Why Sydney’s COVID numbers didn’t get as bad as the modelling suggested

Posted on October 15, 2021 by particularkev

Jamie Triccas, University of Sydney and Megan Steain, University of SydneyLast Monday, Sydney emerged from a lockdown of more than 100 days after reaching the milestone of having 70% of the over-16 population fully vaccinated.

Modelling predicted New South Wales would “open up” with around 1,900 daily cases when this target was reached.

However, the state recorded just 496 new local cases on that day. And the current seven-day average for NSW is 488 cases, with numbers trending downwards.

What’s more, other modelling suggested COVID-19 hospitalisations would peak between 2,200 and 4,000 in greater Sydney in late September.

On September 21, peak COVID hospital occupancy for all of NSW was 1,268 patients. There are currently 711 COVID patients hospitalised in NSW, as of October 14.

We propose there are two main factors which might account for these discrepancies.

Vaccine effectiveness underestimated

Firstly, predictions of vaccine impact have typically used estimates of effectiveness against the Delta variant based on the UK Scientific Advisory Group for Emergencies (SAGE) roadmap, published in June. This suggested an effectiveness against hospitalisation of 87% for Pfizer and 86% for AstraZeneca.

However, more recent data across numerous countries has shown effectiveness against severe infection and hospitalisation is somewhat greater. A different UK study suggested 95% protection against hospitalisation for both Pfizer and AstraZeneca. And a study from the Netherlands found 96% and 94% protection against hospitalisation for Pfizer and AstraZeneca, respectively.

This difference may account for the disparity between the actual NSW hospitalisation numbers and those predicted based on the current vaccine rollout.

Real-time protection

The second reason for the current NSW situation could be a concept we’ve termed “protection in real-time”.

The rapid pace of vaccine uptake during NSW’s Delta wave ensured there was a large proportion of recent vaccines within the population.

This may offset the impact of waning vaccine immunity.

Optimal immunity after vaccination occurs at about two weeks after getting the second dose. But a partial protective effect of vaccination with Pfizer was apparent in clinical trials as early as 12 days after the first dose.

In addition, protection against severe infection may only require a lower level of immune response after vaccination.

How has this played out overseas?

The protection in real-time concept can be used to explain the impact of vaccination in other countries, which may provide a “real world” perspective of the future of the pandemic in Australia.

Denmark reached 25% vaccination of the total population before the arrival of the Delta variant. During the Delta wave there were reduced hospitalisations and deaths compared to previous waves and a dissociation between case numbers and deaths.

You can see the black line (cases) starts to separate from the green line (hospitalisations) and the red line (deaths) as the vaccine rollout progresses.
Data from ourworldindata.org/covid-vaccinations and covidlive.com.au, Author provided

NSW’s achievement of reaching the 70% threshold last week actually equates to around 56% of the total population of NSW. At the peak of its Delta wave in July, Denmark reached 50% vaccination coverage of the entire population.

The restrictions in place at this time in Denmark were requiring proof of vaccination, past infection or a recent negative COVID test to enter certain indoor settings, such as restaurants and cinemas.

With a population size similar to greater Sydney, the coming months in Denmark may serve as an important comparison as to how the pandemic may unfold in Australia.

Similarly in Singapore, vaccination rates are high, at around 80% of the total population, and the pace of the vaccine rollout is very similar to Denmark.

Singapore has seen a recent spike in cases since the relaxation of restrictions, with case numbers at their highest. However, 98% of these cases are mild or asymptomatic. This suggests vaccines are having a major impact on lessening the severity of COVID, but a less pronounced ability to completely interrupt disease transmission.

Another example of the impact of real-time protection is the situation in Israel. Israel is often used as as the benchmark of vaccine effectiveness. Its vaccine program involved a rapid rollout of mRNA vaccines, predominately Pfizer’s. Initial studies in the country found the vaccine had high effectiveness against symptomatic COVID-19 and hospitalisation.

However, the arrival of Delta in Israel resulted in a large increase in COVID-19 cases with accompanying spikes in hospitalisations and deaths.

While this may provide some insight into the impact of Delta in Australia, there are key differences.

Israel experienced a large increase in COVID cases, hospitalisations and deaths after the arrival of the Delta variant.
Data from ourworldindata.org/covid-vaccinations and covidlive.com.au, Author provided

Why did hospitalisations rise in Israel? And what are the lessons for Australia?

Israel saw a large proportion of the eligible population vaccinated quickly. Around 50% of the total population was fully vaccinated by mid-March. But after this, there was a marked slow-down in uptake.

The NSW and Australian populations have been vaccinated much more recently than Israel’s.
Data from ourworldindata.org/covid-vaccinations and covidlive.com.au, Author provided

Thus, a combination of waning immunity and a large unvaccinated population may have exposed Israel to Delta.

While the Pfizer vaccine demonstrates excellent effectiveness against severe COVID-19, recent evidence from Israel suggests some waning of protection against severe disease over time, which prompted the introduction of the country’s booster program in July. A third dose was initially offered to over-60s, before being extended to everyone aged 12 and over.

In Australia, the widespread rollout of booster shots in the near future would be premature. The priority now is to get everyone eligible fully vaccinated, and consider boosters for targeted groups.

