Home quarantine for vaccinated returned travellers is extremely low risk, and won’t damage their mental health


Matt Dunham/AP/AAP

Gregory Dore, UNSWMany thousands of people need to return to Australia, and many at home wish to reunite with partners and family abroad.

A move away from a one-size-fits-all approach to quarantine is a way to make this happen — including home quarantine for vaccinated returnees.

The federal government implemented home quarantine over a short period in March 2020, before switching to mandatory hotel quarantine for returned residents and other incoming passengers.

But the considerably changed circumstances — most importantly, access to effective vaccines — calls for its reintroduction despite caution among politicians and the community.

The low rate of positive cases, and proven effectiveness of further safeguards to limit breaches, make home quarantine a persuasive strategy.

It’s worth remembering people who contract COVID, and their contacts, have successfully self-isolated at home since the pandemic began.

How will we make sure it’s safe?

There are several protective layers which would ensure extremely limited risk of home quarantine for fully vaccinated returned overseas travellers.

The first is requiring a negative COVID test within three days of departure, which is currently a requirement for all returnees.

The second is COVID vaccination. Recent studies indicate full vaccination provides 60-90% infection risk reduction. In cases where fully vaccinated people do get infected, these “breakthrough cases” are less infectious.

It’s also important to test returnees in home quarantine. A positive case would trigger testing of any contacts and may extend self-isolation.

Also, high levels of testing in the broader community can ensure early detection of outbreaks, enabling a rapid public health response to limit spread, if it did leak out of home quarantine.




Read more:
The crisis in India is a terrifying example of why we need a better way to get Australians home


The risk would be extremely low

Data from hotel quarantine in New South Wales, which takes around half of returned travellers in Australia, suggests home quarantine for fully vaccinated returnees would likely present an extremely low risk.

In 2021, NSW has screened around 4,700 returnees a week, with the proportion of positive cases detected during quarantine averaging around 0.6%.

From March 1, since vaccination has become more accessible, only eight of 406 positive cases were fully vaccinated.

Unfortunately we don’t have the overall data on how many returnees were fully vaccinated, but even if only 10-20%, this would equate to a positive rate of around 6-12 per 10,000 among the vaccinated. This is considerably lower than the overall rate of 66 COVID cases per 10,000 since March 1.




Read more:
Hotel quarantine causes 1 outbreak for every 204 infected travellers. It’s far from ‘fit for purpose’


If home quarantine was initially restricted to fully vaccinated returnees from countries with low to moderate caseloads, the rate would be lower again, probably less than five per 10,000.

If NSW increased their quarantine intake by taking an extra 2,500 per week from this population into home quarantine, it would equate to maybe a few positive cases per month, compared to around 120 cases per month in hotel quarantine. As vaccination uptake increases, this capacity could be expanded, with reduced hotel quarantine requirements.

Will people comply?

The enormous desire for stranded Australian residents, overseas partners and family of residents in Australia to return and reunite should ensure a high level of compliance with home quarantine.

Home quarantine has been successfully implemented in other countries with elimination strategies such as Taiwan and Singapore. Taiwan’s system was deployed rapidly and has 99.7% compliance. Singapore uses a grading system to enable lower-risk returnee residents to do seven days in home quarantine, with a negative test required for release on day seven.

Two major reviews of the hotel quarantine system — the Victorian government-commissioned Coate report, and the national review of hotel quarantine — recommended implementing home quarantine with monitoring technology, such as electronic bracelets. Their recommendations were made prior to the approval of vaccines.

Recent data suggests the current hotel quarantine system has harmful effects. Research published in the Medical Journal of Australia in April found mental health issues were responsible for 19% of all emergency department presentations among people in NSW hotel quarantine. It’s highly likely home quarantine would be more beneficial for the mental health of returnees.

What are the barriers?

Issues which would need to be sorted through include:

  • methods for determining how risky different countries are
  • how returnees can prove they’ve been vaccinated
  • how we would test returnees and home-based contacts, and how frequently
  • and how long home quarantine would be for.

But none of these are insurmountable, and small-scale home quarantine already exists in the ACT.

Health authorities could ensure returnees can collect their own COVID testing samples, for example by doing nasal swabs or collecting saliva themselves. This would reduce contact with health workers.

Home quarantine is undoubtedly being considered by major Australian COVID policy committees, along with other measures to enable a larger number of returnees and to increase the safety of the quarantine system.

Australians’ excessive caution continues to have direct consequences for the well-being of many thousands of stranded Australian residents, together with non-resident partners and family members desperate to return.

It’s time to change this situation and make their human rights a public health priority.


The author would like to thank John Kaldor, Esther Rockett, and Liz Hicks for their input.The Conversation

Gregory Dore, Scientia Professor, Kirby Institute; Infectious Diseases Physician, St Vincent’s Hospital, Sydney, UNSW

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

Should we vaccinate all returned travellers in hotel quarantine? It’s no magic fix but it could reduce risks


Catherine Bennett, Deakin UniversityThis week, a returned traveller who was quarantining in South Australia seems to have been infected with the virus during his stay, before testing positive once returning to Melbourne. It’s the latest in a long line of hotel quarantine leaks in Australia.

