Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Roadmap to Recovery
A Report for the Nation
APRIL 2020
Contents
Co-Chairs’ Foreword 4
Methodology 187
Acknowlegements 189
At the very outset, the Taskforce number of daily new cases now
rejected the third option which would are fewer than 25. During the peak,
entail somewhere close to 15 million 90% of cases were imported or a
Australians becoming infected. The direct consequence of importation, a
disruption of healthcare, the lives pathway that has now been practically
lost, the inequalities of impact and stopped. Australia’s testing rate is
the tragic consequences on society amongst the highest in the world,
did not make this a viable option for and its test positivity rate and case
Australia, as Government has made fatality rate amongst the lowest. This
clear. This report focused on the confirms the government’s strategy
remaining two. in controlling the epidemic and the
population’s embrace of it.
Australia is unique among comparable
Western nations, and fortunate, to Therefore, while most countries
have two options – elimination or simply cannot consider the prospect
suppression. This is afforded because of elimination, for Australia, a State
of our success in controlling the by State Elimination Strategy remains
number of cases. From the peak of a conceivable, and some would say
the epidemic in late March when desirable, option for Australia. This
we saw nearly 500 cases a day, the option is detailed in Chapter 2.
What the public must know impositions are here to stay. In both
and understand cases, enhanced hygiene, some
measures of physical distancing and
The choices are not binary, but along greater testing and tracing, will be the
a continuum. They will both require new norm.
some restrictions, large scale testing,
tracing and isolation systems to keep In both cases most of us will remain
us safe. In that regard they are similar. susceptible. The final “exit” from
They differ in the depth, breadth and both pathways will require a vaccine
duration of how these measures that confers immunity to all of us.
are applied. We cannot predict when that will
be. It seems reasonable to expect
The big difference is that while one in the next year or two. Should
Elimination will require the restrictions it become clear that the chance of a
for a longer duration at first, it vaccine is remote – current strategies
offers the reward of lower cases will need to be revisited.
and greater public confidence about
safety and all its attendant benefits. The challenge over the coming
The Controlled Adaptation sends weeks will be to evaluate the relative
a signal of pragmatic acceptance attractiveness of the two options;
of low infections right at the start, to assess, despite considerable
and in return promises a somewhat uncertainty, how best to trade off the
earlier return, greater flexibility with potential rewards of the Elimination
measures, and manages the risk of option against the greater sacrifices
flare ups within the capacity of our required in a framework of values
adapted health system. we share.
Neither of these two will allow for The Go8 looks forward to working
a return to life as we knew it over with the nation and its Government
Christmas 2019. As with air travel to continue its contribution.
after 9/11, some restrictions and
There are things we should not be we articulate the six core principles
prepared to sacrifice, whatever the that should frame Australia’s
circumstances. While in other cases, decisions and policymaking. They
we must be clear about conflicting are not only guides for decision-
values and the consequences of our making about recovery, they are also
choices. To facilitate that discussion, preconditions for its success.
1 https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200402-sitrep-73-covid-19.
pdf?sfvrsn=5ae25bc7_6
Figure 3: Number of COVID-19 cases by place of acquisition over time, Australia (n =
From: Commun Dis Intell 2020 44 https://doi.org/10.33321/cdi.2020.44.34 Epub 17/4/2020
6,394) From: Commun Dis Intell 2020 44 https://doi.org/10.33321/cdi.2020.44.34 Epub
17/4/2020
2 https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-
19-current-situation-and-case-numbers#in-australia
36 – GO8 COVID-19 ROADMAP TO RECOVERY
A basic reproduction number in Chang et al. (2020) suggests that the
the range 2.2–2.7 has been used social distancing compliance levels
in relevant Australian modelling in Australia have approached 90%
studies and appears consistent between 24 March and mid-April 2020,
with local dynamics (Change et al, providing evidence of high community
2020; Moss et al 2020, Coatsworth engagement with the measures.