The federal government announced last week booster shots would be available to Australians who are “severely immunocompromised” from this week.

Governments should also consider a “mix and match” approach of booster shots. This strategy is being pursued in the UK, based on evidence that combining different vaccines may lead to stronger immunity.

Jamie Triccas, Professor of Medical Microbiology, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney and Megan Steain, Lecturer, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney

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

Flattening the COVID curve: 3 weeks of tougher lockdowns in Sydney’s hotspots halved expected case numbers

Posted on September 29, 2021 by particularkev

Allan Saul, Burnet Institute; Brendan Crabb, Burnet Institute, and Mark Stoové, Burnet InstituteIn a pandemic, you expect that as new public health measures are introduced, there’s an observable impact on the spread of the disease.

But while that might have been the case in Melbourne’s second wave last year, the highly contagious Delta variant is different. In Sydney’s current second wave, none of the increased restrictions seemed to directly decrease the spread of COVID-19. Until now.

Our modelling shows the curfew with the other restrictions introduced on the August 23 in the 12 local government areas (LGAs) of concern has worked to halt the rise in cases.

And this wasn’t due to the level of vaccinations achieved so far. It suggests other LGAs with rising case numbers should not rely solely on vaccination to cut case numbers in the short to medium term. They may need to tighten restrictions to get outbreaks under control.

What are the tighter restrictions?

Restrictions across Sydney have been in place in various forms since June 23. But daily case numbers only plateaued in the 12 LGAs after the latest round of restrictions were introduced on August 23.

These included:

a curfew from 9pm to 5am, to reduce the movement of young people
restricting public access to hardware, garden supplies, office supplies and pet stores to click-and-collect only
closure of face-to-face teaching and assessment in most educational institutes that remained open
limiting outdoor exercise to one hour a day.

These came on top of the existing restrictions in these 12 LGAs: only four reasons for leaving home (work/education, care/compassion, shopping for essential supplies, and exercise), 5km travel restrictions and the closure of non-essential shops.

What impact did these restrictions have?

There was a marked and significant decrease in the growth of the outbreak in the 12 LGAs of concern, starting a week after restrictions were introduced.

The expected growth rate of the Delta variant, in the absence of any controls, has a R0 between 5 and 9. This means one infected person would be expected to pass the virus on to five to nine others.

In the 12 LGAs, the Reff — which takes into account how many others one infected person will transmit the virus to with public health measures in place — reduced from 1.35 to 1.0. That means one case currently infects just one other person.

Cases numbers went from doubling every 11 days to case numbers being constant.

Without the additional restrictions introduced on August 23, the outbreak would have continued with close to an exponential increase (see the dashed orange line in Figure 1 below).

Without these stricter measures we expect about 2,000 cases per day by now and about 4,000 per day by the end of the month instead of the 1,000 per day currently in these 12 LGAs.

It’s not possible to assign which specific part or parts of the restrictions package were important, or how they functioned. Nevertheless, it’s encouraging to see a direct association of restrictions and impact on COVID-19 cases.

Vaccination rates have risen, but that’s not the reason

Vaccination rates have steadily risen in the 12 LGAs of concern. Currently, 74-86% of those aged 16 and over have had least one dose, and 34-42% have had both doses.

These vaccination levels have increased substantially in the past month from about 45% with at least one dose and only 22% fully vaccinated.

However, taking into account that it takes about two weeks for vaccination to be fully effective, we calculate that from August 23 to September 9, the increased vaccination rates will have only reduced the transmission of COVID by about 9% in the these LGAs. This is nowhere near enough to account for the dramatic change in the case numbers.

Interestingly, outside these 12 LGAs, there was a gradual slowing of the growth rate that very closely matched the decrease in growth expected from increased vaccine coverage – but no sign of the abrupt change seen in the 12 LGAs of concern.

What does this mean for other parts of Sydney?

The gains associated with the more stringent restrictions are readily reversible. If they are lifted before vaccination can permanently reduce growth, COVID-19 cases could rapidly increase again in these 12 LGAs.

Meanwhile, COVID-19 cases outside the 12 LGAs of concern continue to grow strongly. With the current restrictions in place, cases in the rest of Sydney will soon overtake the cases within these 12 LGAs.

Having slowed the growth in the 12 LGAs of concern, it would be devastating if the strong growth in the rest of the state resulted in hospitals being further overloaded and a substantial increase in severe disease and deaths.

It may be necessary to impose greater restrictions — such as curfews and restricting retail outlets such as hardware stores to click-and-collect only — in at least in some of the LGAs with higher growth rates to curb this growth.

Why we need a vaccine-plus strategy

Increased levels of vaccination remains both crucial and urgent to prevent death and severe disease from COVID-19. But we are some way from vaccination levels that can allow us to relax.

While the national plan aims for 70% and 80% initial vaccination coverage it’s not yet clear how vaccination levels will impact on case numbers, given we still don’t know how well vaccines reduce transmission of the Delta variant.

Our ability to keep case numbers in check will be highly dependent on the efficiency of ongoing public health measures such as the contact tracing.

As low case numbers remain a crucial component of a safe exit, “lockdown” restrictions will be important for some time yet to maintain these lower levels in NSW and Victoria.

