The idea: Innovative surveillance
Deakin University’s Chair in Epidemiology in its Institute for Health Transformation, leading researcher and expert in infectious diseases and community transmission
Professor Catherine Bennett is cautiously upbeat about the trajectory Victoria is on, once we emerge from stage-four restrictions. “I think we will look pretty much like NSW does now,” she says, adding that we might have to get used to some intermittent school or restaurant closures as they are cleaned and investigated. “But I do think we’ll be back in cafes.”
She believes more widespread and innovative public health surveillance in three key areas – wastewater, blood and social media – could help prevent Victoria from sliding back into crisis.
Monitoring sewage for public health, including COVID-19, has been trialled in France, California and is already here in Victoria. In Italy, frozen samples taken in December 2019 showed the virus was there days before the World Health Organisation announced its presence in China. Now sewage monitoring has been identified as a potential early-warning system for new outbreaks. “It’s an accessible, articulated system,” says Catherine of the wastewater network. “It’s like capillaries and blood vessels – they can go out to as fine a detail as they want, and know that they’re sampling people potentially down to street level.” The technique has already been used in Canberra with some success, too.
The same goes for blood. Random or routine blood tests could provide a better understanding of what antibodies are out there in the community. Unlike saliva tests or throat and nose swabs, blood can throw more light on when an infection happened. “Being able to identify recent infections is important,” says Catherine. “People are now doing other work to see if there are other blood markers we can use to distinguish between a recent infection versus one that could have been six months ago.”
The third surveillance tool is Facebook, Instagram and online questionnaires, which have been trialled with some success in the Netherlands. Social-media monitoring algorithms can alert authorities when groups of people start posting key phrases indicating illness or flu-like symptoms. We’re told it can all be done without affecting privacy, too.
“At the end of the day, we’re hopefully going into a period where early warning’s going to be a really useful thing for us,” says Catherine. “And the more creative and innovative we can get about how we do that the better.”
The idea: Change the way we work
The expert: Bernard Salt
Futurist, demographic commentator and business adviser
Whether or not we find a vaccine for COVID-19, Bernard Salt believes we will eventually produce elegant, instant testing technologies, similar to the way thermal imaging was used in airports during the 2003 SARS epidemic. “But maybe not this year. I think this year is a matter of surviving it, managing the best we can.”
But it’s the way we return to work that interests him most. The virus has forced many employers and employees to work from home, accelerating remote working technology and practices as a result. And, although staggered shifts, changes to open-plan office designs and hygiene modifications such as sneeze-guards could help some workers return to the communal office, the safest way to reduce transmission would be to continue to embrace working from home after restrictions are eased.
Bernard estimates between 40 and 45 per cent of working Melburnians are currently doing so from home, compared with a 25-year average of 4 to 5 per cent. “I don’t think it’s going back to that long-term average,” he says. “I think it will go back to maybe 10 per cent or even 15 per cent of workers.” By doubling or tripling the number of long-term stay-at-home workers we could have a significant impact on stopping the spread of community transmission.
A shift like this would also be a huge change to the way we live. Bernard says knock-on effects could include a contraction of the CBD (to form a hub between, say, Spring, Flinders and Bourke Streets to Docklands), the activation of middle and outer Melbourne suburbs with people travelling to the city only every two weeks or so, and increased demand for services that would support our new suburban workforce, such as food and beverage, technology retail and repair, and other office supply-type businesses. In short, it could result in the fast-tracking of a planning utopia known as the 20-minute neighbourhood.
Bernard predicts the next major shift will happen when people realise they can work from a bucolic regional or coastal address instead of the suburbs. “We’ll see a version of seachange or treechange 2.0 emerge, underpinned by people telecommuting from lifestyle areas that are perceived to be safe, secure, and hygienic.” Already there are signs this might be happening, with regional house prices solid compared with metropolitan Melbourne. Just how productive this remote workforce can be will depend on a range of factors, not least of which is a fast, reliable internet connection.
The idea: Embrace our region
University of NSW epidemiologist and member of the World Health Organisation’s Health Emergencies Program Experts Advisory Panel for Infection Prevention and Control Preparedness, Readiness and Response to COVID-19
It’s time to turn to the Asia-Pacific region, says Professor McLaws, who blames the slow response by some of Australia’s traditional partners, such as the US and UK, on poor leadership in those countries. Before Victoria’s second wave, Australia was on an accidental course to almost stamp out COVID-19 and Marylouise argues it should be nations with similar approaches – those on a path to controlling the disease close to elimination – that we form bonds, trade deals and travel bubbles with. “We could set up a regionality where we are assisting each other and assisting ourselves to have a safer life within a pandemic, to still allow for travel, trade [and trade in education as well], and tourism.”
Once Australia is back on track, she says the first countries to share our bubble could be New Zealand, Taiwan and China (‘poster countries’ in terms of their pandemic response), followed by other nations as they gain control, such as South Korea.
Terminology (what constitutes a ‘hot spot’, for example) and responses (such as ring-fencing, contact tracing and mandatory masks) should be standardised nationally and then rolled out across our bubble buddies. In this way, we could have regular, even weekly, regional health meetings to discuss testing, infection numbers and whether we need to slow down travel for a while. Standardised outbreak responses could help avoid economically damaging shutdowns and restarts.
Finally, Marylouise thinks more could be done in the behavioural sciences. It was encouraging to see a recent Roy Morgan survey showing nine out of 10 Victorians backing compulsory mask-wearing under stage-four restrictions. But Marylouise says epidemiologists could do more to spot specific demographic infection trends and then work closely with social scientists to create targeted public health messaging, whether it be via TikTok or toilet-wall posters. “It’s all about speed because human behaviour is a really important factor. You’ve got to get it before humans continue to assist the virus.”