Conceptualising and Managing COVID-19 Risk: The Six Phases in Australia
Australia is well known for being one of the few nations that has successfully managed the spread of COVID-19 within its borders, with relatively low numbers of cases, hospitalisations and deaths per capita compared with other high-income countries. This success is due to the strong restrictions introduced by the Australian federal and state governments early in the pandemic and their continued efforts to eliminate the novel coronavirus using strict border controls (both international and national), a track-test-isolate-quarantine system that has attempted to monitor and isolate every COVID case and close contacts, and the implementation of targeted lockdowns throughout the pandemic.
There have been five distinct phases in Australia’s experience of the COVID-19 crisis thus far, according to my categorisation. The image above shows these phases and the events that occurred during the time periods they span. We are now on the brink of entering a sixth phase — ‘Living with COVID’ — which will challenge many of the risk-related precepts and behaviours to which we have been encouraged to adhere some the outbreak first began.
Phase 1, which I call ‘A Distant Threat’, covers the period January to February 2020, when the world was learning about this mysterious new viral outbreak caused by a new coronavirus. COVID was not at this point viewed as a risk to Australia. The Australian media represented the outbreak as a mysterious pathogen in China that was causing an illness similar to SARS. Not surprisingly, as I found in interviews with Australians from across the country, during this phase most people did not see this new infectious disease outbreak as threatening their country or themselves. It all seemed very far away from Australians’ everyday lives, just as SARS or MERS outbreaks had been.
This situation changed suddenly in mid-March 2020, following the first cases of the disease spread within the community in Australia and the declaration by the World Health Organization that COVID-19 was officially characterised as a pandemic. This began Phase 2: the period of ‘The National Lockdown’. Australian governments, both federal and state-level, quickly implemented a range of strongly restrictive measures such as closing Australia’s international borders to control the spread of the novel coronavirus. Mask wearing was not emphasised, but practices such as physical distancing from others in public places, hand washing, and cough/sneeze hygiene were recommended as the primary ways of preventing the risk of infection. A lockdown involving stay-at-home orders and the closing of schools and non-essential businesses were instituted across the nation, supported by social welfare provisions to avoid too much economic disruption.
These measures worked very well to eliminate the virus. Most Australians took the restrictions seriously. As my interview study demonstrated, they became far more aware of the risk posed to them by COVID: to the point that places such as supermarkets and people who stood too close in public places were positioned as ‘risky’. When case numbers began to fall from early April and by mid-May, restrictions began to be eased and the country moved out of its first and only nation-wide lockdown.
Phase 3 is the ‘COVID Zero’ phase. The ancestral coronavirus was still dominant during this period (June 2020 to January 2021), when there were few cases of COVID across Australia: with the major exception of the state of Victoria. During this phase of the COVID crisis, the main risk to Australians remained escape of the virus from hotel quarantine breaches. The methods implemented to contain this risk were lockdowns and an emphasis on continuing individual strategies of preventing exposure to infection. Mask wearing became promoted as a risk avoidance strategy in periods of lockdown, in addition to the other personal hygiene measures that had already been recommended.
Despite the international border continuing to be closed, exemptions were given to a small number of people, including returning ex-patriot Australians. As hotels were not designed to securely prevent infection, regular cases from returning travellers led to outbreaks in the Australian broader community. A new outbreak in Australia’s second largest city, Melbourne (eventually referred to as a ‘second wave’) sparked the reintroduction of restrictions in June and eventually another extended lockdown for that city and then the state of Victoria as a whole, which lasted from July 2020 to late October 2020. Short snap ‘circuit breaker’ lockdowns were implemented in other cities and states when cases of community transmission were identified, so as to reach ‘COVID Zero’ again.
