#WTFACTSHEET 9.

COVID–19
The right
methods
April 2020 dnm
DNM STRATEGIC CONSULTING
HOW IT ALL ADDS UP
The right methods at the right time
General factors
Burden and adherence
How difficult are the recommendations
to carry out? How burdensome are
they? What proportion of people are
able and likely to adhere to the
recommendations consistently?
Comparative benefits and risks/costs
The anticipated risks and benefits of the
method being considered, and how they
compare to other possible choices. This
is not just the public health benefits.
Economic decisions also have health
costs through increasing homelessness,
family violence, and suicide. People who
lose all their income or become
homeless are at increased risk of dying.
Strength of evidence
The strength of the evidence in support
of each choice. In a rapidly evolving
situation, recent, relevant experience
may be considered as well.
Evidence may be uncertain. This is not a
reason for rejecting evidence
altogether. Nor is uncertainty a reason
for proceeding without evidence, an
approach which is sometimes
misunderstood as the precautionary
principle.
Specific factors
Responsiveness to our own epidemic
The Australian government held back
from introducing a general stay-home
period for weeks. Advocates of the
elimination approach point to the steep
increase in cases of Covid-19 diagnosed
in Australia. They say the steepness of
this curve is evidence of exponential
community transmission—in other
words, an epidemic that is out of control
and requires urgent measures.
The medical experts advising the
government have said they are looking
at the breakdown of the cases that
make up that curve.
At the time of writing, the majority of
cases were overseas travellers, who did
not get the virus in the Australian
community. The curve would look very
different if we took these cases out and
only focused on local cases.
Now that we have banned overseas
traveller and imposed quarantine for all
returning Australians, we can expect to
see the number of overseas cases
decrease. We are likely to see an
increase in locally acquired cases, as
well as a shift in the focus of our
response strategy to address this as an
issue.
HOW IT ALL ADDS UP
CHOOSING METHODS (CONTINUED)
By focusing on the data about our own
epidemic, the medical advisors were
able to recommend a strong priority on
mandatory isolation for all new
international arrivals and contact
tracing for all known cases. This can
prevent these cases causing local
transmission.
Rebound
If we can manage to bring cases down
to zero, do new cases emerge when we
lift the methods we were using?
For example, as the epidemic continues
in other countries, we might need to
continue bans on overseas travel, in
order to prevent new cases being
imported here.
In addition, if we introduce a general
stay-home period, does community
transmission restart when it ends?
As long as we don’t have a vaccine,
rebound is a real possibility when
control measures are lifted. Experts and
health authorities are watching
carefully to see what happens in China
and South Korea, which successfully
curbed their outbreaks without making
use of national shutdown methods.
Herd immunity
This is an ordinary concept in studies of
disease transmission. For example, we
need about 90% of people to get
vaccinated for measles. That level of
‘herd immunity’ offers protection to
people who are not immune. Even if
someone does get measles, it cannot
spread far, because most nearby
contacts are immune. In this sense, herd
immunity is an effect, and the strategy is
widespread vaccination.
Herd immunity has become
controversial in the political debate
over Covid-19 control in Australia. In the
United Kingdom, it was briefly
considered as a strategy for controlling
the outbreak without the help of a
vaccine (which doesn’t exist—yet). This
idea was abandoned when researchers
predicted it would result in tens of
thousands of people dying before the
necessary levels of immunity could be
reached.
Many advocates of an elimination
approach in Australia have accused the
Commonwealth government of relying
on herd immunity as a strategy for
controlling the outbreak without saying
publicly that is what they are doing.
Comments by senior government staff,
which mention herd immunity as one of
the complexities in the debate over
school closures, have been seized-upon
as meaning that herd immunity is the
government’s strategy.
The authors of this booklet do not
believe this has ever been the case.
HOW IT ALL ADDS UP
CHOOSING METHODS (CONTINUED)
If we cannot find a vaccine for the virus,
herd immunity will be an important
effect to consider in long term
predictions. It could only come about
with many deaths along the way, so no
reasonable observer considers it an
acceptable strategy to adopt.
Pulsing control measures on and off
again over time
Some researchers and commentators
have advocated introducing an initial,
very broad stay-home period to curb
most infections, lifting the stay-home
orders, and then monitoring the
epidemic in order to decide when to
reintroduce restrictions until rates come
down again. In effect, this means pulsing
restrictions on and off again repeatedly.
There are big questions about this
approach.
Pulsing restrictions works in a
simulation, but it has serious practical
limitations. It is likely to become very
burdensome over time, as people find it
hard to plan their lives without knowing
when restrictions will be re-imposed.
As people get tired of this, adherence
will decrease, and the approach will be
less effective over time.
It depends on closely monitoring
numbers from testing and contact
tracing, in order to make an informed
guess about what is happening with
transmission in the community.
This can be difficult when there are
unavoidable lags between people
becoming infected, getting sick, seeking
care and being diagnosed with Covid-19.
It could result in repeated shocks to the
hospital system.
This approach openly expects the
epidemic to rebound in between periods
of restriction. It assumes that restrictions
will have the same effect each time they
are introduced. (This is known as a dose-
response relationship.)
However, epidemics are complex and
unpredictable. A cluster or super-
spreader event in between control
periods could change the behaviour of
the epidemic altogether. If everybody in
society rushed out to see all their friends
and family at the same time, these types
of events would be much more likely.
Conclusions
Personal behaviours
In the absence of a vaccine, the basics
really matter. The recommendations are
easy to grasp but incorporating them
into our everyday life is much harder.
As we learnt from the AIDS crisis, panic,
fear, blame, and guilt are not effective
at motivating long-term use of
protective behaviours.
It is essential that we find ways to
translate abstract recommendations
into concrete, personal, everyday life
practices. We need to use humour and
pleasure and positive values, even as we
acknowledge that the crisis is serious.
It is easy to understand how hand
washing and physical separation can
protect us. It is less easy to see how
personal and household practices like
staying home and avoiding gatherings
can add up into a bigger picture —
hopefully, controlling the outbreak.
The timing of control measures matters,
and we may sometimes need to follow
advice quickly and carefully, even
though the reason may not be obvious.
Recommendations may change, possibly
suddenly and drastically.
Finally, adherence is vital. We need
enough people and households to
adhere to recommendations to bring the
outbreak under control.
Policy responses
On page 26 we list many of the different
methods that governments are using
around the world to control the
outbreak. We can add one more:
• Communication and health
promotion
We know that people need information
and motivation and behavioural skills,
as well as belief in their own ability to
carry out actions that will be effective.
Unless we effectively communicate the
rationale for the actions we are taking
and recommending people adopt, they
are not going to blindly obey orders
they don’t understand.
There is a rationale to the Australian
response. It is the right measures, at the
right time, for the right reason.
It requires patience, courage, and
attention to detail.
But panic makes people prefer urgent
messages and simple measures, such as
school closures and ‘shut it all down.’
We are beginning the first weeks of a
stay-home period for all Australians. The
success of this measure at the big
picture level depends on adherence,
which depends on understanding, which
depends on effective health promotion.
SUGGESTED CITATION

