Inside Story

Roads to recovery

A half-year of Covid-19-watching suggests the most effective way ahead

Michael Bartos 11 September 2020 1498 words

Time to devolve: Victorian premier Daniel Andrews arrives for one of his daily media conferences. James Ross/AAP Image

The six-month anniversary of Covid-19’s declaration as a pandemic (and of my first article on the outbreak for Inside Story) seems like a good time to reflect. What has changed? What is new? What have we learnt?

Clearly, not enough. In Victoria, where the interminable debates over modelling and lockdown continue, it sometimes seems like groundhog day. Remember when “bending the curve” was introduced into the popular lexicon? March feels like years ago.

That’s part of the reason why, on 6 September, premier Daniel Andrews attempted a reset, unveiling a “road to recovery” that featured a graduated relaxation of lockdown rules, each step triggered by reductions in the number of new cases over the previous fourteen days. The last stage would only be reached after 23 November, and only then if cases had been kept at zero.

The plan responded to criticisms of a lack of transparency by making each stage explicit and publishing the modelling on which it drew, but the result was a fearfully complex schema with dozens of points of guidance at each step. Reactions ran the gamut from grim resignation to vocal outrage, with the underlying fear that the criteria for escaping lockdown were too stringent ever to be reached.

Victoria’s attempted reset has hints of more inclusive and decentralised approaches, but it was too much in the thrall of an epidemiological logic. The long haul of this epidemic will require a deeper commitment to trust as a two-way street between government and people, and a much wider repertoire of local self-management in crafting durable changes in social organisation to minimise transmission.

Buried in Victoria’s road to recovery was the news that suburban response units would be established to “provide a tailored local response to everything from contact tracing to outbreak management.”

The call for local responses put me in mind of one of my most rewarding jobs, back in the late 1980s, as executive officer of the Victorian Federation of State School Parents Clubs, an organisation with an illustrious history extending back to the 1920s. Throughout the 1970s it was led by Joan Kirner, who would later recount her experiences on visits, as premier, to far-flung corners of the state. Once the formalities were over and the (male) dignitaries had dispersed she would find herself surrounded by women animatedly exchanging news and views on a first-name basis. Incredulous men would ask their wives how they knew the premier, and invariably the connection would be through the state’s parent-advocacy movement.

Victoria was once a leader in community participation, not only in education but also in health, community legal services, and the many other locations where active citizenry is constructed. They were mostly dismantled by premier Jeff Kennett’s Thatcherite turn to privatisation during the 1990s, and they never regained their pride of place.

Not even now, perhaps. A revealing detail in Victoria’s proposed localised response to Covid-19 is the disclosure that the technology giant Salesforce will be contracted to provide a new information management system. Salesforce is a US$160 billion company that promises its users they will be able to “make decisions faster, make employees more productive, and make customers happier using AI.” Its data-visualisation product offers nothing less than “human advancement.”

Salesforce has quickly pivoted to the Covid-19 response with a set of tools devoted to tracking the epidemic and its impacts — in fact, an entire ecosystem to guide businesses in reopening. In this and other ways, the pandemic is revealing the contours of a new form of platform capitalism. In the United States in particular, where central government has abandoned any pretence at steering epidemic control, the vacuum has been filled by the private sector.

These information management platforms are themselves politicised. Salesforce is firmly on the Democratic side; among those lining up on the other side is Alexander Karp, chief executive of another data-management outfit, Palantir, who filed a trenchant statement with the company’s IPO on 25 August.

“Our software is used to target terrorists and to keep soldiers safe,” said Karp. “If we are going to ask someone to put themselves in harm’s way, we believe that we have a duty to give them what they need to do their job.” Many Silicon Valley technology firms use “slogans and marketing” to obscure the fact that “our thoughts and inclinations, behaviours and browsing habits, are the product for sale.” Better to choose Palantir, he concluded, because it wears its politics on its sleeve: “We have chosen sides, and we know that our partners value our commitment.”

These platforms offer to solve the problem of modern government by reducing it to a question of data organisation. The “old-fashioned” politics of community participation proposes a different answer. The pressing issues of pandemic control lie in how easily and quickly people can be tested, receive results, isolate if they need to, find income, food and social support, reduce their social mixing if they may have been exposed, stop working jobs in multiple locations, reduce the risk at worksites, and so on. The experience of the Victorian town of Colac, where an outbreak centred on the local meatworks, speaks of a community taking local control of the response.

My advice to Daniel Andrews? Amplify these signals, be prepared to trust communities to play a bigger role in the Covid-19 response: some mistakes will be made, but more decisions will be right than wrong. The trust needs to be genuine: devolve real power over how people mix and how they manage risk. It doesn’t play the game of adversarial politics, nor give a click-driven media the polarisation they crave — locked down or not? borders open or closed? — but it does give government more space to concentrate its efforts where they will make a real difference, by ensuring communities are supplied with the real-time information, infrastructure and supplies they need.

Meanwhile, more evidence from overseas that science and politics are poor bedfellows.

Last week’s news of a pause in the Oxford University/AstraZeneca vaccine trial was accompanied by quick assurances that occasional adverse reactions among participants are nothing unusual. Perhaps so. A participant in the trial was reportedly diagnosed with transverse myelitis, a serious spinal cord inflammation known to be triggered, albeit rarely, by vaccines. The trial resumed within days, indicating that its safety board didn’t see a substantial risk of adverse events, but the pause does dent the optimistic view that everything will go miraculously smoothly and a vaccine will be available in October.

Covid-19 has caused many of us to dust off the history of Spanish flu, which despite its name originated in a US army base in Kansas. Its impact was front of mind in 1976 when a swine flu outbreak occurred in the US army base, Fort Dix. It was an H1N1 flu similar to the 1918 virus, and US authorities saw a significant risk of a global pandemic. President Gerald Ford, who was up for re-election, announced in March that “every man, woman and child in the United States” would be vaccinated, and he himself was photographed receiving the rushed vaccine less than a month before he narrowly lost the election to Jimmy Carter.

Ford’s strategy wasn’t only politically futile, it was also a healthcare disaster whose legacy is still being felt. As early as April 1976 the World Health Organization had doubts about whether the new flu was likely to develop into a serious pandemic, and advised against rushing out a vaccine. Worse still, the vaccinations caused more than 450 people to develop the paralysing Guillain-Barré syndrome. The suspicion remains that public health and safety judgements were shaped by the political imperatives at play.

The race for a Covid-19 vaccine has been the most overtly politicised of the scientific challenges, but it is worth noting that no effective therapeutic drugs have yet been developed to treat the illness. The only real success to date has been the repurposed steroid dexamethasone. The reality is that the pathway from invention to successful trial conclusion is long and time-consuming.

The last of the potential game-changers is diagnostics, where a reliable rapid, point-of-care antigen test would transform the capacity for real-time control of the epidemic. That much has been recognised by British prime minister Boris Johnson, whose Operation Moonshot is a £100 billion plan to enable ten million tests nationally per day by early 2021. Perhaps unfairly, the plan — relying on an upbeat PowerPoint by another of capitalism’s handmaidens, the Boston Consulting Group — has been received with widespread derision. This is perhaps where politics ought to make its contribution to science: setting, testing, resetting and retesting the balance between realism and ambition.

Six months in, it is tempting to imagine this pandemic is nearly over. That is far from the case. As the next year unfolds, there are sure to be many trying moments. The temptation will be to run them through the prism of heroism or outrage. A more sustainable strategy may be to hold back on both. •