New South Wales opens up for fully-vaccinated – Aus SMC Expert Reaction

Sydney has partially eased Covid-19 restrictions for fully-vaccinated individuals after NSW reached its target of 70 per cent of the population double-dosed.

The Australian Science Media Centre has asked experts about the possible risks of the country opening up again. 

Professor Tony Blakely, Professorial Fellow In Epidemiology, Melbourne School of Population and Global Health, University of Melbourne, comments:

Note: Prof Blakely is a Melbourne-based New Zealand epidemiologist who still retains links to the University of Otago.

Is this a safe/good idea? What are the chances of another lockdown?

“Not too bad. Please see this piece we published last week. This modelling (probably about as sophisticated as one can get – but ‘just’ modelling nonetheless) finds a 6 per cent probability of case numbers going back up above 2000 in the next six weeks with vaccinated folk going to an equivalent of Stage 2 (whilst the rest of NSW stays in Stage 3.5).  Even with all of NSW going to Stage 2 (i.e. imperfect compliance, not recommending this), the risk is ‘only’ 9 per cent.
However, since we undertook this modelling, more freedoms have been granted (which I am not opposing) that means this 6 per cent probability is probably higher now (but still a risk worth taking I think).

“All premiers and CHOs understand, or at least should understand, that when we open up we run the risk of numbers going too high. Thus it is important to keep a close eye on the numbers in about 10 days to three weeks, looking for signs of an increase. If that increase (based on modelling extrapolating it out, and allowing for vaccine coverage continuing to rise) suggests that cases will surge to about 4000 or more (at which point over 2000 or more people would be in hospital on any given day), then NSW will need to tap or hit the brakes to prevent overwhelming the health services.”

How will the opening up of NSW impact the pattern of spread of the virus, and how might we expect new cases to spread through vaccinated communities?

“Spread will still mostly be in unvaccinated communities – including children going back to school. There will be a steadily increasing fraction of cases among the vaccinated, who should only infrequently need hospitalisation.”

Would it make sense for other states to learn from the NSW experience before opening up in the same way?

“Yes – time permitting.  VIC will have just enough time before we hit 70 per cent to see if there is a rapid and immediate upsurge.”

No conflict of interest.

Professor Jaya Dantas is Dean International from the Faculty of Health Sciences and the Curtin School of Population Health at Curtin University, comments:

Is this a safe/good idea?

“As NSW embarks on a new direction of living with the virus, the vaccinated population and businesses, especially small businesses are ready for restrictions to be lifted after 100 days in lockdown. The vaccination rates in the state are high but it will be important to ensure that all take their second dose and that 12- to 15-year-olds are also vaccinated. Whilst case numbers are still high, they are on a downward trajectory. Pandemic fatigue has set in among people of all ages, and the whole country will watch how things evolve as NSW opens up.”

What are the chances of another lockdown?

“This will depend on the NSW government and health officials if case numbers, hospitalisations and deaths increase significantly then lockdown may be re-introduced as we have seen happen in Singapore and Israel. However, Denmark with a population similar to NSW, has avoided restrictions and lockdowns and maintained case numbers below 600 without the need for masks or vaccine passports. We need to be hopeful that 18 months into the Pandemic our hospital system is prepared and able to cope for any increase that may occur.”

How will the opening up of NSW impact the pattern of spread of the virus, and how might we expect new cases to spread through vaccinated communities?

“As we have seen in other countries like the UK, Israel, Singapore – there will be breakthrough infections even with high vaccination rates. Restrictions however, have been lifted in most countries with mask mandates in place indoors and vaccine certificates required in many countries like France, Italy, Canada and the US.”

Would it make sense for other states to learn from the NSW experience before opening up in the same way?

“Yes, all the other states are watching how the situation evolves once restrictions are lifted and there is community transmission but high vaccination rates, they will also learn from the roll-out of vaccine certificates in gyms, pubs, cafes, restaurants and other venues.”

How will this compare to a time before the vaccine was available?

“It may not be possible to accurately compare a time before the vaccine was available as the Delta variant had not impacted Australia.”

What should those who are especially vulnerable to COVID-19 or concerned about their unvaccinated children can/should do to keep themselves safe?

“Mitigation strategies should have been put in place in schools – when schools re-opened in UK, by the end of September, 2.5 per cent of school-going children were impacted with COVID. It is important that all teachers and staff working in schools are vaccinated, 12- to 15-year-olds are vaccinated and we can use the Victorian model of the Three Vs” — ventilation, vaccination, and vital COVID-safe steps to slow transmission rates and reduce community risk.”

