Go8 Road To Recovery

COVID-19
Roadmap to Recovery
A Report for the Nation
APRIL 2020
Contents
Co-Chairs’ Foreword 4
A Roadmap to Recovery – A Report for the Nation 6
Chapter 1: An Ethical Framework for the Recovery 23
Chapter 2: The Elimination Option 26
Chapter 3: The “Controlled Adaptation” Strategy 58
Chapter 4: Border Protections and Travel Restrictions 83
Chapter 5: The Importance of Public Trust,

Transparency and Civic Engagement 92
Chapter 6: Australia’s Optimal Approach for Building

and Supporting a Health System within the
“Roadmap to Recovery” 102
Chapter 7: Preparing to Reopen 114
Chapter 8: Mental Health and Wellbeing 140
Chapter 9: The Care of Indigenous Australians 150
Chapter 10: Equity of Access and Outcomes in Health Support 164
Chapter 11: Clarity of Communication 174
Methodology 187
Acknowlegements 189
GO8 COVID-19 ROADMAP TO RECOVERY – 3

Co-Chairs’ Foreword
As Co-Chairs of the “Roadmap to Recovery” taskforce

it has been a privilege to work with over a hundred of
the brightest scholars in Australia’s leading universities
to address the most pressing question of our times –
How can society recover from COVID-19?
This report is independent, was not with the National Cabinet, our Federal,
commissioned by a Government, State and Territory Governments in
and was produced by the leading the hope that it may help inform the
researchers in this nation based many decisions they have to make.
on the latest evidence available.
For a problem as vast and complex
as COVID-19 there is no one
solution. That is why our Roadmap
to Recovery, offers two alternatives,
How this document differs from the with many side roads – but all taking
hundreds of articles and opinion us to the destination. We provide
choices because at the moment
pieces on this issue is that this
there are many uncertainties in the
report specifies the evidence data and in predictions. Under such
on which it is based … circumstances it is the job of our
research community to illuminate the
possibilities, rather than offer simple
solutions.
COVID-19 is not just a medical or a
How this document differs from the
scientific issue, it is something that
hundreds of articles and opinion
affects each of us, and all of us.
pieces on this issue is that this
Therefore, this is addressed as a
report specifies the evidence on
Report for the Nation. It is shared
which it is based, it is produced by
4 – GO8 COVID-19 ROADMAP TO RECOVERY

researchers who are experts and belongs to Government which must
leaders in their area, and it engages now make the decisions.
the broadest range of disciplines –
from mathematicians, to virologists,
to philosophers.
… it is produced by researchers
Over a three-week period, this
taskforce has debated and discussed,
who are experts and leaders in
disagreed, and agreed, edited and their area, and it engages the
revised its work over weekdays and broadest range of disciplines
holidays, Good Friday and Easter. All
remotely. All with social distancing. – from mathematicians, to
It is a testimony to their commitment virologists, to philosophers.
to the Australian community, to our
enviable way of life, to securing
our standard of living, to increasing
national productivity and to protecting
the values all Australian’s hold dear.
It is research collaboration in action –
a collective expression of a belief that Prof. Shitij Kapur
expert research can help Government MBBS, PhD, FRCPC, FMedSci, FAHMS
plot the best path forward and of Dean and Asst.Vice Chancellor
a commitment to provide this help (Health) University of Melbourne
in support of the nation and the
Australian community.
As Co-Chairs we recognise the
enormous effort expended by our Vicki Thomson
researchers, and they join with the Go8 Chief Executive
Go8 Board and with us the Co-Chairs,
to acknowledge that the hardest task

A Roadmap to Recovery
– A Report for the Nation
from Australia’s Leading Universities
Executive Summary In this Executive Summary, we

provide: one ethical framework; two
Covid-19 has changed the course of options for pandemic response; three
history. What started off as a flu-like requirements for success in recovery
illness in one person in one corner regardless of which path is taken; and
of the world, has changed the lives, six imperatives in the implementation
livelihoods and futures of billions. of recovery plan.
Australia saw its first case on January
25 and now has over 6,600 cases, Nature of this Report
the country is in partial lockdown, and the Reasons for it
schools and universities have left their
campuses, hundreds of thousands of Rather than recommend a single
jobs have been lost. Fortunately, the dominant option for pandemic
tide appears to be turning and we can response in Australia, we present and
start thinking of Recovery. explain two options for the nation’s
To chart a Roadmap to Recovery we consideration – Elimination or
convened a group of over a hundred of Controlled Adaptation. We offer two
the country’s leading epidemiologists, choices for several reasons:
infectious disease consultants, First, there are considerable
public health specialists, healthcare uncertainties around what we know
professionals, mental health and about Covid-19. Estimates of critical
well-being practitioners, indigenous determinants, such as the number of
scholars, communications and carriers, vary by a factor of ten. With
behaviour change experts, ethicists, such uncertainties in facts, there is a
philosophers, political scientists, limit to how sure one can be.
economists and business scholars
from the Group of Eight (Go8) Second, we completed this report
universities. The group developed in late April 2020, when the Prime
this Roadmap in less than three Minister had already set the course to
weeks, through remote meetings May 15th. Therefore, our job was to
and a special collaborative reasoning consider possibilities beyond that date.
platform, in the context of a rapidly The facts regarding the pandemic will
changing pandemic. evolve and change between now and

then. Therefore, rather than prescribe economy for years to come. That is
an outcome for three weeks hence not the focus of this report.
– we propose to present a balanced
case for two of them. An Ethical framework to
Any choice between these two guide decision making
options entails a delicate trade-off
between protecting health, supporting At a time of national crisis, and in
the economy and societal well-being. turning our minds to the recovery, it
It is not the role of researchers, or is vital to clarify the key values and
this report, to make this choice. That principles that will guide us in the
is the role of our Government. We are many difficult dilemmas we face.
responsible for setting out the trade- There are things we should not be
offs and that is what this report looks prepared to sacrifice, whatever the
to provide. circumstances. However, the severity
of this pandemic will force us to
Finally, this report focusses on the sacrifice some things we may not
impact of the virus and short term have ordinarily done. Therefore, we
recovery. The pandemic will change should know the conflicting values
global economies and international at stake and the consequences of
relations. This will have significant our choices.
impacts for Australia, its society and

A Roadmap to Recovery – A Report for the Nation
We propose the following principles disproportionately. Therefore,

to guide us: renewal and recovery programs
should focus on those most
yy Whatever measures we implement
affected first. In the long run, they
to manage COVID-19 must be
should foster social and economic
compatible with a commitment
innovation that will make all
to democratic accountability and
Australians more resilient in the
the protection of civil liberties.
face of future shocks.
Special measures that require
the restriction of movement, the yy Finally, there is the issue of
imposition on freedoms, and partnership and personal
the sharing of private data must responsibility. Recovery is not
be proportionate, time-bound, only what Governments can do
grounded in consent and subject for us. Strong recovery will require
to democratic review. a trusted partnership between
governments and civil society,
yy Equal access to healthcare and a
including business, community
social safety net must be provided
sector, unions, academia and
for all members of our community.
local communities. Recovery is
Attention should also be paid to the
something each person owes their
needs of the non-citizens, keeping
neighbour. We need to look out for
in view their unique circumstances.
each other’s welfare in times like
yy The virus has impacted us all, this. That is our way.
some more than others. The
This is not meant to be a
economic cost must be shared
comprehensive or an exclusive list
fairly across the whole community.
of values, but an effort to articulate
yy Although equal treatment is a the values that should guide our
fundamental Australian value, strategies today. In the long run,
the virus, and our policies to how we respond to this pandemic
control it have impacted some will define us.

Two Options Proposed and a Third Rejected
For any jurisdiction facing an epidemic, there are three
fundamental options:
1. Eliminate the illness;
2. Suppress the illness to a low level and manage it; or
3. Allow the epidemic to run through the population in a way that
does not overwhelm the healthcare system. Some have called
this approach “herd immunity.”
At the very outset, the Taskforce number of daily new cases now
rejected the third option which would are fewer than 25. During the peak,
entail somewhere close to 15 million 90% of cases were imported or a
Australians becoming infected. The direct consequence of importation, a
disruption of healthcare, the lives pathway that has now been practically
lost, the inequalities of impact and stopped. Australia’s testing rate is
the tragic consequences on society amongst the highest in the world,
did not make this a viable option for and its test positivity rate and case
Australia, as Government has made fatality rate amongst the lowest. This
clear. This report focused on the confirms the government’s strategy
remaining two. in controlling the epidemic and the
population’s embrace of it.
Australia is unique among comparable
Western nations, and fortunate, to Therefore, while most countries
have two options – elimination or simply cannot consider the prospect
suppression. This is afforded because of elimination, for Australia, a State
of our success in controlling the by State Elimination Strategy remains
number of cases. From the peak of a conceivable, and some would say
the epidemic in late March when desirable, option for Australia. This
we saw nearly 500 cases a day, the option is detailed in Chapter 2.

Option 1: Elimination Strategy need to be enhanced to achieve it.

Hence the option entails greater
yy The Elimination strategy should
uncertainty regarding the timing
lead to fewer total infections,
of relaxation of social distancing
hospitalisations and deaths, and
measures.
better protection of vulnerable
populations than any of the yy The number of asymptomatic
alternatives. carriers in Australia is not known
for certain and may pose a
yy Once achieved, elimination would
potential risk to this strategy.
allow for a faster decrease in social
However, modelling shows
distancing and other restrictions.
that provided the number of
yy To achieve this elimination, asymptomatic cases is modest,
Australia would likely have to the strategy should still be viable.
continue the lockdown in certain
yy If some jurisdictions have
jurisdictions beyond mid-May,
achieved elimination and others
possibly for another 30 days.
have not, it will require extended
yy It necessitates waiting for new travel barriers within Australia.
local cases to fall to zero, and then
yy The risk of re-introduction of cases
maintaining this for two incubation
from abroad will remain , requiring
periods, i.e. about two weeks.
strict international border control
yy This strategy will require extensive measures. Australia’s unique
testing and contact tracing, but geography, strong border control
modelling shows the extra testing and quarantine procedures would
should be achievable within our enable this.
system with reasonable additional
yy Once achieved, the psychological
investment.
sense of safety and social well-
yy It is hard to predict exactly when being that would result from
the cases of locally acquired “elimination” of all local transmission
disease might fall to zero, and would allow for a fuller and more
whether current measures may vigorous recovery of the economy.

The second option acknowledges the of cases may remain active. It accepts
likelihood of ongoing international this reality and tries to manage it.
infections, a limit to the duration We call this strategy “Controlled
of social distancing measures and Adaptation” because it entails
the potential of asymptomatic controlling the spread of the virus,
or undetected transmission and while making sure that society adapts
therefore accepts that some low level to live with ongoing infections.
Option 2: Controlled yy This strategy will require extensive

Adaptation Strategy testing and contact tracing, but
yy The major immediate advantage with a special emphasis on a very
of this strategy is that the phased tight feedback to those managing
lifting of restrictions can begin as the public health response so that
early as May 15th. they can adjust the restrictions,
in regions, or in segments of the
yy The major long-term advantage population, as appropriate.
of this approach is that it
acknowledges the high likelihood yy However, there is always a risk that
of prolonged global circulation the number of infections could
of this infection, and starts off spike, and some of the spikes could
by preparing Australians and the lead to more extensive “surges”
system to adapt to living with the which may require resumption of
ongoing risk of infections some stricter social distancing, as
has occurred in Singapore.
yy This approach provides a feasible
strategy to safely manage current yy What is hard to predict is how
and future infections within the confident the public will feel
health system. when restrictions are lifted with
new cases ongoing, therefore
yy The strategy accepts a slightly economic and social life may
higher number of cases, resume slower, even though the
hospitalisations, and deaths. restrictions may be lifted earlier.

What the public must know impositions are here to stay. In both
and understand cases, enhanced hygiene, some
measures of physical distancing and
The choices are not binary, but along greater testing and tracing, will be the
a continuum. They will both require new norm.
some restrictions, large scale testing,
tracing and isolation systems to keep In both cases most of us will remain
us safe. In that regard they are similar. susceptible. The final “exit” from
They differ in the depth, breadth and both pathways will require a vaccine
duration of how these measures that confers immunity to all of us.
are applied. We cannot predict when that will
be. It seems reasonable to expect
The big difference is that while one in the next year or two. Should
Elimination will require the restrictions it become clear that the chance of a
for a longer duration at first, it vaccine is remote – current strategies
offers the reward of lower cases will need to be revisited.
and greater public confidence about
safety and all its attendant benefits. The challenge over the coming
The Controlled Adaptation sends weeks will be to evaluate the relative
a signal of pragmatic acceptance attractiveness of the two options;
of low infections right at the start, to assess, despite considerable
and in return promises a somewhat uncertainty, how best to trade off the
earlier return, greater flexibility with potential rewards of the Elimination
measures, and manages the risk of option against the greater sacrifices
flare ups within the capacity of our required in a framework of values
adapted health system. we share.
Neither of these two will allow for The Go8 looks forward to working
a return to life as we knew it over with the nation and its Government
Christmas 2019. As with air travel to continue its contribution.
after 9/11, some restrictions and

Three requirements for success
1. Early Detection and Supported Isolation
2. Travel and Border Restrictions
3. Public Trust, Transparency and Civic Engagement
Regardless of which path Australia yy Both strategies envisage that

chooses in mid-May, some things do testing is widely available and
not change. accessible (including in remote
areas), free of charge, with minimal
1. Early Detection and wait times and a short turnaround
Supported Isolation time (less than one day). Sentinel
testing, which entails testing of
yy Both strategies will require an a few selected persons, alone
extensive system of testing, will not be sufficient. Therefore,
tracing and isolation. testing capacity will need to be
yy Two kinds of tests are useful. Tests significantly increased.
detecting the virus (also called, yy The precise application of testing
PCR, antigen) and tests that detect and contact tracing differs between
personal immunity (antibody, the two strategies. In devising
serology). At this stage the virus- these new approaches Government
PCR test is the critical one. should explore the possibility of
yy The purpose of testing is to identify engaging the community, private
the cases and isolate them, identify and business sector.
the contacts and quarantine them, yy In both strategies, those who are
and assess the level of community positive must isolate in a safe way
prevalence. – with support and monitoring in

an appropriate way. Their potential cautions that automatic uptake

contacts must be traced and may be low, and may require public
contacted, and advised quarantine campaigns to increase acceptance.
and testing if appropriate. Any such use must be with the
person’s consent, for a time-limited
yy Isolation and quarantine should only
period, only for the purposes of
end after confirmation of no further
public health, and without prejudice.
viral shedding.
2. Travel and Border
Rather than waiting for a Restrictions
vaccine, we recommend that yy Given the state of the pandemic

the Government fund research in the rest of the world, we
recommend that the government
into developing and testing continue the two-week period of
new strategies based on virus enforced and monitored quarantine
and/or immunity testing and a and isolation for all incoming
travellers regardless of origin
combination of in-country/overseas or citizenship.
quarantine which may allow for an yy International travel bans remain
earlier resumption of international on all Australians, other than for
travel. sanctioned “essential” travel, for the
next six months and any returning
yy Digital contact tracing apps can essential travellers be subject to
assist – however they are not the quarantine restrictions.
a panacea and work best when
integrated with traditional manual yy If some countries have their
contact tracing methods. epidemics under control in a
manner same as ours, then
yy The Taskforce recommends the our Government may explore
exploration and use of these establishing a special bilateral
innovative digital techniques but travel understanding.

yy The Australian Government by acknowledging uncertainty,
should engage with the World communicating clearly and with
Health Organisation (WHO) to empathy for everyone, especially
anticipate a regime of “International those with vulnerabilities.
Vaccine Certification” were a
yy The Australian population has a
vaccine to become available.
sophisticated understanding of
yy We do not find evidence for a Covid-19 issues and has engaged
reliable “immunity passport” at
the moment.
yy Rather than waiting for a The Australian population has a
vaccine, we recommend that sophisticated understanding of
the Government fund research
into developing and testing new
Covid-19 issues and has engaged
strategies based on virus and/or actively in the social distancing
immunity testing and a combination issues. Treat them as a partner by
of in-country/overseas quarantine
which may allow for an earlier clearly communicating rationale for
resumption of international travel. decisions, including what evidence
3. Public Trust, Transparency is being used, who was consulted,
and Civic Engagement and what impacts were considered
yy Given the months and possibly and why a choice was made.
years of measures and compliance
that are required, winning actively in the social distancing
public trust, transparency of the issues. Treat them as a partner by
information used to make decisions clearly communicating rationale for
and the degree and quality of civic decisions, including what evidence
engagement are critical to success. is being used, who was consulted,
yy Communication is the central link and what impacts were considered
to building trust. Prioritise trust and why a choice was made.

yy This is especially critical if there industries, business organisations,

is use of citizen-generated data and other stakeholders in decisions
(i.e., from mobile contact tracing about options for strengthening and/
applications). Governments must or relaxing containment measures.
address real and perceived privacy
yy The young have been particularly
concerns and mitigate against
displaced by the social distancing
the potential for misuse. Where
policies and many will find it hard
possible use trusted independent
to gain a foothold in the economy.
bodies to oversee some of these
activities to avoid the politicisation Consideration should be given
of health data and to ensure to the establishment of a funded
continuity. national service program (e.g.
Aussies All Together) to inclusively
yy Maintaining civic engagement for engage the young from across
the long haul is critical. Where the nation in the process of social
possible, involve communities, reconstruction across the country.

Six imperatives in the implementation
of Recovery
1. The Health of our Healthcare System and its Workers
2. Preparing for Relaxation of Social Distancing
3. Mental Health and Wellbeing for All
4. The Care of Indigenous Australians
5. Equity of Access and Outcomes in Health Support
6. Clarity of Communication
1. The Health of our Healthcare yy Many have delayed or deferred

System and its Workers their ongoing care and elective
procedures. Support direct
Australia has done an effective job messaging to assure all Australians
of reinforcing its hospitals and its of the safety of the healthcare
critical care capacity. For now, that system and urge a gradual return
seems sufficient. At the same time, to usual patterns of healthcare.
the Australian health research sector Care of COVID-19 patients must
has excelled by isolating the virus, not come at the expense of others.
developing vaccines candidates, and
testing new therapeutics. However, it yy Create a national, real-time, data-
must now prepare for the long run and: repository of all COVID-19-related
care in primary, secondary and
yy Support healthcare workers by
acute care to ensure best care
ensuring they have sufficient
for all. This is critical because we
and assured PPE supplies and
know little about COVID-19 care
comprehensive training in the
now. Developing such a national
appropriate use and bespoke
resource will improve outcomes
programs to support their mental
for all.
health and well-being.

yy Continue to support medical 2. Preparing for Relaxation

research that integrates laboratory, of Social Distancing
epidemiological and clinical
trial-based and health services Australia will soon face the complex
research that models the projected challenge of resuming campus
dissemination and spread of teaching in schools and universities,
COVID-19 in an Australian context, and businesses returning to premises.
informs strategies to minimise the While many will look forward to this,
number of infections and optimise many others will be concerned and
the treatment of Australians. some will personally be at greater
risk. How this transition is supported
yy COVID-19 has resulted in a huge will have a major impact on societal
increase in video/tele-health and wellbeing and economic recovery.
eHealth use. The valuable aspects
of this new model should be yy Return to physical schooling
sustained as an important part with special consideration of
of routine health care, supported the following groups: children
by nationally agreed standards in primary schools as they have
and quality indicators. The digital additional needs in regards to
divide in Australia must be closed socialisation, emotional and
or we risk even further entrenching academic support and require
existing health inequalities amongst greater parental involvement
lower income groups. in schooling at home; students
for whom this is the final year
yy The training and education of for transition to further study or
thousands of healthcare students employment; students and teachers
has been disrupted. The National who have pre-existing conditions
Principles for clinical education and who may feel particularly
during the COVID-19 pandemic are vulnerable on return.
a significant step towards flexibility
in health care worker training yy All schools may need to coordinate
requirements to ensure viability a range of additional resources to
of the health workforce pipeline. help educators identify and address

learning gaps, mental health issues 3. Mental Health and Wellbeing
among students and concerns and for All
wellbeing of staff.
The unprecedented scale and speed
yy There is no one-size-fits-all formula of the COVID-19 pandemic has
for the return of all businesses. implications for the wellbeing of all.
Consideration should be given to Evidence from previous large natural
the creation of a sophisticated disasters and pandemics shows that
national “risk tool” that businesses in its aftermath there is a significant
can use to review and self-assess increase in anxiety, depression, post-
their own situation and create traumatic stress syndromes as well
the appropriate and optimal as substance abuse. These symptoms
environment for return. extract a huge individual and family
price and a significant economic
toll. People with psychological
vulnerabilities and pre-existing mental
There is no one-size-
illness are at higher risk. The greatly
fits-all formula for increased demand for services will
the return of all continue throughout the recovery
phase. The following is recommended:
businesses.
yy Coordinated and sustained public
health messaging on the risks
associated with COVID-19 and
yy A workforce health-tracking system actions that can be taken to maintain
specific to COVID-19 and should be mental health and wellbeing.
developed to ensure that reopening
practices are safe to the workforce yy Rapid scaling of secure evidence-
and public. Information from such a based Health and Telehealth
system should be used to learn and interventions in addition to
design best practices, and those strengthened provision of
should be widely shared. community-based support.

yy Increased capacity to ensure organisations and their partnership

timely assessment and effective with Governments, the number
treatment for people with ongoing of cases is proportionately lower.
mental illness and those at risk However, Indigenous Australians
of suicide. are particularly at risk as Australia
“reopens” with a weakened economy
4. The Care of Indigenous and the resulting consequences.
Australians
yy We recommend the continued
The disproportionate impact financial and logistical support
of pandemics on Indigenous of Indigenous COVID-19 planning
taskforces in all jurisdictions for
the remainder of the pandemic.
Lack of adequate housing yy Lack of adequate housing
particularly adversely affects
particularly adversely affects the
the ability of local aboriginal
ability of local aboriginal health health services to control virus
services to control virus spread spread – immediate and more
enduring interventions are needed
– immediate and more enduring to address the shortage of
interventions are needed to appropriate housing.
address the shortage of appropriate yy The COVID-19 pandemic has
housing. exacerbated vulnerabilities of local
workforces which were dependent
on staff from interstate and even
populations worldwide is well New Zealand. Short and Long-term
documented. Thanks to the initiatives to build local workforce
leadership by Australian Indigenous capacity are needed.

5. Equity of Access and yy The main thrust of our
Outcomes in Health Support recommendations is that there isn’t
a single silver bullet for all these
History tells us that pandemics affect diverse populations. However, a
those with the least resources and central principle is for Governments
with specific vulnerabilities hardest to engage and partner with these
and longest. We must guard against groups in designing and delivering
that. Subsequent generations will judge solutions for them.
us for how equitably we supported
and included in decision-making the
people who are most at risk.
yy The report identifies several
It is also critical that the public
populations that are particularly at understand that even with the
risk: women who are pregnant and Elimination Strategy, life will not
women at risk of family violence,
children and young people, those return to the ‘old normal’.
living in out-of-home care; older
adults and those living in residential
aged care; people with disabilities; 6. Clarity of Communication
people living with a life-threatening
illnesses amongst others. The overall success of the recovery
yy Those who are at the intersection will depend upon engaging
of these attributes, often bear the widespread public support and
greatest brunt. participation regardless of which
strategy is chosen.
yy The main purpose of this section
is to alert the nation to its special If the Elimination Strategy is
responsibilities to these many pursued, it is important that the
populations. public understands the additional

sacrifice needed, why it is worth it It is important that Governments

and what benefits they can expect continues to:
in return. It is also critical that the
yy Communicate the approach and
public understand that even with
associated measures using specific
the Elimination Strategy, life will not
and empathetic language that helps
return to the ‘old normal’.
people feel empowered to act,
rather than just passive recipients
of instructions.    
yy Enlist the support and assistance
Several community reference of independent, credible and
groups should be established so trustworthy advocates (e.g.
healthcare workers, educators,
that collectively, they represent community leaders) to convey
Australia’s demographic and key messages.
socio-cultural diversity. yy Enhance the impact of
communication by establishing
community reference groups to
provide ongoing input into the
With the Controlled Adaptation decisions that affect them and also
strategy, it is critical that the public how best to communicate them.
understand that in exchange for an Collectively they should represent
earlier relaxation, there will be a need Australia’s demographic and socio-
for ongoing adaptation. The public cultural diversity.
should also be prepared that should
yy Be proactive in identifying and
numbers worsen, the course may
actively combatting misinformation
need to be temporarily reversed.
and conspiracy theories by
This would not be a failure of the
transparently providing factual
strategy – rather it is the strategy.
and current information.

1
An Ethical Framework
for the Recovery
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.
There are things we should not be we articulate the six core principles
prepared to sacrifice, whatever the that should frame Australia’s
circumstances. While in other cases, decisions and policymaking. They
we must be clear about conflicting are not only guides for decision-
values and the consequences of our making about recovery, they are also
choices. To facilitate that discussion, preconditions for its success.
Six core principles to frame Australia’s

decisions and policymaking
1. Democratic accountability and the protection of civil liberties
2. Equal access to healthcare and social welfare
3. Shared economic sacrifice
4. Attentiveness to the distinctive patterns of disadvantage
5. Enhancing social well-being and mental health
6. Partnership and shared responsibility
1. Democratic accountability and liberties. Special measures that

the protection of civil liberties: require restriction of movement
Whatever measures Australia or data-sharing, by either
implements to deal with the virus public or private bodies, must
now, and in recovery, must be be proportionate, time-bound,
compatible with a commitment grounded in consent and subject
to democratic accountability and to democratic review.
the protection of fundamental civil

Chapter 1: An Ethical Framework for the Recovery
2. Equal access to healthcare and 3. Shared economic sacrifice:

social welfare: Equal access to While the virus’s economic impact
healthcare and core universal is significant and affects all of us
services and to a social safety in different ways, some bear more
net for all in our community must of the cost than others. Many such
remain a fundamental principle inequities are not a direct impact
now, and later, as we recover. of the virus, but a consequence
of the choices we have made
in responding to it. These and
future economic sacrifices
must be shared fairly across the
Many such inequities are not a community.
direct impact of the virus, but 4. Attentiveness to the distinctive
a consequence of the choices patterns of disadvantage: Equal
treatment is a fundamental value
we have made in responding to in Australia, nonetheless the
it. These and future economic impact of policies and measures
on people varies depending
sacrifices must be shared fairly on their social circumstances.
across the community. Aboriginal and Torres Strait
Islanders, minorities, women,
children, people with disability, the
elderly and others, will experience
distinctive disadvantages as
a result of their relative social,
Attention must also be given to
economic and cultural position.
the healthcare and social needs
Any policies and measures to
of those within our society who
contain the virus, and for recovery,
are not currently citizens, with
must explicitly identify and
appropriate recognition of their
address the negative distributional
special circumstances.
effects of implementation.

