What’s the ‘Indian’ variant responsible for Victoria’s outbreak and how effective are vaccines against it?


Luis Ascui/AAP

Fiona Russell, The University of Melbourne; John Hart, Murdoch Children’s Research Institute, and Katherine Gibney, The Peter Doherty Institute for Infection and ImmunityVictoria’s seven day lockdown, which begins tonight, is an attempt to stop transmission of the quick-spreading COVID-19 B.1.617.1 variant.

Victoria’s chief health officer Brett Sutton said the reproduction number of the strain was yet to be determined, but could be five or more, meaning one person would infect five others.

B.1.617.1 is one of three so-called “Indian” SARS-CoV-2 variant sub-types. Little is known about it but it’s likely to have similar characteristics to the sub-type dominating in India and emerging in the United Kingdom at the moment, B.1.617.2.

Remind me, what’s a variant of concern?

To be classified as a variant of concern, it must pose a risk to public health over and above the original Wuhan virus. This could be due to changes in transmissibility (how easily it spreads), disease severity, its ability to evade detection by viral diagnostic tests, reduced effectiveness of treatments, or an ability to evade natural or vaccine-induced immunity.

The World Health Organization is tracking four variants of concern, which are often referred to by the country in which they emerged:

The B.1.617 variant, which was classified as a variant of concern on May 6 2021, has three subtypes – B.1.617.1, B.1.617.2 and B.1.617.3 – each with small differences in their genetic make-up.




Read more:
What’s the difference between mutations, variants and strains? A guide to COVID terminology


What do we know about the ‘Indian’ variants?

Information about B.1.617 is emerging, but early reports indicate it spreads more easily than the original strain. Although there is limited data specifically on B.1.617.1, it is likely to behave similarly to B.1.617.2 as it is genetically similar.

Early data from the UK’s NHS Test and Trace records showed B.1.617 spreads at least as easily as the UK strain (B.1.1.7). In fact, B.1.617.2 may be twice as likely to infect another person than the UK strain, which was already more infectious than the original Wuhan virus.

The relative disease severity of B.1.617 is still under investigation, however even if it is no more severe than the original virus, increased transmission leads to more cases, more hospital admissions and more deaths.

Laboratory tests also raise the possibility that reinfection might be more common with the B.1.617 variant, but this is yet to be confirmed by real-world data and for all sub-types.




Read more:
Why variants are most likely to blame for India’s COVID surge


How effective are vaccines and how long do they take to kick in?

For most variants of concern, vaccines are still effective, but are often less effective than they were against the original Wuhan virus.

So far, there are no data on how effective any of the COVID-19 vaccines are against B.1.617.1.

B.1.617.2 has one more mutation than B.1.617.1, so they are genetically similar. Therefore the vaccine effectiveness against B.1.617.1 and B.1.617.2 is likely be similar, but this is not known yet.



Data from the UK (non-peer reviewed) on vaccine effectiveness against the B.1.617.2 variant has recently been released. It found:

  • both Pfizer and AstraZeneca are 33% effective against symptomatic disease (COVID-19 symptoms such as fever, dry cough and tiredness) three weeks after the first dose
  • Pfizer vaccine is 88% effective against symptomatic disease two weeks after the second dose
  • AstraZeneca vaccine is 60% effective against symptomatic disease two weeks after the second dose.

The difference in effectiveness between the vaccines after two doses may be due to AstraZeneca taking longer to reach peak protection as this occurs after two weeks following the second dose.

Both vaccines are expected to provide even greater protection against COVID-19 hospitalisation and death than they do for symptomatic disease. As yet there are too few cases to do this analysis but this will take place over the coming weeks.

Lower vaccine effectiveness means even if you are vaccinated, you could still get infected. However, if an infection does occur, symptoms would be milder.

It’s also possible vaccination may not protect you for as long against this sub-type compared to other variants. But this is not known yet for B.1.617.1.




Read more:
What’s the new coronavirus variant in India and how should it change their COVID response?


Time between doses

From December 2020, the UK had been delivering the AstraZeneca and Pfizer vaccines with a 12-week interval between doses to provide some protection to as many people as possible.

A recent study supported this decision, finding that extending the vaccine interval from three to 12 weeks for the second dose boosted the immune response in people over 80 by 3.5 times.

However, due to the spread of the B.1.617.2 variant in the UK, the strategy was changed in mid-May to an eight-week gap in order to provide greater protection from this highly transmissible virus at an earlier opportunity.

Australia delivers the AstraZeneca vaccine with a 12-week interval, while opting for three weeks for Pfizer.

