Thread by @drvyom

@leighsales
Comparing NSW to VIC now is a bit tricky - Both states are achieving similar case numbers, but Vic is worse than it looks right now, barely achieving the same result with lockdowns. Open up = drastically worse. RE: what is truly unique about Vic vs NSW approach -

No doubt Vic contact tracing was inadequate, likely due to a highly centralised structure of DHHS vs localised health model NSW. Lack of local knowledge and inefficiency come with this.

And although our CHO is highly competent, despite same job title as his interstate counterparts, did not have same rank in hierarchy.

Not to mention, Victoria's public health team has been historically underfunded and has smaller staff size compared to other states.

IMO all this affected our approach of who to test, and trace and isolate (always comes back to the trifecta).
It was too narrow at times (definitions of close vs casual contacts in high risk outbreaks).
Or not done fast enough. (less staff)
Nor well enough (using pen/paper)

So our cluster management wasn't great. I say 'wasn't great', and not 'a total shitshow' because the error of margin is smaller than people think. We look at 700/day cases and go 'how'd they let it get that far!'

But by the time daily cases got to 30 they were straining, and at 50 it was all over. I know this because of the delays in contact tracers contacting positive cases. By the time Vic got an 'army' of 2000 tracers, it was too late. Widespread community transmission.

Important to bear in mind that entire nations have given up contact tracing at a national total of 50 daily new cases. Now, there are 100 other factors that played into this but imo the above factors were what's majorly unique in vic vs nsw approach.

There is another factor though that I can't quantify which might explain the diff between Vic and NSW. Luck.
This virus does not spread evenly. The spread is stochastic by nature. 80% of people won't spread the infection to anyone. 20% will do 80% of the spreading. And

You only need the bad luck of the virus 'finding' 2-3 super-spreader events in a row, with at-risk groups/settings (aged care, NESB communities poorly reached by public health messaging, industries w/casualised staff, high risk environments like abbatoirs) and it's over.

So imo there are structural issues that lead us to here. And I think bad luck is a very plausible factor too.

Regardless of the past, now there is no excuse for not having very aggressive cluster management, and safeguarding high-risk workplaces.

I really don't there is anything sexier than this which explains vic vs nsw. Certainly nothing I've seen anyway.
It didn't take a cataclysmic blunder to tip us from from a manageable 20 cases to almost unmanageable 40 cases a day. The margin of error is smaller than we think.

I tend to focus almost zero percent on "we should do what NSW" is doing. I tend to focus on "we should do enough" which is actually a much higher bar.