NSW COVID outbreak is like a bushfire, not a war

How to fix the 2021 NSW COVID-19 crisis. And why it won’t happen

Fed up with the daily dose of absurdity emanating from the NSW authorities (evidently, so is the Premier), I decided to write a plan for fixing the COVID-19 crisis and getting the state out of lockdown. But nobody listens to me, so it won’t happen. In short, it’s a bushfire, not a war, and it’s time to start fighting it like one.

As a start, I’m aware this is just a blueprint and would need to include more specific details on how it would work. The only problem is it needs to happen now, not next week or next month, it needs to happen immediately. Happy to join the NSW COVID-19 response team as an advisor any day of the week if the opportunity presents itself.

Before we dive in, have no illusions – going from zero COVID to a large-scale outbreak resulting in hospitalisations and deaths as we have seen during the past three months is tantamount to criminal negligence worthy of a Royal Commission. The gross failings of how we got to this point from June 2021 are as astonishing as they are inescapable:

  • It was a failure (at multiple levels) to let it in
  • It was a failure not to lockdown sooner and harder
  • It was a failure not to protect the regions
  • It is a failure not to do more to prevent further seeding and spreading (which continues to the time of this writing)

Dying of old age and infanticide are two very different things, as are lightning strikes and arson attacks. It is possible the SARS-CoV-2 pathogen will become endemic within the human population, but that’s not what this is about. The 2021 NSW outbreak would have to be one of the greatest public administration disasters in the state’s (if not Australia’s) history and the line of “learning to live with COVID” is now being used as an excuse for the multitude of failures. There will always be bushfires too, but does that mean we just sit back and play the fiddle?

Now for the post mortem and, hopefully, an extinguisher.

Playing with fire

My, oh my, what a mess. As I commented last year, with the information and evidence the authorities had at the time there was no reason for NSW to accept so much risk with its COVID response. Short, sharp lockdowns would have been effective in quashing the virus and the economy would’ve re-emerged accordingly.

NSW was playing with fire and when you play with fire you get…

The fact NSW was able to successfully test and contract trace its way out of the last two major outbreaks has come back to hurt us big time.

Now we’re the victim of our own “success”. I say “success” because at the time the voice from the healthcare industry was almost universal in taking a harsher stance more towards elimination rather than “managing” outbreaks.

Don’t burn the messenger

If I am going to offer some free advice, let’s go back to the beginning of this outbreak.

The aircrew loophole has been there since the start of the pandemic. Aircrew coming to Australia were known to be testing positive yet permitted to enter the community with little or no quarantine. Now, 18 months later, there appears nothing was learnt by federal and state authorities.

The process for quarantining aircrew should be patently obvious:

  1. Step off the flight and be asked (very politely) to put on full PPE by federal border protection security staff (or defence force security staff).
  2. Be escorted into a separate bus and transported to a separate hotel or quarantine facility
  3. They are not allowed to leave for the duration of their stay, guarded by force
  4. Repeat the process for the flight back

The federal government can only wipe its hands so much when it comes to border protection.

Sure, the states were tasked with managing the COVID quarantine process, but administrative functions like defence, border protection, customs, biosecurity and flights in an out of the country fall under the remit of the federal authorities.

With that in mind, how we went from witnessing a raging pandemic overseas to three aircrew workers jumping into a private limousine and transported to a hotel by an unvaccinated limo driver is mind-boggling. Is anyone able to answer that question?

You can blame the limo driver all you like, but the reality is he should never been put in that position in the first place. Incidentally, there is a rumour within the healthcare community that aircrew seeded the 2020 Northern Beaches outbreak as well.

Planting seeds in a tinderbox

With that level of mismanagement in our midst, the torch was passed onto the NSW authorities who had information about the first seeding events in the eastern suburbs.

WhenThere could have easily been many more cases than det ected by June 30 it was first detected the economy was in motion and people were moving all over the place providing more than enough time for the highly contagious Delta variant to spread far and wide.

The problem was they wrongly assumed it was only a handful of cases. There could have easily been multiple seeding events and dozens of cases by late June – they were just asymptomatic. Those one or two early cases were more like 10 or 20 cases active in the community.

