Melbourne’s COVID-19 outbreak has proven how easily the virus can resurface, and begin spreading on a large scale.

Many countries worldwide are facing either a second wave, or a similar resurgence in infections. Even countries that did manage to control the virus initially, such as South Korea, Singapore, New Zealand and Vietnam, have seen new outbreaks.

South Korea officially announced a second wave of infections in late June, after daily cases had declined to close to zero.

It began when an asymptomatic person partied across five nightclubs in the Itaewon area of Seoul the previous month, spreading the virus.

South Korea’s response has been based on meticulous contact tracing. It tracked down 46,000 people who had been in contact with anyone in the nightclubs and tested them all. In total 160 infections were found.

Alarm spread after a warehouse worker, in a workplace with 4000 other people, was confirmed as infected.

But 9000 of his co-workers, family members and contacts were identified and tested, halting the infections after a week.

While there was a localised shutdown of nightclubs in Seoul, the rest of the city was not locked down.

Contact tracing is organised by a team of 130 trained epidemiologists who were in place before COVID-19 emerged, with hundreds of others recruited during the crisis.

Health authorities interviewed anyone infected, and used mobile phone GPS data, CCTV footage and even credit card logs to track where they had been. Handing such sweeping surveillance powers to the state has caused serious privacy problems. There was a disgusting homophobic backlash after it was revealed that some of the nightclub infections took place in gay bars.

But South Korea’s approach has shown the primary importance of contact tracing in controlling the pandemic. After reaching a peak of 113 cases nationwide on 24 July, daily tallies were brought down to around 30 or 40 a day. But the country now faces another outbreak centred on the Sarang Jeil church, with cases again reaching around 300 a day.

A much larger outbreak in February, which reached a peak of 909 cases discovered in one day, was successfully contained.

Singapore was also initially successful in containing the virus. But it suffered a major outbreak in April amongst migrant workers. Exploitation and appalling living conditions were responsible.

Around 320,000 migrant workers in the city-state live crammed into overcrowded dormitories. Some were moved to alternative accommodation, but thousands were simply locked in under quarantine, much like the treatment of Melbourne’s public housing towers.

As in Melbourne, this should have been dealt with through rehousing people in safe, better quality housing, and providing adequate meals and medical care during quarantine.

But a systematic program of testing all the residents, and isolating those infected or in close contact with them, has been able to control the outbreak.

There has been a steady decline since the peak of 1426 cases on one day in April. Outside the quarantined dormitories there are now only one or two cases a day being found in the community.

Outbreaks

Parts of Europe, such as France and Spain, have also seen particularly severe “second waves”. But their situation is quite different to Australia’s. The virus was spreading out of control in much of Western Europe in March and April, until lockdowns slowed down transmission. The virus was never even close to being suppressed to manageable levels. At Spain’s lowest point it was still recording around 200 new cases a day. That meant infections just picked up again after the lockdown ended.

Adequate testing and tracing regimes able to keep the virus in check after the lockdown ended were not put in place.

The most any country can achieve is substantial suppression. There is no realistic prospect of eliminating the virus anywhere. New Zealand went 102 days without a case before the emergence of a cluster that has grown to nearly 100 people.

Vietnam went 99 days without cases, only to have a cluster emerge in the tourist city of Da Nang in late July. It has now produced more than 500 cases. Hong Kong, which was praised early on, now faces an outbreak triggered by exemptions authorities granted to hotel quarantining.

The reason there has been so much reliance on lockdowns globally is that most governments failed to properly prepare a public health response to the pandemic. Lockdowns are a last resort to try to limit community transmission.

Observing most social distancing measures is sensible. But the measures imposed by governments are always political. They have one rule for sports stadiums and another for protests for example.

And the experience so far shows that the main emphasis has to be on funding a health system capable of efficient testing and tracing to keep the virus under control.

By James Supple

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