5. Enhancing social well-being It is important also to recognise the
and mental health: Any policies inter-relatedness of these principles.
or measures should aim to Each principle reinforces the other.
enhance and strengthen individual
mental health, social solidarity
and reciprocity, both now and as
we recover. Economic renewal Economic renewal programs
programs should focus on lifting should focus on lifting the most
the most disadvantaged first.
We should foster economic and
disadvantaged first.
social innovation that will make
Australia more resilient in the face
of future shocks. Democratic accountability depends on
an engaged community, which in turn
6. Partnership and shared
depends on its social and economic
responsibility: Recovery is not
well-being. The protection of our
just what governments can do for
civil liberties, as well as the universal
us, but what we can do for each
provision of health and social welfare,
other – and in partnership with
depends on our shared commitment
our community organisations,
to upholding the necessary conditions
businesses and industry. Each of
required for civic life.
us has an individual responsibility
to respond in this moment of In the next few months and years, we
crisis. We have a duty to act will not just be responding to a virus.
in ways that both respects the Our response will be defining who we
dignity and equal worth of others, are and what we will become.
contribute to their safety, and
to ensure that the measures
implemented now and in recovery
are equitable and just.

2 The Elimination
Option
Definition: Elimination is defined as the eradication of
community transmission of SARS-CoV-2 at a country,
State/Territory or regional level. In practice this would
mean no new SARS-CoV-2 cases linked to community
transmission or unknown sources of infection over
two incubation periods since the time of the last
known community acquired case, provided a highly
sensitive early detection, case and contact tracing and
management surveillance system is in place.
A jurisdiction-by-jurisdiction Key Points:

elimination approach would
yy Elimination of community
only relax internal containment
transmission, and maintenance of
and social distancing measures
that elimination is achievable and
once there was no evidence of
feasible in Australia, unlike many
community transmission in the
other countries. This has already
relevant jurisdiction, and once
been achieved in some of our
appropriate early detection and
jurisdictions and could be made to
control measures were in place. It
occur for the last State/Territory by
would aim to maintain elimination
June, and hence nationally.
through border control and detection
and control of transmission chains. yy Elimination of community
This contrasts with the “controlled transmission could optimise
adaptation” method (next chapter), health, social and economic
which would allow for an earlier outcomes for Australia and provide
relaxation of social distancing particular safety to the vulnerable
measures while there is still some groups who are especially at risk
minimal evidence of community if we allow ongoing background
transmission – seeking instead to transmission.
maintain such transmission at levels
for a prolonged period.

yy Elimination of community yy Use of a State and Territory approach
transmission in Australia will means that social and economic
present unique geopolitical and activities can be resumed as each
economic advantages, positioning jurisdiction achieves elimination and
Australia as a global and regional builds its surveillance and control
leader, and attracting and capacity, with appropriate jurisdictional
reinvigorating business activity border controls in place until there is
at a greater pace. elimination across all States.
Goal and objectives Methods and

requirements
The goal of Elimination is to optimise
health, social and economic The methods of the elimination
outcomes in Australia through: approach are broadly summarised as:
yy Elimination of local transmission of 1. Continuation of current
COVID-19 on a State and Territory, containment, social distancing,
and then national basis; testing, contact tracing and
yy Maintenance of such elimination, management measures to bring
through border control, highly about elimination of community
sensitive early detection systems transmission of SARS-CoV-2.
and effective control of detected 2. In parallel, further enhancement of
transmission chains; a highly sensitive early detection,
yy Implementation of gradual and case and contact tracing and
targeted relaxation of internal management and border control
containment and social distancing system, with monitoring of
measures once elimination is important parameters. This would
achieved with continuing avoidance build on existing systems and is
of large gatherings and other required for both the elimination
potential super-spreading activities; and controlled adaptation options;
it is outlined in detail below.

Chapter 2: The Elimination Option
3. Community engagement is critical show that elimination has been

to any early detection and control achieved, gradual and targeted
system, to ensure appropriate relaxation of social distancing
support for and engagement measures can be implemented.
with the required measures. The
5. Strong border control measures
Australian community has shown
and quarantining of people
itself to be highly engaged and
coming into Australia from areas
compliant with COVID-19 control
affected by COVID-19 will need to
measures (see below).
be maintained. It is anticipated
that internal containment and
It is anticipated that internal social distancing measures will
be able to be relaxed to a greater
containment and social distancing extent under the elimination
measures will be able to be relaxed than the controlled adaptation
approach, since the risks of
to a greater extent under the resurgence of community
elimination than the controlled transmission will be minimised.
adaptation approach, since the 6. The overall system will need to be
risks of resurgence of community responsive to community needs
and will need to be able to take
transmission will be minimised. advantages of technological
advances as they occur, including
progress with contact tracing apps
4. Once early detection, case and
and potential self-testing for SARS-
contact tracing and management
CoV-2. Systems requirements will
and border control systems
need to be reviewed regularly and
are functioning at the required
adapted (Lurie et al, 2020).
capacity and these systems

Details of early detection and Wider identification and testing of
case and contact management all upstream contacts, (i.e. potential
systems, including performance sources of infection for identified
indicators and targets cases, and their related transmission
chains) is critical, and to be done
In addition to current testing, testing exhaustively requires more resources
should be implemented to detect all than downstream contact tracing.
SARS-CoV-2 transmission chains. Symptom definitions may be broadened
This should occur through testing all as evidence emerges (see below).
syndromic fever and cough primary
care presentations, in combination An Australian study investigated
with exhaustive and meticulous detection and elimination of community
case and contact identification transmission of SARS-CoV-2 and
and management (Lokuge et al). maintenance of such elimination
(Lokuge et al). It compared efficiency
These measures will enable and sensitivity to detect community
appropriate early detection transmission chains through testing
and elimination of community of hospital cases; primary care fever
transmission of COVID-19 and are in and cough patients; or asymptomatic
addition to established regimes such community members, using
as the testing of very fast increasing surveillance evaluation methods and
here symptomatic travellers, contacts, mathematical modelling, varying
health care workers and hospitalised testing capacities and prevalence of
pneumonia cases. If testing capacity COVID-19 and non-COVID-19 fever and
is limited, interventions such as cough, and the reproduction number.
pooling allow increased case This analysis showed that, assuming
detection, even given reduced test 20% of cases are asymptomatic and
sensitivity. Though our first preference that all symptomatic COVID-19 cases
is to increase testing capacity to meet present to primary care – there are
the potential need. 13 unrecognised community cases

(five infectious) when a transmission identify all transmission under any of

chain is identified through the scenarios assessed. Thus primary
hospital surveillance versus three care driven identification seems the
unrecognised cases (one infectious) preferred mode.
through primary care surveillance
System requirements for increasing
(Lokuge et al) – making primary care
testing to allow exhaustive
detection a better choice. These three
identification of all transmission
unrecognised upstream community
chains, and then enable complete
follow-up of all cases and contacts
… there are 13 unrecognised within each chain, were assessed
per million population. The additional
community cases (five infectious) capacity required to screen all fever
when a transmission chain and cough primary care patients
would be approximately 2,000 tests/
is identified through hospital million population per week using
surveillance versus three 1/16 pooling of samples (Lokuge et
unrecognised cases (one al). Australia could easily enhance its
capacity to meet these numbers and
infectious) through primary care with the availability of greater testing
surveillance … may even be able to dispense with
pooling.
cases are themselves estimated to The following are recommended
generate a further 22–33 contacts indicators for elimination
requiring follow-up. The unrecognised achievement and maintenance. They
community cases rise to five, if relate to the ability of the system to
only 50% of symptomatic cases cover and test the population (A),
present to primary care. Screening indicators which will assure one that
for asymptomatic disease in the elimination targets are being met (B)
community could not exhaustively and being maintained (C).

A) Indicators of system prevalence will increase, especially
coverage, uptake and if lifting occurs during winter.
completeness:
yy For the elimination option, the
above indicator is the primary
yy Proportion of fever and cough indicator to be monitored on an
(influenza-like-illness) in the ongoing basis, regardless of
community screened for COVID-19 whether phase of response is
(target=100%): weekly percent aiming towards elimination or
population screening target for maintaining elimination.
all locations to be based initially
on State/Territory-specific yy Related performance indicators:
targets in Table 1, varying with »» Uptake of screening for COVID-19
expected monthly total fever and in patients with fever and
cough incidence (i.e. 0.6%–3% cough in sentinel surveillance
of the population). This percent populations (target=100%), this
target should be reassessed can be part of the information
monthly based on sentinel collected during sentinel follow-
influenza surveillance systems up and monthly fever and cough
(e.g. Flutracker, plus additional prevalence surveys recommended
community-based surveys.) above.
Surveillance system performance
should also be validated through, »» Community understanding of
for example, random community- testing criteria, attitudes towards
based surveillance for unreported uptake of screening, practices
fever and cough at household and related to screening, views on
in general primary care settings. feasibility and burden, support
Fever and cough prevalence have services for enabling screening
decreased due to social distancing, (again, can be included in sentinel
however as these measures are surveillance and surveys).
lifted, it would be expected that

B) Indicators of successful upstream transmission branches

progress towards for every identified case, and total
elimination of number of contacts under follow
community transmission, up per case should be >35, unless
given indicators in (A) there is a clear justification for
have all been met: lower). This figure should also be
reviewed regularly, and contact
yy Proportion of newly reported cases case definitions updated based
that are travel related and/ or on sero-surveys and screening for
known contacts of confirmed cases viral shedding around identified
(target=100%). cases, including in high-risk settings
yy Proportion of newly reported cases (institutional settings, schools,
that are tested on day of symptom health care facilities). Complete
onset (target=100%). follow-up includes:
yy Proportion of newly detected cases »» For upstream contacts: PCR and

serological testing at time of case
detection
… total number of contacts under
follow up per case should be >35 … »» For downstream contacts:
documented quarantining for 14
days after last contact, linked to
that have been under quarantine PCR testing at end of quarantine
from time of exposure event period to exclude asymptomatic
(target=100%). viral shedding.
yy Proportion of complete follow up yy Proportion of hospitalised new
of all contacts (target=100%). cases and/or deaths relative to total
Initially, as the modelling suggests, new community-acquired cases
the number of upstream contacts (target=0%).
under follow up per case should
be at least 2 times number of yy Proportion of tested patients
downstream contacts under provided results within 24 hours
follow up (as there will be 2–3 of testing (target = 100%).

C) Indicators of successful Evidence: rationale,
elimination of community benefits and risks of
transmission, given (A)
and (B) have all been met:
the jurisdiction-by-
jurisdiction elimination
yy Proportion of new cases are travel approach
related introductions of disease
(target=100%). Elimination is a desired outcome
and the lowest risk approach. Apart
yy Proportion of new cases that are
from global eradication, elimination is
classified as unknown source or
the most effective measure to control
local community transmission-
mortality and morbidity from and
related exposure (target=0%).
health services impacts of infectious
Elimination-relevant evidence disease. The desirability of this goal
and technologies regarding early is not disputed, the main concerns
detection and case and contact regarding an elimination approach are:
management systems should be
reviewed rapidly on an ongoing i. that it may not be achievable;
basis, incorporating new evidence- ii. that it may not be sustainable; and
based developments as they emerge.
Such developments include: data on iii. that it may be too costly in social
symptoms that would be appropriate and economic terms to achieve
to include in addition to fever and and maintain.
cough in primary care (e.g. anosmia, We address these concerns below,
milder influenza-like-illnesses); analysis including demonstrating the feasibility
of wastewater; and use of apps related of the approach, its safety and the fact
to contact tracing and management. that it is likely to result in better health,
There is relevant evidence available social and economic outcomes than
from countries and jurisdictions with its alternatives.
experience of effective COVID-19
Elimination is feasible, even in
control, including China, Singapore,
the presence of asymptomatic
South Korea, Hong Kong and Taiwan
infections, based on detection and
(see Appendix).
management of transmission chains.

Figure 1. Sporadic disease Concerns have been raised regarding

the proportion of individuals
infected with SARS-CoV-2 who are
asymptomatic and the implications
of this for elimination and disease
control. Most screening in high
income countries such as Australia
targets detection of sporadic
disease in asymptomatic individuals,
scattered throughout the population
e.g. for breast, bowel and cervical
cancer, PKU, neonatal deafness
(see Figure 1). Population testing

for asymptomatic cases is critical
to the success of such screening.
In contrast, infectious diseases like
Figure 2. Disease in COVID-19 occur in transmission
Transmission Chains
chains, where each case is linked to

another series of cases (see Figure 2).
Detection and control of these
types of infectious diseases relies
on first detecting the transmission
chains, then exhaustive upstream
and downstream identification and

management of all of cases in each
chain. The World Health Organisation
Figure 1. Sporadic disease Figure 2. Disease in Transmission Chains
recommends management of

COVID-19 using transmission chains
(World Health Organisation, 2020).
Provided a proportion of the cases
Figure 1. Sporadic disease in Figure 2. Disease in Transmission Chains
each transmission chain are


symptomatic, each chain will be health care workers, as well as testing
detectable. Subsequent contact tracing with expanded sensitivity (such as that
aims to identify and manage cases in which may be possible with sewerage)
the chain regardless of whether they and sequencing viral samples,
are symptomatic or asymptomatic; for allowing investigation of relatedness
example, quarantining of downstream of infections. Finally, general
contacts of cases will prevent spread measures such as containment,
of disease regardless of whether social distancing and border control
someone develops symptoms. work on both symptomatic and
asymptomatic infections.
The crucial question for COVID-19
control is not the proportion of
cases which are asymptomatic, but
whether the early detection system Australia is in the enviable position
that is applied will detect cases and of having elimination as the
prevent transmission. This relates to
the proportion of transmission chains
preferred option for COVID-19
(rather than individuals) that are totally control, thanks to a range of factors,
asymptomatic. While the proportion including the timely actions of the
of SARS-CoV-2 cases which are truly
asymptomatic is currently not known,1 Australian community.
our analyses indicate that virtually
all transmission chains will include
symptomatic individuals (Lokuge Australia is on track to eliminate
et al). Added to this, early detection community transmission of SARS-
systems should include a broad CoV-2 and elimination is likely
range of testing, including conducting to have already been achieved in
wide serological testing in potential multiple jurisdictions. Australia is
upstream contacts, testing of sentinel in the enviable position of having
and vulnerable populations, such as elimination as the preferred option
1 https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200402-sitrep-73-covid-19.
pdf?sfvrsn=5ae25bc7_6

for COVID-19 control, thanks to a transmission) or have recorded <10

range of factors, including the timely such cases during the course of the
actions of the Australian community. pandemic to date (e.g. Australian
The low number of cases overall Capital Territory, Northern Territory,
mean that elimination is possible South Australia, Tasmania, Western
within a relatively short timeframe Australia).2 Other jurisdictions are
if containment measures are showing rapidly declining case
maintained. A number of jurisdictions numbers, especially those from
are already at or close to elimination, unknown sources. Hence, the most
in that they have recorded no recent available national data indicate
cases where the source was not a small and declining numbers of cases
known case (presumed community with an unknown source (Figure 3).
Figure 3. Number of COVID-19 cases by place of acquisition

over time, Australia (n = 6,394)

Figure 3: Number of COVID-19 cases by place of acquisition over time, Australia (n =
From: Commun Dis Intell 2020 44 https://doi.org/10.33321/cdi.2020.44.34 Epub 17/4/2020
6,394) From: Commun Dis Intell 2020 44 https://doi.org/10.33321/cdi.2020.44.34 Epub
17/4/2020
2 https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-
19-current-situation-and-case-numbers#in-australia


A basic reproduction number in Chang et al. (2020) suggests that the
the range 2.2–2.7 has been used social distancing compliance levels
in relevant Australian modelling in Australia have approached 90%
studies and appears consistent between 24 March and mid-April 2020,
with local dynamics (Change et al, providing evidence of high community
2020; Moss et al 2020, Coatsworth engagement with the measures.
2020, Jarvis et al 2020). Currently,
effective Rt is below 1 across virtually
all jurisdictions in Australia, with The updated model of Chang
the increase in Tasmania due to an et al. (2020) suggests that the
identified cluster of cases. This is
evidenced by declining prevalence social distancing compliance
across states and territories; levels in Australia have
estimates from multiple approaches,
including modelling, are that the
approached 90% between
effective reproduction number (Rt) 24 March and mid-April 2020,
to about 0.5 at present in NSW and providing evidence of high
Victoria (Figure 4).
community engagement with
The reductions in the effective
reproduction number that have been
the measures.
achieved indicate approximately
a two thirds reduction in overall Hence there is good evidence that,
transmission since early March. This if the current efforts are continued,
has been achieved through social elimination will be achieved, state-by-
distancing combined with contact state. Estimates based on modelling –
tracing and increasingly effective and from calculations based on an Rt
public health control as case numbers of 0.5, current national case numbers
have dropped and notification delays of 50/day and a serial interval of five
have fallen. The updated model of days – indicate that elimination of

Figure 4. Time-varying estimate of the effective reproduction

number of COVID-19

(light blue ribbon =
90% credible interval;
dark blue ribbon = 50%
credible interval) up to
5 April based on data
up to and including 13
April, for each Australian
State/Territory with
sufficient local
transmission (excludes
ACT, NT). Confidence
in the estimated values
is indicated by shading
with reduced shading
corresponding to
reduced confidence.
The black dotted line
indicates the target
value of 1 for the
effective reproduction
number required for
control. The red dotted
line indicates the
reproduction number
estimated for the
early epidemic phase
in Wuhan, China in
the absence of public
health interventions
and assuming that
the population was
completely susceptible
to infection (2.68).
Estimates from
Tasmania should be
regarded with caution.
From: Price et al, 2020

community transmission for the last Maintenance of elimination is
remaining state in Australia is likely achievable and feasible. Australia has
to occur within 30–60 days from a long history of successful disease
the time of writing (i.e. from 16 May elimination and of maintaining long
to 14 June). This is assuming no term elimination, including for human
major institutional or other outbreak conditions with and without vaccines.
events. Empirical evidence suggests It has also demonstrated its ability to
it may be quicker than this, depending maintain biosecurity for a wide range
on levels of community action: in
Hubei province case numbers fell
from around 80 cases to <1 case on Australia has a long history of
average per day in two weeks, albeit successful disease elimination
with extreme containment and social
distancing. It would be expected
and of maintaining long term
that with further enhancements of elimination, including for human
surveillance in Australia and resultant conditions with and without
early case detection and case and
contact management, the rate of vaccines.
elimination would be increased.
of animal and plant diseases – such
The reductions in the effective
as equine influenza, bovine brucellosis
reproduction number that have
and foot and mouth disease3 – that
been achieved indicate approximately
remain widespread in the rest of the
a two thirds reduction in overall
world. A number of Asian countries –
transmission since early March. This
including China, Hong Kong, Taiwan
has been achieved through social
and South Korea – and New Zealand
distancing combined with contact
have either implicit or explicit aims to
tracing and increasingly effective
control COVID-19 through elimination,
public health control as case numbers
at a regional or national level. Policies
have dropped and notification delays
in many other countries, particularly
have fallen.
3 https://www.health.qld.gov.au/cdcg/index/brucell

in Europe, are predicated on assuming In a very low transmission setting,

elimination is not possible – partly which is tending to elimination
given the extent of their spread and and where interventions have been
partly because they do not account partially relaxed, it is important to
for the impact of community-based be prepared to rapidly respond to a
case detection and contact tracing breakout spike in cases. Modelling
on transmission control (Ferguson suggests that such a reactive strategy,
et al, 2020). where the strength of social distancing
measures is rapidly increased, is
highly effective.4 In general, such
outbreaks can be managed with
In general, such outbreaks can effective surveillance, even if very
be managed with effective large (e.g. as has been seen in South
Korea) but limitation of non-essential
surveillance, even if very large … mass spreading events will mean the
but limitation of non-essential mass surveillance and case management
spreading events will mean the systems will not be overwhelmed.
surveillance and case management Once elimination, surveillance and

control system and border control
systems will not be overwhelmed. indicators are met, gradual and
targeted relaxation of containment
social distancing measures can be
Mantaining elimination of COVID-19 implemented.
community transmission will require
demonstrable high-performing border There is a chance for rebound cases
controls, case and contact follow- if the current containment and social
up, along with sufficient testing and distancing measures are relaxed
surveillance to detect a low risk of simultaneously and broadly. A phased
COVID-19 circulation in the population approach, tailored to specific cohorts
(Baker et al, 2020). of the population and sectors of
the economy, is recommended.
4 Figure 1, Milne and Xie, medRxiv https://doi.org/10.1101/2020.03.20.20040055

Employees in several prioritised Elimination of community
sectors of the economy can be transmission and maintenance
excluded from strict social distancing of this elimination will optimise
and added in a staggered fashion health, social and economic
to the essential services which are outcomes for Australia. The
currently exempt. elimination strategy will result in
the fewest cases of disease and
Priority can be decided by
lowest mortality compared to
Government, with a focus on:
other proposed strategies. Given
1. manufacturing, construction, the value of life and health and the
mining, agriculture, forestry uncertainties about the long-term
and fishing; effects of COVID-19 infection, this
is a critical consideration. It will
2. wholesale and retail trade; and
also place the least burden on the
3. tourism, education, media health care system, protecting our
and communication, arts health care workers and ensuring
and recreation. they are able to support the health
There is a trade-off between of the broader community. This is
compliance/adoption levels and particularly important given the
duration of the restrictions (Chang likely co-circulation with seasonal
et al., 2020), and so an elimination influenza. Elimination will also permit
strategy would need to err on a side the greatest resumption of health
of caution in recommending time programs – including screening
intervals for resumption of activity. programs – critical to reducing
Consideration would be given to morbidity and mortality in Australia.
continuing social distancing tailored The marginal costs of achieving
to specific community cohorts elimination are low relative to the
(e.g. elderly, immunocompromised alternative of controlled adaptation
individuals, and other vulnerable and, overall, the total economy costs
groups). Given the experience in may be lesser than other strategies.
South Korea, avoidance of large After elimination has been achieved
gatherings would reduce risk. it should permit greater social and

economic activity within the region of influence consumer and business

elimination than its alternatives, up confidence and would also reduce
to the point where a vaccine and/or the uncertainty and associated risks
effective treatments become available. with a new outbreak and subsequent
Additionally, once one region has re-introduction on social distancing
demonstrated the requirements for controls. Importantly, repeated,
sustained elimination in the context large-scale outbreaks, with possible
of lifting of control measures, this re-introduction of controls, as may
provides guidance and unparalleled occur with controlled adaptation,
incentives for other settings to would likely have negative impacts on
implement such measures. As business confidence and investment
the areas and regions achieving as it would make business planning,
elimination grows, the economic beyond the very short term, difficult.
benefits continue to accumulate for
Elimination may mean a slower
those regions. However, those areas
relaxation of mandated controls
not achieving elimination will suffer
(say a maximum of 30 days or so
comparatively greater social and
after controlled adaptation begins
economic marginalisation.
to relax mandated controls, for the
Elimination of domestic transmission latest jurisdiction). Thus, elimination
would not only provide tangible implies initially higher economic costs
benefits, it would result in substantial until mandated controls are relaxed.
intangible benefits related to change The estimated economic costs per
in people’s perception in relation to 30 days of current levels of mandated
infection; it would be expected to controls is approximately 2% of GDP.
result in increasing participation in After mandated controls are relaxed,
the entertainment and hospitality there is a higher level of economic
sectors. Controlled adaptation would activity as Australia moves closer
likely have a greater ongoing impact to (but is still below) pre-COVID-19
on perceptions and behaviour, and economic output – thus leading
therefore on such sectors. Elimination to greater improvement in the
would be expected to positively medium term.

The relative economic performance of illustrated in Figure 6 where the
elimination and controlled adaptation vertical axis measures economic loss.
is illustrated in Figure 5. In this The uncontrolled strategy results
figure, area B (economic output in at least THREE times greater
with elimination, less economic economic loss than an elimination
output with controlled adaptation strategy. Figure 6 also shows that
after 1 August 2020) exceeds area an elimination strategy dominates a
A (economic output of controlled controlled adaptation strategy where
adaptation, less economic output a vaccine is not available, at the
with elimination before 1 August earliest, until the second half of 2021.
2020). An elimination strategy may
be expected to deliver, say, about a
5% higher level of economic activity, The uncontrolled strategy results
on average, for each month from 1
August. Thus, an elimination strategy in at least THREE times greater
might be expected to deliver, over economic loss than an elimination
an 18-month period, about 50%
more increase in economic output
strategy.
compared to controlled adaptation.
Even in the extremely conservative
Figure 7 provides a comparison of
projection that elimination only
the possible number of COVID-19
delivers a 1% extra economic output
infected people in Australia with the
per month, on average, from 1 August
elimination and controlled adaptation
2020 onwards compared to the
strategies. It illustrates that a
adaptation strategy, it remains the
controlled adaptation strategy has a
preferred strategy in terms of the
greater probability of recurrence of
economy.
another outbreak. This is shown by
Both elimination and controlled the ‘ups and downs’ in the number
adaptation overwhelmingly dominate of infected persons with a controlled
an uncontrolled epidemic attempting adaptation strategy but not with the
to achieve herd immunity. This is elimination strategy.

Figure 5
Figure 5

Figure 6
Figure 6

Figure 7

Figure 7
Figure 7
There are significant risks to outbreak will occur resulting in more

allowing continuing background deaths and the possibility of the
community transmission of SARS- reintroduction of physical distancing
CoV-2 in Australia, including for controls. This phenomenon has
vulnerable populations. Cases of already been seen in settings where
COVID-19 in the community will containment and social distancing
inevitably lead to morbidity and measures have been relaxed while
mortality. The greater the number community transmission is still
of cases in the community at the occurring.5 Even in settings with
time when measures are relaxed, the limited transmission, without
greater the probability of a spike in enhanced surveillance transmission
new cases. Controlled adaptation is a resurgence occurs, but with enhanced
higher risk strategy than elimination, surveillance such resurgence is
as with a positive number of cases prevented (as has been seen in South
there is a higher probability that an Korea: see Appendix).
5 https://www.bbc.com/news/world-asia-52305055

This issue is further emphasised by it has not been possible to prevent

recent modelling work demonstrating vulnerable community members from
that, in the European setting, Rt contracting COVID-19, especially
only becomes <1.0 when multiple within institutions such as aged
strong measures of social distancing care homes. This is because these
are implemented (see example for individuals remain connected to
Denmark in Figure 8). Hence, if social community members for their care
distancing measures are relaxed and other needs. The greatest
when community transmission is protection from infectious diseases
active, the Rt may increase to >1.0 for the vulnerable comes from
and remaining cases then become minimising the potential pool of
foci for resurgent infection. infection they are exposed to, with
elimination providing the greatest
To date, even when there have been
assurance of such protection.
small numbers of cases nationally,
Figure 8. Relation of different non-pharmaceutical interventions to Rt

Example from Denmark (Flaxman et al., 2020)

Figure 8. Relation of different non-pharmaceutical interventions to Rt: example from Denmark
(Flaxman et al).