It’s wrong to assume anything in life, but when it comes to virus outbreaks the only thing safe to assume is there are more active cases than what is discovered. Anyone who has lived in Sydney will tell you Bondi and West Hoxton (where? One of my first computers was purchased in Hoxton Park, so there!) are a long way apart. Within about a week there were transmission events in both locations. Such an fast geographic distribution of cases should have sent alarm bells screaming like fire engines.

As an aside, if you look at the data on the early days of the Sydney outbreak, and compared it to other states, caution must be used as it’s not a straightforward comparison. At the time, Sydney was playing a huge game of catch up and only seeing the cases while well on the back foot. In contrast, the other states were already primed for cross-border transmission with a view of Sydney’s outbreak.

The contact tracing lit up

While we’re sifting through the mess, let’s take another look back at the origins of some of the weaponry used to fight the virus in NSW.

The state might have the best contact tracing team in the world, but that doesn’t mean there aren’t physical limits to the process of contact tracing, combined with other problems.

Contact tracing works by identifying cases, interviewing people, determining where they have been and what contact they have had with other people. Then those people and the wider community are notified of the exposure.

If the testing, contact tracing and isolation (be it forward or backward) can keep up with the transmission of the virus then contact tracing will work. Put simply, if the effect effectiveness ratio of contact tracing is, say, 1:2 and the virus spread is 1:2.1 (or greater), then no amount of contact tracing will keep up with the rate of transmission.

There are other fundamental challenges with contact tracing, mostly related to getting the right information out of people. Getting information from the public is notoriously difficult, especially when they are under the duress of being a possible virus spreader.

That’s why the use of lockdowns is especially pertinent when you have no community transmission – it should be seen as a tactic to complement contract tracing, not replace it. In summary, contact tracing will always be important, but it should not be relied on as heavily as it was by NSW.

It’s a bushfire, not a war

An analogy the Premier’s office has chosen to compare Sydney’s COVID outbreak to is a “war”.

Well cosmic button-pusher help us if there ever was a war, but let’s take a big step back and compare to something closer to home we can all relate to – a bushfire – and it’s therefore time to start fighting it like one.

When fighting a bushfire, you take immediate action use whatever tools are available to you to contain, suppress and mitigate the spread. And you use a combination of tools concurrently. This includes technology; such as water bombing, and processes; such as restricting movement of, and evacuating, people.

To stamp out the bushfire of COVID we need to do everything we can, and this includes lockdowns, travel restrictions and vaccinations.

Gathering around the lockdown

If there was ever an Olympic sport on how not to perform a lockdown NSW just won gold by a country mile.

Unfortunately, there was yet another problem with the way NSW authorities handled the outbreak. There was a “Clayton’s lockdown”, or “mockdown”, from the start: it was not expansive enough; differed between local government areas; was not clear about essential work or services; and had many obscure details on what people can and can’t do.

The list of inconsistencies just went on and on – you couldn’t see a medical specialist, but you could swan around a department store to buy furniture – and all that did was help the virus spread to the western suburbs.

And it showed in the behaviour of the people – they were watching a lockdown, not part of it. Since the start, restrictions have been progressively getting tighter with little to show for them. The horse had bolted.

To be most effective, you are supposed to work your way out of a lockdown, not into one. Going hard with “Stage 4 restrictions” across the entire state from the start is a far, far better approach than a gradual “easing in” of restrictions.

A stay at home order is exactly that. It’s okay to shut everything that opens and shuts for a short time to break the chains of transmission. As we saw in other states, even three day snap lockdowns were effective in preventing the spread, so long as you do them at first sign of community transmission.

And, as I wrote about last year, there are things which can be done at the first sign of a case in the community that don’t have a significant impact on the economy. For example, despite the raging case load, NSW only mandated mask wearing more than two months after the first sign of transmission – Queensland did it to coincide with a snap lockdown at the first sign of community transmission.

Also in the mix of daily rhetoric from the Premier’s office was compliance, or lack thereof.

