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Feedback advice for the Chief Health Officer

1 January 2022

4:00 AM

1 January 2022

4:00 AM

Following the passage of Victoria’s Pandemic Management Bill, the Chief Health Officer is required to provide public advice to the government on any recommended pandemic orders. How did he do? Here is an assessment in the form of feedback that a lecturer might give a student.

Dear Brett,

Thank you for submitting your first essay, and on this important topic. It has been a long time coming as we are nearly at the end of second year, but it is welcome all the same.

First, let me congratulate you on the high standard of English expression in your essay. It is well written, with clear formulations of your position. (Did you get some help from the legal department perhaps?)

The level of analysis is rather variable, however.

In discussing the environmental factors that impact on risk, it would have been useful to discuss the climatic factors. You do acknowledge seasonality by observing that ‘transmission of SARS-CoV-2 escalates in cooler months’, and it would have been useful to add that epidemic waves of mortality are only observed in winter in temperate climes, whereas your recommendations will apply in summer.

Moving on to the sections on the suite of measures you recommend; this is where the cracks begin to emerge.

Obsessive monitoring, not only of each individual virus infection, but even of the surveillance of virus particles in wastewater seems like a hangover of the ‘zero Covid’ era and doesn’t seem relevant to the ‘living with Covid’ era.

By the way, you don’t discuss these two very important strategic alternatives in your essay – which seems like a major oversight.


There is generally an absence of strategic thinking in the paper and no consideration of strategic alternatives.

For example, you discuss the need to mandate the use of masks in schools from Year 3 onward, and in many other settings.

As you know, the alternative strategy that has been proposed would be to target measures at the groups at higher risk, which are the oldest cohorts, and especially those individuals with the famous ‘comorbidities’. There is a lively debate going on between the majority of scientists who support universal measures and a minority who support targeted measures. It would have been really interesting to read an analysis of the strengths and weaknesses of each strategy, and why you recommend such broad, poorly differentiated strategies.

And you really need to consider references which contradict your recommendations as well as ones you think support them.

For example, on mask mandates you maintain: ‘Masks have been shown in observational and interventional studies to reduce SARS-CoV-2 transmission, although the magnitude of the effect is not well defined.’

Why did you not consider these contrarian studies?

Most of the favourable studies are low quality, show a temporary effect over a few weeks only, or are limited to particular circumstances. In your survey of the research did you come across anything that showed that mandates could a) change the course of an epidemic wave overall: or b) improve outcomes (such as mortality) over the whole period of the wave?

You go on to discuss various controls that are needed in workplaces. A huge amount of data must have been accumulated by now through the contact tracing and testing program that illuminate where most of the clusters occur, which apparently involve aged care settings. It would have been really useful to analyse and discuss this data, elaborating on the way it could be used for more precise targeting of measures.

Your major recommendations are for vaccination mandates in a wide range of settings, which impose unprecedented infringements of human rights.

You assert: ‘Vaccination remains an evidence-based intervention that not only minimises transmission risk but also protects individuals who contract COVID-19 from the harms of severe illness.’

My colleagues and I were puzzled about the source of the first part of this claim – where did you come across evidence that vaccination significantly reduces transmission in a population? Big claims like this really need to be footnoted. I can’t see any references in your bibliography that support the claims in this section of the essay.

The essence of evidence-based medicine is first to scan all the relevant evidence, and then to submit it to probing critical scrutiny, and you need to urgently acquire more skills in this area.

So overall, I have to give the essay a D and hope that you improve your analysis skills in third year.

We do [not] look forward to future essays on these subjects.

Regards,

Michael

Brett’s essay was downloaded from here.

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