Decisions on the timing between doses must balance providing greater protection earlier, against providing some protection to the maximum number of people. It’s too early to make those changes right now for Victoria but this option should be considered if the outbreak worsens.

People waiting for vaccinations.
Australia currently has a 12-week gap between AstraZeneca doses.
Luis Ascui/Shutterstock

Should people get vaccinated?

Even though we don’t know how effective vaccines are against the B.1.617.1 sub-type, don’t delay getting vaccinated. This time our outbreak is due to B.1.617.1, but next time it could be another variant.

COVID-19 vaccines are equally effective against the original strain and B.1.1.7, and are also effective against the B.1.617.2 variant (albeit a bit lower).

During an outbreak, policymakers should also consider opportunistically increasing vaccine uptake, especially in the outbreak areas. Victoria has made progress in this area and from tomorrow all 40- to 49-year-old Victorians will be offered Pfizer.

But those responsible for the most COVID-19 transmission are aged 20 to 49 years. So vaccinating even younger Victorians – 20 to 39 year olds – would also prevent spread of the outbreak. Even if the vaccine was only 20% effective against transmission this may be a very important additional measure.

Even though there are many unknowns, it is still important to get vaccinated with the vaccine that is offered right now.




Read more:
I’m over 50 and can now get my COVID vaccine. Is the AstraZeneca vaccine safe? Does it work? What else do I need to know?


The Conversation


Fiona Russell, Senior Principal Research Fellow; paediatrician; infectious diseases epidemiologist, The University of Melbourne; John Hart, Clinical researcher, Murdoch Children’s Research Institute, and Katherine Gibney, Senior research fellow, The Peter Doherty Institute for Infection and Immunity

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Four cases in Melbourne’s north as vaccine push rolls on but what if I’ve already been recently exposed?


AAP Image/ LUIS ASCUI

C Raina MacIntyre, UNSWNews of four new positive cases of COVID-19 in Melbourne’s northern suburbs has prompted renewed discussion about the vaccine rollout.

The Victorian department of health is urging people to get tested if they have any symptoms at all, check in at venues and wear a mask on public transport. In a statement it said it is “regularly exploring options for new vaccination centre locations and has previously said that further locations will open.”

But if a person has been infected with coronavirus and is in an early stage of incubating the virus – would a vaccine confer any protection to that person?

The short answer is we don’t know yet for sure. But many vaccines do work in that way and when vaccine supplies are limited, targeting contacts for vaccination could be worth trying. This approach is sometimes called post-exposure prophylaxis, or PEP.

As I argued in The Lancet Infectious Diseases in March this year,

many vaccines are effective as post-exposure prophylaxis (PEP), including those for measles, hepatitis A, and smallpox, and the long incubation period of SARS-CoV-2 means vaccines might work as PEP, and that we should be doing studies to test the effectiveness.

When vaccine supplies are limited, contact tracing and prophylactic use may be the most efficient use of limited doses.




Read more:
COVID is surging in the world’s most vaccinated country. Why?


This approach has helped with other viruses

Many vaccines work to reduce infection and transmission in cases where people are vaccinated after they have been exposed to a virus (or become a contact).

However, the vaccine is sometimes less effective in this scenario than it would be if given to a person who has not been infected (also known as primary prevention).

In the case of smallpox, the vaccine was 95% effective for preventing primary infections but about half as effective in reducing disease among those who had already been exposed to the virus (and possibly in the early stages of infection).

In other words, the smallpox vaccine can be given to contacts of infected people and it will be half as effective as it would be if it was given to non-exposed people – but that is still effective enough.

In fact, contact tracing and vaccination of contacts became the mainstay of smallpox eradication in India, the last stronghold of smallpox.

With measles, vaccinating the contacts of positive cases is also highly effective in preventing further transmission.

This approach is more likely to work with diseases that have a longer incubation period — and SARS-CoV-2 (the virus that causes COVID-19) is one that does.

Australia is in a good position to study this, as we are not dealing with a large burden of COVID-19 on our health system. Outbreaks prior to vaccine availability could be compared to outbreaks where contacts are vaccinated.

This can even inform an approach whereby we vaccinate returning Australians before they board a plane to come home.

Mass vaccination – and getting the space between doses right

In the end, the best protection is mass vaccination and ensuring as many people as possible are fully vaccinated as quickly as possible. For speed, the spacing between doses matters because the longer it takes to be fully vaccinated, the more vulnerable we are during outbreaks.

