The Art of War and the Battle of COVID-19

Apologies in advance for such a long post but this is something I wanted to get off my chest.

The government/s (i.e. National Cabinet but mostly Federal) handling of the coronavirus in my opinion has comprehensively failed to provide a clear articulation of the strategy underpinning what are unprecedented restrictions on people and commerce, and hence how these restrictive measures will actually execute the strategy and see Australia through.

This failure will likely have long-term adverse political consequences (wiping out short-term gains, e.g. Rudd during the GFC), regardless of the success of Australia’s response, and perhaps more so (ironically) if Australia fares well. People have a habit of forgetting near misses but quickly resent the consequences (i.e. $320b spend that will need to be paid back) that avoiding the miss entails. They also get accustomed to the handouts that will eventually have to come to an end. Expect a special case exemption from every self serving interest group in the nation.

The coronavirus crisis is compared daily by politicians and the media alike as akin to a state of war. If that is the case the maxim, “every battle is won before it is fought” seems to have been the first casualty in the battle of COVID-19. What does victory look like? How will it be achieved? What evidence is there it will work? What is the exit strategy? How long will the battle last? What is the cost? What are the risks? These are fundamental questions the government has been largely silent on.

That silence makes evaluation of policy decisions very difficult, reducing accountability which will eventually diminish public confidence and ultimately compliance, particularly as people start to resent being cooped up in house arrest with no end in sight, the restrictions becoming more onerous (and dare one say absurd) and money running out. That is a recipe for social disaster I believe the government/s have under-estimated.

The Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) (the National Plan) is a plan without a strategy. Written by bureaucrats it is long on platitudes and short on substance, and despite one such platitude being “evidence-based decision-making” there is little in the plan that defines key metrics (measures and thresholds) and hence triggers for specific measures or events.

The 50 page (annoyingly tautological) plan manages barely more than half a page to “ensuring a proportional response . . . appropriate to the level of risk” but doesn’t define what proportionality actually means or how to measure it.

It does, however, devote 8 pages to political communications, and another 8 pages on governance explaining how the convoluted mess of duplication and blurred responsibilities that characterises the Australian health system should ideally be managed and explained in a time of crisis.

This is to say, on a conservative estimate, the National Plan of 50 pages, minus the table of contents and executive summary, subtracting the bleeding obvious (i.e. context), and accounting for duplication, is reduced to no more than 25 pages of actual content, of which 16 pages (i.e. 64%) relates to navigating the quagmire of bureaucracy and how to manage the political spin.

To the extent the National Plan reveals anything beyond the obvious (i.e. a reworked seasonal flu plan) it is probably section 5.1.1.2 which makes the telling admission that:

It is unlikely that a vaccine will be available during the course of a novel coronavirus pandemic, unless the pandemic is long lasting and vaccine development is extraordinarily fast.

This admission throws the entire government/s strategy into chaos because it assumes the same strategy as applied in the SARS (2002) epidemic where the transmission rate was comparatively low, can be applied to the COVID-19 pandemic where the transmission rate is seemingly high. Incredibly, the National Plan rates the SARS (2002) virus higher than COVID-19 both for transmission and clinical severity despite SARS (2002) resulting in just 8,096 cases and 774 deaths globally between 2002 and 2004, whereas at the time of writing COVID-19 has resulted in over 1M cases and 53k deaths (see here) in just 3 months. This is to say that the government/s plan is premised on the wrong precedent and an incorrect/faulty comparative analysis, and hence is worthless, incompetent, or alternatively downright dishonest.

Talk of lockdowns lasting for 6 months as Morrison routinely claims (as he is conditioning Australians to believe, albeit hiding behind the caveat of “at least”, but nonetheless reinforced by Treasury designs and costing of welfare measures) are consequently baseless going off his own expert derived plan. Which also means that the fiscal measures to date are at least one third of what they will end up, although in reality you will need to apply a multiplier to the spend because the longer this lasts the fewer businesses will survive and the greater the job losses will be, and hence the greater the government welfare and debt will ultimately end up.