States and regions that have no community transmission should fiercely protect that status until vaccine levels reach very high levels or else they may also face stringent restrictions.

But lockdowns are clearly not sustainable in the long term. At best, they give health services a temporary breathing space until we get high levels of vaccine coverage.

Allan Saul, Senior Principal Research Fellow (Honorary), Burnet Institute; Brendan Crabb, Director and CEO, Burnet Institute, and Mark Stoové, Head of HIV/STI research, Burnet Institute

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

Brad Hazzard is wrong about multicultural western Sydney: new research shows refugees do trust institutions

Posted on August 12, 2021 by particularkev

Tadgh McMahon, Flinders University and Shanthi Robertson, Western Sydney UniversityWith COVID numbers surging in Sydney’s multicultural western suburbs, NSW Health Minister Brad Hazzard speculated that migrant and refugee communities in the region “haven’t built up trust in government”, which might make them reluctant to engage with health authorities.

And yesterday, Hazzard made another oblique reference to residents in western Sydney by saying,

There are other communities and people from other backgrounds who don’t seem to think that it is necessary to comply with the law and who don’t really give great consideration to what they do in terms of its impact on the rest of the community.

Concerns about a lack of trust among migrants and refugees in institutions in Sydney’s west — or their alleged disregard for rules — mirror similar commentary by authorities in Melbourne during COVID outbreaks last year.

Our recent research among refugees in NSW shows these concerns about trust in government are unfounded, particularly among recently arrived refugees.

Our 2019 and 2020 surveys reveal these people, in fact, have very high levels of trust in Australian institutions and a high level of commitment to fulfil their social and civic responsibilities.

What our research reveals

The study, led by Settlement Services International (SSI) and researchers at Western Sydney University, explored refugees’ sense of participation and belonging in Australian society.

We surveyed 418 refugees in their preferred languages, reaching a diversity of backgrounds. All refugees had permanent residency, and those in our 2020 survey had lived in Australia for an average of 24 months.

In the 2020 survey, we found our respondents had very high levels of trust in the government (86% responding “a lot”) and the police (84% “a lot”), with no noticeable difference between women and men.

Trust in the media, however, was considerably lower (39% trusting the media “a lot” and 41% “some”), but still comparable to the general Australian population.

The lowest trust was expressed for people in the wider Australian community, with just 24% saying they trusted these people “a lot”, 45% saying “some” and 10% saying “not at all”. This was comparable to findings from a long-term study of refugees in Australia.

One typical resident in Sydney’s west

Muneera, who came to Australia from Iraq, lives in Sydney’s west with her family and is typical of the refugees we surveyed. Muneera was supported by SSI when she arrived in March 2019 through the Australian government’s humanitarian settlement program.

While she was not part of the research, she was happy to share her story of dealing with COVID-19 during the current lockdown.

With limited English, Muneera gets COVID-19 information from Arabic community social media groups and mainstream TV news. She also relies on her sister, who speaks English very well, for regular updates on public health restrictions.

Like many other families in lockdown, some of her children have lost work and her son struggles with high school from home without a laptop. Yet, Muneera and her family are committed to staying home and understand the need to stay informed and comply with restrictions.

Why community support is so vital

In our survey, we found refugees in New South Wales were strongly motivated to fulfil their social and civic responsibilities, including obeying the law, being self-sufficient, treating others with respect and helping others. In fact, these sentiments were shared nearly universally among our respondents.

They also reported knowing how to get help and access essential services, including how to find out about government services (69% “know very well/fairly well”) and, importantly, what to do in an emergency (77% “know very well/fairly well”). They also knew how to get help from the police (78% “know very well/fairly well”).

When it came to helping others in the community, rates of volunteering among refugees in our survey dipped in 2020 (48%) compared to 2019 (60%), but were still on par with rates of volunteering (49%) in the wider Australian community during the pandemic.

All respondents in this survey had Australian permanent residency, a key factor in enabling their settlement and their access to services.

Refugees in our study also felt welcome in Australia, part of the Australian community and supported by range of networks, including their ethnic and religious communities and other groups. At this early stage of settlement, they found it relatively easy to make friends in Australia, talk to their neighbours and maintain mixed friendships networks.

In western Sydney and other parts of Australia with high cultural diversity, there are multiple challenges in containing COVID-19, including rapidly changing public health advice and the need for accurate information in community languages.

However, the premise that refugees have low levels of trust in institutions or are disinclined to follow rules is not supported by our research.

Rather than labelling diverse communities as lacking in trust, their existing social capital and breadth of their community relationships and networks can be a critical resource in the battle to contain COVID-19, as Muneera’s example shows.

Starting from a position of trust, the challenge becomes how to activate and effectively resource the span of organisations and networks that refugees and migrants engage with in their daily lives.

This should be coupled with clear and consistent messaging in community languages delivered through a variety of channels (including digital) and formats (including video). Peer-to-peer engagement from community members and trusted organisations can be incredibly effective to support behaviour change and maintain health and safety.

Targeted mental health promotion and financial assistance are also key to ensuring families like Muneera’s have the support they need during the pandemic.

The authors’ research on newly arrived refugees will be discussed in a moderated online panel discussion to be held on September 9 from 12:30-2pm (AEST). Registration is free, but essential.