The United Kingdom is seeing a surge of cases linked to the B16172 variant. One recent study found being partially vaccinated was only 33% protective against symptomatic disease with B16172 three weeks after the first dose. The protection went up to 60% for AstraZeneca and 88% for Pfizer after two doses.

Unlike the US, where people got doses of a mRNA vaccine within three weeks or the one-dose Janssen vaccine, the UK chose to space vaccine doses (for both Pfizer and AstraZeneca) by three months. That is a long time during a pandemic.

Despite both countries making a flying start with the UK having a higher proportion of people who received one dose, the US has overtaken the UK in the proportion of people fully vaccinated.

In Australia, the Pfizer vaccine is given with a three week gap between doses but there is a 12 week gap between doses for the AstraZeneca vaccine to ensure best protection. Like the UK, Australia could also look for ways to reduce the time between doses for the AstraZeneca vaccine, but there would be a trade off with reduced efficacy.

A 12 week gap between doses of AstraZeneca is for best individual protection, which is fine while we do not have sustained community transmission. But this leaves us vulnerable if an outbreak takes off (especially if caused by a variant of concern). In the UK, they are moving to offer the second dose of the AstraZeneca vaccine at eight weeks to reduce the time between doses and speed up full vaccination.

Australia would be best protected with a higher proportion of the population fully vaccinated as soon as possible.




Read more:
I’m over 50 and hesitant about the AstraZeneca COVID vaccine. Should I wait for Pfizer?


Correction: the word “much” was removed from the sentence which originally read “Despite both countries making a flying start with a high proportion of people who received one dose, the proportion of fully vaccinated people is much lower in the UK than the US”.The Conversation

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Morrison government commits $1 billion over 12 years for new vaccine manufacturing supply



PMO, Author provided

Michelle Grattan, University of Canberra

The federal government has concluded a $1 billion agreement, funded over 12 years, with Seqirus to secure supply from a new high-tech manufacturing facility in Melbourne which would produce pandemic influenza vaccines as well as antivenoms.

This would boost Australia’s sovereignty when the country was faced with a future pandemic, and make for quick responses.

Seqirus, a subsidiary of CSL Ltd, will invest $800 million in the facility, which will be built at Tullamarine, near Melbourne airport. It will replace Seqirus’ facility in the inner Melbourne suburb of Parkville which is more than 60 years old. The Victorian government has supported the procurement of the land for the new operation.

Seqirus says the complex will be the only cell-based influenza vaccine manufacturing facility in the southern hemisphere, producing seasonal and pandemic flu vaccines, Seqirus’ proprietary adjuvant MF59 ®, Australian antivenoms and Q-Fever vaccine.

Work on construction will begin next year; the project will provide some 520 construction jobs. The facility is due to be fully operating by 2026, with the contract for supply of its products running to 2036.

The present agreement between the federal government and Seqirus is due to end in 2024-25.

Seqirus is presently the only company making influenza and Q fever vaccine in Australia, and the only one in the world making life-saving antivenom products against 11 poisonous Australian creatures, including snakes, marine creatures and spiders.

Scott Morrison said that “while we are rightly focused on both the health and economic challenges of COVID-19, we must also guard against future threats.

“This agreement cements Australia’s long-term sovereign medical capabilities, giving us the ability to develop vaccines when we need them.

“Just as major defence equipment must be ordered well in advance, this is an investment in our national health security against future pandemics,” he said.

Stressing the importance of domestic production capability, the government says when there is a global pandemic, countries with onshore capabilities have priority access to vaccines.

Health minister Greg Hunt said: “This new facility will guarantee Australian health security against pandemic influenza for the next two decades”.

Seqirus General Manager Stephen Marlow said: “While the facility is located in Australia, it will have a truly global role. Demand for flu vaccines continues to grow each year, in recognition of the importance of influenza vaccination programs. This investment will boost our capacity to ensure as many people as possible – right across the world – can access flu vaccines in the future.”

To deal with the present pandemic, the government has earlier announced $3.2 billion to secure access to over 134.8 million doses of potential COVID-19 vaccine candidates developed by the University of Oxford-Astra Zeneca and the University of Queensland, Pfizer-BioNTech and Novavax.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Dear Australia, your sympathy helps, but you can’t quite understand Melbourne’s lockdown experience


Kate Brady, University of Melbourne

The joy Melburnians feel about coming out of lockdown is palpable, but another thread is also emerging: if you don’t live in Melbourne and haven’t experienced what we’ve experienced, you can’t actually understand what we’ve been through.

COVID has affected all Australians, but these last few months have been different for us.

