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RUBY:

From Schwartz Media I’m Ruby Jones, this is 7am.
Outbreaks of Covid-19 are continuing to spread across the country, hitting largely unvaccinated and unprepared populations.
Areas like the Northern Territory, the ACT and regional New South Wales, which have largely managed to avoid the pandemic, are now in lockdown.
Meanwhile Melbourne’s lockdown is set to be one of the longest in the world, and in New South Wales cases continue to spiral.
18 months into the pandemic many Australians are feeling exhausted, and compliance with public health measures is dropping off - leading governments to ramp up policing efforts.
Today, infectious disease and pandemic response expert Dr Alexandra Phelan on the situation in Australia, how governments can maintain public trust, and what the end game looks like.

It’s Thursday August 19.
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RUBY:

Alexandra, could you start by telling me a bit about your work, and what you do?

ALEXANDRA:

Yeah. So I work for the Centre for Global Health, Science and Security at Georgetown University. We help governments prepare and respond to outbreaks and epidemics and pandemics. I do sort of public health, looking at public health measures, their efficacy and the way laws and policies can affect public health, particularly in outbreaks or pandemics.
And I was in New York when the first cases were reported out of China on 31 December. And essentially from 31 December until June, I worked every single day.

RUBY:

And I think for most of the pandemic Australians have looked at the rest of the world, including the US where you live, with this sense of real horror and dread. So what has it been like for you, watching Australia as we avoided the kinds of mass deaths that were seen elsewhere?

ALEXANDRA:

There's been a huge relief obviously until recently that Australia has managed to avoid the large scale epidemics that have been experienced overseas.

Archival tape -- Unknown Reporter 1:

”The numbers continue to rise as ten hospital trusts across England reported a lack of capacity in intensive care.”

Archival tape -- Unknown Reporter 2:

“Well now to that staggering and tragic milestone in the history of our country, over 500,000 American lives lost to Covid-19.”

ALEXANDRA:

But at the same time, with that relief, there was a real, I definitely had a real concern of the potential impacts, that that could have on potentially government complacency or on how that would affect access to vaccines or how the vaccine rollout might go.
The reality of what we're seeing now in particularly New South Wales, but in other states, but the sort of delayed government response, it's like seeing what we were seeing in February, March last year in the US, obviously not at the scale, but at that sort of underestimating how quickly we need to act.

RUBY:

Hmm and I think one thing that feels quite jarring right now, in Australia, is that so much of the country is in lockdown at the same time while the rest of the world is re-opening. Regional New South Wales and the ACT are in their first lockdowns since March last year, Melbourne is on track to be one of the cities with the longest lockdowns in the entire world. And as necessary as this might be to limit case numbers, do you think there’s a risk of exhaustion amongst the community?

ALEXANDRA:

The word lockdown is used to mean many different things. And what level of stringency of public health measures are in place has varied significantly, despite the use of the term lockdown still being in place.
And so when I look at things like lockdowns, these are, if applied correctly and if applied appropriately, and they're the least restrictive measures necessary to achieve the public health outcome, they are our primary tool in the absence of population immunity through vaccination.
The reason why we care about this least restrictive means necessary. And it is language that comes from human rights law. But why public health cares about it is because public health requires public trust. And one of the first things you can so easily lose is public trust in an epidemic response. When the public is concerned that the governments are not being transparent with them or that governments aren't communicating the rationale for the measures that are being posed, or if the government is using a highly coercive part of the system, such as the use of police, you actually erode that trust.
And that's particularly the case in populations that are already subjected to systemic injustice and racism.
A lot of the time, what we see in outbreaks is that when police are heavily involved in fining people for breaching public health measures, you actually encourage people to act to hide that even more so.
People who have very legitimate reasons to be going out, essential workers, but may feel unfairly targeted or may not feel confident that they're going to be given that exemption may also seek to avoid police. You lose a really critical opportunity to provide people with public health information and to help them engage in safer behaviours and that sort of risk reduction process.
You know, there's a real concern for me when I look at, say, New South Wales and Victorian responses in the use of police, that particularly in already vulnerable populations, there is a risk of actually having community transmission occurring in a way that is actually more at risk from using police.

RUBY:

The use of police in Australia, particularly in New South Wales and Victoria, has been a pretty strong element of our pandemic response.

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“The NSW police force will launch operation Stay at Home, Sunday at midnight.”

RUBY:

Just recently we’ve seen governments in both states introduce more severe restrictions and punitive fines.

Archival tape -- Unknown Person 1:

“The fines are some of the biggest fines that I have ever seen and we will be issuing them.”

RUBY:

They’ve even admitted that some of those restrictions they aren’t necessarily based on public health recommendations.

Archival tape -- Unknown Person 1:

“Some of the strongest laws, some of the strongest police action coming. I am not apologetic, please don’t write and complain to me.”

RUBY:

They’re in place because police were pushing for them. So why do you think Australia has gone down this track?

ALEXANDRA:

You know, I think it can be incredibly tempting to use police when things look like they're getting out of control. If cases are increasing, it feels like you need to be using a more stringent approach when that actually may not be what's required.
You know, Australians are incredibly law-abiding we’re incredibly rules following. And I think there's a temptation to feel that that will provide control and address the issue. And the reality is, is from public health perspective, it can be incredibly counterproductive.