The logic deficit in the current government/s response is that we can somehow minimise the health impact of the virus by way of a lockdown, in the absence of a vaccine which on the best estimate is 18 months away (if at all), but somehow we can magically reduce that lockdown by a third of the time. That is illogical and contrary to its own expert advice.

This suggests one of two things, either:

i. the Government believes the risk to Australia is likely low (having put in place strong (albeit a tad slow) border protections, and notwithstanding the major stuff up in terms of the Ruby Princess), or;

ii. the Government believes the risk to Australia is high, and hence the health system is in imminent threat of collapse leading to politically unacceptable deaths and consequent media excoriation.

Either way, Morrison (and the National Cabinet) is either lying about the severity, or lying about the transmission and timeframes, but whichever you look at it, he and Frydenberg are lying by omission about the budgetary and economic severity of their measures.

Taking the National Plan at face value that a vaccine is not an option (noting there was, and remains no vaccine for SARS (2002)), this leaves only herd immunity as a viable option. However, to avoid imminent collapse of the health system herd immunity must be cultivated over the long-term, thereby implying a rolling series of lockdowns whereby restrictions are relaxed, the virus re-emerges, case numbers rise again, and another prohibitive lockdown will be required to save the health system. At best, in the intervening periods we can invest more in the health system to help it cope and lessen the severity of each subsequent lockdown. Where is the government admission of such a plan?

What this really means is that government/s definition of victory is the preservation of the health system and not the eradication of the virus, which cannot happen without a vaccine or herd immunity, which in the case of the latter, the current self-isolation measures work against.

This raises a number of important questions: how many infections can the nation (broken down by state) withstand? What percentage of infected cases do they estimate will require hospitalisation? What is the estimated median duration of hospital stay? What percentage will involve intensive care? How many deaths attributed to COVID-19 are estimated to be sadly unpreventable in any event (i.e. likely to have died from pre-existing conditions or by contracting seasonal flu)? What is the estimate about clinical severity of the virus? What is the estimate of the transmission rate? In answer to all of the above questions what evidence and assumptions are they based on? These answers are important because they all feed into how severe the government/s response should or should not be.

We also need metrics to assess the various measures. At present Australia is faring pretty well. We have relatively low rate of infections and fatalities per million head of population, the number of hospitalisations is low, those requiring intensive care low, and the percentage recovered high. That should not be a cause of complacency as the exponential transmission rate means things can escalate very quickly as indeed they already have (for example, on March 10 the total number of cases was just 91 but as of time of writing was about 5,750, meaning hospitalisations will rise significantly very soon). That said, the number of active cases appears to be levelling off, new cases starting to fall, and recoveries doing well, which begs the question what has most contributed to that outcome?

Given the lag time associated with the incubation period (up to 14 days, median 5-6 days) and the fact that just over 60% of transmissions are from abroad (see here) it would seem that travel bans and mandatory isolation of inbound travellers has done the heavy lifting. The impact of more recent draconian isolation (stay at home) measures is therefore unlikely to be reflected in the current data. This means such measures will have only minor and diminishing benefits in terms of decreasing the load on the public health system, but will come at exceptionally high costs, including the delay of herd immunity.

Without metrics that can assess individual measures we run the very real risk of enacting the very disproportionate response that the National Plan warns against (albeit as a vague target, short of a strategic objective, and presumably less than a key factor),  chasing as we seemingly are a logarithmic tail of diminishing returns at very high cost (e.g. Dan Andrew’s ludicrous ban on fishing coming at a price of 2,000 plus jobs).

The National Plan is clear as mud on proportionate response and our political leaders (state and federal) are seemingly in competition for a one-up-manship prize of who can lead most by extending the range of illiberal restrictions on liberty the furthest without recourse to medical or scientific facts.

The government/s need to come clean about what is the strategy and what are the key metrics that enable us to measure success and validate or falsify that strategy, and hence potentially weigh up alternative strategies and measures commensurate with what should be a guiding principle being a proportionate resposne. This means opening up to public scrutiny the logic, models, data, assumptions and other important information that currently underpins current government policy. At the moment there is a very concerning lack of transparency around what is arguably the most repressive and illiberal set of policies in Australian history.