And in this week’s federal budget, the government has committed to welcoming back over 17,000 Australians stranded overseas over the next year, which will likely place more pressure on our hotel quarantine system.

In light of the seemingly continued spillover of hotel quarantine infections into the community, one researcher raised an intriguing possibility online: should we vaccinate all arrivals on day one of their stay in hotel quarantine?

There may be reasonably high vaccination rates among our arrivals already. But, if not, it’s definitely something worth thinking about.

In my view, overseas travellers should be considered equivalent to frontline workers, as they traverse the routes into Australia and cross through border quarantine. Therefore, they could be included in phase 1a of the vaccine rollout alongside these frontline workers.

It’s complex and there’s a lot to take into account, and vaccinating all arrivals won’t be the magic fix to our hotel quarantine troubles. But it might take the edge off some of the transmission risks.

You only have to prevent one case, which could have otherwise led to community spread and lockdown, for such a scheme to pay for itself many times over.

Here’s how it could work.

Vaccinating all arrivals could reduce infection risk

There are a number of potential ways this strategy could reduce infection risk, by:

  • preventing severe illness in people already infected
  • reducing the chance returnees will pass the virus on if they are infected, or become infected
  • protecting them from infection should they be exposed to the virus while in quarantine.

A Public Health England study found that a case who has had a single dose of either the Pfizer or AstraZeneca vaccine is up to 50% less likely to pass the virus on to their close household contacts.

However, when the researchers looked more closely at the timing, they found the full 40-50% reduction in transmission risk only occurred when the case received their first dose five or six weeks before becoming infected. In fact Pfizer didn’t reduce the transmission risk cases posed to others unless the first dose was given at least 14 days before the case became infected. In other words, giving returned travellers a dose of Pfizer while in quarantine might be too late to protect others.




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Here we go again — Perth’s snap lockdown raises familiar hotel quarantine questions


In saying that, the same study shows AstraZeneca’s vaccine does appear to at least partly reduce the transmission potential of cases even when the dose is given on the same day that person was infected.

In those who’ve received the AstraZeneca vaccine on day zero of their infection, the chance of them transmitting the virus to their close contacts over the ten days or so they’re infectious was on average roughly 20% lower than positive cases who weren’t vaccinated.

Getting the AstraZeneca vaccine when exposed to the virus, or soon after, might therefore marginally protect the wider population if, for example, a traveller contracts the virus late in quarantine and it isn’t picked up in day 12 testing and is released from quarantine.

Both Pfizer and AstraZeneca do provide partial protection from infection within 12 days of the first dose. While this is too late for those already infected, it might still provide some protection from infection for those exposed to the virus in the later stages of their stay in quarantine.

Both vaccines also appear to reduce the risk of subsequently dying from COVID-19 with an 80% reduction in deaths reported in the UK. Some in this study were infected within seven days of their first vaccine dose, but we do not know how this effectiveness against deaths changes with time since vaccination from this report.

Nevertheless, there might be some additional value in offering vaccines to both slightly reduce transmission rates and mitigate against serious illness and death in people who do become infected.

One challenge is that AstraZeneca has more to offer in reducing transmission risk in the first critical two weeks after receiving the first jab, but Australia currently doesn’t advise it for people under 50. Pfizer is in limited supply and our vaccine rollout phase 1a and 1b recipients haven’t all been fully vaccinated yet. The relative risks and benefits of reallocating some of our vaccine supply and delivery must be carefully thought through.

Many of those arriving in Australia will likely have opted for vaccination before travel, if available to them, even if just to increase their chances of testing negative and being allowed to board their flights home. Many are arriving from countries that began their vaccination programs months before Australia.

How many returnees are already vaccinated?

The number of positive cases in hotel quarantine has grown month on month, from 160 in February to 469 in April.

New South Wales provides the most detailed information on returned travellers. Its latest surveillance report on about 21,000 returnees shows 180, or 0.8%, tested positive to COVID-19. About 75% of these positive cases tested positive by day two, suggesting they were exposed before arriving in Australia or in transit.




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The report does include information on how many arrivals have been vaccinated since March 1. Of the 302 positive cases reported to the start of May, 20 had been vaccinated, with six fully vaccinated (two doses at least two weeks prior) and 14 partially vaccinated. Although, those considered “fully vaccinated” might not have been two weeks post-vaccine at the time they actually contracted the virus.

We haven’t been provided the overall vaccination rates for returnees across Australian hotel quarantine, so we can’t yet work out what percentage of arrivals are vaccinated. But if this is quite low, it strengthens the argument for offering vaccines to travellers on arrival.The Conversation

Catherine Bennett, Chair in Epidemiology, Deakin University

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

COVID has made one thing very clear — we do not know enough about Australians overseas


Bianca De MarchI/AAP

George Tan, Charles Darwin University; Andrew Taylor, Charles Darwin University, and Kelly McDougall, University of South AustraliaThe COVID-19 crisis has thrust a largely unseen part of Australia’s population firmly into the national spotlight.

