Scott Morrison's declaration of a coronavirus pandemic is premature, particularly for Australia, where the virus does not appear to have escaped quarantine and containment lines. The very word pan means everywhere, and the word pandemic suggests that the virus has spread, like a serious and sometimes deadly influenza, among the general population, with so many exposed to the virus that segregation of those at risk is no longer possible.
Still, getting ahead of the action has some advantages, not least of all being able to command the coercive power of the state in preparing a response. Morrison has been at pains to say that he and his ministers have been following medical advice from the public health authorities at the Commonwealth, state and territorial levels. But decisions about dealing with epidemics and pandemics are intrinsically political - involving judgments putting in the balance factors such as the risk to individuals and groups, the health dividend from heavy-handed methods, impacts on the economy of decisions taken, and the political, social and economic costs of any measures which have the effect of seriously annoying people, without any demonstrable improvement of their safety.
Down the track, the biggest thing that the Australian government could do to protect its citizens from COVID-19 would be putting maximum resources into fighting off the disease in places such as Indonesia, East Timor, Papua New Guinea and other Pacific nations ill-equipped to recognise, treat or otherwise deal with a pandemic - something far more inevitable for them than for Australia, and far more likely to be fatal when it takes hold. These are nations with shortages of medical resources, including screening and diagnostic equipment, as well as the number of skilled personnel appropriate to an epidemic, or, if a vaccine is developed, to a mass-treatment campaign.
By that stage, it seems likely that infection will have moved generally into the population in most places in the world, particularly in the less-developed countries. It is noteworthy that India has done little case-finding, and is itself a potentially enormous reservoir providing fuel, in south-east Asia and the Middle East, to an epidemic already on the march from China.
Sadly, our government is as yet showing little understanding that our best contribution to holding the line is to go international in our response. This is partly because at least some of the decision-making is focused on making the Prime Minister look proactive and decisive, rather than seemingly clueless and behind the eight ball, as he did during the bushfire emergency. He may, moreover, entertain hopes that he can buy time by taking advantage of the fact that Australia is an island, able mostly to restrict the entry of potentially infected outsiders.
Yet one must wonder how he calculates that Australia could carry on smugly in the face of raging epidemics in our neighbourhood.
Right at the moment, most Australians are not at any serious risk from COVID-19. The number of cases in the community of people blithely walking around, unaware that they are carrying and spreading the virus, must be extremely low, probably fewer than 10. There are more people undergoing treatment, or who may have the virus and are being segregated from their families and the community - some in their own homes - but we are all safe from them, provided we are not doctors or nurses.
In the next few weeks, we are likely to see more people reporting themselves to medical authorities as having flu-like symptoms after having been in contact, or possible contact, with someone who has come recently from an infected area, such as Wuhan or Turin, or with someone known to have the condition (the system, naturally enough, wants notification by phone for home visits, rather than someone sitting around in a surgery or emergency department, infecting others).
What the epidemiologists have divined about the virus since the World Health Organisation was notified of its existence by China suggests that transmission occurs only from person to person, most likely from being in close quarters and breathing in exhaled air from an infected person, or contact with that person's secretions. Anyone - Chinese, Australian, Italian or Martian - whose return from a foreign place was more than a fortnight ago almost certainly does not carry the virus, whether with or without symptoms. Put simply, few Australians are at this stage likely to be next to an infected person. It will be only after our borders are breached that the population generally will be at risk.
The more travel bans, the more quarantine restrictions and, generally, the more containment of people capable of bringing the disease into the community, the longer an outbreak can be avoided. But, sooner or later, most likely, containment will fail and the health authorities will be concentrating on mass treatment, individual treatment and general efforts to ameliorate the condition when found. With luck, the time gained might allow for the development of a vaccine, or an effective treatment, particularly for the old and otherwise vulnerable.
Mercifully, it does not appear that infants or young children are at particular risk. If they acquire the virus, they seem less likely to have it develop into a very debilitating flu, pneumonia, or sepsis. This is one of the reasons why the public health authorities are, or ought to be, reasonably relaxed about schools and childcare centres, even when people attending have been in a danger zone. No reason, however, to drop the focus on washing hands.
Epidemiologists who have been in China at the behest of the WHO guess that the number of reported cases from China is just the tip of the iceberg - perhaps 5 per cent of the actual cases.
Australia is well-served by medical and engineering understanding of the risks of epidemics and pandemics. There is a long line of successful public health programs since the war that have driven from the community, or most of the community, the scourge of epidemic disease. Australia has not had an outbreak of bubonic plague since we had one in Sydney about a century ago. Over the 1940s and 1950s, diligent case-finding and antibiotics virtually wiped out tuberculosis. It has only been in recent times, and with particularly vulnerable communities, including Aboriginal people and refugees, that new cases are being found. Leprosy, once endemic in Northern Australia, is virtually wiped out, even if many hundreds of people, mostly Indigenous, still carry its stigmata. Vaccinations against polio, and, later, against diphtheria, measles, mumps and an array of other conditions, have transformed Australian health profiles. It is true that there is a growing population of militant and deluded anti-vaxxers, willing to put the welfare of other people's children at serious risk by lowering herd immunity, but there are legal measures, if by no means yet severe enough, capable of keeping their numbers under some control.