Even if you ignore how badly the creep into lockdown was handled – thus implanting a psyche that the people are not really in a lockdown – any notion that an administration system should rely on people to “do the right thing” during a crisis is absurd.

On the one hand there are offences with penalties, yet on the other we all need to “do the right thing”. Well, what is it? Back to our bushfire analogy, people are restricted by force from going into bushfire-stricken areas because people will do insane things like that, regardless of all the warnings in the world.

If it makes sense to have non-negotiable restrictions, such as a ban on movement, then have them.

A ring of steel around Sydney? Silly slogan, sound strategy

Like scouts around a campfire, many, including the once-bitten Premier of Victoria, called for a “ring of steel” around Sydney. If you can get over the cheesy analogy, it is clear that preventing seeding is imperative to controling the pandemic.

Australia’s state border wars – as harsh as they are – are the reason why we haven’t had a nationwide uncontrolled outbreak after the first wave.

Not protecting the regions from Sydney’s COVID outbreak is like saying: “There’s a raging bushfire in Sydney, but we will just let it burn to the regions and not do whatever we can to stop it.”

Any fire chief who adopted that strategy would be summarily booted out and charged with criminal negligence. I this case, they’ll just blame the Delta variant or something.

If you look at how the virus made it to the regions there are some remarkable trends. The NSW Central Coast, just north of Sydney, was included in the wider Sydney lockdown, while the Lake Macquarie and Newcastle-Hunter regions to its north were not.

When spill events occurred to both regions, the spread was far less on the locked-down Central Coast than it was in Newcastle-Hunter. The virus had effectively “jumped” the Central Coast and made its way Northwest from there.

Before I talk about what needs to happen to fix this mess, it is worth reminding ourselves that people are supposed to be following these rules already, so it’s by no means any more inconvenient than what they already must deal with. And as we will see, it will lead to greater freedoms for those who do follow the rules.

Establish regional containment lines

First thing’s first. All public transport services in and out of Sydney should cease and be replaced with ticketed buses where people must have a purposeful reason (traveling to a home region) and test negative before stepping on one.

As a start, each regional LGA should be treated like a state

Then they need to do 14 days home quarantine and get tested when they arrive at their regional destination.

Like the pitiless closure of hospitality businesses, this is not the time for commuting into work and building and construction are not exceptions. People who would ordinarily commute to work in Sydney need to either work remotely or look for work outside of Sydney, and vice-versa.

The next step is to toss up roadblocks at all the main entry ways into the highways to the regions.

It might not be practical, or desirable, to block off the main arteries like the M1, but it is possible to filter traffic before it gets that far. In the case of the M1 and old Pacific Highway, these can have roadblocks at Wahroonga and Asquith, respectively.

At the closest point to Sydney as practicable, these roadblocks function as COVID “checkpoints” and if you don’t have a permit and negative test you get turned back. No excuse at a checkpoint will suffice.

At the other end, it should be relatively easy to restrict access on the tributaries to each region and if someone fails to provide a damn good reason why they should enter, they are noted and sent back. Again, this is a two-way system. People in the regions would be subject to the same restrictions for traveling to Sydney to clamp down on any possibility of re-seeding.

In short, travelling to and from the regions would be a similar process to travelling interstate.

From a ring of steel to a grid of steel

The containment lines don’t end there. Where do we go from the ring of steel? We work our way in and restrict access to and from all the local government areas (LGAs) in the Sydney region.

Yes, you read that correctly, the state police in conjunction with LGA traffic control, emergency services and the ADF, would toss up hard borders and checkpoints between each LGA, or, at the very least, two contiguous LGAs where it isn’t practical to split them.

I grew up in the Liverpool-Fairfield-Parramatta corridor and it might make sense – depending on factors like case load – to amalgamate one or two like LGAs to stop the spread, but generally the smaller the area, the better.

All major arteries would have checkpoints before you get on them and smaller “back streets” can be closed by the LGAs with barricades and temporary fencing – operation “Stay at Home” will be succeeded by operation “Stay Safe in Your LGA”.

It should be virtually impossible to move between LGAs during this crisis.

Moreover, all inter-LGA public transport services would cease, replaced by ticketed and test-friendly buses.