Research on collective trauma and community recovery after disaster and upheaval tells us this is common in groups that have faced terrible or challenging experiences together.

If you’re in Melbourne, there are many ways to help yourself and those near you as we emerge from this gruelling period. If you’re outside Melbourne, you can and should support your Melbourne mates — but there are a few things to avoid.

Was Melbourne lockdown really a case of collective trauma?

Collective trauma events are not just disasters; they also have community-wide effects, and challenge people’s understanding of the way the world works.

Collective trauma events are typically thought of as tragedies such as the Lindt Cafe siege in 2014, the Christchurch Mosque shootings in 2019 or the events at Dream World in 2016. But I’d argue the strain of the last months in Melbourne has been experienced as a type of collective trauma event.

This view is informed by my research into disaster recovery, my work as a senior practitioner at Australian Red Cross, workplace seminars I have conducted during the pandemic, and my own experience living in Melbourne through this.

Collective trauma can have direct and indirect impacts. In the pandemic, direct impacts might be bereavement, the effect on your health, employment, education and access to services. Indirect impacts can be much harder to get your head around. They include changes to your worldview, your relationships, and how you see yourself.

For example in pre-pandemic times you may have been in a very equal relationship where domestic duties were evenly shared — but in lockdown, maybe one partner shouldered a bigger burden of childcare and housework, or was under more pressure at work. These stressors can throw the relationship out of whack and have a long term impact.

People who lived alone during lockdown may have watched their relationships change and might wonder if things can go back to how they were.




Read more:
Collective trauma is real, and could hamper Australian communities’ bushfire recovery


In the first wave, there was a sense of “if we just batten down the hatches and get on with it, we will get through this.”

In the second wave, people in Victoria were confronted with a realisation that much in life is outside our control and recovery may not be linear. Instead of thinking “we just need to get through this part and then we’ll get back to how things were”, there was an unsettling day-to-day challenge of thinking, “What if this keeps happening? What if we can’t stop it? What if this changes the way I thought the world worked?”

So you had this disconnect where people outside Victoria kept saying “You’ll get through this! Once you’re on the other side things will be normal!” but, for many of us, those well-meaning cheers of encouragement didn’t line up with our actual experience.

Of course, people in other parts of the country who have been shaken in similar ways, and the restrictions Melburnians have experienced recently are faced by some people all the time. But in Melbourne, the relentlessness has been difficult to escape.

Getting support from others who lived it

We know from research that if a community has been through a challenging experience together — whether that’s bushfire, flood or some local horrific event — getting support from others who experienced it is crucial.

In my work with the Red Cross, we try to encourage people to connect with others after disasters. Just coming together to talk about what happened gives people the opportunity to feel a sense of hope, to normalise their experience and to be able to talk in a “shorthand” with others who will understand, because they went through it too. It’s a relief.

But all the things we’d normally suggest in the early stages of disaster are systemically dismantled by COVID. People have tried to stay connected online but it’s not the same. It’s tiring. It’s been harder to draw on normal points of support, which is crucial to recovery.

If you’re in Melbourne, recognise that we’ve all been through something huge and exhausting. Everyone is going to be in a different place. Try and be as patient and kind as you can with yourself and the people around you.

Dos and don’ts for people outside Melbourne

The research on collective trauma tells us if you haven’t been through the event, you’ll never quite understand. That doesn’t mean people outside Melbourne haven’t had their own experience, or can’t help.

Think about any upsetting personal experience you’ve had, such as miscarriage, divorce or the death of a parent. When someone who hasn’t experienced that specific trauma says “I know how you feel”, you might have felt misunderstood and even resentful or rageful.

You might think, “Not only do I need to explain myself and my feelings to this person — which in itself is exhausting and upsetting — I also have to find the energy to explain why what they said was wrong, even though I know they meant well”.

So over the next few weeks and months, don’t say “I know exactly how you feel” to your Melbourne friends and family. Unless you actually have been through the same thing in another setting, you don’t know how they feel. This experience was very specific.

Instead, ask “What has this been like for you?” and listen to what the person is saying. Say, “That sounds difficult. Tell me why, because I haven’t been in that situation”.

All of metropolitan Melbourne was placed under nightly curfew for nearly two months.
Erik Anderson/AAP

Staying open and empathetic

Research in this field talks a lot about the five mass trauma intervention principles, which are about promoting:

1) a sense of safety

2) a sense of calm

3) a sense of self-efficacy and community efficacy (belief in one’s community or one’s own ability to do something well)

4) connectedness

5) hope.