What challenges will we face now that people are allowed back out again?

“Some challenges will be: increasing vaccination rates among the unvaccinated, rolling-out rapid antigen tests across the country, observing the impact as schools open in NSW and Victoria, and finally supporting our excellent system across the country.”

No conflict of interest.

Associate Professor Holly Seale, School of Population Health, University of New South Wales, comments:

Will putting pressure on businesses and retail workers to check “vaccine passports” mean that people are going to get away with not being vaccinated, or does this open the possibility of fake vaccine cards?

“I have concerns that some local businesses may not be equipped or supported to check vaccine status. Issues came up internationally when vaccine passports were rolled out including situations of verbal and physical abuse towards staff members who asked to see vaccine evidence. Not all businesses have the capacity to hire extra staff members whose sole purpose is to review the evidence. If a customer refuses to show the evidence, what are they going to do? Refuse service? In some situations, we did not see this happening around mask use, even in the big supermarkets.

“On the flip side, many stories are emerging of community members who have not been able to download their vaccine status into the wallet or into their Medicare app, or have not been able to get a hard copy sent to them because the Services NSW hotline has been inundated. Concerns were raised about those community members with low digital literacy being able to navigate the process.

“There is also inappropriate advice being given out to the community members about how to speed up the process. One pub owner suggested that patrons should take a screen shot of the evidence and to have that as the screen saver on their phone. However, if the phone was to be lost, then the persons name and DOB would be known.”

Note: Holly has written a Conversation article about these issues.

No conflict of interest.

Associate Professor Nada Hamad, Clinical and Laboratory Haematologist at St. Vincent’s Health Network, Kinghorn Cancer Centre and a Conjoint Associate Professor at the University of New South Wales, comments:

What should those who are especially vulnerable to COVID-19 or concerned about their unvaccinated children can/should do to keep themselves safe?

“Individuals who are immunocompromised despite having received vaccination should not assume they are protected. Vaccine responses are highly variable in the immunocompromised so all these individuals remain vulnerable.

They should get vaccinated and get the third booster now that this is available but should behave as if they were not vaccinated. Social distancing, masking and avoiding contact with those who are unvaccinated are practical ways to reduce risk.”

No conflict of interest.

Dr Nusrat Homaira is a Senior Lecturer and Paediatric Respiratory Epidemiologist at the University of New South Wales, comments:

“More than 100 days of lockdown in NSW ends today with schools expected to resume back to face-to-face learning by mid-to-late October. Face-to-face learning is imperative for children’s mental, social and cognitive development.

“As we open up there will be mixing of vaccinated and unvaccinated people, and COVID-19 infections in school-going children will surge, which may trigger closure of schools. We must work together to prevent future closure of schools through achieving high vaccination coverage not only for teachers but for all school staff, parents/carers of school-going children and eligible children aged 12 years and above, promoting use of face masks within schools’ settings by all school staff, high school students and where possible older primary school children and ensuring proper ventilation and airflow within classrooms.

“This is not the end of the pandemic but the beginning of an era where we have to continue to act responsibly, get vaccinated and follow public health advice. The virus will behave how we behave so it is extremely important that we play our part to prevent future lockdowns.”

No conflict of interest.

Dr Paul Valent, retired from clinical public and private psychiatric practice; author of many trauma related articles and books, comments:

“Even as we open joyously from COVID-19 lockdowns we should heed Sophie McBain’s warning: the pandemic has led to ‘the biggest hit to mental health since the Second World War.’ (The New Statesman, UK, 10/3/21).

“That ‘post-disaster euphoria’ is followed by a long tail of mental ill health is a well-known phenomenon, seen after natural disasters and wars.

“Freedom provides oxygen to lingering symptoms and releases suppressed ones. Symptoms vary greatly. Medical professionals, carers and parents suffer ‘compassion fatigue’, ‘burn-out’ and guilt for not having done enough. Others are cued back into their loneliness and abandonment. Many now release their grief for their losses. Many realise how disempowered and demoralised they feel. Resentment may increase over now apparent disparities of wealth, accessibility to help and resources.

“Recoveries are long and arduous. Many, even previously stoic people, now fall by the wayside. And if the defeat of the virus turns out to be a sham, to feel better for a while, and especially if freedom was granted for short-term political gains, hopelessness and despair, or rage and riots may ensue.

