Tag Archive for: Coronavirus

New systems needed to stop the spread of the next pandemic

An unprecedented threat demands an unprecedented response. Rarely, if ever, have governments had to shift into crisis-management mode as quickly as they have in the past few weeks. So far, the focus has been on the most immediate medical, political and economic issues raised by the Covid-19 pandemic—as it should be. But gradually, governments’ attention will have to turn to the longer-term consequences of the crisis, and to the need to prevent such disasters in the future.

There have been several severe global health threats in the past two decades. The epidemics of SARS in 2003, MERS in 2012 and Ebola in 2014–16 are just three examples of outbreaks that required a sustained multilateral response. Each episode had its own unique features, but the lessons from all three are similar. Epidemics and the emergence of new diseases become more likely as a result of population growth, urbanisation, deforestation, and production and distribution processes that crowd together many different species. And the expansion of global supply chains and international commerce, not to mention the growth in international air travel, enables contagious diseases to spread around the world more quickly than ever.

Just in the past decade, the World Health Organization has had to declare a health emergency no fewer than six times. Clearly, we haven’t taken the steps needed to meet new outbreaks with the kind of rapid, decisive action that could have prevented the coronavirus epidemic from spiralling out of control.

It’s worth remembering that when SARS (which was also caused by a coronavirus) emerged in southern China in late 2002, the outbreak was covered up for more than a month before the Chinese authorities acknowledged the seriousness of the threat. Likewise, in the early days of the Covid-19 outbreak, police in Wuhan actually silenced medical professionals who tried to raise the alarm, and massive public gatherings were permitted well after the danger of the outbreak had become obvious.

According to one recent study, if Chinese authorities had openly acknowledged the threat and responded properly just three weeks earlier than they did, the spread of Covid-19 could have been reduced by as much as 95%. Because local negligence, ignorance and censorship prevailed at the critical moment, the entire world is now paying an enormous price.

While the WHO has undoubtedly played an important role in combating global health threats over the years, it, too, has faced criticism for being overly bureaucratic and slow to respond. Indeed, during the Ebola crisis, it was the United States, not the WHO, that stepped in to prevent a wider disaster.

In any case, even if the WHO’s performance this time turns out to have been impeccable, it is already obvious that we need a much stronger global mechanism to deal with the threat of pandemics. Stumbling from one crisis to another simply isn’t an option. Covid-19 is the worst pandemic since the outbreak of so-called Spanish flu in 1918, and there’s no reason to believe that the next one won’t be even worse.

Among other things, a new global institution would need to have the authority and the means to intervene as intrusively as necessary to stop a contagious outbreak in its tracks. Reaching an agreement on such a mechanism will not be politically easy, but it is clearly needed to prevent petty diplomatic disputes from hampering global pandemic response efforts.

In the current crisis, even after it was obvious that Covid-19 would reach the level of a pandemic, China still has seen fit to bar Taiwan from global discussions on how to respond. Similarly, the US has continued to pummel Iran with sanctions, making it harder for that government to manage the epidemic within its own borders.

This behaviour is simply unacceptable from a humanitarian as well as a macroeconomic perspective. What would happen if the next highly contagious novel virus emerges in Taiwan or Iran? If there are unnecessary hurdles blocking an immediate response, we’ll be right back where we are now.

Under the current framework, the duty to report new contagious threats to international authorities like the WHO rests with national governments. One critical reform, then, would be to extend that duty to medical and public-health personnel at all levels—that is, from states to individuals. In addition to reducing the time it takes for a multilateral response to shift into gear, adopting a universal ‘responsibility to report’ would make it more difficult for local or national authorities to suppress information they consider inconvenient.

With national borders being closed in response to the Covid-19 crisis, some commentators are already arguing that the era of globalisation is over. But the trends in population growth and urbanisation will continue, and viruses will not suddenly start carrying passports or observing national borders. In the past decade alone, viral threats to global stability and prosperity have emerged from China, West Africa and Saudi Arabia, which suggests that the next one could originate just about anywhere.

Now is the time for the world to come together and agree on a new, more effective early warning and response system. This pandemic was avoidable. There can be no excuse for not doing everything in our power to prevent the next one.

Australia would be better placed to deal with coronavirus if governments had acted on hospital advice

To look forward, without unseemly guesswork, requires an element of looking back. I am not a virologist or epidemiologist; my 38 years in specialist medical practice was as a consultant general physician and diagnostician.

Twice in my medical career I have had special cause to worry about catastrophic medical emergencies.

The first time was in 1970 when I was caring for influenza patients in the intensive care unit of Tamworth Base Hospital; the Hong Kong flu epidemic had moved from the big cities to the rural arena. Despite the excellent care (including ventilator assistance) they received from senior and highly qualified critical care physicians, I watched otherwise fit young adults go from healthy to dead in around four days.

The second occasion was in July 2005. At the time I was the chair of medicine at Sydney Hospital, the only hospital inside the Sydney central business district. London had just suffered a catastrophic four-site terrorist bombing. Thanks to the preparedness developed during the years of the Irish Republican Army terror events, the response by UK doctors, nurses and all emergency services was nothing short of amazing.

I was a doctor at Sydney Hospital in February 1978 when Sydney experienced the Hilton Hotel bombing. I saw first-hand how important it was for the survival of the victims that they could reach a hospital with excellent trauma surgeons and a superb ICU in under 10 minutes. All the victims who hadn’t succumbed to instantaneous death at the blast scene went on to recover fully at the hospital. At least four required major emergency surgery immediately on arrival.