There are also risks to regional wave in regional Australia (seen as
Australia from removing restrictions an inflexion in Fig 3b from Chang
prior to elimination of community et al. 2020). This effect disappears
transmission. In our prior work, under the elimination strategy. Failing
we distinguished between urban to eliminate the current spread
and rural epidemic peaks: “the concentrated in/near major urban
first wave is observed in highly- centres may result in secondary
urbanised residential centres where waves in regional Australia.
the pandemic first reaches a nation
(e.g. near international airports),
whilst the second wave is observed
in sparsely connected rural regions” For the COVID-19 pandemic early
(Zachreson et al, 2018). “In contrast
to many other countries with a more
results indicate that the first wave
even spatial population distribution, may peak in metropolitan areas
Australia comprises a relatively about 45 days before the smaller
small number of densely populated
urban centres distributed along the second wave in regional Australia …
coastline, sparsely connected to many
more low-density inland towns and
rural/regional communities.
Risks of the elimination approach.
This particular population distribution
While States and Territories will
has been implicated in Australia’s
vary in the time taken to SARS-
highly bimodal epidemic curves,
CoV-2 elimination, the jurisdiction-
with modes associated with its
by-jurisdiction approach is likely
urban, and rural communities”. For
to require greater time before
the COVID-19 pandemic early results
containment and social distancing
indicate that the first wave may
measures can be relaxed to the
peak in metropolitan areas about
fullest extent possible. There are
45 days before the smaller second
also risks related to controlling

internal borders while States/ All aspects of control require the

Territories are at different stages of engagement and trust of the Australia
control. The approach depends on people, over an extended period.
being able to establish and maintain There will be multiple challenges to
strong international border controls, this – including the possibility that
including quarantining of people the community may be unwilling
coming into Australia from areas with to continue with certain aspects of
active COVID-19 transmission. It is disease control and early detection
– and clear strategies will need
to be devised, factoring in the
stages when engagement may
As demonstrated by the strong be most at risk. Confidence can
be gained in this regard from the
positive support for leaders that
very effective adoption of social
took early decisive and consistent distancing measures by the Australian
action, the community can and community. As demonstrated by
the strong positive support for
will act appropriately with the right leaders that took early decisive and
leadership and support. consistent action,6 the community
can and will act appropriately with the
right leadership and support.
At a global scale, it has been shown
also dependent on the functioning
that it is possible to repeatedly
of a highly sensitive early detection
eliminate diseases such as Ebola
system, and on resultant case and
virus disease, including in low-
contact tracing and management.
resource settings. Nevertheless, it
Such a system requires additional
remains possible that Australia may
investment and will need to adapt and
not be able to achieve elimination.
mature as the pandemic continues.
6 https://www.abc.net.au/news/2020-04-19/wa-premier-mark-mcgowan-applauded-in-coronavirus-crisis-
analysis/12159020

In this case, the strategy may need Thus, the only risk of the elimination
to change to one of controlled strategy, given its many and
adaptation. Even if this is the case, significant benefits across the
the interventions in place to support spectrum, is the extra cost of about
elimination, such as enhanced
surveillance, will ensure that any
transmission that does occur will be
much lower.
The other challenge that elimination Even if the infection rate were
strategy may pose is to international
travel, especially if the entire world
managed at the current rate of
developed “Herd Immunity” while say about 100 cases a day, it
Australia did not. That is very unlikely would take years and years before
without a vaccine. Were a vaccine
to become available, it is very likely sufficient numbers of Australians
that Australia will be one of the first have been safely exposed to
jurisdictions to use it.
change the international travel
One may think that using the restrictions.
Controlled Adaptation strategy could
allow for easier travel, because of
greater immunity. This is very unlikely
at any scale. Even if the infection
rate were managed at the current 30 additional days of controls and
rate of say about 100 cases a day, it social distancing. Should it fail for
would take years and years before any reason – all the elements will be
sufficient numbers of Australians in place to revert to the Controlled
have been safely exposed to change Adaptation.
the international travel restrictions.

Appendix: for travellers from Wuhan initiated in

Brief summaries early January and then progressively
stronger restrictions for travellers
of experiences of applied over the period from late
countries with evidence January to mid-February. South Korea
of effective COVID-19 then experienced a superspreading
control, aiming for event (or potentially a series of
elimination7 these) connected with members of
the widespread Shincheonji church.
South Korea This led to very rapid growth from
one or two cases per day to 100s
South Korea’s initial response was
of cases per day. In response South
largely focused on international
Korea introduced both focused
travellers and local healthcare
efforts to contain the church outbreak
responses, with enhanced screening
(testing ~10,000 members) and
introduced wider social distancing,
in particular preventing schools and
childcare reopening. They have not,
however, been as restrictive in terms
In response South Korea of business with restaurants and
introduced both focused efforts shopping malls remaining open. After
spikes to as high as 800 cases a day
to contain the church outbreak
during the outbreak, case numbers
(testing ~10,000 members) and fell to about 100 per day by mid-
introduced wider social distancing, March and in the last two weeks have
fallen further, with only eight cases
in particular preventing schools recorded on 18/04 with just three of
and childcare reopening. these locally acquired.
7 Note all of these charts are sourced from the worldometers site: https://www.worldometers.info/coronavirus/

Daily new cases in South Korea
Daily new cases in Singapore

Singapore established in the population of

foreign workers housed in dormitory
Singapore has until recently had
accommodation. This has now led to
the least restrictions on movement
an escalating growth in cases in these
and business, focusing on strong
populations and required Singapore
border controls and quarantine
to adopt a similar social distancing
requirement, well-resourced contact
approach to Australia since early
tracing widespread fever-screening
April but with special measures
and hospital-based isolation of all
for the foreign worker populations.
cases. This strategy appeared highly
With around 700 cases per day at present, it seems likely that
this specific population outbreak will continue for at least
the next two to four weeks despite the extra restrictions. This
highlights the need to identify and focus specific measures
on transmission-related high-risk sub-populations.
With around 700 cases per day at

effective until around the middle of
present, it seems likely that this
March, when as in Australia, imported
specific population outbreak will
cases increased substantially. Over
continue for at least the next two
the 2nd half of March, unlinked cases
to four weeks despite the extra
started to grow, suggesting that local
restrictions. This highlights the
transmission had become established
need to identify and focus specific
and a series of tighter measures
measures on transmission-related
started to be established. However,
high-risk sub-populations.
by this point infection had become

Hong Kong etc.) but has selectively relaxed
these (including not requiring these
Hong Kong has paralleled Singapore
since late March for travellers from
but has not experienced a large
mainland China).
scale outbreak of the kind seen in
either South Korea or Singapore. Hong Kong has introduced similar
They experienced large case but slightly less restrictive social
growth from March 15 connected distancing rules to Australia since
with international arrivals as early April. Previously schools had
seen in Australia and Singapore. been closed and remain closed.
However, this has not led to Case numbers have fallen to four
large local case outbreaks. Hong to five per day in the last week and
Kong has maintained fairly strict their public estimates of Rt now have
home quarantine requirements 95% uncertainty intervals below 1 in
for travellers (wristband monitors this period.
Daily new cases in China, Hong Kong SAR

Taiwan China
Taiwan has operated in a similar China as the first location affected
fashion to Singapore’s initial approach had a large epidemic on their hands
but with perhaps a slightly stronger by the time of the shutdown in
focus on border control. They have Wuhan, with estimates from early
encouraged wearing of masks and modelling studies suggesting
in recent weeks encouraged social ~75,000 cumulative infections
distancing. They also delayed return by this point.8 The shutdown was
to school in February but have kept progressive, initially isolating Wuhan
schools open since then. Businesses but quickly extending to much of
A widely reported, social contact outside of the household

was almost entirely prevented, while the public health and
health system response was scaled up to find and isolate
cases and expand treatment capacity.
remain open. Perhaps due to their Hubei province due to high travel
strong focus on border control and volumes out of Wuhan prior to
home quarantine, they have seen very shutdown. A widely reported, social
little local transmission, with >85% of contact outside of the household
cases being overseas source. They was almost entirely prevented,
have reported fewer than 5 cases per while the public health and health
day in the last week – almost all of system response was scaled up to
these are imported. find and isolate cases and expand
8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7159271/

treatment capacity. Restrictions occurred via importation with 14-day
were less severe in the rest of quarantine restrictions preventing
China due to lower case numbers onward transmission. China does
but still strong, with movement appear to be in an elimination phase
restrictions later applied in mid- but their recent reporting of moderate
February using a rapidly developed daily numbers of asymptomatic
mobile app. The lockdown appears cases suggests some remaining
to have been highly successful in challenges in entirely removing local
reducing transmission, with Hubei transmission in settings that have
province reporting no new cases by experienced widespread, uncontrolled
mid-late March. From that point on, transmission.9
symptomatic cases have primarily
Daily new deaths in China
9 http://weekly.chinacdc.cn/news/TrackingtheEpidemic.htm

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Michael G Baker, Amanda Kvalsvig, Neil M Ferguson, Daniel Laydon,

Ayesha J Verrall, Lucy Telfar- Gemma Nedjati-Gilani, Natsuko Imai,
Barnard, Nick Wilson. New Zealand’s Kylie Ainslie, Marc Baguelin, Sangeeta
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S.L. Chang, N. Harding, C. Zachreson,
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O.M. Cliff, M. Prokopenko, Modelling
Robert Verity, Erik Volz, Haowei
transmission and control of the
Wang, Yuanrong Wang, Patrick
COVID-19 pandemic in Australia,
GT Walker, Caroline Walters, Peter
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Zandvoort, Amy Gimma, Kiesha Prem, Michael Meehan, Emma McBryde,
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10.1056/NEJMp2005630, 2020

3 The “Controlled
Adaptation” Strategy
Definition: What is meant by “controlled
adaptation”?
Controlled adaptation is an approach to achieving a
targeted or minimal level of symptomatic COVID-19
cases with three objectives:
yyMinimal COVID-19 case load;
yyKeeping within health system capacity; and
yyMaximising societal and economic functioning.
Figure 1. Controlled adaptation as an Controlled adaptation – at its heart

optimisation problem (and solution) – is a constrained optimisation
problem (and solution). Some just
call it “suppression.” We have called
it “Controlled Adaptation” because
it entails two elements:
1. controlling the virus by increasing
Minimal
or target
and decreasing the restrictions as
case load indicated by data; and
2. adapting society to function with
it for a long time.
OPTIMISE This strategy accepts that the virus
is here to stay, and therefore our best
Health Societal response is to adapt our ways until a
system capacity and economic vaccine becomes available.
and resourcing funtioning
If the number of new cases of
infections continue to be low as
they are, we think it may be possible

to start lifting social distancing as a major criterion for relaxation. In
restrictions in a phased manner this scenario you relax measures, the
around mid May. cases surge, you clamp down again.
And repeat. They indicate that such
This chapter provides the rationale for
an intermittent strategy will likely
relaxing social distancing, the kind of
continue in the United States until
testing-tracing-isolation system that
2022, and suggest a resurgence could
would need to be in place to make it
occur as late as 2024, necessitating
happen, which restrictions could be
ongoing monitoring.
lifted first, how this could be done while
protecting the vulnerable in society.
We then show how to monitor the This strategy accepts that the virus
success of the strategy, its economic
impact as well as its flexibility, so is here to stay, and therefore our
that it is truly adaptive in the face of best response is to adapt our ways
uncertain outcomes.
until a vaccine becomes available.
In the end, we propose how the
decisions required could be best
made and provide a simple table of The other approach is to aim for
the pros and cons of such a strategy. carefully staged relaxation that has
a low probability of needing severe
What are the best tightening up again in the future.
approaches to relaxing This approach is already occurring in
restrictions? other countries including China and
various European nations. However, in
There are (at least) two schools of drawing international comparisons, it
thought to relaxing restrictions. is important to bear in mind variations
in case load, testing and surveillance
One approach is intermittent measures, and health system
application of social distancing capacity put Australia in a uniquely
restrictions, an on-off scenario advantageous situation to deliver
laid out by Kissler et al (2020) who this strategy.
singled out health system capacity

Chapter 3: The “Controlled Adaptation” Strategy
Once relaxation begins, it will be and contact tracing – including

critical to set the target infection rates app technologies), creating reserve
in a manner that is mindful of reserve health system capacity, developing
in the event of a surge or cross-cover better knowledge regarding effective
of localised explosive outbreaks. therapeutic options, and creating
This is particularly important should stable supply lines for medical
outbreaks occur in those with high consumables and ventilators.
rates of chronic disease, and in aged
In the medium-term, distancing
care facilities, correctional centres,
measures would be progressively
homeless shelters and with other
lifted but with the ability to reinstitute
vulnerable communities.
as the need arises.
Recommendation
This involves a cycle of release, Lift measures in phases, with
evaluate, learn, release some more. an interval/pause of a minimum
of three weeks to determine
the impact on spread and case
The goal of Controlled Adaptation
numbers, and a close watch on the
over the next month (i.e. to mid
effective reproductive number to
May) would be to suppress new
keep it below one.
infections to a minimum using
the currently-in-place social This involves a cycle of release,
distancing measures and travel evaluate, learn, release some more.
restrictions. This period will provide Timelines and case load thresholds
time to prepare for relaxation of for lifting of measures are likely to
distancing measures through differ between states, particularly if
enhanced surveillance capacity and interstate travel restrictions remain,
planning, improved understanding as well as per factors such as varying
of COVID-19 epidemiology and local health service capacities,
modelling scenarios, building public climate, population density and
health capacity (especially testing contact tracing capacity.

Possible criteria for lifting Possible criteria for continuing/
restrictions imposing restrictions
Health care has been expanded Geographic areas of high COVID-19
to adequate capacity activity (Reff>1.0)
Contact tracing capacity has Defined communities or geographic
been enhanced areas containing high proportion
of at-risk individuals (by age,
comorbidity)
Testing is available on a Syndromic surveillance suggests an
significantly wider basis, increase in respiratory presentations
and results are available which is not matched by an increase
more rapidly in testing, perhaps due to temporary
shortfalls in capacity (such as from
inadequate reagent supply)
What are the essential The key to Controlled Adaptation is

requirements before maintaining the effective Reproduction
Number, or the number of new cases
lifting restrictions? that a current generates, to just
under one (i.e Reff ~<1). Modelling
Recommendation will be required to identify the level of
coverage of individual measures and
Put in place extensive testing
their mix to achieve an average Reff of
and surveillance, rapid, effective
1 across time and sub-populations.
case detection, case isolation
Modelling and analysis will continue
and contact tracing, including
to be required to monitor and ensure
potential re-introduction of some
that we are achieving this target. Real
distancing measures if it seems
fluctuations and statistical errors
that Reff will overshoot 1.
mean we will aim for just under one,
and not exactly for one.

Border and travel controls Surveillance systems

and contact tracing
Border and travel controls are likely
to be needed over the long term Surveillance of all infections with a
unless the traveller has documented range of mild and often non-specific
immunity (natural or vaccine-related) symptoms is always challenging, with
or is willing to submit to a two-week reported case numbers reflecting
quarantine period upon arrival. testing rates and methodology.
International border controls will An unknown proportion of cases
with a SARS-CoV 2 infection are
asymptomatic or only mildly
symptomatic (Zhou et al, 2020).
This explains in part why the Prevalence rates of asymptomatic or
current testing approach has failed mild disease have been as high as
50–78% of cases in studies reported
to identify the sources of a number from different countries and contexts
of cases, and reinforces that testing (Day, 2020a; Day 2020b; Nishiura
et al, 2020). Modelling to estimate
strategies need to be expanded. the proportion of asymptomatic
cases on the Diamond Princess
cruise ship suggested much lower
rates (17.9% (95% credible interval
impede tourism and education, which (CrI): 15.5–20.2%)), although this
has traditionally been a key driver population was older and largely
of growth in Australia. The period of contained (Mizumoto et al 2020).
quarantine may, however, reduce as Recent data from Austria, which
testing capacity, speed and accuracy instituted containment measures early
improves – and more innovative in the epidemic, indicated there were
mechanisms of ensuring safety may three times as many acutely infected
be considered (pre-testing before cases than initially thought by testing
presenting at border, off-shore pre- patients that were symptomatic but
arrival quarantine, etc.). not hospitalised (Groendahl, 2020).

Surveillance for COVID-19 disease strategy, while the role of sentinel
to date has focused on high-risk surveillance is secondary. We explain
cases based on epidemiology and/ both below.
or symptoms, which underestimates
There are two types of tests,
the true case numbers to an unknown
both have a role. We specify their
degree. This explains in part why the
respective roles in this strategy.
current testing approach has failed
to identify the sources of many cases Virological testing
and reinforces that testing strategies Universal surveillance aiming at
need to be expanded. detecting the vast majority of
Emerging data suggests symptomatic cases would require
asymptomatic cases can transmit widespread virological testing of
SARS-CoV 2 (Huang et al, 2020), even people presenting with symptoms
if transmission may be less efficient that could be consistent with
than from symptomatic cases. This COVID-19, even when mild.
implies that it will not be possible to
identify all cases and transmission
chains, rendering an elimination Prevalence rates of asymptomatic
strategy difficult to achieve through or mild disease have been as high
case-targeted measures alone.
The prospect of environmental as 50–78% of cases …
transmission poses an additional
challenge. The Controlled Adaptation In addition, the public would need
strategy accepts this reality, and is to be encouraged to seek testing as
built in response to it. soon as they develop symptoms.
There are two potential approaches For this to happen, testing centres
to surveillance: sentinel and would have to be widely available
universal. and accessible (including in remote
areas), free of charge, with minimal
Intensive universal surveillance is wait times and a short turnaround
necessary to underpin the control time (less than one day).

The following would need to be in Recommendation

place:
Create a comprehensive,
yy sufficient laboratory capacity and/ adequately resourced and swift
or point of care testing testing infrastructure supported by
yy electronic test result tracking strong incentives and messaging
to encourage public engagement.
yy sufficient trained workforce
for taking throat swabs and Virological testing of people with
communicating results no symptoms would be unlikely to
yy sufficient capacity to manage waste be useful except when investigating
clusters (including in households). A
yy sufficient PPE single negative test in someone with
yy social marketing to encourage no symptoms would only indicate that
people to come forward for testing they had no detectable virus at the
time of testing. If testing were done
yy education for medical practitioners early post symptom onset, some false
yy spaces suitable for sample negative results may occur (Arima et
collection while allowing social al, 2020), and consideration should be
distancing given to repeat testing for cases with
a high level of suspicion.
yy logistics expertise.
Sentinel surveillance strategies
Standardised systems of based on selective person case-
demographic data collection could testing cannot be used as part of a
also be established at the network of control strategy but can be useful to
COVID-19 testing sites to determine detect trends. Sentinel surveillance
biases in voluntary presentations. In could include testing of all people
addition, mechanisms for managing presenting to selected health care
people with more severe symptoms, services regardless of whether they
including diagnosing other conditions, have symptoms. The selected health
would need to be in place. care services could be targeted

to communities considered to be useful adjunct to inform control
particularly susceptible to COVID-19, strategies, and monitor levels of
such as remote Aboriginal and population immunity.
Torres Strait Islander communities.
The sentinel surveillance would be Recommendation
additional to the current universal
case-based surveillance system Conduct at least periodic (say,
– it cannot replace it. monthly) random antibody
testing snapshots of a cross-
Serological testing section of the community to
To inform whether the removing inform decisions on relaxation
restrictions in high-risk settings, for of local restrictions. Solicit
example, on inter-generational (mixed) detailed statistical advice on
gatherings should be undertaken, an whether to have regionally and
accurate understanding of the level socio-demographically weighted
of positive seroprevalence to infection sampling, conditional on
in the community would be needed. variations in infection rates and
Modelling could do this based on sequelae.
the number of recorded cases and
the likely relative proportion of SARS-CoV-2 immunity registers
asymptomatic individuals with have been proposed and while they
SARS-CoV-2. may have some use in restricted
However, modelling is unlikely to settings (e.g. some businesses
provide localised information and or occupations), at a population
may, therefore, be unable to inform level they are unlikely to be useful
the lifting of localised high-risk given both the small proportion of
control measures. When a reliable the population being infected and
serological test (for IgG) becomes uncertainties about the degree
available, periodic population-based and duration of immune-protection
serological surveillance will be a following primary infection.

Contact tracing Recommendation

Contact tracing is most efficient while Promote and incentivise the use
strong social distancing measures are of contact tracing apps to ensure
in place, as the number of potential sufficient speed of contact tracing
contacts for each case are low and for use as a control strategy.
likely to be known to the case. As
social distancing measures are For this to be most effective,
relaxed, contact tracing becomes high uptake of contact tracing
more challenging because of the apps dispersed widely among the
likelihood of each case having more population would be necessary.
Ferretti et al (2020) suggested
… it is necessary for contacts to be a population uptake of 60% was
quarantined within two to three sufficient to be effective as a control
strategy, but this depends on the
days of contact with the case. distribution of smartphones and
apps in the population. Community
contacts, some of whom may not be organisations and businesses may
well known to the case. Due to the have a role here, in building effective
short latent period of SARS-CoV-2 initiatives for testing and for tracing.
(possibly as low as two to three days), There are many ethical and social
it is necessary for contacts to be considerations that would need to
quarantined within two to three days be addressed to increase uptake
of contact with the case. This may of the App10 (Calvo et al, 2020).
not be possible with current contact If social license allows, the apps
tracing methods or even with more can also be used to monitor the
rapid case identification, particularly level of adherence of contacts
given that transmission is possible in to quarantine.
the pre-symptomatic period.
10 See international hub of research on apps living document

“Unified research on privacy-preserving contact tracing and exposure notification” at
https://docs.google.com/document/d/16Kh4_Q_tmyRh0-v452wiul9oQAiTRj8AdZ5vcOJum9Y/edit#

What aspects of Relaxation Options:
Group Gatherings
Social Distancing
should be relaxed Because of the potential for
initially and how? considerable population mixing and
close contact between attendees at
Controlled adaptation is about the mass gatherings, it is unlikely that
phased reintroduction of ‘normal’ mass gatherings would be compatible
societal conditions, with learning from with maintaining the Reff close to
each phase and the ability to pivot 1. Until there is a sufficient level of
back to controls as needed. We have immunity in the population mass
suggested a possible path below but gatherings are not advisable.
it is important to note that this will A context specific risk assessment
be critically dependent on the precise tool has been developed by the
conditions existing around mid-May. WHO Novel Coronavirus-19 Mass
Gatherings Expert Group (McCloskey
Graduated relaxation (and et al., 2020) which could be applied
when required, tightening) as circumstances change.
of physical distancing policies
Relaxation Options:
Schools and Universities
Schools should be a high priority
Schools should be a high priority
for resuming activity given there for resuming activity given there
is limited evidence on the role of is limited evidence on the role of
children as a source of infection, and
the importance of schools in reducing
children as a source of infection,
inequity of education outcomes. and the importance of schools in
Universities should provide online reducing inequity of education
education as much as possible but
restrictions regarding face-to-face outcomes.
laboratory practicals and clinical
placements could be loosened.

Relaxation Options: There is good evidence for the

Differentiation of High-Risk groups proposition that a simple age-based
In other contexts, such as return to criterion may be needlessly costly.
work, restrictions could be determined Unpublished analysis from the
by health status, age or geographical CHAMP study of older men (Cumming
/postcode data identifying areas of et al., 2009) suggests about a third
high demographic vulnerability. of men in their 70s have none of the
medical conditions associated with
severe COVID-19.
This suggests that if multiple
This suggests that if multiple morbidities, rather than age alone,
morbidities, rather than age are the primary correlate of COVID-19
fatality, then the incidence of
alone, are the primary correlate morbidity should be an indicator
of COVID-19 fatality, then the of risk.
incidence of morbidity should Recommendation
be an indicator of risk.
Urgent analysis is required on
the independent effects of sex,
age, ethnicity and comorbidity of
While age is one risk factor, in sequelae of COVID-19 infection, to
fact co-morbidities appear more improve recommendations on who
important, at least until advanced should be self-isolating.
age (say, 80+), when the impact of
age on the immune system generally Possible staged return of societal
seems to reduce the resistance of activity, should the effective
organ function to the severity of the reproductive number remain at
infection. or below an average of 1.

Containment and Immediate term Medium Term End Game
social distancing (Next 30 days) (30–90 days) (Beyond 90 days and
requirements until vaccine is available,
say, end of 2021)
Travel and border yy Maintain travel for yy Allow domestic travel yy No overseas travel
controls essential services subject to border – unless quarantine
or serious family quarantine or testing observed or testing
issues
Workplaces and yy Staged return – yy Younger workers yy Full return – high risk
Businesses some working at without key workers, if able, to
home comorbidities at work work from home
yy Modified workplace yy Regional plans based yy Modified workplace
practices on comorbidities and practices
demographics
yy Modified workplace
practices
Schools yy Staged return yy Full return but yy Full return – high risk
voluntary students and staff,
if able, to work from
yy Modified practices
home
Universities yy Staged return yy Full return but yy Full return – high risk
voluntary students and staff,
if able, to work from
home
Mass and Public yy Banned yy Banned yy Banned – context
gatherings (Games, specific
Concerts, Rallies)

Modify Workplace and co-morbidities, older age groups, or

Business Practices people who live with these groups.
Work hours could be made flexible
In the process of a staged relaxation to facilitate this, especially in States
of social distancing there are with strong restrictions on hours.
important measures that can be
taken to enhance access to work yy Internal voluntary measures
while mitigating health risks, thereby around physical distancing and
increasing the economic efficiency of rigorous hand hygiene in meal
social distancing. These include: preparation could be extended to
restaurants and public places that
yy Fractional Schooling. Schools can are currently closed.
return with classes divided and half
the students attending each day. Recommendation
yy Canteens and school/university In the short-term workplaces
cafes as take-away only, physical should be encouraged to stagger
distancing in classrooms, hand the schedule of workers, and
hygiene practices maintained. undertake other hygiene and
yy Routine use of PPE in high risk physical distancing measures,
occupations such as dentists, to allow a safer return to work.
optometrists and allied health
workers. Protecting vulnerable
populations
yy Job sharing and shift-work.
Working from home could be Residential aged care facilities
combined with workplace shifts to are internationally recognised as
allow a fraction of people to return exceptionally high-risk environments
to their workplaces but with greater for the transmission of COVID-19,
physical space to allow social among individuals for whom severe
distancing. Policies could allow disease outcomes, including death,
working from home for people with are highly probable. As such, they

are likely to be the last environments access to medical care because of
in which liberalisation of physical remoteness. These controls have
distancing measures would be been successful and provide a good
recommended. exemplar of how community-led and
owned initiatives may work well.
However, there are also serious issues
regarding the adverse impact of
social isolation in these settings. If Economic impacts
elderly people and those with chronic
Social distancing and border
conditions need to be in isolation
restrictions have “brick walled” the
for much of the next year or so, we
travel and hospitality industries which
should prioritise support for these
account for around 9% of GDP and
groups and also provide simple
employ 1.7m people or approximately
understandable information to guide
14% of the labour force (ABS Labour
their isolation.
Force 2020, IBisWord 2020). Further
Similar to fire risk or sunburn indices, unemployment has also been created
there could be a daily or weekly (and by reduced demand and supply
regionally varying) risk index to allow constraints with 49% of business
vulnerable people to determine the impacted, rising to 89% in the next
degree to which they need to self- two months (ABS Business Impacts
isolate. of COVID-19, 2020).
Strict biosecurity controls have been Unemployment generated by the
implemented in Australia’s north at partial shutdown measures will
the request of, and in consultation cause immense hardship to millions
with, Aboriginal and Torres Strait of Australians. Job loss is already
Islander community leaders. These estimated to have increased by
controls have been instigated in approximately 2.1 million people –
recognition of the increased risk of or 15.5% of the labour force (Roy
severe infection outcomes in these Morgan, 2020, ABS, Labour Force
communities, coupled with limited 2020). This is likely to be costing

Australia approximately 1% of GDP will transmit to Australia through

per month, cumulating to 12% of the terms-of-trade (McKibbin and
GDP over a year, which is a similar Fernando, 2020), could also increase
annual decline to those experienced the economic costs.
in the 1930s. The costs would fall
Other considerations include financial
disproportionally on the low-income
losses, particularly the wealth effect
and low wealth households, socially
on superannuation and retiree
disadvantaged groups, those with less
incomes. Mature workers who
secure employment and contingent
become unemployed through this
workers, such as in Arts, and also
period will find it difficult to regain
differ by sector.
equivalent employment in a recovery.
Some may never work again.
An important consideration for
Stronger social distancing Australia is the impact of economic
measures in G7 countries are differences across States and
Territories, including the possibility
estimated to amount to over 2% that some may adopt an elimination
of GDP per month or 25% of GDP strategy and maintain closed borders,
which will increase trade and travel
over a year. costs.
Given that economic costs
The costs could rise further. Stronger accumulate, they have the potential
social distancing measures in G7 to quickly match health risks as a
countries are estimated to amount to social priority. Notwithstanding this
over 2% of GDP per month or 25% of concern, maintaining social isolation
GDP over a year (OECD 2020). Further for some period appears to be a
losses due to a decline in confidence, good investment to allow the health
trade wars, long lasting barriers to system to prepare and to reduce
immigration, supply chain disruptions the probability of an uncontrolled
and global economic conditions, that escalation as well as obtain

more information about medical What are indicators
interventions. But the costs of these of success of this
measures, in human and financial
terms, need to be carefully weighed.
strategy? And how do
Extending the current regime into the we monitor these?
second half of the year risks rising
economic and social costs with It will be important to have in place
very harmful consequences through data collection and analysis of
rising unemployment, income losses, KPIs for contact tracing and case
inequality and social unrest. identification, in order to provide
sufficient confidence that this
strategy can be delivered. This would
Recommendation also be useful to inform modelling
A staged relaxation of social where ‘real-life’ data could inform
distancing should be introduced assumptions used in the modelling.
as soon as the infection rate, Such KPIs would be by public health
health capacity and testing unit area, and could be monitored
thresholds are met to mitigate monthly then collated by state/
the economic costs which will be territory health departments using
disproportionately borne by some line-listed data. These could include:
segments of society. yy Number of tests performed by age,
gender, location
Recommendation yy Duration between symptom onset

and test request (in hours or days)
The adverse impact of border – median, IQR, range
controls on trade, tourism,
business services, education and yy Duration between test request and
immigration to Australia, and test result notified to public health
their impact on economic activity, (for action) (in hours) – median,
needs to be considered and IQR, range
innovative solutions developed.

yy Duration between case These KPIs are more focussed

identification and notification of on the objective of controlling the
contacts (in days/hours) – median, infection rate and keeping it below a
IQR, range (by contact) Reff of 1. Indicators would also have
to be established for rejuvenation
yy Number and proportion of cases for
of economic activity and social life.
whom a source or contact can be
A controlled adaptation strategy
identified
will require the active and adaptive
yy Number and proportion of identified balancing of all three.
contacts able to be contacted.
Key indicators of success will be: Flexibility of the strategy
yy No sustained increase in positive Controlled adaptation can be thought
tests, even as testing rates remain of as a flexible ‘holding position’.
high Depending on future developments,
yy No sustained increase in rates of one can take several paths:
severe disease and ICU admissions yy If an effective vaccination
in at-risk populations becomes available, we can
yy Rapid response to any clusters or pivot to vaccination;
areas of increased transmission. yy Or relax social distancing further
should better treatments become
Recommendation available or measures improve to
protect the vulnerable.
Create key performance indicators
for the controlled adaptation These pivots and fine-tuning cannot
strategy by jurisidiction, establish be detailed now. Rather, as more
a reliable system of compiling research and understanding of how
them, monitor and transparently to manage COVID-19 emerges over
share them. the next few months, these options
can be further explored.

