The sobering reality of opening up

Lisbeth Latham

In recent weeks, political and media commentary about the COVID-19 pandemic in Australia has focused on the question of when, in the context of growing vaccination rates, the country should consider ‘opening up’ (in this context a permanent and total break from lockdowns).

This discussion conveniently ignores the reality that the situation in Australia -particularly in NSW and Victoria - is increasingly out of control and, consequently, neglects the more urgent questions of what should be done now. Despite the situation in NSW, the state government is pushing ahead with its plans to lift restrictions for the vaccinated leaving many of the poorest and most culturally and linguistically diverse local government areas in lockdown[1].

Are Lockdowns sustainable?
This is not a simple question. Nonetheless, it is the case that there is a limit to how long the current lockdowns can be sustained. This is due to the insufficient support being provided to those in the most economically precarious circumstances. This lack of support, which has only worsened as the pandemic has progressed, only serves to punish workers whose work has enabled communities to lockdown in the first place. If this was addressed, the capacity to maintain lockdowns would be expanded, yet at a certain point key sectors of the economy - those necessary for sustaining lives - would also be disrupted. Luckily, no one has ever suggested permanent lockdowns. Instead, governments have advocated for lockdowns of sufficient length to suppress the virus to levels that enable us to protect lives and health.

Mental Health
A major argument against lockdowns has been that they contribute to community mental health concerns. There is no doubt that lockdowns are tough; loneliness and isolation are significant predictors of mental health problems and lockdowns are often very lonely experiences. In addition to these commonly shared impacts, many people are experiencing additional stressors. These include the constant threat of infection; concerns around income loss and the cost of living; relationship stress arising from home confinement; and supporting and caring for children with little to no understanding of the restrictions’ purpose or necessity

However, much of the media discourse around mental health feels disingenuous, many commentators seem to believe that lockdown is the only cause of the current strain on the mental health system and that it’s lifting the only solution. Such commentators conveniently ignore the range of support mechanisms that could be further deployed to support community mental health. Furthermore, their constant depictions of lockdowns as wrong and corrosive are demoralising and may negatively impact people’s ability to cope and persevere. Lifting the lockdowns in the context of widespread community transmission is a recipe for mass infections and large scale death - both of which would devastate communities, particularly when the people dying are your loved ones. Too often media discourse around the psychological impact of lockdowns is nothing more than a cynical exercise aimed at building pressure for opening up, with little or no consideration for people’s actual mental health.

Debate in epidemiology
From the beginning of the pandemic, there have been notable discrepancies in the advice being given by epidemiologists regarding the preventative measures that should be applied to minimise the spread of COVID-19. To an extent, these differences should come as no surprise; COVID is a novel virus and it took time for the mechanisms via which it spreads to be fully understood. Furthermore, with professional reputations at stake, it is unsurprising that many experts have doubled down on their own position or attacked the conflicting opinions of their colleagues. The additional seduction of building a media profile by publicly endorsing or criticising government position(s) has not helped matters either. Nonetheless, a much bigger debate has unfolded within epidemiology throughout the crisis. This debate centres on how and when to make judgements about the adoption of various preventative public health mechanisms. On the one hand, epidemiologists from the “medical-based evidence” camp have resisted adopting measures without conclusive evidence that supports their value or efficacy. These experts argue that the potential cost of such mechanisms far outweigh any benefits - benefits which they say are at best unproven and at worst, nonexistent. On the other hand, were the epidemiologists who argued that, in the context of a major global public health crisis, it was neither possible nor prudent to simply wait for the evidence to come in. For these epidemiologists, adopting measures such as masks and social distancing was essential because their potential to curb infection risk far outweighed any potential costs, most of which were financial. This debate has occurred publicly, most noticeably in the Boston Review, but also in the exponential increase of opinion pieces and media interviews with epidemiologists regarding not only what actions work, but also what level of effectiveness is worth the social and economic cost. Early in the Pandemic, in response to statements by Bill Gates that “COVID was a once in a lifetime pandemic”, Stanford University epidemiologist John Ioannidis wondered if the coronavirus pandemic might rather be a “once-in-a-century evidence fiasco.”

