Australia’s eight leading universities have joined to produce a document impressive in scope and detail to provide a guide out of our crisis.  It’s COVID-19 Roadmap to Recovery.  A Report for the Nation.

The report describes the medical and health options in depth and the myriad health, social and economic issues to be considered in working our way out of pandemic isolation.

Of the six imperatives outlined in the implementation of recovery a resounding plea is made: maintain civic engagement and garnering widespread public support and participation is critical to overall success regardless of which strategy is chosen. This is where civil society organisations like CHF and its membership have a key role to play.

It identifies two options — elimination or suppression — to deal with COVID-19.  These two options do not require one choice or the other, it says.  They would both require some restrictions, large-scale testing, tracing and isolation systems.  How they differ is in their depth, breadth and duration. The final “exit” from both pathways will require a vaccine that confers immunity on us all.

The report, however, does make the point that the marginal costs of achieving elimination “are low relative to the alternative of controlled adaptation and, overall, the total economy costs may be lesser than other strategies”.

There is no easy way to defeat spread when we consider that, according to the report, prevalence rates of asymptomatic or mild disease have been as high as 50–78 per cent of cases.

This is no dry as dust scientific report. Importantly it goes to fundamental values most Australians would accept.  Its fundamental concepts should provide us with a roadmap for future health policy beyond the COVID era.

The Group of Eight universities produced the 200-page document.  Far from focusing purely on medical and economic solutions, it sets out six “core principles” to frame Australia’s decisions and policymaking.

“At a time of national crisis, and in turning our minds to the recovery from it, it is vital to clarify the key values and principles that will guide decision-making when we will face many difficult challenges and trade-offs

The six principles are:  

• Democratic accountability and the protection of civil liberties
• Equal access to healthcare and social welfare
• Shared economic sacrifice
• Attentiveness to the distinctive patterns of disadvantage
• Enhancing social well-being and mental health
• Partnership and shared responsibility

As Roadmap to Recovery states, although equal treatment is a fundamental Australian value, the virus, and our policies to control it have impacted some disproportionately.

“Therefore, renewal and recovery programs should focus on those most affected first. In the long run, they should foster social and economic innovation that will make all Australians more resilient in the face of future shocks.”

Australia’s approach so far has worked better than expected. From the peak of the epidemic in late March when we saw nearly 500 cases a day, the number of daily new cases now are fewer than 25. During the peak, 90 per cent of cases were imported or a direct consequence of importation, a pathway that has now been practically stopped. Australia’s testing rate is amongst the highest in the world, and its test positivity rate and case fatality rate amongst the lowest.

Many have delayed their ongoing care and elective procedures and the report recommends support for direct messaging to assure all Australians of the safety of the healthcare system and urge a gradual return to usual patterns of healthcare.

The report recommends the creation of a national, real-time, data repository of all COVID-19-related care in primary, secondary and acute care to ensure best care for all. This is critical because we know little about COVID-19 care now. Developing such a national resource will improve outcomes for all.

If there is any positive out of the COVID-19 catastrophe it has been the way necessity has pressed forward long-sought developments in health care.

COVID-19 has resulted in a huge increase in video/tele-health and eHealth use.  One of many key findings in the report is that as with the likely ongoing uptake of videoconferencing in the broader community, video or other eHealth options are likely to be able to offer high value care when used appropriately. The report says the valuable aspects of this new model should be sustained as an important part of routine health care, supported by nationally agreed standards and quality indicators. “The digital divide in Australia must be closed or we risk even further entrenching existing health inequalities amongst lower income groups.”

On a more sombre note, the pandemic experience is encouraging more active advice on end of life.  The report says that now is the time for general practitioners, emergency medicine, anaesthetists, intensivists to promote early goals of care discussions for patients at high risk of death or severely impaired functional recovery. “Some patients who have died in ICU from COVID-19 may have benefitted from goals-of-care discussions before their final illness.”

The unprecedented scale and speed of the COVID-19 pandemic has implications for the wellbeing of all. People with psychological vulnerabilities and pre-existing mental illness are at higher risk. The greatly increased demand for services will continue throughout the recovery phase and will require coordinated and sustained public health messaging on the risks associated with COVID-19 and actions that can be taken to maintain mental health and wellbeing.

The disproportionate impact of pandemics on Indigenous populations worldwide is well documented. Thanks to the leadership by Australian Indigenous organisations and their partnership with Governments, the number of cases is proportionately lower. However, Indigenous Australians are particularly at risk as Australia “reopens” with a weakened economy and the resulting consequences and the report recommend immediate and enduring support in such areas as housing.

The report identifies several populations that are particularly at risk: women who are pregnant and women at risk of family violence, children and young people, those living in out-of-home care; older adults and those living in residential aged care; people with disabilities; people living with a life-threatening illnesses amongst others.

It says consideration should be given to the establishment of a funded national service program for younger Australians, (suggested title Aussies All Together) to inclusively engage the young in the process of social reconstruction across the country.

The report emphasises the importance of clear communication to everyone. The overall success of the recovery will depend upon engaging widespread public support and participation regardless of which strategy is chosen. If the Elimination Strategy is pursued, it is important that the public understands the additional It is also critical that the public understand that even with the Elimination Strategy, life will not return to the ‘old normal’.

With the Controlled Adaptation or suppression strategy, it is critical that the public understand that in exchange for an earlier relaxation, there will be a need for ongoing adaptation. The public should also be prepared that should numbers worsen, the course may need to be temporarily reversed. This would not be a failure of the strategy – rather it is the strategy.

There is an important role for CHF in ensuring the community gets and follows the right message.  The report acknowledges the need to enlist the support and assistance of independent, credible and trustworthy advocates such as healthcare workers, educators and community leaders to convey key messages.

It recommends enhancing the impact of communication by establishing community reference groups to provide ongoing input into the decisions that affect them and also how best to communicate them. Collectively they should represent Australia’s diversity and be proactive in identifying and actively combatting misinformation and conspiracy theories by transparently providing factual and current information.

On public trust transparency and civic engagement, the report says change should be communicated early, even with incomplete information, as acknowledging uncertainties does not undermine trust in the information or its source.