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

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.

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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).

Burnet Institute

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.

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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.

Burnet Institute

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.

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What is life going to look like once we hit 70% vaccination?

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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.

Morocco Begins Large-Scale Expulsion of Foreign Christians

Ongoing purge launched nationwide to stop ‘proselytization.’

ISTANBUL, March 12 (CDN) — Moroccan authorities deported more than 40 foreign Christian aid workers this week in an ongoing, nationwide crackdown that included the expulsion of foster parents caring for 33 Moroccan orphans. 

Deportations of foreign Christians continued at press time, with Moroccan authorities expressing their intention to deport specifically U.S. nationals. Sources in Morocco told Compass that the government gave the U.S. Embassy in Rabat a list of 40 citizens to be deported.

The U.S. Embassy in Rabat could not comment on the existence of such a list, but spokesperson David Ranz confirmed that the Moroccan government plans to deport more U.S. citizens for alleged “proselytizing.”

“We have been informed by the Moroccan government that it does intend to expel more American citizens,” said embassy spokesperson David Ranz.

Citing Western diplomats and aid groups, Reuters reported that as many as 70 foreign aid workers had been deported since the beginning of the month, including U.S., Dutch, British and New Zealand citizens.

At the Village of Hope orphanage near Ain Leuh, 50 miles south of Fez, the government on Monday (March 8) expelled 16 staff workers, 10 foster parents and 13 natural-born dependents from the country. The orphanage arranges for orphaned children to live with a set of foster parents rather than in a traditional dormitory setting, according to its website.

Police first came to the orphanage Saturday afternoon (March 6), questioning children and looking for Bibles and evidence of Christian evangelism; by late Sunday night they had told all foster parents and staff that they had to leave on Monday.

New Zealand native Chris Broadbent, a worker at Village of Hope, told Compass that the separation of the foster families and the children under their care was traumatic. As much as they hoped to be re-united, he said, that did not seem likely – officials told them they could visit as tourists in the future, but in reality authorities do not allow re-entry for those who have been expelled.

“At this stage, as much as we want to see the parents get back with their kids, we understand that may be almost impossible,” Broadbent said. “We’re not searching for scalps here, we don’t want to harm Morocco or anything like that, but we want to see the parents re-united with their children.”

Broadbent emphasized that government accusations that they had been proselytizing were unfounded, and that all staff had signed and adhered to a non-proselytizing policy.

“We were a legal institution,” he said. “Right from the start they knew that it was an organization founded by Christians and run by a mixture of Christians and Muslim people working together.”

Authorities told orphanage officials that they were being deported due to proselytizing but gave no evidence or explanation of who, when, where or how that was supposed to have occurred, according to a Village of Hope statement.

The orphanage had been operating for 10 years. Moroccan authorities had never before raised any charges about the care of the children, according to Village of Hope’s website.

In the village of Azrou, about 100 miles east of Rabat, another orphanage called Children’s Haven has been under investigation this week. Although it was still operating at press time, sources said its 20 staff members were prepared for a fate similar to that of Village of Hope, 30 minutes south.

“This action against the Village of Hope was part of a nationwide crackdown against Christians living in Morocco,” read a statement on Village of Hope’s website.

Some Christians in Morocco attribute the change in the country, generally known for its tolerance towards religious minorities, to the appointments of Mohammed Naciri as Minister of Justice and Taieb Cherkaoui as Minister of Interior in January.

Communications Minister Khalid Naciri said the government would be “severe with all those who play with religious values,” reported Agence France-Presse (AFP).

Local Christians Next?

A Moroccan pastor, his wife and a relative were arrested on Wednesday [March 10] and released on the next day, raising fears among local Christians that the wave of intolerance may spread to the country’s small but growing church of nearly 1,000 believers.

An expert on religious freedom in the Middle East who requested anonymity said that attacks on the church are inevitable even in a Western-looking, modern country like Morocco, as the church grows and becomes more visible.

“Because conversion is a taboo, if the government looks like it is doing nothing in regard to all the foreign missionaries that are coming and ‘corrupting’ the country and its ‘national soul,’ it gives credit to Islamists who could challenge the ‘Islam-ness’ of the Royal Family and the government, and that’s just what Morocco can’t afford,” said the expert.

The clampdown on foreign workers could signal government malaise toward the growing church.

“The more they grow, the more visible they become, the more they’ll attract this reaction,” said the expert. “And that’s why they’ve been so quiet with house groups. It’s just a matter of time.”

Communications Minister Naciri reportedly denied the new, tougher line against non-Muslims was a step backward in terms of religious freedom in Morocco.

“Morocco has always been and remains a land of openness and tolerance,” he told AFP. “The rare cases of expulsion have nothing to do with the practice of Christianity but with acts of proselytism.”

The children have reportedly been placed in a care home.

Contradictory Documents

As a signatory to the International Covenant on Civil and Political Rights, Morocco’s accusations of “proselytization” by foreign aid workers apparently contradict its pledge to allow freedom to manifest one’s faith. Article 18 of the covenant affirms the right to manifest one’s faith in worship, observance, practice or teaching.

The covenant also states, however, that “freedom to manifest one’s religion or beliefs may be subject only to such limitations as are prescribed by law and are necessary to protect public safety, order, health, or morals or the fundamental rights and freedoms of others.”

Previously the North African country had a history of religious tolerance. Morocco’s constitution provides for freedom to practice one’s religion, contradicting Article 220 of the Moroccan Penal Code, which criminalizes any attempt to induce a Muslim to convert to another religion.

In its 2009 international religious freedom report, the U.S. Department of State noted that on April 2, 2009, a Moroccan government spokesman asserted that freedom of religion does not include freedom to choose one’s faith.

“The fight against Christian proselytizing in accordance with law cannot be considered among human rights abuses,” the Moroccan government spokesman said, “for it is an action aimed at preventing attempts to undermine the country’s immutable religious values. The freedom of belief does not mean conversion to another religion.”

The crackdown this month appears unprecedented, with only smaller groups previously deported. In March 2009, Moroccan authorities expelled five foreign female Christians for trying to “proselytize” although sources said they were foreign visitors merely attending a Bible study with fellow Christians. In November 2009, police raided a Christian meeting in northern Morocco and expelled five foreigners.

Last month a large, military-led team of Moroccan authorities raided a Bible study in a small city southeast of Marrakech, arresting 18 Moroccans and deporting a U.S. citizen.

In a message yesterday to U.S. citizens registered with the embassy, U.S. Ambassador Samuel Kaplan reportedly expressed concern about how the authorities conducted the deportations. Foreign Christians were told their residence permits were cancelled and that they had to leave the country immediately; they had no rights to appeal or challenge the decision.

“We were disheartened and distressed to learn of the recent expulsion by the Moroccan government of a number of foreigners, including numerous Americans, who had been legally residing in Morocco,” Kaplan said in a statement. “Although we expect all American citizens to respect Moroccan law, we hope to see significant improvements in the application of due process in this sort of case.”

Report from Compass Direct News