This is critically important because parliamentary scrutiny has been shamelessly scuppered (it survived two world wars but cannot withstand the Wuhan Flu), authoritarian (and unconstitutional) powers activated, government reduced to a largely unaccountable inner circle of unelected bureaucrats and experts operating in silos and immune (no pun intended) from the economic consequences of their decisions, with the Left media cheering on every draconian retreat from freedom when not revelling in morbid sensationalism.

In other words, what we are witnessing is a disturbing low point of political accountability at a time of unprecedented authoritarian decision-making, taking place in an echo chamber of elitist groupthink. It is far from clear that this is leading to better policies (just like the Bay of Pigs fiasco). The Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) is a plan in search of a strategy, using tactics to fight the last war (SARS (2002)), with a narrow conception of “health victory” being an at any price mentality.

The bottom line is there is a disconnect between the 6 month timeframe repeatedly spelled out by Morrison with the plan’s admission that a vaccine will not be developed during the crisis (i.e. at least 18 months). In effect, the National Cabinet has no strategy for actually ending the crisis and because there is no exit strategy, the crisis is in effect perpetual, resulting in a potentially endless cycle of lockdowns . Being perpetual, the current response is manifestly uneconomic and consequently not viable suggesting the problem of a better national response is purely politic.

The absence of a grand strategy from day one means that the battle of COVID-19 was lost before it was fought (on economic terms and hence on subsequent health outcomes, i.e. bankruptcy, family breakdown, suicides, mental health and so on). To the extent the Morrison Government or National Cabinet can snatch victory from the jaws of defeat entirely depends on whether it is willing to step outside the echo chamber and start engaging and leveraging off the talents of the broader Australian community, opening up National Cabinet decision making to proper scrutiny, outside expertise, and hence the possibility of a better way. That is the strength of democracy in action, unlike the rush to totalitarianism which led to the pandemic in the first place.

Once again, apologies for the length of this post.

 

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51 Responses to The Art of War and the Battle of COVID-19

  1. sfw

    Well said, I’ve been asking what is the long game and nobody knows. Everyone seems to understand that the response has been illogical and haphazard but no one seems to care. I don’t get it.

  2. Tel

    The government/s (i.e. National Cabinet but mostly Federal) handling of the coronavirus in my opinion has comprehensively failed to provide a clear articulation of the strategy underpinning what are unprecedented restrictions …

    That’s OK, they also failed to articulate what the restrictions are, what goes on at “National Cabinet” meetings … and WHO are our new overlords anyway?

  3. Mater

    Good post. Hits all the pertinent points.

    “Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat.” – Sun Tzu

  4. Tim Neilson

    No apologies necessary.

    Can we confine ScoMo, Prince JoFry, the Hunchback of Spring Street, Health Hazzard et hoc generis and get this recorded and played to them on permanent loop till they comprehend it?

    Or would it be quicker to wait for the vaccine?

  5. Professor Fred Lenin

    We have third rate career politicians and complacent time serving public servants suddenly confronted by a Real Crisis not the contrived climate change ,racist ,homphobic islamophobic ,mysogeny nonsense they are used to ,like all third raters they respond with panic , they can see the gravy train they are on fading before their eyes ,so they play it by ear not thinking at all about consequences only about their own survival .
    people will work out that there is no alternative between liberal and labor , birds of a feather ,an ideal time for the formation of a real populist nationalist Australian party of committed patriots to drain the swamp and nake Australia great again .

  6. Chris M

    The absence of a grand strategy from day one means that the battle of COVID-19 was lost before it was fought

    I agree about the absence of strategy or clear end game – its all open ended. However at this point there is a possibility they may have a surprise and unplanned win. Rather than it slowly wafting through society if the daily cases keep dropping as they have been and foreign visitors remain blocked it’s possible this could be crushed. Same in NZ. This would be a tremendous blessing to this country especially prior to winter.

    This Wuhan disease is a real mystery; if one asymptomatic person can infect dozens it would seem unstoppable, yet here we are with hospitals quieter than usual where I am thank God.

  7. Some History

    Health Hazzard

    LOL

  8. Bar Beach Swimmer

    No apologies needed.
    Great post.