The lovely thing about these principles is they can be applied in many situations, whether that’s holding a press conference, consoling a friend or socialising with colleagues.

Good leaders promote these five things in times of crisis.

When we talk to each other as friends, try to keep those five principles in mind. Be open and empathetic in your listening.

Don’t be scared to talk to each other about how you’re feeling, and don’t be scared to ask your Melbourne friends about what happened.

But recognise that if you haven’t been through it, a good place to start could be “I can’t imagine what that was like. How can I help?”The Conversation

Kate Brady, Research Fellow – Community Resilience, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Coronavirus Update


General

Australia

Spain & Italy

USA

Today marks the official end of the second wave in Victoria, as old freedoms return


Hassan Vally, La Trobe University

Victorian Premier Daniel Andrews today announced the most significant easing of Melbourne’s coronavirus restrictions since the state went into “stage 3” lockdown on July 9.

From 11.59pm on Tuesday night, retail, restaurants, cafes and bars will finally be able to open up in Melbourne. Gatherings of up to ten people outdoors are now allowed from any number of households, and the four reasons to leave your home have been abolished. Outdoor contact sport for under-18s returns, as does outdoor non-contact sport for all ages.

Residents will have to wait until Tuesday for confirmation on how many visitors they’ll be allowed in their homes, as Andrews reiterated that indoor gatherings represent the highest risk of transmission. But he ruled out a “bubble” approach, which I think is smart — if the rules are too complicated they become harder to follow.

The 25km travel limit and the “ring of steel” between Melbourne and regional Victoria will be removed from midnight on November 8. Gyms and fitness centres will also reopen from that date.

Second wave defeated

Although we’ve been through a rollercoaster of emotions over the past 36 hours, the recording of zero new COVID-19 cases today and the further relaxing of restrictions marks the official end of the second wave in Victoria.

By working together, after the peak of more than 700 new cases a day in early August, Victorians have brought virus transmission under control, and now squashed it completely. For this, all Victorians should be commended.

This is a significant achievement — our equivalent of overcoming a ten-goal deficit at half-time in the grand final and starting the final quarter with a slender lead. Although the work is not done, and we’re exhausted, we should celebrate what we have been able to achieve.




Read more:
Of all the places that have seen off a second coronavirus wave, only Vietnam and Hong Kong have done as well as Victorians


Cluster-busting is key

Of course, we cannot ignore what happened in the northern suburbs of Melbourne this past week. The timing of this cluster was unfortunate, and the resulting postponement of the announcement of the relaxing of restrictions yesterday was, for many of us, devastating. But to frame it as a positive, if there was any lingering uncertainty about our capacity to respond to clusters, this should now be laid to rest.

The incident provided the perfect opportunity to show how effectively we can handle clusters. By targeting contacts of known cases as well as contacts of contacts, we’ve shown that, rather than crude geographic lockdowns, we can control transmission of the virus by bringing lockdowns to where the cases are.

This is what best-practice public health looks like, and the government should be commended for continuing to refine and improve the public health response to these clusters. We should now be able to place our trust in the public health response.

With relaxed restrictions comes personal responsibility

But it’s important to be aware these newly regained freedoms come with obligations. As prescribed restrictions ease, the pendulum swings towards individuals taking responsibility for managing their risks, rather than government telling you what you can and can’t do.

As Andrews said, “this virus isn’t going away”. So it’s expected that we continue all of the behaviours we’ve come to know, such as regular and frequent hand-washing, practising physical distancing, avoiding large crowds, and wearing masks when you leave the house.

And most important of all, make sure you get tested as soon as possible if you develop even the slightest of symptoms.

Victorians have shown how responsible they are, it’s time to reward them with the trust they’ve earned.




Read more:
Where did Victoria go so wrong with contact tracing and have they fixed it?


The Conversation


Hassan Vally, Associate Professor, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Of all the places that have seen off a second coronavirus wave, only Vietnam and Hong Kong have done as well as Victorians



Shutterstock

Michael Toole, Burnet Institute

Of the 215 nations and territories that have reported COVID-19 cases, 120 have experienced clear second waves or late first waves that began in July or later. That’s according to the Worldometer global database, which sources data from national ministries of health and the World Health Organisation.

Of these 120, only six have definitively emerged from their second wave: Australia, South Korea, Japan, Hong Kong, Vietnam and Singapore. I am not including New Zealand, as the series of clusters that arose in Auckland in mid-August never evolved into a clear second wave.

