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National Cabinet reduces COVID protections as new data reveal the pandemic’s death toll

From 9 September, people will no longer have to wear masks on domestic flights and the isolation period for many of those with COVID will be reduced from seven to five days, National Cabinet decided yesterday.

The decisions come as new data underscores the significant toll that COVID is taking upon Australians’ lives and health, reports Croakey editor Dr Amy Coopes.


Amy Coopes writes:

National Cabinet moved to reduce the minimum isolation period for people infected with SARS-CoV-2 from seven to five days, as data suggested COVID-19 was on track to be Australia’s third-leading cause of death in 2022, with only dementia and heart disease claiming more lives than the pandemic virus.

Prime Minister Anthony Albanese announced the change, which will come into effect from September 9 for people who are symptom-free at five days and will exclude workers in high-risk settings including the aged, home care and disability sectors, following a meeting of First Ministers in Sydney.

“This is a proportionate response at this point in the pandemic,” the Prime Minister said in a communique post-meeting, which also flagged that it would no longer be compulsory to wear masks on domestic flights from the same date.

The Australian Medical Association called for the release of medical and health advice considered during the deliberations, with President Dr Steve Robson emphasising that decision-making had to be evidence-based and “the politicians need to explain themselves” if they had moved without supportive data.

“As many as 30 percent of people are likely to still be infectious on days six and seven, even longer,” Robson said in a statement following the announcement.

“When isolation rules change we need clear plans for protecting the vulnerable, and careful monitoring. If case numbers climb, then the isolation rules should be re-evaluated.”

Excess deaths

The widely-anticipated changes to isolation requirements came as the latest Actuaries Institute COVID-19 Mortality Working Group monthly report put excess mortality at 12 percent for May, equivalent to 1,800 deaths, and found that total excess deaths for the first five months of 2022 had reached 8,500.

Just over half of these (4,800 deaths) were directly attributable to COVID-19 – including 77 Long COVID deaths. The Actuaries assessment predicted that overall, in the first eight months of this year, the pandemic virus would outstrip cerebrovascular disease and lung cancer to become Australia’s third-leading cause of death.

Only dementia and ischaemic heart disease killed more people than SARS-CoV-2 between January and August, the report said, noting that August was the second successive month to see a record-breaking number of COVID deaths.

There were also notable numbers of excess deaths due to heart disease and stroke, diabetes and dementia, with earlier or intercurrent COVID-19 infection playing an unclear but likely significant role, the Working Group hypothesised.

This was explored in a Financial Times piece this week looking at the “epidemiological aftershock” of COVID-19 leaving people susceptible to a broad range of other conditions.

Actuaries Institute chief Elayne Grace said the ongoing concern about Long COVID in particular “underscores the importance of having strong plans and capacity to manage the long-term consequences of COVID, including in the health care system, income support system and workplaces”.

Disconnect

National Cabinet’s decision came as the Australian Bureau of Statistics reported a slide in testing in recent months, despite large numbers of people experiencing respiratory symptoms as viruses have a field day with the return to face to face work, schooling and socialising.

While close to half (42 percent) of people polled for the ABS’s quarterly Household Impacts of COVID-19 survey reported that someone in their household had experienced symptoms over the past month, testing numbers had declined from 62 percent of households in April to 48 percent.

This data underscores the epidemiological risks of reducing the isolation time, including that not all symptomatic people test, and that even among those who do and have a confirmed positive, there will be an untold proportion who leave isolation at five days while still infectious because they believe they are no longer symptomatic.

The scale of the disconnect between true prevalence and what is reflected in official numbers is starkly illustrated by seroprevalence surveys of Australia’s blood bank donations.

According to this data, roughly one-quarter of the Australian population was infected with COVID-19 in the three months to June – some 6.8 million people overall. Yet, over the same period there were only 2.7 million infections reported.

There is significant inter-individual variability in incubation and infectious periods and in the degree of viral shedding, further complicating universal isolation periods.

Precautions needed

Health professional lobby groups including the Australian Nursing and Midwifery Federation had cautioned ahead of National Cabinet against returning to the ‘let it rip’ mentality which had seen infections surge in the lead-up to Christmas last year.

ANMF federal secretary Annie Butler said the Omicron wave of late 2021-early 2022 had caused “enormous stress on our health and aged care systems, enormous disruption and thousands of deaths”.

“Our politicians must learn from their previous mistakes and ensure all decisions are based on expert health advice, and that nurses, midwives, care workers and other health professionals are not overwhelmed, and the most vulnerable in our community continue to be protected,” she said.

“Supporting and caring for the country’s most vulnerable is much more than personal responsibility, it requires a collective response led by well-informed, committed politicians.”

Butler said any rollback of measures should be staged and measured, with the flexibility to reinstate protections if required. She noted that in other countries where isolation periods had been abandoned, mask-wearing had been mandated and “that is the type of sensible, considered approach we could adopt here”.

Ahead of the meeting, Professor James McCaw – a respected and pivotal figure in Australia’s COVID modelling and response – acknowledged that, while “we cannot keep the (isolation) order in place indefinitely… the pandemic is still highly active so now is not the time” to be winding it back.

Professor Adrian Esterman, also a modelling expert, said adopting the EU approach of test-to-release would be a much sounder alternative, given half of COVID-19 cases remained infectious on Day 5.

Medicos in Federal Parliament, including Dr Monique Ryan and Dr Michelle Ananda-Rajah, warned against any reduction in the isolation period ahead of the National Cabinet meeting.

Experts including Professor Greg Dore, an epidemiologist and infectious diseases specialist from the Kirby Institute, argue that shortening the period from five to seven days is likely to have an impact that is marginal at best on the prolongation of the pandemic.

Regardless of how marginal the impacts will be, they will be felt acutely on the frontlines of an already-strained health system, and they stand to entrench disparities for marginalised communities including people living with a disability or terminal illness, and those in insecure work.

The AMA said it was now more important than ever for people to test if symptomatic, ensure they were up to date with their booster shots, continue social distancing and masking when indoors, and be vigilant about hygiene.

Robson said it was essential that governments at every level take “immediate and ongoing action to address the logjam in our public hospitals, which are suffering under extreme demand and staff shortages, further exacerbated by the number of COVID-positive cases presenting.”

It was also critical to have contingency plans in place to prevent and respond to outbreaks in vulnerable settings, including aged care, he added.

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