QED

The Dizzy Doctors of the COVID Crusade

In Australia and around the world, government public health advisors have become unlikely national celebrities. America has the lovably gravel-voiced Dr Anthony Fauci, tasked with the unenviable job of correcting all of Donald Trump’s mistakes live on television — with the President repeatedly butting in to argue back. Britain had the now-disgraced “Dr Lockdown”, Prof Neil Ferguson, forced to resign in a lurid sex scandal. And Australia had its soft-spoken Chief Medical Officer, Prof Brendan Murphy.

The subject of often glowing media coverage and widely lauded as he stepped down last week, it was Prof Murphy who made the tough calls to shut Australia off from the outside world, beginning with China on February 1 and escalating through Iran (March 1), South Korea (March 4), and Italy (March 11), culminating in the near-total closure of the border on March 20. With Prime Minister Scott Morrison pledging that “all decisions taken by the Government” with regard to the coronavirus would be “guided by the expert medical advice of the Australian Health Protection Principal Committee” (AHPPC) led by Prof Murphy, the country’s fate rested on the professor’s shoulders.

At least, that’s how the story has been spun.

In reality, a day before the National Security Committee of Cabinet (NSC) decided to close the border to China, Prof Murphy told a press conference that the “our Health Protection Principal Committee [AHPPC] does not recommend banning direct flights from China, as it’s not a public health measure.” The story has repeatedly been told of how Prof Murphy then woke up on Saturday morning, February 1, to the realisation that restrictions on travel from China were urgently needed within hours. This apparently had nothing to do with the fact that, overnight, the United States had imposed a China travel ban of its own.

At a February 2 press conference, Prof Murphy explained that the apparent about-face was actually the “corollary” of a simple definitional change resulting from a new awareness of “sustained transmission” of the coronavirus outside the epicentre of Hubei province. As a result of this, the AHPPC unanimously changed its opinion on travel from China, overnight, on a weekend, based on no new information or guidance from the WHO, without reference to American developments, coincidentally with the US decision to ban travel that very night.

That might just be believable, were it not for what came next. On February 13 and February 19, the AHPPC advocated relaxations in the China travel restrictions to allow international students into the country. On February 26, the AHPPC began building a case against any further travel restrictions, arguing that the extension of “travel bans to restrict travel from multiple countries is not likely to be feasible or effective.” On February 29, the AHPPC flatly stated its position that: “border measures can no longer prevent importation of COVID-19 and [the AHPPC] does not support the further widespread application of travel restrictions.”

In that same statement, the AHPPC suggested “preventing entry to Australia for travellers from Iran … could be considered”, but the AHPPC “was concerned that further travel restrictions may set an unrealistic expectation that such measures are of ongoing value for further countries.” The NSC halted entry from Iran the next morning. So much for being guided by medical advice.

On March 4, the AHPPC recommended that “the Government direct primary focus toward domestic containment and preparedness”, reinforcing its message that it “does not support the further widespread application of travel restrictions.” The NSC restricted travel from South Korea the very next day. When it came to Italy, Prof Murphy and the AHPPC didn’t even bother to offer any public guidance. The NSC restricted travel on March 11.

Finally, on March 18, on the eve of the government’s decision to close Australia’s borders to the entire world, the AHPPC offered one last piece of travel advice: either impose “restrictions on all countries” or (with equal effect) consider “lifting all travel restrictions.”

Prof Murphy and the AHPPC consistently showed a preference for fighting the coronavirus in the community instead of at the border. That should come as no surprise: they are doctors, not border guards. But what Australia needed in the crucial early weeks of the coronavirus crisis was just that: alert and enthusiastic border guards.

Had the NSC been less cowed by medical advice and more aggressive in policing the border, Australia might have dodged the coronavirus bullet. That we came so close is entirely down to ignoring the medicos, not following their advice.

Salvatore Babones is The Philistine. Read his full analysis of “The Coronavirus and the Perils of Expert-Driven Policy” in the upcoming July-August issue of Quadrant

13 comments
  • ianl

    Again, thank you Salvatore Babones. A concise summary of bureaucratic mindsets. The basic reason they can flop and flip so cavalierly is that they cannot be sacked, merely moved sideways at the worst. And they know it.