These are the Australians who live and work abroad — our diaspora.

For more than a year, we have been hearing harrowing stories of Australians unable to get home. Most recently, there is the distress of those in India, currently banned from even trying to return.

But despite increasing awareness of this group, there is still much we don’t know about our diaspora. The bottom line is, we don’t have precise or up-to-date information about Australians overseas.

This lack of knowledge and understanding highlights the need for a national diaspora policy that truly reflects contemporary, multicultural Australia.

What do we know about Australians overseas?

Australia’s diaspora is estimated to include around one million people, but this would be significantly higher if former residents, such as international students, were included.

Australian family returning to Canberra in November 2020.
COVID-19 has seen more than 400,000 Australians return home, but more than 30,000 are still registered as wanting to come back.
Mick Tsikas/AAP

Large-scale studies in 2003 and 2006 told us Australians overseas tend to be highly educated and highly valued by employers. Many also retain links with family and friends in Australia. They continue to identify as Australian and intend to eventually come back.

In 2004, without putting a number on them, the Lowy Institute identified five sub-groups of expats.

  1. The who’s who — people at the pinnacle of their careers in significant international positions
  2. Gold collar workers — highly-skilled, well-paid Australians developing their careers on the international stage
  3. Other professionals — including nurses or teachers
  4. Return migrants — first or second generation Australians, going to their family’s original country for family or professional reasons
  5. Rite of passage travellers — young Australians living or working overseas.

Organisations such as Advance (which is supported by federal government funding) work to connect Australians overseas with each other and Australia. The focus here is on high-profile or very successful expats and how we can leverage their skills and networks to Australia’s advantage.

Traditionally, the majority of departures from Australia have been to Europe, the United States and New Zealand. This has lead to a narrative that doesn’t necessarily reflect the make-up of Australia’s population living overseas and Australia’s multicultural story.

We know from immigration and short-term travel data (those away for less than a year) that Asia, and in particular countries such as India, China, Indonesia, Thailand and Japan, are increasingly important for Australians.




Read more:
Is Australia’s India travel ban legal? A citizenship law expert explains


Long-term departure data present a similar picture. Our analysis of Australian Bureau of Statistics data shows India saw a 54% increase as a destination for Australian residents between 2007-08 and 2016-17.

So, the idea that Australia’s diaspora is largely made up of young Aussies backpacking in Europe, or hyper-successful entrepreneurs in Silicon Valley is an outdated one. There is every indication today’s diaspora is complex, and largely made up of everyday Australians doing everyday things.

Yet, we don’t have comprehensive or up-to-date data on where Australians are overseas, what they are doing and whether they are planning to come back.

Why don’t we have a clearer picture?

At a broader level, Australia’s national focus has been on our immigrants, for whom detailed data are recorded and available from the Department of Home Affairs and Bureau of Statistics.

Emigrants have long been an understudied element of Australia’s migration story.

Qantas plane leaving Perth from London in 2018.
Australia does not have a dedicated policy to keep track of and make use of its citizens living overseas.
Tony McDonough/AAP

One of the reasons for our limited and outdated information on our diaspora is the voluntary nature of registration with the Department of Foreign Affairs’ SmartTraveller program.

In 2017, Australia also stopped collecting information on intended destination and reasons for travel on outgoing passenger cards. This was to improve the “traveller experience” and streamline the border clearance process.

Meanwhile, despite recommendations from Senate committees in 2005 and 2013, Australia has not set up a dedicated diaspora policy and monitoring unit within government.

Why do we need a diaspora policy?

At a basic level, a diaspora policy would provide a formal commitment to strengthen links and maintain connections with Australians abroad.

Aside from taking advantage of the knowledge and skills of Australians overseas (which can influence bilateral trade, business and investment opportunities), a diaspora policy should also foster engagement by attending to the welfare of Australians overseas.

COVID-19 has shown us how important it is to understand where Australians are and their circumstances in a time of crisis.

This lack of information makes it difficult to plan and help people quickly. A holistic, consistent and ongoing dataset would tell governments where the pressure points are in times of crisis — where are most of our citizens? How old are they? How vulnerable might they be?

How can we do it better?

A commitment to deeper engagement with our diaspora is fundamental. In addition to a diaspora policy, a relatively easy way to get a better grip on Australians overseas would be to improve how Australians interact with SmartTraveller, so it becomes second nature for travellers to register and update their movements when overseas.




Read more:
The crisis in India is a terrifying example of why we need a better way to get Australians home


Another alternative is to use census data from destination countries. This requires greater synchronisation among national censuses as suggested by the United Nations. However, this also means we are relying on other countries’ data collection, not our own.

We could also look at regular large scale “census-like” surveys of Australians living overseas.

Getting a better grip on Australians overseas will have huge benefits in terms of planning, our economy and national identity. Bringing our diaspora back into our national population and migration story will help us understand its true character, nature and value.