From the mid-1980s onwards, successive NSW governments decided to carve up Sydney Hospital’s funding and clinical activity in order to ‘send beds to the west’. The hospital’s doctors protested the action, but were immediately painted as being motivated by nothing but self-interest. The political decisions were reprehensible, for they caused the elimination of Australia’s first coronary care unit, intensive care unit, renal unit, melanoma unit, colo-rectal unit and biorheology unit, to name just a few.

Following the 2005 London bombings, my colleagues and I at Sydney Hospital (at this stage downgraded to just 100 beds and no ICU) reflected on how Sydney could have responded to a four-site terrorist bombing, let’s say in the Wynyard tunnel, on the Sydney Harbour Bridge, at the Sydney Opera House and in a significant business building on Martin Place. The answer was, shamefully, that it couldn’t respond, and countless unnecessary lives would be lost.

And to add to the madness, NSW Health demanded, just three months after the London bombings, that Sydney Hospital retrench all its general surgeons and trauma surgeons. What were all these people thinking?

With that as background, a restorative proposal for Sydney Hospital to resume its earlier function as the Sydney CBD’s prime emergency hospital was instigated in October 2005. I was asked to promulgate the proposal to the political, health and emergency services leaders in the federal and state arenas. The proposal centred on redeveloping the hospital so that it could pioneer the concept of becoming a national security hospital. The expectation was that each of Australia’s capital cities could then redefine one of its CBD hospitals to do likewise.

The proposal emphasised the need for a specially resourced CBD-located hospital that could be reached within minutes and would be able to handle the first wave or waves of victims of any catastrophic event.

The national security hospital would obviously include the ability to skilfully triage the victims and optimise their transfer to any available hospitals outside the CBD. From the start, it was emphasised that the anticipated catastrophic events could include terrorist attacks, viral pandemics, earthquakes, major fires, tsunamis and the like.

Between December 2005 and March 2019, the proposal was discussed in detail with over 40 Australian and NSW political, health and emergency services leaders, including several federal and state ministers for health. And what happened? Nothing.

We have all been let down massively, especially by those health bureaucrats in whom Australians have over the last four decades placed their trust and faith. It is little wonder that today’s politicians and health advisers are struggling; they have had to start well behind the eight ball.

Had the federal and state governments over the last 15 years heeded the advice they were being given, Australia would already have an established national security hospital in every capital city’s CBD. The staff of those hospitals would have already received special training in managing catastrophic health emergencies, including viral pandemics, and would have been able to provide much earlier and more definitive advice to government on how best to limit the emergence of the Covid-19 pandemic in Australia.

The hard work being carried out now by Prime Minister Scott Morrison, Health Minister Greg Hunt, Chief Medical Officer Brendan Murphy and their state and territory counterparts is commendable and all Australians must support them.

In times of military warfare we can’t expect governments to tell citizens all the facts, as doing so could well help our adversaries. But in a war against a virus, there’s nothing to be gained by not telling the citizens all the facts; viruses don’t have ears.

Over my career as a doctor, I found that people can cope with anything, as long as they’re told the truth and the whole truth. Anything less simply breeds distrust, and distrust in the management of the current pandemic will only lead to non-compliance. Governments cannot afford that.

And once the Covid-19 pandemic has dissipated, it will be important for all governments in Australia to learn some worthy lessons so that any future catastrophic events can be more readily handled.

Two obvious initiatives will be the development of a national security hospital within the CBD of each capital city and an increase in spending on health from the current level of about 10% of GDP to about 14% (a figure more in line with the spending on health in the United States). Such an increase in health expenditure will enable increased resilience of Australia’s health system both in cities and in rural towns. An ageing population will present its own difficulties, but catastrophes mandate a total rethink.

More of what we have had to settle for in recent decades is not an option. There is nothing more certain than that there will be more catastrophes in the decades ahead. Being prepared might be expensive, but it is the only option if we want Australia to become more resilient.

The vicious cycle of pandemic-induced panic

The frenzy outside a local butcher’s shop was electric, as sharp-elbowed women forced their way through the door, where dozens were already packed to the counter thrusting their purses, seeking the butcher’s attention. One pushed her way out of the shop in disgust, swearing there was ‘no bloody mince, they’ve sold out’.

While shoppers are rushing to buy before it’s too late—whether that’s toilet rolls, tins of tomatoes, mince or slabs of beer—investors are rushing to sell.

The Germans have a word for it: torschlusspanik, which translates as ‘door-shut panic’—literally the panic to get through the door before it slams shut. It dates from the Middle Ages when peasants were fearful of being locked out in the unprotected wilds as the city gates closed at nightfall. If you don’t act now, you might not get the chance again.

It is also happening in the share market. Selling may seem rational; no one knows what will happen to the domestic and global economies beyond the certainty that corporate earnings will collapse.

Shares had hit record levels in February in anticipation of a healthy year of profit growth ahead. The S&P/ASX200 has dropped by around 40% since then, and any reasonable guess is putting the fall in profits over the year ahead far beyond that. But the same psychology is at work as investors seek to sell before it’s too late.

The closure of the ASX trading floors in 1990 means there’s no longer the palpable hysteria of the 1987 share crash (or the scene at the local butcher shop), but the lurches downwards in share markets show that the same herd behaviour is at work.

