Three worlds

I was saddened, but not surprised, to hear the Qantas CEO say that he did not expect international travel to resume from and to Australia until after June 2021.  Saddened, because Julie and I were hoping our postponed six month hike on the Continental Divide Trail in the US would happen next year.  Not surprised, because I don't see how the COVID-19 pandemic can be contained until a vaccine is available and vast populations have been innoculated.

Early morning swimmers at Terrigal this morning (courtesy Julie)

Australia, along with countries such as New Zealand, Taiwan, South Korea, Vietnam and China, seem to have a very good chance of suppressing the virus to very low levels, with occasional quickly-addressed hotspot outbreaks.  But most other countries in the world seem unlikely to be as successful.  I'm thinking of those located in Europe, the Americas, Asia (with the exception of those listed above) and Africa.  I think the more developed countries in this latter group are going decide to live with a level of coronavirus so long as their hospital systems are not overwhelmed, and reopen their borders to international travellers.

Italy (averaging 224 new identified cases per day), for example, is already allowing international travel, without quarantine, from many countries where the virus is still widespread, such as the UK (still averaging 1,000 new identified cases per day).

The Haven at dawn this morning (courtesy Julie)

Until a vaccine is available and deployed, I can envisage the world evolving into three groupings within each of which quarantine-free international travel will be allowed.  The "suppressed" group, where there is little or no COVID-19 present, the "managed" group, where there is significant COVID-19, but there are effective control efforts and the hospitals are coping, and an "uncontrolled" group, where COVID-19 is everywhere and facilities are stretched.  There will be limited quarantined travel between the groups.

This will pose a test for the Australian authorities.  Do they want to participate in the wider business and recreation travel recovery promised by membership of the "managed" group, or do they want to retain their purity by participating in a much smaller grouping?  I suspect Australia will stick with the "suppressed" group, but the pressure is going to build to join the "managed" group as time goes by and we see travel in much of the rest of the developed world resume.

This conundrum is not dissimilar, in relative terms, to that faced by the Australian states where there is currently no community transmission of the virus.  Do they want to remain in the "eradicated" group, and keep their borders closed, or do they want to enjoy the economic benefits of joining the "suppressed" group of States?

I endured another 30 minutes on the bike trainer for exercise today, still feeling like I'm on an improving injury trend, but not getting carried away.

Testing! Testing!

Donald Trump has prevaricated about whether he suggested the US authorities do less testing for COVID-19.  His rationale appears to be that the less testing you do, the fewer COVID-19 cases you find, and the better you look, both internationally and domestically.  Fortunately, there is no indication the rate of testing has declined.  Widespread testing, as has been demonstrated in other countries, is key to containing the virus.

International Comparison of Positivity Rates and Tests Per Capita (Source: John Hopkins University)

The US has been doing more testing than anyone else in the world, as Trump claims, although that is only on an aggregate basis.  When you adjust for population, the US is not such a standout, though on a marginal basis (last seven days), it still ranks highly.  Of course, some countries that have brought the virus under control, aren't doing as much testing because they don't need to.

The problem for the US is that since the start of the pandemic it also ranks very highly in the number of tests that prove positive (13.86 per thousand), only beaten by the likes of Brazil, Peru, Qatar, Chile, Mexico, Nigeria, Pakistan and Sweden.  Countries like South Korea, Australia, New Zealand and Taiwan have a positive test rate of around 1.0 per thousand or less.

Reducing the number of tests in the US, as Trump would like, won't reduce the number of hospitalisations or deaths due to COVID-19 in the short-term, and almost certainly will increase deaths and hospitalisations in the future as the virus spreads uncontained.

My exercise for today was another 30 minutes on the bike trainer.  My hip injury felt a little better and walking around today has been less painful, so I'm becoming more optimistic.

Federal leadership needed

Crackneck pre-dawn this morning (courtesy Julie)

In Australia, both the Federal and State leaders have done well to this point in managing the COVID-19 pandemic.  There are exceptions and occasional slip-ups, but the two levels of government have worked well together to make management of the pandemic in Australia a global success story ...... thus far.

The arrangement has seen the Federal government leave the States to formulate and manage their own social-distancing restrictions, including tolerating the closing of State borders.  However, there is now a need for the Federal government to provide some firm leadership.  It should to use its substantial levers of power to open the internal Australian borders and drive a national policy for dealing with COVID-19 hotspots as they arise.