Importantly, it will also move beyond the narrative of Australians overseas as either a “burden” or an “asset”.The Conversation

George Tan, Research Fellow, Charles Darwin University; Andrew Taylor, Associate professor, Charles Darwin University, and Kelly McDougall, Research fellow, University of South Australia

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

Official medical advice warned of health risks Australians stranded in India face


Michelle Grattan, University of CanberraThe official medical advice to the Morrison government recommending “pausing” Australian arrivals from India also contained a blunt warning that those stranded risk serious illness and even death.

Chief Medical Officer Paul Kelly’s advice said: “It is important in any measures we implement that we balance the burden on our quarantine and health systems and the protection of our community with the need to help Australians to get home, including those currently residing in high risk countries”.

Kelly said COVID-19 continued to be “a severe and immediate threat” to health in Australia and India was a high risk country, with a sharp increase recently in the number and proportion of overseas-acquired cases coming from there.

“Each new case identified in quarantine increases the risk of leakage into the Australian community through transmission to quarantine workers or other quarantined returnees and subsequently into the Australian community more broadly,” Kelly wrote in his Friday advice to Health Minister Greg Hunt.

“This quarantine ‘leakage’ presents a significant risk to the Australian community.”

The advice was in relation to the government’s determination under the Biosecurity Act – announced in the early hours of Saturday – which makes it an offence for anyone to enter Australia if they have been in India in the preceding two weeks.

This was to close any loopholes enabling people to arrive via third countries after the government suspended flights from India until at least May 15.

Kelly said in his advice, running to more than three pages, that Australia’s quarantine and health resources to prevent and control COVID from international arrivals were limited.

“Due to the high proportion of positive cases arising from arrivals from India, I consider a pause until 15 May 2021 on arrivals from India to be an effective and proportionate measure to maintain the integrity of Australia’s quarantine system,” he said.

But Kelly was careful to put on record a clear warning about the dangers faced by Australians who could not get home.

“I wish to note the potential consequences for Australian citizens and permanent residents as a result of this pause on flights and entry into Australia.

“These include the risk of serious illness without access to health care, the potential for Australians to be stranded in a transit country, and in a worst-case scenario, deaths.”

However he said “these serious implications can be mitigated through having the restriction only temporarily in place, i.e a pause, and by ensuring there are categories of exemptions.”

Under the law, action taken must be no more restrictive or intrusive than necessary and in place only so long as needed.

The determination will expire on May 15 unless extended.

The exemptions include crews of aircraft and vessels and associated workers, Australian officials, defence personnel and diplomats and family members, foreign diplomats accredited to Australia and family members, and members of an Australian Medical Assistance Team (AUSMAT).

There are more than 9,000 Australian citizens and residents registered in India of whom 650 are considered vulnerable.

The advice pointed out this would be “the first time that such a determination has been used to prevent Australian citizens and permanent residents entering Australia”.

On Monday Kelly was anxious to say he had nothing to do with the penalties that exist for breaching the determination, which include large fines and up to five years prison and have received much negative publicity. His letter did note the penalties the act carries.

Scott Morrison told 2GB the arrangement was aimed at ensuring Australia did not get a third wave of COVID and its quarantine system could remain strong.

He downplayed the sanctions, saying they would be used appropriately and responsibly.

Morrison said people who had been in third countries for 14 days could return home to Australia. “But if they haven’t, then they have to wait those 14 days.”

Asked on the ABC whether the government should vaccinate Australians stranded in India, Kelly said: “It’s certainly worth looking at. I would say, though, that we know that many of the Australians that are in India at the moment, they’re very scattered. So it’s a huge country; being able to get to them would be a challenge”.

Queensland Nationals senator Matt Canavan has condemned the government’s stand, tweeting: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.

Human Rights Commission expresses ‘deep concerns’ at ban on returnees from India


Michelle Grattan, University of CanberraThe Australian Human Rights Commission has declared the government’s travel ban on Australians returning from India, including criminal sanctions, “raises serious human rights concerns”.

In a strong statement at the weekend the commission said it held “deep concerns about these extraordinary new restrictions on Australians returning to Australia from India”.

It called on the government to show the measures were “not discriminatory” and were “the only suitable way of dealing with the threat to public health”.

The commission also urged the senate committee on COVID-19 to review the restrictions immediately, and said it was approaching the government directly with its concerns.

Last week the government stopped repatriation and commercial flights from India until at least May 15, and said indirect access was also blocked. After it found there was a loophole through Doha, it took drastic action to close all gaps.

In a statement issued in the early hours of Saturday, the government said all travellers from India would be banned from entering Australia if they had been in that country within 14 days of their intended arrival date in Australia, and anyone who breached the provision could face a large fine, imprisonment for five years, or both.

The government is acting under the Biosecurity Act.

Health Minister Greg Hunt said it was “critical the integrity of the Australian public health and quarantine systems is protected and the number of COVID-19 cases in quarantine facilities is reduced to a manageable level”.

Foreign Minister Marise Payne said the temporary pause on returns from India under the Biosecurity Act was ‘entirely founded” in the advice of the Chief Medical Officer.

She said in the month before the decision on Indian returnees 57% of the COVID positive cases in quarantine were in arrivals from India, up from 10% the month before that.

