COVID-19 gap widens between Australia and rest of world

By Professor Michael Toole AM

This article was first published in The Age and Sydney Morning Herald.

In the global fight against COVID-19, an ever-widening gap has emerged between our region and the rest of the world. While East Asia and the Pacific have been relatively successful in containing the disease, the infection and fatality numbers for Europe and the United States in particular are shocking. The graphs plotting these cases are startling for an epidemiologist like me.

More than 210,000 people have lost their lives to COVID-19 across 31 European countries, including Britain, and a further 6.2 million people have been infected.

During the past week, 20 European countries reported all-time daily record numbers. Some countries, such as the Czech Republic, Poland and Georgia, are now reporting daily case numbers that are 25 to 30 times higher than during their first waves.

This week, Ireland, France, Germany and the Netherlands all imposed national lockdowns and many other countries are considering doing so. Night curfews have been imposed in Brussels, Paris, Prague, Athens and Rome.

The US is experiencing a third surge, reporting more than 500,000 new cases in the past week, and states and cities have resorted to stricter new measures to contain the virus that is raging across the country, especially through the American Midwest heartland.

With a population of 12.6 million, the state of Illinois has reported more than 30,000 new cases in the past week – more than Australia has recorded since January. And hospitalisations and deaths are also rising.

Countries in South Asia, Latin America, North Africa and the Middle East are also battling out-of-control outbreaks and massive second waves of COVID-19.

Sub-Saharan Africa has been largely spared the worst effects of the pandemic, although South Africa continues to report more than 1,500 cases a day. Yet in East and South-East Asia and the Pacific, the situation is starkly different. Ten Pacific island countries, including Vanuatu and Tonga, have not reported a single case of COVID-19.

China, Taiwan, Thailand, Laos, Cambodia and East Timor emerged from their first wave months ago and now have almost no community transmission.

South Korea, Singapore, Hong Kong, Vietnam and Japan have navigated through their second waves to varying degrees.

Despite clusters of cases in August, New Zealand prevented a second wave and Papua New Guinea has reported only 10 cases in the past two weeks.

Myanmar, Malaysia, Indonesia and the Philippines are a different story. Malaysia’s and Indonesia’s numbers show no signs of abatement, but the Philippines and Myanmar are showing steady improvement.

What can we learn from this wildly varied pattern of coronavirus spread? As far as Europe, the Americas and the Middle East are concerned: not very much, except that premature easing of restrictions will almost always lead to a resurgence in cases.

Of the 120 countries around the world that have experienced clear second waves or late first waves,only six have emerged from them, to varying degrees – Australia, South Korea, Japan, Hong Kong, Vietnam and Singapore.

And only the Australian state of Victoria imposed a complete lockdown to get there. None of these Asian countries had a national lockdown, except for a two-week lockdown in Vietnam.

Excellent testing and tracing systems allowed them to avoid this fate. South Korea had a decentralised system whereby local government areas conducted drive-in testing and contact tracing that included care and support for those who had challenges in self-isolating. South Korea also pioneered the use of registering QR codes at retail and hospitality venues.

Japan practised “upstream” contact tracing whereby they looked for people who had been close to cases before as well as after they had symptoms. This is now routine in Victoria and NSW. Community engagement, involvement, trust and support are also essential features of effective case finding.

Each of these countries also had a high level of adherence to public health directives and a culture of wearing masks. Face coverings are a highly effective, low-cost measure that does not disrupt the economy. And it’s time for Sydney to mandate masks on public transport.

As we go into summer, we need to continue to practise proper hygiene and social distancing. But as an island nation, how will we ever engage with the world again?

A one-way travel bubble is in place with New Zealand and that could be cautiously extended two-way to other Pacific and Asian countries with low transmission like Vanuatu, Taiwan, South Korea, Thailand, Vietnam, Singapore and Hong Kong.

Until there is an effective and widely adopted vaccine, or highly effective prophylactic and/or therapeutic drugs to be used most likely with point-of-care diagnostic tests, we probably can’t count on travel beyond the Asia-Pacific region.

There is hope on the vaccine front, given the massive scientific and financial investment. However, even if an effective vaccine becomes available in the short term, there are major logistical challenges to its distribution widely and equitably.

For example, the Pfizer candidate vaccine needs to be stored at minus 80 degrees and requires two doses. Even in a resource-rich country like Australia, that will pose huge challenges. It may prove to be a major impediment in many low- and middle-income countries.

For Australia, the lesson of what’s happening in Europe – and of Victoria’s second wave – is that we are just one bad decision, one slice of bad luck, away from a new COVID-19 bushfire.

We must not be complacent or self-congratulatory. Leadership, science and unity got us and our Asia-Pacific neighbours to this place. And it’s these things that stand between a “zero COVID” life and the devastation of a new wave.

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