The key research necessary to guide predictive value of these tests
decision making in the medium and should be calculated for both an
long term will include: asymptomatic screening population,
and symptomatic ‘case’ population;
yy vaccine development and
clinical trials of their safety and yy the extent of asymptomatic
effectiveness; infections and the role of
asymptomatic individuals in
yy new treatments or re-purposing of
disease transmission. This may
existing treatments;
vary by age and co-morbidities,
yy information on the impact of social
and physical distancing measures
on SARS-CoV-2 infection rates and Multiple tests are now available for
sequelae, both in isolation and as identifying SARS-CoV-2 and have
packaged measures (e.g. from
improved agent-based simulation been registered by the TGA, but
models and “nowcasting”, and cross- their accuracy is uncertain.
national comparisons of strategies
implemented in similar societies);
but knowledge on this would help
yy durability of immunity following
underpin decisions regarding
infection. Viral mutation and
removal of restrictions. As an
waning immune-protection may
example, understanding the
both contribute to risks of infection
potential contribution of school
recurrence. Multiple tests are
age children in transmission of
now available for identifying
infection to teachers would provide
SARS-CoV-2 and have been
scientific data to underpin decisions
registered by the TGA11, but their
regarding school closures;
accuracy is uncertain. The positive
11 https://www.tga.gov.au/covid-19-test-kits-included-artg-legal-supply-australia

yy economic decision modelling Recommendation

on the health gains and costs
(health system and societal) of Federal and State Governments
various policy options, relative to and Health Agencies develop
each other, and impacts of social a coordinated repository of
restrictions, including border control emerging COVID-19 research
restrictions, on unemployment and information, perhaps in
economic activity more generally; collaboration with universities
and other research organisations,
to guide decision making during
Controlled Adaptation.
In the absence of a ‘single’ best
method, more flexible methods Optimising the strategy
such as multi-criteria decision There are a range of methods
analysis have been developed. and approaches for balancing the
competing concerns and available
Capacity for such optimisation
alternatives, from mathematical
resides in Governments, optimisation procedures to decision
universities and the private sector analytic approaches. Economic,
but is currently fragmented and not epidemiological and simulation
modelling is critical. In the absence
directed as a coordinated mission. of a ‘single’ best method, more
flexible methods such as multi-
criteria decision analysis have
yy public preferences and responses been developed. Capacity for such
to measures such as surveillance, optimisation resides in Governments,
testing, and ongoing restrictions universities and the private sector
on extended family and public but is currently fragmented and not
gatherings. directed as a coordinated mission.

Recommendation Recommendation
Commission a coordinated stream Consideration should be given
of modelling, data collection to creating a multi-sectoral,
and analysis in multiple sectors independent advisory body to
to help optimise the adaptation manage and depoliticise the
function of the Controlled process of controlled adaptation.
Adaptation strategy, make the
data transparent, and use it in the
medium to long-term for decision-
making on COVID-19.
Existing political decision-making However, rising social

approaches (e.g. Australian Health
Protection Principal Committee
and economic costs
(AHPPC) and other agencies will bring political
advising Government) have pressure upon State,
effectively managed approaches
to date. However, rising social and Territory and Federal
economic costs will bring political governments to relax
pressure upon State, Territory and
Federal governments to relax social
social distancing faster
distancing faster than the data may than the data may
suggest. It may help to create an suggest.
independent, multi-sectoral body to
advise on the relaxation of social
distancing with agreed targets, to
reduce this political pressure in the
medium to long term.

Risks and benefits of this strategy?
Benefits of controlled adaptation Risks of controlled adaptation

Controlled adaptation is a flexible
strategy, and allows policies to quickly
pivot in response to new information
Allows a progressive re-opening of Impacts of climate on transmission
sectors of society, up to the set target of COVID-19 are uncertain, but
of manageable infection rates reducing restrictive measures in
the next 1–3 months, precisely co-
incident with the known period of
maximal transmission of respiratory
viruses in Australia, could be a risk
Allows a much-needed earlier
economic recovery to be initiated,
thus alleviating widespread economic
and personal hardship
Calibrate restrictions to COVID-19 Calibration of relaxed distancing
case load and health system capacity policies to infection rates may go
awry, and outbreaks may not be able
to be contained without moving to
full lockdown
Contact tracing capacity enhanced Compliance with contact tracing
app may be suboptimal leading to
pressure on manual contact tracing,
potentially exceeding available
resourcing
Testing is available on a significantly Development of a rigorous, rapid and
wider basis, and results are available comprehensive testing system will
more rapidly require significant resourcing and
infrastructure

Benefits of controlled adaptation Risks of controlled adaptation
More rapid return to normal operations
by the healthcare system
There is evidence that individuals
are delaying or forgoing medical care,
potentially leading to poorer health
outcomes in the long term (Tam et
al 2020)
If we aim for elimination and fail, we Success of the strategy depends on
may lose community responsiveness long-term societal acceptance of,
to hand-washing and social distancing and compliance with, behavioural
messages, meaning that next time restrictions. This includes the
extreme distancing measures are prospect of localised escalation of
needed to avoid an impending distancing requirements in response
exponential growth in cases, we to outbreaks
may not succeed

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4 Border Protections
and Travel Restrictions
Key issue: What regime of border protection and
travel restrictions will be needed in the short and
medium term? How should Australia coordinate its
response to the changing realities of the pandemic
elsewhere?
This crisis is a pandemic which yy Recommendation: International

means that Australia’s ongoing travel bans remain on all
success in containing the spread Australians, other than those
of the SARS-CoV-2 virus is also sanctioned for “essential” travel,
contingent on what other countries do for the next six months and any
to contain their respective epidemics. returning essential travellers
A clinically proven, efficacious, be subject to the quarantine
vaccine will be important to aiding restrictions.
both Australian and global recovery.
yy Recommendation: In the event the
Until a vaccine is developed and
Australian Government enters into
widely available border measures
an agreement with another country
and travel restrictions remain critical
to permit entry of its citizens
to Australia’s health security and
and/or permanent residents (i.e.
economic recovery.
New Zealand), the border control
policies of the other country must
Recommendations be identical to Australia’s and
and Key Findings stringently enforced.
yy Recommendation: A two-week yy Recommendation: The Australian

period of enforced and monitored Government initiates discussions
quarantine and isolation is and policy development with the
maintained for all incoming World Health Organization for the
overseas travellers, irrespective creation of a new internationally-
of origin and citizenship, for a accepted vaccination certificate for
minimum of the next six months. clinically-proven COVID-19 vaccine
candidate(s).

Chapter 4: Border Protections and Travel Restrictions
yy Key Finding: Approximately two- General Background

thirds of Australia’s COVID-19 cases
have arisen from either international The World Health Organization has
travellers or close contacts of tended to advise against the use of
international travellers. As a result, travel restrictions in disease outbreaks
the risk of reintroduction of the virus and epidemics. This position has
into Australia from international been adopted on the basis of the
travellers remains very high. International Health Regulations
(2005) to which Australia is a
Border measures that are too signatory. The evidence surrounding
the effectiveness of trade and travel
restrictive will adversely harm restrictions has historically been
Australia’s economy not only via very weak, with what limited studies
reduced tourism, but also through that have been done revealing they
prove economically costly, require
Australia’s balance of payments considerable resources to implement,
and export industries. and have limited benefit in delaying
the start of a local epidemic, eg., by
yy Key Finding: Based on the evidence only a few days or weeks (Ryu, Gao,
to date, travel restrictions including Wong, et al 2020; Mateus, Otete, Beck,
travel bans appear to have been et al 2014; Otsuki and Nishiura 2016);
effective internationally in slowing although others have noted that a
the spread of the virus. Retaining a delay of even two or three weeks
ban on Australian citizens travelling can be important for preparedness
overseas will reduce the risk of (Epstein, Goedecke, Yu, et al 2007).
travellers potentially re-introducing Further, travel restrictions and flight
the virus on their return to Australia, cancellations in particular have been
as well as reduce the risk that observed to harm public health efforts
Australian citizens may become by preventing or delaying the arrival of
sick overseas, requiring repatriation healthcare workers and supplies such
and/or consular assistance. as personal protective equipment into
affected countries (Tambo 2014).

Following the announcement by will adversely harm Australia’s economy
the World Health Organization of not only via reduced tourism, but also
a novel coronavirus – now known through Australia’s balance of payments
as SARS-CoV-2 – a number of and export industries. Conversely, if
countries implemented travel border measures and travel restrictions
restrictions against China before are too loose, Australia will face the
expanding these measures to include ongoing risk of re-introducing the virus
the worst-affected countries. The after it has been largely controlled
Australian Government was one and contained. For these reasons, the
of the first countries to implement Australian Government must strike the
travel restrictions, initially against right balance between reducing the
residents of China’s Hubei province risk of further importation of COVID-19
(29 January) before extending this cases and the commensurate risk to
to all of China (1 February), Iran our healthcare system arising from
(1 March), South Korea (5 March), significant human morbidity and
and Italy (11 March). On 19 March, mortality, with Australia’s economic
the Prime Minister announced recovery and a return to normal social
Australia was closing its borders functioning as much as possible.
to all non-citizens and non-residents Although the evidence on the use of
from 9pm on 20 March. travel restrictions and border closures
during the COVID-19 pandemic
Current Context remains preliminary and has yet to
be sufficiently peer-reviewed, there is
Irrespective of the pathways taken nevertheless sufficient indication that
by State and Territory Governments travel-related measures have proved
to relax social distancing measures effective in slowing the international
internally within their respective spread of the virus. Maintaining
jurisdictions, the decision regarding restrictions on incoming and outgoing
national border controls and travel travellers gives the Australian
restrictions remains firmly within the Government flexibility to pursue
authority of the Federal Government. either a full elimination strategy or
Border measures that are too restrictive suppression strategy.

Evidence and et al 2020). Accordingly, an ongoing

Analysis to support focus on limiting the ability for
incoming travellers to circulate
Recommendations amongst the wider community
and Key Findings during a 14-day incubation period
is essential to ensure that the virus
In this section the main is not re-introduced after it has
Recommendations and Key been controlled or contained across
Findings are expanded upon. Australia (Leung, Wu, Liu, et al 2020).
In addition, maintaining a focus on
Recommendation quarantining incoming travellers in
hotels allows Australia to lift the ban
A two-week period of enforced
on all non-citizens, non-residents and
and monitored quarantine and
international students allowing for the
isolation is maintained for all
progressive recovery of the tourism,
incoming overseas travellers,
hospitality and education sectors.
irrespective of origin and
citizenship, for a minimum One of the considerations in
of the next six (6) months. maintaining this policy is whether
the cost of the 14-day period of
This is based on the evidence to date quarantine is met by the State or
that two-thirds of Australia’s COVID-19 Territory of disembarkation (current
cases are international travellers policy), the Federal Government,
or close contacts of international or the individual traveller. This is
travellers. Modelling studies have an important issue to resolve as it
identified that between 45.6% and has implications for the long-term
64% of infected incoming travellers sustainability of this policy, as well as
may not exhibit symptoms on arrival impacting the viability of additional
or be pre-symptomatic (Quilty, policies such as creating special
Clifford, CMMID nCoV Working Group, travel arrangements with individual
et al 2020; Wells, Sah, Moghadas, countries (Recommendation below).

At the moment we do not find any grounds (i.e. to attend a funeral of a
good evidence for the popular idea of close family member); but returning
a “immunity passport.” There may be travellers must then enter a 14-
other innovative ways of managing day period of quarantine as per the
safe travel (e.g testing in the earlier Recommendation. In the
embarking country, or part quarantine event the current travel ban is not
in the embarking country). However, maintained, it is considered highly
none of these have been rigorously likely we will see Australian citizens
tested or proven. Given the critical seek to travel overseas for leisure or
importance of travel for Australia, business. Given 185 countries have
for Australians and for our economy documented COVID-19 cases, no
– the Government is encouraged to overseas destination can currently be
support further research into these considered safe for travellers. There
initiatives. Any such initiatives should is a high-risk Australians travelling
only be adopted after they have been overseas during the next six months
thoroughly tested. will be exposed to the virus. Further,
most Australian travellers will travel
Recommendation for short periods and then want to
return to Australia, increasing the risk
International travel bans remain of reintroducing the virus, or become
on all Australians, other than for unwell while overseas, necessitating
sanctioned “essential” travel, medical repatriation and/or high
for the next six months and any levels of consular assistance. This
returning essential travellers situation is likely to persist until a
be subject to the quarantine vaccine becomes available, or a
restrictions.
significant proportion of the world’s
population develops a level of
Exceptions could include travel for immunity to the virus preventing
essential purposes or compassionate onward transmission.

Recommendation control policies identical to Australia,

such as mandatory quarantine for
In the event that the Australian
all international travellers other than
Government enters into an
Australian citizens and permanent
agreement with another country
residents. This is to both protect
to permit entry of its citizens
each respective country while also
and/or permanent residents (i.e.
ensuring costs are shared equitably
New Zealand), the border control
(i.e. if the other country requires
policies of the other country must
mandatory quarantine costs be
be identical to Australia’s and
recovered from international travellers
stringently enforced.
but Australian States and Territories
This recommendation is predicated

upon the assumption that an effective
… any country seeking
vaccine is not yet widely available. relaxation of Australia’s
In this context, should the Australian border controls must
Government agree to permit be certified as free from
international travel from any country
in order to help re-invigorate the COVID-19 infections
Australian travel and tourism industry for a minimum of
and support economic recovery, it is
28 days …
essential that a number of conditions
are met. The first is that any country
meet these costs, it could result in
seeking relaxation of Australia’s
disproportionate costs to Australian
border controls must be certified as
taxpayers). Third, these policies
free from COVID-19 infections for
must be strictly adhered to and
a minimum of 28 days (i.e. double
enforced. Any deviation would result
the length of the incubation period).
in the suspension of any special
Second, the requesting country must
arrangements given the risk of re-
commit to implement external border
introduction of the virus into Australia.

Recommendation Key Finding
The Australian Government, Approximately two-thirds of
via the Department of Health, Australia’s COVID-19 cases have
initiates discussions and policy arisen from either international
development with the World Health travellers or close contacts of
Organization for the creation of international travellers. As a
a new internationally-accepted result, the risk of reintroduction
vaccination certificate for of the virus into Australia from
clinically-proven COVID-19 international travellers remains
vaccine candidate(s). very high.
This recommendation is based on the As the virus is now present in 185

Yellow Fever vaccination certificate countries and there are now multiple
model, which required internationally epicentres, the risk of reintroduction
agreed standards on certification of into Australia from international
vaccination to avoid unnecessary travellers remains very high and
disruption to international travellers without quarantine measures in
(Barnett, Wilder-Smith and Wilson place the virus will spread given
2008; Gear 1948). An internationally pre-symptomatic cases are unlikely
agreed vaccination certificate will be to be detected by exit and entry
critical to global economic recovery. screening. Border measures such
as strict quarantine and isolation of
all incoming travellers are essential
to limiting the overall number of
… the risk of COVID-19 cases in Australia.
reintroduction
into Australia from
international travellers
remains very high …

Key Finding This increases the risk of Australian

travellers becoming seriously unwell,
Based on the evidence to date,
potentially necessitating medical
travel restrictions including travel
repatriation, or dying. Either scenario
bans appear to have been effective
requires considerable consular
internationally in slowing the
support, placing multiple persons
spread of the virus. Retaining
at increased risk of infection. Given
a ban on Australian citizens
that COVID-19 cases are also still
travelling overseas will reduce
present in Australia, it is possible that
the risk of travellers potentially
Australian travellers may inadvertently
re-introducing the virus on their
spread the virus to other countries
return to Australia, as well as
in the event they are permitted to
reduce the risk that Australian
travel, which would reflect negatively
citizens may become sick
on Australia especially within our
overseas, requiring repatriation
immediate region.
and/or consular assistance.
References
The general consensus is that
travel restrictions help delay the Elizabeth Barnett, Annelies Wilder-
international spread of COVID-19 Smith and Mary Wilson (2008) Yellow
and give countries time to prepare fever vaccines and international
and strengthen their public health travellers. Expert Review of Vaccines
response. Without these restrictions 7(5): 579-587.
remaining in place, there is a high
Edward De Brouwer, Daniele
risk the virus will be re-introduced
Raimondi, Yves Moreau (2020)
via returning Australian travellers.
Modeling the COVID-19 outbreaks and
In addition, Australians travelling
the effectiveness of the containment
overseas are at increased risk of
measures adopted across countries.
contracting the virus given there are
Pre-print MedRxiv, https://doi.org/10.1
multiple epicentres that are common
101/2020.04.02.20046375.
destinations for many Australians.

Ramses Djidjou-Demasse, Yannis Shiori Otsuki and Hiroshi Nishiura
Michalakis, Marc Choisy, et al (2020) (2016) Reduced Risk of Importing
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containment of human influenza a measures on the global spread of
systematic review. Bull World Health the novel 2019 coronavirus. PNAS
Organ 92(12): 868-880. 117(13): 7504-7509.

5 The Importance of Public
Trust, Transparency and
Civic Engagement
Key issue: The ongoing success of Australia’s
pandemic response points to the critical importance
of public trust, transparency, and civic engagement as
part of the Government’s optimal approach.
The most promising evidence- Recommendations

informed strategy is only possible if
public involvement and cooperation yy Recommendation: Prioritise trans-
can be sustained. Here, we focus parency and trust by acknowledging
on importance of transparency uncertainty and communicating
and civic engagement, Chapter 11: clearly and with empathy.
Communications elaborates further on yy Recommendation: Communicate
the specific forms of encouragement, rationale for decisions including
support and communication needed what evidence is being used, who
to control COVID-19. was consulted, and what impacts
were considered and why a course
was chosen.
Federal, State and Territory yy Recommendation: Involve commun-
ities, industries, organisations, and
governments have responded other stakeholders in decisions about
quickly and at scale, and a options for strengthening and/or
recent Newgate Australia survey relaxing containment measures.
(2020) reports that 76% of the yy Recommendation: Consideration

should be given to the establishment
public strongly supports social of a funded national service program
distancing measures, bans on mass for younger Australians (e.g. Aussies
All Together) to inclusively engage
gatherings, and limiting outdoor the young from across the nation in
activity to essential tasks. the process of social reconstruction
across the country.

Background/Context Evidence and
Analysis to support
Australian efforts to contain Recommendations
transmission of the SARS-CoV-2
virus and achieve a ‘flattening of the Public trust
curve’ have so far been successful.
Federal, State and Territory Trust is a key resource in harnessing
governments have responded public cooperation and sustaining
quickly and at scale, and a recent the behaviours needed for pandemic
Newgate Australia survey (2020) management. Trust is affected by
reports that 76% of the public perceived competence, objectivity,
strongly supports social distancing fairness, consistency, sincerity, faith
measures, bans on mass gatherings, and empathy (Renn and Levine,
and limiting outdoor activity to 1991). A lack in one area may be
essential tasks. These strategies compensated if there is a surplus
have been enabled by strong of the other. Credibility and trust
pandemic planning and public are key factors in effective crisis
health workforce infrastructure and communication (Briñol & Petty,
high levels of cooperation from 2009) and can be expressed at the
all sectors. In the months ahead messaging, personal, institutional and
however, Australians will have a political/cultural levels (Renn, 2008).
less immediate sense of risk while Levels of trust in Government
continuing to feel the impact of differ between socio-economic
public health measures on all parts and demographic groups (Stoker
of their lives. The ongoing success et al., 2018). For this reason, broad
of Australia’s pandemic response messaging aimed at the general
points to the critical importance public must be complemented
of public trust, transparency, and with more targeted communication
civic engagement as part of the and involvement. While policy
Government’s optimal approach. decisions should be announced

Transparency and Civic Engagement
and articulated by political figures, wellbeing, the more likely they will
public health officials and other respond favourably to Government
relevant experts must continue to advice. Leaders should also
provide public communications, to help communicate respect and a belief that
communicate that such policies are they trust the public, as this is more
underpinned by appropriate evidence. likely to elicit cooperation (Van Bavel
Where possible, appropriately et al 2020).
summarised abstracts of this evidence
should be made publicly available on Transparency
the Government COVID-19 websites.
The Commonwealth Dashboard, Trust in government and organis-
and the various State Dashboards, ations is enhanced when there is
are welcome developments – keep transparency of information, evidence,
them current. and a clear decision-making process.
Governments and organisations should
Inconsistency between jurisdictions therefore seek to provide access to
in policies may sometimes be justified accurate information, both positive
but cause confusion because they and negative, so that people may
result in different emphases on risk build accurate expectations. Change
and the ‘right’ approach. When Federal, should be communicated early, even
State and Territory approaches are with incomplete information, as
not in alignment, the reasons must acknowledging uncertainties does not
be clearly explained to the public. undermine trust in the information or
Furthermore, since ‘evidence’ is facts its source (van der Bles et al., 2020).
plus values, both should be clearly While people dislike uncertainty, a
articulated (Carter et al., 2011). perception of obfuscation is worse
When communicating, leaders because it diminishes trust. Moreover,
should express genuine empathy and withholding information can motivate
concern (Reynolds & Quinn, 2008). people to look for information
The more Australians believe that elsewhere, which can foster belief
leaders empathise with them and in misinformation (Kovic & Füchslin,
are genuinely concerned for their 2018).

There should be appropriate levels al., 2019), however, digital tracking
of transparency in decision-making applications also raise justified
processes. This includes what concerns by experts and some
evidence is used in decisions, who members of the public. Using data-
was consulted, and what impacts driven approaches, including new
were considered. Where risk is tracking applications to accelerate
inherent, acknowledgment of risks contact tracing, has the potential for
and their magnitude enhances perceived and actual Government
trust. Strong risk negations (e.g., overreach. The public will have many
it’s perfectly safe) may make people legitimate questions. Government
more risk averse (Betsch & Sachse, transparency on what information
2013). It is better to acknowledge is collected, how it is encrypted,
a risk when it is present including
information about its magnitude,
even if outweighed by the benefits. Change should be communicated
Governments should prioritise early, even with incomplete
transparency and trust in situations information, as acknowledging
where the State acts rapidly and
with limited consultation for the
uncertainties does not undermine
greater good, as is often the case in trust in the information or its source.
health emergencies. Elimination and
controlled adaptation scenarios both
who has access, where the data
require significant data collection,
is stored, and whether dual-use of
analysis, and sharing to reduce
health-related data is allowed, must
ongoing chains of transmission.
be addressed by the Government in
Aggregated anonymised data from
advance of deploying mobile tracking
telecommunications, social media
applications. Addressing these issues
and satellite-based systems have the
is especially important with respect
potential to improve traditional public
to data collection relating to First
health data collection approaches
Nations peoples (Kukutai and Walter,
(Buckee, 2020; George & Taylor et
2019; Mann, DeVitt and Daly, 2019).