This was “placing a very, very significant burden on health and medical services in the states and territories and through the quarantine program.”

But she flatly denied this proved the government did not have confidence in the quarantine system, and rejected any suggestion of racism.

The chair of the senate COVID committee, Labor’s Katy Gallagher, said on Sunday she would be looking to schedule a hearing on the matter as soon as the committee could do so.

Meanwhile a poll done by the Lowy Institute and released on Monday found that in the second half of March – before the issue with returnees from India blew up – nearly six in ten people (59%) believed the federal government had done the right amount in helping Australians overseas return home. A third (33%) said the government had not done enough.

The Lowy COVIDpoll, with a sample of 2222 people, is part of the Lowy annual survey of Australian attitudes to the world.

Australians were divided over how much freedom they should have to travel abroad.

The poll found 41% agreed that only Australians granted special exemptions should be allowed to leave, which is the current policy.
But 40% said those who had been vaccinated should be allowed to leave. Only 18% believed all Australians should be free to travel.

People overwhelmingly (95%) said Australia had handled COVID well.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.

The crisis in India is a terrifying example of why we need a better way to get Australians home


Divyakant Solanki/AP/EPA

Liz Hicks, The University of MelbourneThe federal government’s suspension of flights from India leaves some 9,000 Australian citizens stranded, 650 of whom are registered as financially or medically vulnerable. They are trapped in a country where hospitals are running out of oxygen, and where the number of new infections is more than 300,000 per day.

Along with the unfolding humanitarian disaster, the suspension of flights is yet another example of the ongoing dysfunction of Australia’s repatriation system.

As I have explained in my recent research, the pandemic has created a temporary, but desperate minority in Australia. These are the roughly 34,000 citizens abroad who are currently registered with the Department of Foreign Affairs as wanting help to get home, though the true number is likely far higher.

Australia continues to have a large diaspora living and working abroad, who cannot register with the government until they have attempted to return home of their own accord.

So how did we end up here?

A consistent theme of Australia’s response to COVID-19 — including leaks in hotel quarantine — has been to blame individuals (be they guards or travellers), rather than the way the system is designed.

At the time of writing, Australia’s hotel quarantine programs have “leaked” 16 times. Many have come from poor ventilation and inadequate protocol for personal protective equipment. Experts say more must be done to prevent aerosol transmission of the virus.

When leaks have occurred, the political instinct of Australian governments has been to reduce the caps on overseas arrivals and — increasingly — point the finger at members of the public who have left Australia on federal government-approved exemptions.

The West Australian government’s response to its most recent leak is a useful case study. Despite warnings in March the Mercure hotel was “high risk”, it was not pulled from operation. Amid Premier Mark McGowan’s criticism of people travelling to India for family events, Western Australia has now halved its cap.

But a defective system not designed to accommodate aerosol transmission will continue to leak even with the reduced cap. It will merely do so at a lower rate.

Banning flights from India follows this logic. Australian governments have argued it is necessary to reduce the number of positive cases in quarantine. This implicitly acknowledges fundamental flaws in Australia’s hotel quarantine programs.

No constitutional right to return

Australians abroad have limited protection in this situation.

Australia is one of the only liberal democracies in the world without a bill of rights. Minority rights were explicitly rejected during the constitutional conventions during the 1890s, with a view that minorities

must trust to the sense of justice of the majority.

The lack of a rights framework creates particular problems during crises, when popular responses emerge in an atmosphere of fear and urgency. For a majority unaffected by travel bans, halving caps and suspending flights is an easy solution in the face of government failures. It also appeals to Australia’s cultural and historical reflexes regarding border control.

It also means Australia doesn’t necessarily prioritise its citizens or residents amongst arrivals. In February, only 44% of Australian arrivals were citizens. Victoria has now proposed introducing a separate stream for “economic cohorts”, even as it insists members of the public should only be allowed to leave and return for “genuinely urgent or compassionate reasons”.

Quarantine confusion

To make matters more complicated (and tougher for Australians trying to get home), we have a federal framework for quarantine. Quarantine is a “concurrent legislative power”. This means the federal government may assume responsibility for running quarantine, or it may leave it to the states. Ideally, the federal and state governments would work together and pool resources based on their respective strengths to maximise capacity and safety.

Prime Minister Scott Morrison and Foreign Minister Marise Payne.
The federal government has suspended all flights from India until May 15.
Dan Himbrechts/AAP

At an initial National Cabinet meeting, it was agreed the states would assume responsibility for running quarantine. The public has no insight into the reason for this decision, with National Cabinet deliberations remaining secret. It is likely the Commonwealth lacked short-term capacity, having dismantled quarantine infrastructure over many decades.

But with little public understanding of the complexities of federalism, governments of all levels have deflected responsibility to one another. Labor governments and oppositions at state and federal level claim quarantine is a “federal constitutional responsibility”. The federal Coalition claims responsibility lies with the states.

A need for leadership

As we move into the second year of travel bans, there are real questions about Australia’s longer-term strategy for facilitating essential travel in and out of the country — particularly for the 30% of Australians born overseas with family and significant ties elsewhere.