  9. Leo G

    Some perspective: Each year around the world there are about 4 million serious or critical cases of influenza (mainly Influenza-A) and about a half-million deaths. The present coronavirus outbreak to date has involved about 250,000 serious or critical cases and 70,000 deaths.
    The COVID-19 outbreak is superficially comparable to the early stage of an annual influenza epidemic (pandemic if you like).
    So why is the response to COVID-19 so frenzied?
    Possibly because COVID-19 appears to be targeting the more affluent.

  10. Leo G

    This Wuhan disease is a real mystery; if one asymptomatic person can infect dozens it would seem unstoppable, yet here we are with hospitals quieter than usual where I am thank God.

    Yes, the evidence suggests that close person-to-person contact is not the mode of infection in most cases. There must be an indirect mode involving inhalation of very high virion concentrations- a mode which has not been identified.

  11. Lazlo

    Deaths from flu and pneumonia in the last month are well down on their seasonal averages. Is this because The Virus is now killing people who would otherwise have died from flu or pneumonia, or just mis-reporting? Who knows? But overall death rates are fairly constant. This is not a plague.

    There must be an exit strategy from the current political/economic crisis. To date politicians have adopted the (apparent) low risk strategy of going with alarmist projections because they could not then be accused of doing “too little” – a strategy that defies all principles of risk management.

    But how about this risk Gladys? Your Health Minister is looking incompetent and your lack of leadership is increasingly apparent.

    Do you want to risk losing the next election?

  12. John A

    Tim Neilson #3396668, posted on April 6, 2020 at 9:41 pm

    No apologies necessary.

    Can we confine ScoMo, Prince JoFry, the Hunchback of Spring Street, Health Hazzard et hoc generis and get this recorded and played to them on permanent loop till they comprehend it?

    Or would it be quicker to wait for the vaccine?

    There will not be a vaccine.

    Therefore the most effective way to impress this upon them is the have them commence the herd immunity process themselves. Infect THEM first.

  13. Leo G

    Therefore the most effective way to impress this upon them is the have them commence the herd immunity process themselves.

    The herd immunity threshold for COVID-19 is believed to be in excess of 50%. But COVID-19 does not appear to infect more than 20% of populations in any outbreak. The only way to achieve the HIT is by vaccination, when there is no vaccine.

  14. Megan

    Nailed it! The absence of strategy is disturbing, but in my experience, unsurprising. The tactical approach of being seen to ‘do something’ is the common approach for those not blessed with abity to see the big picture and assess unforseen consequences.

  15. JC

    Great post Justinian. Truly excellent and should on the desk of every Lib politician.

    I’m a little optimistic than you are on the matter of going back to work. Trump is itching to send people back to work as he realizes just how damaging it is. Once he does that, there’s zero possibility Morrison won’t follow with our stats. Wait for the US to open up then we will.

  16. iain russell

    Sack the bureaucrats responsible at all levels for the cock ups, especially wrt the Rube Prince. I can guarantee that neither Glad nor Brad signed off on the Exodus File.Have a Court of Inquiry into all ‘experts’ consulted by governments at all levels.

  17. Beachcomber

    A “grand strategy” would be utterly pointless in what has been a monumental disaster of media hysteria and idiotic, frenzied Statist excesses from the governing establishment.

    Evidence from Australia and around the world shows that the flu viruses going around right now, including the supposed COVID-19, are no more dangerous than those in an average flu season. There is no plague or pandemic. But this is ignored by the media who push harder with the hysteria-mongering and the governing elites who continue smashing the economy and our freedoms. It would be nice if there was a reckoning for this someday, but it is unlikely. History is written by the rulers.

  18. Tintarella di Luna

    I can guarantee that neither Glad nor Brad signed off on the Exodus File.Have a Court of Inquiry into all ‘experts’ consulted by governments at all levels.

    The bureaucrats and public servants are immune from accountability because in any inquiry they will say the ministers responsible didn’t want to know (plausible deniability) — since ministerial responsibility appears to no longer apply then there will be no reckoning — let’s remember the deaths of the four young people in the deadly pink batts fiasco no accountability there — Rudd without a conscience and Garrett without a heart and a conscience.

