Highly infectious COVID variants spur calls to shut Australia’s borders

Matt Woodley

5/01/2021 4:52:21 PM

A former WHO epidemiologist told newsGP the best way to handle a potential outbreak of a new strain is ‘by stopping it from happening in the first place’.

Graphic showing coronavirus cell mutating.
The new variants are believed to be around 70% more infectious than previous versions.

The new variants, which emerged in South Africa and the UK, are thought to be much more infectious and, in the former’s case, may potentially affect vaccine efficacy.
Returned overseas travellers in hotel quarantine in Brisbane, Sydney, Melbourne and Adelaide have already tested positive for the new variants, while Perth has now also recorded its first cases.
While not thought to produce more severe responses in those infected, the variants’ transmissibility has led to calls for Australia to follow the lead of other countries and ban entries from affected areas.
According to the Herald Sun, University of Melbourne epidemiologist Professor Tony Blakely believes Australia should consider halting international flights until all frontline workers in hotel quarantine can be vaccinated.
‘The way that we’ve managed hotel quarantine here, we’ve actually got to be pretty good but we’re hitting the ceiling as how good we can get,’ he said.
‘No matter how good your processes are, occasionally it’s going to get out.
‘[The new variant] will make the risk of leakage greater again ... and once it gets out it can explode much quicker.
‘Should it be done? That’s above my paygrade and also requires considering politics and the issue of Australian citizens coming home and the compassionate grounds and other things. But is there a case? Yes there is.’
Professor Blakely’s assessment is similar to that of Professor Adrian Esterman, Foundation Chair of Biostatistics at the University of South Australia and former World Health Organization (WHO) epidemiologist. He told newsGP the easiest way to combat any new variant is simple – do not let it enter the country.
‘The new B.1.1.7 variant of SARS-CoV-2 now rampant in the UK … is approximately 70% more contagious than the original version,’ he said.
‘It is reported to lead to an increase of 0.4 in the reproduction number [R0], making controlling the epidemic much more difficult.
‘It would be far better to tackle the problem of a potential outbreak of the new strain by stopping it from happening in the first place.’ 
Like Professor Blakely, Professor Esterman is in favour of suspending international arrivals into Australia but concedes this is unlikely to happen.
‘From a purely public health perspective, we should immediately stop the return of Australians from overseas … but [I] assume that there are legal and political reasons why this is not an acceptable option,’ he said.
‘What we can certainly do and should do, is to mandate testing both pre-departure [PCR] and on arrival [rapid antigen] for all returning Australians, as well as any international flight crew.
‘The current methods of controlling outbreaks in Australia have been very effective, especially the recent hard lockdowns in Victoria and South Australia, and would work against the new variant.
‘However, the more laissez faire approach taken by the New South Wales Government would be problematic.’ 
There have been cases stemming from four separate hotel quarantine breaches in NSW in the past month alone, and Victorian Emergency Services Minister Lisa Neville recently warning of the ‘significant risk’ posed by flight crew in particular, who in NSW can be exempt from hotel quarantine.
According to Minister Neville, since Victoria revamped its hotel quarantine program on 7 December, nearly one third of the 27 coronavirus cases housed in hotel quarantine have been found in flight crew members.
‘This is over and above the averages that we are seeing in international returned travellers,’ Ms Neville said.
‘This was an incredibly important decision to make sure that we are quarantining flight crew and that we are testing flight crew. Those odds are very high.
‘In fact, I would be today saying to the other states, this is such a high risk for all of us, for the country, everyone needs to follow the lead around quarantining and testing of flight crew. It is absolutely critical, given the numbers that we are seeing.’

Hotel quarantine leaks have led to a number of different COVID-19 outbreaks. (Image: AAP)
Minister Neville said Victoria’s Acting Chief Health Officer Professor Allen Cheng will raise the issue with the Australian Health Protection Principal Committee (AHPPC), and Professor Esterman believes other states and territories should at minimum follow Victoria’s approach.
‘The systems in the different jurisdictions are clearly not 100% safe, with no guarantee that the new variant will not escape,’ he said. 
‘We have seen leaks from the quarantine systems in Victoria, New South Wales and South Australia, and many security guards in the South Australian system suspended or sacked for various reasons.
‘Why on earth don’t we set up a national quarantine station on Christmas Island? We could get the ADF to extend the runway and spend a few billion on improving infrastructure. This might sound a lot of money but is only equivalent to a short lockdown in New South Wales
‘If the Federal Government won’t do this, then at least get all jurisdictions to adopt best practice in hotel quarantine – which at the moment is the Victorian system.’
UNSW epidemiologist and infectious disease expert Dr Abrar Ahmad Chughtai told newsGP enhancing and standardising infection control safeguards in medi-hotels should be a high priority.
‘We need to keep COVID-19 under control in Australia until we achieve herd immunity through vaccination,’ he said. ‘If COVID-19 spreads here, we may see the same situation what we see in US, UK and some other European countries.
‘One reason Australia and New Zealand did very well is quarantining returning travellers in hotels, as this resulted in less spread in the community.
‘But we have also seen some breaches … I think the most important [safeguard] is to use police and law enforcement people at hotel quarantine sites, instead of private security guards.
‘Returning passengers from the UK, South Africa, US and any other country in future with the new strain should [also] be very closely monitored.’ 
But while Dr Chughtai believes flight crew need to isolate, he feels there is less of a need to test them as many only spend short periods in the country and present a high chance for false negatives.
‘More control measures … [are] better. But the problem is, even if you test them, you still need to quarantine them [anyway],’ he said.
‘Because, for example, even PCR tests only return positive results a few days after exposure sometimes. So, even if they test negative, you still can’t let them go in the community.
‘They should be staying in the hotel and they should be leaving from the hotel, and it should be that simple.’
Should the variants eventually make it into the community in Australia, Dr Chughtai does not believe GPs or healthcare workers will need to take any further infection control steps to protect themselves – with one caveat.
‘Regardless of the strain, I am a strong supporter of using respirators for healthcare workers,’ he said.
‘Respirators provide more protection compared to masks and all frontline healthcare workers need to use respirators.’  
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Dr Peter James Strickland   6/01/2021 12:06:20 PM

These epidemiologists talk about elimination. The virus(es) are NOT going to be eliminated, and by attempting to close the borders (as has happened in WA) makes the population vulnerable to not only Covid 19, but to all the other respiratory viruses that affect the community , and eventually giving herd immunity by one respiratory virus tending to block other future respiratory viruses.
The solution is to expedite the vaccine campaign for Covid 19, and think about influenza vaccine as well---what are the Australian government waiting for until March 2021 ---get it going NOW, and give priority to all the health workers and vulnerable elderly and other health compromised people!

Dr Mark Karaczun   11/01/2021 12:10:38 AM

I am a UK GP who is scheduled to fly to OZ in the coming weeks. Having assisted with (Pfizer) vaccinations here, in principle, I am ready to hit the ground running to help with Australia's vaccination problem. However, I will be restricted by AHPRA's insistence on presenting in person (despite me being in their office in Dec 2019) before my AHPRA number can be issued. Then, I need to apply for a Medicare Provider number, etc. Instead of helping vaccinate Australians the day after I emerge from quarantine, I need to wait for bureacracy before I can help. So frustrating!