We have annual vaccines against influenza, free to the elderly and most workers. Its form is shaped by the best guess at the way the virus is mutating. Flu is a serious killer in Australia, and, like COVID-19, it particularly attacks the elderly, and those with pre-existing respiratory conditions. All things being equal, it is not impossible that COVID-19 will come to be regarded by the most healthy part of the population as a particularly unpleasant form of flu, even if, like many of the existing ones, only the very vulnerable end up with a severe acute respiratory infection. In that sense, it will become a permanent, even endemic feature of our society, but not a very mortal one.
Some of those who have been watching the development of the condition in China think that China, in its diagnostics, has focused particularly on the pneumonia that has taken victims, most of whom are old. Many of those who have recovered, and who have been less affected, report symptoms rather more like a common cold - with a raised temperature, dry cough and some shortness of breath. It is because of this that epidemiologists who have been in China at the behest of the WHO guess that the number of reported cases from China is just the tip of the iceberg - perhaps 5 per cent of the actual cases. Most of the 95 per cent were probably not even aware that they had it, or that they were capable of passing on the disease to others. Those who had the more severe infections - mostly people over the age of 65 - were likely to be identified by active case-finding (including, now, financial rewards for people who present themselves for treatment).
If the above is true, it could be that the mortality associated with COVID-19 is not the 2 or 3 per cent suggested by the initial figures, but 0.1 per cent, say a fatality for every thousand people. That's similar to the fatality rate for an ordinary influenza virus. Typically, only about five in a million people under the age of 50 die in such an outbreak. About 75 people aged between 50 to 65 die, and about 1000 people in every million people older than 65 die.
The Spanish flu, about 100 years ago, saw about one in 40 in the population die - a death rate 25 times that of an ordinary flu season. The pattern did not resemble an ordinary flu season, with young people and young adults particularly at risk. About half the population caught it.
Australia has had other flu pandemics, including the Asian flu of 1957 - a completely new strain - and its mutated relation, the Hong Kong flu of 1968. On the evidence so far, COVID-19 will not have the death rates of these, nor their deviation from the norm in killing higher-than-expected numbers of children and young Australians. It could, however, match the impact of the passing through Australia, in 2009, of the human swine flu. While all of these pandemics provoked a major public health response, none involved the state girding itself with extra power.
The WHO experts who travelled through China, and had access to Chinese records, believe the disease plateaued there between January 23 and February 2, and that new cases and incidence have been declining since. Although many have been critical of the slowness of the response from China's central government, this suggests that measures taken - no doubt including the quarantining of Wuhan in Hubei province - were swiftly effective. It suggests that the epidemic reached its zenith - in terms of incidence - within a month of it first being identified as a new and serious flu-like condition. That's pretty smart work by any definition; it is by no means clear that Australia, the US, or Europe would have been quicker.
Some of those who consider the initial response too secretive and too concerned about appearances, rating the two-week delay between discovery and public action far too long, do not seem to realise that China notified the WHO of the new virus entity on December 29. Major public health action, particularly so as to avoid the added confusion of Chinese New Year, made things worse, but if China was concealing the problem from its people, it was not concealing it from the world.
That's something to bear in mind when one reads commentary focusing on the pandemic as a political crisis for the communist state, or for Xi, its leader. Of course there will be significant economic effects, including a major disruption of trade, further blows to China's growth, and some weakening of public confidence in both the efficiency of the total surveillance state and the omniscience of its rulers. It is not clear that infection rates have stabilised in Beijing. And China, like most other nations now trying to cope with the problem, has been caught short without enough supplies, including diagnostic supplies - even in the epicentre of COVID-19. But one can take this only so far: I would hazard a guess that Xi, rightly or wrongly, has more cred in his domain than Morrison does here.
Some of the commentaries focus more on the hopes and wishes, or the prejudices, of the authors than on the facts as we know them. But then again it is hard to be 100 per cent confident of any Chinese statistics, even when gathered in good faith. It will take time for the economy to begin rolling again, and the hardships will, no doubt, reflect from local politics up to the central government. But it may be a bit early to forecast a collapse of public confidence in China's leaders, or the imminent demise of their systems of control.
Likewise with the Australian body politic. So far, all is well on at least this venture of modern government, even if confidence in the management and integrity of many other aspects of government are calculated to make citizens despair. Initially, at least, there's no downside, even if things get worse before they get better.
The big risks are twofold, it seems to me. The first would be from neglecting an attack on the virus in our neighbourhood. The other is from an officious overreach of power by the Department of Home Affairs, armed Border Force officers, or anyone else trying to herd ordinary Australians into a political, as opposed to a public-health, view of the public response.
Given the authoritarian disposition of the minister, Peter Dutton, his hang-ups about challenges to the authority of the state, and the militarisation of what once seemed a much more efficient quarantine service, that seems inevitable. In a pandemic, there is only limited scope for concentration camps with Serco guards, forced arrests, or bully-boy tactics designed to prove who's boss. Australians will willingly, even meekly, obey the instructions of a firefighter taking on a bushfire when it comes to not using a road. The Prime Minister, we might remember, has perfected his argument about rejecting the advice of experts, at least on climate change.
All of the marketing of Morrison, crisis-mongering by Dutton, or bullying by policemen is unlikely to convey the same sense of emergency as the bushfires. Health expertise will be - should be - respected, but politicians will still be unpopular if they are too draconian in pretending to follow advice.
- Jack Waterford is a former editor of The Canberra Times. firstname.lastname@example.org