January 19, 2022

Issues and policies

Marshall law

By Russell Marks
Image of South Australia Premier Steven Marshall addressing the media during a press conference in Adelaide, August 24, 2021. Image © Morgan Sette / AAP Images

South Australia Premier Steven Marshall addresses the media during a press conference in Adelaide, August 24, 2021. Image © Morgan Sette / AAP Images

Premier Steven Marshall claimed South Australia was “COVID-ready” when the state opened borders just as Omicron was emerging, but it now faces the same issues as the eastern states

“Borders open, a normal Christmas, parties at home!” gushed The Advertiser – South Australia’s only statewide daily printed newspaper – on October 26 last year, the day after Premier Steven Marshall announced what the Murdoch-owned paper obligingly called the “Marshall plan”. That plan promised “the joy of normal family Christmas gatherings, free of punishing COVID-19 restrictions and fears of lockdowns”. The premier’s comms team couldn’t have done a better job of boosting him. The ’Tiser’s headline: “Golden path to freedom”.

Three decades of Murdoch media monopoly means that alternative views aren’t often heard outside Adelaide’s university campuses. (InDaily, an online news site, provides some balance.) But there were murmurings of disquiet about Marshall’s plan to open borders. South Australia had been relatively unscathed by the virus for two years, thanks to its replication of Western Australia’s and Queensland’s closed-borders strategy. (Happily for Marshall, a Liberal, he’d largely escaped the barrage of criticism that Scott Morrison and The Australian had heaped on Labor premiers Mark McGowan and Annastacia Palaszczuk for keeping their states’ borders closed.) Opening the border to New South Wales and Victoria – which on October 26 reported 305 and 1534 new cases respectively – meant that South Australia would be bringing COVID in.

Was the state ready? For weeks, South Australians had been assured that, yes, it was. The health workforce was at a “record high”. Hospital capacity was given a “massive boost”, and there would be another 149 “community beds” so patients could receive “hospital-level” care at home. At the end of October, the state’s chief health officer, Nicola Spurrier, provided to The Advertiser modelling from the University of Adelaide showing that, at an 80 per cent vaccination rate, there was “just” a 27 per cent chance of an outbreak averaging more than 100 new cases per day over any three-day period. Reopening with 80 per cent of the adult population vaccinated meant that SA’s hospitals would most likely need to cope with no more than 36 ward admissions and nine intensive care patients at any one time. It was an abundantly “manageable scenario”, Spurrier said. Meanwhile, doctors working in public hospitals were shown alternative modelling, which predicted that 300 acute care beds would be needed. It was ignored. Marshall brought SA’s “open day” forward to November 23.

The scenario couldn’t have been better for a first-term Liberal premier facing re-election in March. Unlike his counterparts in Victoria and NSW, Marshall had for two years been quick to lock down in response to community transmission, thus avoiding for SA the prolonged lockdowns that had plagued the eastern states. South Australians approved of Marshall’s pandemic management and thanked their lucky stars he wasn’t Gladys Berejiklian. Now it seemed he was Santa Claus, giving Adelaide its Christmas.

There were two problems. The first was that all of the modelling, and Australia’s entire vaccine program, was based on COVID-19’s Delta variant. But on November 24, the day after SA’s borders opened, South African authorities reported the Omicron variant to the World Health Organization. Nobody had any idea, then, how it would behave. There wasn’t any modelling. There was barely any epidemiology. And Morrison was due to reopen the international border on December 1. An open border to Sydney and Melbourne would almost certainly let Omicron into Adelaide, with unknowable consequences.

The second problem was that, for all of Marshall’s spin, South Australia’s public health system has been a well-documented disaster zone for a very long time. Faced with chronic overcrowding and ambulance “ramping”, the previous Labor government oversaw from 2015 a disastrous, 1980s-style efficiency drive, which it called “Transforming Health”. It cost billions and cut jobs, beds and capacity across the state’s hospitals. Marshall’s Liberal government, elected in 2018, has made things even worse. By late last year, nearly every part of the health system was at breaking point. Patients were dying because ambulances were taking too long to reach them, or they were being ramped for hours outside hospitals.

This was the environment in which Marshall declared South Australia to be “COVID-ready”. The term was all over the state government’s COVID websites (though it now seems to have disappeared). On December 1, the state saw its first cases of community transmission. The following day, there were 18 cases. At an emergency meeting of SA’s COVID directions committee on December 4, Spurrier and SA Health recommended the borders close again. Despite conceding an “absence of more detailed information” about Omicron, Marshall decided to keep them open, even announcing that existing restrictions would ease further after Christmas. (They didn’t.) Meanwhile, Queensland closed its border to SA.

Contact-tracing resources were quickly overwhelmed. Authorities delayed publishing exposure sites for up to 10 days, and then only if they were deemed to be a “high-risk setting”. Seven-day average case numbers reached 55 on December 19, and 253 the day before Christmas – well above the modelled 100 daily cases. Marshall insisted this was all part of “living with COVID”.