“We must enjoy our freedoms, but also acknowledge our two lost years and what they have meant to us. Let us cry tears of both joy and sadness. Then we can rejoin the humanity that has been in hibernation for two years.”

No conflict of interest.

Associate Professor Sanjaya Senanayake, specialist in Infectious Diseases and Associate Professor of Medicine at The Australian National University, comments:

“In short, NSW’s easing of restrictions will be a valuable lesson for the rest of Australia. In fact, 70 per cent of people 16 and over being fully vaccinated only represents about 56 per cent of the total population. This is closer to the vaccination rates of the US but less than other countries that have opened up like Norway, Singapore, the UK and Denmark. Yet, in those European countries and Singapore, the hospitals have not been overwhelmed even though the UK is averaging around 30,000 cases per day.

“At the end of the day, maintaining hospital capacity is key here. We know that fully vaccinated people can still get breakthrough COVID-19, and can transmit it, but this is less of an issue than in unvaccinated people. Thus, if the easing of restrictions is for the vaccinated populace, then we would expect to see an increase in cases, but not to the same degree as if unvaccinated people were moving freely.

“Also, we would expect less severe breakthrough infections in vaccinated people. In other words, we should be more optimistic about this new phase in the NSW COVID-19 strategy than pessimistic. The fact that this is occurring as the R0 in NSW is falling is also a bonus (0.88 now versus 1.01 a week ago) i.e. you ideally don’t want to ease restrictions if an outbreak hasn’t peaked yet.

“When unvaccinated people can access the eased restrictions, the impact on cases will depend on whether they are associating with lots of vaccinated people, thereby diluting their infection potential, or whether they are mixing with mainly unvaccinated people. The latter scenario is likely to result in more hospitalisations.

“But models and overseas experiences can only tell us so much; therefore, NSW’s easing will be watched on with interest and hope.”

No conflict of interest.

Nikolai Petrovsky, Professor in the College of Medicine and Public Health at Flinders University. and Research Director, Vaxine Pty Ltd, comments:

“To set policy based on the assumption that a vaccinated person cannot be infected and cannot transmit disease is a very bad idea, as it is completely at odds with the science.

“Particularly when dealing with delta variant, currently available vaccines in Australia at best reduce but do not prevent infection or transmission. This is not new information and we can already draw upon experiences in Israel and the UK of what will now likely happen in NSW. Opening up now will cause cases of infection to spiral higher, as in due course will hospital admissions and deaths. This will overstretch an already under-resourced NSW public hospital system and inevitably necessitate another shutdown to bring things back under some form of control.

“A premature opening up of NSW will enable the virus to gain easy entry to nursing homes, dialysis units and cancer care facilities, all where vulnerable people will be exposed. We know from experiences overseas that the current vaccines will struggle to protect such immunosuppressed patients, and these patient communities will thereby carry the brunt of serious infections and deaths upon opening up.

“Other States, particularly those with minimal disease, would be sensible to wait and see how NSW goes before relaxing their own control policies.

“Those who are especially vulnerable to COVID-19 in NSW will need to lock themselves up tightly and stay isolated to keep themselves safe during the expected exponential increase of infections in NSW resulting from an opening up.

“With expected exponential increase of infections in NSW regional travel bans are unlikely to protect other states, as more cases will break through as we have already seen in interstate outbreaks involving truck drivers and flight crews.

“Vaccine passports are a blunt coercive tool that has minimal scientific basis. They provide a false impression that vaccinated individuals cannot transmit disease which is not true and can result in detrimental behaviour. Mandating vaccines runs the risk of splitting the community, and increasing dissension, rather than unifying the community around the collective need to work together to defeat the virus.”

Conflict of interest statement: Nikolai is Research Director of Vaxine Pty Ltd, which is currently developing a COVID-19 vaccine

David Vaile, stream lead for Data Protection and Surveillance, Allens Hub for Technology Law and Innovation, UNSW Law and Justice Faculty, comments:

“Putting pressure on NSW businesses and retail/front of house workers to check immunisation statuses means that some people are going to try to get away with (and often succeed) entering enclosed premises without being vaccinated. And it also opens the possibility of fake vaccine cards, apps or documents being used and accepted.

“Making this critical public health safeguard a matter for individual ‘choice’ by venue operators, and thus moving the crunch point of conflict to a vulnerable, typically untrained low paid front-of-house staff member –– in many cases without the support of security personnel for aggressive anti-vaxxers, the backup of management for taking a strict line, or the skill that comes with conflict de-escalation and security training –– is a recipe for projecting the risk and stress of this risky government public health control onto those least able to shoulder the burden or enforce rock-solid strict compliance.