Tadgh McMahon, Adjunct Lecturer, College of Medicine and Public Health, Flinders University and Shanthi Robertson, Associate Professor, Institute for Culture and Society & School of Humanities and Communication Arts, Western Sydney University

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

When will Sydney’s lockdown end? Well, it depends who you ask

Posted on August 12, 2021 by particularkev

James Trauer, Monash UniversityDuring the pandemic, infectious disease modelling has come to prominence as never before. A plethora of models have been used to guide policy.

The models use computer programs to predict, for example, how COVID outbreaks develop and which public health measures are most likely to contain them, under different future scenarios.

Among the big questions modellers are trying to answer currently is what should Sydney’s strategy be for addressing its current Delta outbreak, to allow release from lockdown while minimising COVID-related deaths.

Different groups of researchers give different predictions. And it’s easy to be bewildered, especially if you’re in lockdown and looking for answers.

Why do answers vary?

At their best, infectious disease models should provide a way of integrating all the available information relevant to the problem at hand. This includes the characteristics of the virus circulating, the scope of the epidemic, the history of the outbreak to date, and evidence from clinical trials and other research.

We can then use this to challenge our own ideas about what the best policy response should be and develop a high-level strategy for the future.

Many of the mathematical models that have informed COVID policy across the world have been “mechanistic”. They explicitly represent the population in which the virus is transmitting and so simulate the process of susceptible people becoming infected with the virus through exposure to others.

Although many other mathematical techniques have been used during the pandemic, this approach has the advantage of being able project the outcomes of a wide range of policy responses.

This approach also has several limitations. One of the most important is that tiny changes in what you feed into the model can have a huge effect on the output.

Another important consideration is that future projections inevitably represent the expected outcomes under a particular set of policy choices, which are impossible for modellers to predict.

In short, infectious disease epidemics are difficult to predict because their dynamics are volatile and dependent on the policies we choose to implement.

Let’s look at the Sydney predictions

Several groups have modelled Sydney’s lockdown recently and have shared their results with the public. These include groups at the Burnet Institute and at the universities of Sydney and Melbourne.

The Burnet model

The Burnet Institute simulates individuals and their characteristics and behaviours (an agent-based model). It can mimic the social networks through which individuals interact in specific settings, fundamental to how the epidemic spreads.

This approach is particularly well-suited to considering interventions that affect groups of people interacting. These include closing specific venues or activities, such as restaurants, gyms, schools or sporting events.

The Burnet Institute’s modelling shows that without the initial stay-at-home orders, the results would have been catastrophic (red line).
Burnet Institute

This model, released July 12, predicted a more stringent lockdown (blue line in the chart above; something like Melbourne’s stage 4 lockdown in 2020) should be enough to drive case numbers in Sydney back down towards low levels (less than five new local cases per day) over several weeks. This would lead to elimination of the virus, allowing lockdown to lift.

University of Sydney model

The University of Sydney model is also an agent-based model, similar in several ways to the Burnet model. It builds on previous work on modelling influenza in which the researchers constructed a detailed representation of the Australian population using census data.

Along with their COVID status, the age, gender, residence and workplace of individuals is simulated, along with their commuting patterns. Various interventions are simulated, including isolating contacts of cases in quarantine, and social distancing.

The Sydney model found that unless interactions between people are reduced substantially for several weeks, the epidemic is unlikely to decline rapidly.

University of Melbourne model

The University of Melbourne model represents people or groups of people as agents who move in two-dimensional space, potentially becoming infected as susceptible agents interact with infected ones.

Because discrete individuals are represented, models like this can be used to define when the last case has recovered and elimination has been achieved.

This model generally had more optimistic findings for Sydney than the other two, with most model runs showing the epidemic dying away within two months if current restrictions or tighter are sustained. Unfortunately, case numbers already seem to be escalating beyond these predictions.

The University of Melbourne's modelling of Sydney's COVID outbreak — The University of Melbourne’s modelling suggested Sydney’s COVID outbreak could take until early September to be brought under control.
Chart: ABC news. Source: University of Melbourne

The similarities

Despite some differences in findings, we can take the following messages from these models:

if there had been no lockdown or if lockdowns were released now, a devastating epidemic would result
the public health response (including lockdown) is having a major effect in driving down transmission
with the current response and level of restrictions, at best it will take months to bring the epidemic fully under control
if restrictions are tightened considerably for at least one to two months, case numbers may decline to the point that elimination could be targeted.

Take-home message

The epidemic in Sydney is at a crossroads, with the only two feasible choices being to go hard towards elimination (as supported by all modelling groups) or to maintain manageable case numbers until vaccination begins to take effect. Current policy choices in NSW appear to prefer the latter.

The next task for modellers should be to simulate this chosen pathway and the length of lockdown it would imply.

James Trauer, Associate Professor, Monash University

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

We can’t rely solely on arbitrary vaccination levels to end lockdowns. Here are 7 ways to fix Sydney’s outbreak

Posted on August 9, 2021 by particularkev

Quentin Grafton, Crawford School of Public Policy, Australian National University; Mary-Louise McLaws, UNSW, and Tom Kompas, The University of MelbourneOn July 15, New South Wales Premier Gladys Berejiklian said Sydney’s COVID lockdown wouldn’t end until the number of new cases not in full isolation was zero or as close to zero as possible.