As noted, the borders between LGAs (and the regions) would be hard, not soft. It would be virtually impossible to get from one LGA to another without a permit and negative test. Going to another LGA, or region, would be like going to another state. You would have to test, quarantine, and then re-test.

It also won’t matter how close the LGAs are, or whether they are contiguous. As we see from Sydney’s geographic distribution of cases, many areas are on fire, yet neighbouring LGAs are almost COVID-free. Recently, a positive case caught a train from Sydney to the Central Coast. I thought people were meant to be staying at home?

If about 85 per cent of cases are being found in a handful of LGAs then it makes sense to contain them to prevent large scale seeding once restrictions are inevitably eased.

Each LGA would be designated a status:

  • Red: Infections are increasing
  • Amber: Infections are stable
  • Green: Infections are decreasing and/or all known infections are in isolation (some regions are still COVID-zero BTW)

To cite one example, if you live in Penrith, which would be designated as a Red zone, it will be virtually impossible to travel to the Blue Mountains even though it is a contiguous region. To use the Northern Beaches as another example, it would be designated Amber and it would nigh impossible to get in or out without a state-like permit and quarantine process. During this time, cross-LGA movement would be essentially limited to critical services. For example, a dentist or carpenter who lives in Parramatta, but works in Manly would be refused a permit.

With everything locked and loaded, we do a short, sharp full lockdown for 14 days. Everything except essential services like food production and distribution, healthcare and utilities is closed, including beaches, parks and take away restaurants (financial support available, of course). Sorry, construction and trade work would also cease. In the event of an emergency, people must notify the authorities.

I don’t want more lockdowns, but if you are going to do them, they need to be done properly. To get people on board there could be a financial incentive as well. something along the lines of, if you stay at home for 14 days you get a cash payment.

In the case of groceries or fuel, the shops need to have a “store front” system where people must place an order and pay at the door without entering the building. We do know transmission is greatly reduced outside (not 100%, but certainly noticeable) so let’s put an end to this farce of people window shopping for groceries. During the 14 stay at home time, there could also be limits on how many trips you get for essential items – two should be more than enough.

With the nuisance of rule breakers (and the potential for a catastrophic mass seeding after lockdown!) out of the way, we can focus our attention on testing and vaccination in the areas of concern and the workforce most likely to transmit the virus.

Of course, there will need to be some exceptions to inter-LGA restrictions, such as truck drivers and emergency services personnel, but that doesn’t mean movement can’t be managed more prudently than what is done now and strengthened as needed.

An Australia Post truck driver can do his or her job transporting mail to another LGA or region, but in addition to routing testing, PPE and vaccination support, there must be a strict protocol to abide by. Even things like separate rest stops for transient workers should be established by the regions.

If a worker drives from Sydney to Bowral for essential services the person can’t just swing around town, sip a latte and do some boutique browsing while they are there – that would be a dismissible and punishable offence.

Workers and citizens can be classified as such:

  • Transient: someone who is more likely to seed (truck driver)
  • Interactive: someone who is more likely to spread (school teacher)
  • Solo: someone who is low risk (IT pro working from home)

To open safely there is likely to be some form of two-speed economy in NSW, but that’s better than many thousands of more cases and a potential collapse of the healthcare system.

From barricades to testing and traffic lights: the road out of lockdown

With the grid in place and a proper lockdown over, it is time to think about re-opening safely.

While I strongly believe we should have had a zero-COVID policy all along (there was no reason not to, and NSW would be like QLD now) if we have back burning going on, then it should not turn into a bushfire of its own! And after a proper stay at home period it’s very possible that some regions will return to zero cases.

This is where the traffic light system comes in to its own.

The road out of lockdown: Contiguous regions with the same risk profile can be linked for work and travel.

Regions and LGAs can start to reopen and connect with each other provided they are green and continuous. A person can’t travel from a green region to amber or red region, but travel between green regions is fine.

In the case of the Central Coast and Newcastle-Hunter, if the Central Coast is properly protected from Sydney then there is no reason why there can’t be a green light for those two regions allowing, for example, tradespeople to perform work across regions without a permit.

