OzSAGE releases independent expert advice on opening safely in the COVID-19 pandemic

Today, OzSAGE, a diverse, multi-disciplinary network of Australian experts, releases its first preliminary advice paper and high-level recommendations for the safe opening of Australia to complement the National Plan. The full advice may be found at ozsage.org (https://www.ozsage.org/) and a summary follows.

OzSAGE is an additional resource for federal and state governments and parliament, business, health, education, community and non-government agencies in Australia. The group will formulate independent advice on public health, health systems and other policy matters relevant to COVID-19 control, underpinned by the best scientific evidence, modelling (https://www.auscmi.org/) and by our values and principles.

Inspired by the UK Independent SAGE (Independent Scientific Advisory Group for Emergencies), all OzSAGE members are volunteering their time and expertise with a view to improving the effectiveness of Australia’s pandemic exit plan.

Summary of Initial Recommendations:

Live with occasional outbreaks – not widespread disease: COVID-19 is here to stay, but we may not need to live with widespread disease or lose all the gains won in 2020. We may feasibly achieve control of COVID-19 in the same way we have with measles, a more contagious virus. For now, that requires Ventilation and Vaccines-Plus to manage outbreaks. The vaccine pipeline is not static. When boosters or vaccines matched to variants are available, herd immunity should be possible by using a smart and agile vaccine strategy.

Ventilation and “Vaccine-Plus” are the pillars that will support safe lifting of restrictions. Ventilation (and filtration) is about providing safe air and mitigating airborne transmission in shared indoor spaces. This includes workplaces, borders, health and aged care, schools, prisons, social venues and homes, especially where overcrowding is present. COVID-19 is airborne, so prevention requires safe air.

Vaccines are essential to our pandemic exit strategy, but overseas experience from countries with vaccination rates similar to our national targets shows that current vaccines alone are insufficient against the Delta COVID-19 variant. “Plus” refers to testing, contact tracing, masks and other non-pharmaceutical strategies, which will continue to be required in the medium term to fight Delta, and may need to be scaled up or down depending on severity of the epidemic.

No-one left behind: Vaccine targets must be met for all population subgroups recognising structural and social disadvantage. This includes all Aboriginal and Torres Strait Islander people, remote and regional Australia and other high risk and disadvantaged groups. While vaccination is not available yet for all children, we recommend additional steps to protect them from infection and make schools safe.

Protection of the health system: Despite having one of the best health care systems in the world, already, urgent non-COVID care is impacted in NSW. A range of strategies are essential to prevent health worker loss and protect hospitals, patients and the health system in city and regional areas. The best laid plans to re-open society may be disrupted if the capacity of the health system to deal with COVID and non-COVID care is exceeded by a (https://www.sydney.edu.au/news-opinion/news/2021/08/26/pandemic-peak-in-sight—but-we-must-brace-for- an-infection-surg.html) surge in cases. (https://www.sydney.edu.au/news-opinion/news/2021/08/26/pandemic- peak-in-sight—but-we-must-brace-for-an-infection-surg.html)

Quotes

Children can get infected with COVID, transmit it to others and get sick and die, including long COVID. The expansion of vaccine eligibility to teenagers is welcome, however many children remain unvaccinated or too young to be eligible. Fortunately, there are numerous measures that can be taken to protect all children, including

vaccinating the adults around them, ventilation improvements in schools and smarter scheduling. Many countries are already implementing these measures and if Australia delays we risk being left behind, just as we were on our vaccine rollout.” Dr Greg Kelly

“Most infections occur in shared indoor spaces. The most fundamental measure to eliminate the virus from indoor air is ventilation: every public building must have control measures to provide adequate ventilation.” Prof Lidia Morawska

“It is for all to get behind Aboriginal and Torres Strait Islander leaders, communities and services to get everyone through this pandemic – together. Communities are at particular risk, as are the large, urban groups in our major cities and towns.” Prof Lisa Jackson Pulver

“All data on vaccinations, rollouts, and cases MUST be disaggregated so we can see the true picture for the many demographic groups and act accordingly. Lumping different groups under LGA’s or similar hides the truth of the effect of COVID-19 on the hardest hit in the community.” Prof Lisa Jackson Pulver