Economist Justin Wolfers at the University of Michigan explains the market for toilet paper rolls in terms of game theory. There are two states in which that market is balanced, or in equilibrium.

There’s the normal state, when everyone believes there will be enough toilet rolls. No one stockpiles, and their belief is confirmed with well-stacked supermarket shelves.

And then there are panicked times, when everyone fears shortages, which leads them to stockpile, which creates shortages. ‘You run to get toilet paper not because you think society is about to crumble, but because you fear that others fear this. Fear of a run on toilet paper—like a run on banks—is enough to create an actual run.’

Wolfers says the answer in a run on the banks is for the government to insure the bank by having the central bank act as lender of last resort so that the bank has enough cash on hand to meet all requests for withdrawals. Even if everyone else is running to the bank to withdraw their savings, you don’t have to beat them.

He, perhaps flippantly, suggests a government strategic reserve of toilet paper. The alternative, as practised now by Australian supermarkets, is rationing.

For share markets, however, there’s no public institution at the ready to assure investors that they won’t make even greater losses if they don’t sell out now. Globally, investors are pulling their money out of the share market and putting it into government bonds in the belief that governments—possessed of taxing powers—are much less likely to go broke than businesses.

The logic of market crashes was spelled out by the late US economist Charles Kindleberger, whose classic 1978 book, Manias, panics and crashes, argued that economies were inherently unstable and subject to periodic booms and busts. He argued there was usually a catalyst for a crash.

‘The specific signal that precipitates the crisis may be the failure of a bank or of a firm, the revelation of a swindle or defalcation by an investor who sought to escape distress by dishonest means, or a sharp fall in the price of a security or a commodity.’ This time, of course, it is a pandemic. He continues:

‘The rush is on—prices decline and bankruptcies increase. Liquidation sometimes is orderly but may degenerate into panic as the realization spreads that only a relatively few investors can sell while prices remain not far below their peak values.’

He argues the downturn is self-reinforcing. Asset prices decline, reducing the value of any collateral against which banks have lent, leading them to call in loans and to refuse to advance fresh ones. Households sell shares and firms postpone borrowing and investment, leading to further declines in the value of collateral until firms start failing.

The emergency economic packages being rolled out by governments around the world are intended to sever this vicious circle by encouraging banks to keep rolling over business debts and providing more funds as required. But no bank will lend to a business that is fundamentally insolvent. In a crisis, ‘bankers lend money only to those that do not need it’, Kindleberger comments.

If it were simply a matter of keeping businesses alive until the pandemic passes, one could expect economies to bounce back at the end of it all as the queues reform outside the coffee carts and the footie resumes. The worry is that zones of excessive indebtedness will be exposed and that what begins as a health crisis becomes a financial crisis.

Introducing coronavirus health response teams would save lives

The coronavirus sweeping Australia and the rest of the world will reshape our ways of life for many months, if not years. It has already changed what we can do, who we can spend time with, and where we can and can’t go. It’s a scary time for many Australians, thousands of whom have already lost or will lose their jobs, and for the elderly and the ill, who are particularly vulnerable in the face of the virus.

But there are also stories of heroism in this crisis. It’s not all toilet-paper hoarders. A huge number of Aussies, like our volunteer firefighters only months ago, are carrying on at significant risk to themselves in our Coles, IGAs and Woollies, in trucks, hospitals, schools, restaurants and petrol stations. So-called ordinary people are making a big difference by doing their jobs regardless of fears they may have. They have families too. They should be treated with respect.

We need to channel this focus that gets so many of our workers to their shifts each day and night and direct it to driving down the infection curve. As the government continues to roll out measures to do this, it should urgently consider standing up coronavirus health response teams.

What’s crystal clear from the advice of healthcare workers is that as the situation continues to degrade in coming weeks and months, there will be an urgent need for supplementary, temporary, semi-trained health workers to save our healthcare system from reaching crisis point.

Health professionals I’ve consulted say that having assistants to help disinfect waiting rooms and treatment rooms between patients, as well as transport and advise patients on isolation, would help relieve some of the immense pressure they’re under. As the pandemic worsens, the need is only going to grow for such a mobile, semi-skilled workforce to provide basic support at the medical front line.

That needs to be done to help hospital workers, the first echelon, save lives. But how do we get there while mitigating the obvious health and safety risks? There are three options, though if conditions become critical, we may need to consider a mix of all three under separate or joint command.

Calling up the Australian Defence Force Reserves as the second echelon is an obvious step. Planning is well underway. The call-up of reservists in Operation Bushfire Assist is fresh in our memory. This recent deployment has put them in a good position to go again. In the UK, 20,000 troops have just been put on standby to help with the Covid-19 outbreak there. In the US, over 2,000 National Guard troops have been called up in similar roles to try to reduce a pandemic toll that could surpass the number of American personnel killed in both world wars.

Another option is to draw on our private and not-for-profit sectors. Professional training organisations could create a three- to five-day course covering risk management procedures, cleaning procedures, virology concepts, the use of personal protective equipment and a health system overview for response team members. I’m advised that setting up thousands of personnel reasonably quickly is achievable. Team Rubicon Australia is a model of a third-echelon organisation which recently applied the skills of 3,000 volunteers, most of them veterans, to support drought, flood and bushfire victims.

