The thought of returning to strict coronavirus lockdowns is something most of us would rather not consider. But sadly, it’s the reality for those in Melbourne and Mitchell Shire, after a major outbreak ground the city to a halt in July. It’s made experts consider whether a shift from a ‘suppression’ to an ‘elimination’ strategy might be required to prevent further outbreaks from springing up across the country.
Australia’s coronavirus situation looked promising in May and early June. Daily infections remained low nationally and it seemed we would get to the other side of restrictions fairly soon, with fewer consequences than many other nations grappling with the pandemic. A small uptick in cases was brewing in Melbourne, but from the outside, it looked manageable, and ultimately, a small rise in cases was inevitable, given easing restrictions — a prophecy health experts predicted and politicians echoed.
As the rest of Australia opened up and considered lifting border restrictions in early July, Melbourne’s case tally soared, leading to a new set of lockdowns that will remain in place until at least mid-August.
It’s a solemn reminder that the threat of the virus is not yet over and the suppression strategy — keeping the infections low but not entirely eliminated — isn’t as successful now as it was at the start.
Given the potential contagiousness of the virus, a renewed discussion has been sparked over whether an elimination strategy — locking down until no new cases appear — might be the best way to get things re-opened with a lower risk for future outbreaks.
We spoke to an epidemiologist, a mental health expert and a economist to ask what that could look like, and whether the potential benefits could outweigh the serious risks.
What an elimination strategy in Australia could look like
Prime Minister Scott Morrison has maintained Australia is chasing a suppression strategy against coronavirus. That means placing restrictions on non-essential services in order to stop outbreaks, and then slowly lifting restrictions as the situation improves or remains steady.
It’s an attempt to delicately balance the needs of the economy while keeping the public health crisis under control. As the Melbourne outbreak showed, however, suppression doesn’t always work the way it’s intended. Instead, the elimination strategy is being touted as a tough approach that could remove the risk of outbreaks with more success.
Associate Professor Hassan Vally, an epidemiologist at La Trobe University, said eliminating COVID-19 would likely mean tougher restrictions than those currently imposed on Melbourne.
“The theory behind elimination is that you lock down harder for longer in order to completely eliminate any community transmission of the virus,” Professor Vally said to Lifehacker Australia over the phone.
“The way people seem to be talking about elimination is they envisage something a little stricter than what’s happening in Melbourne right now.”
Metropolitan Melbourne and Mitchell Shire are facing stage three ‘stay at home’ orders, meaning residents can only leave their homes for essential tasks, and hard borders have been set up stopping outside Victorians from entering the zone, or Melburnians leaving without an acceptable reason.
Rumours swirled earlier this week over a potential increase in restrictions — dubbed stage four — that could see even tougher rules on leaving residences. The state’s premier denied there were plans to enforce stricter measures, but didn’t completely rule out further changes if the situation continued to deteriorate.
“There’s no point having this conversation unless we suppress transmission first, which is what we’re trying to do.”
The suppression strategy was never designed to completely eliminate the virus in Australia, but in some states it’s seemingly done nearly that — cases haven’t been detected for weeks on end. The strategy posits that once restrictions are lifted, some cases will appear but further spread will be quelled by health authorities.
The situation in Victoria, Professor Vally said, was not part of anyone’s plan.
“What you’d hope is, you get transmission down low enough so that every time there’s even just a hint of an upsurge or there’s a cluster that’s detected, then the public health response can get onto it really quickly, and control things so that you don’t have to go back into lockdown,” Professor Vally said.
With the suppression strategy seemingly failing in Victoria, it’s led many to wonder if the elimination strategy could be a short-term pain for a long-term gain: if we can get through a few weeks or months of hard lockdowns and keep borders closed, the virus will be eliminated and future lockdowns won’t be necessary.
Professor Vally said this was an optimist’s take, and the unpredictability of coronavirus meant it required a more sober look.
“I do worry about the people that are talking about elimination, talking about it in a sense that if you do it, we can guarantee that you won’t have the virus,” Professor Vally said.
“No one can make those guarantees because it’s a very difficult thing to achieve elimination with this particular virus.”
Achieving elimination would also require everyone to abide by the rules. One asymptomatic person could break restrictions and spread the virus to others, perhaps without authorities even knowing. Given how tough the restrictions could hypothetically be and for long periods of time, it might be hard to get everyone to obey them.
