Are lockdowns answer every time there is a COVID-19 outbreak?

Professor Brendan Crabb AC and Professor Mike Toole AM address how we can reduce the likelihood and frequency of the need for lockdowns in this commentary for Nine Media.

Australia’s COVID-19 policy of zero community transmission until it’s safe to be otherwise is the right one. It has delivered a healthier, richer and socially freer society – yes, better civil society – than almost any country on earth.

But as Victoria emerges from successfully suppressing the latest community outbreak with a state-wide shutdown and all its collateral damage, it is understandable that there is frantic renewed interest in all things ‘lockdown’; are they really necessary, how could we reduce their frequency and impact and, the big one, when will we not need them at all?

Everybody hates lockdowns, but they are an essential part of the pandemic-response toolkit. They have been used in almost every developed country in the world. Every jurisdiction in Australia uses them although they differ in their approaches to geography, timing and degree of restriction.

Much has been said about Victoria’s four lockdowns, as though the state has an addiction to them. But, notwithstanding Victoria’s dreadful second wave, it is not really a lockdown outlier.

In most cases it is the nature of the specific outbreak, which differs each time, that determines the nature of the lockdown. In Australia, and Victoria is no exception, the first consideration is to initially try and control an outbreak using a combination of intensive test, trace and isolate (TTI) , mask wearing, QR code check-ins, ventilation where people gather indoors and physical distancing. Victoria has handled a number of outbreaks in that way without the need for lockdown.

But authorities have to make a call as to when certain factors coalesce to be especially concerning; where there is a reasonable chance that things might get out of control. In the latest instance in Victoria, a combination of the extended time between ‘escape’ and community detection, the large number of potential exposure sites and a new more transmissible variant was concern enough to pull the lockdown trigger.

And, with zero community cases detected on the day of writing, lockdown – together with an extraordinary TTI effort – has once again delivered a spectacular outcome within two weeks. Many individuals and businesses – and the nation as a whole – will reap the extraordinary benefits of such action.

Of course, this tremendous gain comes with much pain; many individuals suffer significantly more than others, and some sectors, especially small businesses, are hammered by lockdowns. So, if lockdowns have to occasionally happen, what have we learned in the last 18 months or so that could minimise the damage?

How do we reduce the pain associated with lockdown? The first and most important thing is to commit to wanting as little lockdown as possible. The irony is that to achieve that you must have a willingness to use circuit-breaking lockdowns; in the context of aiming for ‘zero’ and going hard early on in an outbreak.

Countries like Australia which have done that have had vastly less lockdown overall than countries that, paradoxically, rejected the notion of lockdown wanting instead to stay ‘open for business’ – see the UK and Italy for example.

Prior to last Christmas, shops and pubs were open in the UK and crowds of maskless shoppers mingled freely. At the time, the country was reporting an average of 14,000 cases a day. This laxity led to Britain’s most severe wave and to a five month lockdown from which the country is only just now emerging.

From the perspective of lockdown alone, those countries wanting to remain ‘open’ have been more closed, and those – like Australia and Victoria – willing to pay an upfront price have been vastly more ‘open’ in the longer term.

A key related mitigation is to keep lockdown as short as possible; preferably under 2 weeks. And the only way to keep lockdowns short is to use them very early on in the outbreak when there are very few cases in the community, before there is great certainty about whether or not the outbreak will go out of control. This is a tricky wisdom-of-Solomon moment.

With all we now know, we simply must be better at anticipating and preventing collateral damage. For example, by providing certainty to small businesses ahead of lockdowns and ensuring they are compensated adequately. Also, there needs to be more explicit planning to reduce the impact of lockdowns on the mental health of children and their parents.

Going forward, we need to consider smarter mitigation measures in order to try and keep schools open. That would require addressing ventilation in schools, vaccinating teachers, testing regimes and mandating masks in high schools.

And the big one; when will we be done with lockdowns? We will leave for another day discussion around the specific criteria Australia might set to decide to allow COVID-19 to circulate in the community.

Suffice to say vaccine coverage, variants of concern and the scale of the overseas epidemic will all be crucial factors in that decision; and that we are likely to be 6 or more months away from seriously considering it.

Leading up to that time at least, and even perhaps after – as a study by the Burnet Institute released today shows – public health measures will be required for some time yet. That means further lockdowns remain in the mix.

Improving hotel quarantine, quarantine in general and community transmission more generally, especially through more actively mitigating airborne transmission, will help reduce the likelihood and frequency of the need for lockdowns.

But if they do need to happen again, we must use all the lessons of our 18 months of experience to mitigate their impact. That means urgent and bold policy response in COVID peacetime; there is no space to do it when there’s an invasion underway.

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