I think it can be very tempting to feel that the solution is to create more and more strictures and control around the situation, when what we know works is supportive approaches.
We know that all of these sorts of supportive measures can be conducive with public health rather than constraining measures which can undermine public health and drive transmission underground.

RUBY:

We'll be back in a moment.
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RUBY:

Alexandra, I think a lot of people in Australia want to know what the answer is, how we get out of the situation, what the pathway is, I know that that's a hard question, but what are the things that you think we should be focussing on right now that we aren't at the moment?

ALEXANDRA:

I think there were some good initiatives early on in the pandemic and initiatives within some other countries, those sort of support payments that ensure that people are able to stay at home, that ensures that essential workers have the flexibility to isolate and quarantine if required. These are just really fundamental, very basic things that should be addressed and should be really, really centred in response
Curfews and measures that require that force people inside earlier actually sort of go against the sort of steps that we say that we need to be we need to be doing,
If someone can go walk their dog at 10 p.m. at night and they get some fresh air and they get outside and is not in close contact with anyone and, maybe even if they're wearing a mask, depending on the the scope of the measures, that is incredibly low risk activity in comparison to, having everyone suddenly inside and increasing, say, family or household transmission whilst reducing community transmission.
So there's a lot of thought that can go into the nuance of these measures and make them much less restrictive whilst also centring public health and protecting the public’s health.

RUBY:

I think what is frustrating for so many Australians right now is that it did feel like we had managed to avoid much of the pandemic's impacts by isolating ourselves and implementing things like the strict border closures that we have. But it’s now very hard to see an end point, because the Delta variant doesn’t seem like it’s going away… and earlier this week we covered the fact that New South Wales has essentially abandoned this Covid zero goal. So what do you think is the end point here for us?

ALEXANDRA:

You know, this is a really, really tough question, and I think, with the scale of of transmission that is occurring overseas, the fact that in many places the general consensus is we're going to have some form of endemicity because of the amount of transmission, which means that it becomes potentially a seasonal virus, we still have a lot to learn about this virus. But that looks like it could be a potential pathway.
There has to be better communication to the Australian public, particularly from the federal government as the sort of national government is about what not just the timelines, but what are the outcomes of those timelines? You know, obviously subject to change with any future variants. But, what can our hospitals cope with? What sort of level of transmission is going to happen? You know, I think Covid zero and elimination approaches will require Australia disconnecting itself from the international community for a lot longer period of time and really thinking about whether that's actually going to be achievable. If we see new variants emerge, or we see vaccine efficacy wane over time.
So I think that's really important to put upfront that even with the challenge of Delta, vaccination is still just so critical.

RUBY:

And there is no doubt that Delta has changed everything - Alexandra - it's the reason we’re back in lockdown again in Australia. And we spoke at the start of this interview about the sense of creeping exhaustion that the community feels as a result of going in and out of lockdowns in the way that we have. So far the response from governments to that exhaustion has been to implement harsher rules, and larger fines and more police. I just wonder how viable you think that approach is in the long term… because it does seem like we’re in this for the long haul.

ALEXANDRA:

You know I think lockdowns are incredibly, incredibly tough. I very much empathise with the experience. It is incredibly isolating, incredibly lonely. It has been a long haul overseas and it looks like there may be a bit of a longer haul in Australia.
So I think this is where this least restrictive measure angle is just so critical is it's about how do we protect public health across the board? It's not just simply from Covid-19. It is also mental health. It is also physical health. It is ensuring that people have access to health care. And it's not just the impact of or Covid-19 the impact of a pandemic on the specific virus, but also the other aspects of health care that are all impacted. So it is a multifaceted and complex dynamic that I think really little things in the way lockdown measures are imposed is going to be critical.
Having high policing or high stigma driven lockdown measures is incredibly stressful. People are less willing potentially to go out for those walks, those daily walks and get that movement, which, for a range of reasons is going to be critical, particularly if lockdowns extend for weeks or months.
And so, you know, I think this is where things like curfews are less about public health then than really there could be. You know, having sensible measures that allow people to get outside, to see people at a distance where appropriate, masks to be able to go to the grocery store, go for their walks to be able to exercise. I think all of those things are going to be really critical.
You know it is a marathon.

And it's not a dichotomy. There is nuance. But there are ways to approach public health that engenders trust, builds community support. And actually, that is the fast way out of this epidemic and that includes within the broader international community as well.
That complexity can be really difficult, but that's really where our leaders are so important to be able to communicate that complexity in a way that is accessible and appropriate for the community. And I think that's really, that has to be the path going forward, is real leadership and clarity for the public to understand, whilst also ensuring that public health and the broad definition of public health is appropriately protected.

RUBY:

Alexandra, thank you so much for talking to me about all of this. I really appreciate it.

ALEXANDRA:

Thanks so much for having me.

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RUBY:

Also in the news today,

The first Australian flight evacuating citizens and local support staff from Afghanistan has landed in the United Arab Emirates after collecting 26 people from Kabul on Wednesday.

The government says it plans to evacuate around 600 people including Australians and local Afghans who worked for Australian forces from the country.

And, New South Wales authorities reported 633 new locally acquired cases of Covid-19 and three new deaths on Wednesday. At least 62 were infectious in the community.

Premier Gladys Berejiklian warned the state still hasn't seen "the worst of it" yet.

I’m Ruby Jones, this is 7am. I’ll see ya tomorrow.
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