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The latest changes to Covid-19 rules – shortening isolation periods and removing some mask mandates – were made without any written advice and no modelling was provided to national cabinet. By Rick Morton.

No model for change to Covid isolation rules

Prime Minister Anthony Albanese after the national cabinet meeting in Sydney.
Prime Minister Anthony Albanese after the national cabinet meeting in Sydney.
Credit: AAP Image / Dan Himbrichts

When national cabinet met on Wednesday in a bid to shorten isolation requirements for people with Covid-19 and ditch the mandatory requirement for face masks on domestic flights, the health advice was not provided in written form. The federal health department could not point to any modelling provided at the meeting.

One of the Commonwealth’s deputy chief medical officers, Professor Michael Kidd, provided a verbal briefing to Prime Minister Anthony Albanese and the country’s first ministers, as has happened in the past, but in Wednesday’s case there was no accompanying agenda paper. Under Scott Morrison’s leadership, health advice was provided to national cabinet members ahead of any meeting for due consideration.

Another key plank in the Morrison strategy – commissioning modelling from the University of Melbourne’s Peter Doherty Institute for Infection and Immunity to inform changes to Covid-19 measures – has also been abandoned. No such modelling from the institute was commissioned or presented at Wednesday’s meeting.

“The national cabinet agreed that the isolation periods for Covid-19 positive cases would be reduced from seven to five days following a positive test, with the following caveats: this would apply to people with no symptoms – clearly, if you have symptoms, we want people to stay home, we want people to act responsibly,” the prime minister said after the meeting.

“Seven days’ isolation will remain for workers in high-risk settings including aged care, disability care, home care, which is important as well. I believe, and first ministers agreed, that on the weight of evidence this was a proportionate response at this point in the pandemic.”

The new rules, which come into effect on Friday, September 9, represent a difficult balancing act that has played out since the novel coronavirus arrived on Australian shores. As Kidd said in an official video released by the Department of Health, the road has been long and frequently demanded sacrifices in the name of public health.

“Back in the early days of the pandemic, before we had effective vaccinations, a well-fitted mask was a critical piece of personal protective equipment, or PPE, serving as a physical barrier to Covid-19, especially protecting front-line healthcare workers, and they still play this role,” he said in the video, posted last month.

“But now in our third year of living with Covid-19, masks also play a key role in reducing the risk of transmission. After all the hard but necessary public health measures, including lockdowns, contact tracing and border closures, we find ourselves in a different space today where we are learning to live with Covid-19. But it doesn’t mean that the risk has gone away.”

Indeed, just weeks before the national cabinet meeting that reached a consensus on relaxing isolation requirements, a paper published in The Lancet Respiratory Medicine attempted to quantify that risk in a real-world setting. Using a small sample of community cases for whom pre- and post-infectious periods could be identified, researchers from Imperial College London and other institutions showed that people with the Delta variant had a median infectious period of five days.

“However, our empirical data suggest that a crude 5-day self-isolation period releases two-thirds of still-infectious cases into the community, albeit with a 43 per cent reduction in mean log-infectious viral load relative to peak viral load, whereas by seven days post-symptom onset, one-third are still infectious with an 83 per cent reduction in infectious viral load,” the paper, which was published on August 18, says.

“Such evidence could enable policy makers, and the public, to calibrate self-isolation guidance.”

The researchers noted that their study was not able to capture data for the subsequent Omicron wave, which appears to have a slightly smaller window of infectiousness, estimated at being possibly 10 per cent shorter.

“Strategies based on our infectious window would therefore be, if anything, slightly cautious when applied to Omicron, consistent with the principle of public health infection control that favours caution over risk,” the paper says.

New Labor MP Dr Michelle Ananda-Rajah – an infectious diseases physician who announced on live television in February last year that the AstraZeneca vaccine had “failed” – used the above study to declare on Tuesday that “five days is not enough”. A day later, the prime minister said otherwise.

“We had a discussion about people looking after each other, people looking after their own health, people being responsible for that and making sure that they look after each other,” Albanese said, echoing the sentiments of Morrison when he urged “personal responsibility” in managing the pandemic.

“That is what has been happening. There aren’t mandated requirements for the flu or for a range of other illnesses that people suffer from.

“What we want to do is to make sure that government responds to the changed circumstances. Covid likely is going to be around for a considerable period of time and we need to respond appropriately to it based upon the weight of evidence.”