2020, Jarvis et al 2020). Currently,
effective Rt is below 1 across virtually
all jurisdictions in Australia, with The updated model of Chang
the increase in Tasmania due to an et al. (2020) suggests that the
identified cluster of cases. This is
evidenced by declining prevalence social distancing compliance
across states and territories; levels in Australia have
estimates from multiple approaches,
including modelling, are that the
approached 90% between
effective reproduction number (Rt) 24 March and mid-April 2020,
to about 0.5 at present in NSW and providing evidence of high
Victoria (Figure 4).
community engagement with
The reductions in the effective
reproduction number that have been
the measures.
achieved indicate approximately
a two thirds reduction in overall Hence there is good evidence that,
transmission since early March. This if the current efforts are continued,
has been achieved through social elimination will be achieved, state-by-
distancing combined with contact state. Estimates based on modelling –
tracing and increasingly effective and from calculations based on an Rt
public health control as case numbers of 0.5, current national case numbers
have dropped and notification delays of 50/day and a serial interval of five
have fallen. The updated model of days – indicate that elimination of
3 https://www.health.qld.gov.au/cdcg/index/brucell
Figure 5
Figure 5
Figure 6
Figure 6
Figure 7
Figure 7
5 https://www.bbc.com/news/world-asia-52305055
Figure 8. Relation of different non-pharmaceutical interventions to Rt: example from Denmark
(Flaxman et al).
46 – GO8 COVID-19 ROADMAP TO RECOVERY
There are also risks to regional wave in regional Australia (seen as
Australia from removing restrictions an inflexion in Fig 3b from Chang
prior to elimination of community et al. 2020). This effect disappears
transmission. In our prior work, under the elimination strategy. Failing
we distinguished between urban to eliminate the current spread
and rural epidemic peaks: “the concentrated in/near major urban
first wave is observed in highly- centres may result in secondary
urbanised residential centres where waves in regional Australia.
the pandemic first reaches a nation
(e.g. near international airports),
whilst the second wave is observed
in sparsely connected rural regions” For the COVID-19 pandemic early
(Zachreson et al, 2018). “In contrast
to many other countries with a more
results indicate that the first wave
even spatial population distribution, may peak in metropolitan areas
Australia comprises a relatively about 45 days before the smaller
small number of densely populated
urban centres distributed along the second wave in regional Australia …
coastline, sparsely connected to many
more low-density inland towns and
rural/regional communities.
Risks of the elimination approach.
This particular population distribution
While States and Territories will
has been implicated in Australia’s
vary in the time taken to SARS-
highly bimodal epidemic curves,
CoV-2 elimination, the jurisdiction-
with modes associated with its
by-jurisdiction approach is likely
urban, and rural communities”. For
to require greater time before
the COVID-19 pandemic early results
containment and social distancing
indicate that the first wave may
measures can be relaxed to the
peak in metropolitan areas about
fullest extent possible. There are
45 days before the smaller second
also risks related to controlling
6 https://www.abc.net.au/news/2020-04-19/wa-premier-mark-mcgowan-applauded-in-coronavirus-crisis-
analysis/12159020
7 Note all of these charts are sourced from the worldometers site: https://www.worldometers.info/coronavirus/
With around 700 cases per day at present, it seems likely that
this specific population outbreak will continue for at least
the next two to four weeks despite the extra restrictions. This
highlights the need to identify and focus specific measures
on transmission-related high-risk sub-populations.
Taiwan China
Taiwan has operated in a similar China as the first location affected
fashion to Singapore’s initial approach had a large epidemic on their hands
but with perhaps a slightly stronger by the time of the shutdown in
focus on border control. They have Wuhan, with estimates from early
encouraged wearing of masks and modelling studies suggesting
in recent weeks encouraged social ~75,000 cumulative infections
distancing. They also delayed return by this point.8 The shutdown was
to school in February but have kept progressive, initially isolating Wuhan
schools open since then. Businesses but quickly extending to much of
remain open. Perhaps due to their Hubei province due to high travel
strong focus on border control and volumes out of Wuhan prior to
home quarantine, they have seen very shutdown. A widely reported, social
little local transmission, with >85% of contact outside of the household
cases being overseas source. They was almost entirely prevented,
have reported fewer than 5 cases per while the public health and health
day in the last week – almost all of system response was scaled up to
these are imported. find and isolate cases and expand
8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7159271/
9 http://weekly.chinacdc.cn/news/TrackingtheEpidemic.htm
Recommendation
This involves a cycle of release, Lift measures in phases, with
evaluate, learn, release some more. an interval/pause of a minimum
of three weeks to determine
the impact on spread and case
The goal of Controlled Adaptation
numbers, and a close watch on the
over the next month (i.e. to mid
effective reproductive number to
May) would be to suppress new
keep it below one.
infections to a minimum using
the currently-in-place social This involves a cycle of release,
distancing measures and travel evaluate, learn, release some more.
restrictions. This period will provide Timelines and case load thresholds
time to prepare for relaxation of for lifting of measures are likely to
distancing measures through differ between states, particularly if
enhanced surveillance capacity and interstate travel restrictions remain,
planning, improved understanding as well as per factors such as varying
of COVID-19 epidemiology and local health service capacities,
modelling scenarios, building public climate, population density and
health capacity (especially testing contact tracing capacity.