    >”But what Australia needed in the crucial early weeks of the coronavirus crisis was just that: alert and enthusiastic border guards …”

    Yes indeed. Earliest imposition was how Taiwan, Hong Kong and South Korea managed way ahead of everyone else. A recent webinar I joined had a highly placed Hong Kong official who reiterated the success of earliest external border closure. He noted that the only “lockdowns” in HK were the karaoke bars for a period of two weeks.

  • Stephen Due

    Alternatively, the AHPPC was right in the first place, and government policy was changed because of political pressure. The most important points to note from this article are (a) that conventional, long-established epidemiological principles (reflected in the AHPPC initial responses) were ignored by government; (b) that decisions were made without an adequate understanding of the long-term epidemiological scenarios (such as are now starting to emerge with ongoing ‘spikes’ and ‘second waves’); (c) that no serious attempt was made to model alternative strategies; and (d) that no cost-benefit assessment of the chosen strategy was ever attempted.
    In other words the response adopted by government could fairly be described as irrational and unscientific. The statement that “Prof Murphy and the AHPPC consistently showed a preference for fighting the coronavirus in the community instead of at the border” is correct, but the explanation offered is not based on evidence. There is no doubt their advice reflected proven epidemiological principles. The idea that “they are doctors, not border guards” is hardly relevant.
    More to the point, border guards are not epidemiologists. It is precisely because the ‘border guards’ took over that we now have the economic, political and social disaster that is unfolding every day in Australia. The thing that was most wrong with Murphy et al was that they “lacked all conviction” (Yeats).

  • ianl

    Stephen Due

    You have avoided the actual results from Taiwan, HK and South Korea.
    Why ?

  • DG

    1 To Stephen Due: government policy is made using the policy dart board. Nothing else. Risk analysis, scenario analysis, failure mode analysis, c-b studies, etc. are all so much flimflam to occupy graduates with. The real game is a game of darts.

    2. I never fail to be amused at the expansion of the term ‘epicentre’ from earthquakes to everything. Its as thought ‘epi’ means ‘really really serious’, instead of ‘above’ or ‘over’. So why not avoid journalistic hyperbole and talk about the ‘original source’ of the naughty virus, you know, convey meaning rather than bluster.

  • Occidental

    Ianl.
    Because this is ongoing, because if you view WuFlu as a virus of similar lethality to influenza, you should actually attempt to have it move through the general population as quickly as possible. There are two extremes of response, New Zealand, which as far as I know was the first to implement nation agnostic restrictions, with hard lock downs, and Sweden which kept its borders open, and allowed (encouraged by laxity really) the virus to move through its population. My money is on the Swedish approach.

  • Citizen Kane

    The contention that a coronavirus bullet has been, or could be, dodged is perhaps premature. The ultimate course of this pandemic can only be appreciated through a global lens, where it is fair to say its rife and beyond any containment strategy preventing its ultimate spread. There is clearly virus circulating around the community here in Australia and even if there weren’t, Australia would need to remain excommunicated from the rest of the world until such time as there is an effective vaccine, which may be some way down the road. The corollary to this is that Australia has suffered much the same economic impact as those counties which will soon be starting to demonstrate a degree of herd immunity due to widespread infection rates which the US CDC stated overnight were 10X greater than official case statistics in the US as is being revealed through widescale antibody testing. That is 25 million cases in the US alone. We will likely have a situation in the ensuing period where contrary to popular belief Australia is not the safest place to be in respect to the Wuhan flu but in fact in one of the most vulnerable.

  • Salvatore Babones

    Thanks everyone for reading … be sure to catch the full analysis in the July-August Quadrant!

  • Elizabeth Beare

    “We will likely have a situation in the ensuing period where contrary to popular belief Australia is not the safest place to be in respect to the Wuhan flu but in fact in one of the most vulnerable.”

    Yes, the Swedish approach certainly has some merit, because we cannot remain isolated completely from the rest of the world. Much depends on a vaccine, but even that will provide only partial cover, and we are not yet sure how much long-term immunity is conferred upon an asymptomatic case, although it is a fair bet that some form of herd immunity will develop. We should hope that Covid19 will eventually die out world-wide as a significant pathogen, losing virulence, or become spot endemic in Australia, given our protective locational spread. Better treatments hold out real promise for control. Australia should do some antibody testing; that might be instructive given our relatively large urban Chinese and Middle Eastern populations and high rates of international travel by all Australians. I’d like to take an antibody test; as reassurance for future travel if I was already positive.
    False negatives and false positives are also an issue around all forms of testing.

