Victoria and New South Wales may be accustomed to parochial interstate rivalries, but when it comes to combating coronavirus, the stakes have never been higher.
Just as we thought the pandemic gripping global shores was in a lull, the nation has once again found itself at an uncomfortable crossroads.
As Victoria grapples with the fallout from close to 3,000 active cases of COVID-19, NSW Premier Gladys Berejiklian has conceded her state is at a "critical point".
It is, in many ways, a tale of two cities: Sydney and Melbourne, both faced with a sudden resurgence of the virus, and both dealt the unenviable task of trying to contain the spread.
Health authorities recorded another 20 coronavirus cases in NSW on Monday, including several linked to known Sydney clusters and fresh outbreaks appearing almost every day.
As NSW residents watch and wait, many feel rising concern that the state is a ticking time bomb, about to follow Victoria into a second-wave lockdown.
What are the risk factors?
While socially distinct, there are few inherent differences in the geographical features of Sydney and Melbourne that predict an outbreak says Hassan Vally, an epidemiologist and associate professor at LaTrobe University.
Both are dense metropolitan centres with similarly-sized populations, and while the latter may face additional challenge of a colder climate ("We're indoors more, so that could lead to more transmission," Vally says), it is unlikely to be a major contributor.
"I think the biggest driver for an epidemic is the fact that you have a population that isn't immune," Vally offers. "So even if you have some sort of seasonal effect, I don't think that's a major driver."
This isn't good news for Sydneysiders who also lack herd immunity.
Differences in the public health response, however, could provide a greater insight into the ability (or inability) of either state to limit the spread.
And to date there is one key difference that gives some hope that Sydney and NSW may avoid Victoria's predicament: community transmission — when the source of the infection is unknown.
The level of community transmission in Melbourne is high. But this is not the case so far in Sydney. "So NSW is better placed really to stamp out transmission," Vally believes.
"With identifying every case and cluster ... they can stop these transmission cases," he says. "Whereas in Melbourne and in the Mitchell Shire, that's a lot harder."
How does Sydney compare to Melbourne?
It's an assessment reflected in the data.
With less than 100 active cases in NSW, all of those recorded on Monday came from known sources, authorities said.
In contrast, about 30 per cent of the 3,000-plus active cases in Victoria have been linked to community transmission. This is of concern, because it means the virus has emerged in places authorities had not anticipated.
An increase in community transmission translates to a looser grip on infection control, as there are missing links between cases.
"The first wave was [driven] by the Ruby Princess and this one is the failure of Victorian quarantine," says Stephen Duckett, a health economist and health program director at the Grattan Institute.
"It's not surprising that we have a second wave. If we follow a suppression strategy and lift restrictions while the virus is still circulating, it's inevitable we will see more infections.
"The only question is whether it will be small and easily controlled by local lockdown and contact tracing or if it is going to be big."
It's a sentiment echoed by Vally, who describes the seeding of clusters through quarantine breaches as a "nightmare scenario".
"That's clearly a large part of why Melbourne finds itself in this situation."
Sydneysiders not as socially distant
The big question for NSW is whether it can maintain this edge over the virus and minimise further spread.
Regular discoveries of new virus clusters are testament to the risk and seem to defy the NSW's plan to continue to pursue a suppression strategy that includes voluntary mask-wearing and businesses open as normal.
A new report from the Doherty Institute, examining the uptake of social distancing measures, found the average Victorian was interacting with 5.9 non-household contacts per day between early June and July 1.
Across the border in NSW, that number was 8.1 people.
Those numbers don't look comforting for NSW but the variable to watch for could be a single super-spreader.
"One of the things we know is that super-spreader events are part of this disease. That's what happened in Victoria. That is why [infections] got away so quickly," Duckett says.
"That's not what has happened so far in NSW, but clusters of infection have potential to become widespread across the Sydney metropolitan area."
Vally concurs. COVID-19 is an "equal opportunity virus", he says, that "exploits any weaknesses in the community or public health response".
"What is happening on Melbourne could equally have happened in NSW," he says.
"Melbourne [should be] a reminder as to how quickly things can get out of control.
"[But NSW has] already encouraged people to travel less and limit their social gatherings. So if things don't stabilise, I'm sure they'll go to the next phase and introduce restrictions."
Melbourne's mixed message problem
Will NSW residents cooperate and comply with social restrictions designed to slow, suppress, or eliminate the spread?
Duckett believes messages coming from federal and state governments have at times been contradictory and this has in turn undermined the authority of COVID-19 guidelines.
"We have received mixed messages — is the virus bad, or is it not? Should we be in lockdown or not? The Prime Minister says one thing and the premiers another," he says.
"We need more consistent messaging otherwise people will listen to the message they like the best."
Patrick O'Leary from Griffith University, who has conducted research into factors motivating public attitudes towards coronavirus restrictions, agrees.
"When people don't have consistency in the message they lose faith," he says. "It creates doubt and people take a decision to follow this guideline but not that guideline.”
He argues that this discrepancy in the message has been most marked in Victoria.
"There has been some awkwardness in delivery between the Commonwealth and Victorian governments in the way they have communicated things compared with the full embrace [of the federal perspective] by the NSW government," O'Leary says. "Daniel Andrews' approach is about community compliance but there has been a degree of lecturing about [being well-behaved]. Some of the other approaches have been less personal and more about communicating that this is what's expected."
O'Leary also believes that messages that appeal to people's values are more effective than enforcing particular behaviours.
"What we know about human behaviour is that none of us particularly likes to be told what to do and in democratic societies we are encouraged to make our own decisions. That includes the right to take risks if we want to take risk," he says.
But the dilemma posed by COVID-19 straddles personal risk and community responsibility.
"We don't like authoritarian regimes and if we look across to the US we see claims about rights being taken away or a nanny state," he says. "But this is a different situation. It's different to restricting free speech, for example, but it can get collapsed [in people's minds].
The challenge is for governments to promote a public health policy that encourages widespread compliance.
But it is not easy.
No-one can let their guard down
While acknowledging failures in Victoria's public health response, Vally says there is often "a lot of randomness" that factors into potential outbreaks.
A mistake here or a mistake there, he says, could see other states and territories facing a similar quandary.
"This is a really difficult situation that we're dealing with, and you just need one or two things to go wrong," he says.
"So the lesson here is that no-one can let their guard down. Every place is just at vulnerable to a resurgence."
https://news.google.com/__i/rss/rd/articles/CBMiZmh0dHBzOi8vd3d3LmFiYy5uZXQuYXUvbmV3cy8yMDIwLTA3LTIxL2Nvcm9uYXZpcnVzLW91dGJyZWFrLXN5ZG5leS1tZWxib3VybmUtb25lLW1vcmUtYXQtcmlzay8xMjQ3MjQwNtIBJ2h0dHBzOi8vYW1wLmFiYy5uZXQuYXUvYXJ0aWNsZS8xMjQ3MjQwNg?oc=5
2020-07-20 19:00:00Z
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