A third option is to go directly to the people, especially those who have no work or who have been made redundant due to the bushfire or coronavirus crisis, be they in the retail, airline, restaurant or tourism industries. The Queensland government has started to call for expressions of interest from the public to help. Under this model, a decentralised army of thousands of volunteers with very useful soft skills could be assembled from those fit and keen to help.

There are also many casual workers and out-of-work sole traders like tour guides and adventure leaders who would make a big difference. They could be quickly trained and organised into health emergency assistance and response teams. These volunteers and the supporting training organisations and businesses would require funding in the form of a stimulus measure.

There are costs and benefits with each option. The biggest risk across all options is that insufficient training and leadership leads to volunteers doing more harm than good by inadvertently contracting and spreading the virus themselves. The history of medicine is full of examples of well-intended interventions spreading disease. That’s why there must be strict professional standards.

But doing nothing except calling out the reserves also presents an unacceptably high risk. As we saw in the bushfires and earlier disasters, Australians are already volunteering without direction from government. Some 11,000 people have joined a Facebook group to support healthcare workers. Another 1,000 are helping the elderly in Perth. Many groups have spontaneously sprung up to deliver food and are doing their civic duty unasked. They are an example to all of us.

But the brave Australians volunteering their time and money to help their neighbours will face an escalating risk of contracting or spreading the virus. Since it’s predictable, governments have a duty of care to intervene and mitigate this threat. The federal government can reduce the risk by funding health response teams and paying for their training and time.

As push comes to shove, I have no doubt we’ll all come together, as Australians do in times of trial. But we need a framework in which everyone in society is informed and playing their part. We also need real leadership that harnesses the immense talents and resources of the Australian people to support the health and wellbeing of our society and the recovery of our economy.

The coronavirus pandemic is a global test of leadership

We will see many things that frighten us as we walk along the various threads of the coronavirus pandemic. But whether it’s about panic shopping, closed borders or social distancing, it will be the leadership or lack of leadership that will stick in our minds when we come out the other end. People in leadership roles usually inherit the system they’re leading and are often handed the situations they find themselves in. As this pandemic stretches our leaders, we’ll find out whether they can make the necessary adjustments to enable us to thrive rather than just survive.

The ability of leaders to shift their thinking and the thinking of those around them will be key to our successfully managing our personal and professional lives through the current crisis. To do that, these leaders, our leaders, will have to grasp the need for a change in thinking focused on actions that can create and achieve the best results.

Being inspired is important, but it must be more than simply inspiration, which often ends after the ‘feel-good period’. Instead, we will need to see transformation to successfully traverse this extreme situation. There may be no better quote than this: ‘Do not go where the path may lead; go instead where there is no path and leave a trail.’ We find ourselves with no clear path, but with an expectation that leaders will make one for all of us.

It’s clear that there’s panic—we all fear what we have seen elsewhere and what we are now experiencing in our own communities. However, that panic can be a short-lived if leaders can assuage the intense anxiety, while showing us that they are in control and are making decisions that will have a positive impact. We know that in battling this pandemic leaders will have to make decisions quickly and  implement the steps required to try to stay ahead of the virus. We are better off overreacting and apologising than underreacting and being sorry.

We will quickly see that not all leaders are created equally. Some will innately take the role they have been given, and, as Churchill said, make this their finest hour. Others will prove they have no finest hour.

Prime Minister Erna Solberg of Norway took quick action following a dramatic increase in Covid-19 infections in the country. She ordered the closure of borders and schools and implemented a compulsory 14-day quarantine for international travelers. She also announced measures that will assist laid-off employees and affected businesses to access benefits and financial support quickly.

Solberg has addressed the challenges Norway is facing, and she has communicated carefully and thoughtfully with her constituents. She spent 30 minutes on air speaking to the children of Norway, explaining the challenges they face and the impact that the virus is having and will continue to have on them and their families. Although challenged in the beginning, Norway’s leadership exhibited an aggressive approach that responds to the problems the pandemic brings at multiple levels.

Singapore’s Prime Minister Lee Hsien Loong was out early, explaining to citizens what the government would do to help the country survive the pandemic, including rolling out economic, medical and resilience programs. He spoke about the early problems for South Korea and set out how Singapore would learn from those mistakes. His announcement of a $4 billion support and stabilisation package came early, providing stability to the country. Overall, Lee showed that he grasped the importance of early decision-making, focusing on a rapid response rather than waiting for news from other regions.

In 2015, South Korea experienced an outbreak of another novel coronavirus, Middle East respiratory syndrome or MERS, and was widely condemned for its response. The country’s leadership was heavily criticised for keeping details from the public and for being inadequately prepared and slow to take action. It was hoped that they had learned from their earlier experience; however, they quickly slipped into the same mistakes with Covid-19—keeping information from the public, downplaying the impact of the disease and refusing to recommend social isolation strategies.

To South Korea’s credit, though, there has been a reversal since the initial failures. Increased testing, tracing and tracking systems and isolation measures have been put in place, and South Korea is now in a much better position to combat the pandemic.

Whether we are seeing or will see a transformation in the leaders of other countries, including Australia, will likely be debated more in the coming months and years than right now. Putting appropriate measures in place to flatten the curve of infections, bringing forward economic aid for businesses and individuals and helping our society build resilience are all areas in which we will grade our leaders. Also important will be the ability to increase capacity and capability within the country and to work in parallel with other nations and learn from successes and failures.