I’m not in a position to judge the scientific merits of the modelling, but it is important to recognise that these judgements are not purely objective, but informed by subjective judgements regarding how we ought to weigh threats to life against the economic impacts of policy options. I personally stand by the idea that preserving human life and health is where we need to place our priorities - not only because saving lives is the whole point, but also because of the harmful impacts mass illness and death have on people’s livelihoods and the economy at large. Those who prioritise the economy at the expense of human life are not only lacking in empathy but have an unaccounted for, built-in error in their calculations.

Vaccinations: are they a magic bullet?
Since the emergence of viable vaccinations for COVID - public discourse has shifted towards the idea that the way to deal with the virus is to focus on mass vaccinations and that a vaccinated population would effectively eliminate the need for lockdowns. This argument has a number of flaws. First, reaching mass vaccination has been slow. This is understandable, since achieving mass production of vaccines takes time. In particular, the mNRA vaccines such as Pfizer and Moderna are essentially new technologies, meaning that whole new production and supply chains have had to be created from scratch.

Related shortages in production have contributed to and exacerbated the uneven distribution of vaccines globally. This is not just devastating for those populations left unvaccinated and who are left more vulnerable to infection and death; the mass transition also creates much better conditions for the mutation of the virus and is associated with the development of new strains, some of which may be more infectious, more deadly and/or more resistant to available vaccines. For this reason, it is essential that overcoming global inequalities in vaccine distribution becomes a priority for all rich countries, including Australia - not just as an act of solidarity (though this should be the primary driver) but also as an act of self-preservation.

In addition to the problem of vaccine inequality and the associated risk of new and increasingly deadly strains, much of the discourse around vaccination has overstated the effectiveness of vaccines in preventing infection, illness, and transmission between and among populations. While the effectiveness of vaccines is uneven, no vaccine for any illness delivers these outcomes. This disjuncture between promise and reality has thus lent undue credence to bad-faith actors, expanding and legitimising opposition to vaccinations and lockdown. Opponents, therefore, argue (or at the very least imply) that inaction is preferred to measures that cannot guarantee a 100 per cent success rate.

Still, the reality that mass vaccinations will not eliminate the virus has done little to impede the proliferation of media commentary linking mass vaccination to “opening up”. Instead, it has led to a growth in public discourse about the need to “live with the virus”. Such discourse initially relied on technically true statements that the vaccine would make it less likely for the vaccinated to get infected, to become seriously ill, and to die or infect others. Yet as concerning levels of infections continue to be recorded in countries with much higher vaccination rates, the rhetoric from a section of capital, political parties/leadership and the media have attempted to normalise infections and COVID-related deaths, arguing that these are acceptable price pay for ending “unsustainable lockdowns”. This push has, in many cases, been heavily reliant on modelling by researchers at the Doherty Institute whose research has informed the National Plan to transition Australia’s Covid response. What is clear is that this modelling is inadequate, but also that even the most optimistic projections include much higher levels of infection and death than Australia's previous strategy ever contemplated. Moreover, it is also clear that many of the assumptions which underlie this more optimistic projection, such as effective test, track and isolation mechanisms do not currently exist. Australians are thus being softened up for precisely the horrors seen in other countries - horrors which our collective sacrifice of lockdowns was aimed at avoiding.

This pressure is not new. It has been at play in Australia since the start of the pandemic. The idea that the economy should be prioritised over life - a position that was resisted not only by unions, but sections of capital, and most importantly some of the state and territory governments - most notably Victoria, WA, and Queensland - has drawn persistent attacks from large sections of capital, the media, and the LNP. This is despite the complete failure of their preferred model. Thus these ongoing attacks are not only bad in terms of their intent or potential outcome but are divisive and demoralising, sapping people’s reserve of endurance and tolerance. Lockdown is hard enough without constant reminders that it is too hard, unnecessary, or the supposed fever dream of a crazed dictator. While those who think lockdowns are horrible but necessary are unfairly denounced as mindless cultists, such discourse continues to create fertile ground for the conspiracy theories being actively spread by the far-right.