In relation to the use of citizen- Civic engagement

generated data (i.e., from mobile
contact tracing applications), As the threat of COVID-19 becomes
Governments must address real and less immediate but costs continue to
perceived privacy concerns and data be felt, Australia will need to prioritise
ethics, and mitigate the potential for active and ongoing engagement
misuse, including the politicisation of with communities, industries,
health-related data (Daly, Devitt, and organisations and other stakeholders.
Mann, 2019). There should be sound Civic engagement is about enabling
evidence justifying data surveillance communities and social networks to
especially if less imposing measures be involved in the decisions that will
would be sufficient. Consultation on affect them (Miranti & Evans 2019;
the use of surveillance technologies Adler & Goggin 2005). However, this
should include cybersecurity can be challenging in times of crisis
experts, data ethicists, public health when Governments must make rapid,
researchers and other stakeholders. life-saving decisions that may require
imposing strict measures with little or
no time for community involvement.
Civic engagement is about Australia’s initial success in reducing
enabling communities and social the rate of transmission has provided
a valuable window of opportunity
networks to be involved in the to establish deliberative processes
decisions that will affect them. in which social groups, businesses,
and organisations can influence
the containment measures that
With respect to anonymised public
are likely to affect them (Cammett
health data, there should be a
& Lieberman 2020). Meaningful
strong commitment to data sharing,
stakeholder engagement will improve
exchange, and interoperability
the effectiveness of containment
(Wilkinson et al., 2016; Research
measures (Renn 2008). It will
Data Alliance COVID19 Working
encourage greater ownership of
Group, 2020).

decisions and accordingly more containment measures are being
chance of public cooperation considered, it is important to identify
(Head 2011). which specific groups have a stake
(Renn 2008). These could be groups
Community groups, businesses,
whose health may be affected (such
and organisations also have specific
as older Australians, or teachers), or
expertise and local knowledge that
sectors that have a direct financial
is needed to devise implementable
interest (such as the hospitality
containment measures over the
industry). Representatives from these
long-term (Wynne 2002). An
groups, identified via community
excellent example of this is the
organisations, professional or
way in which the major Australian
industry associations, unions, or
supermarket chains have translated
a set of general social distancing
requirements into specific, workable
When options for strengthening or
shop-floor practices. Stakeholder
engagement also permits input relaxing containment measures are
from those groups who are likely to being considered, it is important to
shoulder the consequences and risks
of a potential cause of action and,
identify which specific groups have
as the subsequent chapters describe a stake.
in some detail, some communities
patient advocacy groups, should then
and professions are more vulnerable
be considered as participants in a
than others.
deliberative process. It may be useful
Australia’s approach must, therefore, to establish COVID-19 community
be a collaborative one. reference groups to represent key
groups that could then provide
The specific consultative process
ongoing guidance for the duration of
will depend on measures being
the pandemic (see for example, the
considered and the types of groups
Aboriginal and Torres Strait Islander
that are likely to be involved. When
Advisory Group on COVID-19).
options for strengthening or relaxing

Groups should be provided with an find it hard to get a foothold in the

opportunity to delineate and appraise economy. As social distancing begins
the risks as they perceive them (Renn to be relaxed, they will have an
2008). They could be provided with increased capacity to serve Australian
decision parameters, permissible communities, but potentially few
options and methods for minimizing options. Civic engagement, including
harm. Industry representatives could both community and industry, has
be encouraged to consult more widely been a purposeful component of
and present a plan for commencing Australian policymaking for several
commercial activity in a way that decades (Head 2011). There also
minimises risk. exists a wealth of expertise and
experience among governments,
communities, industry and academia
in public policy focused on
Research shows that young people volunteering (Volunteering Australia,
are influenced by “top down” 2014; Walsh & Black 2015).
signals from policies and programs, Aussies All Together (suggested

title) could be an inclusive program
and are motivated by grassroots or that provides opportunities for skills
“bottom up” programs to support development and engagement in
the aftermath of emergencies within
communities. Australia’s borders. Participants will
receive culturally appropriate training
to support communities in order to
Establish a funded national improve health and wellbeing, (re)
service program build infrastructure, provide peer-
tutoring, perform conservation
Due to the COVID-19 response in and wildlife preservation. Such
Australia, the young have been a program could offer meaning,
particularly displaced by the social purpose and social connectedness
distancing policies and many will to those involved, and will contribute

to Australia’s long-term national Briñol, P. & Petty, R. E. (2009).
health and education strategy. Source factors in persuasion: A self-
Research shows that young people validation approach. European Review
are influenced by “top down” signals of Social Psychology, 20, 49-96.
from policies and programs, and are doi:10.1080/10463280802643640
motivated by grassroots or “bottom
Buckee, Caroline (2020) Improving
up” programs to support communities
epidemic surveillance and response:
(Walsh & Black, 2015). There is
big data is dead, long live big data,
considerable empirical evidence
Lancet Digital Health, https://doi.
on the benefits of fostering youth
org/10.1016/S2589-7500(20)30059-5
volunteerism in Australia and New
Zealand (Black, 2012; Lewis, 2013). Cammett, M. & Lieberman, E. Building
Solidarity: Challenges, Options and
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do we mean by “civic engagement”? safrawhitepaper4c.pdf. Accessed 18-
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Education, 3(3), 236–253. doi: Carter, S. M., Rychetnik, L., Lloyd, B.,
10.1177/1541344605276792 Kerridge, I. H., Baur, L., Bauman, A.,
Betsch, C., & Sachse, K. (2013). Zask, A. (2011). Evidence, Ethics,
Debunking vaccination myths: and Values: A Framework for Health
strong risk negations can increase Promotion. Am J Public Health,
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Psychol, 32(2), 146-155. doi:10.1037/ ajph.2010.195545
a0027387 Daly, A., Devitt, S.K., Mann, M., eds
Black, R. (2012). Educating the (2019). Good Data. ISBN 978-94-
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George, DB and Taylor, W et al Miranti, R. & Evans, M. (2019).

(2019) Technology to advance Trust, sense of community, and
infectious disease forecasting for civic engagement: Lessons from
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Head, B. (2011). Australian Experience: Australia’s Response to COVID-19
Civic Engagement as Symbol and Has Reached Rare Consensus,
Substance. Public Administration As Community Wants to Stay the
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https://www.newgatecomms.com.
Kovic, M, & Füchslin, T. (2018).
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policy-and-best-practise/

6 Australia’s Optimal
Approach for Building
and Supporting a Health
System within the
“Roadmap to Recovery”
Building and supporting our health system requires
focus on two interrelated key aims:
1. resuming and optimising routine, comprehensive
health care; and
2. simultaneously managing COVID-19 across the
healthcare system using ongoing preparedness
and readiness to re-escalate crisis management.
Recommendations yy Recommendation: Establish a

and Key Findings national real-time health data
repository starting with COVID-19
Recommendations related data that links primary,
secondary and acute care that can be
yy Recommendation: Agree and extended to other areas of heath care.
optimise national guidelines, yy Recommendation: Maintain e-health
training (including evidence-based (e.g. video/telehealth and apps) as
use of PPE and other infection an important part of routine health
control approaches) and supply care, supported by nationally agreed
chains for managing SAR-CoV-2 standards and quality indicators.
and COVID-19 screening, testing
and management that strengthens yy Recommendation: Support
community messaging to seek
primary and hospital care
medical care in managing existing
collaboration.
conditions and diagnosis and
treatment of both COVID-19 and
non-COVID-19 conditions.

yy Recommendation: Provide the that particularly supports elective
flexibility in health care worker surgery. The public sector could
training requirements that will maintain, and if needed escalate,
ensure the viability of Australia’s COVID-19 care while elective care
essential health workforce (public and private) is escalated
pipeline. in collaboration with private care
providers.
yy Recommendation: Provide
accessible mental health care yy Key finding: PPE is vital for both
support specifically designed staff protection and to maintain
for health care workers. health services across the spectrum
from community to hospital care.
Key Findings Uncertainty about appropriate use
and supply are therefore obvious
yy Key finding: Lack of transparency, major stressors for health care
inconsistent messaging and workers and the system. Misuse
uncertainty undermine confidence includes both inadequate PPE and
and performance in health care. overuse of PPE.
yy Key finding: Australia has a yy Key finding: The pandemic is
strong, Government-supported threatening both educational
primary and community health opportunities for students and the
sector led by general practice and health care workforce pipeline and
supported by PHNs. Voluntary this must be rectified.
patient registration would further
strengthen the ability of general yy Key finding: As with the
practices to engage with their likely ongoing uptake of
patients on an ongoing and videoconferencing in the broader
proactive basis. community, video or other eHealth
options are likely to be able to
yy Key finding: Australia has a offer high value care when used
strong public hospital sector appropriately.
combined with a private sector

Chapter 6: Australia’s Optimal Approach for
Building and Supporting a Health System within
the “Roadmap to Recovery”
yy Key finding: There has been marked Australian context has been
reductions in pathology testing critical in informing strategies to
and clinical presentations for non- minimise the number of infections
COVID-19 problems indicating a and optimise the treatment of
possible delay in the management Australians who have already been
of existing conditions and lack of infected. More Health Services
attention for new problems. Research is now needed to prepare
for the changes in the healthcare
yy Key finding: Electronic health
system to deal with COVID-19 and
records and data linkage are
its consequences.
key to comprehensive COVID-19
surveillance as well as managing
non-COVID-19 clinical problems. General Background
yy Key finding: All critical care Current Context
specialties have previously
supported advanced care planning The COVID-19 crisis challenges
for patients likely to have poor all aspects of health care and all
outcomes, COVID-19 has further overlapping sectors of our system.
emphasised this need. For patients with COVID-19, 80%
can be adequately cared for in the
yy Key finding: Medical research
community, 15% require hospital
integrates laboratory,
inpatient acute care; and 5%
epidemiological and clinical
require critical care (ICU) usually
trial-based programs aimed at
for respiratory support. Health care
understanding the fundamental
professionals are also at increased
molecular, biological and
risk of contracting COVID-19. Dealing
biochemical characteristics
with the crisis has led to delaying non-
of COVID-19 and for devising
urgent elective surgery; i.e. surgery
treatments and vaccines.
unlikely to lead to death or significant
yy Key finding: Epidemiological harm within 30-days. Also, many
modelling of the dissemination patients are avoiding the health care
and spread of COVID-19 in an system for non-COVID-19 problems.

Evidence and Analysis to The central role of primary care
support Recommendations in the “Roadmap to Recovery”
and Key Findings into
Australia’s recovery phase The centrality of primary care has
been re-enforced during the COVID-19
ARS-CoV-2 testing and pandemic as countries with strong
screening and vaccination primary care have demonstrated
greater capacity to flexibly respond.
With the dual aims of managing the
Recovery will be prolonged – this is a
pandemic and increasing clinical
marathon, not a sprint. Primary care
activity for non-COVID-19 needs,
has a key role in preventing, testing,
both community and hospital sectors
tracing and managing COVID-19.
require agreed expert evidence-based
Primary Health Networks have played
guidance on testing and screening
a vital role in supporting primary care
for SARS-CoV-2, as epidemiology and
in the response.
antibody and antigen tests evolve.
This advice should include managing
those who screen or test positive. For patients with COVID-19,
Escalating elective surgery will be
highly dependent on this advice 80% can be adequately cared for
including Australian epidemiology. in the community, 15% require
Similar guidance will be needed
should a vaccine become available.
hospital inpatient acute care; and
5% require critical care (ICU)
Analysis:
usually for respiratory support.
yy Ensure updated national guidelines
on managing SARS-CoV-2 and
COVID-19 screening and testing in
The understandable focus on
community and hospital settings.
COVID-19 has led to the unintended
yy Link screening and testing data to consequence of a reduction in those
enhance national surveillance. seeking health support for non-

COVID-19 care. Tele(video)health yy Collecting, curating and linking

(with new MBS item numbers) has health data across the health
helped to some extent. Many hospital- care system should be supported
based ambulatory services including including MyHR.
outpatient clinics have also moved Hospitals as Partners in the
to telehealth. Concern remains that “Roadmap to Recovery”
we will see increased morbidity and
mortality from the current altered To date, Australian hospitals have
focus of health care workers and avoided the nightmare of other
from patient reluctance to engage countries such as the UK, Spain, and
on non-COVID-19 problems. This is the US. Our acute and critical care
also likely to be disproportionately sectors are treating an unexpectedly
the case in socioeconomically small number of COVID-19 patients
marginalised groups. but are prepared for many more. There
is now a need to resume elective
As hospital services, particularly diagnostic and therapeutic procedures
elective surgery resume, the (medical and surgical) in low risk
severity of both comorbidity and the patients as soon as possible. There is
underlying reasons for the patient concern that following the pandemic
requiring surgery may have worsened there will be the adverse effects
increasing risks of complications of neglecting other health issues,
and mortality. This places greater including worsening mental health.
demands on all three areas: primary This is a public health problem.
community care, acute hospital care
and critical care. Primary care and hospital clinicians
need to increase collaboration to
Analysis: improve patients’ chronic conditions
yy Primary care should be supported that may have deteriorated during the
as the central component of the pandemic and ensure that access to
health system including care for procedures is based on need rather
conditions well managed using than the loudest voices. Escalating
care in the community. elective diagnostic and therapeutic
procedures will require Government

facilitated collaboration between the yy Support community-based “goals-
public and private sectors. of-care” discussions for patients
at risk of poor outcomes – so
Due to our timely response, the
patients are better prepared should
Australian health care system has
circumstances so require.
been provided with time to plan.
It is well documented that older yy Facilitate public and private
Australians are more likely to require sector collaboration in escalating
intensive care and ventilation than elective diagnostic and therapeutic
younger Australians. Now is the time procedures.
for general practitioners, emergency
medicine, anaesthetists, intensivists to
promote there being early goals of care Now is the time for general
discussions for patients at high risk of practitioners, emergency medicine,
death or severely impaired functional
recovery. Some patients who have
anaesthetists, intensivists to
died in ICU from COVID-19 may promote there being early goals
have benefitted from goals-of-care of care discussions for patients
discussions before their final illness.
at high risk of death or severely
The health care system needs to be
primed for a COVID-19 resurgence as
impaired functional recovery. Some
has been seen in other countries and patients who have died in ICU from
to be able to pivot quickly in response. COVID-19 may have benefitted
Primary care and public hospitals will
need to maintain COVID-19 readiness from goals-of-care discussions
and the ability to escalate. before their final illness.
Analysis:
yy The public must be supported to yy Priorities for resuming care must be
seek medical care for existing cond- based on need – and may require a
itions and diagnosis and treatment communications campaign to build
of non-COVID-19 conditions. momentum.

Mental Health and Wellbeing Analysis:

of Healthcare Workers in the
Recovery phase A targeted mental health plan for
healthcare workers is essential
Supporting the wellbeing of including:
healthcare workers at elevated
risk of experiencing psychological yy Optimising informal and formal
distress and adverse mental health support networks and education on
symptoms is vital for both their health the possible psychological impact
of COVID-19.
yy Screening of healthcare workers for
psychological distress and mental
The psychological harm of the health symptoms.
pandemic for healthcare workers yy Access to free evidence-based
is a continuum from stress and eHealth mental health interventions,
and face-to-face treatment for
burnout to post-traumatic stress individuals requiring more intensive
and other mental health symptoms. support.
Personal Protective Equipment
(PPE)
and for managing the pandemic. The Personal protective equipment has
intensive workload, uncertain PPE, been an important and emotive subject
fear of infection and spread to family during this COVID-19 pandemic.
members, saturation media coverage, However, PPE is only one part of
inconsistent messaging and reduced protecting staff and other patients
contact with loved ones all contribute from COVID-19 cross-infection.
to the added mental burden on
healthcare workers. The psychological PPE is a collective term for differing
harm of the pandemic for healthcare levels of protection, and it has been
workers is a continuum from stress complicated by the lack of any
and burnout to post-traumatic stress agreed terminology. There has also
and other mental health symptoms. been uncertainty about when to use

the various levels of PPE, and also Availability of PPE is dependent on
uncertainty about availability of PPE both supply and use. Unnecessary
with a marked disparity of access use (misuse) does not enhance safety
across community and hospital care. and undermines availability. Clear
understanding of the levels of PPE
Appropriate PPE use significantly
and when they are needed is required
reduces risk of viral transmission.
to sustain stocks and de-escalate
PPE should be matched to the SARS-
use of PPE during the return to pre-
CoV-2 risk, which will depend on
pandemic clinical activities. Adhering
location, and should be based on
to guidelines such as those from the
national case definitions and guided
College of Anaesthetists (ANZCA)
by local infectious diseases and
should help de-escalate use of PPE
public health advice. It should also be
and re-escalate if needed.
matched to the potential mode of viral
transmission occurring during patient Analysis:
care – contact, droplet, or airborne.
yy Use of consistent terminology of
Suggested Levels of PPE based on levels of PPE based on method of
mode of transmission risks: transmission
1. Low risk: Standard work clothes yy Ensure a nationally coordinated PPE
and procedures; stockpile with reliable, accessible
estimates of different PPE
2. Contact precautions: Gloves and
components and greater certainty
plastic apron;
about adequate access for hospital
3. Droplet precautions: Gloves, and community workforce.
plastic apron, surgical mask and
yy Develop agreed national guidelines
eye protection;
in collaboration with relevant
4. Airborne precautions: Gloves, professional bodies (such as the
fluid repellent long sleeved gown, medical Colleges) for appropriate use
goggles or full-face shield and of PPE for each level of transmission
N95 mask. (Purified Air Powered risk, including: an agreed list of
Respirators (PAPRs) with training.) aerosol-generating procedures.

Managing the Professions and disruption is expected due to loss of

the training pipeline within the required clinical training. Universities
“Roadmap to Recovery” and other training organisations
Prior to the COVID-19 pandemic are working within jurisdictions to
Australia was already facing major leverage existing resources, capability
challenges in maintaining and and capacity in order to provide
sustaining a health workforce to meet scalable, high quality, interdisciplinary,
the growing and distributed demand evidence-based training solutions to
for health care. Workforce strategies rapidly upskill the health workforce
to address these pre-existing and support workforce supply while
imbalances in supply and demand, providing career pathways that aid
particularly in nursing and midwifery, retention.
will not be sufficient to meet the Analysis:
added immediate and longer-term
impacts of the COVID-19 pandemic. yy Professional regulators should
consider removing minimum
The immediate surge in workforce mandatory hours as a requirement
demand from the pandemic along for registration and adopt a flexible
with any subsequent waves, will approach to the assessment of
continue to require rapid up-skilling work readiness that includes work
and re-deployment of large numbers experience, scope of practice and
of health professionals to the frontline clinical competence and recognise
for up to 18 months. Interruptions are and promote innovative approaches
anticipated through natural attrition, to clinical education within new
work stress, burnout, sick leave, models of care (such as telehealth).
isolation leave, and added caring
responsibilities. yy Pandemic preparedness should
be compulsory curriculum for all
Further, healthcare workers will health care courses and students
access annual and long service should be trained to the highest
leave which will have been limited standards in the correct use of PPE
during the pandemic. Workforce and consideration to how students

can be safely involved in learning into health care, yet this must be
about COVID-19, including the use accompanied by appropriate standards
of virtual health care placements. and guidelines for training, and quality
indicators and management. Virtual
yy Ongoing in-person clinical
healthcare can be extended beyond
placements should recommence
voice/video interaction to include
when there are sufficient supplies
asynchronous communication,
of appropriate PPE. Final year
consumer empowerment and
students should be prioritised to be
biomedical monitoring.
involved in COVID-19 related care
as they will commence practice in The COVID-19 pandemic has also
2021 and must be prepared for their demonstrated the importance of
role. real-time health data in the planning
response and management of the
The National Principles for Clinical
crisis. The engagement of the public
Education during the COVID-19
in following the daily data updates
recently published by the Australian
has been unprecedented. The time is
Government are a helpful contribution
ideal to capitalise on the alignment
in this space. It is important the
of the public, practitioner and policy
professional accreditors now conform
need for data.
to these principles.
The silver lining of a digitally Analysis:
connected health care system as yy eHealth (virtual Healthcare) should
we move into a recovery phase become routine health care.
COVID-19 has catapulted our health Standards and Quality indicators
care systems into the digital delivery should be developed in conjunction
of health care. This has been largely with the relevant professional
welcomed by the public and the health bodies to support the integration of
care workforce. There is an opportunity virtual healthcare into routine care.
to build upon the experience of Consider how to integrate virtual
tele and video consultations and healthcare into training health care
incorporate these permanently professionals.

The contribution of medical and Analysis

health research to Australia’s
capacity to manage the COVID-19 yy Medical research integrates
pandemic laboratory, epidemiological and
clinical trial-based programs
Australia’s medical research aimed at understanding the
community has made significant fundamental molecular, biological
contributions to Australia’s response and biochemical characteristics
to the COVID-19 pandemic through of COVID-19 and is critical for
universities, medical research treatments and vaccines.
yy Medical research models the
projected dissemination and spread
Australia has been at the cutting of COVID-19 in an Australian context,
to inform strategies to minimise the
edge being one of the first outside number of infections and optimise
China to isolate the virus, develop the treatment of Australians who
have already been infected.
virus-detection tests, publish on
the immune response to the virus yy Health services research will be
critical in supporting the health
and lead in developing innovative system more broadly in the recovery
Vaccine candidates. from COVID-19.
References
institutes, hospitals and other Babbage S. COVID-19: Impacts and
research institutions. Australia has opportunities for Australia’s Health
been at the cutting edge being one of Care System. Price Waterhouse
the first outside China to isolate the Coopers, Sydney, Australia, 20/3/2020.
virus, develop virus-detection tests, https://www.pwc.com.au/important-
publish on the immune response problems/coronavirus-covid-19/
to the virus and lead in developing healthcare-system-impacts-
innovative Vaccine candidates. opportunities.html

Horton R, COVID-19 and the NHS—“a Australian and New Zealand College
national scandal”. The Lancet, of Anaesthetists (ANZCA), Royal
Volume 395, Issue 10229, 2020, Page Australasian College of Surgeons
1022, doi.org/10.1016/S0140-6736 (RACS): Medical colleges support
(20)30727-3 resumption of selective elective
surgery for low-risk patients.
Cook TM. Personal protective
http://www.anzca.edu.au/
equipment during the COVID-19
communications/media/media-
pandemic – a narrative review.
Anaesthesia. 2020 releases-2020/medical-colleges-
support-resumption-of-selective-e
Australian and New Zealand
College of Anaesthetists (ANZCA). Choosing Wisely. ANZCA, ANZICS,
Recommendations for PPE ACEM. https://www.choosingwisely.
according to SARS-CoV-2 risk org.au/recommendations
status. 2020. http://www.anzca.edu. Australian and New Zealand Intensive
au/documents/anzca-covid-ppe- Care Society. COVID-19 resources
statement-v24-09042020-(1).pdf for critical care professionals. https://
Burns, H., Hamer, B. & Bissell, A. www.anzics.com.au/coronavirus/
(2020). COVID-19: Implications for The Australian Commission on
the Australian healthcare workforce. Safety and Quality in Health Care.
Retrieved from: https://www.pwc. A guide to the potentially preventable
com.au/important-problems/ hospitalisations indicator in Australia.
coronavirus-covid-19/australian- 2017.https://www.safetyandquality.
healthcare-workforce.html gov.au/sites/default/files/migrated/A-
Australian Government (2020). Impact guide-to-the-potentially-preventable-
of COVID-19. Theoretical modelling on hospitalisations-indicator-in-Australia.
how the health system can respond pdf
https://www.health.gov.au/sites/
default/files/documents/2020/04/
impact-of-covid-19-in-australia-
ensuring-the-health-system-can-
respond-summary-report.pdf

7 Preparing to Reopen
Key issues: What are the special considerations,
preparations and support needed to assist the
reopening of businesses and workplaces, schools
and tertiary education institutions?
Recommendations Tertiary Institutions

and Key Findings
yy Key finding: Losses in research
Businesses and Workplaces and teaching capacity of post-
school educational institutions
yy Recommendation: Create a national (universities, colleges, VET
risk diagnostic tool with review providers) as a result of the current
criteria for businesses to review and crisis will greatly hinder economic
self-assess their own shortage of recovery and long-term prosperity.
resources, ability to reopen/reform,
challenges and limitations in post- yy Recommendation: Federal and
COVID-19 situations. State Government support the
post-school education sector
yy Recommendation: Develop a health to help prevent researcher and
tracking system and new hygiene teacher job losses, and support
standards to ensure reopening a swift return to capacity in both
practices are safe for the workforce teaching and R&D.
and public.
yy Key finding: It is important
yy Recommendation: Develop a
that post-school educational
staged approach to a return to
institutions account for gaps in
work, taking account of geographic
syllabus knowledge and work/
location, occupation/industry type,
vocational placement skills through
and characteristics of workers
students’ first year of candidature.
which might indicate high risk of
serious infection. yy Recommendation: Post-school
yy Recommendation: Diversify educational institutions make
opportunities for new employment appropriate accommodations and
styles and extend the criteria for take necessary actions to assist
receipt of the JobKeeper allowance. the transition of incoming first year

students who may not have all the Schools
assumed syllabus knowledge or
expected work/vocational skills. yy Key finding: Online and remote
learning remain useful temporary
yy Key finding: Students in accredited
measures, but place significant
programs due to graduate in 2020
burdens on students, families and
and research students collecting
educators. Continued use of remote
data and undertaking fieldwork
learning for some or all students,
in 2020 are at significant risk of
as opposed to school-based
disruption.
in-class teaching, may deepen
yy Recommendation: Australia existing inequalities in educational
develop a coordinated, national attainment and engagement.
(or state-based, as appropriate)
response to graduating students
and apprentices/trainees from
accredited programs agreed by
Australia’s response needs to
the relevant accrediting bodies. balance consideration of the
yy Key finding: Australia’s response priority of domestic students, with
needs to balance consideration of the important benefits that come
the priority of domestic students,
with the important benefits that
from a strong, vibrant international
come from a strong, vibrant education sector.
international education sector.
yy Recommendation: Balanced with
critical health and epidemiological yy Key finding: Schools face several
considerations, there is a need for major challenges in the return to full
early decision-making about when operations in terms of addressing
and how international students student well-being, mental
return to Australia for on-campus health concerns, as well as other
learning. operational issues.