Relaxation Options:
Schools and Universities
Schools should be a high priority
Schools should be a high priority
for resuming activity given there for resuming activity given there
is limited evidence on the role of is limited evidence on the role of
children as a source of infection, and
the importance of schools in reducing
children as a source of infection,
inequity of education outcomes. and the importance of schools in
Universities should provide online reducing inequity of education
education as much as possible but
restrictions regarding face-to-face outcomes.
laboratory practicals and clinical
placements could be loosened.
Travel and border yy Maintain travel for yy Allow domestic travel yy No overseas travel
controls essential services subject to border – unless quarantine
or serious family quarantine or testing observed or testing
issues
Workplaces and yy Staged return – yy Younger workers yy Full return – high risk
Businesses some working at without key workers, if able, to
home comorbidities at work work from home
yy Modified workplace yy Regional plans based yy Modified workplace
practices on comorbidities and practices
demographics
yy Modified workplace
practices
Schools yy Staged return yy Full return but yy Full return – high risk
voluntary students and staff,
if able, to work from
yy Modified practices
home
yy Modified practices
Universities yy Staged return yy Full return but yy Full return – high risk
voluntary students and staff,
if able, to work from
yy Modified practices
home
yy Modified practices
Mass and Public yy Banned yy Banned yy Banned – context
gatherings (Games, specific
Concerts, Rallies)
11 https://www.tga.gov.au/covid-19-test-kits-included-artg-legal-supply-australia
and articulated by political figures, wellbeing, the more likely they will
public health officials and other respond favourably to Government
relevant experts must continue to advice. Leaders should also
provide public communications, to help communicate respect and a belief that
communicate that such policies are they trust the public, as this is more
underpinned by appropriate evidence. likely to elicit cooperation (Van Bavel
Where possible, appropriately et al 2020).
summarised abstracts of this evidence
should be made publicly available on Transparency
the Government COVID-19 websites.
The Commonwealth Dashboard, Trust in government and organis-
and the various State Dashboards, ations is enhanced when there is
are welcome developments – keep transparency of information, evidence,
them current. and a clear decision-making process.
Governments and organisations should
Inconsistency between jurisdictions therefore seek to provide access to
in policies may sometimes be justified accurate information, both positive
but cause confusion because they and negative, so that people may
result in different emphases on risk build accurate expectations. Change
and the ‘right’ approach. When Federal, should be communicated early, even
State and Territory approaches are with incomplete information, as
not in alignment, the reasons must acknowledging uncertainties does not
be clearly explained to the public. undermine trust in the information or
Furthermore, since ‘evidence’ is facts its source (van der Bles et al., 2020).
plus values, both should be clearly While people dislike uncertainty, a
articulated (Carter et al., 2011). perception of obfuscation is worse
When communicating, leaders because it diminishes trust. Moreover,
should express genuine empathy and withholding information can motivate
concern (Reynolds & Quinn, 2008). people to look for information
The more Australians believe that elsewhere, which can foster belief
leaders empathise with them and in misinformation (Kovic & Füchslin,
are genuinely concerned for their 2018).
yy Key finding: There has been marked Australian context has been
reductions in pathology testing critical in informing strategies to
and clinical presentations for non- minimise the number of infections
COVID-19 problems indicating a and optimise the treatment of
possible delay in the management Australians who have already been
of existing conditions and lack of infected. More Health Services
attention for new problems. Research is now needed to prepare
for the changes in the healthcare
yy Key finding: Electronic health
system to deal with COVID-19 and
records and data linkage are
its consequences.
key to comprehensive COVID-19
surveillance as well as managing
non-COVID-19 clinical problems. General Background
yy Key finding: All critical care Current Context
specialties have previously
supported advanced care planning The COVID-19 crisis challenges
for patients likely to have poor all aspects of health care and all
outcomes, COVID-19 has further overlapping sectors of our system.