The decisive approach needed will not always be popular, but leaders need the experience of others to build their own. Shared knowledge and merging of initiatives and approaches taken in different nations may facilitate global success. Each leader must not wait to follow others but must work in parallel with them. They must be open to information and insights from others’ experience but also clear-minded and confident enough in themselves to decide on the best approach for their own nation.

We expect those to whom we have entrusted our safety, security and even our future to make tough and perhaps unpopular decisions as if our lives depended on it—and so they may. We should expect that those in leadership roles are focused on our communities, both domestic and international, and on the people they serve. And we expect that they can be trusted to make the right decision for us.

Let’s hope that those who are leading us through this pandemic, more than ever before, will be able to say that this was their finest hour.

Policy, Guns and Money: Coronavirus crisis

In this episode, we speak with three experts to help understand the global health crisis caused by the novel coronavirus.

You’ll hear from Raina MacIntyre, who’s a professor of global biosecurity at the University of New South Wales, as well as ASPI visiting fellow and former head of the UN Office for Disaster Risk Reduction, Robert Glasser.

We also speak with Anna Powles of New Zealand’s Massey University about the impact of the virus on the South Pacific.

For the latest government information on Covid-19 in Australia, click here.

Australia needs a national mobilisation committee to navigate the coronavirus crisis—now

The new national cabinet the prime minister has formed with state premiers and territory chief ministers will need to grow quickly in reach, speed of action and composition to get ahead of the rapidly unfolding set of events the coronavirus is bringing.

Step one is for the cabinet to reach across the aisle, now that it has already reached across federal–state boundaries. Bringing in the opposition leader and his deputy is a big but simple move that will reinforce the national unity that our leaders need to build and project.

Beyond politics, though, thinking of this cabinet as a national mobilisation committee during a time of crisis akin to a war seems the right frame of mind. Australia had an Advisory War Council during World War II that included members of the opposition.

The coronavirus is primarily a public health crisis, but it also comes wrapped in intermingled financial, political, economic, international relations and community stability crises. And the usual ways of coordinating government–corporate cooperation will just not work in this rolling set of related crises.

Departments and ministers with individual working relationships with particular businesses and business leaders won’t be able to integrate information quickly enough—either to brief the national cabinet on possible actions, or to broadcast cabinet decisions so that implementation can begin. Such relationships and procedures below the level of this cabinet, no matter how accelerated, like the now activated National Coordination Mechanism located in the Department of Home Affairs, won’t be sufficient.

Decisions that Australians need taken cut across not just Commonwealth–state jurisdictions, but also across public and private sector boundaries. Some of the people with the power to take critical national decisions are not in any parliament, but are the leaders of key functional enterprises like major supermarket operators, big logistics companies, and the heads of various private sector medical firms and hospitals.

Key corporate leaders will be informed by their own experts and driven by their own corporate and institutional drivers, with the nation’s wellbeing in mind, but probably a loose understanding of national implications and imperatives. (Think of some of the decisions the Qantas CEO and the heads of Woolworths and IGA have taken recently as examples.)

So, the national cabinet can’t be left as just government and political machinery. The result would be reactive to events and the assessments of others, swamped by the disparate decisions of key leaders in critical sectors.

The speed of decision-making and action required mean that any top-level national body will need to be connected to the actual sources of power and advice that will allow our nation to manage this crisis—and emerge from it not just with a sense of having been controlled by the virus, but with an understanding that we responded to changing demands as needed, with an overall design and coherence to how we worked.

Think about a prospective decision to close schools in one or more of our major population centres. Is it unthinkable to do now because of the disruption it will cause to our health professionals and other essential workforces? Or is it unthinkable not to do now if we are to prevent large clusters of infections in our cities?

It’s probably both. But without rapid and deep planning, a move in either direction could have first-, second- and third-order effects. Maybe the big providers and government can find a way we can close schools to staunch the rate of spread of the epidemic and support the workers and families in these critical sectors. Maybe the answer is to close schools to all children except for those of essential service workers and use the reduced school populations to implement social distancing there. We won’t find the answer fast enough unless we take a different approach to planning and interaction than we do for normal times.

Food distribution, production and distribution of medical supplies, power, transport, telecommunications, education and other activities like waste management will all need to be similarly ruthlessly prioritised and orchestrated as Australian population centres enter various levels of lockdown to slow the virus’s spread.

Including the CEOs of our big national medical, aged care, food, logistics, power, financial, transport and telecommunications companies in advisory and decision-making processes, rather than at the end of complicated chains of communication, will be essential through this time.

This will require more than the machinery in place so far: the well-practised National Security Committee of cabinet, the Australian Health Protection Principal Committee and Home Affairs’ National Coordination Mechanism. It will require giving key corporate leaders a seat at the national cabinet table where they are involved in designing and implementing the big decisions. That ‘seat’ will need to be via teleconference or videoconference so people can be where their organisations operate best during the crisis and to minimise the risk of key leadership staff falling ill.

All this needs to be heavily laced with what leaders of any kind find hard to do: delegation and transparency.

Any national mobilisation committee, no matter how integrated across government and corporate power centres, will need to delegate much decision-making to others. That’s likely to be messy and experimental, but it will be essential.

Even more important will be transparency about the actual factors driving decisions. Here, the balance might need to shift even more to letting experts—whether from the public or private sector—speak directly and frankly to the Australian people, unmediated by political overlays. That will require the government to establish and empower consistent individual voices that the public can turn to for coherent and clear information. Laying out some of the nastier scenarios and issues that are involved—as in the case of deciding who gets triaged for scarce intensive-care beds and who doesn’t—will be more likely to build public support and confidence than repeated words of reassurance and calm.