Dawn at The Haven this morning (courtesy Julie)

We currently have a hotchpotch of State approaches.  Three States (Northern Territory, Victoria and New South Wales) have no restrictions on visitors from other States, three States (Queensland, Western Australia, Tasmania) ban visitors from all other States, and one State (South Australia) allows visitors from some States.  This is compounded by "advice" from New South Wales not to travel to, or accept visitors from, Melbourne, and "advice" from Victoria for residents of hotspot LGAs not to leave their area.

Early morning swimmers at Terrigal (courtesy Julie)

It should be possible to come up with a set of nationally implemented criteria for defining hotspot LGAs and the actions to be taken in response.  This would recognise that the great majority of the country is virus-free and allow residents of those areas to more quickly resume normal economic intercourse with the rest of the country.  State borders are too arbitrary a tool to manage COVID-19 hotspots now the virus is largely under control, and it seems the decision to keep borders closed has become very political in some States.  The Federal government taking control would provide cover for State leaders to open their borders despite it being politically unpopular.

For exercise, I rode for 30 minutes on the bike trainer this morning.  There were a few sharp twinges in the hip initially, but when warmed up, the pain was very low-level.  I remain optimistic about coping with the demands of everyday biking when we leave next week, and will have those anti-inflammatories for backup.

The new normal

Tuggerah Lake this morning

With respect to COVID-19, South Korea and Australia have much in common.  Both have the benefit of being islands (discounting the closed land border between North and South Korea), and both have similar per capita case and death rates.  Both have relatively compliant populations, good testing and tracing capacity, and excellent health systems.

COVID-19 surfaced about 20 days earlier in South Korea so it might be a good short-term predictor of what will happen in Australia.  If that is the case, then we should get used to what is currently happening in Melbourne where virus hotspots are causing such angst.

The Entrance this morning

In South Korea, with double Australia's population, an average of between 40 and 50 new cases of the virus have been identified each day during June, predominantly in Seoul, the capital.  The South Korean authorities are fearful that they may lose control of the virus and are contemplating reimposing regional restrictions if the number of new cases does not decline in the next few days.

All of this sounds very similar to what is happening in Melbourne, where new cases have been averaging between 10 and 20 in June with a recent uptick.

I am skeptical that either Australia or South Korea can eliminate the virus.  The new normal will be an underlying base of community transmission, identified hotspots and temporarily-tightened regional restrictions in both countries.

For my exercise today, I took my touring bike out for an hour and a half to see how the hip flexor coped with real biking, as opposed to the trainer.  There was pain there, but it was low level and easily tolerable.  Not that different from when I took some long bike rides a month or so ago, so I'm feeling a little more optimistic that my body will cope with our looming bike adventure.  Nine days to go, assuming the Queensland government does the right thing and announces this weekend that they will open their borders on 10 July.

Earlier than we thought

Italy's National Institute of Health recently announced that analysis of sewage water sampled on 18 December 2019 showed traces of the COVID-19 virus.  That was two months before the first identified cases of the virus in Italy and about the same time virus cases were first identified in Wuhan in China.

Crowds on the Terrigal beach this wintry afternoon

These findings are consistent with analysis from Spain showing genetic virus traces in their sewage from mid-January, 40 days before their first identified case, and findings in Washington state in the US that two patients who had COVID-19 symptoms in December 2019, but were not identified as virus cases, were later found to have COVID-19 antibodies in their systems.

None of these instances is proof that the current pandemic cases in those countries was sourced from those early cases, but it is fairly conclusive evidence that the virus was around months before the authorities knew of its existence.

It would be interesting to see historic analysis of sewage for Wuhan to determine how long it was before the Chinese first recognised that there was a new virus circulating.  I suspect it was months.  There may have been a subsequent Chinese cover-up, but given the virus was present in other countries months before it was identified as such, I think it is safe to assume that it also took the Chinese some time to realise what they were dealing with, by which time the virus had taken hold.

I did a 30-minute session on the bike trainer this morning without much hip flexor pain.  Later, I limped around the block feeling very sore.  Walking clearly causes more pain than cycling.  During that limp, I filled a prescription for anti-inflammatories that was given to me by my GP prior to our aborted Continental Divide Trail hike.  I'm not going to start taking them yet, because the discomfort is tolerable, but will take them when we start the cycling trip if I really need them.