Read more:
Should Aussies stranded overseas go to the United Nations for help to get home?


Within this are questions about how sustainable flight suspensions will be over coming years, with many developing countries unlikely to be vaccinated until 2024.

As the situation in India shows, there is a desperate need for leadership at both state and federal level to design systems that can facilitate essential travel until borders can safely reopen.

Unfortunately, this is unlikely to occur until voters insist political leaders step up.The Conversation

Liz Hicks, PhD / Dr. iur. candidate, The University of Melbourne

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

Flights from India suspended until at least mid-May


Michelle Grattan, University of CanberraAll flights from India have been suspended until May 15, to take pressure off the quarantine system especially in Sydney and at the Howard Springs centre in the Northern Territory.

Scott Morrison on Tuesday also announced an initial package of supplies to assist the crisis-ridden country, including 500 non-invasive ventilators, gowns, goggles, gloves, masks, and face shields. The 500 ventilators are for rapid deployment – the government says there is a capacity to deploy up to a total of 3,000 ventilators.

With an acute shortage of oxygen in Indian hospitals, the government will also procure 100 oxygen concentrators, with tanks and consumables for them.

The suspension and the aid package were ticked off by the federal cabinet’s national security committee.

More than 9,000 Australian citizens and residents are registered in India including 650 considered vulnerable.

Morrison said the decision would affect two passenger services into Sydney and two repatriation flights into Darwin, involving about 500 people.

Last week the government cut arrivals and flights from India but has decided on the suspension because those coming from there are forming such a high proportion of the COVID cases in quarantine.

Morrison said 95% of the cases among recent arrivals into the Howard Springs facility were people from India.

He said the future of flights from India would be reviewed before May 15.

The passengers on all future flights, when and if these were resumed, would be required to have both a negative PCR test and a negative rapid antigen test before leaving, Morrison said.

Indirect entry to Australia from India through Singapore, Dubai and Kuala Lumpur is also blocked, because “we are aware flights to and from these transit points and India have been paused by the respective governments”.

Australia is restricting exemptions for travel to India to essential travel only.

Since March last year the federal government has facilitated 38 flights out of India.

Foreign Minister Marise Payne said Australian posts in India “will be redoubling their efforts” to maintain contact with Australians there, to ensure they know about travel settings, any changes and available assistance.

Morrison said the government would also reach out to the local Indian community in Australia.

Asked about the position of the Australia cricketers now in India Morrison said they would get no special priority when flights resume. Priority would go to vulnerable people.

“This wasn’t part of an Australian tour. They’re under their own resources. And they’ll be using those resources to, I’m sure, to see them return to Australia in accordance with their own arrangements.”

The latest daily number of new cases in India reported on Tuesday for the previous 24 hours was more than 323,000, down from the more 350,000 reported on Monday.

Before last week’s announcement the government had eight government-sponsored flights from India planned for the month of May.

Queensland Premier Annastacia Palaszczuk said the decision to suspend flights “will be difficult for families, but it is the right decision at this time”.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.

I understand the rationale to limit travellers from India, but I still feel uneasy


Hassan Vally, La Trobe UniversityOn Thursday, national cabinet agreed to list India as a “high-risk” country and temporarily reduce the number of people returning to Australia from the country by 30%.

Prime Minister Scott Morrison said other countries would soon be added to the high-risk list, although only India has been included so far.

Being an Australian who is of Indian heritage but has lived in Australia his whole life, the images from India over the past few days have pulled at my heartstrings in a way that has surprised me — just when I thought I’d become somewhat desensitised to the destruction the COVID-19 pandemic can wreak.

India is in the midst of an unparalleled catastrophe, even by the devastating standards we have witnessed over the last year. On Thursday it reported the largest single-day increase of COVID cases for any country since the pandemic began, with 314,835 new cases. Many hospitals are running out of oxygen.




Read more:
After early success, India’s daily COVID infections have surpassed the US and Brazil. Why?


It’s not necessarily surprising, given many substantial drivers of transmission are present in India: poverty, areas of very high population density, a lack of resources and limited lockdowns, to name a few. What’s also very clear is that, as alarming as the COVID numbers being reported are, they’re clearly an underestimation of the true level of spread.

With one in three tests coming up positive in some parts of the country, the real number may be several times higher than what’s being detected.

I have to admit I’m torn by the Australian government’s response to this situation. From a disease-control perspective, I understand the rationale. By limiting entry of people from high-risk countries, we certainly limit our exposure to risk in Australia.

As we have seen many times during the pandemic, hotel quarantine is not perfect and the risk of infection escaping these facilities is very real. Clearly, one of the triggers for this decision has been the hotel transmission of cases seen over the past few days in Perth.

But from a humanitarian perspective, I feel uneasy. One could argue those wishing to return from India need us to look after them more than ever right now. With transmission uncontrolled and lives at risk due to infection and a lack of hospital resources, we shouldn’t abandon people in India or any other country facing a similar situation.