Human Rights
Questions surrounding the implications of lockdown measures for human rights, including the most appropriate means for convincing people to adhere to public health measures have also been a constant topic of debate. There is no doubt that the impact of lockdowns has been uneven, with race and class location significantly impacting certain populations' experience of not just lockdown but also some of the more repressive measures deployed by governments in the name of public health. For this reason, there need to be not only more and better resources allocated to support those in lockdown, but also increased accountability and scrutiny of the actions of the police. Having said this, focusing on the rights of individuals to not be impacted by the state ignores the intent and positive consequences that such health measures have on reducing infection rates. Protection from potentially life-threatening and debilitating illness is also a significant human right and in weighing these two rights we need to form a judgement about where to place our emphasis. In this respect, I am firmly in favour of preventing loss of life and promoting health. Public health orders play an important role in achieving this goal, and in order for them to be meaningful, there need to be consequences for breaching them - consequences which also must be appropriate, proportionate, and consistent in their application.

Pressure on public health
Part of the discussion regarding the response to’ COVID-19 has focused on pre-existing problems in public health systems, both in Australia and across the globe. These critiques point to the impact that decades of underfunding have had on public health systems as part of the neoliberal transformation of our societies. This transformation has effectively reduced both the available staffing in frontline and support roles and the number of available beds. It has also meant that, despite long-standing concerns regarding the risk of an emergent pandemic, little was done to prepare for it. These are important critiques. Nonetheless, it is important to recognise that even in the most ideal situation COVID, with its high level of infectiousness and increased risks of hospitalisation and long term complications, would have been a challenge. This can be seen that globally, despite the different capacities of health systems globally, as well as the different suites of policy responses have had varying degrees of horrific outcomes with a few notable exceptions.

Concerns about lifting lockdown restrictions prematurely
This concern is based on the fact that there is only a narrow margin for error and getting the timing and details wrong would put significant pressure on the country’s already strained health care systems. The reality is that while decisions about how hospital beds are used can be made quickly, simply designating additional beds for ICU or ventilation isn’t sufficient. In order to make these arrangements work, hospitals need additional qualified and trained staff - and those staff simply don’t exist. The Victorian health unions went further on September 17 released a joint statement which included: 

‘‘This has been a long, tough and incredibly stressful 18 months for healthcare workers. The impact on their mental and physical wellbeing has been huge. We need the Premier to hold the line and maintain strong public health measures to help keep the pressure on the hospitals and the healthcare workers as low as possible. We must stop counting bed capacity and start looking at healthcare worker capacity, both mental and physical. Healthcare workers are at breaking point. You have no health system without health professionals to run it”.

So, what are we to do? It is true the current lockdown will eventually need to end. However, the question of when and how must be contested. While rates of community transmission remain high you can’t substantially weaken the provisions without also substantially increasing the level of vaccination rates in the community. Even at this point, the measures need to account for and seek to protect those sections of the community that are unable to be vaccinated. This means that most of the social distancing and PPE measures that have been in place for the virus will need to be retained, at least at some level, for the foreseeable future. Finally, we should not accept the idea of a permanent end to lockdowns. In the event that infections rise again, we must continue to look to lockdowns as an option to protect people and to safeguard health care systems which, if overwhelmed, would exacerbate the possibility of further (and otherwise preventable) loss of life.

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1 As a disclaimer, it is important to acknowledge that, like the vast majority of commentators in Australia, I am not an epidemiologist. As such I will not attempt to interpret models or do my own modelling, instead, I seek to simply explore issues that I feel are being overlooked in the current discussion.

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