“Reduce the risk of lockdowns during the holiday season.” OzSAGE calls for coordinated action to control the spread of Omicron, including the use of air gapped quarantine facilities and rapid 3rd dose vaccine uptake.
The World Health Organization (WHO) has classified the B.1.1.529 a new variant of concern orginating in southern Africa and have named it Omicron.
Travel related importations have already been documented in Hong Kong, Israel, The United Kingdom, Germany, Italy, the Czech Republic, the Netherlands, Denmark, Canada, Austria, Belgium and Australia. Transmission in hotel quarantine has been reported.
The US, Canada, UK, Japan, Russia, the European Union and many other countries have placed travel restrictions and/or border control measures for people entering from South Africa and other Southern African nations including Botswana, Zimbabwe, Namibia, Lesotho, Eswatini, Mozambique, and Malawi. Canada has closed its borders to non-citizens who have travelled to Southern Africa in the last two weeks. Israel has closed its border to foreign citizens.
Already there are at least two confirmed cases in NSW in fully vaccinated arrivals. Fully vaccinated arrivals into both NSW and Victoria must now self-isolate for 72 hours after arrival. The states have also imposed new rules on international flight crews, who need to isolate for 14 days or until they leave the country — bringing the rules for vaccinated crew into line with unvaccinated workers.
Omicron was first formally reported in South Africa on 24 November 2021, but the first known confirmed Omicron infection was on 9 November 2021 in Botswana. We applaud South African health authorities and WHO for their quick, open and decisive action in alerting the world and allowing precautionary measures to be put in place against this global challenge. Thus 20 days have elapsed since the first confirmed infection making it possible that Omicron has already seeded in many locations around the world.
There are a number of reasons for the concern surrounding the Omicron variant. The WHO has assessed that there is an increased risk of reinfection with Omicron compared with other variants of concern, and transmission may occur more readily than other variants, including Delta. Incidence is increasing rapidly in South Africa. Another key reason for the global concern is Omicron has mutations that suggest it may be partially vaccine resistant. If this proves to be the case, the relatively high double-vaccination rates in Australia (ages 12+) may not be enough to stop epidemic spread of this variant, without instigating a broader “vaccine plus” public health response and ensuring high 3rd dose coverage and vaccination of younger children.
Adopting precautionary measure to prevent further importation of this virus into Australia and reducing the spread of all variants of SARS-CoV-2 allows us time to understand the biology of the Omicron variant and prepare accordingly. Time is also needed to assess the effectiveness of the vaccine and current therapeutics against it. It also buys time to prepare for the use of Omicron matched boosters (already in development) if they are needed.
Many jurisdictions have initiated or planned the relaxation of COVID-control infrastructure and aspects of the public health response when high levels of two doses of vaccination are achieved. OzSAGE reiterates that a ventilation and vaccine-plus strategy is more important than ever now. Vaccination, safe indoor air, testing, tracing, masks, border control and quarantine are critical to our response at this time.
OzSAGE supports the Federal Government’s Immediate travel restrictions on non-residents coming from South Africa, Botswana, Zimbabwe, Namibia, Lesotho, Eswatini, Mozambique, and Malawi, and the Victorian, NSW and ACT Governments’ re-introduction of quarantine for all international arrivals
Oz SAGE recommends.
- Use of a ventilation and vaccine-plus strategy to protect Australia against Omicron and other variants that may emerge. Reliance on two doses of vaccination only is not adequate.
- Self-isolation or self-quarantine for international arrivals is not adequately precautionary given limited testing for Omicron in other regions, spread outside of the African continent and the potential for wider spread of the variant to have been undetected.
- Effective air-gapped quarantine facilities and 14 days quarantine with PCR testing to be used for all inbound travellers to Australia from all countries until more is known about Omicron. Hotel quarantine has had multiple breaches because of failure to systematically address ventilation and airborne transmission in all jurisdictions. Caravan parks, holiday cabins or other air gapped facilities are more reliable. In addition, hotels may be suitable if ventilation is tested and poor ventilation is mitigated.
- Effective air gapped quarantine for all air crew, including provisions to stop transmission to airport workers and transport workers. This includes respirator use for those workers who share air with the aircrew and passengers, indoors or in vehicles, in the course of their work. The Federal government should consider setting up air gapped quarantine facilities on airport land for air crew to reduce the risk of transmission. OzSAGE supports the use of quarantine and testing for air crew in Australia until they depart.
- Ensure high quality community surveillance for Omicron and other variants. Urgent PCR testing and supervised quarantine is required for all travellers who arrived in Australia from countries of concern in the last two weeks, given Omicron has been detected in early November. Those travellers waiting for results should be housed in air gapped accommodation whilst waiting for results. This may be at a suitable dwelling providing a surveillance program similar to the SA Health Check App. Apartments with enclosed internal circulation are not suitable for home-based quarantine.
- Retain indoor mask mandates, as well as testing and tracing infrastructure in the current circumstances. That includes the use of QR codes and digital tracing which can be rapidly scaled up. Victoria should take responsibility for contact tracing and reverse the decision to make infected people notify their own contacts.
- Urgent vaccination recommendation for 5-11 year olds and ensuring adequate supply of paediatric formulations in Australia. Also ensure no-one is left behind and that vaccination rates are equally high in remote and regional communities, among Aboriginal and Torres Strait Islander populations, groups facing structural disadvantage including people living with disability.
- Recommend 3rd dose booster any time from 2-6 months since the second dose and conduct a communication campaign to encourage 3rd dose vaccination. The waning of vaccine-induced immunity begins 2-3 months after the second dose, and an Omicron epidemic may be curtailed with high and rapid 3rd dose coverage.
- Negotiate arrangements for Omicron-matched boosters. Some manufacturers have already announced these are being developed. Also make procurement arrangements for promising new antiviral treatments.
- Increased Australian support for COVAX, particularly for vaccination initiatives in low and middle income countries and to ensure vaccine equity globally. Omicron is a stark reminder that until the whole world is highly vaccinated, COVID19 will remain a serious and disruptive threat to all nations. Australia should greatly amplify our support for immunisation in developing countries so no-one is left behind.
- Support to Australian researchers and clinicians working with international groups to understand viral biology, epidemiology and likely vaccine and therapeutic responses to Omicron.
- Strengthened measures to prevent transmission to unvaccinated children in schools and day care, particularly those that are ineligible for vaccination. This includes safe indoor air, vaccination of adults around them and masks.
- Ensure health facilities are as adequately resourced as possible to manage a surge in cases. Ensure third doses of vaccines and respirators are prioritised for frontline workers.