emphasised this need. For patients with COVID-19, 80%
can be adequately cared for in the
yy Key finding: Medical research
community, 15% require hospital
integrates laboratory,
inpatient acute care; and 5%
epidemiological and clinical
require critical care (ICU) usually
trial-based programs aimed at
for respiratory support. Health care
understanding the fundamental
professionals are also at increased
molecular, biological and
risk of contracting COVID-19. Dealing
biochemical characteristics
with the crisis has led to delaying non-
of COVID-19 and for devising
urgent elective surgery; i.e. surgery
treatments and vaccines.
unlikely to lead to death or significant
yy Key finding: Epidemiological harm within 30-days. Also, many
modelling of the dissemination patients are avoiding the health care
and spread of COVID-19 in an system for non-COVID-19 problems.
References
institutes, hospitals and other Babbage S. COVID-19: Impacts and
research institutions. Australia has opportunities for Australia’s Health
been at the cutting edge being one of Care System. Price Waterhouse
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Tertiary Institutions
The COVID-19 crisis has directly and to provide a pathway through the
substantially impacted the tertiary current crisis and return to wellness
sector through closures of campuses, and prosperity. Australian health and
cessation of in-class learning, and a medical researchers are engaged in
rapid shift to remote online learning. world-leading programs to develop
Even though off-campus learning effective treatments and vaccines for
already represented part of the COVID-19, with Australian universities
regular experience for one in three training the future workforce in ways
higher education domestic students that are crucial to responding to this
in Australia (Norton, Cherastidtham crisis. Our vocational colleges and
& Mackey, 2018), that applied mostly TAFEs are also providing critical
to adult learners and postgraduate workforce training needed for this
students. recovery. Perhaps the greatest demand
on universities and other post-school
institutions comes at a time when they
are also most under threat.
Rapidly developing policies
The following Key Findings and
surrounding the operations of Recommendations take into account
schools within the COVID-19 all post-school educational institutions
pandemic context have been a and pathways.
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2 https://www.abc.net.au/news/2020-03-19/coronavirus-why-is-australia-keeping-schools-open/12070702
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5 https://www.theguardian.com/commentisfree/2020/mar/27/more-harm-than-good-the-cases-for-and-
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6 https://www.abc.net.au/news/2020-04-15/coronavirus-covid19-education-schools-scott-morrison-
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The Corporation was able to push code – such as the system being
assistance beyond banks into local used in China or a tracking app –
economies thus restoring confidence such as the TraceTogether used in
in the financial system (Vossmeyer, Singapore,7 can be used to slow the
2014), and has been used as a coronavirus spread and limit any
stabilisation agency and device to further outbreak when the mass
redirect the flow of capital investment population attempts to return to
to socially desirable enterprises such work and mass gatherings.
as small businesses (Sprinkel, 1952).
Hand sanitizers at entry and
In general Government needs to egress points in business should
simplify, where possible, the process be mandated and installed at
and complexity of supporting minimal cost to ensure basic
resources (such as business loans, health standards.
grants, or other stimulus schemes) to
Contactless service rules and
increase the uptake and engagement
maintenance of social distancing
of small businesses who have limited
is required until reliable preventative
time dealing with operational issues.
vaccines or effective treatments
are available at scale
Recommendation
Develop a health tracking system Recommendation
and new hygiene standards to
ensure reopening practices are Develop a staged approach to a
safe for the workforce and public. return to work, taking account of
geographic location, occupation/
industry type, and characteristics
Basic temperature testing can be of workers which might indicate
implemented at public places to high risk of serious infection.
prepare for reopening. A health colour
7 https://www.zdnet.com/article/singapore-introduces-contact-tracing-app-to-slow-coronavirus-spread/
The social changes caused by the Australia leads the world in the
COVID19 crisis and associated social development and dissemination
distancing measures are and will of parent support strategies that
be accompanied by an increased empower parents to provide a positive
likelihood of such exposure for child caregiving environment. These
Australia’s children. This exposure programs improve parent mental
is likely to be manifest as increased health, reduce parent-child conflict,
mental, physical and social health and improve child mental health over
costs for this generation. Ensuring the the course of several parent support
health of children during this crisis sessions (Rae & Zimmer-Gimbeek,
by minimising exposure to adversity 2007; Sanders et al., 2017).
