It’s being dubbed Australia’s coronavirus success story — open businesses, (mostly) open borders, and slow infection growth.
Prime Minister Scott Morrison yesterday described NSW’s test-and-trace strategy as the “gold standard” in COVID-19 suppression.
With several states at odds about how best to manage the pandemic, the Federal Government has made it clear it believes authorities in Sydney have developed the most sustainable model.
“New South Wales is the gold standard. That is where we have to get everybody to to ensure that Australia can be open,” Mr Morrison said.
So what’s been the recipe for success in Australia’s most populous state?
The situation right now
To date NSW has recorded almost 4,000 COVID-19 cases and the state’s infection rate is 1.3 per 100,000 people according to last month’s data.
The number of overseas-acquired cases still outweighs local transmission in the state.
NSW had success in controlling the first wave of COVID-19, however over recent weeks there has been an increase in cases.
Here’s how NSW restrictions compare to the rest of the country:
- In NSW capacity limits in gyms, restaurants and other indoor businesses are calculated to allow one person for every four square metres of space. In SA and WA it’s a two-square-metre-rule.
- In NSW up to 20 visitors may visit another household. It’s 30 people in QLD (or 10 in a restricted suburb), 50 people in SA, and in WA there is no maximum number.
- NSW is open to all other states except for Victoria. QLD is closed to NSW, Victoria and the ACT, while SA is closed to NSW and Victoria, and WA has a hard border closure.
How has NSW kept on top of COVID-19?
NSW had all the ingredients for a second wave like Victoria, but there were some key differences.
Brendan Murphy, secretary of the Department of Health and former chief medical officer, said NSW had preparedness on its side.
“They’ve had a proud history of many, many years of advanced investment in public health … they’ve had embedded public health units in all their local health districts,” he said.
“They’ve had very good outbreak response teams. They’ve got a large group of people.”
Leading infectious disease expert Raina MacIntyre from the Kirby Institute said while NSW was investing in its health system over the last 20 years, Victoria had been stripping its system bare.
“When it comes to public health infrastructure and resources per head of population, Victoria is much worse off than any other state in Australia,” she said.
“Victoria is just a shell of a system, it’s just been decimated, and that’s fine in the good times, you can get by on a minimal model, but when there’s a pandemic all those weaknesses are exposed.
Professor MacIntyre said NSW had a far better resourced, integrated and accountable health system which had flexed its muscles in this pandemic.
Since 2012, the NSW Government has boosted the nursing and midwifery workforce by more than 18 per cent and the number of doctors by 35 per cent. It’s also invested $10 billion in health infrastructure since 2011.
Epidemiologist Catherine Bennett from Deakin University, who has previously conducted disease outbreak work in NSW, said it was a clear case of resourcing leads to responsiveness.
She also said NSW’s decentralised health system of 15 local districts paved the way for better management of the virus in every pocket of Sydney and wider NSW.
“It means when you’re working in you own area, you know the people, you know the situation … you can you use local intel and local relationships to get results.”
Better contact tracing?
NSW Chief Health Officer Kerry Chant has long credited the state’s contact tracing team with keeping a lid on widespread community transmission.
The team of more than 300 people make over 2,000 calls a day to determine an infected person’s hourly movements and who they potentially exposed.
Dr Chant said the disease detectives worked creatively to connect the dots.
“We use lots of strategies that might help jog [a patient’s] memory. This often includes photos, phone calendars, appointments and receipts,” she said.
This has been the saving grace, according to Professor Bennett.
“It’s not just being fast but it’s also that extra ring of context.”
Professor Bennett also lauded NSW’s use of so-called “case control studies”.
This is about much more than looking at a list of people who ate at the same restaurant, it’s about understanding why some people get infected and others don’t.
“They do a more drilldown investigation … even if we don’t know exactly where they got the virus, they look at behaviours to see what can be learnt,” she said.
A spokesperson for NSW Health said significant investment had been made in case surveillance and the health force would be further boosted with 8,300 more frontline staff over the next four years.
But could it have all been very different?
The advantages of the NSW health system aside, Professor MacIntyre said this was no time to be patting anyone on the back.
She said NSW had kept up with contact tracing because it had a small daily number of cases for the past few months. But if that number spiked, the system wouldn’t hold up.
“It’s all about the volume of cases you’ve got to trace … not even the best resourced system will be able to keep up with contact tracing by writing contacts on a whiteboard and doing it manually, which is essentially what’s been done everywhere, including NSW,” she said.
Professor MacIntyre, who recently gave evidence at the COVID-19 Senate inquiry, said if NSW also had an infection surge like Victoria, authorities wouldn’t necessarily be better placed to curb it.
She believes Australia needed to “get with the picture” and invest in digital contact tracing technologies to avoid overwhelming the “old-fashioned” manual system.
Professor Bennett agrees that NSW could easily be living under stage four lockdown restrictions like Victoria right now.
“But NSW had a heads up and could get ahead.”