Freedom or folly: experts wade in on the NSW roadmap out of Covid lockdown

By Catherine Bennett, Bill Bowtell, Alexandra Martiniuk and Tony Blakely
nurse vaccine
‘The upside is that the plan for increased freedoms might increase vaccination rates,’ says Prof Alexandra Martiniuk. Photograph: Brendon Thorne/EPA

Make the last weeks of lockdown the most effective

Light at the end of the lockdown tunnel is going to help people hang in there as we move through these last weeks of restrictions that are still important for holding infections at bay while vaccinations bookings are made. The modelling tells us that we can expect to have better control of viral transmission once we approach these high levels of cover, but we will also be able to see that for ourselves in the way the current outbreak is being brought further under control with each passing week.

The projected date for reaching the 70% level of vaccine cover in New South Wales puts the likely easing date five and a half weeks from now. That is time enough to bring the case numbers down; they don’t have to be zero, just low enough to have eased pressure on the health system and to allow more minimal safety measures to keep numbers in check from there. In the second wave, Victoria dropped from its peak of 725 cases to under 50 cases a day in just five and a half weeks.

The NSW roadmap opens up more of hospitality and retail than would otherwise be possible coming out of a large wave while still having virus circulating in the community. But they are managing the risk by limiting access to those with the protection of being fully vaccinated to access businesses. This will be a challenge for those booked in but still some way off receiving their Pfizer, but the only other option is to open up later for everyone so it would not change their access in the long run.

The roadmap banks on the fact that those vaccinated are less at risk if they are exposed to the virus when out mixing. The recent React-1 study report from the UK found fully vaccinated people had only one-third the infection rate compared with those who were unvaccinated. What’s more, we know if someone is infected, they are 95% less likely to experience serious illness and so it is less of a risk to them, and to our hospital system. And while they may initially be as infectious as an infected unvaccinated person, the evidence suggests fully vaccinated people are infectious for a shorter time, reducing the risk they pose to others.

Some will be anxious about this seemingly big step, but as we close in on those vaccine targets, we will know in advance if there is sufficient control of transmission to make this a safe and sure step. The best way to guarantee that outcome is to make the last weeks of lockdown the most effective they can be. A last concerted effort from everyone to minimise transmission risk while accelerating vaccine uptake will make this opening less risky, and might even make it happen sooner.

• Catherine Bennett is chair in epidemiology at Deakin University

Many words might describe this but ‘freedom’ isn’t one

In mid-June, the NSW government took the fateful decision not to suppress the outbreak of the Delta variant that infected frontline workers at Sydney airport.

According to the NSW premier, the “living with Covid” plan has been prepared over the past 18 months, but its essential elements were never divulged to or approved by either the people or parliament.

“Living with Covid” is thus the expression of the two great failures of Australia’s response to Covid-19: inadequate border protection protocols and botched vaccine procurement, supply and distribution – and both compounded by opaque policymaking and lack of transparency.

The social, educational and mental health pressures of the lockdown required to transition to “living with Covid” are obvious to all. The unalloyed benefit has been rapidly increased vaccination coverage.

But there was no need to impose “living with Covid” in order to achieve high vaccination rates. As supply increased and incentives were offered, NSW vaccination coverage rates would have risen just as quickly.

The roadmap to freedom for the fully vaccinated reveals more of the costs of the NSW government decision to vaccinate after, and not before, allowing cases to soar.

High case numbers will persist. Into the indefinite future, restrictions, lockdowns, lockouts, border closures, monitoring and lack of certainty for people and businesses will be integral to the management of “living with Covid”.

Many words might describe this, but “freedom” is not one of them. We are much better off to be vaccinated. But there was a much less costly and better way to do it.

• Bill Bowtell AO is an adjunct professor at UNSW and a strategic health policy consultant. He was an architect of Australia’s successful response to HIV/Aids and has contributed to the global and national response to HIV and other infectious diseases

We may have reached the peak of cases in NSW

We all want to be on the road to freedom. We are all getting there. But these freedoms for some, at 70% vaccinated, come with more health risk for the community than waiting for 80% vaccination rates. The 70% vaccinated freedom timeline lands around mid-October, schools are returning on 25 October, and a peak in hospitalisations and need for ICU is due to occur around this same time.

Given 70% of those 16-years-plus being vaccinated means that about 44% of the total population remain unvaccinated and that vaccination rates are not uniform across NSW. Some individuals and some communities will likely experience an increased risk of Covid-19 infection when this freedom plan commences. Vaccinated people can be infected themselves and spread Covid-19 (albeit less than those not vaccinated). Not everyone who wants a vaccine has had the opportunity to access one as well. Hotspots may remain with tight restrictions. Freedom will not be uniformly available.

Many rural local government areas in NSW have double vaccination rates around 30-40% of the 16-plus population (equivalent to 24-32% of the total population). The regional travel allowed under the vaccinated freedom plan may contribute to seeding events of the infection into largely unvaccinated (including Indigenous) communities.

The upside is that the plan for increased freedoms might increase vaccination rates.

Our effective reproductive rate appears to be dropping, and estimates today put it at just under 1.0, which may mean we have reached the peak of cases in NSW on Thursday and are on our way down. This will help.

Overall, I think NSW would benefit from a plan designed by industry and health.

• Prof Alexandra Martiniuk is an epidemiologist at the University of Sydney

We still need to be cautious

The NSW roadmap looks reasonable – we have to open up at some point, and this plan seems a reasonable plan.

However, a good plan does not mean it will work – especially with Covid-19. What will be required is very close monitoring of daily cases after (each) incremental opening up.

If the daily increase in numbers surges, and a forecast suggests the numbers will surge beyond whatever is the threshold of daily cases that NSW is prepared to tolerate (say 2,000, with 100 hospitalisations per day as a maximum), then some opening up will need to be reversed.

Secondly, vaccinated people can still get infected and transmit the virus. AstraZeneca has about 60% effectiveness at stopping any infection, Pfizer 80% (they are both much better at stopping serious illness and death). Assume an average of 70%.

Then the chance of transmission in an environment is reduced by over 90% if both people contacting each other are vaccinated, compared with two unvaccinated people contacting each other. So yes – greater liberties for vaccinated people are justified, but we still need to be cautious (for example: masks on, get tested if symptomatic, etc).

• Tony Blakely is a professor of epidemiology at the University of Melbourne

What is inkl?

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