should be a priority investment in Further, recent evidence shows that
Australia’s future and a preventative these treatments are equally effective
measure against future burden. when delivered online as either
therapist assisted programs (Dadds
et al., 2019) or self-directed programs
Australia leads the world in the (Piotrowska et al., in press). Thus,
development and dissemination a major initiative should be a public
campaign to steer parents toward
of parent support strategies that these programs during this phase.
empower parents to provide
a positive child caregiving References
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(Reger et al., 2020);
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yy People with mental illness
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Recommendation Recommendation
Enlist the support and assistance Enhance the impact of
of independent, credible and communication by establishing
trustworthy advocates (e.g. community reference groups to
healthcare workers, educators, provide ongoing input into the
community leaders) to convey decisions that affect them and
key messages. also how best to communicate
them. Several community reference
Continue to use those from trusted groups should be established so
professions to explain and justify the that collectively, they represent
controlled adaptation approach. It Australia’s demographic and
is obviously highly appropriate that socio-cultural diversity.
key policy decisions are announced
and articulated by politicians while Norms and modes of communication
authoritative health officials (such differ between social and cultural
as the Chief Medical Officer), and groups. In addition, some groups will
key public health and scientific be impacted much more severely
experts must continue to provide than others by Australia’s response
public communications. This will to COVID-19. Communications
help to convey that such policies are should be tailored towards these
underpinned by ‘apolitical’ evidence. groups by working closely with group
representatives. The following groups
in particular require tailored messaging:
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crisis-leadership-135541. Accessed
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We thank the following for active participation Dr Kyllie Cripps Ms Bernadette Hyland-Wood
on the SWARM platform: University of New South Wales University of Queensland
Professor Charles Abraham Professor Donna Cross Associate Professor Tim Inglis
University of Melbourne University of Western Australia University of Western Australia
Professor Karen Adams Professor Mark Dadds Associate Professor Andrew Jackson
Monash University University of Sydney University of New South Wales
Associate Professor Eva Alisic Professor Sara Davies Professor Jolanda Jetten
University of Melbourne Griffith University University of Queensland
Dr Kelly-Anne Allen Professor Megan Davis Ms Yawei Jiang
Monash University University of New South Wales University of Queensland
Dr Erik Baekkeskov Professor Patricia Dudgeon Professor John Kaldor
University of Melbourne University of Western Australia University of New South Wales
Professor Emily Banks Professor Sandra Eades Associate Professor Adam Kamradt Scott
Australian National University University of Melbourne University of Sydney
Associate Professor Anthony Bell Associate Professor Ullrich Ecker Professor Shitij Kapur
University of Queensland University of Western Australia University of Melbourne
Dr Andrew Black Ms Nicole Ee Ms Alex Kennedy
University of Adelaide University of New South Wales Group of Eight
Dr Andrew Black Professor Jane Fisher AO Dr Elise Klein
University of Sydney Monash University Australian National University
Professor Tony Blakely Professor John Freebairn Professor David Le Couteur AO
University of Melbourne University of Melbourne University of Sydney
Dr Chris Blyth Dr John Gardner Professor Julie Leask
University of Western Australia Monash University University of Sydney
Ms Katrina Boterhoven de Haan Professor Ross Garnaut AC Professor Karin Leder
University of Western Australia University of Melbourne Monash University
Professor Robert Breunig Professor Marie Gerdtz Mr Yulin Li
Australian National University University of Melbourne University of Adelaide
Professor Alex Broom Associate Professor Kathryn Glass Associate Professor Kamalini Lokuge
University of Sydney Australian National University Australian National University
Dr Matthew Brown Professor Quentin Grafton Professor John Mangan
Group of Eight Australian National University University of Queensland
Professor Romola Bucks Professor Len Gray Professor Andrew Martin
University of Western Australia University of Queensland University of New South Wales
Professor Jim Buttery Professor Jane Gunn Professor James McCaw
Monash University University of Melbourne University of Melbourne
Dr Katherine Carroll Professor Ian Hickie Dr Christopher McCaw
Australian National University University of Sydney University of Melbourne
Professor Allen Cheng Ms Anna Hickling Professor Lisa McDaid
Monash University University of Queensland University of Queensland
Professor Alex Collie Professor Keith Hill Dr Siobhan McDonnell
Monash University Monash University Australian National University
Professor Rae Cooper AO Professor Richard Holden Professor Patrick McGorry AO
University of Sydney University of New South Wales University of Melbourne
Professor Kim Cornish Professor Eddie Holmes Professor Warwick McKibbin AO
Monash University University of Sydney Australian National University