“There is also an unresolved concern about access to app data — the potential for law enforcement, intelligence, national security or other entities claiming the right to access either app login info or vaccine status info for purposes unrelated to assisting NSW Health ‘track and trace’ health contact staff, or confirming you are vaccinated to door staff.

“If there are rules and systems like this created by government as a condition of weakening public health restrictions when 46 per cent of the actual NSW population are not fully vaccinated (eg when 70 per cent of the eligible people over 16 have had both jabs), they should be mandated by law (so there is no point trying to ‘negotiate’ or bully you way past the staff on the door); and extra privacy and data protections should rule out law enforcement or intelligence access to the expanded Service NSW app and its data, so that people will be able to trust it to be used ONLY for the purpose claimed.

“Creating a loophole for bullies to use try to get past the door, and creating a risk of other uses for the data, will both contribute to the system coming into disrepute and failing, potentially with serious consequences for public health, and thus also for business.”

No conflict of interest.

Dr Roger Lord, senior lecturer in Medical Sciences, Faculty of Health Sciences, Australian Catholic University; and Visiting Research Fellow, Prince Charles Hospital (Brisbane), comments:

How will the opening up of NSW impact the pattern of spread of the virus, and how might we expect new cases to spread through vaccinated communities?

“Recent preprint data from the UK indicate individuals who are fully vaccinated (two doses of COVID-19 vaccine) and who subsequently contract the Delta variant of COVID-19 are less likely to infect close contacts compared to those who are unvaccinated (Eyre DW et al). This protective effect is however short lived only lasting 3 months following the second vaccination.

“Individuals fully vaccinated with AstraZeneca who subsequently contract the Delta variant had a 57% likeliness of transmission to unvaccinated close contacts.

“Three months following vaccination transmission rose to 67% with similar findings for those who received the Pfizer COVID-19 vaccine (42% versus 58%). These findings help to explain levels of breakthrough transmission for Delta despite widespread vaccination in some populations.

“Currently we do not know what level of antibody response equates to a significant level of protection and if booster vaccination will help overcome the short term problems experienced with vaccination against Delta.

“Certainly individuals who were fully vaccinated more than 3 months ago are likely to be a source of increased viral transmission as NSW comes out of lock down. Viral transmission will therefore need to be closely monitored in the vaccinated population.

“The original premise still applies, vaccination reduces severity of the disease and likeliness of hospitalisation.”

No conflict of interest declared.

Dr Karina Powers, Consultant Occupational and Environmental Physician in Western Australia in government departments and in private practice, comments:

“Transmission of the SARS-CoV-2 virus despite full vaccination will still occur. Without adequate controls in place for indoor spaces or in failure of controls, e.g. businesses poorly ventilated without safe air, people with masks off, staff not vaccinated, the disease will impact the unvaccinated, people with low immunity, front-line and first responder workers with waning immunity, those who are impoverished or with limited access due to disability and those in rural and remote Australia as health systems breakdown.

“That is, the main burden of transmission will be sustained by society’s most disenfranchised, the sick and by our critical workers. The rich will notice the impact of any increased transmission mainly with substandard access to health care, e.g. delayed ambulance or one fully qualified paramedic trying to deal with their airway and bleeding at the same time in multi trauma instead of two, delayed health care for their cancer and angina for example, lack of access to overwhelmed paediatric health systems for their children.

“All controls that can be practically kept in place, including movement restriction, are vital in an airborne transmissible disease to protect the vulnerable and maintain societal function, and allow vaccination for susceptible groups and booster vaccinations to safely continue at pace.”

No conflict of interest.

Professor Peter Collignon AM, Infectious Diseases Physician and Microbiologist, Canberra Hospital; and Medical School at Australian National University, comments:

“My views are what NSW is doing is ok. Not a true freedom day (as for UK where there were no restrictions) but now less restrictions for those fully vaccinated. Unvaccinated not till Dec 1st.

“Vaccination works, so get vaccinated and it will have even more freedom but we need to expect some restriction on a more localised scale until maybe this time next year (but not stay at home for fully vaccinated unless they are infected).

“We need to look at hospitalisation and death as a measure now rather than case numbers (just like Germany is doing).

“Zero COVID is not possible. So minimise hospitalisations etc. by vaccines and proportionate restriction e.g. indoor crowd numbers limits.”

No conflict of interest declared.

Note: The University of Sydney has gathered some more responses.