Chapter 7: Preparing to Reopen
yy Recommendation: Any resumption/ Context

expansion of in-class school
operations should be contingent Businesses and Workplaces
upon physical distancing measures
appropriate to each school The Australian economy, in common
context. A staged return of school with most of the rest of the world,
operations should consider the will confront serious recession in
social, emotional, developmental coming months, and will probably not
and academic needs of different regain levels of activity recorded at
groups. the end of 2019 for two years or more
(Ketchell, 2020). Updated forecasts
yy Recommendation: To support
from the International Monetary
academic, mental health, and
Fund suggest real GDP growth of
school to post-school transitions,
–6.7% in 2020. This indicates the
government should provide schools
recession Australia is facing will
with adequate funding, resources,
dwarf those that came before it. In
and coordination support to
order to realise the projected 6.1%
facilitate adaptive responses
real GDP growth forecast by the IMF
to current circumstances and
in 2021, government needs to support
emergent contingencies.
businesses in a number of ways.
Tertiary Institutions
In order to realise the projected The Australian Higher Education

sector comprises over 1.5 million
6.1% real GDP growth forecast by students enrolled in 136 universities
the IMF in 2021, government needs and non-university higher education
institutions (Department of Education,
to support businesses in a number Skills and Employment, 2019), with
of ways. about half a million of them from
overseas (DESE, n.d). More broadly
across the tertiary education sector

the Australian Bureau of Statistics to 26% or more). At the same time,
estimates that in May 2019 there there has been a collapse in gross
were over 2.1 million people in Australian expenditure on R&D, falling
Australia aged 15–64 studying from 1.88% in 2015–16 to 1.79%
for a non-school qualification at of GDP in 2017–18 (ABS, 2019),
Certificate III level or above (ABS,
2019a). Many of the educational
challenges and recommendations Universities play a vital societal/
relevant to the tertiary education economic role in research and
sector are substantially the same
as the ones for schools. However,
development (R&D), contributing
there are also issues particular to $41 billion to the national economy
the tertiary education sector and the and employing 259,100 full-time
contributions this sector makes to
Australia’s national benefit. equivalent staff.
Universities play a vital societal/
while the OECD average annual R&D
economic role in research and
spend was 2.37% of GDP in 2017
development (R&D), contributing
(OECD, 2020). While universities’
$41 billion to the national economy
role as a major export industry is
and employing 259,100 full-time
increasingly recognised, this is not
equivalent staff (Deloitte, 2018).
always so with R&D activities which
International education brought in
also support significant innovation-
around $40 billion in 2019 (ABS,
driven economic growth. Independent
2020). Despite amounting to around
modelling by London Economics
40% of Australia’s exports of services
estimates that Go8 research activity
and nearly 10% of all goods and
alone contributed $24.5 billion to the
services, Commonwealth funding has
economy each year, with an estimated
fallen from 37% to 30% (DESE, 2020)
$10 return to the private sector for
as the share of university revenue
every $1 of Go8 research income
from international students has risen
(London Economics, 2018).
(between 2003 and 2018 from 14%

The COVID-19 crisis has directly and to provide a pathway through the
substantially impacted the tertiary current crisis and return to wellness
sector through closures of campuses, and prosperity. Australian health and
cessation of in-class learning, and a medical researchers are engaged in
rapid shift to remote online learning. world-leading programs to develop
Even though off-campus learning effective treatments and vaccines for
already represented part of the COVID-19, with Australian universities
regular experience for one in three training the future workforce in ways
higher education domestic students that are crucial to responding to this
in Australia (Norton, Cherastidtham crisis. Our vocational colleges and
& Mackey, 2018), that applied mostly TAFEs are also providing critical
to adult learners and postgraduate workforce training needed for this
students. recovery. Perhaps the greatest demand
on universities and other post-school
institutions comes at a time when they
are also most under threat.
Rapidly developing policies
The following Key Findings and
surrounding the operations of Recommendations take into account
schools within the COVID-19 all post-school educational institutions
pandemic context have been a and pathways.
flashpoint for public media debate. Schools
In 2019, nearly four million students

The COVID-19 crisis has also were enrolled in 9,503 Australian
highlighted the crucial need for schools (ABS, 2020). While the re-
innovation and productivity-driven opening of schools to face-to-face
growth for our national economy and operations needs to be considered
the health of our citizens. A strong from the public health perspectives,
tertiary education sector is one of our it is also vital that the diverse
greatest assets, strongly positioned educational impacts of moves to

remote online teaching and learning context have been a flashpoint for
on young people, educators, education public media debate. Federal and
systems and the broader Australian State/Territory governments have at
economy are recognised. This report times appeared at odds over strategy,1
examines the key educational issues and teachers and education unions
that must be considered alongside have expressed strong concerns
epidemiological factors when regarding the health and safety of
determining the reopening of staff, especially those with relevant
schools around Australia. pre-existing health conditions, as
schools remained open into late
Schools play a complex role in
March.2 Anecdotal reports from mid-
society, integrating the production
March have attendance rates at only
of both public and private goods
35% to 50%.3 Numerous medical
(Labaree, 1997), and balancing
experts and the Federal Government
multiple, overlapping purposes of
have not been entirely supportive
academic learning, socialisation, and
of families removing children from
individual development (Biesta, 2015).
schools in the absence of illness
Considerations for the re-opening of
or other specific concerns (Creagh,
schools need to remain aware of this
2020),4 drawing on modelling and
complexity.
epidemiological support (e.g., Viner
Rapidly developing policies et al 2020) – though positions on
surrounding the operations of schools this shifted with rapid change in the
within the COVID-19 pandemic national and international situations.
1 https://www.abc.net.au/news/2020-03-23/federal-and-state-governments-school-closures-amid-
coronavirus/12080062
2 https://www.abc.net.au/news/2020-03-19/coronavirus-why-is-australia-keeping-schools-open/12070702
3 https://www.theage.com.au/national/victoria/parents-are-voting-with-their-feet-school-attendance-rates-in-
freefall-20200317-p54aw0.html
4 https://www.abc.net.au/news/2020-04-15/coronavirus-covid19-education-schools-scott-morrison-
response/12149984

By the end of Term 1 and immediately Evidence and

following Easter, schools moved Analysis to Support
students to remote online learning.
Schools remain open for in-school
Recommendations
remote learning for children of and Key Findings
essential service workers and
Businesses and Workplaces
vulnerable students; however, there
has been some confusion as to what
constitutes an essential service Recommendation
worker, with contrasting messaging Create a national risk diagnostic
from Federal and State/Territory tool with criteria for businesses
levels.5 Currently, it is envisaged to review and self-assess their
that students will start returning
own shortage of resources, ability
to in-class learning some time in
to reopen/reform, challenges
TermTwo, but it is unclear who, how
and limitations in post-COVID-19
many, and when they will return to
situations.
in-class learning. Thus, Australian
schools seem to be transitioning to a
mix of in-class, remote, and flexible
Recommendation
learning arrangements—with precise
arrangements and plans varying Government should facilitate
between states, and likely, between information-sharing to support
schools.6 business reopening and recovery
with centralised information sharing
platforms to be developed at State
and Federal Government levels.
5 https://www.theguardian.com/commentisfree/2020/mar/27/more-harm-than-good-the-cases-for-and-
against-closing-schools-during-the-coronavirus-pandemic
Argoon, A. (2020) Victorian schools will close and childcare centres have rigid rules eased Herald Sun
Newspaper, Victoria March 24, 7.29am heraldsun.com.au
6 https://www.abc.net.au/news/2020-04-15/coronavirus-covid19-education-schools-scott-morrison-
response/12149984

For those firms with cash reserves, Another important tool in helping
the hibernation policy will work. businesses to recover are revenue-
However, firms without sufficient contingent loans (RCL). This facility
cash reserves will not have the ability could, for example, be deployed
to pivot to adapt to the changing to continue wage support as the
business environment, nor pay the JobKeeper scheme is wound down
accountants and other business through the recovery period for
professionals required to develop firms not at risk of financial distress
business strategies (Sneader and (Botterill, Chapman and Kelly, 2017).
Singhal, 2020).
The advice of financial professionals
with expertise in business strategy Government could encourage
could be of assistance. Government and facilitate legal and financial
could encourage and facilitate legal
and financial advisory assistance for
advisory assistance for small and
small and medium sized businesses medium sized businesses at low
at low cost, through subsidies to the cost, through subsidies to the
service providers. The $100,000 cash
flow support for small and medium service providers.
businesses the Government has
already implemented is an appropriate It can also be useful to consider
strategy to assist in this area. strategies that have worked in the
past. Following the Great Depression,
In addition, an exit strategy for firms
the United States introduced Federal
with high risk of financial distress
Government programs to provide
can be an important foundation for
employment and support businesses,
strategic renewal (Ren, Hu and Cui,
such as the Reconstruction
2019) as they free up committed
Finance Corporation that loaned or
resources and, therefore, contribute
invested billions of dollars to rescue
to the formation of new ventures
important parts of the economy.
(Carnahan, 2017).

The Corporation was able to push code – such as the system being
assistance beyond banks into local used in China or a tracking app –
economies thus restoring confidence such as the TraceTogether used in
in the financial system (Vossmeyer, Singapore,7 can be used to slow the
2014), and has been used as a coronavirus spread and limit any
stabilisation agency and device to further outbreak when the mass
redirect the flow of capital investment population attempts to return to
to socially desirable enterprises such work and mass gatherings.
as small businesses (Sprinkel, 1952).
Hand sanitizers at entry and
In general Government needs to egress points in business should
simplify, where possible, the process be mandated and installed at
and complexity of supporting minimal cost to ensure basic
resources (such as business loans, health standards.
grants, or other stimulus schemes) to
Contactless service rules and
increase the uptake and engagement
maintenance of social distancing
of small businesses who have limited
is required until reliable preventative
time dealing with operational issues.
vaccines or effective treatments
are available at scale
Recommendation
Develop a health tracking system Recommendation
and new hygiene standards to
ensure reopening practices are Develop a staged approach to a
safe for the workforce and public. return to work, taking account of
geographic location, occupation/
industry type, and characteristics
Basic temperature testing can be of workers which might indicate
implemented at public places to high risk of serious infection.
prepare for reopening. A health colour
7 https://www.zdnet.com/article/singapore-introduces-contact-tracing-app-to-slow-coronavirus-spread/

Links between prevalence of medical Many owner-operators do not
condition, geographic area, and take wages or salaries from their
occupational type could be used to businesses, but instead rely on
formulate a staged opening by area, drawings or dividends for their income.
or, if a geographically uniform re- Where evidence can be provided that
opening is undertaken, where medical these owner-operators are losing
resources might be needed. While income from lost work opportunities,
observed prevalence of COVID-19 in eligibility criteria for the JobKeeper
a given area is clearly a relevant risk allowance should be extended.
factor, other considerations are also
important (Chomik, 2020).
Workers with co-morbidities are
Workers with co-morbidities are
probably more at risk of serious probably more at risk of serious
infection than older workers, and infection than older workers …
should be guided appropriately
in returning to work. There is a
significant fall in infections in men Mass layoffs across a range of
with no medical condition between business and projections from the
the 70–74 age group compared to International Monetary Fund of
later age groups (Cumming et al., unemployment of 8.9%, up from 5.2%
2009). Pre-existing medical conditions in 2019, [15] signifies the need for
appear to be present in almost all redeployment of the labour force.
serious infections (Onder, 2020). This will also require many individuals
to upskill or reskill in order to adapt
to the new business landscape
Recommendation
post COVID-19 restrictions. Many
Diversify opportunities for new businesses around the world are
employment styles and extend already requiring staff to improve
the criteria for receipt of the their skills to refocus in longer term
JobKeeper allowance. preparations [16].

Retraining and upskilling programs As a case in point, universities

could be geared towards providing a play a key role in delivering high-
workforce able to deliver on building level training in critical nation-
up national supply chains for health- building skills such as education,
related essential goods with less medicine, psychology, minerals
reliance on international markets. and engineering, and research
International trade flows, however, and development (R&D) activities
should not be impeded with moves (Deloitte, 2018). A loss in R&D
towards old protectionist trade policies. and teaching capacity as a result
of this crisis would greatly hinder
Tertiary Education
economic recovery and long-term
prosperity (Universities Australia,
Key finding 2020). Continued isolation threatens
Losses in research and teaching both, especially as critical aspects
capacity of post-school educational of tertiary education and research
institutions (universities, colleges, cannot be conducted in an online
TAFEs) as a result of the current environment. Universities will play
crisis would greatly hinder a significant role in developing
economic recovery and long-term the evidence base, treatments,
prosperity. and policies, as well as in training
the professionals of the future
(Universities Australia, 2019), but
Recommendation remaining closed hampers those
endeavours. Universities have been
Federal and State Government set back markedly in their capacity
support the post-school education
to deliver on these objectives
sector to help prevent researcher
(Universities Australia, 2020). Post-
and teacher job losses, and
school colleges and TAFEs face
support a swift return to capacity
similar challenges in preparing the
in both teaching and R&D.
tradespeople of the future.

Key finding school education may be hampered.
Possible mitigating strategies include
It is important that post-school institutions offering a pre-university/
educational institutions account college bridging week or revision
for gaps in syllabus knowledge in Week 1 (specific to a course to
and work/vocational placement ensure subject-specific readiness),
skills through students’ first year and using teaching staff to monitor
of candidature. and attend to identified knowledge
or skill gaps as courses proceed
through first year. Vocational colleges
Recommendation and TAFEs may offer pre-college
Post-school educational or Week 1 practical instruction to
institutions make appropriate address practical skill gaps (arising
accommodations and take from lost work placements in Year
necessary actions to assist the 12). This may also require institutions
transition of incoming first year offering first year students expanded
students who may not have all the support through learning/counselling
assumed syllabus knowledge or support units.
expected work/vocational skills.
Due to disruptions to in-class Possible mitigating strategies

learning in 2020, there may be include institutions offering a pre-
students entering university, college,
or TAFE from school who do not university/college bridging week
have all the assumed syllabus or revision in Week 1 (specific to a
knowledge or who may not have
the met all the required work/
course to ensure subject-specific
vocational placement hours/days. readiness) …
To the extent this is the case, these
students’ pathways through post-

Key finding of 2020 graduating students into

the workforce or further study. This
Students in accredited programs is especially critical for accredited
due to graduate in 2020 and university programs (e.g. engineering,
research students collecting data medicine, exercise science,
in 2020 are at significant risk of psychology, podiatry, teaching,
disruption. etc.) and also apprenticeships
and traineeships. There are
inconsistencies and instances
Recommendation
of inflexibility across accrediting
Australia develop a coordinated, bodies’ response to this issue. If
national (or state-based, there is delay in achieving practice/
as appropriate) response placement hours, some students
to graduating students and may require significant revision of
apprentices/trainees from preparatory units. Some students
accredited programs agreed by may have to wait so long to achieve
the relevant accrediting bodies. those hours that they risk dropping
out. This could leave Australia short
Students due to graduate in 2020 of the very specialists and skilled
are most at risk. Research students tradespeople needed to rebuild
collecting data in 2020 are also at post COVID-19. Australia requires a
risk. Strong coordination between coordinated, national response (or
Government services, industry state-based response if appropriate)
(major employers), accrediting to graduating students from relevant
bodies, and universities is essential programs agreed by the accrediting
to ensure staff are available to bodies in a given profession. Similar
teach and conduct research, as considerations will be needed for final
well as to manage the transition year apprentices and trainees.
If there is delay in achieving practice/placement hours, some

students may require significant revision of preparatory units.

Key finding Australian educational institutions,
rather than other international
Australia’s response needs to competitors, ceasing to occupy the
balance consideration of the third position among the favourite
priority of domestic students, with countries to study abroad (UNESCO-
the important benefits that come UIS, 2017). That scenario would
from a strong, vibrant international threaten the viability of the Australian
education sector.
Recommendation If the shift to remote, online

Balanced with critical health and learning persists there may
epidemiological considerations, be a decreased incentive for
there is a need for early decision-
making about when and how
international students to choose
international students return to Australian educational institutions,
Australia for on-campus learning. rather than other international
competitors …
Whilst the recovery focus is and
should be on domestic students,
international education is a key
tertiary education sector; in the
export for Australia and must be
case of universities, one-fourth of
safeguarded. Australian university
total university revenue comes from
degrees are highly regarded around
overseas student fees (Universities
the world and Australian tertiary
Australia, 2019). Alongside critical
education is thus a highly attractive
health and epidemiological
export opportunity (Universities
considerations, there is a need for
Australia, 2018). If the shift to
early decision-making about when
remote, online learning persists
and how international students return
there may be a decreased incentive
to Australia for on-campus learning.
for international students to choose

Schools one to three also face additional

challenges engaging in a purely online
environment without significant help
Key finding
and face-to-face support, as do young
Online and remote learning remain people with developmental delay,
useful temporary measures, but such as ADHD or autism (Tanner et
place significant burdens on al., 2010). Australian teachers may
students, families and educators. not have sufficient time, resources or
Continued use of remote learning expertise to adequately and promptly
for some or all students, as shift teaching into online modes
opposed to school-based in-class (Reimers & Schleicher, 2020). Failure
teaching, may deepen existing to ensure learning continuity can lead
inequalities in educational to learning gaps that adversely impact
attainment and engagement. in-school, post-school transition
outcomes, mental health, and post-
There is growing concern about education employment (Cutler &
the ‘digital divide’ in education, and Lleras-Muney, 2014).
the corresponding likelihood that
online learning will lead to deepening Key finding
existent inequalities among students
(Karp & McGowan, 2020). There Schools face several major
are considerable gaps in terms of challenges in the return to full
the proportion of internet access at operations in terms of addressing
home between areas (88.3% access student well-being, mental
in greater capital cities versus 77.1% health concerns, as well as other
in remote or very remote areas) operational issues.
and by incomes (88.9% access in
the highest quintile versus 67.4% Pandemic conditions, physical
in the lowest quintile) (ABS, 2018). distancing and remote learning may
Students in early childhood settings, exacerbate youth wellbeing issues,
including prep/kindergarten and Years in a context where evidence shows

that one in four students already Recommendation
suffer from mental health issues
Any resumption of school
(Mission Australia, 2017). For some
operations should be contingent
the current crisis comes after the
upon physical distancing
devastating bushfire season along
measures appropriate to each
with other extreme weather events
school context. A staged return
(floods and cyclones), traumatic
of school operations should
disruptions which may lead to
consider the social, emotional,
increased family and sexual violence
developmental and academic
and mental health issues which
needs of different groups.
all impact life at school (Cahill,
2020). Students’ elderly family
members may have passed away Limited evidence exists regarding the
or remain very sick. Reduced social use of social distancing measures
mixing with friends and peers over within schools in response to
extended periods will itself have communicable disease, beyond the
negative effects (Collington & strategy of closure. However, a recent
McLaws, 2020; Brooks et al 2020). review (Uscher-Pines et al, 2018)
Schools, universities, and colleges provides a good account of the types
are uniquely placed to provide a of practices which schools could
safe and supportive space and to consider as they resume substantial
help emotional and social recovery face-to-face operations:
post emergencies (Cahill 2020),
yy Cancellation of all non-essential
but this will be reliant on sufficient
and high-mixing activities (e.g.
resources, training and support.
field trips, camps, assemblies,
This confluence of significantly
performances)
disruptive circumstances highlights
the need to provide ongoing social yy Students remain in constant class
and emotional interventions as part groupings (where possible) and
of a wide-ranging school-based remain in the same classroom,
response to young peoples’ wellbeing while teachers move between
(Recommendation 2). rooms where necessary.

yy Well-defined walking paths within classrooms. Close and sustained

school buildings. contact of students on public
transport services to/from school,
yy Separating individual desks within
university, etc. potentially poses a
classrooms to the maximum
significant issue to be addressed.
amount possible.
Three groups may deserve special
yy Grade or class dismissal instead
consideration in the return to face-
of full school dismissal in case of
to-face schooling. Young people and
registered infection.
older staff with pre-existing medical
yy Staggered start/end to the school conditions, who face the possibility
day. of more severe COVID-19 disease if
infected (Sinha et al, 2020; Centers
yy Staggered break times for different
for Disease Control and Preventions,
student groups; allocating groups
2020), may not elect to return to
of students to classrooms for
school campuses, and will require
break times.
continuing remote and online support.
yy Enhanced cleaning and disinfection Final year secondary students
of school buildings. face a high-stakes period of their
education which has been thrown
into significant uncertainty with the
Final year secondary students disruption to schooling (Roberts,
face a high-stakes period of their 2020). Students in the early primary
school years have additional needs
education which has been thrown
regarding socialisation, emotional
into significant uncertainty with and academic support in comparison
the disruption to schooling. to older students, and while at home
have a greater impact on the working
Hand-hygiene practices could be capacity of parents. These student
integrated more intensively into school groups may be prioritised if a staged
routines, for example using hand return to face-to-face schooling is
sanitizer when entering and leaving instituted.

Recommendation development of national or state-based
taskforce(s) integrating key school
To support academic, mental
stakeholders could assist in effectively
health, and school to post-
managing the complexities of
school transitions, government
resuming school operations (Reimers
provides schools with adequate
& Schleicher, 2020), and maintain
funding, resources, and
adaptive preparedness in regards to
coordination support to facilitate
a potential second wave of COVID-19
adaptive responses to current
infections (Wood & Geard, 2020).
circumstances and emergent
contingencies.
To address the academic, mental There is strong evidence exposure

health and personal wellbeing issues
identified under Key Findings, school
to adversity can be encoded in the
systems may need to coordinate a developing child and be expressed
range of additional resources and as a range of physical and mental
training. This includes funding for
school-psychologists, but also up- health throughout their lifetime and
skilling of staff in areas such as subsequent generations.
trauma-informed education (Brunzell
et al, 2016). Teachers will need
time and professional development
support to identify and address Children require special consideration
learning gaps, identify mental health with respect to the current crisis and
issues among students and to its management. There is strong
deal with them both from a referral evidence exposure to adversity can
perspective and with targeted in-class be encoded in the developing child
support. Staff also will need to receive and be expressed as a range of
mental health and wellbeing support physical and mental health throughout
(Beltman et al 2016) as workloads will their lifetime and subsequent
be highly demanding and variable. The generations (Shonkoff et al., 2012).

The social changes caused by the Australia leads the world in the
COVID19 crisis and associated social development and dissemination
distancing measures are and will of parent support strategies that
be accompanied by an increased empower parents to provide a positive
likelihood of such exposure for child caregiving environment. These
Australia’s children. This exposure programs improve parent mental
is likely to be manifest as increased health, reduce parent-child conflict,
mental, physical and social health and improve child mental health over
costs for this generation. Ensuring the the course of several parent support
health of children during this crisis sessions (Rae & Zimmer-Gimbeek,
by minimising exposure to adversity 2007; Sanders et al., 2017).
should be a priority investment in Further, recent evidence shows that
Australia’s future and a preventative these treatments are equally effective
measure against future burden. when delivered online as either
therapist assisted programs (Dadds
et al., 2019) or self-directed programs
Australia leads the world in the (Piotrowska et al., in press). Thus,
development and dissemination a major initiative should be a public
campaign to steer parents toward
of parent support strategies that these programs during this phase.
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8 Mental Health
and Wellbeing
Key question: What are the expected impacts
and needed interventions for maintaining societal
well-being and individual mental health through
this process?
Recommendations yy Recommendation: Rapid and

and Key Findings stepped scaling of secure evidence-
based eHealth and Telehealth mental
yy Key Finding: The universal nature health interventions for people who
of the COVID-19 pandemic has require treatment and support in
implications for whole of society addition to strengthened provision
wellbeing. of community-based support.
yy Key Finding: People with yy Recommendation: Strengthen

psychological vulnerabilities and provision of community-based
pre-existing mental illness are support to maintain individual
at higher risk of experiencing health and societal wellbeing.
worsening mental health. yy Recommendation: Increased
yy Key Finding: COVID-19 has capacity to ensure timely
placed unprecedented demand on assessment and clear care pathways
Australia›s mental health system to effective treatment and support
and its capacity to respond to is essential for people with mental
that demand, which will continue illness and those at risk of suicide.
throughout the recovery phase.
Current Context
yy Recommendation: Coordinated
and sustained public health The measures being implemented
messaging on the risks associated to manage the threat of COVID-19
with COVID-19 and actions that can will have broad short and long-term
be taken in response to maintain effects across the whole population,
mental health and wellbeing. beyond the fear of contracting and
spreading the virus. These include:

yy As individuals and families retreat to of purpose, and from being
their homes, feelings of confusion, socially disconnected. The grief
anxiety, stress and loneliness can process ranges from anticipatory
arise (Brooks et al 2020). grief, complicated grief to
disenfranchised grief (Wallace
yy Social isolation can negatively
et al., 2020).
affect a person’s social, emotional
and physical health (Relationships yy Early reports of increased suicides
Australia 2018; Holt-Lundstad et al., associated with COVID-19 are
2015). concerning (Montemurro, 2020).
yy Economic insecurities and financial
hardship cause stress and increase
the risk of conflict and violence,
particularly to women and children Economic insecurities and
(Peterman et al., 2020).
financial hardship cause stress
yy Increased risk of self-harm and
suicide may result from the
and increase the risk of conflict
combination of home confinement and violence, particularly to
and increased economic and women and children.
mental stressors (Gunnell et al.,
in press).
yy Disruption to ability to earn and
work will lead to loss in sense of Most importantly, these various
purpose and identity for many factors interact and intersect
(Harms et al., 2015). to produce and reinforce the
consequences from the pandemic,
yy Grief and bereavement will
requiring a comprehensive and
be experienced beyond the
holistic approach to managing
pandemic from loss of lives,
the road to recovery.
from losing, autonomy and sense

Chapter 8: Mental Health and Wellbeing
People with previous or existing mental The Australian mental health system
health problems are at particular risk: was struggling with demand before
the COVID-19 crisis and has limited
yy A higher likelihood of suicidal
capacity to cope in the face of
thoughts and self-harm from health,
escalation of demand. Mobilising and
social and economic consequences
redeploying the health workforce to
(Reger et al., 2020);
test, treat and care for individuals with
COVID-19 reduces resources available
Critically, there is evidence to manage individuals with other health
supporting the utility of self-guided conditions. Reforms are required to
ensure the mental health system can
internet-based interventions … cope with the increased demand.
Tele- and digital mental health service
yy People with mental illness are
provision provides some response
also at increased risk of physical
capacity (Wind et al., 2020) with
comorbidities (Copeland et al.,
the unique benefits of accessibility,
2007; Seminog & Goldacre, 2013;
flexibility and scalability. Critically,
Firth et al., 2019), which in turn
there is evidence supporting the
places them at high risk of negative
utility of self-guided internet-based
health outcomes from COVID-19;
interventions (Karyotaki et al., 2018),
yy Physical distancing strategies may telephone counselling, (Leach et
increase loneliness and exacerbate al., 2006), internet-based cognitive
or trigger the onset of mental health behavioural therapy (Titov et al., 2018),
problems; and psychological therapy delivered
via video conferencing software for the
yy People with mental illness
treatment of mental health problems
experience barriers in accessing
such as depression, anxiety, PTSD,
health services due to stigma
insomnia and substance misuse
and discrimination in healthcare
(Bashshur et al., 2016; Totten et
settings (Yao et al., 2020), which
al., 2016; Zhou et al., 2020). These
can be exacerbated with COVID-19.
conditions are likely to arise from

and be exacerbated by COVID-19. Evidence and
Examples of these programs have Analysis to Support
been shown to be effective in Australia
and are scalable (Titov et al., 2019;
Recommendations
Rice et al 2018; D’Alfonso et al. 2017;
A stepped care model of service
Hickie et al.; 2019). In addition, other
delivery is recommended which is
low intensity services such as the
consistent with the directions in
Improving Access to Psychological
the Fifth National Mental Health
Therapies (IAPT) program that have
and Suicide Prevention Plan
been shown to be successful in
(Commonwealth of Australia, 2017).
Australia and could also be expanded,
This will ensure interventions are
as demonstrated in the UK (Cromarty
provided at the right time and level
et al., 2016; Clark, 2018).
of intensity to meet the needs of the
Child Mental Health target population or the individual.
The key factor in child mental health Recommendation

is parenting. Australia leads the world
Coordinated and sustained
in parenting interventions for child
public health messaging on the
mental health and they are available
risks associated with COVID-19
in e-delivery form. Currently hundreds
and actions that can be taken
of thousands of parents are isolated
in response to maintain mental
at home caring for children many
health and wellbeing.
of whom have severe behaviour,
emotional and developmental
disorders. Rates of conflict and abuse
are at risk of escalating. Rolling out All communication should be
these interventions, if parents will be in simple and clear language,
isolated at home with their children,
may be a first-line evidence-based
such that it is accessible to all
response. Australians …

Clear and concise public Recommendation

communication across a range of
Rapid and stepped scaling of
media platforms likely to be accessed
secure evidence-based eHealth
by different demographics is essential
and Telehealth mental health
to foster preparedness for facing the
interventions for people who
problem; increase knowledge through
require treatment and support in
education and provide outreach
addition to strengthened provision
for those most affected. The likely
of community-based support.
impacts of COVID-19 (stress, grief
Significant national investment and

well-designed, accessible and flexible
Public communication should
national service infrastructure will
explain symptoms that indicate a be required. Due consideration must
need for additional support; and also be given to quality standards for
adjunctive digital mental health tools
provide clear guidance on where (e.g., apps) and personalised digital
support can be sourced. literacy for culturally and linguistically
diverse populations.
and loss, risk of violence) should be Recommendation

articulated and normalised. Public
communication should explain Strengthen provision of
symptoms that indicate a need for community-based support to
additional support; and provide clear maintain individual health and
guidance on where support can be societal wellbeing.
sourced. All communication should
be in simple and clear language, such Individuals should be better
that it is accessible to all Australians, assisted to maintain their health and
including those with low levels of wellbeing, including assisting in self-
health literacy and from culturally and management of chronic physical and
linguistically diverse backgrounds. mental health conditions, as well

as a broader whole of population factors for self-harm. These include
support aimed at maintaining healthy campaigns about safe and responsible
living. Strategies include healthy diet, drinking, increased risk of violence to
exercising, meditation, and engaging women and children and the importance
in daily activity. Interventions for of checking in on friends, neighbours
delivering these strategies with allied and work colleagues (Gunnell et al., in
health professionals can be accessed press). Maintaining and expanding the
to help to maintain mental health. paid (e.g. crisis helplines, safe houses,
Active community involvement is shelters) and volunteer workforce to
helpful for both individual mental provide services to support individuals
health and community wellbeing. is urgently needed during this transition
from responding to recovering
from COVID-19. In addition, flexible
Recommendation
work options and mobilising other
Coordinated and sustained support services to supplement and
public health messaging on the complement the existing workforce
risks associated with COVID-19 will be necessary.
and actions that can be taken
in response to maintain mental References
health and wellbeing.
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Mapping the evidence for patient

9 The Care of Indigenous
Australians
Current Context
The disproportionate impact of pandemics on
Indigenous populations worldwide has been well
documented. In responding to the global COVID-19
pandemic, Australian Indigenous organisations
have shown exemplary leadership and innovation in
their efforts towards preparedness. Urgent action is
required to ensure Australia’s indigenous community
is protected from COVID-19, now and especially in
the recovery phase as the nation ‘reopens’. Plus, the
inevitable recession will aggravate an already critical
situation for many Indigenous people.
A failure to act decisively will have including at the time of writing

devastating consequences that not just under 50 cases of COVID-19,
only compound existing traumas and representing 0.7% of all Australian
disadvantage, but will also result in cases. Just over half of these were
many needless Indigenous deaths acquired overseas and the remaining
and suffering on a catastrophic identified as local acquisition. This is
scale. The COVID-19 response must a significant outcome thus far.
address four issues for Indigenous
A key attribute of the COVID-19
people: housing, workforce, data and
response has been the banding
organisational support.
together of Aboriginal leadership
During the COVID -19 pandemic, across all sectors (health, education
enormous efforts have been put in land councils together with
place to mitigate risks of COVID-19 government agencies.).
for Aboriginal and Torres Strait This health response is also a clear
Islander Communities. This has demonstration of self-determination.
resulted in significant outcomes The National Aboriginal Community

Controlled Health Organisation All sections contained within this
(NACCHO), their State and Territory report concern Aboriginal and
Peak Organisations as well as Torres Strait Islander peoples and it
member services across the country is critically important to work with
have participated in a national Indigenous organisations, Elders,
Advisory Group that reports directly communities, and public health
to the Chief Medical Officer. The sectors to appropriately implement
Advisory Group is Co-Chaired the proposed recommendations
by NACCHO with the Australian outlined throughout the report.
Government’s Department of
Health. The group’s outcomes have Recommendations
been significant, taking leads in and Key Findings
developing a National Management
Plan, clinical guidelines, and specific It is recommended that the
initiatives to mitigate risk and prepare Government addresses four key
communities for COVID-19. issues to design the COVID-19
Together these actions which were recovery roadmap for Aboriginal
enacted early in the pandemic and Torres Strait Islander people
phase arising from Aboriginal and and communities.
Torres Strait Islander Organisations, yy The right to self-determination
communities and individuals is & coordination
an exemplary example of self-
determination in practice in yy Housing Supply
contemporary Australia. Recognising yy COVID-19 Public Health and
that there is some time to go before Clinical Responses should be
the COVID-19 pandemic is over, we maintained
make the following recommendations
regarding the road to recovery in yy Aboriginal and Torres Strait
respect to Aboriginal and Torres Strait Islander Health Workforce Review
Islander peoples.

