For many Americans, imagining what might
have been will be painful. But especially now, at the milestone of 1 million
deaths in the United States, the nations that did a better job of keeping
people alive show what Americans could have done differently and what might
still need to change.
Many places provide insight: Japan, Kenya,
Norway. But Australia offers perhaps the sharpest comparisons with the American
experience. Both countries are English-speaking democracies with similar
demographic profiles. In Australia and in the United States, the median age is
38. Roughly 86% of Australians live in urban areas, compared with 83% of
Americans.
Yet Australia’s COVID death rate sits at
one-tenth of America’s, putting the nation of 25 million people (with around
7,500 deaths) near the top of global rankings in the protection of life.
Australia’s location in the distant Pacific
is often cited as the cause for its relative COVID success. That, however, does
not fully explain the difference in outcomes between the two countries, since
Australia has long been, like the United States, highly connected to the world
through trade, tourism and immigration. In 2019, 9.5 million international
tourists came to Australia. Sydney and Melbourne could just as easily have
become as overrun with COVID as New York or any other US city.
So what went right in Australia and wrong
in the United States?
For the standard slideshow presentation, it
looks obvious: Australia restricted travel and personal interaction until
vaccinations were widely available, then maximised vaccine uptake, prioritizing
people who were most vulnerable before gradually opening up the country again.
From one outbreak to another, there were
also some mistakes: breakdowns of protocol in nursing homes that led to
clusters of deaths; a vaccine rollout hampered by slow purchasing. And with
omicron and eased restrictions, deaths have increased.
But Australia’s COVID playbook produced
results because of something more easily felt than analysed at a news
conference. Dozens of interviews, along with survey data and scientific studies
from around the world, point to a lifesaving trait that Australians displayed
from the top of government to the hospital floor and that Americans have shown
they lack: trust, in science and institutions, but especially in one another.
When the pandemic began, 76% of Australians
said they trusted the health care system (compared with around 34% of
Americans), and 93% of Australians reported being able to get support in times
of crisis from people living outside their household.
In global surveys, Australians were more
likely than Americans to agree that “most people can be trusted” — a major
factor, researchers found, in getting people to change their behaviour for the
common good to combat COVID, by reducing their movements, wearing masks and
getting vaccinated. Partly because of that compliance, which kept the virus
more in check, Australia’s economy has grown faster than America’s through the
pandemic.
But of greater import, interpersonal trust
— a belief that others would do what was right not just for the individual but
for the community — saved lives. Trust mattered more than smoking prevalence,
health spending or form of government, a study of 177 countries in The Lancet
recently found. And in Australia, the process of turning trust into action
began early.
Government: Moving Quickly Behind the
Scenes
Greg Hunt had been Australia’s health
minister for a couple of years, after working as a lawyer and investor, when
his phone buzzed Jan. 20, 2020. It was Dr. Brendan Murphy, Australia’s chief
medical officer, and he wanted to talk about a new coronavirus in China.
Murphy, a low-key physician and former
hospital executive, said there were worrisome signs of human-to-human
transmission.
“What’s your honest, considered advice?”
Hunt recalled asking.
“I think this has the potential to go
beyond anything we’ve seen in our lifetime,” Murphy said. “We need to act
fast.”
The next day, Australia added the
coronavirus, as a threat with “pandemic potential,” to its biosecurity list,
officially setting in motion the country’s emergency response. Hunt briefed
Prime Minister Scott Morrison, visited the country’s stockpile of personal
protective equipment and began calling independent experts for guidance.
Sharon Lewin, director of the Peter Doherty
Institute for Infection and Immunity, one of Australia’s top medical research
organizations, received several of those calls. She fed his questions into the
meetings that had started to take place with scientists and officials at
Australia’s public health laboratories.
“There was a very thoughtful level of
engagement, with politicians and scientists, right at that early phase in
January,” Lewin said.
The first positive case appeared in
Australia on Jan. 25. Five days later, when the Centers for Disease Control and
Prevention confirmed the first human transmission of the virus in the United
States, President Donald Trump downplayed the risk. “We think it’s going to
have a very good ending for us,” he said.
The same day, Hunt struck a more practical
tone. “Border, isolation, surveillance and case-tracing mechanisms are already
in place in Australia,” he said.
