It’s easy to get desensitised to the numbers during a pandemic. Even as an epidemiologist, whose bread and butter is dealing in numbers, I’ve had to stop myself every so often during the last year and make a deliberate effort to gain perspective on the scale of it all. I’ve needed to remind myself that these are not just numbers of infections and deaths that we are hearing about every day, these are people’s lives. It’s easy to forget that behind every number is a person, and behind every person is family.
I think we need to remember this as we try and make sense of the scale of the humanitarian disaster in India. With more than 300,000 cases a day and over 2,000 deaths for five straight days, the figures are almost impossible to get your head around. The true number of cases per day may be up to 10 times higher than this, so we’re potentially talking about millions of cases. And the number of deaths is almost certainly underreported, but by exactly how much is anyone’s guess. And it’s only going to get worse, much worse, with the peak potentially being many weeks away.
Why we’re seeing this level of disease transmission in India is not a question with an easy answer, and no doubt there are many factors that have contributed to this. Whatever the reasons, what we need focus on as a global community is, however, how we can help.
A significant amount of much needed resources are being committed to India right now from many countries around the world, including from Australia. It highlights that no one is underestimating the magnitude of this disaster, and countries are prepared to assist, despite the considerable challenges many of them are facing at home. The willingness to help also reflects the knowledge that what is happening in India has significant implications in terms of controlling transmission globally. Unless we bring transmission under control in all countries, particularly one with 1.3 billion people, we will never overcome the pandemic.
Australia has a number of difficult issues to grapple with during this emerging crisis. The most challenging issue concerns our responsibility to the approximately 9,000 Australians who are in India and want to come home. When considering these individuals it’s important to remember a couple of things. First, these are fellow citizens, who mostly through no fault of their own have found themselves trapped. Second, we are not a few months into this pandemic, we are more than a year into it. That we haven’t been able to bring those back who have wanted to come back from any country, let alone one in which their very safety is now threatened, isn’t something that should rest easy with any of us.
No one should understate that this is a difficult issue. There are competing obligations to protect what we have fought so hard for in Australia and the obligation to look after our own citizens wherever they may be and whatever circumstances they find themselves in. Given the very real threat to the health of those who are trapped in India, this is very much a moral issue. This complex problem can be boiled down to one fundamental question: how much risk are we willing to tolerate as a community to look after Australians who are in need and stranded in India? With the temporary block on travel from India, announced by prime minister Scott Morrison on Tuesday, it seems this answer is that we are not willing to tolerate any risk, at least until 15 May, when the decision will be reviewed.
The suitability or not of Australia’s existing quarantine arrangements, and in particular hotel quarantine, is at the heart of this dilemma. If we truly had confidence in hotel quarantine, this would not be an issue. If we all felt confident that we could bring Australians back with little risk of virus escaping into the community, then we would simply bring people back as quickly as we could, regardless of other considerations.
Notwithstanding the concession that no one can expect perfection in hotel quarantine – or any other system of quarantine, for that matter – the reality is that we clearly don’t have enough faith in the current system. Whether this lack of faith is justified is confusing, depending on who you listen to. The contrasting opinions reflect the messiness of this whole situation and the muddled relationship between state and federal governments in managing this system.
Federally, one feels there is a hope that this problem will go away with the rollout of the vaccine. As vulnerable groups are immunised and vaccine coverage of the population increases, the implications of escapes from quarantine are much reduced. But of course we all know the vaccine is taking longer to deliver than we had hoped, and along with supply issues, vaccine hesitancy and the effectiveness of vaccines to new variants there are going to be a number of bumps along the way to achieving sufficient vaccine coverage of the population to impact on the level of threat the virus poses to the population.
So with all this considered, it may be time to think about the long game here. While doing everything we can to prevent future escapes from hotel quarantine – which we are going to have to rely on for some time to come, regardless of future decisions – it may be the time, as many are calling for, to invest in the future and set up purpose-built quarantine centres that can cope with higher volumes of people coming from severely-affected countries. There is only one thing for sure here in a world of uncertainty that we all living in, and that is that this pandemic is going to be with us for a while yet, and that it’s not the last pandemic we will face.
Hassan Vally is an epidemiologist and associate professor in public health at La Trobe University, Melbourne