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.




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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.




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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.




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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.




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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.




Read more:
New COVID variants have changed the game, and vaccines will not be enough. We need global ‘maximum suppression’


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.

Vaccines may soon make travel possible again. But how quickly will it return — and will it be forever changed?



RUNGROJ YONGRIT/EPA

Joseph M. Cheer, Wakayama University; Colin Michael Hall, University of Canterbury, and Jarkko Saarinen, University of Oulu

The COVID-19 pandemic brought the global tourism industry to a screeching halt in 2020. With vaccines starting to be rolled out, there is hope international travel can resume soon, but exactly when — and how — is the million-dollar question.

Before COVID-19, there was much concern about whether tourism had grown too big for our planet. There were calls to scale back tourism, make it more environmentally sustainable and help over-touristed locations become more resilient to crises.

However, with almost no international travel in 2020, we now have the opposite problem. The pandemic caused a 70% drop in international tourist arrivals globally from January to August, compared to the same period last year.

Destinations reliant on international tourists have been the hardest hit. Many are in developing countries, where tourism is a major export earner. For example, according to the World Bank, tourism makes up nearly 15% of Thailand’s GDP, which is why it recently started allowing select foreign tourists to return for extended stays.

But attempts to reboot international travel on a wider scale have so far failed due to successive waves of COVID-19.

As a more transmissible and harder-to-control coronavirus variant has emerged in the UK and South Africa in recent days, dozens of countries have announced they would close their doors to travellers from both nations. Some countries, like Japan and Israel, have gone a step farther, banning all foreign nationals from entering.

Even before this, travel bubbles and corridors between countries have been proposed, but few have managed to take root.

The recently-announced trans-Tasman bubble between Australia and New Zealand is one of the few options for international travel in the pipeline.
DEAN LEWINS/AAP

With borders closed, many countries have put a focus on attracting domestic tourists instead. This has helped maintain economic stability in countries such as China and Japan.

Hopes for a swift recovery of international travel are now pinned on a silver bullet: the rapid and widespread distribution of a vaccine.

Beyond this, we believe getting people back in the air again will be shaped by three key issues.




Read more:
A vaccine will be a game-changer for international travel. But it’s not everything


1) What travel regulations will prove effective?

Travel health requirements may soon start to resemble the past. In the 1970s, having appropriate vaccinations and health clearances was essential for travel to and from many countries. Coronavirus vaccinations will likely become similarly standard for international flights.

This should be rapidly adopted by all countries, and could even be applied more broadly – in hotels, for example.

However, any vaccination regime will need governments to pass strong laws and regulations. Digital travel passes and vaccination passports may be one solution, but in order to work, these will require standardisation across borders.

Travellers are screened and have their temperature checked at Los Angeles International Airport.
ETIENNE LAURENT/EPA

One solution may be the CommonPass, a new digital health passport that looks to be a trustworthy model for validating people’s COVID-free status consistently across the globe.

Other health measures will also remain vital, including mandatory in-flight masks, pre-departure and arrival testing, mandatory quarantining and social distancing. If vaccination uptake in destinations is low, these measures will become even more important.




Read more:
Can governments mandate a COVID vaccination? Balancing public health with human rights – and what the law says


Touchless travel should also become standard at most airports through the use of biometric technology. And passengers should expect temperature screening and reduced in-flight services to be the new norm.

Lengthy quarantine periods are one of the biggest obstacles to restarting international tourism — few people can afford 14 days in a quarantine hotel on top of their holiday.

There are potential alternatives being tested. Before the new COVID variant emerged, British Airways and American Airlines had piloted a voluntary testing program for some passengers as a way of avoiding the mandatory 14-day quarantine period in the UK.

The British government also implemented its new “test and release” policy in mid-December, which could shorten the quarantine period to five days for international arrivals.

2) How will airlines restart their businesses?

The International Air Transport Association expects the airline industry won’t reach pre-pandemic levels again until at least 2024.

This means any tourism restart is going to require restoring transportation infrastructure and networks, especially for aviation and cruising.

Many planes are now parked in deserts in the US and Australia. They will need to be retrieved and thoroughly serviced before recommencing flights. Crews will have to be rehired or retrained.

Grounded planes parked at a storage facility in Alice Springs, Australia.
DARREN ENGLAND/AAP

But it’s not as simple as just getting planes back in the air. A more formidable challenge for airlines will be reestablishing air routes while ensuring their ongoing viability.

As airlines slowly build up these networks again, travellers will have to put up with less frequent connections, longer journeys and drawn out stopovers.

There is some encouraging news, though. In the US, domestic airfares have dropped, and though international flight schedules have been drastically reduced, low demand has kept some prices down.

Smaller and more nimble airlines should perform better. And expect smaller and more efficient aircraft to also become more common. Demand for long-haul flights may remain low for some time.

Airports, meanwhile, will require temporary or permanent reconfigurations to handle new public heath screening and testing arrangements — providing yet another possible frustration for travellers.

Cruise ships and port terminals will face similar requirements, as will hotels and other accommodation providers.

3) Will traveller confidence return?

For leisure travellers, the lingering fear of coronavirus infections will be the most formidable obstacle to overcome.

The Thanksgiving holiday in the US and Golden Week in China suggest the appetite for travel remains robust. Some analysts also anticipate leisure travel will likely recover faster than business travel.