Chapter 9: The Care of Indigenous Australians
Recommendation effective allocation of resources,

in light of an expected shortfall
Self-determination & Coordination
between emergency funding and
community needs, is best undertaken
The creation of the Indigenous in partnership with Indigenous
COVID-19 planning force and health organisations. Supporting the
taskforces in all jurisdictions led by expansion of jurisdictional Indigenous
Aboriginal Controlled Health Services COVID-19 advisory groups to oversee
to coordinate and implement effective this process during recovery would
localised responses to the pandemic avoid navigating complex Federal and
has been a success. We recommend State responsibilities.
the continued financial and logistical
support of Indigenous COVID-19
Recommendation
planning force and taskforces in all
jurisdictions for the remainder of the Housing Supply
pandemic. This will enable a single
point of engagement with health The ability of families to self-isolate
services, police, education, and family and quarantine effectively has been a
and community services. significant issue with COVID-19. Many
This recommendation is based on communities are limited by critical
the right of self-determination to keep housing shortages in urban, regional
our communities safe, recognition and remote areas. Lack of adequate
of local cultural practices, and housing has a direct impact on the
the need for efficient pandemic ability of local health services and
responses. Aboriginal and Islander communities to control virus spread,
health services are most familiar as well as exacerbating interrelated
with the social determinants of issues including child and family
our health in local areas, relevant safety, pre-existing overcrowding
cultural considerations, and are the and ageing infrastructure. During
most well-equipped to advise on the COVID-19 this has also been
correct allocation of funding. The exacerbated by many people returning

to their traditional homelands. Many Recommendation
communities remain extremely
COVID-19 Public Health and
vulnerable to COVID-19 without any
Clinical Responses should be
ability to isolate or to quarantine
maintained
suspected and/ or confirmed cases.
An immediate supply of alternative
It is recommended that the existing
housing is needed in local
Aboriginal and Torres Strait Islander
communities to alleviate the pressure
Health Advisory Group be maintained
on over-crowded households and
until Australia has fully recovered
enable effective disease suppression.
from COVID-19.
Housing is a long-standing issue.
Some communities have been able to
work with government and business … community infrastructure building
such as Minerals and Exploration
projects should be awarded
companies to secure emergency and
temporary housing, but for many to Indigenous enterprises that
this remains a significant risk for provide jobs and skills training to
widespread disease transmission
and disastrous outbreaks. In the
Indigenous workers …
medium-term an urgent supply of
permanent housing infrastructure
Availability of reports of COVID-19
and sustainable supply of utilities
cases and outcomes: Particular
is required to ensure that future
efforts will be required to ensure
outbreaks are containable. To this
adequate monitoring of COVID-19
end, community infrastructure
cases and detailed epidemiology
building projects should be awarded
reports are reported regularly
to Indigenous enterprises that provide
and publicly. Accurate data which
jobs and skills training to Indigenous
includes notifications, testing
workers perhaps as alternatives
numbers and rates, location of
to replacing schemes such as
notifications at a local area level,
Community Development Programs.

rates and types of complications, Recommendation

rates of hospitalisation, including ICU
Aboriginal and Torres Strait
admissions, number of deaths, as well
Islander Health Workforce Review
as the economic impacts, differential
care burden and the incidence of
family violence including child abuse The COVID-19 pandemic has
notifications in all jurisdictions is exacerbated vulnerabilities in local
required. health workforces who are dependent
on staff from interstate and even
Public health messaging will need to
New Zealand. Long-term initiatives
be maintained throughout recovery.
to build local capacity are needed.
Timely, accurate and accessible
This recommendation is made
information must be communicated
because significant issues have
regularly to the Indigenous public to
arisen for Aboriginal and Torres Strait
develop strong health literacy.
Islander communities throughout
Research into the effects of the pandemic thus far relating to
COVID-19 on community social workforce. This issues have arisen
and emotional wellbeing and for several reasons, such as the need
mental health will be required to to quarantine locum staff before they
evaluate how Aboriginal and Torres can provide clinical services; and the
Strait Islander peoples have fared restrictions on Aboriginal and Torres
through COVID-19 that will provide Strait Islander people aged 50 and
important learnings for future over with a chronic disease being
pandemics and crises. Such research isolated. We strongly recommend that
must be Indigenous-led and based NACCHO, as a lead agency, instigate
on scholarly and cultural ethical a Health Workforce reform process in
practices. To conduct this research partnership with Commonwealth and
and enable rapid decision-making, State and Territory governments.
issues of data quality and sharing
This will need to encompass the
must be addressed quickly.
following:

yy How to best increase and retain yy Economic recovery: Recognition
Aboriginal Health Practitioners in all that many Indigenous organisations
areas of Australia to help reduce the including Aboriginal Community
reliance on overseas and interstate Controlled Health Organisations
locum staff. (ACCHOs) will require specific
economic recovery and income
yy How to scale up Aboriginal Public
support programs to help in
Health and Infectious Disease
the recovery from COVID-19.
expertise so that each Federal and
State Health Department has a
senior Public Health Group. This issues have arisen for several
yy The need for surge workforces reasons, such as the need to
should outbreaks occur in
communities.
quarantine locum staff before they
can provide clinical services; and
In addition to the four primary
recommendations, there are broader the restrictions on Aboriginal and
considerations that impact the Torres Strait Islander people aged
roadmap to recovery, including:
50 and over with a chronic disease
yy Food security: Continue efforts
initiated during COVID-19 to guarantee
being isolated.
grocery and medication supply,
across communities and water for Expansion of existing commitments
those communities still impacted by for Indigenous businesses
2019–2020 natural disasters. should be considered. This will
yy JobSeeker: Maintaining the assist in revitalising economies
JobSeeker allowance at the present in Indigenous communities,
emergency levels to help reduce supporting local businesses and
Aboriginal and Torres Strait Islander improve the health and wellbeing
poverty and to stimulate economic of individuals both now and in the
activity throughout Australia. recovery phases.

General Background Due to the relative social and economic

disadvantage, Indigenous peoples
At present, approximately 800,000 also experience significant barriers to
people, or 3% of Australia’s population accessing health care services (Peiris
identify as Indigenous, and most et al., 2018). Preventable hospital
Indigenous people (approximately admissions and deaths (conditions
80%) live in cities and non-remote which should have been prevented
areas (Australian Bureau of Statistics, by primary healthcare services) are
2018). The median age of Indigenous three times as high in Aboriginal and
people is significantly lower than Torres Strait Islander people, due, in
non-Indigenous Australians (23 part, to failures in implementation of
and 38, respectively), with higher the “close the gap” policies (Australian
mortality rates making early middle Government, 2013). The health gap
age and older Indigenous people is the result of historical long-term
and Indigenous Elders especially systemic neglect and recurring social
vulnerable (ABS 2018). determinants of health.
The discrepancy between Indigenous Neither do remote Indigenous

and non-Indigenous populations communities have a sufficient local
is particularly pronounced in workforce. Initiatives to build local
Australia (United Nations, 2009). It capacity are needed.
is well established that Indigenous
Australians have higher rates of Evidence and Analysis
health problems, such as high to support Key Findings
blood pressure, respiratory and
circulatory disease, obesity and yy In addressing the global challenges
diabetes(Australian Institute of posed by pandemics it needs to
Health and Welfare, 2018; Australian be acknowledged that Indigenous
Bureau of Statistics, 2019), as well as populations are potentially highly
higher rates of psychological distress vulnerable.
compared to other Australians
»» The disproportionate impact
(McNamara et al., 2018).
of pandemics on Indigenous

populations worldwide (La Ruche »» The rapid spread of COVID-19 on
et al., 2009) and in Australia cruise ships has demonstrated
(Trauer et al., 2011; Flint et that crowded living quarters
al., 2010; Rudge and Massey, facilitate the transmission of
2010), was well documented respiratory illness and create a
during the 2009 H1N1 influenza high-risk environment. These
and prior (Kelm, 1999). During case studies demonstrate
the 2009 Influenza A H1N1, that COVID-19 in over-
Indigenous communities in crowded Australian Indigenous
Australia were particularly communities is likely to have
affected with higher levels of dire consequences4,5.
hospitalisation and fatality
»» There is a real concern that
from reduced and delayed
COVID-19 will compound
access to care, cultural health
existing health and mental
approach differences, as well as
health issues in Indigenous
healthcare-seeking behaviour.
communities due to the
The poorer socioeconomic
restrictions on community
status of Indigenous peoples
mobility and interaction (United
and the relational way of
Nations, 2020); in addition to the
living and being means risk of
higher risk of virus fatality in the
exposure and transmission may
presence of underlying health
have devastating effects.
conditions. Youth vulnerability
»» Current evidence from the US is a particular concern. Ensuring
shows COVID-19 is more prevalent Indigenous children and youth
and fatal in African American1 have continuing access to
and Indigenous Americans2,3. quality education through the
1 https://www.bbc.co.uk/news/world-us-canada-52194018
2 https://www.kob.com/albuquerque-news/statewide-data-reveals-native-americans-are-disproportionately-
impacted-by-covid-19-/5701649/
3 https://edition.cnn.com/2020/04/07/opinions/native-american-nations-risk-from-covid-19-sepkowitz/index.html
4 https://www.health.com/condition/infectious-diseases/coronavirus-cruise-ship-sickness
5 https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e3.htm

acute and recovery phase of the increase in domestic and

COVID-19 is essential. Not all family violence during the acute
Indigenous households have phase of COVID-19 it is likely that
ready access to technology or mandatory reports of children’s
reliable internet and parents will exposure to violence by police
need to be supported. will increase. The need for clear
and consistent messaging
»» Indigenous children and youth
about what this means and
who are particularly vulnerable
what supports are available is
are those in out of home care
essential, especially if children
and in juvenile justice detention.
are being removed including
At 30 June 2019, about 18,000
commitment to the Aboriginal
Indigenous children were in
Child Placement Principle and
out-of-home care—a rate of 54
keeping children on country.
per 1,000 Indigenous children,
which was nearly 11 times »» Children and young people
the rate for non-Indigenous are the subject of custody
children (Australian Institute orders with shared parenting
of Health and Welfare, 2020a). arrangements may also
Additionally, on an average night be vulnerable to changed
in June 2019, 53% of juveniles circumstances that may put
in detention were Indigenous them in unsafe situations.
(Australian Institute of Health
yy The core requirement for both the
and Welfare, 2020b).
acute phase and the recovery is
»» The interrelationship between sound evidence-based policy. That
child abuse and neglect with policy needs to be developed by
domestic and family violence and led by Indigenous peoples,
has long been established based on Indigenous values,
(Commission for Children and funded on a needs basis, with clear
Young People, 2016). With accountabilities and systematic
concerns already raised about evaluation.

yy The level of need for health care »» Community controlled healthcare
in Indigenous Australians is has shown commendable
approximately 2.3 times higher innovation in the COVID-19 crisis.
than other Australians. In response The response from Indigenous
to COVID-19, there is a pressing communities7,8,9 and organisations
need for the allocation of needs- (e.g., NAACHO (Australian
based funding. Department of Health, 2020),
Kimberley Aboriginal Medical
yy Under the international norm
Services (KAMS)10, CAAMA11) and
of Indigenous peoples right to
affiliate member services has
self-determination, the Food and
been swift and effective (planning,
Agriculture Organization of the
advocating, managing spread of
United Nations (FAO) encourages
virus, creating resources, health
Governments to include Indigenous
promotion), yet they still lack
peoples’ representatives, leaders
sufficient funding.
and traditional authorities in
emergency and health response »» Many Indigenous communities
committees or any entity dedicated have restricted entry onto their
to the COVID 19 pandemic, both lands and assumed responsibility
during the outbreak as well as in to ensure health information is
the aftermath/recovery.6 reaching their people.
6 http://www.fao.org/indigenous-peoples/news-article/en/c/1268353/
7 https://www.smh.com.au/national/nsw/we-treat-them-like-gold-aboriginal-community-rallies-around-elders-
20200327-p54ekl.html?fbclid=IwAR3G7GtKb54cA0le917a-z5TYQQjeX8FbhxzYA6u1VB8rf4YamI2dSo5W0M
8 https://www.abc.net.au/news/2020-04-02/indigenous-dot-paintings-coronavirus-health-message-uluru/121
10988?fbclid=IwAR17fg73d2rmCd8_uvBE3mSoGGPo2B1bSCPu635TSe2QEW-O4Jyg5lx6OMM
9 https://www.abc.net.au/news/2020-03-28/battle-to-keep-coronavirus-out-of-remote-communities-
translation/12084886
10 http://kams.org.au/covid19/
11 https://www.gayaadhuwi.org.au/coronavirus/

yy Indigenous leadership, worldviews and tourists, as well as when

and values should be at the their schools should re-open.
forefront on the path to recovery. The health in these communities
is poor, their elders in particular
»» There is a need to ensure
are highly vulnerable, and they
Indigenous health workers are
are entitled to exercise their right
supported especially in areas
to self-determination in these
where there are worker shortages
matters of life and death12.
and risk of infection could result
in no care being available. yy Immediate health and mental health
concerns need to be balanced with
longer term cultural, social and
emotional wellbeing of individuals
Valuing the Indigenous and communities.
knowledges of Australia’s First »» A whole-of-community approach
Peoples and especially the to healing is needed, as well as
culturally appropriate services for
knowledge that our Elders possess. grief and community wellbeing.
»» Valuing the Indigenous
knowledges of Australia’s
»» Aboriginal and Torres Strait
First Peoples and especially
islander people in more remote
the knowledge that our Elders
areas must make final decisions
possess. Losing a number of
about their readiness to, and the
Elders would be devastating
conditions under which, they
to the ongoing practice and
will open their communities to
transmission of cultural
non-essential workers and other
practices. It would be a loss to
visitors, such as FIFO workers
the community and Australia.
12 https://www.un.org/development/desa/indigenouspeoples/declaration-on-the-rights-of-indigenous-peoples.html

References Australian Institute of Health and
Welfare (2018). Aboriginal and Torres
Australian Bureau of Statistics (2018). Strait Islander Health Performance
Estimates of Aboriginal and Torres Framework (HPF) Report 2017, https://
Strait Islander Australians, June 2016, www.aihw.gov.au/reports/indigenous-
Cat no: 3238.0.55.011. https://www. australians/health-performance-
abs.gov.au/ausstats/abs@.nsf/ framework/contents/tier-1-health-
mf/3238.0.55.001 status-and-outcomes
Australian Bureau of Statistics (2019). Australian Institute of Health and

National Aboriginal and Torres Strait Welfare (2020a). Child protection
Islander Health Survey, 2018-19, Cat Australia 2018-19. https://www.aihw.
no: 4715.0. https://www.abs.gov.au/ gov.au/reports/child-protection/
ausstats/abs@.nsf/mf/4715.0 child-protection-australia-2018-19/
contents/table-of-contents
Australian Government (2013).
National Aboriginal and Torres Strait Australian Institute of Health and
Islander Health Plan 2013-2023, Welfare (2020b). Youth detention
https://www1.health.gov.au/internet/ population in Australia 2019. https://
main/publishing.nsf/content/ www.aihw.gov.au/reports/youth-
B92E980680486C3BCA257 justice/youth-detention-population-
BF0001BAF01/$File/health-plan.pdf in-australia-2019/contents/table-of-
contents
Australian Government (2020).
Australian Health Sector Emergency Commission for Children and Young
Response Plan for Novel Coronavirus People (2016). Always was, always
(COVID-19), Department of Health, will be Koori children. https://ccyp.vic.
https://nacchocommunique. gov.au/assets/Publications-inquiries/
files.wordpress.com/2020/03/ always-was-always-will-be-koori-
management-plan-for-aboriginal-and- children-inquiry-report-oct16.pdf
torres-strait-islander-populations.pdf

Flint, S.M., Davis, J.S, Jiunn-Yih, Peiris, David, Brown, Alex and Cass,
S., Oliver-Landry, E.P., Rogers, Alan (2018). Addressing inequities
B.A., Goldstein, A., Thomas, J.H., in access to quality health care for
Parameswaran, U., Bigham, C., indigenous people. CMAJ, November
Freeman, K., Goldrick, P., and Tong, 04, 179 (10) 985-986; DOI: https://doi.
S.Y.C. (2010). Disproportionate org/10.1503/cmaj.081445
impact of pandemic (H1N1) 2009
La Ruche, G., Tarantola, A., Barboza,
influenza on Indigenous people in
P., Valliant, L., Gueguen, J., Gastellu-
the Top End of Australia’s Northern
Etchegorry, M., epidemic intelligence
Territory, Medical Journal of Australia,
team at InVS (2009). The 2009
192 (10): 617-622. https://www.
pandemic H1N1 influenza and
mja.com.au/journal/2010/192/10/
indigenous populations of the
disproportionate-impact-pandemic-
Americas and the Pacific. Euro Surveil
h1n1-2009-influenza-indigenous-
Oct 22: 14(42), https://www.ncbi.nlm.
people-top-end
nih.gov/pubmed/19883543
Kelm, M.E. (1999). British Columbia
Rudge, S., and Massey, P.D. (2010).
First Nations and the influenza
Responding to pandemic (H1N1) 2009
pandemic of 1918-1919. BC Studies,
influenza in Aboriginal communities
122, 23-47.
in NSW through collaboration
McNamara, Bridgette J., Banks, between NSW Health and the
Emily, Gubhaju, Lina, Joshy, Grace, Aboriginal community-controlled
Williamson, Anna, Raphael, Barbara health sector, New South Wales
and Eades, Sandra (2018). Factors Public Health Bulletin 21(2) 26-29,
relating to high psychological distress https://www.phrp.com.au/issues/
in Indigenous Australians and their volume-21-issue-1-2/responding-
contribution to Indigenous-non- to-pandemic-h1n1-2009-influenza-
Indigenous disparities. Australian in-aboriginal-communities-in-nsw-
and New Zealand Journal of Public through-collaboration-between-nsw-
Health, https://doi.org/10.1111/1753- health-and-the-aboriginal-community-
6405.12766 -controlled-health-sector/

Trauer, J.M., Laurie, K.L., McDonnell,
J., Kelso, A., and Markey, P.G. (2011).
Differential effects of Pandemic
(H1N1) 2009 on Remote and
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United Nations (2009). State of
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socdev/unpfii/documents/SOWIP/en/
SOWIP_web.pdf
United Nations Declarati
United Nations Expert Mechanism
on the Rights of Indigenous Peoples
(EMRIP) 6 April 2020

10 Equity of Access
and Outcomes in
Health Support
What special considerations could be required
for the vulnerable in society during an exit and
recovery phase?
General Background disadvantaged groups. groups. It is

also the case that those who are at
The impacts of COVID-19 are not the intersection of these attributes
felt equally across the community. often bear the greatest brunt.
The next steps of a recovery strategy There are key community groups
will be critical to improving equity in deserving of targeted policy support
outcomes. Special considerations as Australia works to manage
will be required for: women who are COVID-19 recovery. There follows
pregnant and women at risk of family a number of recommendations on
violence; children and young people, how those groups can be supported,
each backed by evidence-based key
findings and subject specific research.
The next steps of a recovery Recommendations

strategy will be critical to and Key Findings
improving equity in outcomes.
yy Recommendation: Government
advances its policies against
family violence by recognising an
specifically those living in out-of-
additional $180 million is needed to
home care; older adults and those
fund the ‘Keep Women Safe in Their
living in residential aged care; the
Homes’ program which is designed
homeless; people with disabilities;
to address the scale of need. That
people living with a life threatening
it develops tailored responses to
illness(es); LGBTQI+ people; ethnic
address the specific and diverse
minorities and refugees and asylum
needs of: women with disabilities,
seekers; and socioeconomically

indigenous women, and women yy Recommendation: Funding for the
from culturally and linguistically evidence-informed “Home Stretch26”
diverse (CALD) backgrounds who program to offer in-care and post-
are experiencing family violence. care support to children in OOHC
until they are 21 to foster their
yy Recommendation: That maternity
COVID-19 recovery process because
health services and postnatal care
those are young people who are
should be virus free and safe for
forced to live out of home (OOHC).
women screened as high risk to It is also recommended that police
attend in person; to reduce their are conscious of the vulnerability of
stress. Women pregnant during those in OOHC.
disasters such as a pandemic and
at risk of family violence require yy Recommendation: Government
extra support while women’s needs support community service
before during and after giving organisations and health services
birth should not be de-prioritised to help older adults self-isolate by
because of COVID-19 healthcare. providing access to in-home medical
care, medication, and regular
yy Recommendation: An infant, child assessment of social isolation
and youth reference committee20 risk.32 It is critical that online and
to provide expert advice (i.e. telephone strategies are available
educational, mental health and to foster social connections with
social aspects) be established family, friends and volunteers.33
as children and young people Health security methods that
may require tailored support to support safe visitation from select
manage the stress of COVID-19. primary visitors or informal carers
Support for young people’s to older adults who will suffer undue
pathways to employment through distress from social distancing
government funded projects, such measures is a prime need.
as construction projects employing yy Recommendation: For LGBTQI+
young people as trainees is people, pharmaceutical companies
another key recommendation as an ensure the provision of gender
investment in Australia’s future. affirming hormone products and

Chapter 10: Equity of Access and Outcomes
in Health Support
PrEP, and clarification regarding investments achieve their goals,

what products are available, what especially for those disadvantaged
PBS covers, and whether products by socio-economic issues.46,47,48,49
can still be shipped into Australia.
yy Recommendation: COVID-19
yy Recommendation: The continued responses should not be at the
funding of services such as expense of, or result in a reduction
Foodbank and Community Meals of, capacity to treat existing acute
programs, community outreach, care needs.
healthcare programs, and legal aid
to support refugee and migrant Key findings
groups is required.
yy Reports suggest that web
yy Recommendation: Compassionate searches on domestic violence
policies for the homeless with are up by 75 %, and that family
a continuation of funding of violence perpetrators were using
Isolation and Recovery Facilities COVID-19 restrictions as a new
to ensure they have a safe place way of exercising coercive control
to self-isolate and quarantine and over victims. Women in abusive
that we ensure the homeless are domestic violence circumstances
not targeted for breaching social are at increased of harm.
distancing regulations.
yy For pregnant women enduring high
yy Recommendation: That there levels of stress (i.e. in a pandemic)
be flexibility, sensitivity and and at risk of family violence it
responsiveness to modifying, can be shown that their babies are
managing and implementing NDIS often born small for gestational age
plans and other support for people due to restricted foetal growth and
with disabilities. additional stress.13,14 While pregnant
yy Recommendation: Policies such women are more susceptible
as JobKeeper and the increased to COVID-19 than the general
JobSeeker allowance are kept population.15
in place to ensure that these

yy The UN Convention on the Rights urgent needs to support this must
of the Child, ratified by Australia, include access to medical support,
stipulates that children have the affordable basic supplies and social
right to participate in decisions support in homes.28, 29 It is known
that affect them.16 A total of that social isolation increases older
50,000 children and young people adults’ risk of morbidity/mental
of schooling age are known to health concerns30, 31 and that some
already be fully disengaged (i.e., aged care facilities have adopted
not enrolled) in school,17 which may discretionary policies of removing
increase with schools currently all visitor access.
disrupted and youth unemployment
has increased as young people A total of 50,000 children and
often work as casuals in hospitality
and retail.18,19 It is also known that young people of schooling age
children often experience mental are known to already be fully
health or learning issues following
severe adversity, such as disaster
disengaged (i.e., not enrolled)
and loss.20, 21, 22 in school …
yy Young people living in out of home yy For LGBTQI+: gender diverse
care, OOHC, experience higher rates populations report high levels
of adverse physical and mental health of discrimination in mainstream
outcomes and continue to experience healthcare settings34 so may be
disadvantage in educational less likely to report COVID-19
achievements, employment, housing, symptoms, that they are likely to
and health after care, compared to experience mental illness, and
other young people.23,24 suicidal tendencies.35,36,37,38,39
Social distancing measures may
yy For older Australians
be additionally challenging for
superannuation is a key source of
those forced to isolate with family
their household income allowance.27
members who don’t accept their
Social distancing is stressed during
sexual or gender identities.38
COVID-19 but immediate and

in Health Support
yy Those from asylum seeker and or quarantine are at great risk

migrant backgrounds faced of contracting COVID-19 while
social distancing measures that homeless groups and individuals are
further isolated and compounded being fined by police for breaches
their stressors.40,41 Also, many of social distancing regulations
from refugee and asylum seeker and given ‘move on’ notices,
backgrounds do not currently have when homeless individuals often
access to any form of financial congregate in groups for safety.
support, experience insecure
yy Eighteen per cent of Australians live
housing and have no access to
with physical or intellectual disability
Medicare. COVID-19 information
and face high health vulnerability if
may not always be accessible to
they became infected with COVID-19;
those people from non-English
while they may have reduced their
speaking backgrounds and there
support services within the home to
is also a concern that taking a
reduce exposure to infection.44 The
COVID-19 test may mean risk of
current inability to attend regular
arrest or detention.
support and health services outside
home may result in a short- term
increase in support needs during the
Also, many from refugee and COVID-19 recovery phase.
asylum seeker backgrounds do not
yy Those with a socio-economic
currently have access to any form disadvantage are often in casual
of financial support, experience and insecure employment have
greater risk of unemployment and
insecure housing and have no that unemployment effects endure
access to Medicare. over individuals’ careers and across
generations if no sufficient support
is offered to help.
yy Australia’s homeless or those
without secure accommodation yy People with life threating illnesses
and who cannot self-isolate face high risk of infection and

compromised immune systems, References
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Wuliji, T., Diallo, K., Campbell.,
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Ireton, G., Alkemade, N., Roberts,
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22. Spuij, M., Reitz, E., Prinzie,
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about-working-differently-better-
outcomes/place

