Nine months into the COVID-19 pandemic, what can be learnt from the Australian experience? Well, first of all, despite some significant glitches, we have done pretty well, and have been well served by our chief health officers and our political leaders, national and state, who have generally followed the scientific advice and resisted populist approaches or the temptation to score political points.
The result has been that there have been just over 27,500 cases and 900 deaths - a little shy of the almost certainly underreported number of deaths in a bad flu season.
This is orders of magnitude better than the situation in the USA, UK, Europe, South America, Russia, India, the Middle East and elsewhere. We are amongst a handful of countries in the world (New Zealand, Japan, Norway, Vietnam, Taiwan, China), whose health and political systems have best managed the pandemic.
But there have been serious glitches - an initial lack of personal protective equipment nationally for the first wave, tardiness in closing the borders to countries other than China, inadequate clarity over procedures for entry into Australia as in the Ruby Princess in NSW, standards for hotel quarantine in Victoria, inadequate contact tracing services in the initial stages of the second wave in Victoria, insufficient protection for some healthcare workers, and inadequate infection control in aged care facilities, particularly non-government facilities.
The point about the glitches is not so much to try to score political points, point fingers or try and attribute blame, but rather to learn from experience. It doesn't really matter one jot whether the Aged Care Minister knows the number of aged care deaths at a press conference, but it does matter whether there is a proper system in aged care facilities for COVID-19 infection control and what to do when a case is detected.
We were learning on the run and made a pretty good fist of it, but we can and should do better. Most of the issues highlighted above are systemic failures, rather than the fault of individuals. So what are the lessons?
Firstly, far too many people died in aged care facilities. Experience from around the world should have made it obvious that a large proportion of the deaths would occur there, but authorities are still struggling to mount appropriate responses. It is clear that the balance between profit and provision of skilled care has tipped seriously out of balance, and there is a pressing need for an overhaul of the regulations for service provision standards in aged care facilities.
It is also clear that while those responsible for aged care facilities should bear the responsibility for appropriate measures for the prevention of the introduction of the virus, the occurrence of a single infection in a facility is an acute emergency and infection control at that stage must become the responsibility of skilled health staff from the local health department. The lack of clear procedures for the prevention and management of COVID-19 in aged care facilities seems to have fallen between the cracks between the departments of health and aged care, and that is a matter which requires urgent and ongoing attention.
The Ruby Princess debacle highlighted the confusion between the multiple agencies involved - state and Commonwealth health departments and the Commonwealth Border Force and agriculture agencies. Hopefully, there are now clear lines of responsibility preventing any further recurrences.
But what should be learnt from the Victorian experience? It is presumably now evident that relatively untrained staff cannot be thrown in at the deep end for tasks of fundamental importance like quarantine. It doesn't really matter at this stage who said what in various phone conversations and emails in an effort to try to pin down the individual responsible for the decision to employ private security services, so long as the real lesson about the importance of training for quarantine (and other key services) has been learnt.
But the real lesson from Victoria is that despite their best efforts, states and territories have to be prepared for the eventuality that someday, somehow, the virus may leak into the community - and they must have world-class testing and contact-tracing ready to go without any delay. This was a costly lesson, and it is to be hoped that all other states and territories have learnt from the Victorian example.
It ought to be now beyond issue that there needs to be a national stockpile of essentials - personal protective equipment, essential medications and other essential supplies so we do not have to bid against the rest of the world in a crisis situation. There is also a strong argument for national manufacturing capacity for such items.
Finally, the number of health workers who became infected is unacceptably high. It is not clear whether this happened due to a lack of sufficient protective equipment, a lack of training, exposure to high viral loads or other factors, but this needs to be the subject of investigation and remedial action.
It is pleasing that Australia's most vulnerable population, Aboriginal and Torres Strait Island people, appear to have been spared the consequences of this pandemic that were feared. This was due in part to a lower likelihood of overseas travel for the first wave, and outstanding work by the National Aboriginal Community Controlled Health Organisation. But given the central importance of testing, it is quite extraordinary that, apart from NSW, the rate of testing for COVID-19 amongst Aboriginal and Torres Strait Island people is unknown. It remains a possibility that the apparently lower rates of COVID-19 in Indigenous people is due in part to lower rates of testing. It should not be beyond our wit to ensure the Indigenous identifier is on COVID-19 testing request forms, as it is on other health documents.
Australia has done remarkably well so far, but we are not out of the woods yet. A safe and effective vaccine is a hope but not a given. Elimination of the virus should be the aim, but is unlikely to be guaranteed in a country the size of Australia that needs to interact and trade with other parts of the world.
The Victorian experience, as well as that of many other countries, shows just how quickly things can get out of hand. It can be hoped that most of the lessons above have been learnt by now but, at a minimum, there is still further work that needs to be done for aged care, and the protection of health workers. Should a vaccine be developed, there are many challenges to be faced for a successful rollout, and ongoing questions about the degree to which it would entirely eliminate COVID-19 as a public health threat.
These challenges will require that same combination of political leadership and sound scientific advice that has served Australia so well.
- Professor Ian Ring, AO, is a professor of tropical health and medicine at James Cook University.