However, it remains to be seen whether travellers will have a high appetite for risk, or how quickly they’ll adapt to new safety protocols.

The key to bringing traveller confidence back again will be standardising safety and sanitation measures throughout the global travel supply chain. One idea is a “Safe Travels” stamp once companies have complied with health and hygiene protocols.




Read more:
Worried about COVID risk on a flight? Here’s what you can do to protect yourself — and how airlines can step up


How we can build back better

COVID-19 has prompted much reflection about our relationship with the planet.

Advocates for more sustainable tourism are hoping the coming years will lead to a rethink of international travel, with more innovation and a renewed commitment to addressing climate change and crisis management.

However, the likely reality is that destinations will be desperate for economic recovery and will compete vigorously for tourism dollars when borders reopen.

So, if consumer behaviour trends are anything to go by, the new normal might not be too dissimilar from the old. It’s doubtful, for example, that we would tolerate flying less when travel is proven safe again. This doesn’t bode well for the planet.

If international travel is going to “build back better”, communities, governments and the global tourism industry must come up with a transformative plan that is workable and helps drive traveller behaviour change and decarbonisation.

The pandemic has given us a chance for a reset — we should make the most of the opportunity.The Conversation

Joseph M. Cheer, Professor in Sustainable Tourism, Wakayama University; Colin Michael Hall, Professor in Tourism and Marketing, University of Canterbury, and Jarkko Saarinen, Professor in Human Geography (Tourism Studies), University of Oulu

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

How to keep COVID-19 at bay during the summer holidays — and help make travel bubbles a reality in 2021



Shutterstock/S Curtis

Michael Plank, University of Canterbury and Alex James, University of Canterbury

Recent announcements on travel bubbles and quarantine-free travel between New Zealand and Australia from early next year will be welcome news for whānau and friends as well as businesses and the tourism industry.

But as the prime minister made clear, the travel bubble will be contingent on the virus remaining well under control in both countries.

We will need to keep up testing rates on both sides of the Tasman to ensure that, if and when there is another community outbreak of COVID-19, we detect it before it gets too big.

And with the summer holidays about to begin, we will all need to remain vigilant.

What to do on your summer holidays

The virus won’t be taking a summer holiday so, if we want to have one, there are three main things we all need to do:

  1. Scan in wherever you go using the NZ COVID Tracer app and enable the bluetooth tracing function.

  2. Use a mask on public transport or in crowded places.

  3. If you feel unwell, stay home and call Healthline — you can get tested for free no matter where in New Zealand you are.

As the government outlined this week as part of its resurgence planning, people need to be prepared to change holiday plans if there is an outbreak.

This means having a backup plan in case you need to stay longer than expected, or being prepared to return home early. If we all play our part, we will be able to enjoy a well-earned break safely and help make a travel bubble with Australia and the Pacific a reality in 2021.

Risk of re-incursions from managed isolation

If trans-Tasman travellers were exempt from the current requirement to spend 14 days in a managed isolation facility, this would free up capacity for New Zealanders returning from elsewhere.

This sounds like a good thing, but it comes with its own risks. COVID-19 is still raging around the world. There were more than 595,000 new cases and 12,700 deaths from COVID-19 globally on December 15 alone and these grim records are being shattered with heartbreaking regularity.

With these sorts of numbers, the risk of people arriving from the northern hemisphere and carrying the virus is higher than ever. Increasing the number of arrivals from countries with high prevalence will unfortunately increase the risk of COVID-19 leaking out of our managed isolation facilities.




Read more:
An Australia–NZ travel bubble needs a unified COVID contact-tracing app. We’re not there


New Zealand has had at least six re-incursions of COVID-19 into the community from managed isolation facilities in the last four months. These include a maintenance worker and nurses working at quarantine facilities, a returnee who caught COVID-19 in managed isolation and the Defence Force cluster.

We have been able to contain most of these without needing to increase alert levels. But if this pattern continues, sooner or later we are likely to experience a larger outbreak. We need to remain vigilant and recognise that any increase in the number of arrivals from high-risk countries will lead to an increase in the risk of community outbreaks.

Travel bubbles might not be forever

If we do get a significant community outbreak in New Zealand or Australia, it’s possible travel restrictions will have to be brought back, at least until the outbreak is controlled. This could mean that travellers are required to self-isolate at home or in a quarantine facility and get tested before or after travelling.

This is similar to the situation in Australia, where each state has its own rules about travellers entering from other states, and these rules change depending on case numbers in each state. Having robust contingency plans and being able to adapt to a rapidly developing situation is key to stopping the virus getting out of control.

This may mean travel plans get disrupted or cancelled from time to time, but this is an unfortunate reality of life in an ongoing global pandemic.




Read more:
Pacific tourism is desperate for a vaccine and travel freedoms, but the industry must learn from this crisis


The prospect of a travel bubble with the Cook Islands will also be welcome news for people with whānau in the Cooks and tourists alike. The biggest risk with this bubble is that COVID-19 could be transported from New Zealand to the Cook Islands, where it could cause a devastating outbreak.

New Zealand has a history of exporting infectious diseases to the Pacific, the most recent example being Samoa’s measles epidemic in 2019. We need to make sure we don’t end up repeating this with COVID-19.

Again, continued community testing in New Zealand will be critical in minimising this risk.The Conversation

Michael Plank, Professor in Mathematics, University of Canterbury and Alex James, Associate professor, University of Canterbury

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