Ultimately, Victoria has performed extremely well by international standards. Only Vietnam and Hong Kong have enjoyed comparable success in quashing the second wave. Victorians’ sacrifice during lockdown has left Australia well placed to sustain very low numbers of cases through the coming summer.

A grim global context

Any comparison between Australia and other countries takes place amid a grim global context. The worldwide tally of cumulative cases is adding one million new cases every three or four days. On Wednesday, of the 100 countries with the highest total reported cases, just seven reported fewer than 50 new cases: Australia, China, Nigeria, Singapore, Ivory Coast, Zambia and Senegal. The same day, France and the United Kingdom each reported more than 26,000 new cases, and 20 European countries posted all-time daily record numbers.

Some European countries, such as the Czech Republic, Poland and Georgia, are now reporting daily case numbers 25-30 times higher than during their first waves.




Read more:
Lockdown, relax, repeat: how cities across the globe are going back to coronavirus restrictions


Europe and North America face enormous challenges to control their outbreaks as winter looms and pandemic fatigue sets in. But already there are signs of decisive measures including a national lockdown in Ireland — very similar to Melbourne’s — and night curfews in Paris, seven other French cities, Brussels, Athens and Rome. Their current struggles stand in stark contrast to Australia’s situation.

Israel’s second wave came early

Which countries offer the most instructive comparison with Australia? Let’s start with Israel, one of the first countries to experience a second wave far more severe than the first.

Israel was also a founding member of the long-forgotten First Movers Group, comprising Austria, Denmark, Norway, Greece, the Czech Republic, Israel, Singapore, Australia and New Zealand. Each member nation implemented restrictions early in the pandemic, and held a virtual summit in May to share tips about controlling the virus. Since then, every member except New Zealand has experienced a major second wave.

Israel’s second wave was largely caused by transmission among high school and middle school students, and an uncoordinated exit from the first lockdown. By the end of May, citizens were allowed to go to shopping centres and community gatherings, despite a growing resurgence of cases. During the Israeli summer there was minimal enforcement of face mask use, and moderate restrictions were reimposed on July 17.

Cases continued to surge, prompting a second lockdown introduced on September 18. This included restricting people’s movement to within 1km from their homes. The mishandling of the first wave had eroded public trust in the government, and morale was seemingly bleak during what was the first national lockdown in the world in response to a second wave. While cases have declined in the past few weeks the country has not yet emerged, with daily new case numbers still between 800 and 1,100.

National lockdowns not essential for success

Four of the five Asian countries that have emerged from their second wave demonstrate that lockdowns aren’t an all-or-nothing choice. There are intermediate options, but they only work if certain conditions are met. These include effective testing, contact tracing and isolation capacities; a culture of wearing masks and following public health directives; electronic contact tracing; and selective local restrictions such as closing bars, restaurants and places of worship.

Vietnam was one of the first countries to contain its first wave and did not record a single death until July. Measures included early border closures, aggressive testing and tracing, and enforced quarantine of all cases and their contacts. This may not be an option in less authoritarian countries. Vietnam did have a national lockdown for a two-week period in April.

Clear communication with the public was a crucial element of Vietnam’s response. The government used a range of creative ways to spread messages about symptoms, prevention and testing sites, including via state media outlets, social media, text messages and, famously, a viral song about the importance of handwashing.

Vietnam’s viral video.

After 99 days of zero daily cases, Vietnam’s first community transmission case was reported in Da Nang on July 25. It started with a man who tested positive without any travel history, and it’s still unclear how he contracted the virus.

By September 4, Vietnam’s health ministry had confirmed 632 new cases and 35 deaths. As during the first wave, blanket testing was conducted in Da Nang, transport in and out of the city was cancelled, and bars and restaurants closed. The same local measures were implemented in certain neighbourhoods in Hanoi when new cases were identified. The country has not reported any community transmission since early September.




Read more:
Europe’s second wave is worse than the first. What went so wrong, and what can it learn from countries like Vietnam?


Besides enforced quarantine, Japan, Hong Kong and South Korea have mostly followed the same strategy as Vietnam and haven’t imposed blanket lockdowns. After two months of near zero daily cases, South Korea experienced a series of spikes linked to bars, nightclubs and karaoke venues, with a major surge in August linked to a large church. The response has been characterised by robust decentralised testing, contact tracing and isolation, and a registration system at entertainment venues based on QR codes. However, the country is not yet out of the woods, reporting 50-90 cases a day.

Likewise, Japan continues to report 400-700 cases a day. But Hong Kong is approaching the same level as Victoria, reporting between five and 18 cases a day.

