Possible COVID quarantine changes flagged

Possible changes to the COVID isolation requirements will be discussed when State and Federal politicians gather for a National Cabinet meeting on Wednesday (30 August).
 
The current isolation requirement of seven days in Australia is longer than in many other countries, with no restrictions in place in the UK, while in the US it was cut to five days late last year.
 
The NSW Premier Dominic Perrottet has said he would like to reduce the isolation period to five days, while the Victorian Premier Daniel Andrews said he would be open to a change depending on health advice.
 
The Health Services Union (HSU), meanwhile, is advocating a complete end to mandated isolation requirements, while others including ACT Chief Minister Andrew Barr believe the current settings should be maintained for now.
 
Dr Marguerite Tracy, a Sydney GP and a member of the RACGP’s Expert Committee – Quality Care, told newsGP the recent discussion has made her reflect on the implications of any change.
 
She notes there is still a ‘considerable amount of disease circulating in the community’ with ‘admissions still high in our hospitals’, and highlights the complexity involved in setting quarantine time.
 
‘There are many competing issues when looking at the impacts of reducing or removing mandated isolation,’ Dr Tracy said.
 
‘Business and many of the public are keen for a return to normal for mental health and productivity.
 
‘Balancing these valid reasons against risking a surge in case numbers, not allowing a bit of space for the health system to recover and not minimising the concerns that are still held about what we don’t know about COVID is tricky.’
 
Dr Tracy believes a ‘compromise’ of five days may be the best way forward at this stage, along with extended post-infection exclusion and testing requirements for high-risk settings such as aged care.
 
The gap between the number of people who have had a primary course of COVID-19 vaccination but are yet to have a booster also needs to be addressed, according to Dr Tracy.
 
Professor Catherine Bennett, the Chair in Epidemiology at Deakin University, again stresses the complexity of any change. Describing it as a ‘very complicated issue’, she also highlights how many people are likely to be in the community without declaring or detecting COVID-19 infections.
 
‘We’re probably now hearing about less than a third of infections,’ Professor Bennett told newsGP.
 
Acknowledging that reducing the isolation period could increase the number of infectious people in the community, she suggests the risk would be relatively mild – particularly as many people do not start to isolate until after they are infectious.
 
‘When you go out to seven days, 75% of people are no longer shedding infectious virus, and that’s probably equivalent to a five-day isolation period, because it will take a day or two to get into isolation,’ Professor Bennett said.
 
‘If you’ve got 25% or less who are still infectious at the end of that period … they’ve got a very low viral load.
 
‘Even if [they are] shedding infectious virus, it may not be in sufficient volume to really pose a risk, particularly if people do the things they are advised to do after isolation such as wear masks.’
 
She believes there is a delicate balance between keeping people engaged and deterring compliance with stricter guidelines.  
 
‘When you put all those things together, the risk in dropping from seven to five days is less than the risk that people are going to drop out of isolation altogether if it stays at seven days,’ Professor Bennett said.
 
Like Dr Tracy, she also advocates for stricter monitoring in high-risk settings such as aged care and says that clear explanation of the reasoning behind any decision is crucial.
 
‘We call it mandatory, but it’s not in any way enforceable now,’ Professor Bennett said.
 
‘Given that it’s only for a fraction of the actual number of infections out there, mostly through no fault of the infected because they don’t even know they’re infected, then I don’t think it can ever be enforced.
 
‘Now is the time to put disease control into the hands of people by supporting them with really good, clear information.’
 
The college has said the length of quarantine is a matter for states and territories, but in its submission to the 2020 Senate Inquiry about the Australian Government’s COVID response, it called for a consistent national approach to prevent confusion.
 
A number of politicians have also referenced the need for consistency this week.
 
Dr Tracy is hopeful that the trend of COVID-19 infections will continue to decline and offer some relief to exhausted health professionals.
 
Both she and Professor Bennett say it is only a matter of time before COVID-19 is treated in the same way as other infectious diseases with no official isolation requirements – but that no definite timeline could yet be defined.
 
‘We’ll probably still do this in steps,’ Professor Bennett said. ‘That’s a good thing. Come spring … then summer, hopefully we [will] have a reprieve from new variants and will be in a better position.’
 
Dr Tracy, however, highlighted the unpredictable nature of the pandemic.
 
‘Eventually we won’t have restrictions but I suspect [the timing] will depend on what the next variant brings us,’ she said.
 
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