In Phase 4, ‘Vaccine Dilemmas’, the focus from February to May 2021 turned to rolling out a mass COVID vaccination program as a ‘way out’ of the risks and uncertainties of continued lockdowns. High-income countries around the world had already successfully begun their mass vaccination programs. However, the Australian government had delayed procuring vaccines because of a sense of security, having successfully eliminated COVID each time a case or cluster of cases developed from a hotel quarantine breach. Adequate supply of the two vaccines the government had invested in — AstraZeneca and Pfizer — was not yet available. This became an even greater problem when very rare but serious side effects of the AstraZeneca vaccine received high levels of reporting in the Australian news media. While supplies of this vaccine, manufactured in Australia, were beginning to increase, many Australians who were eligible to be vaccinated began to refuse it. In this phase, issues of risk became centred on the relative risks of contracting COVID compared with accepting vaccination. National surveys of Australians during this phase identified high levels of vaccine hesitancy, which were unusual for a nation that previously demonstrated a positive attitude to mass vaccination.
With the advent of the more highly infectious Delta COVID variant into Australia, we entered Phase 5, ‘Delta Response’. A single case of the Delta variant in Sydney quickly grew into a large outbreak and eventually spread to other areas. Sydney entered a strict lockdown on 25 June, followed by prolonged lockdowns in Melbourne (from 5 August) and Canberra (from 12 August) as Delta cases appeared in those cities, as well as shorter snap lockdowns in other states and regional areas.
It gradually became apparent that the lockdown approach and seeking elimination of COVID could no longer be successfully pursued in the face of the Delta variant. The focus on mass vaccination as the ‘way out’ of the pandemic became intensified. Vaccine hesitancy levels declined significantly — particularly in areas experiencing lockdown. Adequate supply of the vaccine continued to be a problem, so higher-risk groups such as older people, those in care homes, disabled people and Indigenous populations were prioritised at first(if not necessarily adequately reached by vaccination programs). Once vaccination supplies improved, the numbers of people aged 16 and over rapidly increased by the end of this phase (June to September 2021). By 9 October, 68% of the whole Australian population had received at least one vaccine dose: higher than comparable countries such as Germany and the US, and just a few percentage points behind the UK, Sweden and France.
With the move now into Phase 6, ‘Living with COVID’, risk concepts and practices are changing again. The focus on case numbers and the strict and hugely labour-intensive track-trace-isolate-quarantine approach is loosening, even while the state of Victoria is recording the highest numbers of COVID cases ever seen in Australia. From today, the New South Wales government is beginning to wind back the Greater Sydney lockdown that has been in place for over 100 days. The goal of eliminating COVID (‘COVID Zero’) has been relinquished.
Australians are now advised by government and health officials that they must ‘learn to live with COVID’. This involves accepting higher case numbers, hospitalisations and deaths — particularly for those people who have not yet been fully vaccinated. Greater emphasis is now being placed on managing how vaccinated citizens will be treated compared with non-vaccinated people and how best to limit transmission in spaces such as schools, where children under the age of 12 have not had an opportunity to be vaccinated. The trade-offs for greater ‘freedoms’ such as travelling across state borders, welcoming visitors to homes, and mingling with greater numbers of people in homes and public spaces.
These are practices that in other phases of COVID management in Australia have been actively portrayed as highly risky and therefore to be avoided at all costs — to the extent that they have been actively enforced by police and health authorities. There are many complexities involved in this new orientation towards greater acceptance of risks. It is a confronting time for Australians. On the one hand, a promise of greater certainty and lower risk is being offered now that high vaccination rates have been achieved in some areas. On the other hand, we are being asked to accept the new idea (for us) that we cannot eliminate COVID anymore and that there will be new and potentially far more cases and deaths into the foreseeable future. There are new uncertainties.
The progressive loosening of restrictions from today in the state of NSW has been characterised as a ‘great experiment’ and ‘uncharted territory’ in the news media. Politicians have referred to as ‘greater freedom’ and ‘returning to normal’. But how things will work out in terms of the challenges posed to Australians of balancing the competing risks involved (deaths and overwhelmed hospitals versus ‘freedoms’, unvaccinated higher-risk groups being exposed to greater infection, loosening restrictions leading to more lockdowns, alleviation of loneliness or unemployment compared with anxiety about becoming infected or getting stuck in quarantine, booking holidays without being sure if flights will not be cancelled or state borders will remain open, whether to continue wearing a mask even if it’s not mandated any longer) remains to be seen.