Jack Waterford with Pearls & Irritations

The US already has a two-tier health system: when the disease takes hold in the general population, many of its facilities will be swamped, with only the wealthy able to be sure of proper treatment.

The Australian public will probably be more forgiving if things go awry in managing the COVID-19 epidemic than they will be in managing its economic fallout. It is, after all, novel, and the management has been fairly competent so far, even if, in my view, there has been too much consideration given to extreme measures, including school, street and arena closures. There’s also too much talk of deploying Border Force not as a passive agent of quarantine on the perimeter, but as some sort of armed militia trying to push, or move, people around inside the country itself. This is not leadership stuff, whether from the medical establishment or governments. But it fits some notions that because COVID-19 is a threat to the nation’s security, it must be “attacked” by guns, intelligence, coercion, retired cops of no great distinction and the Department of Home Affairs.

The language of war is particularly ill-adapted for local, national and international efforts to deal with epidemic disease, the more so when it is clothed with references to the foreign origins of the “horrible” virus, and the need to defeat it. That’s one of a good many reasons why doctors sighed, and stock markets crashed, when President Trump addressed the nation with his response to the developing COVID-19 pandemic.

Australia is one of a number of countries which has had a more considered and calm response, driven more by epidemiology than by politics. But while prime minister Scott Morrison deserves some credit for this, he cannot smirk too much, because the fate of Australians at risk, and of the world pandemic, will still be governed as much by what happens in America, or Europe, or soon, perhaps Africa or South East Asia and by anything Australia is able to achieve over the next year. Australia, as an island, has more capacity than most to attempt controls on the entry of those carrying the virus, but even then, such controls will eventually fail.

Even in metaphor, one does not “defeat” an epidemic disease, least of all in the short to medium term. Rather one manoeuvres in retreat to buy space and time so as to minimise the size and nature of the inevitably extending grip of the disease upon the population. Time to prepare with screening devices, so that those in contact with the virus can be identified and efforts made to reduce the risk of transmission into the general population. Time to gain understanding of the virus and its modes of transmission, so that strategies for containing it, and for treatment of the victims, can be developed. Time, perhaps for developing an effective vaccine so that those most at risk — in this case older people, particularly with compromised respiratory systems, can be protected. Time perhaps for an epidemic to lose some of its virulence, whether because of the development of resistance, or mutation, or a weakening of infectivity with each succeeding transmission.

And time as well to slow the rate at which the virus, and the illnesses, sometimes fatal, that it causes spreads into the general population. In almost all countries of the world, including Australia, it is by now virtually inevitable that the virus will sooner or later jump the quarantine and containment lines, and that it will be virtually impossible to identify and isolate those carrying, and spreading and shedding, the virus. Many of those with the virus will have no obvious symptoms, though some may develop them a few days after infection. One can slow things by trying to reduce the opportunities for people to pass on the virus to others — for example by trying to avoid large gatherings, encouraging s ocial distance and frequent hand-washing. Or, as in Italy, closing down most of the shops, other than supermarkets, and virtually closing down the tourist industry. But whether in Italy or Australia, Peru or Pakistan, the likelihood is that more than half the population will have been exposed to the virus by the end of next year. In some places — quite possibly including the United States — it will be even earlier.

Some might think that if exposure is inevitable, it would be better that a community accept the virtual certainty of near universal exposure and get it over with. But this runs the risk of overwhelming public health facilities with very sick people, reducing the quality of care able to be given. It is better to attempt to contain the spread of the virus for as long as possible, even as one knows that the barriers will eventually fail and nearly everyone will be exposed. That way, the call on the system for hospital beds, for doctors, nurses and other health professionals, will be spread over time and within the resources which are available.

In the meantime, of course, countries without the resources, the facilities or the health professionals to deal with severe cases will face higher levels of infection, and, probably higher death rates. Those who have pretended that the epidemic has largely passed them by — such as Indonesia — and those who have very little idea of how far the disease has penetrated into their area, and very little idea of what to do about it — will probably be in crisis more quickly. Nations such as the US which took some action but did not use the lead-time they were given — ©will probably end up with higher rates of infection and higher rates of death. The US may be repelling some risks by border controls, but has been woefully negligent in failing to screen at risk individuals. The Trump Administration has also run down some of its once excellent — indeed world leading — research centres. The US already has a two-tier health system: when the disease takes hold in the general population, many of its facilities will be swamped, with only the wealthy able to be sure of proper treatment.

Trump and the Republican Party have been trying, if without all of the success they wanted, to dismantle Obamacare, at best an inadequate safety net falling well below the standards and coverage in socialised health systems in virtually all first world countries. They wasted time ridiculing the idea that Coronavirus was much of a threat, insisting that it was no more than an influenza. They also accused Democrats of creating “false news” and spreading hysterical alarm and despondency about the threat. Since then, even Trump has recognised a crisis, and is pretending that he has been masterful in fighting it. Many Trump supporters find it hard to blame him for anything, but some of his key constituents are particularly vulnerable to pandemic COVID-19. While I expect that Trump will be re-elected, the health impact of the pandemic may prove the event most likely to change the politics of the November presidential election.

Jack Waterford is a former Editor of The Canberra Times.

This story was originally published in Australia’s leading public policy site Pearls & Irritations.

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