The 4 lies of COVID-19 in Australia
I like the Doherty Model.
Not that anyone needs my validation of it, but I think it’s a clear and honest piece of work. I’ve now spent a fair bit of time understanding its constraints and limitations, and the results of the Model actually give me hope about our ability to take our first steps toward a “COVID safe” future.
What doesn’t give me hope is the way certain politicians are talking about the Model and how they seemingly intend to use it to justify decisions that are wholly unsupported by the Doherty Institute’s work.
First up, it’s important to acknowledge what the Doherty Model is. Two points stand out to me:
It’s a next step Model – the Doherty’s work only looks at the transition from Phase A (current) to Phase B (ongoing low-level restrictions, some lockdowns, border caps, etc) of the National COVID-19 Response Plan. It says nothing about the transition to Phase C (further lightening of restrictions, targeted lockdowns, more international travel), let alone Phase D. Nor should it. There would be very little point in Modelling the transition to Phase C until you have the data from the Phase B implementation, which could seriously change assumptions – for better or worse.
It’s an acceptable losses Model – there’s been a lot of focus on the conclusion that we can move to Phase B when we hit a 70% vaccination rate. But what does 70% actually buy us? The core idea of the Model is that we maintain case counts “around some average level”, being a level that is below the health sector capacity. In Phase B, with our 70% vax rate, we are able to maintain “some average level” of cases by oscillating between a base of low-level restrictions with occasional stricter restrictions and lockdowns (somewhere between 0-20% of the time). The Model, however, doesn’t recommend what that “some average level” should be – it simply says that cases numbers shouldn’t get significantly worse than that average if we do these things. Setting the level (and the losses that arise from those cases) is up to the politicians. This is why we hear Vic Premier, Dan Andrews, talking about “thresholds” and setting “the low number that we can cope with”.
So why does this matter?
Because some of our political leaders may just be telling pork pies about the Doherty Model to justify what they see as politically or ideologically desirable decisions.
Lie #1: It’s safe to open up at 80%
The NSW Premier, for one, is reported as referencing the “national plan” to end lockdowns at 80% vaccination and arguing that the Doherty Model deems it safe to open up at that point. Firstly, the national plan says no such thing. Even in Phase C targeted lockdowns are still part of the response suite.
As for what Gladys says about the Model: a lot depends on what she means by “open up”. She is either showing uncharacteristic restraint or reckless misunderstanding of the data.
If “open up” means moving to Phase B, my question is this: is Gladys suggesting NSW might now hold off implementing this transition until the state hits 80% (rather than the planned 70%)? This might be reasonable given the high case loads, and would be a remarkable shift of attitude from the NSW Premier.
Hands up everyone who thinks this is what Gladys is talking about?
So, if “open up” means moving to Phase C, the Doherty Model categorically does not show that it is “safe” to do so at 80% vax because, as discussed, the Model never considered the transition to Phase C. In this context, arguing ‘Doherty says it’s safe’ is a complete fabrication.
80% may indeed be proven to be right. It’s certainly a number that feels about right – strangely it has long been a number that people in our focus groups have pointed to, so it does give me pause for concern when I hear political leaders parroting it back. I’m sure as we move into Phase B that the Doherty Institute will be developing Models for the next step to Phase C – but right now to suggest that the Doherty Model says anything beyond Phase B is wrong.
Lie #2 – Case load doesn’t matter
This is another favourite argument from the NSW Premier. First up, a statement from the Doherty Institute reads, “Once we reach 70% vaccine coverage, opening up at tens or hundreds of cases nationally per day is possible, however, we will need vigilant public health interventions with higher case loads.” Sounds to me like case load does matter to the public health response and that with higher cases comes a need for more interventions (read restrictions). Yes, you can transition to Phase B with high case loads, but expect more lockdowns and tougher restrictions if you want to contain COVID. More a Phase A- than Phase B really.
Secondly, we need to remember that the Doherty Model is about maintaining “some average level” of cases. If, as a politician, you are proposing to move to a “full” Phase B setting (only using tougher restrictions to limit growth of cases, not drive down case numbers) then you are proposing to maintain the case levels that you enter Phase B with – at least, until you burn through enough of your un-vaccinated community to slow things down that way.
This is a real problem for NSW, where case numbers are at a level that means track and trace is already far from “optimal” and the sustained load on the health system is causing cracks to appear. Is this a level that a responsible government should be aiming to maintain? I wonder if those working in ICUs think load doesn’t matter.
Lie #3 – We’re going back to normality
This is more a lie of omission, but there is a certain skirting around the truth of what life will actually look like under Phase B and even Phase C. While governments are not explicitly saying ‘it’s back to normal’, some (e.g. Gladys and the PM) are creating an impression of an unequivocal end to lockdowns and most don’t seem to be engaging in the harder task of preparing people for the ongoing restrictions that are essential to the Doherty Model outcomes. As the Model report notes: “The contingency of these outcomes on population behaviours including vaccine acceptance, co-operation with behavioural restrictions and active engagement and compliance with public health responses is critically important for achieving programmatic outcomes.”
Let’s be clear: in the Model, under Phase B, we will have lockdowns (up to 20% of the time, depending on what happens with our track and trace). We will have ongoing baseline restrictions on our lives (social distancing, mask wearing, checking-in, density caps in public and work places). We will not see a full MCG for a long time – possibly never again.
This is the world we need to be preparing people for if we are to maintain the co-operation and compliance needed to keep infections under a manageable level.
Under Phase C, these things are planned to relax a little – but not entirely (targeted lockdowns remember). But, again, let’s not get too excited about that because a) there’s no Modelling on what that might look like in health terms and b) what actually happens in Phase B will (and should) have a massive effect on our approach to the Phase C transition.
Right now, allowing a false (but politically expedient) impression to foster could well end up doing more harm than good.
Lie #4 – It’s a national Model
There is an impression being set that as each state hits 70% it should open up to the rest of the country. But this fails to recognise that the Doherty Model is inherently state-based and that case load has a sting in the tail.
In the Model, the “some average level” of cases that we’re trying to maintain should be set relative to health system capacity. Health systems are inherently state-based. Health system capacity is inherently geographic. Do we really think that we’ll be flying COVID patients around Australia to where there is most capacity in the system? Of course not.
So, it will be incumbent on the states – as the operators of the health systems – to set that “some average level”. This will look different in each state depending on their system capacity and broader population health factors that influence base-line demand on that system.
Where that becomes a problem for the “national story” is that if you have one state that has substantially greater case load than another. Unfettered mixing of those populations could change the pandemic dynamics in the state with the lower case level: it could be expected to seed more cases, requiring stronger health interventions to bring case numbers back to that manageable level.
In this way, even at 70% vaccinated, states with higher case loads can end up exporting restrictions to states with lower case loads. Is that fair? Is that desirable? I think we know the WA Premier’s view. But this is the question we need to address in re-opening the country to each other as massive differences in case loads persist.
In the end…
The frustrating thing here is that we don’t need this misinformation and misuse of the Model. There is a pathway here. As for much of this pandemic, our biggest risk lays in the politics around it. We’ve come so far compared with countries like UK and the US, why abandon caution now? From our political research we know that voters want a plan to open up safely – they want pragmatism and honesty. They are actually made nervous by plans that sound too good to be true. They are made angry by governments seeming to squander the sacrifices they have made. No government will escape punishment at their next election if they get this transition wrong for what are seen to be political or ideological reasons.
It’s one step at a time … oh, and get your jab.
Director – Redbridge Group Australia
Research and Policy Analyst