Professor Brendan Crabb, Professor Mike Toole and Dr Suman Majumdar explain why NSW needs to reset its response to COVID-19 in an editorial for Nine Media publications.
Australia's third wave is showing no sign of peaking. All of NSW, ACT and Melbourne are in lockdown; all outbreaks have originated from the international border breach in NSW. It's hard not to conclude that NSW has lost control of its COVID-19 outbreak with the seven-day average at 502 and a current doubling time of 11 days. If the trend continues, that translates to 1000 cases a day by the first week of September and jettisons the nation's roadmap out of the pandemic.
The federal government's roadmap defines the vaccination levels required for restrictions to be eased - but it relies on a starting point of zero cases. This is what is required at the end of Phase A for any restrictions to be lifted. It also depends on Phase B dealing with an outbreak of just 30 cases across Australia.
Until now, every state and territory has pursued a policy of zero COVID (no community transmission) but recent signals from Premier Gladys Berejiklian suggest NSW has deviated from this goal. This makes the Doherty Institute modelling of scenarios based on 70 to 80 per cent vaccination redundant. Even if vaccination rates get to 80 per cent, the state cannot afford to lift restrictions at current case levels or the health system will be overwhelmed.
It is clear the state needs to reset its response to this outbreak if it is to grant its citizens more freedoms, in the long term, in line with the national roadmap.
Greater Sydney and the rest of NSW urgently need a strategy that is marked by uniformity, clarity and strong financial and social support. The current approach has the NSW government always behind the virus - gradually expanding local government areas of concern on the basis of infections that occurred a week earlier while the virus continues to spread elsewhere.
All of Greater Sydney at least should be under the same level of restrictions to simplify the message and stop transmission across the city. The government needs to work with community groups to ensure everyone is getting the support they need and that the message gets across to everyone. And it should share more information about how and where transmission is occurring, especially the role of workplaces when it comes to transmission, to help both the health authorities and the public understand how the virus is spreading and what they can do to prevent infection.
There is evidence to inform the measures in a reset. The impact of various stages of restrictions imposed during Victoria's second wave has been clearly documented. Stage 4 restrictions were introduced in Melbourne on August 3 last year when the daily number of new cases reached 671. This led to a steady decline in cases that reached fewer than 10 a day 10 weeks later. And that was without the addition of vaccination.
While it is impossible to disaggregate the relative impact of each component of Stage 4 restrictions, the package worked. It included mandatory masks indoors and outdoors, a five-kilometre limit on travel, the closing of all non-essential retail, containment of workplace transmission, a night-time curfew, and a strict definition of essential workers. It's worth trying at least in Greater Sydney and western NSW, to get the state back in sync with the rest of the nation.
Over the next six months Australia will transition from living with COVID-19 in a largely unvaccinated population to living with it in a highly vaccinated population. The boundaries and milestones that will mark this transition are still unclear and will be underpinned by epidemiological modelling based on data, international experience and emerging factors such as new variants.
The health consequences and strain on the health system are what ultimately trigger a lockdown. Once health services and, specifically, intensive care capacity are threatened by this virus, lockdown is unavoidable. That's why Britain - an early adopter of the "live with COVID" philosophy - spent much of the past 12 months in lockdown. Yet it ended up with the double-whammy of a terrible health outcome -130,000 of its citizens died, half a million were hospitalised and more than 2 million are suffering from long COVID.
This is why lockdowns are still a possibility even in a highly vaccinated population. In wanting lockdowns to be a thing of the past, as we all desperately do, it's important to recognise the real drivers of lockdowns: the Delta variant of the virus and its potential to overrun our health system, which will remain if about 20 per cent of adults (4.1 million) are unvaccinated and at-risk of hospitalisation.
No one wants a lockdown. But the evidence is clear that lockdowns are the most effective intervention in stopping SARS-CoV-2 transmission if they are implemented early as new outbreaks emerge. China has demonstrated the clear health and economic benefits of getting to minimal community spread.
And the current situation in NSW shows how a reluctance to use lockdown early can result in an extended and widespread lockdown instead. When you "go hard, go early", the less lockdown you eventually have - and the more freedom and less economic damage.
The degree to which we mitigate airborne transmission in community settings and apply other non-lockdown tools will have a lot to do with avoiding future lockdowns. This is what we call vaccines-plus. We need to plan and implement the "plus" as much as we do vaccination. The modelling used in the national roadmap assumes that such measures - testing, tracing, masks, and some restrictions - are continued alongside vaccination. Smart, bold ongoing public health measures will keep us safe and allow society to stay open.
The only way to live freely prior to high vaccine coverage is by being free of transmission in the community or close to zero COVID. A vaccine-led "exit" from this pandemic is on the way, but it is six months or so away as we refine our targets and plans. And all indications are that once high vaccination rates are achieved, our best shot at living freely is to start with almost no COVID in the community.
There are no data or country experiences to guide us on an alternate path. It is time to be ambitious and bold about the pursuit of low COVID in Greater Sydney and zero COVID in the regions through vaccine-plus, so we can live with more freedoms and live with COVID-19 in the best possible way.
