The NSW roadmap is uncharted territory, a Covid experiment pitting the vaccinated against the rest
It feels a little unsettling to think that in New South Wales those of us who are vaccinated will be returning to pubs and restaurants in October at the very time that hospitalisations and deaths from Covid-19 peak.
It’s as if an exhausted government and its citizens have shouted a collective “whatever!” and surged en masse towards a footy match and a glass of beer.
At Thursday’s press conference, the NSW premier, Gladys Berejiklian, and her treasurer, Dominic Perrottet, seemed almost lighthearted as they announced the planned relaxation of the lockdown for the vaccinated once 70% of those eligible have had two doses – probably in the third week of October.
The chief health officer, Dr Kerry Chant, not so much.
The NSW government, having failed to rein in case numbers with lockdowns, has now put its faith in modelling by the Burnet Institute.
The theory is this: by mid-September, as high vaccination rates start to kick in, particularly in the hotspot local government areas (LGAs) that still account for about 80% of cases, new infections will start to fall due to vaccine-acquired immunity.
This implies the number of people each person infects has fallen below one. Last week the government said the reproduction number was 1.3, which means that for every 10 people with the virus they will infect 13 others.
The number of people in intensive care, or dying, will continue to rise in October, as already infected people struggle, or fail, to beat Covid.
It will be horribly challenging and confronting for our hospital staff and for families who lose loved ones, but in theory, there will be light at the end of the tunnel.
Of course, the other input to the Burnet model, other than vaccination rates, is the lockdown settings and compliance. Its predictions of hospitalisation levels and 724 deaths in the LGAs of concern alone by December are based on the current restrictions and good compliance.
But we are planning to relax restrictions – at least for the vaccinated – and so we enter uncharted territory.
The immediate reaction to this announcement from the experts has been – at least in some quarters – raised eyebrows.
Prof Mark Stoove, the head of public health at the Burnet Institute, told the ABC that his general advice was to be “extremely cautious” in lifting restrictions at 70%.
The Australian Medical Association called on the NSW government to provide more details with the roadmap, including modelling of future case numbers and the impact on the health system.
For her part, Chant refused to say she was happy with the plan, but she did describe it as “cautious”.
There have been reports she wanted to wait until 80% of adults were fully vaccinated and that vaccines were more available to children. Chant did not confirm this but she said the state will reach a single-dose rate of 80% next Monday or Tuesday, pointing to the 80% double-dose target being achievable.
Chant has also been given the power to declare any need to backtrack on the reopening. Both she and Berejiklian were not specific about what would trigger a reversal of the recovery roadmap.
Berejiklian explained: “If there’s high numbers of cases and a concern about an outbreak, and the vaccination rates aren’t … at a level we would like, Dr Chant is at liberty to say to the government: people in this community, even if they’re 70% double vaccinated, they can go to the hairdresser and do this and that, but they might be limited only to a radius outside their home, or within that area.”
Chant foreshadowed that there could also be other restrictions reimposed “based on our understanding of the circumstances of how transmission is occurring”.
“So they may not be geographical, there may be other strategies,” she said.
Neither were clear about whether continued high case numbers in hotspot LGAs could mean parts of the state are in some form of lockdown longer.
“Now, as an epidemiologist, I do not want to call it too early,” Chant said. “But I just want to give some hope that if you continue to stick the course, we may well see declining case numbers in some of those areas, as we see vaccination rates climb.”
Chant also emphasised – twice – that the current lockdown had to hold until 70% vaccination was reached.
Enforcing the roadmap
The big unknown in the plan is how on earth the new restrictions will be enforced.
The freedoms only apply to the fully vaccinated. Will the NSW police be attending weddings to check the status of the 50 guests? Will they be turning up at places of worship to make sure the minister or imam is ensuring proper check-ins of the vaccinated godly?
It will be easy enough to check vaccination status at hotels and restaurants, particularly if the NSW government plans for QR check-ins to also display vaccination status.
It’s less easy to ensure all staff are vaccinated, and even harder to police the gatherings of five fully vaccinated adults in private homes.
And how will retail staff at a small boutique or cafe fare in barring entry to an unvaccinated customer?
The good news for other states is that they can watch the NSW experiment and decide whether they want to follow suit. Some activities will prove safer than others. Some may turn into super-spreader events.
But have no doubt: NSW cases will go up. The NSW government is just hoping that the epidemic among the unvaccinated, who will not be protected from potential severe disease, will be slow coming.
Meanwhile, life will be pretty miserable for those who aren’t vaccinated.
Aside from being the most vulnerable to Covid, they will be largely stuck under the current restrictions, confined to visiting only essential retail, such as supermarkets, and taking walks.
The government will need to come up with an alternative to vaccine passports for those with medical conditions and ensure the anti-vaxxer movement doesn’t exploit this exception.
The government should also get ready for a ferocious backlash from the extremists. From mid-October, anti-vaxxers will have to live with the consequences of their belief in dubious science, divine intervention, or individual freedoms over the collective social good.
So, it’s really unsettling, but unfortunately it’s the new normal.
The last word goes to Chant.
“I think everyone around the world watches the situation overseas, and I think we have been very honest that we have to learn to live with Covid,” she said.
“We are going to be vaccinated, vaccinated again. We’re going to be potentially challenged by different variants. This will be a journey.
“But the real hope is that we have effective – safe and effective – vaccines. We will have to learn how to live with Covid and after years of cycling through this, we will get to a level of comfort.”