New South Wales should introduce new restrictions in order to avoid uncontrollable spread of Covid-19, experts have said, after the premier, Gladys Berejiklian, reiterated the state was on a “knife-edge” when it came to containing the virus.
Infectious disease and epidemiological experts said while contact tracing efforts in the state have been strong, more measures including further restrictions on venue capacity and increased testing efforts were needed in order to ensure mystery cases did not lead to further spread.
“It’s a daily battle in NSW, we have to be on our toes, we are in a state of high alert,” Berejiklian told reporters on Tuesday. “My anxiety has not subsided in relation to what a knife’s edge NSW is on, but we need to keep pulling together, doing the right thing and keep maintaining our social distance, and most importantly, even with the mildest symptoms stay home and get tested,” she said.
Berejiklian made similar comments on 6 August, saying: “We are on a knife-edge, and we are about halfway through what is a really critical period.”
The state reported 22 cases on Tuesday with eight of those linked to a cluster at the Tangara School for Girls in the north-west Sydney suburb of Cherrybrook. The NSW health minister, Brad Hazzard, said: “It’s not always possible to determine the source and that’s what worries us most.”
The program head with the Kirby Institute, Dr Gregory Dore, said to achieve zero community transmission, “an objective for which most people are on-board, further restrictions should be instituted”.
“These should focus on limiting larger indoor gatherings, with a short-term closure of pubs, clubs and larger restaurants the most obvious step to take,” Dore, who is also an infectious diseases doctor at a major Sydney hospital, said.
Prof Peter Collignon, who is part of the expert group advising the federal government on Covid-19, said he was concerned too many people were still being allowed to gather indoors.
“Quite rightly the premier says we are on a knife-edge, and this is happening in winter, a time when many infectious diseases spread more readily, partly because people stay indoors and gather together,” he said. “They should reduce the number of people allowed to gather including in venues because we have seen how many clusters are related to venues such as restaurants and pubs, and if they don’t do it now, they should do it in a few days.”
The law in NSW allows 20 people from different households to visit a home at any one time, though advises people not to gather in homes in more than groups of 10. In restaurants, cafes and pubs, group bookings are limited to 10 people, with venues observing the four square metre per person rule, and there is a limit of 300 people at a venue at any one time. Food courts are open.
The adjunct professor of epidemiology at the University of Sydney and the University of Toronto, Alexandra Martiniuk, said any time there was community transmission with no known source there was reason to be worried. “The new Tangara school cluster is a concern given the original source of the cluster remains unknown and the cluster size is also growing,” she said.
She believes NSW should consider temporarily closing indoor bars and restaurants until there is no community transmission. Mandating masks in indoor spaces and high school students and staff would also be useful, she said.
While Martiniuk said NSW Health contact-tracing efforts were “stellar” compared to other states and internationally, and data transparency was strong, there could be stronger governance regarding self-isolation when someone has symptoms, when someone has been tested and is awaiting results, and clearer messaging regarding what to do regarding self-isolation when a member of the household has symptoms.
“Removing the need for GP letters regarding the need to stay away from school for students with symptoms or students awaiting Covid-19 test results would also be useful as some parents are now being chided by schools for students missing too many days,” she said. “Parents don’t want to attend GP offices to attain letters for school absences for the sniffles so send their child to school to save all the hassle. The community is becoming lenient regarding attending school and other places with mild symptoms.”
The chair in epidemiology at Deakin University, Prof Catherine Bennett, said the government could be doing more to encourage people without symptoms, but who had been to venues or locations where outbreaks had occurred, to come forward to get testing.
“There is strong enough contact tracing being done to prevent an explosion of cases and stay on top of the virus, but they are not really shutting it down,” Bennett said.
She said there were very few “mystery” asymptomatic cases in the community in NSW, but that those cases, if they went to an area vulnerable to infection such as a workplace, could provoke spread very quickly.
“I just think if you tested everybody associated with a known cluster in those first few days after the cluster is identified, whether they have symptoms or not, you might catch a few people who never get symptoms,” Bennett said. “It still might be better at the moment to take this targeted approach rather than shutting the whole community down.”
