The coronavirus pandemic is a fast-moving crisis, but there are many opportunities for long-term investments that will pay off over its duration. The Australian government should immediately create a body to identify, lead, fund and drive solutions to critical capacity and capability shortfalls.
Australia’s deputy chief medical officer says that between 20% and 60% of us could wind up infected. With Covid-19’s estimated 1% fatality rate, that would mean 50,000 to 150,000 deaths. The Imperial College London’s coronavirus response team predicts that in a business-as-normal situation Covid-19 would infect roughly 80% of the populations of the UK and the US. That would translate into 510,000 deaths in Britain and 2.2 million in America.
And 1% is probably optimistic. In countries in which Covid-19 has escalated beyond control, fatality rates appear to be many times higher as health systems are overwhelmed, and nurses and doctors are left with making the impossible decisions on who lives and who dies.
Around 160,000 Australians die from a variety of causes each year. We have about 95,000 hospital beds and just over 2,200 intensive care beds. Many people with Covid-19 require critical care to survive. Based on the Imperial College assumptions, combined with Australian Bureau of Statistics data, a 20% infection rate—even if half of infected people are asymptomatic—would mean almost 180,000 Australians would need to be hospitalised, 60,000 of whom would require intensive care.
In the absence of public health measures, the virus would spread rapidly, might peak in months and could be resolved by the end of the year. In this scenario, most people requiring intensive care would not get it and so fatality rates would probably be much higher. And we’d lose all capacity to deal with other health issues.
Current public health measures—including social distancing, isolation, quarantine and travel restrictions—are designed to slow the spread of the virus, or ‘flatten the curve’. These measures reduce both the total number of people affected by Covid-19 and the number requiring hospital treatment at any one time. These severe restrictions give our health system the best chance of coping with the inevitable increase in demand.
Paradoxically, the more successful our mitigation measures are, the longer they need to remain in place. They delay infections, but given the worldwide spread of the virus we can no longer hope to eradicate it. Covid-19 is now circulating globally and will inevitably be reintroduced to Australia. Without widespread immunity in the population, any relaxation of bans and restrictions could result in the resumption of the rapid outbreak that we are working to avoid.
There are only three scenarios where life returns to normal.
The first and worst option is that the virus burns through Australians and we develop a ‘herd immunity’ because so many of us have become infected. Once the virus has run that course, we could return to life as normal. Two underlying assumptions in this scenario are that people develop immunity and that it’s politically and socially acceptable for hundreds of thousands to die unnecessarily without modern medical care. It seems that this course of action was originally considered in the UK but has since been roundly rejected. Now the restrictions imposed in the UK are tighter than Australia’s.
The second scenario is that we maintain our extensive control measures, and perhaps institute even more stringent ones, until a vaccine is developed. Scientists are optimistic and many efforts are underway, but it will take time to ensure a vaccine is safe and effective and to produce millions to billions of doses to deal with a global crisis. Even a very rapid deployment of vaccine will take 12 to 18 months.
The third and most optimistic scenario is that drugs are developed or discovered that treat Covid-19 effectively. Some existing treatments hold promise and might be available faster than a vaccine, but they’ll have to be proven to be safe and effective and able to be produced in the huge numbers of doses required. We’ll be competing with the rest of the world to secure supplies, and that may take months.
In this war of attrition, the government has the opportunity to start on some long-term initiatives that will reap benefits in the months (or even years) to come.
It should focus investment on three key areas: improving detection of the virus, increasing the capacity of our healthcare system, and maximising the productivity of our recovered workforce.
We should expand our testing and contact-tracing capabilities by orders of magnitude.
Although Australia is already performing well internationally on testing for Covid-19 per capita, our capacity is still constrained. Investment to secure a self-sufficient tenfold increase in capacity would allow testing to extend much more broadly into the community to detect small pockets of infection before they become large outbreaks. Such an ambitious target may need extensive funding, in addition to the investment in the ‘smarter and better’ testing initiatives already underway, to develop or bolster local supply chains, convert university and research labs into testing centres, and train new staff.
In addition, we should invest in technology and processes to more effectively trace contacts. In the aftermath of a 2015 outbreak of MERS (Middle East respiratory syndrome, an even more lethal coronavirus), South Korea enacted legislation to allow warrantless access to private data such as credit card histories, surveillance footage and smartphone data from confirmed and potential patients. An opt-in process enabling infected individuals to voluntarily provide permission to use their information for contact tracing could make the identification of close contacts far more effective. This technology could also help jog the memories of patients about exactly what they’d done and where they’d been in previous days or weeks. Banks, telecommunication companies and perhaps a body such as Data61 in CSIRO would need to be involved. Such a scheme would be unlikely to yield any immediate benefits but it could bring considerable firepower in a longer war of attrition.
We should also expand our healthcare capacity.
Critical healthcare is a highly skilled job, but there may well be opportunities to retrain or reskill medical professionals to bolster the ranks of frontline hospital staff. As this will be a long war, fast-track options become feasible and worthwhile. Current cohorts of students should be accelerated through their studies and employed as quickly as possible.
People could also be trained to fulfil basic healthcare jobs and free highly trained staff to focus on life-saving activities. Already, laid-off airline workers in Sweden are being trained to perform straightforward roles in healthcare.
Shortages of medical equipment should be tackled. Ventilators to help us breathe when we are critically ill will be in short supply, and since these shortages will be global, it’s unlikely that we’ll be able to import as many as we’d like. We should harness our manufacturing base, engineering sector and university talent to build our own. As my colleague Michael Shoebridge has noted, standards and regulations may need to be relaxed, but a quick-build ventilator may be better than no ventilator at all.
As the pandemic continues to unfold, we need to make the best use of those who have suffered through Covid-19 and recovered.
These workers are very likely to be immune, but may not currently be employed in the most useful roles. Being able to work without worrying about infection would be an asset in many frontline healthcare roles and other critical industries. The longer this epidemic continues, the greater the benefit this recovered workforce will provide.
Many more long-term initiatives will be worthwhile, but it’s likely that the pace at which this crisis is developing is overwhelming decision-makers’ capacity to focus on long-term solutions. The government should immediately create a Covid-19 funding body with a mandate to identify critical capacity and capability shortfalls and to encourage, lead and drive solutions.
The time to start is now.