28 Jul 2020

Why Victoria's Covid-19 cases aren't dropping despite lockdown

2:02 pm on 28 July 2020

The epicentre of Australia's coronavirus outbreak, Melbourne and Mitchell Shire, is coming up on three weeks into lockdown.

Members of the Melbourne Fire Brigade (MFB) prepare to take food parcels to residents in a locked down public housing estate in Melbourne earlier in July.

Members of the Melbourne Fire Brigade (MFB) prepare to take food parcels to residents in a locked down public housing estate in Melbourne earlier in July. Photo: AFP

Residents must stay home except for essential shopping, care, exercise, study or work reasons, and on Thursday last week it became mandatory to wear a mask in public places.

Despite these actions, daily new case numbers have stayed stubbornly high and yesterday reached a new record of 532.

Today, Premier Daniel Andrews announced 384 new cases, and six deaths.

So why has Victoria's lockdown not brought case numbers down more dramatically? And what else could we be doing to stop the spread?

ABC put those questions to the experts. Here's what they said.

Masks may be changing behaviour

By now the case numbers were hoped to be dramatically lower, says Dr Philip Russo, president of the Australasian College of Infection Prevention and Control.

The fact the state only has a loose lid on infection does not come down to the government's response; it is squarely on the public, Dr Russo says.

"Clearly people aren't following the guidelines and perhaps there's a sense that they're not going to be bothered too much if they do get the infection," Dr Russo says.

"There's some really obvious disobedience displayed on social media."

Commuters walk past Melbourne's Flinders Street Station on July 23, 2020 on the first day of the mandatory wearing of face masks in public areas as the city experiences an outbreak of the COVID-19 coronavirus.

Commuters walk past Melbourne's Flinders Street Station on July 23, 2020 on the first day of the mandatory wearing of face masks in public areas as the city experiences an outbreak of the coronavirus. Photo: AFP

It is pleasing that mask-wearing has been largely embraced in Melbourne, but Dr Russo worries people will have a new false sense of confidence and leave their house more and more.

"Although we're all wearing masks now we still need to continue to only go out for the four reasons (to shop for food, for medical treatment, exercise or work and study).

"It may be giving them a sort of false bravado to think they are protected and can go out as much as they like."

Compliance appears to be a 'when it suits me' idea for some and the daily hype and hysteria online is distracting people from the key messages, Dr Russo says.

"It's still has to be about distancing, hygiene and staying at home."

Pressure to turn up to work

Victorian Premier Daniel Andrews says "far too many people" are going to work while sick, instead of getting tested and staying home while waiting for a result, labelling it "the biggest driver" of coronavirus transmission in the state.

The problem has been particularly prevalent in aged care, the Premier says.

Julie Leask, a social scientist who specialises in risk communication and nursing at the University of Sydney, says this reluctance to call in sick is largely linked to how financially stable people feel.

"For example, for casual workers ... isolation after a test could mean no work, less chance you will get a shift in future, and considerable financial stress. In that situation, it's easy to rationalise a scratchy throat as just being a bit of a cold," she says.

Professor Leask says casualisation and presenteeism - working while ill - was already a problem in the health industry so it could not expected to be resolved overnight.

"This is something we already knew - pandemics and epidemics throw light on existing vulnerabilities."

Weak lines of communication with culturally and linguistically diverse people could also be a setback, but Professor Leask stressed each state was in urgent need of behavioural data to fully understand people's attitudes.

"We need better evidence on where the vulnerabilities are occurring. Having data on the biggest barriers to needed behaviours will tell governments where they need to most improve processes."

Australia's Victoria state premier Daniel Andrews speaks during a press conference in Melbourne on July 15, 2020, as the city battles fresh outbreaks of the COVID-19 coronavirus while under lockdown.

Australia's Victoria state premier Daniel Andrews speaks during a press conference in Melbourne. Photo: AFP

More full-scale lockdowns needed

Professor Mary-Louise McLaws, epidemiologist and World Health Organisation member, says there's one major reason case numbers keep spiralling upwards.

"It's simple, the ring-fencing wasn't done properly. If you lock down people you actually have to keep them there, you don't let them leave," she says.

Professor McLaws believes full-scale lockdowns, like those implemented in public housing, should have been applied in hotspots weeks ago so people weren't leaving for work.

"You basically just let the virus walk out then ... but if you're going to do the 'lite' version of ring-fencing you should at least mandate that people wear masks to work."

Aged care, distribution centres, meatworks, cool stores and warehouses have driven most of the second wave in Victoria, but Professor McLaws said this could have been avoided if authorities had learnt from mistakes elsewhere.

"We knew that aged care was an area of severe underemployment and many staff work across facilities. If we didn't learn that from Tasmania, we should have learnt that from NSW. But still those workers weren't required to wear masks in the early phase."

Professor McLaws said she understood there were a multitude of reasons why some workers felt pressured to attend work, so the best approach was to change the work environment.

"If you can't put up perspex barriers then make sure all workers are wearing face shields... but really what should have been done is experts visiting factories and the like to assist employers."

Notwithstanding the mistakes made, Professor McLaws said Victorians should "hold their mettle" as not enough time had passed.

We haven't seen the full effect of masks yet

It has been less than a week since the introduction of mandate mask wearing, so the benefits of that are not being seen in the daily case numbers yet, Hassan Vally, an epidemiologist at LaTrobe University, says.

"We're only four days, five days since that happened. I've always had it in my head that come Wednesday, this week, we would probably see the drop associated with mask wearing," Dr Vally says.

"That's probably the easiest thing to explain. And then it gets really messy after that."

One thing that seems to go hand-in-hand with a rise in daily case numbers is a call for stage four restrictions, but Dr Vally says that's premature, and a blunt instrument.

"If it was that easy a decision, every single person would make that. We'd all give up four weeks of our life to stop this horribleness that we're in right now.

"But I don't think it's as easy as that and there's a huge cost associated with shutting everything down."

More effective, he says, is targeted shutdowns based on good evidence.

One of the issues is aged care, which can't simply be shut down, and authorities are working on improving infection control measures in that sector.

"There's an extraordinary amount of effort being done to limit the spread of cases through these workplaces and aged care centres."

Despite the complexity of the Melbourne outbreak, Dr Vally is hopeful the shift in the curve will be evident soon.

"We're still not seeing rapid doubling," he says.

"I remain very optimistic that we will maybe have a few more days of hovering around this level and it might even go a little bit higher but then I really feel like towards the end of this week ... we'll start to see some positive results."

Bad luck

The numbers in Victoria may look bad, but they would have been many times worse without intervention, says Gideon Meyerowitz-Katz, an epidemiologist at the University of Wollongong.

Just how much worse is impossible to say, but outbreaks in other parts of the world with similar population densities to Melbourne have seen exponential increases with thousands of cases a day, Meyorwitz-Katz says.

"I understand people's frustration that they're making these sacrifices [but] without these actions, if we had everyone still mingling like we were a few weeks ago, we would expect to see far more numbers than we have seen already."

He says the continued rise in cases is probably a sign that a lot of people were infected early on in the outbreak, and the after effects of that are still trickling through.

"Most likely, what we're seeing now is an artefact of the last few weeks and we would expect those cases to stay at this level for a while longer, I would guess, because these people were infected not today, not yesterday, but maybe even a week ago or more," he says.

"It's really a matter of patience."

As for why it's happened in Victoria? Bad luck, for the most part.

"Unless you have zero circulating cases, which fortunately some states in Australia have managed to maintain, there's always the potential, even if there's a very small risk, of having an outbreak. But it can happen.

"I think it could have happened anywhere."


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