Singapore is a very different case. It has by far the highest per capita number of cases in Asia. With a population of just 5.8 million, the country has reported 57,921 cases — more than twice the number of Australia (which has more than four times the population).

Between mid-April and mid-June, Singapore experienced a massive spike in cases mostly among overseas migrant workers. On June 19, the country eased restrictions opening restaurants and gyms. In the seven subsequent weeks leading up to August 8, Singapore reported 13,096 new cases or 267 per day. Cases have subsequently declined to single digits, comparable to Victoria.The Conversation

Michael Toole, Professor of International Health, Burnet Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Finally at zero new cases, Victoria is on top of the world after unprecedented lockdown effort


Stephen Duckett, Grattan Institute and Tom Crowley, Grattan Institute

If the past few months have been like a long-haul flight, Victorians are now standing in the aisles waiting for the cabin door to open, a little groggy and disoriented but relieved.

They have every right to be. No other place in the world has tamed a second wave this large. Few have even come close.




Read more:
Of all the places that have seen off a second coronavirus wave, only Vietnam and Hong Kong have done as well as Victorians


It’s not a competition

Comparing different countries’ fights against COVID-19 is not a straightforward exercise, given differences in demography, geography, health system capability, and government strategy.

Perhaps most importantly, not every country has tried to get down to zero, or near zero, community transmission. This may not have been a realistic goal for countries with less border control than Australia.

Also, as Victorians understand acutely, the virus is unpredictable. Today, as the crisis accelerates in Europe and elsewhere, Victoria’s “zero new cases” are the envy of the world. But there can be no certainty about where things will be in a few months’ time.

All of this is to say that a favourable international comparison should not encourage complacency. But it is nevertheless true that Victoria’s efforts are notable on the world stage. The state’s success has warded off a significant human toll and further economic damage. As a result, Australia has a much better chance of returning to an approximation of “normal life” in the new year.

Victorians should be proud of these efforts, and the starkly different outcomes in countries that were in a similar position should reassure them that the efforts were worthwhile.

Surfing the second wave: Victoria, Singapore, then daylight

On August 5, Victoria’s seven-day average of daily new cases reached 533, the worst numbers seen anywhere in Australia.

Several other countries had similar numbers around that time, including Canada, Japan, Singapore, and most of Europe. They had taken different paths to get there; for Europe, these numbers represented a low ebb, not a peak. But the trajectories after this period diverged even more dramatically.

As the chart below shows, case numbers in several European countries began to accelerate steeply and are now much worse than ever. In contrast, Japan, Denmark, Sweden, Norway, Singapore, and Australia have so far kept case numbers at a moderate level.

A chart shows that from a similar position to Victoria, many countries lost control entirely.

Grattan Institute, Author provided

But as this next chart shows, there is significant divergence even among these relatively stable countries. Sweden appears on track to replicate the sharp acceleration seen elsewhere in Europe. In Denmark and Japan, case numbers remain at a moderate level but are not trending towards zero. Only Victoria and Singapore, which peaked at around 300, have returned to single digits.

A chart shows that among places where numbers have remained low, Victoria and Singapore are outliers.

Grattan Institute, Author provided

By suppressing their second waves, Victoria and Singapore are well placed to join a small club of countries that have sustained zero or near-zero cases, including New Zealand, Thailand, Vietnam, China, and the rest of Australia. The dividend for these countries has been economic, not just health-related, as the chart below shows.

A chart shows that countries with the worst death tolls have had the worst economic outcomes.

Grattan Institute, Author provided

Victoria’s lockdown has been long and difficult, but it now occupies a rare and envious position. As Victorians await new freedoms on the next step towards COVID-normal, they should feel a sense of accomplishment.




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The Conversation


Stephen Duckett, Director, Health Program, Grattan Institute and Tom Crowley, Associate, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Melburnians will soon be able to have 2 visitors per day. It’s far riskier than an exclusive bubble



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Mary-Louise McLaws, UNSW

Victorian Premier Daniel Andrews announced on Sunday a further easing of coronavirus restrictions, as Victoria’s 14-day average of new daily cases continues to trend downwards.

Among the changes, Melburnians were told that from November 2 they can have two visitors at home per day, plus any dependants. Regional Victorians can already enjoy this rule, as their 14-day rolling case average is much lower at 0.4, compared with Melbourne’s 6.4.

This new rule replaces the “bubble” concept featured in the original roadmap. Under the previous plan in Melbourne, “step 3” of easing restrictions included a household bubble, whereby residents could nominate one other household with whom to socialise exclusively at home.

