The compounding disasters of bushfires, COVID-19 shutdown and economic depression are leading to a further disaster in the mental health of Victorians. There is also now increasing knowledge of the growth in mental illness and reduced wellbeing in the state.

This can be found in increased generalised anxiety and depression, and suicidal thoughts and behaviours, particularly in young people and other vulnerable populations.

Ongoing social disconnection and prolonged social isolation, as well as greater levels of uncertainty about employment prospects, can exacerbate prior mental health issues as well as lead to the development of new conditions.

Taking advantage of Cold Spots

Re-opening businesses is central to Melbourne returning to 'normal'. Hot spot suburbs, with high concentrations of case numbers, have been used to gain greater control over COVID spread. There is merit in thinking about a similar approach to unlocking: cold spots if you like.

At Local Government Area (LGA) level, potential cold spots might be identified by comparing active case numbers to resident population. Active case numbers change daily, so numbers as published on 31/7, 7/8 and 14/8 were averaged to obtain 'representative' figures across the high point of the second wave, as shown in Figure 1.

Brimbank, Wyndham, Melton, Maribyrnong, Hume, Whittlesea and Moreland all had more than two active cases per 1000 residents. These LGAs are all in the north or west of Melbourne.

Conversely, 17 LGAs averaged fewer than one active case/1000 population, with the lowest 16 all being in the south or east, joined then by Nillumbik in the north-east. This underlines how COVID is really a tale of two cities in Melbourne.

Influences on active case numbers

At first glance, LGAs with the lowest case numbers would be candidates for early re-opening, provided Stage 4 substantially reduces overall numbers and these LGAs keep their numbers low.

Looking to assess possible re-opening, however, should also include consideration of factors that might be associated with higher/lower numbers.

Thirty such factors were considered, but multiple regression analysis suggested four significant explanatory variables:

• Resident population - the number of active cases in an LGA was predicted to increase by 0.9 for each additional 1000 people

• Percentage of the population speaking English-only at home - a one percentage point increase here is predicted to reduce the number of active cases by 5.3, highlighting the importance of language appropriate COVID messaging

• Percentage of the population aged 80 and over - a one percentage point increase in the population in this age group is predicted to reduce the number of active cases by 52.7. This finding suggests good risk awareness in this vulnerable age group, notwithstanding the terrible impacts that have emerged in many care settings

• Percentage of the adult population who are smokers - a one percentage point increase is predicted to increase the number of active cases by 13.3, perhaps suggesting lower health risk awareness among adult smokers and/or increased predisposition to respiratory illness. The adult smoking rate is also highly correlated with a number of indicators of socio-economic disadvantage.

The model was used to identify relative performance by LGA.

The LGAs with the most favourable difference between actual active case numbers and predicted numbers, given their characteristics in terms of the four explanatory variables, were all in Melbourne's SE and the least favourable were in the NW.

Data on casual employment by LGA would have been be interesting to include but does not appear to be available.

Greater Dandenong is an interesting case, with low numbers of active cases compared to predicted cases, reflecting well on its community. There should be lessons here.

Re-opening Melbourne

Looking to a brighter future post Stage 4, the sooner that Victoria can re-open the better. Ideally all Victoria will be able to re-open for business at the same time.

However, if substantial spatial disparities in incidence were to persist, then there is a case to look at a possible staged re-opening, supporting better outcomes at an earlier time in the lower risk parts of the metropolitan area (and regional Victoria).

Tackling spatial disadvantage

A caveat for staged re-opening is that it poses risks of continuing, and even accentuating for a short time, the spatial disadvantage that has long been experienced by LGAs in the north and west of Melbourne, relative to the east and south.

This spatial disadvantage should be tackled, with resources channelled in coming weeks into the north and west, to accelerate return to normal from COVID, including a focus on messaging in languages other than English and on people who are less health conscious.

An approach along these lines will, ideally, remove any need for staged re-opening but will also minimise risks of adding to disadvantage, should staging be considered.

Looking further ahead

Longer term, increased resources should be devoted to ensuring that entrenched disadvantage in the north and west of Melbourne is removed.

For example, rather than starting to build a Suburban Rail Loop in Melbourne's south-east, which will further disadvantage the north (including La Trobe University), the State Government should immediately improve Medium Capacity Transit in the north, connecting to the east, south and west (e.g. SmartBus, Bus Rapid Transit, light rail).

One lesson from this pandemic is that, as a society, we need to move away from blaming individuals as being solely responsible for their disadvantaged conditions, in terms of (for example) unemployment, early school leaving, and low wellbeing.

The pandemic reveals that it is often the lack of opportunities that perpetuates disadvantage, where resources are not evenly distributed between people and places.

In this sense, COVID compounds existing disadvantage, including in many fast-growing outer suburbs, where population growth has run ahead of provision of the requisite infrastructure and services.

A comprehensive strategy to tackle entrenched disadvantage should be one legacy from COVID in Melbourne.

To improve long term social resilience and wellbeing, COVID has reminded us that there is a social gradient of impact/harm, with the poorer suburbs hurt more.

Addressing disadvantage is a matter of social justice, but is also, as Stiglitz (2012) reminds us, a strategy of enlightened self-interest for the rest of the community.

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