I used many kinds anti-inflammatories during my running prime with mixed results.  I have come to the view that inflammation is the body's way of repairing injuries and that anti-inflammatories may slow that healing process.  I also know, from bitter experience, the pain-masking attributes of anti-inflammatories can entice you to cause more damage to the injured tissue.  Better to feel the pain and know how you are going, unless it is intolerable and there are things that must be done.

Re-evaluating

Crackneck at dawn this morning

As predicted in yesterday's post, Victoria is re-evaluating its COVID-19 restrictions.  It's possible that this move heralds the end of Australia's exceptionalism with respect to the virus.  Australians (including me) were beginning to think that, with closed international borders, there was a chance we could eliminate the virus in Australia as has been done in New Zealand.  We were looking at the rest of the world's efforts with a mix of scorn and triumphalism, perhaps prematurely.

With Victorian mid-year school vacations starting at the end of next week, many Victorian residents will be seizing the opportunity to travel to warmer climes.  They will not be allowed into Queensland, but they can come to New South Wales.  It's unlikely that those who feel unwell will cancel their trips, and of course, cases may be asymptomatic.  The sources in 21 of the new cases identified in the last week in Victoria have not been identified, making it highly likely that there are other unidentified cases in the community.

It's not hard to envisage a situation where these unidentified cases infect people in New South Wales, and that over the course of the next month, the latter travel to other states as borders open.  Within three months, there could be much wider community transmission.  Australia's contact-tracing is very good, and it's unlikely that the virus cases will escalate rapidly, but I wouldn't be surprised if Australia has to be become accustomed to scores of daily cases of community transmission and occasional deaths.  The hospital system will not be overrun, but large gatherings will continue to be prohibited.  States will be tempted to keep their borders closed, but the Federal government has already indicated it will join the legal case to challenge the closed borders on constitutional grounds, so I think they will reopen in July as mooted.

I have been forced to re-evaluate my returning to fitness strategy.  After yesterday's 6.5km walk/jog, my hip flexor injury was quite sore all day.  I decided to modify my planned run/jog of 11km today to just a walk, but after only 500m, I decided that too was unwise.  My hip was sore and it seemed likely to be sorer by the end of my walk.  I returned home and tested the hip with 30 minutes of cycling on my trainer.  It wasn't too bad.  The most important fitness goal now is to be bike-capable by 2 July when we will leave on our big bike adventure, so I will likely abandon my plan to step up my walking/jogging distances by one kilometre every two days.  Very disappointing. 

Instead, I will now focus on getting as much exercise as I can each day compatible with the hip improving and being able to ride the bike.  Running a 50th anniversary marathon on 22 August is now looking even more unlikely.

Second wave?

Terrigal lagoon this morning

The number of cases of community transmission of COVID-19 in Victoria has tripled this week compared to last week.  The number of cases is still low, 21 this week compared to 6 last week, but are still a matter for concern.  The authorities aren't yet willing to reimpose restrictions, or delay the planned easing of restrictions, but have said it will happen if numbers continue to rise.  We returned from a short vacation in Victoria this week and Julie received an SMS from her employer asking her not to come into work if she was exhibiting any virus symptoms!  A demonstration of the concern the surge is creating.

Terrigal sunrise this morning

Although not directly comparable, Beijing has also seen a spike with 183 new cases of the virus in the past week.  In contrast to Victoria, these cases all seem to derive from a single source, a wholesale market, where the Chinese suggest the virus may have been imported with Europe products (however this has not been scientifically proven yet).  The Beijing authorities claim the outbreak has now been contained, but doing that required the suspension of public transport, the closing of schools, the delay of planned restriction easing and the testing of 360,000 people.  Melbourne may yet have to follow suit.

The best example of what a second wave of infections would look like comes from Iran (see chart).  They were one of the earliest countries to be hit by the pandemic, and eventually seemed to get it under control, but since then, with the easing of restrictions, has come a severe second wave that is still growing.

I walked and jogged 6.5km this morning, with the damaged hip flexor causing some pain the whole way.  It's not real bad, but definitely impacting my movement and enjoyment.  Given it is only 12 days until we head off on our bike adventure, and I'm keen to improve my general fitness before then, I'll persevere.  Once on the bike ride, I'm hoping the injury will get a chance to repair.  I followed my walk/jog with 30 minutes on the bike trainer.  It's toughening my butt up, if nothing else.