The “Roadmap to freedom”, unveiled this week in NSW, plans for a significant decrease in restrictions once 70% of people over 16 years are fully vaccinated. This represents just 56% of the whole population fully vaccinated, and is not enough to control the Delta variant. We need a higher proportion of the total population double vaccinated, and even then, vaccinations alone may not be enough to stop the spread.
Israel, the UK, and the United States all lifted restrictions between May and June, after Delta arrived, when total population vaccination rates were about the same as the NSW targets. This resulted in a resurgence in all three countries of high and significant rates of infection with heavy strain on health care and hospitals, even though all of these countries also had much higher levels of immunity due to natural infection and vaccination than in Australia.
As restrictions ease, cases will surge
As we progressively increase movement and mixing of people, the spread of the virus will escalate. With hundreds or thousands of cases at the time of lifting restrictions a further surge of cases primarily affecting the unvaccinated (about 44% of the population) is likely. Given that the health care system is already expecting substantial strain, a further surge may result in an overwhelmed health system over the holiday period in December and January. We will be releasing modelling of the roadmap scenario next week.
Ventilation and “Vaccine-Plus” are the pillars of safe lifting of restrictions. “Plus” refers to testing, tracing, masks and other strategies. Contact tracing, quarantining of contacts and identifying and isolating cases are key to keeping the virus under control. We must massively scale up the capacity to rapidly trace contacts and keep up with rapid testing. We must ensure mask use is high. We currently estimate 65% of people are wearing masks, but this needs to be over 80%. Instead, the road map will decrease this to about 50%.
Ventilation is about providing safe air and mitigating airborne transmission in health and aged care, in our schools, workplaces, social venues and homes. Australia has not systematically addressed the dominant mode of transmission of SARS-CoV-2, the air we share, and the community has low awareness of the importance of safe indoor air. Raising public awareness, testing ventilation in public spaces and shared private spaces, and mitigating poor ventilation can reduce transmission risk. OzSAGE urges the NSW government to adopt our advice in safe indoor air.
No-one left behind. OzSAGE is concerned that the roadmap assumes equal access to vaccines for all people in NSW. The rates of vaccination across NSW are highly varied, with the highest rates in affluent parts of Sydney, and lower rates in regional areas and less affluent parts of Sydney. Unvaccinated people should not be blamed or vilified. Many people face barriers to vaccination, and unvaccinated people may not have access because of ongoing restricted vaccine supply. Younger people cannot get bookings until the end of the year. Many people with disability have been unable to access vaccines due to inaccessible vaccination sites, booking systems, and, in some cases, vaccine providers have not done in-reach into group home settings as planned. Many regional and remote communities and Aboriginal communities have much lower rates of vaccination, and have to travel far to get to a vaccine centre. Many of these regions do not have the same level of primary health services or hospital services as metropolitan areas, or the same capacity in COVID-19 vaccination. An influx of visitors will put unnecessary strain on already stretched services. Travel to these areas should not occur until vaccine targets are met for all regional and remote communities, all Aboriginal communities and all groups with structural or social disadvantage. If this does not occur, the Delta variant will rip through these communities when restrictions are lifted. OzSAGE urges the NSW government to protect these communities.
Safe schools and childcare (masks, ventilation and vaccination of teachers and childcare staff) are also a key part of lifting restrictions, so that unvaccinated children are protected. There is much more that can be done to protect our precious children in childcare and schools. OzSAGE will be releasing separate advice on this, but our response to the NCIRS report contains some key recommendations.
The health system needs health workers still standing
As health workers become infected and quarantined, the health system will not be able to function well, just as cases are surging. There is evidence that the protection of vaccines, especially Pfizer, may wane after about 6 months. Data from available studies suggest that a third dose dramatically boosts immunity, even in people with weakened immune systems. Israel has started vaccinating older adults with a third dose booster and the US will soon do so for everyone. Our health workforce was vaccinated in March 2021 and may be having waning immunity just as the COVID-19 epidemic in NSW surges. A 3rd dose booster should be provided for the health workforce, especially those caring for COVID patients. Supplies of N95 and P2 respirators also need to be scaled up to ensure adequate protection of health workers.
OzSAGE will be holding media conferences in the near future. Stay tuned.