  19. Mark M

    If the politicians hadn’t let the Ruby Princess passengers disembark, they would have even less reason to impose their draconian measures.

  20. George

    None of our politicians are skilled strategists, all the really know is knee-jerk reaction.

  21. Rafe Champion

    No need to apologise for the length and you can put a fold in it so it only takes up a smaller part of the page until you open it and we see what else is on offer without scrolling.
    No biggie but i get irritated scrolling down CL’s worthy contributions to see what is next.

  22. Petros

    Leo G it’s not just the more affluent but the baby boomers are feeling threatened. They can’t handle getting old and want everyone to suffer as well if they have to. Expect more hysterical overreactions to bad flu like illnesses as long as the boomers dominate society.

  23. Rafe Champion

    To the substance, I made a strategic decision a few days ago that I don’t have anything special to contribute to this debate, even though it is the biggest game in town right now. More strength to the arms of the Cats and everyone else who is on the front line in what will become known as The Virus Wars.
    I decided we can sacrifice a footsoldier in the Virus Wars in the hope that I can make a larger contribution in the Climate and Energy Wars when they get more attention, which hopefully will be sooner rather than later.

    Nations are rarely prepared for the wars that they are forced to fight and this war on the strategy of the Covid-19 response reminds me of the conscription debate during the Vietnam War This was the fourth or fifth iteration of conscription debates that started in 1908 and raged most bitterly in WWI.

    The point is that a policy on conscription needs to be decided during peacetime because the debate will not go well with the smell of cordite in the air. Years after the Vietnam War a Committee of Inquiry addressed the issue and eventually delivered proposals for a reasonable policy. Nobody was very interested and I can’t even recall the provisions or whether they were legislated. Maybe we will have to go through it all again if we have another shooting war.

    It is too late to say it now, but it would be nice to have a strategy for dealing with pandemics discussed widely and thoroughly after the last pandemic , whatever it was. Clearly it did not alarm the horses enough to prompt serious consideration about the way to face the next one.

    So what else are we not thinking about at present that will bite us if we don’t wake up? I was going to suggest the choke point in RE but all the Cats know about that:)

    Incidentally at 5.30 South Australia was importing power. Across the NEM wind was providing 5% of the very low demand, with the mills running at 13% ranging from 4% in Victoria and 6% in SA to 35% in The Premier State.

  24. Rafe Champion

    On the topic of things to think about, I was going to suggest Chinese “soft” diplomacy and their trade war, since then Jo Nova has just put up a post on that very topic.

  25. Rafe Champion

    Apparently a bitter personal debate has been raging in Britain for years between rival epidemiologists and this is playing out in the policy debate at present. Hopefully the link to the London Telegraph works.

  26. Mak Siccar

    Rafe, linky doesn’t work.

  27. 132andBush

    Keep on them, Rafe.
    You just know they will be trying to tie in the lower emissions caused by the lockdown to something climate related. Farmer Gez is keeping an eye on Mauna Loa readings, will be telling when they don’t show a decrease.

    Re the herd immunity; in the last ten days the seasons have done the usual “step change” into the colder months. We’ve seen the last of the summer heat and now have conditions generally favoring the longevity of the virus in the open and because of the shutdown no sign of herd immunity. The window to let it relatively gently make it’s way through the population is now shut.

  28. yarpos

    You seriously think you can have an exit strategy at the beginning? Its pretty clear you have never been involved in anything chaotic, rapidly evolving and large scale. That is just magical thinking.

  29. John Bayley

    i.e. $320b spend that will need to be paid back

    It will never be paid back.
    The debts most developed countries’ government have incurred are long past being able to be paid back.
    This is why we see the growing popularity among politicians of economic voodoo like MMT.
    They will print, borrow, tax, print and print some more. Until the current fiat regime inevitably collapses.
    Then they will do an Argentina, cut off a few zeros and start again.
    And Joe & Jane Public will applaud and ask for more.
    After all, freedom is slavery.
    Comrades.