It’s a counterintuitive fact that all the attributes we need in this crisis will be even more valuable as we emerge from it. That’s brought about by the reality that we live in an interconnected world. The ways of operating and organising we’ve used in the past are not suited to a world of category collapse, in which boundaries and responsibilities are blurred, and effects compound and escalate. Australia will prosper in this world if we use this crisis wisely.

The convening of the first meeting of the national mobilisation committee can’t happen fast enough.

Coronavirus and the perils of our ‘just enough, just in time’ food system

Toilet paper shortages, profiteering from hand sanitiser and empty shelves in supermarkets.

Thanks to Covid-19, governments in most industrialised nations are preparing for shortages of life’s necessities. If they fail, riots over food may be inevitable. Some wonder if we are responding appropriately to Covid-19, and it’s clear that recent events expose a fundamental flaw in the global systems that bring us our daily bread.

We live in a wondrous age when global supply chains seamlessly link farmers and consumers using the principles of ‘just enough, just in time’. For years, companies have worked hard to keep inventories low, timing shipments to balance supply and demand using knife-edge accuracy.

In many ways, this system is a miracle. Low-cost food is one outcome. And if there’s a problem in one part of the supply chain, the global system is good at finding alternatives. (Mangoes from Asia gone bad? Try the mangoes from Central America!)

But with this abundance—and convenience—comes a hidden cost that Covid-19 has exposed: a loss of resilience. Our global food system depends on the tendrils of international trade to wrap the world in an ever more complex system of buyers, sellers, processors and retailers, all of whom are motivated to keep costs low and operations lean.

So when the supply-chain system itself is thrown into question—as it is now thanks to Covid-19—then the wheels threaten to come off the proverbial apple cart. Covid-19 shows that we need to wake up and realise that if we really want to be resilient, we need to build more redundancies, buffers and firewalls into the systems we depend on for life.

In practical terms, this means we should be keeping larger inventories and promoting a greater degree of regional self-sufficiency.

These measures will help ensure that our communities don’t panic if the food deliveries stop.

But while this may sound sensible, high inventories and more regional self-sufficiency are, in fact, antithetical to the ‘just enough, just in time’ approach that drives most of our economy, even though no one’s suggesting we need to be completely self-sufficient all of the time.

Take the systems that produce and distribute the corn, wheat and rice that fuel most of humanity’s calories. The latest United Nations report on the global grain system contains some bad news. Last year, the world ate more grains than it produced within the year, and our carryover stocks (defined as the amount of food we have, globally, at the end of the year to see us through to the next harvest) are declining.

The good news is that this decline comes after a run of good years in which farmers delivered one monumental harvest after another. So our carryover stocks started last year in pretty good shape and this means we’ve currently got about four months of food stored. But there’s a downward trend regarding those stockpiles, and this is worrisome.

But what if Mother Nature doesn’t play nice with us this year?

Climate change, after all, is making food harder to produce. What if we face a major drought in Europe and Asia like we did in 2010 to 2011? Or another big drought in America’s Midwest similar to the situation in 2012 and 2013? And what if Covid-19 doesn’t go away by summer?

If any of these things happen, we may not have the buffers to protect ourselves. And it won’t be toilet paper and hand sanitiser we need to worry about. It might be wheat, rice and corn.

Today, conventional wisdom is that the average city in North America has a three-day supply of fresh food (dried, canned and other preserved food supplies will last a bit longer). This, according to some, means that we are all only ever ‘nine meals from anarchy’. Luckily, North American supermarkets have sophisticated supply chains, so no one is seriously suggesting that the panicked purchasing of the last few days that has emptied shelves will persist. Nevertheless, the systems we depend upon are, in many ways, fragile and inherently vulnerable.

In all likelihood, Covid-19 will pass and most of us will only suffer economic setbacks from lost wages and disruptions linked with cancelled classes, travel and meetings. But in the aftermath, it’s important to ask whether we—as a society—will treat this as a moment to learn a bit about the fragility of the modern world.

Will we work collectively to put resilience alongside efficiency as a primary driver for the systems we depend on each and every day to feed ourselves? The Conversation

How to expand our capacity to deal with the coronavirus crisis

Across many countries, an important strategy to counter Covid-19 is to ‘flatten the curve’. That strategy involves a deliberate attempt to slow transmission of the virus in order to allow the demand for medical services to better fit the resources available. That’s achieved primarily by ‘social distancing’. But there’s a second string to that bow—namely, working at the margin to increase the resources available to deal with the crisis.

We tend, for good reason, to think of medical resources as a relatively fixed quantity. It takes years to train medical staff and, notwithstanding China’s recent—and troubled—display of rapid hospital construction, just as long to build new hospitals. But in the UK, the hunt is on for ways to enhance resources quickly. Opening military field hospitals is one option, but those will be in short supply. Another is to consider turning empty hotels into temporary hospitals.

There’s a degree of opportunism in that approach: it can be done only when the tourism industry is flat on its back. But, sadly, that’s about where we are today—and hotels also need a new source of revenue. National lockdowns and low public confidence levels have further damaged an industry that in Australia’s case was already beset with the challenge of the bushfires.