On this front, Albanese has also found himself in lockstep with the New South Wales premier, Dominic Perrottet, who has been a leading proponent of winding back isolation requirements and other measures.

On Thursday, Perrottet told ABC News Breakfast he didn’t want to pre-empt any further decisions that could remove mandatory quarantine periods altogether by the end of the year.

“So what I will say is that I do believe we need to move away from public health orders and we need to move to a place where if you’re sick, you stay at home, and if you’re not sick, you go to work, and that we respect each other,” he said.

“That’s the cultural change where we need to get to, rather than having mandates in place. So yesterday’s announcement is very pleasing, reducing it from seven to five [days]. But ultimately, the point we need to get to is a less reliance on public health orders and a greater reliance on people respecting each other.”

In the United States, people who test positive for Covid-19 must isolate for five days while in Britain and parts of Europe there is no mandatory period at all.

Much of the relaxation in the third year of the pandemic is due to vaccines and new drugs that have become available to limit hospitalisations and severe cases of illness. Even so, in absolute terms, health systems have remained under sustained pressure.

On Thursday, the NSW Department of Health reported 1754 hospitalisations from Covid-19 – among the lowest levels since the winter peaks – with 36 people in intensive care. In Queensland, 316 people were in hospital on the same day, with 10 admitted to intensive care. Across the country, according to point-in-time national data collected on Tuesday, the number of people in hospital with Covid illnesses had fallen by more than 300 from the week before. On Thursday, more than 50 people were reported to have died from Covid-19 nationally.

What works particularly well at restraining serious or severe illness is third-and fourth-dose vaccination. In Australia, almost 20 million people aged 16 and over are eligible for a third Covid-19 vaccine dose but just 14.2 million have had it. The rates are lowest in Victoria, NSW and Queensland, where just 69.7, 69.6 and 64.8 per cent, respectively, have had a booster.

New data from the US Centers for Disease Control and Prevention shows that, in June, an entirely unvaccinated person aged 50 or over had 14 times the risk of dying from Covid-19 than a vaccinated person with a primary series inoculation and two boosters. More importantly, a person with just one booster shot still had three times the risk of dying from Covid as someone with two boosters.

In February this year, well after the Omicron variant had surged through Australia, the then minister for Aged Care, Richard Colbeck, asked for advice about vaccine effectiveness against the strain. The Department of Health’s Mary Wood emailed the chief medical officer, Paul Kelly, to advise that her team “has put together some pithy (and sobering) news on efficacy of vaccines against Omicron”. Subvariants that emerged later proved even trickier, but new tools have arrived to fight them.

Early on Thursday morning, the US Food and Drug Administration gave final authorisation to two second-generation Covid-19 vaccines from Moderna and Pfizer. Both vaccines are bivalent, targeting the original and Omicron variants of the virus, which have shown greater immune escape during the latest wave of the pandemic.

Injections with these two drugs will begin in the US from Monday. Australia’s Therapeutic Goods Administration provisionally approved Moderna’s candidate on Monday – a lower level “provisional determination” was made for Pfizer’s drug in July – but it has yet to be officially added to Australia’s vaccination roster.

“The potential use of this vaccine in the national Covid-19 vaccination program is still to be determined. As with all Covid-19 vaccines, the Australian Technical Advisory Group on Immunisation (ATAGI) will provide advice to the Government on these matters in the coming weeks,” the TGA said in a statement.

“The Spikevax [Moderna] Bivalent Original/Omicron vaccine elicited a superior neutralising antibody response against Omicron BA.1 strain and a similar response against the ancestral strain, 28 days after use as a booster dose compared with the original Spikevax vaccine.

“Initial analysis shows that the bivalent vaccine also generates a higher immune response against the sub-variants BA.4 and BA.5 than the original Spikevax vaccine.”

The Department of Health said in a statement that advice was provided to the national cabinet “taking into account the current epidemiological context and phase of the pandemic”.

“A range of factors informed this advice, including advice from chief health officers to their respective premiers and chief ministers,” the statement said.

Prime Minister Anthony Albanese’s office declined to respond to specific questions about whether modelling for national cabinet’s decision was presented to the meeting on Wednesday.

This article was first published in the print edition of The Saturday Paper on September 3, 2022 as "No model for Covid changes".

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