  30. From the graph showing the age profile of deaths in Australia in 2017

    https://www.aihw.gov.au/getmedia/499f30fd-a14f-488e-973d-b74d26c7f73a/2-1.png.aspx?width=800&height=574

    I extracted the following estimates for deaths/day and assumed 14 days for the current corona virus deaths. To create the following table comparing average deaths per day from Covid -19 with average deaths per day all causes Australia. I am not seeing any dramatic deviation from a normal year with this data

    Deaths/day
    Age. ————- Corona Virus, 2017 Australia
    60 – 69.——— (5) 0.36—————50
    70 – 79. ———(12) 0.86.———— 90
    80 – 89. ———(12) 0.86. ———-145
    90 +. ————-(4) 0.29. ————30

  31. Iampeter

    Yea, this was a really good post, Justinian.

    What this really means is that government/s definition of victory is the preservation of the health system and not the eradication of the virus,

    It’s about preserving the bureaucracy as a whole, which is what has made us so vulnerable in the first place.
    This is a good opportunity to dismantle vast tracts of useless and wasteful government but they’d rather our industrial civilization comes to an end before they let that happen.

    That is the strength of democracy in action, unlike the rush to totalitarianism which led to the pandemic in the first place.

    Nah, democracy in action IS totalitarianism and that’s exactly what we’re seeing. The Morrison government has just gone with the majority.
    But this was to be expected. The real issue is that there is no clear understanding anywhere in the mainstream of what a government is supposed to do under normal circumstances, let alone what it should do in a crisis.

  32. iamok

    The thing that most concerns me most is that whatever the result the politicians will claim they are vindicated and hence victorious. If the outcome is a shitstorm they will say it could have been worse if they hadn’t acted. If it succeeds (whatever that looks like) of course they will be heroes. This is a totalitarian wet dream – dependent and scared masses, and unrestricted and unlimited spending. Whatever could go wrong?

    The other concern is the utter compliance of the masses. Many a shit scared and this does not augur well for whenever something actually goes wrong bigtime.

  33. John Bayley

    The real issue is that there is no clear understanding anywhere in the mainstream of what a government is supposed to do under normal circumstances, let alone what it should do in a crisis.

    Ah, but of course there is an “understanding”!
    It says that the government is here to “save us”, “protect us” and “look after us”.
    And above all, “They need to Do Something!
    Which is precisely what “they” are doing.
    And the public, except for the few old grouches here, loves it.

  34. John Bayley

    If the outcome is a shitstorm they will say it could have been worse if they hadn’t acted.

    “Climate change” was the template.
    This is the test run.
    Kristallnacht will be the real thing.

  35. Mater

    You seriously think you can have an exit strategy at the beginning? Its pretty clear you have never been involved in anything chaotic, rapidly evolving and large scale. That is just magical thinking.

    I agree that a plan is just basis for change, but if he doesn’t have one, he is just crossing his fingers and pissing resources up against the wall.

  36. Alan

    Can someone help me. I could be wrong.
    So this page is for “health professionals”, but I was just wondering what these terms mean:
    TGA: COVID-19 testing in Australia – information for health professionals
    • “cannot detect if an individual is infectious”
    • “The reliability of COVID-19 tests is uncertain”
    • “presumptive positive”
    • “false-negative rate … is not known”
    • “False-negative results pose a significant risk”
    Does that mean you could be diagnosed with Covid-19 when it is really not Covid-19?
    Does that mean the number of “confirmed cases” in Australia is just a guess?

  37. Caveman

    It’s all about the curve baby, it’s getting flattenerd and flattenerd that’s all we need to know. And that’s unprecedented, you can take that to the bank…if they still around.

  38. If properly modelled, and net cases (ie infected minus recovered) are considered, the correct modelling shows that by and large the number of hospital cases can be considered ‘constant’ which means that the hospital facilities were never going to be overrun except in the febrile imaginations of people who can’t understand the meaning of cumulative numbers which just do not exist.
    In South Australia near the beginning there were 24 cases in hospital, including ICU, and yesterday there were 20 including. Statistically that is very close. However statistics in this case are not much use as predictors because the net number of hospital admissions must simply be less than the number of beds available. It’s not that difficult.