True, hotels aren’t equipped to be hospitals. In particular, they don’t have oxygen supplies and ventilators, which in this case is an important failing as Covid-19 is a respiratory infection. Still, they do have rooms, beds and commercial kitchens.

The Best Western chain has already offered to turn its hotels into temporary hospitals as a backstop to the UK’s National Health Service—a valuable reminder that Western societies typically harbour a depth of resources that might be useful in crises. The offer was apparently made on the basis that other companies would partner with the chain to provide medical equipment and supplies, a non-trivial qualification.

Of course, the hotels would also need properly qualified medical staff. That hurdle’s also an important one. Because medical services are expensive, Western societies typically run on a ‘just in time’ basis: services are available just in time to meet the need. That’s economically efficient, though it’s achieved by minimising spare—or surge—capacity in the system. Even in normal times, it’s a strategy with little headroom: hospitals struggle to meet their own performance indicators in emergency wards.

Some sort of volunteer organisation—a sort of medical ‘Dad’s Army’—would probably be useful, although in this case it would have to be a volunteer army of the young rather than of the old, leavened by health providers used to setting up and operating in difficult conditions, as companies like Aspen Medical can do. Even then, enthusiasm is no substitute for training. The merely enthusiastic could certainly wipe down surfaces, but their roles would be limited.

Still, training in limited tasks related to hygiene and social isolation protocols could produce a set of usefully skilled volunteers that can help operate those temporary health centres effectively. Medical training needs to be thought of on different levels now. Tasks that can be done by people with minimal training should be delegated to such people, allowing highly trained medical personnel to concentrate on what only they can do.

In the struggle to grow the numbers of medically trained personnel, it’s also possible to imagine the developed world preying on the resources of the underdeveloped, luring suitably qualified personnel to their shores. That strategy would, in the long run, probably backfire: it would pretend that nations can seek individual outcomes against a global pandemic, when the truth is that the medical assets should probably be flowing from the developed world to the underdeveloped in order to promote a better, shared global outcome.

A smarter strategy would do the opposite of preying on weaker nations: it would see the cruise-ship industry as a set of floating temporary health centres able to be positioned near urban centres in countries with weak health systems—Papua New Guinea comes to mind. Setting them up with local and volunteer staff trained in hygiene and social isolation protocols might turn a sector that has been a disease vector into a valued element in controlling and dealing with the pandemic. That will be a way of helping regional partners and will be appreciated during the crisis and perhaps even more so after it has passed.

In World War II, the British developed habits of national resilience. Taking lessons from those practices and that experience might offer useful guidance for Australia in relation to coming challenges. One lesson is to be flexible and adaptable in turning existing infrastructure and resources to new, urgent uses. That’ll depend on re-energising the Australian quality of improvisation and adaption that our history shows has been one of our strengths. Another lesson from wars and other crises is to empower volunteers—again, Australians are probably ready and willing to help others in our community as long as they are trained and equipped to do so as safely as practicable in these troubled times.

Coronavirus could tear down dictators and democracies alike

Amid much uncertainty about the spread and lethality of the novel coronavirus Covid-19, national security planners everywhere will be applying tough-minded geopolitical analysis to anticipate what worst-case scenarios for the virus might mean for the global strategic balance.

Political elites may hope for the best, but their security advisers plan for the worst—and the worst, for this virus, is very bad indeed. Here are some assumptions which will hopefully be proven wrong, but which, on current evidence, no one can afford to dismiss.

First, despite brutally stringent measures in China, the global spread of Covid-19 has not been contained. As of yesterday, 85 countries and territories have reported cases of infection. There will be dozens of other countries, including many in Australia’s nearer region, where the virus may be present but has yet to be identified or reported.

Second, it seems clear that Covid-19 is passing by human-to-human contact that is no longer traceable back to Wuhan. China was the start of the story, but not the end. The virus will spread from many other locations in a world where every spot is reachable from every other part of the world in around 24 hours.

Third, the World Health Organization has reported a case mortality rate of 3.4%. This is much worse than seasonal flu and no one has immunity. The rate may come down as we learn more about the numbers of mild cases that didn’t require medical treatment, but we will know this for sure only after the virus has had its global effect.

Fourth, a tested and proven vaccine is 12 to 18 months away from being available, and months more will be needed to manufacture and distribute globally significant amounts.

Last, social isolation only protects people for as long as they remain isolated. Physical separation is at best a temporary measure and will breakdown en masse long before the virus has worked through the world’s population.

If these five statements are true, then it’s likely that we’re seeing only the beginning of a profound Covid-19 crisis which will be with us for months; kill hundreds of thousands of people globally; break the economic, travel, IT and social intermeshing of the world for a time at least; and profoundly strike at the stability of entrenched political systems.

What does a sustained outbreak of Covid-19 mean for China and for the stability of President Xi Jinping’s regime? There are possibly two somewhat contradictory results: in the short term Xi strengthens his power, but only at the longer-term cost of undermining the Chinese Communist Party’s effectiveness.

The shape of China’s response to the virus is already well known: early January reports of the virus were suppressed, and false assurances were given that the situation was under control. Xi appeared disengaged, leaving management of the issue to his subordinate, Premier Li Keqiang. Xi became more publicly engaged in leading a response only last month, by which time the scale of the outbreak was such that the president could not afford to remain personally distant from it.

