The press has been spattered in recent weeks with hindsight wisdom about Australia’s – and particularly Victoria’s – handling of the pre-vaccine pandemic. The relatively easy time we are having with COVID now and the low numbers of people being hospitalised with COVID are being used to argue that earlier restrictions were unnecessary but it is crucial to remember what the world looked like when those decisions were made.
Epidemics and pandemics are as much a matter of response and luck as nature. In an era of constant air travel, diseases can seed around the world long before they have been identified around their source. The original SARS incipient pandemic was stopped in its tracks because it was less easily spread, and manifested symptoms at the same time as becoming contagious. This allowed hotspots around the world to be scotched before they could explode. Ebola, while having a 50% mortality rate, faces similar constraints on its spread. Swine flu was similarly contagious to early variants of COVID-19, but turned out to be much milder.
Specialists knew that another global pandemic was due for some time. Each year or so in the decade/s leading up to 2020, another contender would emerge, only to avoid the characteristics that would drive the world to a halt.
COVID-19 provided a number of challenges. One is that it spread invisibly before cases were detected, contagious people often remaining asymptomatic or apparently suffering a mere cold. Initially the transmission mechanism was not clear. Could it be spread by fomites on surfaces or through the air? The science ultimately established that the former had little impact and the latter is key but knowledge about the coronavirus that caused SARS in 2002 – 2004 meant initial focus on fomites as the likely means of spread of the new coronavirus in 2020.
In the ocean of ignorance that surrounds a virus new – or novel – to human populations, it takes time to work out the strategies to limiting spread, preventing contraction, and treating.
The great fortune for limiting the duration of the worst impact of this pandemic was that vaccine science had some technologies ready to deploy. Coronaviruses are a common candidate for possible pandemics, so traditional technology could relatively easily transition from one strain to this new kind. The newest technology – MRNA – functions like a gin distillery. The standard “white spirit” of the base is infused with the “botanicals” of the particular virus as required. Worldwide scientific and bureaucratic convergence allowed honing, testing and production to take a fraction of the time without the usual lags produced by insufficient funds, competitive secrecy and official inertia. Without this readiness and removal of unnecessary roadblocks, the pandemic would have crippled us years longer.
As COVID emerged around the world, Australians came to see what it could do. The initial jetsetter cases were replaced by stories about people living in close confinement and often with the health issues deriving from poverty and living within a racist system.
Photos of refrigerated trucks on the streets of New York to take the overflow of corpses were matched with recordings of a city ringing with the doppler clash of competing sirens. Other photographs showed mass graves being dug in parkland to take the piling bodies that morgues couldn’t sustain. In Italy, churches filled with coffins and obituary notices took up multiple pages in newspapers in the country’s northeast.
And over all those images, we saw desperate medical workers exhausted and shattered by unending shifts of misery watching people destroyed by a virus that could be terrible; one that is exacerbated by the body’s own flailing immune system in a cytokine storm, attacking every organ including the skin.
India showed us most brutally what could happen if COVID was allowed to run without check. We read chilling stories of even the wealthy and powerful tweeting in search of oxygen supplies that had become impossible to find. Others that recounted the people driving from hospital to hospital as the mother of their small children suffocated in her own lungs, ultimately dying in a hospital carpark because every hospital was swamped. The sky was thick with the smoke of mass burnings. People became desperate within their homes, unable to work or afford food and medicine, as the brutal crackdown that followed the collapse of the system harshly worked to limit the duration of the nightmare.
The crisis of COVID was rarely the individual case. This is what made it so hard to convey to the inattentive the need for strong action. The crisis of COVID rests in percentages. For every 1,000 additional cases the greater the number who would need ambulances, hospitals and long-term intensive care.
Leading into the pandemic, Sydney had retained a stronger public health framework and emergency bed number compared to Victoria. Victoria’s had been savaged during the Kennett years and never been rebuilt, starting the pandemic with fewer than 20% of NSW’s public health officers. All the other states had even less capacity to cope. This fact allowed NSW more latitude in dealing with the pandemic than the other states.
Leading COVID specialists and epidemiologists have also speculated about the climate factors that allowed potential outbreaks in NSW to peter out. The temperature in NSW, for instance, allows many more months of open-door trading, ventilating businesses, in a way that is impossible in the cold of Melbourne and the extreme heat of the north of the country. When the much more contagious omicron strains emerged, NSW’s luck died too along with many citizens.
The Andrews’ government in Victoria was given a weekend to pick up most of the nation’s quarantine after the federal government threw NSW into turmoil over the Ruby Princess and abandoned its own responsibility to manage quarantine (seeing it as an unpopular aspect of pandemic management). Many aspects of the system did not function as well as we would hope and the acquisition of knowledge about what dangers lay in various systems, such as hotel quarantine, was painful.
Premier Daniel Andrews saw the reports coming from the federal government’s chaotic private aged “care” system. There is no doubt he heard the accounts that emerged from first responders who have PTSD from the literal nightmare scenes they saw in some of those homes.
Lockdowns come in two forms, pre-emptive and reactive. Pre-emptive ones can come to seem pointless because they prevent the catastrophes that might have occurred. Reactive ones are of limited use, desperately trying to protect the overwhelmed systems crashing around them. In Britain, buses had to be converted into 4-case ambulances. People died who would not have in less chaotic times, and not just of COVID. Around the world, an estimated 10 million children have lost a parent or caregiver. Millions more are being ground down by long COVID symptoms.
In the vaccine era, we see a reduction in the risk of dying by about 90%. For the young and healthy, that means there will be very few deaths. But for those older and sicker people whose baseline risk was high, we continue to see high numbers of deaths with the current unchecked spread of COVID. These deaths are tragic, and the nation’s failure to continue easy steps such as masking in public may well prove to herald many more deaths. Variants continue to emerge, and we do not know what the next will bring.
As things stand, we may well face a desperate shortage of hospital beds as a result of staff shortages in years to come. We have proven ourselves demanding and ungrateful to the people who have battled to save our relatives in miserable work conditions.
In the meantime, it would be justice to remember all this and acknowledge that Victoria, and all the non-NSW states, made decisions based on the nightmare potential for system collapse and miserable death tolls before the vaccine era.
This was first published in Pearls and Irritations
This piece was written in cooperation with a leading Victorian Infectious Diseases specialist who continues to work with COVID.
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