I understand the lifting of restrictions must be done compassionately with an eye on collective mental health. But from an outbreak-management perspective we must be very careful about indoor gatherings. The two people per day rule seems to be riskier than an exclusive bubble.

The bubble contains the infection risk

The risk of indoor spread is often greater because of poor ventilation, which might add to the risk of airborne spread. Further, people can unmask and fail to maintain physical distancing, which are more likely to happen indoors.

Close indoor contact poses the highest risk of transmission of SARS-CoV-2, the virus that causes COVID-19. Victorian Chief Health Officer Brett Sutton reminds us indoor contact is about “20 times more dangerous than outdoors”. This is reflected in one study from Japan, which is yet to be peer-reviewed, and estimates “the odds that a primary case transmitted COVID-19 in a closed environment was 18.7 times greater compared to an open-air environment”.

Transmission still does occur outdoors, but the risk is lower.

The practice of exclusive social bubbles likely makes outbreaks easier to contain. The only people an infected person would have close indoor contact with would be their own household and their bubble household. In this scenario, contact tracers would know exactly whom to contact for isolation, testing and interviewing.

Here’s why the new lifting of the social rule is riskier

The proposed new rule could make timely contact tracing more difficult. With Melburnians allowed to have two adults over per day, they could have up to 14 contacts per week who don’t come from the same household.

Let’s go through a hypothetical example.

Say you are exposed to the virus unknowingly, on day zero. Over the next few days you start having visitors to your house. You can become infectious up to three days before showing symptoms. When COVID-19 cases have been diagnosed while asymptomatic (symptom-free but infectious) and followed up for at least seven days, up to 20% remain asymptomatic but infectious to others. Half of all people infected will develop symptoms around day five and day six and 97% will develop symptoms within 11 days.

So, you could be infectious to your visitors between day three and day five after being exposed while asymptomatic. That leaves three days when you could be contagious without knowing. We think people are more contagious when showing symptoms, but it’s widely accepted now that people can, and do, transmit the virus while asymptomatic.

Under the upcoming rule, during this three-day window, you could theoretically pass the virus to six adults from six different households (assuming you’re an extrovert who has lots of friends round for dinner). They can then transmit it to their households and friends in three days’ time to 18 people while they are asymptomatic. If your friends also brought their children or other dependants, who then got infected and went to school, the number could be even higher. Under the exclusive bubble, the problem would have been confined to just two households.

Then, after your final two guests leave on the evening of day five post-infection, you develop symptoms. You get tested on day six because your cough or sore throat did not go away. Your positive result is returned on day seven and a contact tracer interviews you within 24 hours. On day eight your visitors will start to be interviewed. If they don’t get interviewed immediately, your friends infected on day three have now already infected two others. Over the next two days your other four friends also became infected and passed it onto their friends.

Obviously this is a worse case scenario. But you can see how the chain of transmission can easily get out of control. That’s why being tested as soon as you have symptoms is so important. It speeds up the tracing of every contact you had over the 72 hours prior to your symptoms.

Four people gathering indoors
Indoor close contact is a much higher coronavirus risk than outdoor contact with masks.
Shutterstock

If we added to our scenario continuous asymptomatic transmission (where you never developed symptoms) it becomes even more concerning. This is because your infected friends could go on to infect many others before someone becomes sick and alerts contact tracers. Even more concerning is when you delay testing, which makes it even harder for you to recall who your contacts where and when your day zero was.

This is just a hypothetical situation. But it illustrates why I’m concerned about allowing widespread indoor close contact.

The hope is that new daily case numbers, by the time this rule is implemented, are so low the risk of new chains of transmission is very low too. Meanwhile, Victoria’s contact-tracing team is more robust than ever before.




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The other relaxed restrictions are less concerning

The other relaxed restrictions are of little concern. Allowing ten people to gather outdoors, from only two households, poses a negligible risk.

The extension of the 5km travel radius to 25km makes epidemiological sense. The risk increases when you allow people from high-risk areas into low-risk areas, so maintaining the “ring of steel” between metropolitan Melbourne and regional Victoria is logical. This approach of “ring-fencing” is a well-established tool and is why Wuhan, the city where the pandemic began, controlled the outbreak early and is now welcoming millions of tourists.

The next step, planned for November 2, also sees the return of retail shopping. This poses negligible risk as long as shoppers wear masks, maintain hand hygiene, and use QR codes on entry. In my view, the risk of transmission from wandering through shops is much lower than having people over to your house.The Conversation

Mary-Louise McLaws, Professor of Epidemiology Healthcare Infection and Infectious Diseases Control, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.