As hard as it is to make a decision like this, it’s not without precedent. Limiting or preventing travel from high-risk countries to reduce the risk of importing disease has been a mainstay of the pandemic response in Australia and elsewhere. This policy of reducing traveller numbers from high-risk areas looks similar to the UK’s “red list”, which bans people travelling from certain countries (unless they’re British or Irish citizens, who can enter but have to quarantine at their own cost and test negative).

It does raise the question, however, of how we will define “high-risk” from now on. Expecting a rigid definition is probably unreasonable, given how many variables need to be considered, including which variants of the virus are circulating in other countries.

But despite this, I think it will be important for the government to communicate as much as it can about how these determinations will be made.

The more transparency and clarity we have on these decisions, the more confidence we can have in their fairness. If we understand the basis for these decisions, it may help us understand when and why a country is added to the list, and of course when and why it should come off again.

The response to this crisis in India speaks yet again to the complexity of public health decision-making. Although one has to listen to the science, the science cannot tell you what what your policy settings should be. In setting policy, one has to factor in fairness, consider the human perspective, and at the same time balance what’s acceptable to the wider community.

We’ve seen the challenge of balancing these various, and often competing, considerations in other difficult decisions that have been taken during the pandemic. This is just the latest example.

The federal government has probably landed on a pretty reasonable and pragmatic response to protect Australians by not closing the border to India completely, but instead reducing the risk of importing COVID by restricting the number of arrivals. Like many, however, I’m deeply concerned by the situation in India. The unfolding crisis highlights that until we bring virus transmission under control in all countries, we still have a long way to go for this pandemic to be behind us.




Read more:
3 ways to vaccinate the world and make sure everyone benefits, rich and poor


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.

What’s the risk if Australia opens its international borders? An epidemiologist explains


Tony Blakely, The University of MelbourneCoinciding with the Trans-Tasman travel bubble starting today, over the past week there have been murmurings Australia could soon relax its borders further, through mechanisms such as home quarantine or letting in vaccinated people.

But what are the risks?

Here I propose three things we must consider:

  • the prevalence of the virus in the country from where travellers are coming, including the strain of virus
  • measures taken for the people travelling, including home quarantine and whether travellers are vaccinated
  • the percentage of our population who are immune.

Importantly, all these factors matter. It’s not simply a case of needing to ensure all travellers are vaccinated.

The level of infection in the country of origin matters enormously

At around Christmas time, roughly 2% of the UK population was infected. That percentage is now considerably less, but it’s still likely around 1,000 times higher or more than the risk in China and other East Asian countries. The risk is near zero for New Zealand, Taiwan and many Pacific countries.

However, things will change. At the moment the United States seems to be maintaining high infection rates while also rapidly vaccinating the population. This is probably because of more transmissible variants, and society loosening up, offsetting gains from more people being immune. But at some point, perhaps around mid-year, the infection rate in the US should plummet as the percentage of people immune increases to somewhere around 60-80%. All this is to say we can expect infection rates in countries to vary a lot in the next six to 12 months.




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Let’s work through an example of the United Kingdom. Assume the UK has another surge of infections such that 0.5% of British people are infected and unaware of it, and could jump on a plane to Australia. Let’s assume we decide to let 10,000 Brits come to Australia each month. So 0.5% of 10,000 would mean roughly 50 infected people arriving per month.

Mitigating the risk of travellers

Of course, we would do more to reduce the risk. We could test people before they get on the plane and when they arrive. Let’s assume that weeds out another 50%, as the other half may be still incubating and not yet testing positive. That’s 25 COVID-positive British people arriving per month.

Next, let’s assume we require all travellers to be vaccinated. That will reduce their risk of unwittingly carrying the virus (through either symptomatic or asymptomatic infection) by between 66% for the UK variant and 81% for “normal” virus for the AstraZeneca vaccine. Data are still sketchy on any infection for Pfizer, but it’s likely 90% or more, given 95% protection against symptomatic disease in Pfizer’s clinical trial. If we assume 80%, we are now down to five infected Brits arriving here per month.

Importantly, the vaccine also reduces both the duration of the disease and its infectiousness, for vaccinated people unlucky enough to get infected. We don’t know by how much as the real-world evidence is still accruing, although animal data on peak viral load and duration of likely infective viral load supports this contention.

If we assume (conservatively in my view) that there is a 50% reduction in duration and 50% reduction in peak infectivity for hapless vaccinated people who still get infected, that is 25% of the risk of passing it on (that is, 50% of 50%).

Therefore, if an unvaccinated person, infected with the UK variant, was going to infect an average of 3.5 people in the absence of any social measures such as mask-wearing, the infected-after-vaccination person would only infect 0.875 other people – a 75% reduction in the reproductive rate. So our remaining five infected Brits are less infectious.

Intensity of quarantine measures for arrivals

Let’s consider the option of home quarantine. We don’t know how effective this will be, because of potential compliance issues.

But the risk of home quarantine breaches can be reduced by technology like ankle bracelets, GPS tracking on travellers’ phones to ensure they stay home, and only allowing home quarantine if any other members of the household are also vaccinated, to give an extra layer of protection.

Let’s assume home quarantine with these extra measures stops 80% of infected people getting out and about in Australia while infectious.