But by August 1 the premier’s message had shifted:

Once you get to 50% vaccination, 60%, 70% it obviously triggers more freedoms […] The challenge for us is to get as many people vaccinated in August as possible so that by the time August 28 comes around, we have a number of options before us as to how we can ease restrictions.

There are around five million Australians under 16 who aren’t eligible to be vaccinated (bar a few groups of 12-15-year-olds whom the Australian Technical Advisory Group on Immunisation (ATAGI) said this week should be prioritised for vaccination, including Aboriginal and Torres Strait Islanders and those with certain underlying health conditions).

So, vaccinating 50% of the eligible population represents only about 40% of the whole population. Vaccinating 70% of the eligible population means only 56% of the whole population are vaccinated.

There can be no relaxation options determined solely by vaccination rates of 50% or even 70% of the eligible population. We cannot give up on our safety by pretending these vaccination rates in over-16s during an insufficiently controlled COVID outbreak would be like “living with the flu”. It won’t be.

Relaxing lockdown prematurely based solely on an arbitrary (and much too low) vaccination rate will likely lead to escalating cases and impose huge costs on Sydney and the rest of Australia.

Having not gone early, hard and fast, we propose seven key actions to save Sydney.

Crucially, Sydney’s lockdown needs to continue until the number of new daily cases who weren’t in full isolation reaches zero.

What does 70% of the eligible population vaccinated mean for Australia?

The premier’s August 1 announcement was similar to the federal government’s National Transition Plan released on July 30. The plan states that when 70% of Australians over 16 are vaccinated, governments should “ease restrictions on vaccinated residents”, and that lockdowns will be “less likely but possible”.

As we’re seeing in Southeast Queensland now, Delta is acquired and transmitted by children. This means only vaccinating 70% of over-16s will leave our kids vulnerable to COVID outbreaks. In the absence of public health measures, these children will pass it on to their friends and families.

While the risk of death from COVID, even with Delta, is lower among children than adults, there’s still a risk of long-term health consequences called “long COVID” among the young (and old).

Researchers dispute how common long COVID is in kids. But a study of children in Italy who have had COVID reported more than half had at least one symptom lasting more than four months, and more than 40% had a health problem due to long COVID that impaired their daily activities.

A UK survey of 23,000 households, published online as a preprint in June, found 5% of children infected with COVID had suffered persistent post-COVID symptoms for longer than four weeks.

What could happen if Sydney’s lockdown is relaxed too soon?

As of August 6, and since the Delta outbreak began in Sydney on June 16, there have been 4,610 locally acquired cases and 22 deaths. On August 6 there were 304 people hospitalised, 50 in intensive care with 22 requiring ventilation.

Using these stats, we can estimate what might happen should there be a partial relaxation of the current Sydney lockdown after 70% of over-16s in Greater Sydney are fully vaccinated and the outbreak is still ongoing.

First, if the vast majority of new daily cases aren’t in full isolation while infectious when lockdown restrictions are relaxed, this could easily result in a rapid growth in infections. This is because Delta is highly transmissible — infected people develop a viral load on average 1,000 times higher than the original strain. Even with new daily case numbers much lower than the numbers in early August, contact tracing wouldn’t be an effective secondary prevention strategy.

Let’s say partial relaxation after August 28 resulted in rapid and uncontrolled growth of new cases. We estimate that over a few months, and in the absence of subsequent lockdowns, this could result in as many as 100,000 cumulative hospitalisations, a total of more than 10,000 COVID patients in intensive care and, tragically, thousands of deaths in Greater Sydney alone.

This assumes that in an uncontrolled spread, eventually all unvaccinated people become exposed to COVID. We based these figures on the current ratios of how many people in Sydney have been hospitalised and died from COVID from the total number of cases, multiplied these numbers by the unvaccinated population, and extrapolated these numbers forward in the scenario of an uncontrolled outbreak.

Based on our previous research, the minimum economic cost of those hospitalisations (ignoring lost wages and the costs of “long COVID” and ongoing care generally) in Greater Sydney could easily exceed half a billion dollars. The economic costs from the expected loss of life would be in the tens of billions.

7 ways to fix Sydney’s outbreak

Experience from Australia and around the world tells us what needs to be done to protect public health and the economy.

NSW must:

ensure Sydney’s lockdown continues beyond August 28 until the number of new daily cases who aren’t in full isolation reaches zero
focus on daily testing of essential and front-line workers so pre-symptomatic and asymptomatic workers are identified before they enter the workplace. NSW should use the very best rapid test technology. Essential workers can be quickly and easily screened at a fraction of the cost and time of the standard PCR test
ensure everyone in lockdown gets adequate financial support to stay home, including those on visas. This is much more cost-effective than having those struggling financially not get tested and go to work, get infected and possibly spread COVID
actively minimise leakage to rural NSW, including setting up a “ring of steel” around Greater Sydney. This should include checking essential services drivers are up to date with daily rapid testing and measures to prevent other travellers from leaving
make masks mandatory outdoors as well as indoors (outside the home) throughout Greater Sydney
maintain the focus on increasing the vaccination rate among Sydneysiders by taking vaccinations to essential workplaces
recognise that until Sydneysiders, including children, have had the opportunity to be fully vaccinated then stringent lockdowns will need to be implemented rapidly whenever there are uncontrolled outbreaks of COVID.