Only a deeply authoritarian system like China’s under the CCP could mobilise such a sweeping response to the virus. Current reporting has it that around 760 million Chinese are subject to home lockdowns, enforced by hundreds of thousands of party members and the biggest People’s Liberation Army mobilisation since the 2008 Sichuan earthquake.

For all its harshness, the Chinese response has worked quite effectively to slow the domestic spread of the virus, but this has been bought at the price of closing down the economy and of potentially exposing hundreds of thousands of CCP and PLA cadres to the virus.

Sooner rather than later, Xi must find a way to get people back to work in a country where everyone will be feeling the effects of a substantial economic slowdown and where the virus will still be active. Doing that too early without provoking a second outbreak looks hard.

Crucially, the virus became too big a problem for the CCP leadership to simply blame on local maladministration. A massive propaganda effort has been spent in Chinese state media presenting Xi as the rather premature hero of the ‘people’s war’ against the virus.

Covid-19 has sparked social-media-driven nationwide unhappiness with the CCP’s handling of the crisis. This is new territory for Xi, who has painted himself as being a leader close to the people.

None of this is to suggest that Xi’s leadership is under immediate threat. The party retains immense power to repress all opposition. Nevertheless, Covid-19 may well end the high point of Xi’s personal authority and the CCP’s central control.

Turning to the United States and, as Covid-19 carves its way through California’s nursing homes, an obvious conclusion is that President Donald Trump failed to think his way through how the administration should gear up for the crisis.

Apart from an obvious underinvestment in developing working virus test kits, the administration’s early response exposed the reality of what a drained swamp looks like in Washington. In 2018 the Trump administration began systematically cutting spending and reducing the scope of the Centres for Disease Control and Prevention. National Security Council positions relating to pandemic crisis management were abolished.

Unlike in Australia, where the government could reach for orderly and well-rehearsed plans for managing a health crisis, Trump appeared to have little to turn to other than his instinct and Twitter, where, on 26 February, he wrongly claimed that Covid-19 was receding as a threat in the US and that its fatality rate was lower than the flu’s. ‘View this the same as the flu’, Trump said at a press conference in New Delhi on 25 February. That was at least three to four weeks after a point when the president should have had a much clearer understanding of the extent of the problem.

In appointing Vice President Mike Pence to lead a taskforce responding to the virus, Trump may also have repeated Xi’s mistake of trying to push a difficult role to a subordinate. Inevitably, national crises demand that the national leader is seen to be in charge.

The virus will possibly have a sustained impact on the presidential election. The US can swing substantial resources into the anti-virus fight, but it will be doing so much further behind in preparation than it should be. It’s also reasonable to assume that the rapid growth in numbers of infections and deaths in California will continue for some time.

At the end of 2019, Trump was looking well positioned to win a second term. The economy was in rude health, Trump had stared down a wasted impeachment effort in the Congress, and the Democrats were endlessly fighting and factionalised.

Less than three months later, the president has a substantial self-inflicted wound from an undisciplined approach to a health crisis that will only get worse at precisely the moment in the political cycle when the Democrats’ presidential nominee will be resolved.

Covid-19 may not end Trump’s presidency, but it’s certainly not going to help him in the run-up to the November election.

What does Covid-19 mean for Australia’s wider Indo-Pacific neighbourhood? I suggest there are three lenses through which one can view the regional impact of the virus: markets, mendicants and military forces.

Among the developed and successfully developing countries of the region exists a network of economic interdependencies and just-in-time supply relationships that deeply undermine any real capacity for sovereign independence.

Thus China locks its factories down and within days Australia faces shortages of medical supplies, building components and consumer products of all types. If South Korean or Singaporean fuel refineries stop operating or bulk tankers (high-risk virus incubators) stop taking to sea, it will only be one to two weeks before Australian bowsers dry up.

Does Covid-19 herald the moment of peak economic interdependence globally? That’s a big judgement call to make, but such are the levels of interdependency built by reliance on global just-in-time supply chains that the developed economies will largely sink or swim together.

We shouldn’t be surprised if the lesson some countries take from this experience is that more sovereign self-reliance in critical areas like vaccine production and access to medical supplies, food and key areas of defence technology is worth paying a premium for.

Then there are the immense health challenges presented by the Pacific island states and many lesser developed countries that struggle to maintain the most basic levels of health care and populations with high comorbidity—where people can be suffering more than one medical disorder at the same time.

Further, the potential for social isolation strategies to work is lower, meaning that the mortality rate of Covid-19 could well be higher in developing countries.

Think of what that means for Australia’s closest neighbour, Papua New Guinea, with a population of around nine million people, to date no reported Covid-19 cases and more than 10,000 Australians resident in the country.

Australia will not sit by if Port Moresby or other regional friends look to us for help when the reality of Covid-19 becomes clear in their villages and city streets, but our capacity for large-scale response is tiny compared with the potential scale of the problem.

A final thought about military forces. We already know that, because of cramped quarters and air conditioning, ships are highly dangerous locations for Covid-19 to strike at high ‘attack rates’. The same could be said for military barracks and headquarters.

As in China, so too will other regional countries be tempted to put ill-prepared and poorly equipped military forces into the front line of responding to Covid-19. Something to watch will be the impact of the virus on the PLA and its ability to deploy forces, especially at sea.

Covid-19 will eventually pass and become more controllable with vaccines and developed natural immunity, but not yet and not before it could wreak profound change on those who currently hold political, economic and military power around the globe. There has never been a more important time for Australians to think about how we protect our strategic interests in this dangerous world.