So we are now down to one infected British person who has slipped through per month. But given they are also vaccinated, they’re less likely to pass on the infection. And this risk can be reduced further still by ensuring they’re wearing a mask – although if they “breached” home quarantine rules they may not be likely to wear a mask.

It’s important to remember even “proper” quarantine isn’t foolproof. About one in 250 infected people last year in hotel quarantine caused a leakage.

Is Australia a tinderbox?

Yes. Perhaps only 5% of us are immune. Even if, via the above measures, we get just one infected person a month in Australia – the situation could blow up. Keep in mind the above example assumes we’re only allowing travellers from one country too. More countries means more travellers means more risk – although as above, the risk varies based on the infection rate in the origin country.

You can play with various scenarios in our COVID-19 Pandemic Trade-offs tool, launched two weeks ago. What you’ll find is that until most adults in Australia are vaccinated, any loosening up of how we respond to the virus incursion is unwise. If contact tracing cannot mop up the inevitable incursions, we’ll still need to use social restrictions, including lockdowns, until the vaccination rollout is complete.

But we can probably think about inching forward to some increased risk once all over-50s are vaccinated (phase 2A), with some modest relaxation of the border. Yet we can never totally escape the risk of outbreaks.

So what can we do now with borders?

First, continue with the Trans-Tasman bubble.




Read more:
A quarantine-free trans-Tasman bubble opens on April 19, but ‘flyer beware’ remains the reality of pandemic travel


Second, remove or greatly reduce quarantine for vaccinated travellers from many East Asian countries, which present a low risk to Australia. As an example, the average number of known active infectious people in China at any point in time recently is about 250. Let’s assume this equates to about 100 unknown infections at any point in time (that is, people who are not yet symptomatic or detected). For a population of 1.4 billion, that’s a 0.000007% risk of any person in China being infected.

This suggests that for 10,000 vaccinated arrivals from China per month with modified quarantine, the expected number of infected people unwittingly getting out into the Australian population per month is 0.000014. Or, put another way, our above UK example presents 70,000 times the risk of an arrival from China. Given such low risk, it’s hard to justify why university students from China cannot start in time for semester two this year if they’re vaccinated and going into some form of modified quarantine.

Third, we need a national framework to assess the risk. Focusing on one measure alone isn’t wise — you have to look at the whole system. Such a framework can be developed now, at the same time as setting our risk thresholds so policy-makers, airlines and other industries can start planning.The Conversation

Tony Blakely, Professor of Epidemiology, Population Interventions Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne

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

Morrison government to subsidise holidaymakers in $1.2 billion tourism and aviation package


Michelle Grattan, University of Canberra

Nearly 800,000 half-price air tickets for travel to and from holiday areas will be provided under a $1.2 billion program to support aviation and tourism, to be announced by the Morrison government on Thursday.

The measures are designed to assist these industries, still hard hit by the effects of the pandemic, after JobKeeper finishes late this month.

The cheap fares will run from April 1 to July 31.

The loan guarantee scheme that operates for small and medium sized businesses is also being expanded and extended for enterprises that leave JobKeeper in the March quarter.

While this is an economy-wide measure, the government says those eligible will be especially in the tourism sector.

Thirteen regions have been designated initially for the cheap flights – the Gold Coast, Cairns, the Whitsundays and Mackay region (Proserpine and Hamilton Island), the Sunshine Coast, Lasseter and Alice Springs, Launceston, Devonport and Burnie, Broome, Avalon, Merimbula, and Kangaroo Island.

The number of tickets will be demand driven, as will the places the flights depart from, but it is estimated there will be about 46,000 discounted fares a week over 17 weeks. A return ticket counts as two discounted fares, the government said.

Under the loan initiative, the maximum size of eligible loans will be increased from the present $1 million to $5 million. The maximum eligible turnover will also be expanded, from $50 million to $250 million.

Maximum loan terms will go from five years to 10 years, and lenders will be allowed to offer borrowers a repayment holiday of up to two years.

Eligible businesses will also be able to use the scheme to refinance their existing loans, so benefitting from the program’s more concessional interest rates.

The government says more than 350,000 businesses which are on JobKeeper are expected to be eligible under the expanded scheme, for which loans will be available from the start of next month and must be approved by the end of December.

For international aviation, there will be support from April until the end of October, when international flights are expected to resumer. The assistance across both airlines will help them maintain their core international capability, keeping 8600 people in work as well as planes flight-ready.

Among the assistance for aviation, several existing support measures are being extended until the end of September, including waivers for air services fees and security charges.

There are also extensions for the business events grants program, the assistance for zoos and aquariums, and the grants to help travel agents.

More than 600,000 people are employed by the tourism sector with domestic tourism worth $100 billion to the economy.

Tourism has suffered severely from the closed international border and from the state border closures and restrictions.

Scott Morrison described the package as “our ticket to recovery … to get Australians travelling and supporting tourism operators, businesses, travel agents and airlines who continue to do it tough through COVID-19, while our international borders remain closed.

“This package will take more tourists to our hotels and cafes, taking tours and exploring our backyard”.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.