Quentin Grafton, Australian Laureate Professor, Crawford School of Public Policy, Australian National University; Mary-Louise McLaws, Professor of Epidemiology Healthcare Infection and Infectious Diseases Control, UNSW, and Tom Kompas, Professor of Environmental Economics and Biosecurity, The University of Melbourne

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

Coronavirus Update: Australia

Posted on July 17, 2021 by particularkev

A tougher 4-week lockdown could save Sydney months of stay-at-home orders, our modelling shows

Posted on July 17, 2021 by particularkev

Allan Saul, Burnet Institute; Margaret Hellard, Burnet Institute; Michael Toole, Burnet Institute; Nick Scott, Burnet Institute, and Romesh Abeysuriya, Burnet InstituteResidents in Sydney, the NSW Central Coast, Blue Mountains and Wollongong today received confirmation their lockdown would be extended to at least 30 July.

But our modelling suggests it may take until the end of the year to get case numbers close to zero, unless more stringent measures are introduced.

NSW health authorities increased restrictions on Friday. These limit outdoor gatherings to two people, exercise to within 10km from your home, and shopping to one person from a household each day, with no browsing.

These restrictions are similar to Victoria’s Stage 3 and came on top of existing rules, which began on June 23, to only leave your home for four reasons: work/education, care/compassion, shopping for essential supplies, and exercise.

But additional measures – at least as strong as in Melbourne’s Stage 4 – are needed to get the greater Sydney outbreak under control.

For Melbourne’s second wave, this included closing non-essential retail, restricting movements to 5km from home and within the hours of 8pm to 5am, and mask-wearing outdoors.

COVID case numbers will fall if Victorian Stage 4 measures are applied in greater Sydney, for at least a month.

Our predictions

Our modelling shows that without the initial stay-at-home orders, the results would have been catastrophic (red line).

NSW’s updated level of restrictions (orange line, similar to Victoria’s Stage 3 + masks) would prevent daily case numbers from increasing further. But it’s not enough to eliminate community transmission before the end of the year.

But if Stage 4 restrictions were applied now (blue line), the epidemic curve would decline sharply.

It’s difficult to estimate the time to return case numbers from current levels to a seven-day average of less than five per day, but it’s likely to take at least a month.

So how did we reach these conclusions? We use two complementary modelling approaches to generate information about the measures needed to get case numbers under control.

Simulating people’s decisions

The first model, COVASIM, simulates individual people who reflect the diversity of the population. Individuals are allocated different numbers of daily contacts and can participate in various activities (for example going to school, work, bars/cafes, shopping, playing sport), which affect their risk of transmission.

People respond differently to COVID-19: whether they get tested, how long they wait before being tested, and how compliant they are with quarantine. For infected people, their infectiousness and disease prognoses also depend on their age and vaccine status.

COVASIM includes interventions such as testing, contact tracing and quarantine, and public health restrictions that can reduce transmission risk, such as masks and density limits, or the number of contacts.

We calibrated this model using extensive data from Melbourne’s second wave, then simulated a theoretical Delta variant outbreak. We wanted to know whether previous restrictions would be likely to contain the Delta variant, given improved contact tracing and limited vaccine coverage.

To produce a “Sydney-sized” outbreak, we ran the model with light restrictions until it reached a seven-day average of 30 diagnoses a day. We then applied three policy packages: no additional restrictions, restrictions similar to Melbourne’s Stage 3 + masks, and Stage 4 restrictions.

Looking at the whole city

Our second model, MACROMOD, takes the opposite view to COVASIM: it models what happens at the city level, instead of building up from the outcomes of many individual behaviours.

It assumes the epidemic proceeds as a series of periods of exponential growth or decline and is being updated daily as new daily case data becomes available.

MACROMOD was successful in describing Melbourne’s second wave (June to November 2020) and accurately predicted the time to reach zero cases in Melbourne under Stage 4 restrictions.

What does it predict for Sydney?

We modelled Sydney’s current outbreak with MACROMOD for 21 days from June 23, when stay-at-home orders began, to July 13.

The impact of the stay-at-home orders was expected to start by July 1. But we couldn’t detect any decrease in the exponential growth in COVID case numbers.

This tells us that despite the fine work done by contact tracers and the NSW public, the high transmissibility of the Delta variant requires a much more vigorous response.

We then projected the model forward to predict the impact of the extended controls on July 9, and a further hypothetical increase similar to Melbourne’s Stage 4 restrictions.

The model suggests that the extended controls may be enough to “flatten the curve”, but are unlikely to contain the outbreak.

Thankfully NSW still has public health levers it could use to get the outbreak under control. We found if Stage 4 restrictions were applied now, the epidemic curve would decline sharply.

