shows Sydneysiders are locking themselves down, with foot traffic and public transport use still significantly below baseline levels.

An empty Circular Quay: data from Apple and Google shows Sydneysiders are locking themselves down, with foot traffic and public transport use still significantly below baseline levels.Credit: James Brickwood

Community anxiety lingers over the clusters, which have been geographically widespread (from Casula in the west to Potts Point in the east) and rapid in their growth (more than 100 cases are linked to Wetherill Park's Thai Rock outbreak). Constant news of where infected people have been, and daily warnings for others who may have visited those places, compound a sense that the virus is omnipresent and on the precipice of an exponential blowout.

Many people feel another lockdown is inevitable, and some consider it desirable. Community Facebook groups are running polls about if and when it will happen. Mobility data from Apple and Google shows Sydneysiders are locking themselves down, with foot traffic and public transport use still significantly below baseline levels and trending down over the past month.

The NSW government has been adamant another lockdown won't occur, or that it would be an absolute last resort. But it also spent the past week revising its positions on all sorts of issues relating to how the state lives with COVID-19, including quarantine, masks and socialising.

NSW residents returning from Victoria must now enter hotel quarantine for 14 days, rather than isolating at home. Masks have gone from an optional extra to something the government strongly recommends in many situations. Health Minister Brad Hazzard said masks should "definitely" be worn on public transport. And where the government once encouraged the masses to get back out and restart the economy while maintaining social distancing, it's now urging young people to limit their socialising.

Health Minister Brad Hazzard dons a mask at Tuesday's coronavirus briefing.

Health Minister Brad Hazzard dons a mask at Tuesday's coronavirus briefing. Credit: Nick Moir

The pressure on the government is coming from several quarters. Labor found its voice last week, prosecuting the case for mandatory hotel quarantine for people returning from Victoria, and stepping up the pressure over masks. Asked in question time whether NSW had enough masks, a rattled Hazzard delivered a bizarre and unlettered tirade against Labor leader Jodi McKay. Later he issued a press release assuring the public there was a "robust supply", and apologised.

Discussions in the media, and particularly on social media, can also tend towards the alarmist. It was reported on Nine's television news last week that 17 flights from Melbourne were due to arrive in Sydney in a single day, a misconception caused by an airport glitch. For weeks each airline has been running just one flight a day on that route. But the claim, amplified by former Australian Medical Association president Kerryn Phelps on the ABC's Q&A program, no doubt galvanised the government into action on quarantine.

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Other claims about the NSW situation are repeated by the commentariat despite sketchy evidence. The assertion NSW is two weeks behind Victoria in terms of a second wave hasn't come to fruition, but is still routinely heard, including on last week's Q&A. Meanwhile, the federal deputy chief medical officers have consistently said the caseload in NSW is "under control".

However, that does not necessarily mean the community feels things are under control, especially when Queensland has declared the entire state a hotspot and other states (plus neighbouring New Zealand) have vanquished the virus. Gladys Berejiklian herself says NSW is "on a knife edge".

This is a vexed question for policymakers and health experts. NSW came close to elimination, or what Australian authorities are now calling the goal of "zero community transmission". Melbourne entering its six-week, stage-four lockdown shifts the equation: should elimination now become the nationwide goal? "If you ask the average Victorian why are they going to suffer like this for the next six weeks or even longer, it's that they are going to get down to zero spread," said the ABC's coronavirus expert Norman Swan on Thursday. "That's what they want."

Many health experts say that should have been the goal all along. Bill Bowtell, who advised the Hawke government on the HIV/AIDS crisis, argues NSW, Victoria and federal authorities continue to make a grave mistake by officially pursuing a suppression strategy.

Professor Peter Collignon and Adjunct Professor Bill Bowtell at a Senate select committee hearing on the coronavirus in Canberra last month.

Professor Peter Collignon and Adjunct Professor Bill Bowtell at a Senate select committee hearing on the coronavirus in Canberra last month. Credit: Alex Ellinghausen

"The best way to live with COVID-19 is to live without it," Bowtell says. "That's not pious hope. If you don't go for elimination and you come out with this idea there's a stable rate of transmission that can be obtained in a society - which is wrong - then you run the real risk of mistakes being made again and heading into Lockdown 3.0."

In order to achieve that goal, Bowtell says another lockdown "has to be looked at very carefully" - but it's not the only option. He says the more important steps are making masks mandatory, paid pandemic leave so people don't go to work when they're sick and better communications about behavioural change.

Phelps shares that view. "I don't want to see any more restrictions than we really have to. But we do have to identify potential problem areas," she says. "It only takes one unexpected outbreak, particularly if they're not able to track the source, and we're going to be Victoria all over. We want to get ahead of community transmission - masks are the simple way of doing that."

While the NSW government was late to the party on masks - and has still not gone as far as those experts would like - it has moved ahead of the Australian Health Protection Principal Committee and the Infection Control Expert Group, which have been reluctant to urge people to wear masks outside Melbourne in a serious way.

In late July, the ICEG chair Lyn Gilbert, a clinical professor of medicine and infectious diseases at the University of Sydney, told the ABC: "There's really no evidence, I don't think, that wearing masks in the [NSW] community at this stage would make any difference."

Those comments were widely noted by other medical experts. They were also referenced in a letter to federal Health Minister Greg Hunt from 23 frontline health workers last week, expressing no confidence in the ICEG and calling for Hunt to intervene. "This message is irresponsible given that Victoria is in crisis and NSW is on a knife edge," they wrote. "Everything that can be done to flatten the curve should be strongly advocated by public experts such as the chair of the ICEG."

NSW has now gone as far as it can in urging people to wear masks without making it compulsory. Collignon, the Australian National University expert who was alarmed by the crowded Potts Point restaurants, thinks that's the correct call given the low caseload in Sydney.

Nail technicians at Broadway Shopping Centre. Mirvac Retail has mandated masks be worn by all their staff in shopping centres as part of their health and safety precautions in response to the ongoing COVID-19 pandemic.

Nail technicians at Broadway Shopping Centre. Mirvac Retail has mandated masks be worn by all their staff in shopping centres as part of their health and safety precautions in response to the ongoing COVID-19 pandemic. Credit: Getty Images

"There's still not a lot of community transmission. Masks are mostly of benefit when there's a lot of community transmission," he says. He is also concerned that making masks mandatory would lead people to forget about other preventative measures such as physical distancing.

Rather, Collignon says the government should consider tighter limits on venue capacity, perhaps lowering the booking limit from the current 10 to four or six. Particularly if alcohol is involved, "it may be that those rules for 'what's a crowd' have to change". That's not a lockdown, but neither is it the open society NSW has championed and which some other states currently enjoy.

Other health experts have backed varying degrees of lockdown. Greg Dore, a professor at the University of NSW Kirby Institute for infectious diseases, says a four-week closure of pubs, clubs and restaurants would be preferable to a longer lockdown later, while AMA NSW president Danielle McMullen says the government must impose tighter limits on the size of groups at venues.

For now, Hazzard is pleading for people to limit their activities, rather than trying to compel them. Authorities were alarmed by the case of a 20-something man who visited seven venues (including Woolworths) while infectious last weekend, though many would consider that a standard level of social activity across a weekend.

It is not clear how the government could impose or enforce any limit on the number of venues a person can visit. Such a rule would certainly give weight to the charge that NSW is locking down without calling it a lockdown.

Hazzard dismissed suggestions of another lockdown as "silly stuff". "It would be helpful if people would limit their movements, particularly young people," he says. "There's no appetite to make it compulsory at this point."

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