11 Clarity of
Communication
The overall success of the recovery will depend upon
engaging widespread public support and participation
through partnership with civil society regardless of
which strategy is chosen.
If the Elimination Strategy is constraining the infection rate and

pursued, it is important that the enabling economic activity. And if the
public understands the additional infections increase, the measures
sacrifice needed, why it is worth it, may need to be reinstated.
and what benefits they can expect
in return. It is also critical that the Recommendations
public understand that even with and Key Findings
the Elimination Strategy, life will
not return to the ‘old normal’. yy Recommendation: Communicate
the approach and associated
measures using clear, specific
… it is critical that the public and empathetic language.
understand that in exchange for yy Recommendation: Enrol individuals
an earlier relaxation, there will be a who are perceived as credible and
trustworthy (e.g. healthcare workers
need for ongoing adaptation. and population health scientists) to
convey key messages publicly.
With the Controlled Adaptation yy Recommendation: Enhance the

strategy, it is critical that the public cultural appropriateness and
understand that in exchange for thus impact of communication.
an earlier relaxation, there will be A number of community
a need for ongoing adaptation. reference groups for this should
Specific containment measures be established that represent
may be carefully relaxed in several Australia’s demographic and
phases to achieve a balance between socio-cultural diversity.

yy Recommendation: Define and yy Key Finding: Broad communications
implement a color-coded public need to be supplemented with
health alert system. A color-coded messages tailored to particular
public health alert system with communities and social groups.
four levels (“Prepare”, “Reduce”, Engagement with public health
“Restrict”, and “Lockdown”), enables messaging is heavily influenced by
the community to see and plan for socio-economic background, cultural
the restrictions that governments and social identity, age, gender etc.
may be required to put in place.
Australia’s efforts to contain COVID-19
The public health alert system
and ‘flatten ‘the curve’ have been
may be geo-targeted at the town,
successful.
council, state/territory level, and
shows increased or decreased The Government responded quickly
limits on human contact, travel (Swerissen, 2020), and this resulted in
and business operations. the rapid and widespread uptake of a
range of behaviours by the community.
yy Key Finding: Health professionals
and population health scientists) Below is a communication strategy
are generally viewed as credible aimed at engaging maximum public
and trustworthy sources of public support and participation in Australia’s
health-related information. optimal approach going forward. This
reflects decades of research into
yy Key Finding: Previous research
effective public communication from
illustrates that people’s willingness
a range of inter-related disciplines,
to act on public health advice
including psychology, sociology, risk
during a pandemic is driven by
communication, health promotion, and
their sense of pragmatism as well
science and technology studies. This
as trust – they want to know what
communication approach is one that
actions will benefit in their personal
occurs in a spirit of participation and
circumstances Hence, public health
consultation; which is attentive to the
messaging has more impact if it
diversity of Australia community that
helps with empowerment.
and appeals to people’s capacity to act.

Chapter 11: Clarity of Communication
Evidence and communication, while essential, is

Analysis to support not sufficient to change behaviours
because communication tends to
Recommendations focus on changing motivation. People
and Key Findings also need to have the capability and
opportunity to perform the needed
General Principles of Risk behaviours and thus environmental
and Crisis Communication factors are also relevant, along with
having sufficient resources (Michie
Communication matters. There is et al., 2020). Second, the unique
evidence of a significant relationship communication needs of special
between the communication and diverse audiences need to be
strategies of agencies responding respected; different audiences will
to a crisis and the level of public to some extent benefit from distinct
reassurance and compliance. (Carter frames, messages, and messengers
et al., 2013). Some general principles (Moser, 2010).
… the unique communication needs of special and diverse

audiences need to be respected; different audiences will
to some extent benefit from distinct frames, messages,
and messengers.
of risk and crisis communication are

summarised below (Covello, 2003; As the development of such tailored
Reynolds, 2004; Seeger, 2006). communication strategies requires
an investment of time and other
It is worth pointing out two resources, the following principles
constraints that will be elaborated should form the backbone of
on in the following sections: first, immediate communication strategies.

Principle 1 A communication strategy for
Engage in clear, consistent maximum community support
communication and participation
Principle 2 There are four specific

Strive for maximum credibility recommendations which should
form the basis of a strategy in
Principle 3 which broad community messaging
Communicate with compassion, is supplemented with tailored
care, and empathy communications for particular
Principle 4 groups.
Communicate with openness,
frankness, and honesty Recommendation
Principle 5 Communicate the approach

Recognise that uncertainty and associated measures using
and ambiguity is inevitable specific and empathetic language
that helps people feel empowered
Principle 6 to act, rather than just passive
Help people to feel recipients of instructions.
empowered to act
Principle 7 Provide a succinct and clear

Consider health and statistical explanation as to why ongoing
literacy in messaging containment measures are necessary.
Be explicit about the goals of the
Principle 8 controlled adaptation approach, and
Be proactive in combating the reasons for undertaking particular
misinformation measures. The risks of pursuing the
approach and specific measures
Principle 9
also need to be clearly articulated.
Recognise and embrace
Empathise by explicitly recognising
diverse audiences
hardships of measures.

Recommendation Recommendation
Enlist the support and assistance Enhance the impact of
of independent, credible and communication by establishing
trustworthy advocates (e.g. community reference groups to
healthcare workers, educators, provide ongoing input into the
community leaders) to convey decisions that affect them and
key messages. also how best to communicate
them. Several community reference
Continue to use those from trusted groups should be established so
professions to explain and justify the that collectively, they represent
controlled adaptation approach. It Australia’s demographic and
is obviously highly appropriate that socio-cultural diversity.
key policy decisions are announced
and articulated by politicians while Norms and modes of communication
authoritative health officials (such differ between social and cultural
as the Chief Medical Officer), and groups. In addition, some groups will
key public health and scientific be impacted much more severely
experts must continue to provide than others by Australia’s response
public communications. This will to COVID-19. Communications
help to convey that such policies are should be tailored towards these
underpinned by ‘apolitical’ evidence. groups by working closely with group
representatives. The following groups
in particular require tailored messaging:
… authoritative health officials, and yy Young children (up to 12 years old)

and their parents
key public health and scientific
yy Secondary school children
experts must continue to provide
yy Young adults (18–30)
public communications.
yy Older adults (70+) and those living
in residential care

yy Aboriginal and Torres Strait Islanders message and over time lead to fatigue
and non-compliance. It is critical that
yy Gender diverse / LGBTQ+
the labels used and their implication
communities
be uniform across the country.
yy People affected by bushfires Australia has long experience with
fire-risk warnings and most of the
yy People with life-threatening illnesses
population understands and responds
(i.e. immunocompromised)
to escalation and de-escalation of
yy Hearing-impaired community these warnings. It is recommended,
yy Vision impaired community. that in consultation with experts
and the different jurisdictions a
Community reference groups would uniform public health alert system
advise on: key messages and be developed.
approaches; ensuring the framing
and tone of messages would
Recommendation
be most appropriate to ensure
engagement; and the modes of Define and implement a color-
communication (e.g. Auslan, TV coded public health alert system.
broadcast, SMS, health messages A color-coded public health alert
on social media platforms) that will system with four levels ( e.g.
increase dissemination among their “Prepare” [blue], “Reduce” [amber],
communities. “Restrict” [brown], and “Lockdown”
[red]), enables the community to
There is a likelihood that as different
see and plan for the restrictions
Governments and jurisdictions find
that governments put in place.
themselves at different levels of
The public health alert system
risk that they use different labels
may be geo-targeted at the town,
and wording for risk. The different
council, state/territory level, and
messages in different jurisdictions
shows increased or decreased
along with different restrictions in
limits on human contact, travel
different areas will create confusion
and business operations.
amongst the community, dilute the

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Methodology
The Roadmap project was designed Standard remote collaboration

to provide considered and evidence- methods, such as circulating drafts
based responses to questions by email, have many drawbacks such
of critical and pressing national as the difficulty of keeping track of
importance. document versions, integrating edits
and comments on many different
Experts were recruited from across
versions, and ensuring that everyone
the Go8 universities – Australia’s
can see the latest version. It seemed
leading research-intensive universities
clear this approach would struggle
– in areas as diverse as epidemiology,
with an expert group as large as the
statistical modelling, infectious
Roadmap Task Force.
diseases, public and mental health,
psychology, economics, political The Steering Committee made the bold
scientists, Aboriginal and Torres decision to try a new crowdsourcing-
Strait Islander expertise, business, inspired approach. All members were
international relations scholars and given access to the SWARM cloud
political scientists. collaboration platform, a research
prototype being developed by a team at
Individuals ranged from eminent
the University of Melbourne’s Hunt Lab
professors to early career researchers,
for Intelligence Research. The platform
to capture the diversity of expertise
is the result of a three-year research
across generations of talent.
effort funded by the US Intelligence
The Task Force faced the challenge Advanced Research Projects Activity,
of articulating the collective wisdom aimed at developing better ways
of this large and diverse group on a to support groups of analysts to
complex set of questions in a short work through difficult problems and
period, under conditions of great produce high-quality reports. The
uncertainty and rapid change and platform’s design is generic enough
where no members could physically that it can support analytical work in
meet. many other domains.

Methodology
On the platform, all Task Force would need to be carefully monitored

members were able to access nine and that adjustments may be
workspaces, one for each of the main required. In the second week, three
questions being addressed. Within a such changes were made: addition
workspace they could view, create, of new Task Force members to cover
and collaboratively edit contributions expertise gaps; off-platform video-
of various kinds, including draft conferencing to accelerate coordination
section reports; rate and comment of small emergent teams; and, where
on contributions; and use real-time appropriate, relaxation of anonymity.
chat. While these activities are
By the end of week 2, draft reports
supported by many cloud platforms,
were available for all nine questions.
a combination of design features
These were woven together into
makes the SWARM approach unique.
a single Final Report by a small
These include:
editing team from the Group of Eight
yy A “groupsourcing” model in which Directorate. Task Force members were
small teams from within the large briefly given a final opportunity to
expert pool coalesce and self- provide comments. The Final Report
organise to tackle specific questions; was then reviewed by a team of
selected independent commentators
yy Support for “contending analyses,”
and approved by the Go8 Board
where any member can put up
of Directors before being provided
a draft report and the group as
directly to Government.
a whole can select the most
promising via “readiness” ratings; The result is a comprehensive,
independent, evidence-based report for
yy Use of pseudonyms, intended to
Government that provides guidance as
mitigate social dominance effects
to how and when Australia can move
arising from the differing status of
to the recovery phase.
members.
Dr Tim Van Gelder
The Steering Committee understood
from the outset that the approach Dr Richard De Rozario

Acknowlegements
We thank the following for active participation Dr Kyllie Cripps Ms Bernadette Hyland-Wood
on the SWARM platform: University of New South Wales University of Queensland
Professor Charles Abraham Professor Donna Cross Associate Professor Tim Inglis
University of Melbourne University of Western Australia University of Western Australia
Professor Karen Adams Professor Mark Dadds Associate Professor Andrew Jackson
Monash University University of Sydney University of New South Wales
Associate Professor Eva Alisic Professor Sara Davies Professor Jolanda Jetten
University of Melbourne Griffith University University of Queensland
Dr Kelly-Anne Allen Professor Megan Davis Ms Yawei Jiang
Monash University University of New South Wales University of Queensland
Dr Erik Baekkeskov Professor Patricia Dudgeon Professor John Kaldor
University of Melbourne University of Western Australia University of New South Wales
Professor Emily Banks Professor Sandra Eades Associate Professor Adam Kamradt Scott
Australian National University University of Melbourne University of Sydney
Associate Professor Anthony Bell Associate Professor Ullrich Ecker Professor Shitij Kapur
University of Queensland University of Western Australia University of Melbourne
Dr Andrew Black Ms Nicole Ee Ms Alex Kennedy
University of Adelaide University of New South Wales Group of Eight
Dr Andrew Black Professor Jane Fisher AO Dr Elise Klein
University of Sydney Monash University Australian National University
Professor Tony Blakely Professor John Freebairn Professor David Le Couteur AO
University of Melbourne University of Melbourne University of Sydney
Dr Chris Blyth Dr John Gardner Professor Julie Leask
University of Western Australia Monash University University of Sydney
Ms Katrina Boterhoven de Haan Professor Ross Garnaut AC Professor Karin Leder
University of Western Australia University of Melbourne Monash University
Professor Robert Breunig Professor Marie Gerdtz Mr Yulin Li
Australian National University University of Melbourne University of Adelaide
Professor Alex Broom Associate Professor Kathryn Glass Associate Professor Kamalini Lokuge
University of Sydney Australian National University Australian National University
Dr Matthew Brown Professor Quentin Grafton Professor John Mangan
Group of Eight Australian National University University of Queensland
Professor Romola Bucks Professor Len Gray Professor Andrew Martin
University of Western Australia University of Queensland University of New South Wales
Professor Jim Buttery Professor Jane Gunn Professor James McCaw
Monash University University of Melbourne University of Melbourne
Dr Katherine Carroll Professor Ian Hickie Dr Christopher McCaw
Australian National University University of Sydney University of Melbourne
Professor Allen Cheng Ms Anna Hickling Professor Lisa McDaid
Monash University University of Queensland University of Queensland
Professor Alex Collie Professor Keith Hill Dr Siobhan McDonnell
Monash University Monash University Australian National University
Professor Rae Cooper AO Professor Richard Holden Professor Patrick McGorry AO
University of Sydney University of New South Wales University of Melbourne
Professor Kim Cornish Professor Eddie Holmes Professor Warwick McKibbin AO
Monash University University of Sydney Australian National University

Professor Jodie McVernon Professor Tania Sorrell AM Professor John Piggott AO, University of New
University of Melbourne University of Sydney South Wales, Professor Peter Robertson,
University of Western Australia, Associate
Professor Tracy Merlin Professor Marc Stears
Professor Linda Selvey, University of Queensland
University of Adelaide University of Sydney
Chapter 4: Border Protection and Travel Restrictions
Professor George Milne Professor David Story
University of Western Australia University of Melbourne Associate Professor Adam Kamradt-Scott,
University of Sydney
Dr Nikki Moodie Ms Vicki Thomson
University of Melbourne Group of Eight Chapter 5: The Importance of Public Trust,
Dr Lucy Morgan Professor Carla Treloar
University of Sydney University of New South Wales Dr John Gardner, Monash University, Ms Bernadette
Hyland-Wood, University of Queensland, Professor
Professor James Morley Professor Tim Usherwood Julie Leask, University of Sydney
University of Sydney University of Sydney
Associate Professor Julia Morphet Professor James Ward Building and Supporting a Health System within
Monash University University of Queensland the “Roadmap to Recovery”
Dr Sally Nimon Professor Jim Watterston Professor Jane Gunn, University of Melbourne
Group of Eight University of Melbourne Chapter 7: Preparing to Reopen
Professor David Paterson Professor Peter Whiteford
University of Queensland Professor Jane Gunn, University of Melbourne,
Australian National University Mr Roberto Schurch Santana, University of
Dr Collin Payne Professor Harvey Whiteford Queensland, Professor Romola Bucks, University
Australian National University University of Queensland of Western Australia, Associate Professor
Dr Michael Phillips Andrew Jackson, University of New South
Professor Simon Wilkie Wales, Dr Chris McCaw, University of Melbourne,
Monash University Monash University Professor Andrew Martin, University of New
Professor John Piggott AO Professor Deborah Williamson South Wales
University of New South Wales
University of Melbourne Chapter 8: Mental Health and Wellbeing
Professor Jane Pirkis
Associate Professor James Wood Ms Anna Hickling, University of Queensland,
University of Melbourne
University of New South Wales Professor Harvey Whiteford, University of
Ms Maeve Powell Queensland
Dr Mandy Yap
Australian National University
Australian National University Chapter 9: Considerations for Aboriginal and
Professor Mikhail Prokopenko Torres Strait Islander Peoples
Professor Paul Young
University of Sydney
University of Queensland Professor Patricia Dudgeon, University of
Dr Signe Ravn Western Australia, Dr Kate Derry, University
Special Acknowledgements to the Following:
University of Melbourne of Western Australia
Professor Ian Reid Chapter 1: An Ethical Framework for the Recovery
Chapter 10: Key Populations
University of Adelaide Professor Duncan Ivison, Deputy Vice Chancellor,
Professor Helen Skouteris, Monash University
Professor Peter Robertson Research, University of Sydney, Professor Marc
Stears, University of Sydney and Prof Susan Chapter 11: Communications
University of Western Australia
Dodds, LaTrobe University Dr John Gardner, Monash University, Associate
Mr Ross Roberts-Thomson
Chapter 2: The Elimination Option Professor Ullrich Ecker, University of Western
University of Adelaide
Australia, Professor Julie Leask, University of
Associate Professor Simon Rosenbaum Professor Emily Banks, Australian National Sydney, Ms Bernadette Hyland-Wood, University
University of New South Wales University, Dr Grazia Caleo, Australian National of Queensland
University, Dr Stephanie Davies, Australian National
Professor John Savill University, Associate Professor Kathryn Glass, Thanks to Prof. Neville Yeomans for helping
University of Melbourne Australian National University, Professor Quentin consider the Contributions
Dr Ashley Schram Grafton, Australian National University, Associate We acknowledge Associate Professor Tim van
Australian National University Professor Kamalini Lokuge, Australian National Gelder and Associate Professor Richard de
University, Professor George Milne, University of Rozario and their “SWARM” team: Ashley Barnett,
Mr Roberto Schurch
Western Australia, Professor Mikhail Propenko, Dr Ariel Kruger, Yao Pan, Tamar Primoratz, Dr
University of Queensland
University of Sydney, Dr Leslee Roberts, Australian Morgan Saletta, Sujai Thomman, Luke Thorburn,
Dr Theresa Scott National University, Ms Tatum Street, Australian Dr Ivo Widjaya, Andrew Wright, Zeyu Zha
University of Queensland National University, Associate Professor James Thanks to our additional Contributors:
Associate Professor Linda Selvey Wood, University of New South Wales
Dr Elizabeth Adamson
University of Queensland Chapter 3: The Controlled Adaptation Option University of New South Wales
Professor Louise Sharpe Professor Tony Blakely, University of Melbourne, Professor Jon Altman
University of Sydney Professor Karin Leder, Monash University, Australian National University
Dr Kirsty Short Professor John Mangan, University of
Dr Jacqueline Anderton
University of Queensland Queensland, Professor James McCaw, University
of Melbourne, Professor Jodie McVernon,
Professor Helen Skouteris Professor Nicholas Aroney
University of Melbourne, Professor Warwick
Monash University University of Queensland
McKibbin AO, Australian National University,
Dr Joseph Smith Professor Tracy Merlin, University of Adelaide, Professor Gabriele Bammer
University of Adelaide Dr Collin Payne, Australian National University, Australian National University

Associate Professor Margo Barr Dr Trish Hill Professor Ian Ring AO
University of New South Wales University of New South Wales James Cook University
Dr Megan Blaxland Dr Jessika Hu Mr Tyler Riordan
University of New South Wales Murdoch Children’s Research Institute University of Queensland
Dr Alexandra Bloch-Atefi Associate Professor Janet Hunt Dr Penny Round
University of Adelaide Australian National University Monash University
Dr Karen Block Professor Raja Junankar Professor Richard Saffery
University of Melbourne University of New South Wales Murdoch Children’s Research Institute
Dr Noreen Breakey Associate Professor Nicole Kaims Professor Andreas Schloenhardt
University of Queensland Monash University University of Queensland
Associate Professor Julie Brimblecombe Professor Yoshi Kashima Dr Brett Scholz
Monash University and University of Queensland University of Melbourne Australian National University
Dr Timothy Broady Professor Ilan Katz Ms Naomi Schwarz
University of New South Wales University of New South Wales Murdoch Children’s Research Institute
Professor Deborah Bunker Associate Professor Sabina Kleitman Professor Anthony Scott
University of Sydney University of Sydney University of Melbourne
Dr Beatriz Cardona Professor Stephan Lewandowsky Dr Jennifer Skattebol
University of New South Wales University of Melbourne University of New South Wales
Dr Susan Carland Associate Professor Daniel Little Dr Pearl Subban
Monash University University of Melbourne Monash University
Deputy CEO Dawn Casey Professor Simon Loertscher Dr Stewart Sutherland
National Aboriginal Community Controlled University of Melbourne Australian National University
Organisation (NACCHO) Professor Nigel Lovell Dr Cathy Thomson
Dr Andrzej Ceglowski University of New South Wales
Monash University Dr Sue Lukersmith
Associate Professor Cathy Vaughan
Australian National University
Associate Professor Mark Davis University of Melbourne
Monash University Professor Guy Marks
Professor Melissa Wake
Professor Simon Dennis Murdoch Children’s Research Institute
University of Melbourne Professor Greg Marston
Mr Josh White
Professor Sara Dolnicar University of Melbourne
University of Queensland Miss Antje Martins
University of Queensland Dr David Whyatt
Associate Professor Frank Donnelly University of Western Australia
University of Adelaide Professor Kirsten McCaffery
University of Sydney Associate Professor April Wright
Dr Antony Eagle University of Queensland
University of Adelaide Dr Ros McDougall
University of Melbourne Dr Yongxin Xu
Dr Elizabeth Edwards Monash University
University of Queensland Professor Alistair McEwan
University of Sydney Professor Neville Yeomans AM
Dr Thorlene Egerton University of Melbourne
University of Melbourne Dr Susan Mendez
University of Melbourne Professor Alison Young
Dr Christian Ehnis University of Melbourne
University of Sydney Professor Patricia Morrell
University of Queensland Dr Adam Zulawnik
Dr Megan Ferguson Monash University
Monash University and University of Queensland Dr Jack Noone
University of New South Wales Thank you to our independent reviewers:
Dr Tony Florio yy Mr Jeff Connolly, Chairman and CEO, Siemens Ltd
Dr Sze-Yuan Ooi
University of New South Wales yy Professor Glyn Davis AC, CEO of the Paul
Professor Pauline Ford Ramsay Foundation
Associate Professor Roger Patulny
University of Wollongong yy Professor Stephen Duckett, FASSA,
Dr Paul Garrett Grattan Institute
Associate Professor Amy Perfors
University of Melbourne yy Ms Kathryn Fagg, AO, FAATE
Dr Lynn Gillam
Dr Michelle Peterie yy Dr Alan Finkel AO, Australia’s Chief Scientist
University of Melbourne University of Queensland
Professor Sharon Goldfeld yy Dr Cassandra Goldie, CEO, Australian Council
Professor Ove Peters of Social Service (ACOSS)
Murdoch Children’s Research Institute University of Queensland
Professor Bronwyn Harch yy Mr Andy Keough CSC, Managing Director,
Dr Kate Power
University of Queensland Saab Australia
Associate Professor Ian Hardy yy Ms Linda Nicholls, AO, Chair of Melbourne Health
Dr Bridget Pratt
University of Queensland University of Melbourne yy Dr Jennifer Westacott AO, CEO, Business
Associate Professor Ben Harris-Roxas Council Australia
Associate Professor Gaby Ramia
University of New South Wales University of Sydney
go8.edu.au

Go8 Road To Recovery

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Go8 Road To Recovery

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COVID-19

A Roadmap to Recovery – A Report for the Nation 6

Chapter 1: An Ethical Framework for the Recovery 23

Chapter 2: The Elimination Option 26

Chapter 3: The “Controlled Adaptation” Strategy 58

Chapter 4: Border Protections and Travel Restrictions 83

Chapter 5: The Importance of Public Trust,

Chapter 6: Australia’s Optimal Approach for Building

Chapter 7: Preparing to Reopen 114

Chapter 8: Mental Health and Wellbeing 140

Chapter 9: The Care of Indigenous Australians 150

Chapter 10: Equity of Access and Outcomes in Health Support 164

Chapter 11: Clarity of Communication 174

GO8 COVID-19 ROADMAP TO RECOVERY – 3

As Co-Chairs of the “Roadmap to Recovery” taskforce

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GO8 COVID-19 ROADMAP TO RECOVERY – 5

Executive Summary In this Executive Summary, we

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We propose the following principles disproportionately. Therefore,

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GO8 COVID-19 ROADMAP TO RECOVERY – 9

Option 1: Elimination Strategy need to be enhanced to achieve it.

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Option 2: Controlled yy This strategy will require extensive

GO8 COVID-19 ROADMAP TO RECOVERY – 11

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Regardless of which path Australia yy Both strategies envisage that

GO8 COVID-19 ROADMAP TO RECOVERY – 13

an appropriate way. Their potential cautions that automatic uptake

vaccine, we recommend that yy Given the state of the pandemic

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GO8 COVID-19 ROADMAP TO RECOVERY – 15

yy This is especially critical if there industries, business organisations,

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1. The Health of our Healthcare yy Many have delayed or deferred

GO8 COVID-19 ROADMAP TO RECOVERY – 17

yy Continue to support medical 2. Preparing for Relaxation

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GO8 COVID-19 ROADMAP TO RECOVERY – 19

yy Increased capacity to ensure organisations and their partnership

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GO8 COVID-19 ROADMAP TO RECOVERY – 21

sacrifice needed, why it is worth it It is important that Governments

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Six core principles to frame Australia’s

1. Democratic accountability and liberties. Special measures that

GO8 COVID-19 ROADMAP TO RECOVERY – 23

2. Equal access to healthcare and 3. Shared economic sacrifice:

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GO8 COVID-19 ROADMAP TO RECOVERY – 25

A jurisdiction-by-jurisdiction Key Points:

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Goal and objectives Methods and

GO8 COVID-19 ROADMAP TO RECOVERY – 27

3. Community engagement is critical show that elimination has been

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GO8 COVID-19 ROADMAP TO RECOVERY – 29

(five infectious) when a transmission identify all transmission under any of

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B) Indicators of successful upstream transmission branches