“It is increasingly recognised that COVID-19 impacts on populations with social and structural disadvantage. This includes the Aboriginal and Torres Strait Islander community, people from culturally and linguistically diverse communities, people with mental health issues, the homeless and people within the justice system. It is vital there is immediate extra effort to ensure these groups are vaccinated against COVID-19, and are socially and financially supported to help them get tested for COVID-19, and isolate and follow public health restrictions as required. In the longer run it is also important that we address the structural issue that puts these groups at greater risk.” Prof Margaret Hellard

Australia has successfully eliminated measles and polio with vaccines. Elimination doesn’t mean that outbreaks never occur – they do, but do not become uncontrollable because there is herd immunity. The good news is, vaccines matched to Delta and other variables will become available, and boosters are on the horizon. This changes the game in favour of herd immunity, so we should aim high and aspire to a measles-like situation, where occasional outbreaks occur but life mostly continues as normal.” Prof Raina MacIntyre

“We all have a right to breathe safe air. COVID-19 has brought this need, and the role of government in ensuring it, into sharp focus.Prof Guy Marks

A core lesson of the COVID-19 pandemic has been that it’s impossible to have a well-functioning economy with an out-of-control virus. As Australia moves toward reopening we must do so in a way that allows us to preserve policy options and adapt to changing circumstances. This requires vaccines PLUS other strategic measures.” Prof Richard Holden

COVID-19 has had an enormous impact on the mental health of Australian adults and children, but we cannot wish the pandemic away. COVID-19 will be with us for a long time, and so taking a range of sensible actions to minimise its spread and harm is the best way to help protect both the physical and mental health of all Australians. We are not helpless, though. There are actions within our own control that can help us keep ourselves and the community safe. For example, teaching everyone how to reduce infections by improving indoor air quality and using well-fitted masks for children and adults, both of which will help children to return to school safely. Ensuring mental health services are available for all in need must remain a key priority of the pandemic response.”Dr Benjamin Veness

Children can get infected with COVID, transmit it to others and get sick and die, including long COVID. The expansion of vaccine eligibility to teenagers is welcome, however many children remain unvaccinated or too young to be eligible. Fortunately, there are numerous measures that can be taken to protect all children, including vaccinating the adults around them, ventilation improvements in schools and smarter scheduling. Many countries are already implementing these measures and if Australia delays we risk being left behind, just as we were on our vaccine rollout.” Dr Greg Kelly

Risks of COVID-19 infection, serious disease and death are not equitably distributed. They disproportionally cluster among groups – including Indigenous and Torres Strait Islander people, persons with disability, prisoners, and persons with insecure housing – at high risk due to clinical vulnerability (stemming from high rates of comorbidities) as well as barriers to access to quality healthcare. Vaccine access and uptake is also lower in many of these groups. Disadvantaged Australians therefore face triple jeopardy – low vaccination rates, greater likelihood of being infected with COVID-19, and higher risks of serious disease and death from COVID-19. Despite this, the current national vaccine strategy does not have an explicit focus on equitable vaccine allocation. Achieving equity in vaccination uptake for those groups at highest risk of the consequences of COVID needs to be a critical part of the National COVID Transition Plan or many of the most at risk Australians will be unprotected. Prof Nancy Baxter

As President of AMAWA, I have significant concerns regarding the welfare of our children based on the plan to reduce restrictions predicted on 70 or 80 % of adults being vaccinated. The Office of National Statistics in the UK based on NHS data has shown that 7.4 % of children that get COVID, get long COVID.

The Doherty Report data (table 5.6, page 20) show that if reduced suppression measures of COVID were undertaken at 80 % of adults and no children vaccinated as modelled, there would be on average in the first 6 months in the paediatric population (less than 16 yrs):

  • 57 deaths
  • 206 ICU admissions
  • 276, 506 symptomatic cases

Applying the 7.4 % to the 276, 506 cases modelled by Doherty, there would be approximately 20 000 cases of long COVID in our children in the first 6 months.

Applying the 7.4 % to the 5 million children in Australia, there would be potentially 370,000 cases of long COVID in our children eventually.

AMAWA supports a scientific, evidenced based approach to COVID modelling, advice and recommendations. This is consistent with the goals and aspirations of the independent experts represented by OzSage. Accordingly, AMAWA welcomes the contribution of OzSage to the debate regarding COVID.” Dr Mark Duncan-Smith, President AMAWA, MBBS FRACS GCGOVM MAICD