But as December rolled on, South Australians became aware of just how unprepared their government was for COVID-19. Wait times for testing swelled to nine hours and beyond. Interstate arrivals were excused from even being tested, to relieve the existing burden. It has never admitted it, but by the week before Christmas the government had effectively given up on meaningful contact tracing. (In response, thousands of Adelaideans contributed unpublished exposure sites to a Facebook page.) By early January there were thousands of new cases every day and more than 100 people in hospital: figures vastly beyond the government’s preferred projections, and climbing exponentially. Marshall and Spurrier continued to insist these numbers were well within the state’s capacity. But health workers and other essential workers were dropping like flies. Testing clinics were closing. Furloughed nurses were unable to see their aged-care clients. Supermarket shelves emptied, not just because of panic-buying but – for the first time – because supply chains were losing workers. Like elsewhere, there are nowhere near enough testing kits available in the state. SA recorded its first COVID-related deaths after Christmas. During the past week, four patients have died, on average, every day.

Omicron, as we now know, is less deadly than Delta, but much more transmissible. Marshall’s “normal Christmas” turned out to be more abnormal than the previous two: as their relatives tested positive, many families shelved their plans to get together. And instead of a Christmas bonus, Marshall has instead handed SA businesses a shit sandwich. A week into the new year, more than nine in every 10 patients hospitalised due to COVID-19 had the Omicron variant. Most of them were at least double vaccinated. For the first time in this pandemic, SA is experiencing significant economic, social and health consequences of COVID-19.

On Boxing Day, Marshall belatedly reintroduced some mild restrictions. But he hasn’t wanted to mandate much at all. He “urged” people to work from home, but plenty of employers have used the absence of a mandate to force employees back into offices. His solution to supply chain woes was to exempt COVID-positive staff at Teys Australia’s Naracoorte abattoir – which supplies Woolworths – from the requirement to isolate. Predictably, staff began showing up with symptoms. Just as predictably, the ACTU mobilised to protect the other workers, and convinced Woolworths to temporarily halt taking orders from Teys. The meatworks isn’t the only battleground on which Marshall will be fighting unions during his election campaign. SA’s teachers are now threatening to strike in response to Marshall’s bizarre plan to force some students back into classrooms next month and have their teachers potentially forced to isolate from their own families.

Compared with Sydney and Melbourne, Adelaide’s case numbers remain small. But its health system’s capacity to withstand them is probably much less. A view has emerged, nationally and internationally, that major outbreaks are inevitable, that governments can no more prevent them than they can prevent influenza. The policy intention in Australia was always to keep the virus out for as long as it took to vaccinate the population. Australia’s leaders have mostly achieved that. Even at the peaks of the outbreaks in Melbourne and Sydney in 2020 and 2021, the case numbers in Australia were miniscule in comparison with other parts of the world. But Australia now has one of the highest rates of new daily cases per population anywhere.

All of this only makes the decisions to allow Omicron in before anything was known about its responsiveness to vaccination more puzzling. In November, Australian leaders effectively decided to abandon a two-year-old strategy that largely worked, in favour of hope and prayer. No adequate answer has been provided by any of Australia’s premiers, or the prime minister, as to why decisions to open borders and relax restrictions weren’t delayed until we knew something useful about Omicron. The desire to relax restrictions and free economic activity is understandable. But as Melbourne and Sydney (and London and New York) learned in 2020 and 2021, freedom doesn’t mean much when businesses are forced to close anyway, when hundreds or thousands are hospitalised, and when friends and family are dying terrible deaths. Across Australia, consumer confidence is now the lowest it’s been since 1992 – not because of border closures or lockdowns, which the economy endured relatively well, but because of the Omicron outbreak and governments’ new laissez-faire approach to it.

These problems aren’t evident in Western Australia or New Zealand, which have both bucked the global trend and retained strong protective borders. (Their hardline approach has, however, created different problems.) Mark McGowan and Jacinda Ardern have been realistic about their respective health systems’ capacity to withstand COVID outbreaks, and have delayed opening up until vaccination rates are much higher than 80 per cent and much more is known about Omicron.

For his part, Marshall has defended his decision to open SA to Omicron. The WHO didn’t declare it a “variant of concern” until November 28, he said just after Christmas, when he belatedly began expressing public concern about it – as if he needed positive evidence of Omicron’s dangerous potential before he was able to act prudentially. By January he was finally using the kind of language he should have been using in November: “Omicron is a complete and utter game changer”; “we are very concerned about Omicron”; “we don’t want Omicron to overwhelm our health system”. If only he could have done something preventative. It’s hard to know whether South Australians are buying Marshall’s newfound concern. He’ll find out in two months’ time.

Russell Marks

Russell Marks is a lawyer and an adjunct research fellow at La Trobe University. He is the author of Crime and Punishment: Offenders and Victims in a Broken Justice System (Black Inc., 2015). 

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