  39. Wyndham Dix

    Northern hemisphere emerging from its winter; southern hemisphere entering its.
    .
    Proportion of global population in the northern hemisphere: circa 90%
    https://bigthink.com/strange-maps/563-pop-by-lat-and-pop-by-long?page=all
    Doubtless there are more authoritative sites that tell much the same thing.
    .
    Global deaths so far from COVID-19: 73,917
    https://www.bing.com/search?q=covid+19+death+toll+worldwide&FORM=QSRE5
    .
    Global deaths annually from respiratory infections: 290,000 to 600,000
    https://www.bing.com/search?FORM=U528DF&PC=U528&q=annual+world+deaths+from+influenza
    .
    On what grounds panic, hysteria and political oppression, not least in Australia?

  40. Roger

    The Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) (the National Plan) is a plan without a strategy. Written by bureaucrats it is long on platitudes and short on substance

    The plan highlighted the need for governments to “innovate solutions” as the pandemic unfolded here.

    Doctors are currently finding themselves having to “innovate solutions” for government ineptitude by buying PPE at Bunnings & online.

    Where on earth are 3 000 000 masks the CMO said were sent out to the states last week? (Specifically for medical staff, since the advice is still that the general public doesn’t need them)

    Meanwhile, Qld’s Health Minister was on the news last night assuring hospital staff that the government “has their back”.

    However this thing plays out, the public must demand that the governmental response at federal and state levels is subjected to the closest scrutiny and that heads roll, starting with the CMO who vacillated when decisive advice was needed early on. (Memo to government: Don’t put a nephrologist in charge of the response to a viral pandemic).

  41. flyingduk

    So far, our strategy appears to be one of ‘slow this down as long as possible so we can keep as many old, sick people alive as possible by running them through the ICUs for a couple of weeks at 10k a day’. No one appears to be bothered by the ‘but we cant afford it, and even if we could, is it a win?’ problem.

    One thing I do know: no general wins a war by stating ‘first priority is to minimise casualties’, then cutting his own supply lines to achieve it.

  42. Carl

    I would add this questions to your list:
    How many people in the community have had the virus and didn’t show any symptoms?

    It might be that the death rate is far less than we think because we are calculating the number of deaths divided by the number who show up at hospital instead of the number of deaths divided by the total number of infections. A deatch rate of 5% or 10% would need much more drastic action than a death rate of 0.1% or 0.5%. Destroying peoples jobs and future to save 0.1% of the population who are already in a high risk group and have only a short time left anyway, wouldn’t make sense.

  43. flyingduk

    Destroying peoples jobs and future to save 0.1% of the population who are already in a high risk group and have only a short time left anyway, wouldn’t make sense.

    I am sensing more voices starting to say that. In response, have you noted the media are already pushing out the ‘this virus doesn’t discriminate’ and ‘young people get this too’ stories. The Italian data showed that most deaths are old men (2:1 M/F ratio – yet to hear the feminists agitating to close *that* gap) with at least one and usually 3 chronic diseases. The death rate under 20y is 0.2% and under 50y is 0.5%, and those numbers are likely gross overestimates due to underreporting of minor/asymptomatic cases. Has anyone asked the grandparents if they think its a good idea to sacrifice their grandchildrens futures for their own?

  44. TFX

    With hindsight Australia already has a very effective model for dealing with pandemics. There was a major nationwide exercise on dealing with a foot and mouth disease incursion in 2014. Unfortunately it has been tested only on animals but with the support of a huge variety of government agencies and industry support. Rereading the report there are obvious lessons that could be applied to other government agencies and industries. I only have significant knowledge of the Queensland component of the exercise and was very impressed at the openness and honesty of all participants admitting what they got right, what they got wrong and what they could do to improve.
    There were many aspects of the exercise that could have been applied and I do not know if the agriculture departments have been involved in this human health pandemic. Attached is a link to the report on the exercise.
    https://www.agriculture.gov.au/sites/default/files/sitecollectiondocuments/biosecurity/emergency/exercise-odysseus-report.pdf

  45. Peter S

    You have clearly articulated my concerns.

  46. Carl

    To find the true death rate, we need to test a large random sample of people for antibodies, to find out how many people have had it without serious symptoms. Testing for antibodies is essential if we’re not going to gambol with people’s livelihoods and futures.

