Welcome to Coronavirus Government Global Briefing, Mandarin Premium’s morning update on everything in local and global government responses to the COVID-19 outbreak.
How data could guide us out safely
As Australia, New Zealand, and a host of other countries slowly begin to reopen, understanding the effectiveness of specific public health measures — and in turn, the impact of removing them — will become crucial to preventing future outbreaks.
With that in mind, Nature reports that researchers at the London School of Hygiene and Tropical Medicine have begun work on a WHO platform aggregating data from 10 groups currently tracking interventions, “including teams at the University of Oxford, UK, the Complexity Science Hub Vienna (CSH Vienna), and public-health organisations and non-profit organisations such as ACAPS, which analyses humanitarian crises.”
While researchers urge some caution in quantifying the effectiveness of a single measure — some policies may only prove effective in coordination with others, for example, while intercultural, socio-economic and geographical differences mean one control measure can create wildly different impacts across countries — the goal is to create the most comprehensive, standardised database of existing research, to be made free and staffed by 1,100 volunteers working on cleaning, combining and updating the information.
For example, CSH Vienna has captured details of about 170 interventions across 52 countries, “ranging from small measures such as floor stickers that mark a two-metre separation to major, restrictive policies such as school closures.” Oxford’s ‘COVID-19 Government Response Tracker’ also monitors 13 interventions across 100 countries, creating a “stringency” index from 7 of the 13 to capture and compare the overall severity of approaches.
The Vienna team is also examining how some countries are starting to reopen and institute other measures, including the mandatory use of face masks, and comparing patterns across countries, and comparing patterns though methods such as “clustering countries by how early in their epidemics they began interventions and by the total number of restrictions introduced.”
Ultimately, researchers hope the database could help forecast how adding and removing interventions could impact the number of infections, with two potential, imperfect methods:
“One approach involves using a machine-learning technique called a recurrent neural network to learn from patterns in the data and make predictions. Researchers can learn how important a given intervention is by looking at how predictions shift when they remove information about it from the network.”
“Another technique involves regression analysis, which estimates the strength of the relationship between a particular measure, such as school closure, and a metric, such as R, across all countries. Using a regression technique such as Lasso, for example, researchers can determine which measures reduce R most.”
On the domestic data front, QUT researchers earlier this week launched a model to predict the trajectory of the virus and its mortality, available at covidwave.org, suggesting that Australia’s death rate has — at least for this cycle — peaked.
The model compares a) the ratio of known infections to recoveries with b) the number of reported daily deaths in each country;
- A Washington Post op-ed unpacks the fallout from US Senate Majority Leader Mitch McConnell suggesting that states should should declare bankruptcy rather than receive federal aid, while Politico reports that, amongst various other threats to state governors, Donald Trump has suggested federal bailouts could hinge on looking at “sanctuary city” policies protecting undocumented migrants from ICE.
- In an interview with Fox New, McConnell has also pledged not to support another relief bill unless it includes liability or litigation protections for businesses seeking to come back to work.
- Dick Grant, at The Interpreter, has examined New Zealand’s “marathon” journey to recovery within the context of a lack of international unity; examples range everywhere from major controversies around the WHO to less newsworthy stories like the Cairns Group, a coalition of 20 agricultural exporting countries, not making a peep since late January.
- German Foreign Minister Heiko Maas, in an interview with Der Spiegel, has discussed Germany rejecting the two extremes of China’s authoritarianism and America’s delayed, incoherent responses.
- Separately, Maas acknowledged apparent tension with Italy — Germany had, like many countries, implemented an early ban on exporting PPE — but promised not to abandon the country, and highlighted Germany’s subsequent efforts in accepting Italian patients and delivering protective clothing and ventilators to the country.
- According to Business Day, a new report from consultancy firm McKinsey has warned that lockdown measures imposed on various African countries are set to wipe out about a third of jobs across the continent.
- Finally, two weeks after Pakistan began rolling out US$900 million in emergency funds via poverty alleviation program Ehsaas, the World Economic Forum reports that the payments of around US$75 — “enough to provide subsistence nutrition for 4 month” — have already flown to 5.9 million people of a total goal of over 80 million.
Group of Eight’s ‘Roadmap to Recovery’ points to two possible ways forward
Yesterday, Australia’s Group of Eight universities released the ‘Roadmap to Recovery‘ report, an analysis from over 100 researchers — including mathematicians, virologists and philosophers — on the economic, societal and health trade-offs of “elimination” and “controlled adaptation” recovery strategies.
First, the report provides an ethical framework for decision-making — which considers the “floor” for values such as civil liberties, healthcare, economic and social equality, and collaboration — as well as an explanation of the rejected, third “herd immunity” strategy.
Option 1, the Elimination Strategy, would “lead to fewer total infections, hospitalisations and deaths, and better protection of vulnerable populations than any of the alternatives,” and while there are multiple variables and unknowns — the report, for example, posits a necessary “state by state elimination strategy” — the main costs/benefits are:
- Once achieved, elimination would allow for a faster relaxation in social distancing and other restrictions. To achieve this elimination, Australia would likely have to continue the lockdown in certain jurisdictions beyond mid-May, possibly for another 30 days.
