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RUBY:

From Schwartz Media, I’m Ruby Jones, this is 7am.

Yesterday, Victorians were told the state’s 7 day ‘circuit breaker’ lockdown would be extended for another week, as health authorities race to contain the latest Covid-19 outbreak.

It’s the fourth lockdown in the state since the start of the pandemic, and now questions are being asked about why Victoria in particular, seems so susceptible to the spread of the virus.

Today, health columnist at The Saturday Paper Melanie Cheng on what went wrong this time and what it will take to control this outbreak.

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RUBY:

Melanie, just last week, you told us that if vaccination rates did not start increasing and if complacency in the community continued, we could see another outbreak and potentially a third wave.

It kind of seems like you predicted what might happen in Victoria?

MELANIE:

Unfortunately. Yes, I suppose I knew that we were vulnerable because of people not getting tested early, not checking into venues and these low vaccination rates in addition to this highly contagious variant of concern in hotel quarantine.

And our podcast aired on Monday, the 24th of May, and it was later that afternoon, in fact, that two cases of community transmission were announced in Victoria.

Archival tape -- Reporter 1:

“Good afternoon we’ve just learned of a fresh covid outbreak in Melbourne, four infections detected in the city's northern suburbs.”

MELANIE:

And since that time, things have got worse.

Archival tape -- Reporter 2:

“Thousands of people are being told to self isolate and get tested, with ten new venues listed as exposure sites.”

MELANIE:

Unfortunately, we've had exposure lists growing by the day.

Archival tape -- Reporter 3:

“They’re including shops and workplaces, cafes, gyms and most worryingly a series of bars along the Chapel Street nightclub strip.”

MELANIE:

We've had tens of thousands of primary and secondary contacts having to be in mandatory quarantine. And more recently, of course, we've gone into a quite severe lockdown.

Archival tape -- James Merlino:

“From 11:59 pm tonight Victoria will enter a 7 day circuit breakdown lockdown…”

MELANIE:

And even more recently, we've had a mystery case which then led to an outbreak in aged care.

Archival tape -- Reporter 4:

“Aged care homes are once again on the Covid frontline, two facilities have recorded infections, with three workers and a resident testing positive.”

“The next few days remain critical. And I want to be really clear with everyone that this outbreak may well get worse before it gets better.”

RUBY:

And I think the question a lot of people have right now is, why is this happening in Victoria again? Is this down to bad luck or is it bad management? What is going on here? Why does Victoria keep seeing the worst of this?

MELANIE:

I think each outbreak is actually quite unique, and I certainly have found it useful to think of outbreaks using the Swiss cheese model of incident causation. So that's a model that's used in some areas of medicine, like anaesthetics.

And basically in the Swiss cheese model, human systems are imagined as slices of Swiss cheese stacked side by side. And if you have a hole in just one layer, it won't lead to a failure. But if you have holes in multiple layers, then that will - and the failure in this circumstance is an outbreak.

So in the case of this particular outbreak in Victoria, I think there were really five main layers and a hole in each of them.

RUBY:

Mmm, right, so can you talk me through those five layers then - and those five problems that we’re seeing, which have led to us being in this position?

MELANIE:

Yeah, sure. So I think obviously the first layer is our hotel quarantine that's meant to protect us from the virus coming in from overseas. And in this outbreak, the breach occurred in South Australia and that was due to aerosol transmission occurring between residents and neighbouring rooms.

The second main layer of our defence is contact tracing. And we now know that there was a link that was missed in the tracing of the Wollert man who travelled from South Australia.

Another layer in our defence is our testing. We know that several early cases in this outbreak did take some time to present for testing. And that was consistent with my experience as a GP as well, seeing people with a lot of respiratory illness that just assumed it couldn't be Covid.

And then there's social distancing measures. And at the time that this outbreak occurred, there were really minimal restrictions in place in Victoria. And the last layer, which is a new layer as of this year, is vaccination. Some of the problems there with a very slow rollout, a lack of urgency, and also, of course, hesitancy within the population.
But I haven't really spoken to why Victoria specifically has suffered the brunt of the outbreaks and lockdowns in Australia. Some of the other factors, that you know, have been offered by experts pointed to the lack of a centralised QR system that perhaps could be improved, including with its enforcement. And the other, of course, major reason that comes up a lot is our weather. Obviously we are one of the colder states and Melbourne is the biggest cold city in the country.
So I think those are all the kind of reasons why perhaps Victoria has unfortunately borne the brunt of this. But there's also an element of luck, of course, as well.

RUBY:

Mm hmm. And so, Melanie, all of this leads us to the lockdown, which was announced last Thursday. That announcement was that the entire state would shut down for seven days. And in the days that followed, there was a lot of concern, I think, that restrictions would go on and last longer than that one week.

MELANIE:

Yeah, I think that perhaps authorities in the very early stages of this did think that seven days would be enough.

Archival tape -- James Merlino:

“If we can ease those restrictions earlier, we will. But this is a seven day circuit breaker lockdown.”

MELANIE:

This is the first experience that Australia has had with this variant of concern that originated in India.

Archival tape -- James Merlino:

“Our public health experts' primary concern is just how fast this variant is moving.”