  47. DaveR

    Great post, addressing all the necessary questions.

    But I am much less pessimistic that you JtG. I think the signs are already there that this will be a much shorter lockdown than 6 months – maybe only 3.

    And to my thinking, the strategy is to stop the spread of the infection by identifying and isolating all infected people by using targeted testing of contact-link chains, within a locked-down community. In this scenario, they aim to defeat it with a big hit up front. Once the spread is reduced to some low figure – restrictions will be progressively relaxed.

    The alternative strategy, like in Sweden and early on in the UK, was to allow the infection to spread through the population and allow the development of natural immunity from recovered cases and try to limit deaths. That may not be working, such is the severity of the chronic part of this infection.

    In any event, I dont think they know how this is going to play out in Australia, their ideas are only based on computer models. I think the “6 month” lockdown is a deliberate over-statement by ScoMo to prepare people for the worst, should it be required because of features like recurrant infection etc, which is not well understood.

  48. Gerard

    The other way out is to adopt an approach which treats patients with medicines that have been shown to be effective elsewhere – e.g. the combination of hydroxychloroquine and antibiotic azithromycin. Several trials are in train with results due within weeks.

  49. Leo G

    Can someone help me. I could be wrong.

    The TGA is referring to the serious sensitivity and specificity deficiencies of current diagnostic tests for Coronavirus in the context of statistical inference.
    Sensitivity is the sample proportion of true positive cases detected as positive. Specificity is the proportion of true negative cases detected as negative.
    The performance of these tests for RNA viruses has improved over the past 15 years but is still inadequate. The available tests for CV-19 are woefully inadequate.
    It’s difficult to find recent published figures, but it was reported for tests on the passengers and crew of the cruise ship detained at Yokohama in February- overall testing sensitivity of 88.66% and specificity of 90.63%. However, reports in the journal Radiology in February and from Envision Healthcare (US) state that currently available tests have sensitivity around 70%.

  50. Leo G

    I think a hypothetical test case might best highlight the significance of sensitivity and specificity in diagnostic testing for coronavirus.
    The model will be the expected results from 4,000 passengers and crew of a cruise ship detained for diagnostic testing.

    Case 1: 20% on board are true positives for CV-19, test sensitivity is 85%, specificity 90%.
    Of the 800 true-positives, 680 test positive and 120 are false-negative.
    Of 3200 true-negatives, 2880 test negative and 320 are false-positive.
    The tests indicate that 1,000 are positive, but 320 of are actually negative. Similarly, 3,000 test negative, but 120 are actually positive. The test overstates positive cases by 25%, and understates negatives by 6.25%. The “precision” is therefor 71%.

    Case 2: 20% on board are true positives for CV-19, test sensitivity is 70%, specificity 90%.
    Of the 800 true-positives, 560 test positive and 240 are false-negative.
    Of 3200 true-negatives, 2880 test negative and 320 are false-positive.
    The tests indicate that 880 are positive, but 320 of are actually negative. Similarly, 3,120 test negative, but 240 are actually positive. The test overstates positive cases by 10%, and understates negatives by 2.5%. The “precision” is still 71%.

    Case 3: 2.5% on board are true positives for CV-19, test sensitivity is 85%, specificity 90%.
    Of the 100 true-positives, 85 test positive and 15 are false-negative.
    Of 3900 true-negatives, 3315 test negative and 585 are false-positive.
    The tests indicate that 670 are positive, but 585 of are actually negative. Similarly, 3,330 test negative, but 15 are actually positive. The test overstates positive cases by 570%, and understates negatives by 0.4%. The “precision” is therefor 14.6%.

    Case 4: 0.1% on board are true positives for CV-19, test sensitivity is 85%, specificity 90%.
    Of the 4 true-positives, 3 test positive and 1 is a false-negative.
    Of 3996 true-negatives, 3596 test negative and 400 are false-positive.
    The tests indicate that 404 are positive, but 400 of those are actually negative. Similarly, 3,597 test negative, but 1 is actually positive. The test overstates positive cases by 100 times, and understates negatives by 10%. The “precision” is therefor just 1%. Case 4 highlights the absurdity of population screening using such tests.

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