Allan Saul, Senior Principal Research Fellow (Honorary), Burnet Institute; Margaret Hellard, Deputy Director (Programs), Burnet Institute; Michael Toole, Professor of International Health, Burnet Institute; Nick Scott, Econometrician, Burnet Institute, and Romesh Abeysuriya, Senior Research Officer – Computational Epidemic Modelling, Burnet Institute

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

Support package for Sydney better and more fit for purpose than JobKeeper

Posted on July 17, 2021 by particularkev

Steven Hamilton, Crawford School of Public Policy, Australian National UniversityThe economic support package announced by Prime Minister Scott Morrison and NSW Premier Gladys Berejiklian is exactly what is needed, and just in the nick of time.

In a number of ways, in fact, it is more fit for purpose than the JobKeeper and JobSeeker policies that played such a key role in shielding the nation from the worst economic impacts of the COVID-19 pandemic.

There is support for workers who lose their jobs or have their hours cut, and incentives for affected businesses to keep their workers on the payroll.

In the face of what looks set to be an extended lockdown for Sydney, significant support was clearly needed. The federal government has rightly resisted calls to reinstate the JobKeeper wage subsidy, and opted instead for a new, more flexible scheme better suited to the circumstances.

There are two key planks of support, working together.

Payments to individuals

The first is payments for individuals. For Melbourne’s lockdown in late May and early June the federal government provided up to A$500 a week to those losing more than 20 hours of work a week. It is boosting this to $600 a week. For those losing eight to 20 hours a week, the payment is increasing from $325 to $375. The liquid assets test that applied to the Victorian payments has been scrapped.

Critically, any worker who loses enough hours is eligible. That means the payment can help virtually all workers losing work due to the lockdown, at least to some degree, and gives businesses the flexibility to scale down by reducing hours while minimising the impact on workers. We can squabble about the generosity of the payment, but it is more than double the rate of JobSeeker.

Importantly, it means the cost of the lockdown is being shared by the federal and state governments, rather than just falling on businesses and workers. This provides confidence that lockdown decisions will be made entirely in accordance with the public health advice.

Payments to businesses

The second plank is a partnership between the federal and state governments to revive the cash-flow boost instituted at the beginning of the pandemic, before the federal government introduced JobKeeper.

Only businesses with annual turnover between $75,000 and $50 million are eligible. For those suffering a 30% decline in annual turnover (compared to pre-pandemic times), the payment will cover 40% of their payroll costs up to a maximum of $10,000 a week. To qualify, however, they must not lay off any staff.

This emulates one of the best features of JobKeeper by maintaining the connection between employers and employees through the crisis to speed the recovery once restrictions lift.

Improvements on JobKeeper

In his press conference, the Prime Minister described the measures as targeted, timely, proportionate, scalable and able to be administered quickly and simply.

It’s hard to disagree.

One aspect that’s a big improvement over JobKeeper is that the turnover test is based on actual turnover, rather than projected turnover or trailing turnover, as with the earlier schemes. This should see the money better targeted to the businesses genuinely in need.

Another improvement is that it drops the cumbersome JobKeeper approach of paying employers a per-employee subsidy they were then expected to pass on to each worker at a fixed rate regardless of actual hours. This time businesses will get a payroll subsidy they can use however they see fit — so long as they don’t lay anyone off.

This should maximise flexibility, and minimise business failures and layoffs. And compliance should be straightforward to enforce via Business Activity Statements and Single Touch Payroll records.

But it is all a bit reactive

I do, however, see one negative.

Just as many ordinary Australians seem to have assumed and behaved as though the pandemic was behind us, so did the federal government in configuring its fiscal support measures earlier this year.

It was right to end the JobSeeker supplement and JobKeeper as the economy recovered. But it was wrong not to replace them with a suite of more flexible, contingent measures to be triggered in the event of future lockdowns. It should have foreseen the possibility of a future prolonged lockdown and been prepared for it, rather than be forced to play catch-up.

Following the announcement of these measures, the federal minister for government services, Linda Reynolds, said “our response will continue to evolve”. But what businesses and consumers have needed all along is certainty — to know that if things go pear-shaped there’s a plan and they will be looked after.

Without that certainty, consumers will hold back on spending and businesses will hold back on investment, putting a brake on the economic recovery.

Every Australian consumer, worker and business — in every Australian state and territory — needs to know today exactly how they’ll be supported should things get a lot worse or go on a lot longer than currently expected.

Steven Hamilton, Visiting Fellow, Tax and Transfer Policy Institute, Crawford School of Public Policy, Australian National University

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

Why the federal government’s COVID-19 fear appeal to Sydney residents won’t work

Posted on July 13, 2021 by particularkev

Jane Speight, Deakin UniversityOn Sunday July 11, the federal government released two new COVID-19 campaigns.

The first, shared across Australia, is a call to “arm yourself” (and others) against the virus by getting vaccinated as soon as you’re eligible.

The second is a graphic fear appeal, broadcast only in New South Wales, which shows a young woman in a hospital bed struggling to breathe. The advert has the caption: “COVID-19 can affect anyone. Stay home. Get tested. Book your vaccination”.

It’s clearly intended to leave the NSW audience shaken by the severity of the virus, and with the knowledge that residents, particularly younger people, are susceptible to the virus.