Less than 24 hours later, on Feb. 1,
Australia closed its border with China, its largest trading partner. On Feb. 3,
241 Australians were evacuated from China and placed in government quarantine
for 14 days. While Americans were still gathering in large groups as if nothing
was wrong, Australia’s COVID containment system was up and running.
A full border closure followed. Hotels were
contracted to quarantine the trickle of international arrivals allowed in.
Systems for free testing and contact tracing were rolled out, along with a
federal program that paid COVID-affected employees so they would stay home.
For a business-friendly, conservative
government, agreeing to the COVID-containment measures required letting go of what
psychologists describe as “sticky priors” — long-standing beliefs tied to
identity that often hold people back from rational decision-making.
Morrison trusted his close friend Hunt. And
Hunt said he had faith in the calm assessments and credentials of Lewin and
Murphy.
In a lengthy interview, Hunt added that he
also had a historical moment of distrust in mind: Australia’s failures during
the 1918 flu pandemic, when inconsistent advice and a lack of information
sharing led to the rise of “snake oil” salesmen and wide disparities in death
rates.
In February and March, Hunt said, he retold
that story in meetings as a warning. And in a country where compulsory voting
has been suppressing polarization since 1924, Australia’s leaders chose to
avoid partisanship. The Morrison government, the opposition Labour Party and
state leaders from both parties lined up behind a “one voice” approach, with
medical officers out front.
Still, with a highly contagious virus,
scientists speaking from podiums could do only so much.
“Experts ‘getting on the same page’ only
matters if people actually trust the actions government is taking and trust
their neighbours,” said Dr Jay Varma, director of Cornell’s Center for Pandemic
Prevention and Response and a former COVID adviser to Mayor Bill de Blasio of
New York.
“While that type of trust is relatively
higher in New York City than in other parts of the US,” said Varma, who has
worked extensively in China and Southeast Asia, “I suspect it is still quite
low compared to Oceania.”
Health Care: Sharing the Burden
The outbreak that many Australians see as
their country’s greatest COVID test began in late June 2020, with a breakdown
in Melbourne’s hotel quarantine system. The virus spread into the city and its
suburbs from guards interacting with travellers, a government inquiry later
found, and within a few weeks, daily case numbers climbed into the hundreds.
At Royal Melbourne, a sprawling public
hospital built to serve the poor, clusters of infection emerged among
vulnerable patients and workers. Case numbers and close contacts spiralled
upward. Vaccines were still a distant dream.
“We recognized right away that this was a
disaster we’d never planned for, in that it was a marathon, not a sprint,” said
Chris Macisaac, Royal Melbourne’s director of intensive care.
A few weeks in, the system started to
buckle. In mid-July, dozens of patients with COVID were transferred from
nursing homes to Royal Park, a satellite facility for geriatric care and
rehabilitation. Soon, more than 40% of the cases among workers were connected
to that small campus.
Kirsty Buising, an infectious disease
consultant at the hospital, began to suspect — before scientists could prove it
— that the coronavirus was airborne. In mid-July, on her suggestion, Royal
Melbourne started giving N95 masks, which are more protective, to workers
exposed to COVID patients.
In the United States, hospital executives
were lining up third-party PPE vendors for clandestine meetings in distant
parking lots in a Darwinian all-against-all contest. Royal Melbourne’s supplies
came from federal and state stockpiles, with guidelines for how distribution
should be prioritized.
In New York, a city of 8 million people
packed closely together, more than 300 health care workers died from COVID by
the end of September, with huge disparities in outcomes for patients and
workers from one hospital to another, mostly according to wealth.
In Melbourne, a city of 5 million with a
dense inner core surrounded by suburbs, the masks, a greater separation of
patients and an intense 111-day lockdown that reduced demand on hospital
services brought the virus to heel. At Royal Melbourne, not a single worker
died during Australia’s worst institutional cluster to date.
In the US, coordination within the health
care system was haphazard. In Australia, which has a national health insurance
program and a hospital system that includes both public and private options,
there were agreements for load sharing and a transportation service for moving
patients. The hospitals worked together, trusting that payment would be worked
out.
“We had options,” Macisaac said.
Society: Complying and Caring
“I’d just hate to be the one who lets
everyone down.”
