Eliminating COVID-19 a false hope
An opinion piece by the Australian Government’s Deputy Chief Medical Officer, Dr Nick Coatsworth.
The current Victorian COVID-19 outbreak has seen renewed calls for Australia to pursue a coronavirus “elimination” strategy. This is surprising. It’s unrealistic – and it’s dangerous.
The inference is that if Victoria had eliminated community transmission, this second outbreak would not have occurred – something which is patently false.
As the Victorian Premier, Daniel Andrews, has said, this outbreak has largely stemmed from breaches in quarantine arrangements for Australian citizens returning from overseas. Such breaches would have seeded this outbreak even if community transmission had been eliminated for several weeks.
Part of the challenge in this debate is that the definition of elimination is not commonly held by people who are prosecuting the case for it in the media.
If we take the accepted public health terminology, that we reduce to zero the number of infections in Australia and target deliberate public health interventions to prevent re-establishing community transmission, that sounds very similar to what we have achieved in most parts of Australia.
We have termed this “aggressive suppression”, where we take whatever measures are necessary, including the difficult decisions to reintroduce restrictions and close borders, to shut down community transmission where it occurs.
However, true elimination is really only a realistic strategy when you have a vaccine. And we do not yet have a vaccine for COVID-19.
Measles is a good example. It is eliminated in Australia and we received that distinction from the World Health Organization (WHO) in 2014. We have occasional outbreaks, which are quickly brought under control by our public health teams and because we have an excellent immunisation program.
In Australia, we have pursued aggressive suppression with the knowledge this will lead to periods of elimination in parts of the country. Pursuing elimination and suppression are not mutually exclusive concepts; rather a continuum that can be adjusted to local circumstances.
Local elimination is wonderful when it occurs, and it allows significant relaxation of distancing measures.
It should not, however, lead to a complete relaxation of basic principles to combat the virus. Physical distancing, recording of contact details in venues and practising good hygiene are a way of life now. Had full relaxation occurred in Victoria in recent weeks, this latest imported outbreak would certainly have been even more significant.
We are not in a position in Australia to achieve elimination where global transmission is increasing.
It is impossible to completely seal the borders of any country – even an island continent such as Australia – and nor should we try to. Returning travellers, freight vessels and associated crews will continue to come from countries with widespread transmission.
No country or part of a country can assume that a period of local elimination is protection against further community outbreaks. Our systems are excellent, but they will never be perfect, and it would be irresponsible for any leader to claim they could be.
The risk elimination creates is a false sense of security that may diminish the community engagement with widespread testing and lead to a downsizing of the enhanced public health response, based on an assumption “we have got rid of the virus once and for all in our part of the world”.
This is dangerous. Every country and region with the capacity to do so should be on the lookout and have the ability to respond to COVID-19 outbreaks, whatever their current state of community transmission.
The WHO has recently confirmed its view that elimination and eradication are unrealistic goals.
In Australia, we will continue to strive for local elimination wherever possible. We remain one of the world’s most successful nations in the fight against COVID-19. We have achieved this, not by pursuing the false hope of elimination, but by realistic, pragmatic and proportionate action when it is most necessary.