It’s easy to see why fear-based campaigns are appealing. Some may even think focusing the public’s attention on the severity of COVID is necessary to combat complacency in the wake of the low number of deaths in Australia overall.

Unfortunately, a fear appeal about COVID, particularly in NSW at this point in time, is highly unlikely to be effective, and certainly not as effective as some other approaches could be.

Fear appeals can have unintended consequences

The underlying assumption of fear appeals is that, when people are confronted emotionally with the potential severity of a threat, they will act accordingly to prevent it. The reasoning is simple enough, but it’s only true when certain other conditions are met.

This COVID vaccine advert addresses motivation, but it ignores other key elements of behaviour change. That is, do people have the capability and opportunity to make the change(s)?

When one or both are absent, people are likely to react defensively. They tend to become more, not less, distressed, and this doesn’t necessarily translate to behaviour change.

Indeed, increasing fear may actually be unhelpful. Fear drives panic, stigma and further fears. It acts as a barrier to an effective community response.

Fear can discourage people from adopting protective behaviours, such as hand hygiene, physical distancing or self-isolation; from seeking health-care for screening or treatment; and from disclosing their illness, to avoid discrimination and/or abuse. There are also numerous accounts of people panic-buying in supermarkets.

Psychological theory and evidence do not support fear appeals overall.

Threatening communications are effective only when people have high “self-efficacy” to undertake the behaviours. This means the target audience needs to be confident they can actually change their behaviours.

Can people change their behaviour in this context?

When we examine the three behaviours the federal government promotes in this campaign, it’s clear that capability and opportunity are, at best, variable across the community.

Let’s take a look:

1. “Stay home”

People’s ability to stay home is based not only on their perception of threat, but also on their personal, economic and social circumstances.

For example, it has been evident during the pandemic that some people cannot or do not stay at home because they have insecure or low-paid work with no sick leave entitlements.

2. “Get tested”

When people know they have engaged in potentially risky behaviours, like shopping or visiting family and friends, they are likely to be anxious about what a COVID test will reveal. This can lead to avoidance of the test.

They may well also be concerned about the potential consequences beyond the threat to their health. They might wonder whether they will be punished with fines they cannot afford, or shamed by the media for their behaviour.

3. “Book your vaccination”

Australia’s problem with vaccine hesitancy is well-documented. But, we need strategies to encourage people to make the right decisions, not beat them into submission.

Especially so, given the federal government’s vaccine supply and rollout program, which is currently an international embarrassment. According to the latest figures, Australia has delivered 35 vaccine doses per 100 people. That compares to 126 in Israel, 118 in the UK, 99 in the USA, and 44 worldwide.

In many ways, this campaign is unethical

It’s also unethical to use distressing campaigns when many people, particularly younger people, are already experiencing considerable mental health impacts due to the pandemic. When many don’t have the financial security to stay at home. When they are genuinely confused by the risks associated with the vaccines, and many remain unable to access the vaccine. When the reality is the Australian health-care system has the capacity (currently) to ensure no-one would be left alone in hospital gasping for breath.

And when the NSW government itself has done a 180-degree turnaround in its messaging in a single day from: we may need to give up on lockdown and live with the Delta variant to NSW “can’t live reasonably” with the Delta variant — and now expects a similarly rapid U-turn from the public.

It’s not surprising young people (and many others) are already expressing their outrage at this government advert.

We need the government to leave behind the draconian fear appeals of the 1980s, and instead embrace the lessons learned about “gain-framing” from multiple, evidence-based mass communication campaigns.

Gain-framed messages focus on the positive consequences of adopting the behaviour rather than on the losses associated with not doing the behaviour.

Recent COVID vaccine campaigns in Europe have been uplifting. Some dare us to dream of a COVID-free future, for example one French campaign.

And some, like one UK campaign, even use a little humour.

At this point in the pandemic, we don’t need scare tactics. What we need is for everyone to feel encouraged, empowered and supported to do the right thing to protect their own health and that of the wider NSW and Australian community.

And we need governments to understand and use the theory and evidence supporting an effective approach.

Jane Speight, Foundation Director, Australian Centre for Behavioural Research in Diabetes, Deakin University

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

Coronavirus Update: Australia

Posted on July 12, 2021 by particularkev

Sharing my thoughts with the world from a Particular Baptist perspective

Vaccine effectiveness underestimated

Real-time protection

How has this played out overseas?

Why did hospitalisations rise in Israel? And what are the lessons for Australia?

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What are the tighter restrictions?

What impact did these restrictions have?

Vaccination rates have risen, but that’s not the reason

What does this mean for other parts of Sydney?

Why we need a vaccine-plus strategy

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What our research reveals

One typical resident in Sydney’s west

Why community support is so vital

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Why do answers vary?

Let’s look at the Sydney predictions

The similarities

Take-home message

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What does 70% of the eligible population vaccinated mean for Australia?

What could happen if Sydney’s lockdown is relaxed too soon?

7 ways to fix Sydney’s outbreak

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Our predictions

Simulating people’s decisions

Looking at the whole city

What does it predict for Sydney?

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Payments to individuals

Payments to businesses

Improvements on JobKeeper

But it is all a bit reactive

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Fear appeals can have unintended consequences

Can people change their behaviour in this context?

In many ways, this campaign is unethical

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