COVID-19 roadmap to recovery

The “Group of Eight” major research Universities has released a “Roadmap to Recovery” which spells out two alternatives for recovery from COVID-19:

Media release: Go8 provides evidence-based “Roadmap to Recovery” report to Federal Government

The first is continued restrictions for longer to “Eliminate”.

The second is for quicker lifting of restrictions for “Controlled Adaptation” accepting some ongoing level of infections while avoiding the health system getting overwhelmed.

The second is current Australian government policy accompanied by a steady drumbeat from business and the media insisting on a rapid return to work. The first is a clearly viable better alternative.

I find the pretence at academic neutrality between the two options quite irritating and the proclamation of “ethical principles” even more so.

But they have struck a blow that will make it much harder for “business” to get its way. The report release is well timed as efforts to reopen schools are being rushed in an effort to pre-empt a policy of Elimination.

The two page “snapshot” version makes it obvious that “Eliminate” is the way to go.

The 28 page summary obscures this with academic waffle.

The 192 page full report will not be read by many.

A major weakness is the parochial focus on Australia. An “Aussies all together” program of national service is proposed “to inclusively engage the young from across the nation in the process of social reconstruction across the country.” (p16)

Any country lucky enough to be able to “Eliminate” has major responsibilities to help the rest of the world. Australia will have particular responsibilities to help PNG and Indonesia as well as joining with New Zealand in support of others in the region. That is far more engaging and inclusive than a vision limited to “across the country”.

Some minor weaknesses:

1. The section on “Six imperatives in the implementation of Recovery” is confusing as much of it applies mainly to “Controlled Adaptation” rather than to both approaches, but it appears before either approach has been set out. (p17-22)

2. The next section on ” 1 An Ethical Framework for the Recovery” adds nothing whatever. (p23-25).

3. After a very brief introduction, the report should have simply started with “2 The Elimination Option” (p26-57) followed by “3 The ‘Controlled Adaptation’ Strategy” (p58-82).

In fact I strongly recommend readers should simply skip everything before page 26. Just read the separate 2 page “snapshot” first rather than getting bored by academic pontification either in the summary or preceding the full report.

4. Section 2 should start with a clear explanation that “Elimination” does not mean zero cases but rather, as explained by the New Zealand government, “zero tolerance” of cases, with any occasional sporadic outbreaks promptly suppressed. The opposite impression was created on p10.

5. Key Performance Indicators for contact tracing cite a pre-print by Lokuge et al but do not provide any means for accessing it. The doi URL should have been included:
https://www.medrxiv.org/content/10.1101/2020.04.19.20071217v1
This technical paper is very important. It rightly stresses the importance of upstream tracing.

In discussing KPIs for contact tracing, reference should also be made to:

Rapid Audit of Contact Tracing for Covid-19 in New Zealand
Dr Ayesha Verrall
University of Otago
10 April 2020
https://www.health.govt.nz/publication/rapid-audit-contact-tracing-covid-19-new-zealand

Lokuge et al includes a reference to Ferretti et al and to Imperial College Report 9. But it omits the essential confirmation in Imperial College Report 15, that testing cannot replace, but must be combined with, digital tracing , citing Ferretti et al. See links at:
https://github.com/dentarthur/next-waves/blob/master/Schools_and_TTT.md

A full appreciation of that should result in clearly linking public acceptance of digital tracing to a goal of “Elimination”. A government aiming at anything less than Elimination will not be able to get whatever level of public tolerance of dataveillance it needs for “Controlled Adaptation”. As Ferretti et al document, pre-clinical transmission itself has a reproduction number almost high enough for an uncontrolled epidemic without any symptomatic transmission. So success at Elimination requires far more contact tracing than can be achieved without popular enthusiasm. Transmission chains can be detected from primary care surveillance of symptomatic cases but with restrictions on social contact lifted the necessary upstream and downstream contact tracing could not get anywhere close to the results achieved manually under near lockdown conditions.

I included those references together with links on transmission through chools because the battle over reopening schools will largely determine whether the outcome is Eliminate or not.

7. Suggestions that elimination could be achieved in 30 to 60 days “assuming no major institutional or other outbreak events” weakens the argument. Epidemics are inherently stochastic. The argument should simply be that although local outbreak events can be assumed, they can also be locally suppressed. That is New Zealand’s “zero tolerance” as opposed to “Controlled Adaptation”. The uncertainty arising from risk that one might be infected in an outbreak is no different from normal risks of accidents. It is very different from living in a society that has “adapted” to a stream of deaths from “controlled” infection.
I only skimmed the alternative “3 The ‘Controlled Adaptation’ Strategy” (p58-82) as I don’t really take it seriously. Not sure whether it is meant to be taken seriously. Seems obvious that if it was possible to “control” an epidemic with R just under 1 it would make sense to go for Elimination with a lower R. I did not notice any evidence supporting the idea that there is some way “gradually” lifting restrictions could change the reality that lifting them enough to resume normal economic activity would leave R above 1 and an epidemic explosion as already demonstrated around the world.

Overall my impression is that this report is more than enough for Victoria to hold out for Elimination and that is sufficient to put a spanner in the works of any pretence at “Controlled Adaptation”.

So despite both the major and minor weaknesses mentioned above, what I have read of the full report is a very welcome counter blast to the endless droning from the pro-death lobby. It does a job that needed doing.