“As we’ve seen with the other states, you can have a suppression strategy and then achieve elimination, or you can have a suppression strategy and then look at eliminating transmission, so there’s no point having this conversation unless we suppress transmission first, which is what we’re trying to do,” Professor Vally said.
Not only is elimination not a guaranteed strategy but it could come at a heavy cost to the mental health of many Australians.
Lockdowns have a detrimental effect on mental health
Generally speaking, lockdowns aren’t great for mental health. For most people, being locked in is a constant and daily reminder of the virus and its dire effects across the country and the globe. It’s also led to an increase in anxiety and depressive symptoms.
“I think one of the things contributing to this anxiety is the uncertainty, is feeling, ‘we just don’t really know why and we don’t know for how long.’”
It’s something Professor Jane Fisher, a mental health expert at Monash University, saw in her team’s survey of the impact of restrictions on Australians during the first month of lockdowns.
“There was a more than doubling, two-to-three times increase in quite moderate-to-severe depressive symptoms, and a similar increase in anxiety symptoms,” Professor Fisher told Lifehacker Australia.
“More than half the people said they were more irritable than usual. So these are all indicators of worse psychological functioning as a result of the impact of the restrictions.”
Professor Fisher and her team are conducting a second survey to track changes as we enter the seventh month of the virus being present in the population. She speculates, however, that while many Australians were able to find productive solutions during the first lockdown — think bread baking and extreme gardening — the second round of lockdowns will be far tougher to cope with.
“I think if we go into a more severe lockdown, the psychological consequences will be inevitably more severe, because people will begin to experience the real impact of loss of income but also loss of hope that they will ever get an income again, loss of capacity to act with agency to go and solve some of these difficulties,” Professor Fisher said.
“I think one of the things contributing to this anxiety is the uncertainty, is feeling, ‘we just don’t really know why and we don’t know for how long.’”
One way to attempt to ameliorate the severe impact, Professor Fisher said, was for policymakers to consult with the people experiencing the situation most severely. That way those creating the packages aiming to assist struggling Australians can understand the core issues and attempt to address them.
But an elimination strategy has another big impact — one which also ties in with mental health. It’ll be tough on the economy.
A flailing economy further damages future hopes
Part of the reason strict lockdowns affect mental health so much is their ability to make people feel a sense of hopelessness. Coupled with losing employment, which would likely happen for anyone not able to work from home, they could be catastrophic.
It’s Morrison’s primary excuse for resisting calls to consider an elimination strategy.
“You’re talking about hundreds of thousands of more people unemployed for a start, and other businesses closing and livelihoods destroyed, and [you’ve] got to put that up against what it achieves,” Morrison said in a press conference on 16 July.
“In Victoria, they had the hardest lockdowns and their’s is the state that has succumbed … the outbreak was initiated by a failure in hotel quarantine by returning Australians.
“You can’t mortgage off your economy for what would prove to be an illusory goal by the process.”
Dr Gennadi Kazakevitch, an economist with Monash Business School, said it was a tough call to make from an economic point of view. Continuing on with a suppression strategy would only be better in the long term if further lockdowns were prevented — something neither strategy can really guarantee.
“The experience of the state of Victoria alone tells us that the premature relaxing of constraints makes the second lockdown inevitable, and the task of repairing the economy much harder,” Dr Kazakevitch said to Lifehacker Australia over email.
The problem is that decisions have, and will continue to be made, without a full understanding of what the virus can do and as a result, uncertainty arises from that.
“In the long run, not choosing the elimination path will be costlier to the economy and society, than a longer and harder lockdown for now.”
Because of that fact, it’s hard to say whether elimination will be the better path over our current suppression focus.
“We don’t know yet what kind of humanity we will be if we continue getting infected for another year or more, until a vaccine becomes widely available. We don’t know yet, what medium and long-term consequences of even the mild cases of the illness will be in humans of different ages, how it will affect physical and mental capacity, fertility, and life expectancy, and as the result — overall long-term productivity of the society and pressure on the health system,” Dr Kazakevitch said.
“It may well happen that, in the long run, not choosing the elimination path will be costlier to the economy and society, than a longer and harder lockdown for now.”
An elimination strategy may not be good news for anyone, but if Melbourne-like situations pop up in other parts of the country, it might be one we’ll have to consider.
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