MELANIE:

And now of course we know that the lockdown has been extended.

Archival tape -- James Merlino:

“It's why on the advice of the Chief Health Officer Professor Sutton the current restrictions remain in place for Melbourne for further 7 days - with some small changes.”

“In the end this is about saving lives.”

RUBY:

We'll be back in a moment.

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RUBY:

Melanie, Victoria’s lockdown has just been extended for another 7 days. The big fear here is obviously that this will continue on and turn into a third wave and another extended lockdown like the one that we saw last year. So how likely is that to eventuate? How bad are things in Victoria right now?

MELANIE:

I think having spoken to patients during this lockdown, there is a lot of anxiety, understandably, amongst Victorians about this outbreak being a repeat of what we saw in 2020 and a really extended severe lockdown.

But, you know, I think we learnt a lot from that situation last year. And a lot has changed in Victoria in terms of its public health response. So for that reason, I think we are better placed to deal with this.

In 2020, we took a long time to lock it down. I distinctly remember that I was in Healesville around the time that we were having 70 cases a day, and it was only then that we were doing localised lockdown. So the rest of Melbourne was still moving quite freely when we had 70 cases a day.

So we know that in 2020 we didn't, for instance, have a good surge capacity for testing. I personally remember having a test done in the middle of that outbreak and the result taking up to three days to come back, even though I was supposedly priority as a health worker, whereas now the surge capacity for testing is, is quite amazing, you know, up to 57,000 tests in it in a 24 hour period. So there's been some massive improvements there.

The other issue is, you know, the bolstering of contact tracing. So our system itself has improved and so becoming instead of paper-based, we now have a digitised system which is much more efficient. We've also moved away from centralised contact tracing to decentralised tracing with local hubs and local expertise.

RUBY:

And I just want to follow up on what you're saying about contact tracing, because as we know, one of the biggest criticisms of the last time around was this lack of contact tracing ability in Victoria. So are you saying that things have improved enough in this space, that this and any other potential future outbreaks can be traced adequately?

MELANIE:

I think we're in a much better position than we were.

Archival tape -- Brett Sutton:

“With more numbers today coming through, we are neck and neck with this virus and it's an absolute beast.”

MELANIE:

So this week, Brett Sutton said we were keeping a neck and neck with this virus, which contrasts with last year, where I think a lot of the discourse around the outbreak was that our contact traces and were being overwhelmed.

Archival tape -- Brett Sutton:

“It's been a huge response, we’ve got thousands of primary close contacts being followed up, but they are being followed up in absolutely record time.”

MELANIE:

It's quite clear from the enquiry into the pandemic response last year that one of the major factors in a second wave was deficiencies in the contact tracing. At the beginning of the pandemic in March 2020, there were only 14 contact tracers in Victoria, whereas now we have a much bigger group of contact tracing and we also have a surge capacity. So in a similar way, with the testing, we can increase those numbers quickly.

And similarly with the exposure site detail, we weren't getting that last year either. So we certainly have improved those systems.

RUBY:

Mm hmm. So it does sound like we have learnt some of those important lessons from the long lockdown last year. But despite the improvements to our public health system that you're detailing, we are still in a situation with another outbreak and another lockdown. And it does still seem like Victoria is more susceptible than other parts of Australia. So is that just a sign that it doesn't really matter how good our systems are? We are always going to be vulnerable.

MELANIE:

Of course, to some degree, we are vulnerable because this is a global pandemic, and as long as the virus exists and particularly as it's so it's mutating, there will be this risk of outbreaks. So there's been a lot of talk recently, particularly with the hotel quarantine, so on average, we're having a breach every one to two weeks and they're probably going to continue as long as we continue with hotel quarantine.

And so purpose-built quarantine facilities are likely to reduce the chance of those leaks. And of course, now encouraging people to go out and get vaccinated. These are all the things that we can do to improve those layers in that Swiss cheese model so that we don't get another failure.

RUBY:

And just on vaccinations, Melanie, when we spoke last week, we talked a lot about vaccine complacency, people coming to your GP clinic saying they weren't sure about the vaccine and when they would actually go and get vaccinated. But we are seeing a lot of people now, I think, spurred on by what's happening in Victoria, queuing up to get vaccinated. And we've also seen it become available to another segment of the population. So is this cause for optimism?

MELANIE:

Oh, I think definitely I'm disappointed that it took an outbreak for us to lose some of that hesitancy and get vaccinated, but I'm, I'm still pleased that people are getting out and doing that.

So, of course, this will all hold us in good stead for the next outbreak. And if we've learnt anything, we know that there almost certainly will be a next outbreak.

RUBY:

A warning to remember. Mel, thank you so much for your time.

MELANIE:

No worries. Thanks again for having me.

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Also in the news today...

Victoria’s second 7 day lockdown begins at midnight tonight, with slightly changed restrictions. The five kilometre radius around the home has been increased to 10 kilometres, and restrictions in regional Victoria will ease.

At this stage it seems the outbreak has not spread to NSW, though the south coast of the state is on high alert.

NSW health authorities have listed some exposure sites after a Victorian man and his family who holidayed at Jervis Bay tested positive.

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

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