The government's insistent and oft-repeated message as the coronavirus crisis hits home has been for Australians to take responsibility. Wash your hands for longer than feels feasible, disinfect surfaces, stay home with the sniffles, and keep your distance from friends and associates. The coronavirus epidemic can be slowed if people step up on these part-simple, part-highly disruptive measures, we are told.
But this message of personal responsibility is at odds with the government's other message of "trust us". Now, the Public Health Association and even doctor group the Australian Medical Association are weighing in, urging medical experts, health experts and doctors to toe the line.
Remember Li Wenliang, the 34-year-old Chinese doctor who raised the alert in December, and who died on February 7? Instead of listening to Dr Li, China silenced him and punished him for speaking out.
"There should be more openness and transparency," Dr Li told The New York Times from his hospital bed, in an interview published a week before his death.
Openness and transparency have been in short supply in recent years, a deficit arguably at the core of the much-lamented fracturing in Western democracy. Now, madly, openness and transparency are being compromised again.
At one level, the government and its health advisers have been admirably open, updating the situation in daily press conferences, and, at least in the early days, answering questions interminably in appearances that went well longer than the norm.
Also admirably, the government has let the experts lead on this, always standing alongside Chief Medical Officer Brendan Murphy or deputy Paul Kelly, and taking its advice from a national expert group.
However, there are questions they will not answer. I'm referring here to two bits of information that authorities steadfastly refuse to release, despite being asked at virtually every daily press conference: What does the modelling show about Australia's likely infection rate? And, how many test kits do we have? We could add to this another question that for some reason went unanswered last week: How many infected people have needed intensive care treatment? And we could add a piece of information that feels almost like disinformation that has entered the fray: The vast majority of Australian cases are sourced overseas.
Authorities have held fast to this last statement even as transmission has taken off in Australia. The last available numbers, from Thursday March 19 (a change in reporting means the detail now lags more than a week), show that of the total of 565 (by Sunday it was well over 1000), 259 cases, or 45 per cent, were believed to have been contracted overseas. In 100 cases the source was either a known contact (about 72 of them) or unknown (28). That left 206 still being investigated. In that context, suggesting that the vast majority are from overseas is confusing and quite possibly not even accurate. By Friday, finally, the rhetoric was shifting, with Murphy now referring to "a large number of imported cases", rather than a majority.
There is another reason the majority might have been from overseas and that is because overseas cases and contacts are the only ones being tested. It's the equivalent of looking for your keys under the streetlight. And it is the source of much dispute in the medical world. The testing protocol to date has been that only people who have come from overseas and show symptoms, or close contacts of already known cases, can be tested, shifting now to also include doctors and health workers. This is to limit pressure on testing materials, which are in short supply. But it also means the picture is distorted; we don't know how far the virus might have spread in the community, other than calculating backwards from hospitalisation and death rates. Which is why Australia was sceptical of Iraq's figures early on, when the country was reporting far too many deaths for its official numbers.
Australia's death rate is reassuring in this respect, sitting at under 1 per cent of known cases, which suggests the number of undetected cases is not wildly out of whack with official numbers. Its strike rate is also reassuring, also with fewer than 1 per cent of tests showing up positive. But it nevertheless seems crucially important as cases take off to build an accurate picture of the spread by testing people with symptoms whether or not they have been overseas. A person who thinks they probably just have a cold is less likely to adhere to strict isolation protocols than someone who knows they have the virus.
The limits on testing are because testing materials are in short supply. We know that much because it has been conceded, albeit in vague terms - the glimmers of detail on this coming via the states - Victoria, for example, has talked of a shortage of swabs and others referring to a shortage of reagents. Health Minister Greg Hunt is happy to trumpet numbers when test kits arrive, telling us that 97,000 more arrived last week, but avoids telling us how many we have. Again, the demands for more testing might come with more nuance if people knew precisely what the numbers are.
It is also via the states that we got the first modelling numbers, with NSW Chief Health Officer Kerry Chant telling an estimates committee in that state that authorities were working on 20 per cent infected, and of that, 5 per cent needing intensive care and 1 per cent dying. This, it seems, is national modelling, and the ACT Health Minister, Rachel Stephen-Smith, confirmed as much. But the federal health authorities, the federal modellers and the federal political leaders won't confirm and won't discuss numbers. They presumably are worried about igniting panic. But panic and fear develop in a vacuum and reassurance comes with information. Armed with the truth, people can digest and move forward. Armed with the truth they might also take more seriously the isolation measures demanded of them.
To be clear, there is no suggestion the government has a terrible secret it is withholding. The terrible truth is already on display for all. But it does have information that it hasn't shared. And if it wants to build the trust and cooperation it needs, it would do well to rethink that reluctance, and stop trying to shut up the doctors and experts who are speaking out.
A refusal to answer means the questions get louder and it risks the erosion of trust. When people don't trust what they're told they won't want to do as they're told; and when people don't get answers, they'll make up their own.
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- Australia has trouble sourcing 'consumables' for testing kits
- Pandemic could knock $2.3 trillion or more from global economy
- Coronavirus infection rate will slow: Paul Kelly
- For information on COVID-19, please go to the federal Health Department's website.
- You can also call the Coronavirus Health Information Line on 1800 020 080
- If you have serious symptoms, such as difficulty breathing, call Triple Zero (000)
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