  • Elizabeth Beare

    Looking forward to your write-up in July-August Quadrant, Salvatore.

    ps. I think a number of what you call Trump’s ‘televised mistakes’ are often artefacts of a very hostile mainstream media, strongly Democrat and hardly bothering in this election year to even pretend to be neutral. For example, I see Trump make an offhand joke at a rally about test-and-you-shall-find (which is simply a truth, that the more testing you do the higher the case load is likely to be) and the media goes bananas misinterpreting him as calling for an end to testing. They do this sort of misreporting constantly. Blinkers, Dr. Balbones, they put them on you at universities and dear me, they do sometimes stick. 🙂

  • Stephen Due

    EB. Surely there’s no certainty that there will ever be a vaccine for this virus? Therefore your argument that “we cannot remain isolated” (with which I concur) might be further developed to encompass the positive options for ‘safe’ health policy without either a vaccine or social isolation. If there is a viable, humane regimen, such as a combination of testing, quarantining of cases, and special protective measures for the elderly, then clearly there are many reasons (economic, social, medical, ethical) why Australia should be moving more rapidly to remove travel barriers and restore democratic freedoms.
    I agree strongly with your call for antibody testing. At present politicians talk about ‘data’ and ‘case numbers’ but actually the data is woefully deficient. Certainly the true distribution of the virus in the community, determined from historical case numbers, cannot be known without population-wide antibody testing. Political leaders and health ministers claim to base their actions on science, and yet the science is woefully deficient. Key epidemiological research is not being done. The infection fatality rate (IFR) of this virus in Australia remains unknown. The rate of change of the IFR over time is also unknown. This is vital information without which fully rational policy is not possible.

  • lloveday

    I recently went to get a cortisone shot and had to wear a mask. The danger represented by masks is obvious to me – lack of Oxygen, excess of CO2, and the older one get, the amount of activity needed before being classified as exercise becomes less and less.
    .
    15 minutes with the mask on, sitting, standing, a bit of walking and talking was enough for my blood pressure and pulse to be “off the scale” when they measured me – 165/97 pulse 105! – that’s as if I’d spent 20 minutes on the exercise bike and I did not climb stairs, not even a couple of steps. I got them to calm down by explaining I measure my BP every morning and night and it’s normal but this was caused by lack of Oxygen because of the mask.
    .
    It’s reported that two Chinese teenage boys died after a fiercely contested distance time-trial while wearing masks.
    .
    Further, they took my temperature (35.5), and I never been measured at <36 before – apart from regularly taking my BP and Pulse, I regularly take my temperature, and at a restaurant where they take customer's temperature I've been 36.3 to 36.5, as at home. It has, from my reading and common sense long been established that a lack of oxygen leads to a lowering of body temperature.
    .
    Is mask-wearing weakening cardiac and respiratory systems, particularly in the elder, and making people who do contact COVID-19 more likely to die?

  • lloveday

    My niece responded to my warning:
    “My mum has one lung with damage and she can’t breathe in the masks which the medical people have to wear for COVID protection”.
    .
    Her mum is able to take recognise the danger and make the decision to wear or not, but what about those who are forced to wear them? All elderly have weakened respiratory systems to some extent and masks exacerbate their difficulty getting enough oxygen for proper function of their bodies.

  • Elizabeth Beare

    There is recent work from a well-funded and recognised Swedish institute suggesting that many people who have had the viral infection have mounted such a strong response in their T-cells (which under biological analysis show this) that they have not had to mount a further immunity of the sort that shows positive in immunological testing, suggesting the Sars-Cov2 virus is unlikely to threaten them again. This newest work is currently under peer review, but looks interesting.
    It means that many more people in the community than we know of even if we do simple immunological tests may have had contact with, and yet have quickly conquered, this virus. The true fatality rate would thus be significantly lessened. Which is not to say that we should ignore the higher rate of death in those who fall ill enough to require hospital attention nor fail to protect those who seem to be at this sort of risk.

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