The LGA-led economy will start and the COVID response – including vaccination, testing and isolation – can be focused on the LGAs of concern. And even if the LGAs of concern started to see further spikes, at the very least they would be contained and manageable.

One state MP, John Barilaro, sees a near future where NSW can begin to open up again, albeit in “patchwork fire blanket” way. But it will need to be tightly controlled!

Another tool we have available to help with the recovery is testing. What we haven’t seen a lot of throughout the pandemic is proactive, surveillance testing.

The failure not to promote testing as a means of getting ahead of the virus ranks right up there with the ignorance of assuming there was little or no airborne transmission.

If the authorities were serious about stopping the spread they would push testing and isolation as much as vaccines. The messaging is and always has been “get tested even if you have the slightest of symptoms”.

We would be better served with messaging along the lines of “of you are in a position to transmit you need to get tested weekly”. Going back to our types of worker, if you are a transient or interactive then you need to get tested as part of your role.

Testing means discovery, isolation and less transmission. They keep babbling on about how many cases of COVID are asymptomatic, yet only recommend testing if you have symptoms. An asymptomatic disease calls for asymptomatic testing – especially among people who are most likely to spread it.

With the traffic light system people who do get tested and vaccinated can be rewarded with travel permits to the regions: A test before you leave, a test while there and a test when you return.

I wrote this because I want people to know for every problem there is a solution. As hard as it is (and not inconsistent with what people are supposed to be doing anyway) there is more that can be done to manage this crisis.

This plan also serves as a blueprint for managing localised outbreaks. If there was an outbreak one part of any large Australian city then it makes sense to restrict movement in and out of it, which we have done many times during the pandemic, albeit without as much force as would be required with Delta in our midst.

At the time of writing Victoria is grappling with a stubborn case load of several hundred per day. It could adopt the grid and traffic light system across greater Melbourne and the whole state to keep case distribution in check.

The Premier (and disturbingly quiet Prime Minister) can’t be serious if they think we shouldn’t do more to contain the spread at this point. If we start easing restrictions now the stage is set for an enormous cataclysm, when one giant “cat” is let out of the bag. Even if we never get back to zero COVID, doing more to prevent seeding and spreading will buy us time! It will also enable more options for focusing vaccinations and other countermeasures in the specific areas that need them.

I want the Premier of NSW to be the leader she is capable of being. True leaders don’t change the rules just because they can. They admit they made mistakes and do everything in their power to correct them, including using the best advice they can get.

Only two things need to be done to control the pandemic – stop seeding and stop spreading – and the directives and mysterious “health advice” of the past three months have failed to achieve either.

To recapitulate, here is the Premier’s to do list for September-October 2021:

  1. Immediate closure of all public spaces and non essential services, including beaches and fast food shops
  2. Stop all inter-regional and inter-LGA public transport services, replace them with emergency buses
  3. 14-day stay at home order (you can only leave to get vaccinated, buy food up to 2 times or in an emergency, financial incentive available)
  4. Supermarkets and malls operate “order from outside”
  5. Roadblocks to all major highways and inter-LGA links
  6. Once the proper lockdown is over, replace “Operation Stay at Home” with “Operation Stay Safe in your LGA”
  7. Start a traffic light system where you need a permit to leave your LGA and need to test, quarantine and retest.
  8. You can’t commute between LGAs for any type of work except for emergency services, and in the case of the CBD you will need a “CBD work permit” so we know exactly who is leaving their LGA.
  9. Focus vaccination efforts in the hot spot areas, including drive through clinics
  10. Plan for a more controlled roadmap out of lockdown

Once that is done (which would last until about mid-October) we can start allowing people to leave their LGA for personal reasons, including holidays, but they must test negative twice and get a permit.

Instead, the NSW and federal authorities have opted to collude on brainwashing process that we all need to “learn to live with the virus” and that “vaccination is out ticket to freedom”.

In my next post I might cover the false sense of security with vaccines and if you think they are path to freedom from an epidemiological standpoint then be sure to prepare the paediatric wards first.

About the author

IANAE! (I am not an epidemiologist)

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