When Australians are asked why they
accepted the country’s many lockdowns, its once-closed international and state
borders, its quarantine rules and then its vaccine mandates for certain
professions or restaurants and large events, they tend to voice a version of
the same response: It’s not just about me.
The idea that one’s actions affect others
is not unique to Australia, and at times, the rules on COVID stirred up
outrage.
“It was a somewhat authoritarian approach,”
said Dr Greg Dore, an infectious diseases expert at the University of New South
Wales in Sydney. “There were lots of mandates, lots of fines for breaching
restrictions, pretty heavy-handed controlling, including measures that were
pretty useless, like the policing of outdoor masking.”
But, he added, the package was effective
because the vast majority of Australians stuck with it anyway.
“The community coming on board and
remaining on board through the tough periods of 2020 and even into 2021 was
really, really important,” Dore said. “There is a general sense that for some
things, where there are major threats, you just have to come together.”
Studies show that income inequality is
closely correlated with low levels of interpersonal trust. And in Australia,
the gap between rich and poor, while widening, is less severe than in the
United States.
During the toughest of COVID times,
Australians showed that the national trait of “mateship” — defined as the bond
between equal partners or close friends — was still alive and well. They saw
COVID spiral out of control in the United States and Britain, and chose a
different path.
Compliance rates with social distancing
guidelines, along with COVID testing, contact tracing and isolation, held
steady at around 90% during the worst early outbreaks, according to modelling
from the University of Sydney. In the United States, reductions in mobility — a
key measure of social distancing — were less stark, shorter and more
inconsistent, based in part on location, political identity or wealth.
In Australia, rule-following was the social
norm. It was Mick Fanning, a surfing superstar, who did not question the need
to stay with his American wife and infant in a small hotel room for 14 days of
quarantine after a trip to California. It was border officials cancelling the
visa of Novak Djokovic, the top male tennis player in the world, for failing to
follow a COVID vaccine mandate, leading to his eventual deportation.
It was also all the Australians who lined
up to get tested; who wore masks without question; who turned their phones into
virus trackers with check-in apps; who set up food services for the old, infirm
or poor in lockdowns; or who offered a place to stay to women who had been
trapped in their homes with abusive husbands.
At a recent awards luncheon in Melbourne
for people who made a difference during COVID, those were the kinds of people
being celebrated. Jodie McVernon, director of epidemiology at the Doherty
Institute, was the only scientist lauded at the event.
“Care is so undervalued,” she said. “This
was all about the power of care.”
And, perhaps, the power of adaptability.
When the delta variant flooded the country
last year as vaccine supplies were low, Australia’s ideas of protection and
compliance changed.
Hunt scrambled to procure vaccines — far
too late, critics argued, after the AstraZeneca vaccines made in Australia
seemed to pose a greater-than-expected risk of heart problems — while community
leaders fought against a moderate burst of fear and scepticism about vaccines.
Churches and mosques became pop-up COVID
inoculation clinics. Quinn On, a pharmacist in western Sydney’s working-class
suburbs, took on extra staff at his own cost to get more people vaccinated.
Mayor Chagai, a basketball coach in Sydney’s South Sudanese community, hosted
Zoom calls with refugee families to answer questions about lockdowns and
vaccines.
Many Aboriginal Australians, who have
countless reasons to distrust authorities, also did what they could to get
people inoculated. Wayne Webb, 64, a Wadandi elder in Western Australia, was
one of many to prioritize a collective appeal.
“It all goes hand in hand with protecting
our old people,” he said he told the young men in his community.
Vaccination uptake in Australia surged last
year as soon as supplies arrived, rushing from roughly 10% of Australians over
age 16 to 80% in six weeks. It was the fastest rate in the world at the time.
Once that 80% was reached, Australia eased open its national and state borders.
Now, more than 95% of Australian adults are
fully vaccinated — with 85% of the total population having received two doses.
In the United States, that figure is only 66%.
The arrival of the omicron variant, which
is more transmissible, has sent Australia’s case numbers soaring, but with most
of the population inoculated, deaths are ticking up more slowly. Australia has
a federal election Saturday. COVID is far down the list of voter concerns.
“We learned that we can come together very
quickly,” said Denise Heinjus, Royal Melbourne’s executive director for
nursing, whose title in 2020 was COVID commander. “There’s a high level of
trust among our people.”
© 2022 The New York Times Company
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