If we went back two months, “epidemiologist” was a word you might need occasionally to complete a crossword. But now we hear it all day long. Throughout each day, we see and hear people who with a few exceptions, have never been household names. Most prominent have been Brendan Murphy, the chief medical officer and secretary of the Department of Health and Aging; his deputy, Paul Kelly, as follicularly challenged as his more famous musician namesake but lately also bringing us daily salve in the form of hopeful news about falling new cases; and the peerless Norman Swan, for 35 years the presenter of ABC’s The Health Report, mandatory listening for all seriously interested in evidence-based health and medicine.
There’s also Professor Raina McIntyre from UNSW, a global expert in pandemic epidemiology; state chief health officers like NSW’s Kerry Chant, also with post graduate qualifications in public health; a phalanx of highly connected mathematical epidemic modellers; and many, many others working tirelessly in the background to fast-track testing, obtain personal protective equipment for front-line health care workers, contact tracing, record keeping, and scientists working in vaccine development.
The daily ritual for many of us in checking bookmarked data sites mapping the COVID-19, pandemic has lately brought huge relief. The chart showing newly confirmed cases is the first we click on. Since hitting a peak of 450 new cases on March 28, Australia has seen almost continual daily falls, with an average of 37 a day reported in the last 10 days, a fall of 413 or 92% off the peak.
While it is very early days, and while cautions about possible upswings if we take our foot off the brake too quickly are deadly serious, these encouraging data look very much like a trend. There are key signs that we are getting on top of this thing, quite fast.
The decline is exactly what our newly limelighted national heroes, the public health experts advising the government and communicating with the public, would have hoped for. If it continues, and does not dramatically bounce back when isolation is eventually relaxed, it will go down in our history as a triumph of evidence-based health policy, the lessons of which deserve to be indelibly seared into the national public and political DNA.
What are some of these lessons? First, if it ever needed saying, this is a dramatic, thundering reminder that health protection and prevention can avert national catastrophes. In medicine, the “rule of rescue” has for decades dominated health care resource allocation and political urgency. This rule states that those in need of medical attention will always take primacy over vague backroom recommendations from faceless committees about how we might prevent people from needing medical attention in the first place.
Public health (health protection, prevention and education) has long been the Cinderella of the health services. Next to high tech treatment centres, it has drab offices, much less than 2% of the health care budget, and few prominent individuals to fight for its goals. Unlike treatment with its memorable patients, its waiting lists are unnamed statistical victims who will need health care in the future, if prevention fails. Prevention can often wait for the next budget. Treatment cannot. This might well change for good, thanks to COVID-19.
Second, Australia’s likely success is a reminder that Nanny State policies and interventions for public safety are politically hobbled and denigrated to our great peril. Never in anyone’s living memory have we seen more draconian measures here than we are all living with today. With each new ratcheting up of social isolation edicts, we have heard pin-drop silence from the doctrinaire civil libertarians. The National Cabinet of conservative and Labor leaders are behaving like a socialist politburo and everyone is applauding them wildly.
Nanny is not just good for us, she is yet again saving many, many lives. Meanwhile, the libertarian right remain in the brace, foetal position, seeing their dogmas collapsing around them.
Third, the truth serum of science and evidence being force fed to our political leaders seems likely to have lasting impacts in tempering the global creep of anti-science. As former Liberal leader John Hewson put it, the coronavirus story is a dress rehearsal for what happens if governments continue to ignore science. Its few remaining carnival barkers in parliament have been struck a fatal blow with the political unanimity across all major parties. The last memorable time I recall this happening was when the Opposition fully supported the Gillard Labor government’s plain packaging bill way back in 2010.
And next, the widespread population-wide embrace of social isolation, and the stories of untappable geysers of community support and care for those doing it tough may be rejuvenating communities, in many wonderful ways. We are enduring the deprivations not just for the sake of reducing our own risk, but because suddenly we all understand that Margaret Thatcher’s infamous “no such thing as society” has deadly, dehumanising consequences. It feels very good to be living among a resurgence of such values. They will resonate well into the future with progressive policies right across government.
Australia’s achievement is simply remarkable
In 2018, Australia 158,493 people died from all causes. So far, COVID-19 has claimed 74 Australian lives, at a median age of 79 (which is around the same as all-cause life expectancy). Australia has 261 cases per million population and 3 per million deaths, while Spain – at the moment the nation worst infected on a per capita basis — currently has 4367 cases per million people and 455 per million deaths, 17 times our per capita rate of cases and 152 times our death rate. These are just remarkable differences.
In 1996, I wrote one of my columns in the BMJ on the paradox of prevention. I wrote:
“That’s the paradox with prevention – it works when nothing happens. People thank doctors for performing a lifesaving operation, but if they grow up without being badly injured or without taking up smoking and developing emphysema they are seldom thankful for the preventive actions of people who bore the brunt of public anger about inconvenience years ago.”
Our infectious disease prevention heroes deserve our greatest thanks and support for all they are doing. As of course do our thousands of front-line health care staff. We’re not just some lucky country. We’re a public health vanguard country, setting standards for the world.