- It necessitates waiting for new local cases to fall to zero, and then maintaining this for two incubation periods, i.e. about two weeks.
- It will require extensive testing and contact tracing, but modelling shows the extra testing should be achievable within our system with reasonable additional investment.
- It is hard to predict exactly when the cases of locally acquired disease might fall to zero, and whether current measures may need to be enhanced to achieve it. Hence the option entails greater uncertainty regarding the timing of relaxation of social-distancing measures.
- The number of asymptomatic carriers in Australia is not known and may pose a potential risk to this strategy. However, modelling shows that provided the number of asymptomatic cases is modest, the strategy should still be viable.
- If some jurisdictions have achieved elimination and others have not, it will require extended travel barriers within Australia.
- The risk of re-introduction of cases from abroad will remain, requiring strict international border control measures. Australia’s unique geography, strong border control and quarantine procedures would enable this.
- Once achieved, the psychological sense of safety and social well-being that would result from “elimination” of all local transmission would allow for a fuller and more vigorous recovery of the economy.
Conversely, the main immediate advantage of Option 2, Controlled Elimination, would be a phased lifting of restrictions as early as mid-May.
- The major long-term advantage of this approach is that it acknowledges the high likelihood of prolonged global circulation of this infection, and starts off by preparing Australians and the system to adapt to living with the ongoing risk of infections
- This approach provides a feasible strategy to safely manage current and future infections within the health system.
- The strategy accepts a slightly higher number of cases, hospitalisations, and deaths.
- This strategy will require extensive testing and contact tracing, but with a special emphasis on very tight feedback to those managing the public health response so that they can adjust the restrictions, in regions, or in segments of the population, as appropriate.
- However, there is always a risk that the number of infections could spike, and some of the spikes could lead to more extensive “surges” which may require resumption of some stricter social distancing, as has occurred in Singapore.
- What is hard to predict is how confident the public will feel when restrictions are lifted with new cases ongoing, therefore economic and social life may resume slower, even though the restrictions may be lifted earlier.
The final two points of each strategy — the psychological consequences between immediate and delayed spending — is perhaps the most surprising takeaway; as The Sydney Morning Herald led with yesterday in interviews with researchers, maintaining strict lockdowns until June could create a 50% greater economic bounce compared to May.
While the strategies obviously differ in length and severity of existing health measures, researchers emphasise that the choices are not binary, but part of a continuum that, either way, will require “some restrictions, large scale testing, tracing and isolation systems to keep us safe.”
“Neither of these two will allow for a return to life as we knew it over Christmas 2019. As with air travel after 9/11, some restrictions and impositions are here to stay. In both cases, enhanced hygiene, some measures of physical distancing and greater testing and tracing, will be the new norm.”
Finally, the report details three requirements for success in recovery “regardless of which path is taken” — early detection and supported isolation, travel and border restrictions, and public trust, transparency and civic engagement — and six imperatives in the implementation of recovery:
- The health of our healthcare system and its workers
- Preparing for relaxation of social distancing
- Mental health and wellbeing for all
- The care of Indigenous Australians
- Equity of access and outcomes in health support
- Clarity of communication
State wrap: Hygiene push as states prepare to ease restrictions
Ahead of an expected easing of lockdown measures over the next few months, both NSW and WA have announced new hygiene programs.
The NSW government announced a $250 million cleaners’ package aimed at both hygiene maintenance across public facilities, including state transport, schools and TAFE, and supporting an additional 3000 full-time cleaners by the end of June 2020.
Supplementary contracts available to businesses through the Emergency Cleaning Stimulus Prequalification Scheme will include:
- general cleaning in low-risk areas,
- enhanced cleaning for COVID-19 risk reduction,
- environment cleaning of facilities after a suspected COVID-19 diagnosis and cleaning auditing services.
Meanwhile, WA has launched mandatory COVID-19 hygiene training and assessment for the hospitality industry, with venues only able to reopen when restrictions are lifted and every employee has successfully passed assessment.
Draws on both state and federal health directions regarding COVID-19, the Hospitality & Tourism COVID-19 Hygiene Course is being delivered by the Australian Hotels Association, includes two tiers across staff and management, and covers the following elements:
- Understanding COVID-19 and venue restrictions,
- Reporting personal health issues,
- Maintaining personal and work environment hygiene practices specific to COVID-19,
- Reducing cross contamination through procedures specific to COVID-19, and
- Effective cleaning and sanitising practices specific to COVID-19.
In other state news
- Victoria has announced the $45 million International Student Emergency Relief Fund, which will provide relief payments of up to $1,100 to international students — enrolled at universities, TAFEs, private vocational education and training providers and English language colleges — who have lost wages and work due to the pandemic.
- In $3.35 million commitment, the South Australian government has launched ‘COVID-19 Support Grants’ of up to $10,000 for community organisations and non-profits.
- SA also committed to expanding ‘My Home Hospital‘ to both help free up hospital beds and enhance the experience of patients who can be better managed and supported in the community.
- The Queensland government has informed growers they will be able to maintain a seasonal workforce while meeting public health obligations, with any worker seeking to come to the state asked for written confirmation of a job in Queensland, where they had been for the previous two weeks, and where they planned to reside.