Daniel Reeders. Responding to Coronavirus in Australia: The rationale behind the

recommendations. A plain language guide (April 2020). Sydney: DNM Strategic
Consulting. Available at: www.dnm.net.au/covid19

COPYRIGHT

Copyright 2020 DNM Strategic Consulting Pty Ltd. All rights reserved. Permission is
granted to download, circulate and republish this document unchanged.

ABOUT THE PUBLISHER

DNM Strategic Consulting Pty Ltd is based in Sydney. We facilitate insightful strategic
outcomes and deliver reliable, independent health promotion initiatives.

The author of this booklet is Daniel Reeders, director and principal consultant at
DNM. Daniel has over 16 years’ experience in health promotion involving HIV, viral
hepatitis, sexual and reproductive health and cancer prevention in communities
including gay, bisexual and queer people, migrants and refugees, Aboriginal and
Torres Strait Islander peoples and people living with socioeconomic deprivation.

Since 2014 Daniel has been a researcher looking at the mobilisation of networks,
cultures, markets and communities in response to public health issues and disability.
Daniel has qualifications in law, cultural studies and public health and is a PhD
researcher at the ANU School of Regulation and Governance (RegNet).

ACKNOWLEDGEMENTS

This booklet has been produced with the generous input and feedback of a small
crew of passionate researchers, clinicians and practitioners. They are not named
here because their roles as advisors to government preclude them from making
public comment. The content in this document may not represent their individual
views and does not represent the position of their employers or any government
department or public sector agency to which they provide advice.

FUNDING

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DISCLAIMER

The information in this resource is general in nature. Readers should use your own
discretion and seek relevant expert advice before applying it to your own situation.

Every effort has been made to ensure the information in this booklet is correct. DNM
accepts no responsibility for any error, omission or defect herein. As mistakes are
found, corrections will be made and recorded in an appendix at the end of this PDF.